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NECROTIZING ENTEROCOLITIS MEDICATION
Category: Pediatric Surgery
Abstract : MEDICATION of necrotizing enterocolitis Pharmacologic therapy includes agents
to treat the developing disease and those to provide supportive and symptomatic
relief. Drug Category: Antimicrobial agents -- Although no definitive
infectious etiology is known to cause NEC, clinical consensus finds that
antibiotic treatment is appropriate for the threat of sepsis. Broad-spectrum
MEDICATION of necrotizing enterocolitis
Pharmacologic therapy includes agents
to treat the developing disease and those to provide supportive and symptomatic
relief.
Drug Category:
Antimicrobial agents -- Although no definitive
infectious etiology is known to cause NEC, clinical consensus finds that
antibiotic treatment is appropriate for the threat of sepsis.
Broad-spectrum
parenteral therapy is initiated at the onset of symptoms after collecting blood,
spinal fluid, and urine for culture. Antibacterial coverage for gram-positive
and gram-negative organisms is essential, with the addition of anaerobic
coverage for infants older than 1 week who show radiologic disease progression.
Antifungal therapy should be considered for premature infants with a history of
recent or prolonged antibacterial therapy or for babies who continue to
deteriorate clinically and/or hematologically despite adequate antibacterial
coverage.
Although any combination of drugs can be employed, one
frequently used regimen includes vancomycin, cefotaxime, and clindamycin or
metronidazole. This combination provides broad gram-positive coverage (including
staphylococcal species), excellent gram-negative coverage (with the exception of
pseudomonads), and anaerobic coverage.
Drug Category:
Antifungal
agents -- Their mechanism of action may involve an alteration of RNA and DNA
metabolism or an intracellular accumulation of peroxide, which is toxic to the
fungal cell. If antifungal therapy is warranted, fluconazole can be initiated.
Fluconazole is less toxic than amphotericin B, which is substituted if no
clinical response to fluconazole occurs or if evidence of microbiological
resistance is present.
Drug Category:
Vasopressors -- Babies with
serious illness may progress to shock and require pharmacologic blood pressure
support.
Drug Category:
Volume expanders -- Patients with severe
illness may experience fluid shifts to the extracellular space, resulting in
intravascular depletion requiring expansion.
Drug Category:
Opioid
analgesics -- Although difficult to assess, premature infants presumably
experience pain with severe illness and invasive procedures. Narcotic analgesics
are safe and effective in premature infants and have a long history of clinical
experience.
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