Selective decontamination of the digestive tract by pipemidic acid

The possible use of pipemidic acid for preventing infections in granulocytopenic patients by selective elimination of the gram-negative rods from the digestive tract was evaluated. Fecal samples were collected before, during, and after therapy from 23 adults who were undergoing treatment of urinary tract infections with pipemidic acid at a dosage of 200 mg orally four times daily for 10 days. The concentration of pipemidic acid in the majority of the stool samples tested was 220 to 600 micrograms/g. However, in 19% of the samples collected on day 5, the concentration was below the detection limit (23 micrograms/ml). Approximately 90% of the fecal samples collected during or shortly after therapy were negative for members of the family Enterobacteriaceae. Resistance of the gastrointestinal tract against colonization by microorganisms from the environment (so-called colonization resistance) remained unimpaired, as measured by the absence of beta-aspartylglycine in the stool.