Antibiotic Use in Intestinal Obstruction

Indications for Antibiotic Therapy

In patients with intestinal obstruction without systemic signs of infection, the World Journal of Emergency Surgery recommends prophylactic antibiotic therapy primarily targeting gram-negative bacilli and anaerobic bacteria due to the potential for bacterial translocation 1, 2
Prophylactic antibiotics should be discontinued after 24 hours (or 3 doses) to minimize the development of antimicrobial resistance 2
The obstruction causes mucosal injury with a subsequent increase in mucosal permeability and, therefore, bacterial translocation 2
In cases of strangulation or intestinal ischemia, the risk of bacterial translocation increases significantly, and empirical antimicrobial therapy is recommended 3, 4
In patients with intestinal obstruction and signs of sepsis/septic shock, prompt and adequate antimicrobial therapy is crucial 5, 6
In patients with perforation associated with intestinal obstruction, antibiotic therapy directed primarily against gram-negative bacilli and anaerobic bacteria is always suggested 7

The empirical antibiotic regimen should be based on the patient's clinical condition, individual risk of infection by resistant pathogens, and local epidemiology of resistance 3, 4
Antibiotics should cover gram-negative and anaerobic bacteria, considering combinations such as fluoroquinolones or third-generation cephalosporins with metronidazole 8
In critically ill patients with sepsis, early use of broad-spectrum antimicrobials is suggested 7
Therapy should be reevaluated according to intraoperative findings to decide whether to continue, discontinue, implement, or de-escalate 4, 5

In uncomplicated intra-abdominal infections where the source of infection is definitively treated, postoperative antibiotic therapy is not necessary 9
In complicated intra-abdominal infections with adequate source control, a short course of antibiotic therapy (3-5 days) is recommended 9
Patients with ongoing signs of peritonitis or systemic disease beyond 5-7 days of antibiotic treatment require diagnostic investigation 9

In patients with strangulated rectal prolapse, empirical antimicrobial therapy is suggested due to the risk of intestinal bacterial translocation 6
In patients with inflammatory bowel disease presenting with acute abdominal pain, antibiotics should not be administered routinely but only if a superinfection or intra-abdominal abscess is suspected 8

The prolonged and inappropriate use of antibiotics appears to be a key factor in the rapid increase in antimicrobial resistance worldwide 9
Rational and appropriate use of antibiotics is fundamental to optimize high-quality clinical care and reduce the selection pressure on resistant pathogens 9