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Bioavailability of oral antibiotics in children with short-bowel syndrome
Insights
Children with short-bowel syndrome can absorb oral antibiotics like cephalexin and trimethoprim-sulfa, though absorption varies with remaining bowel length. Parenteral therapy is recommended for aminopenicillins due to reduced absorption.
Area of Science:
- Pediatric Gastroenterology
- Clinical Pharmacology
- Antibiotic Therapeutics
Background:
- Short-bowel syndrome (SBS) significantly impacts nutrient and medication absorption in children.
- Neonatal small bowel resection is a common cause of SBS, leading to malabsorption.
- Optimizing antibiotic therapy in SBS requires understanding drug absorption profiles.
Purpose of the Study:
- To evaluate the oral absorption of common antibiotics in children with SBS.
- To determine the relationship between remaining small bowel length and antibiotic absorption.
- To provide evidence-based recommendations for antibiotic use in pediatric SBS.
Main Methods:
- Prospective study involving five children with significant neonatal small bowel resection.
- Oral administration and serum concentration monitoring of aminopenicillins, cephalexin, and trimethoprim-sulfa.
- Correlation analysis between antibiotic absorption and the length of the remaining small bowel.
Main Results:
- Antibiotic absorption was directly proportional to the length of the remaining small bowel.
- Cephalexin and trimethoprim absorption decreased by 10-50%, maintaining therapeutic levels.
- Aminopenicillin absorption was reduced by approximately 10%, potentially below therapeutic levels.
Conclusions:
- Oral cephalexin and trimethoprim-sulfa are viable therapeutic options for children with SBS.
- Parenteral aminopenicillin therapy is advised for children with SBS when this antibiotic class is indicated.
- Individualized antibiotic selection and administration routes are crucial in managing pediatric SBS.
Abstract:
Absorption of orally administered antibiotics (two aminopenicillins, cephalexin, trimethoprim-sulfa) was investigated in five children with sizeable resection of small bowel in the neonatal period. The absorption was proportional to the length of the remaining bowel and independent from the resected part of the gut. For cephalexin and trimethoprim a reduction of the absorption of 10% to 50% was observed, still resulting in therapeutic serum concentrations. The absorption of aminopenicillin was reduced approximately 10% of the usually achievable concentrations. Our data suggest that oral cephalexin and trimethoprim-sulfa can be used therapeutically in children with short-bowel syndrome. If aminopenicillin is indicated, parenteral therapy is advisable.