Hirschsprung's disease medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Medical therapy only plays a supportive role in the management of Hirschsprung's disease. Medical therapy indications | Medical therapy only plays a supportive role in the management of Hirschsprung's disease. Medical therapy indications include preventing complications of Hirschsprung's disease, preventing [[infections]] during reconstructive surgery, and managing postoperative bowel function. [[Intravenous]] fluid resuscitation and maintenance, nasogastric decompression, and administration of [[intravenous]] [[antibiotics]] (as indicated) remain the cornerstones of initial medical management.<ref name="pmid28180937">{{cite journal |vauthors=Langer JC, Rollins MD, Levitt M, Gosain A, Torre L, Kapur RP, Cowles RA, Horton J, Rothstein DH, Goldstein AM |title=Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease |journal=Pediatr. Surg. Int. |volume=33 |issue=5 |pages=523–526 |year=2017 |pmid=28180937 |doi=10.1007/s00383-017-4066-7 |url=}}</ref><ref name="pmid24002048">{{cite journal |vauthors=Burkardt DD, Graham JM, Short SS, Frykman PK |title=Advances in Hirschsprung disease genetics and treatment strategies: an update for the primary care pediatrician |journal=Clin Pediatr (Phila) |volume=53 |issue=1 |pages=71–81 |year=2014 |pmid=24002048 |doi=10.1177/0009922813500846 |url=}}</ref> | ||
==Medical Therapy== | ==Medical Therapy== | ||
===Supportive therapy=== | ===Supportive therapy=== | ||
*All patients should be kept nothing by mouth (NPO) | *All patients should be kept nothing by mouth (NPO) | ||
*Patients should receive intravenous fluids | *Patients should receive [[intravenous]] fluids | ||
*A large tube (20-24 F) is introduced through the rectum, and small amounts of saline solution (10-20 mL) are instilled through | *A large tube (20-24 F) is introduced through the [[rectum]], and small amounts of [[saline]] solution (10-20 mL) are instilled through the [[lumen]] of the rectum in order to clear it. | ||
*The liquid rectal and colonic content is expected to drain through the lumen of the tube. The tube is then rotated in different directions and moved back and forth. | *The liquid rectal and colonic content is expected to drain through the [[lumen]] of the tube. The tube is then rotated in different directions and moved back and forth. | ||
*The operator continues to instill small amounts of saline solution, allowing the evacuation of gas and liquid stool through the tube. | *The operator continues to instill small amounts of [[saline]] solution, allowing the evacuation of gas and liquid stool through the tube. | ||
*Metronidazole is usually given. In older children, oral antibiotics can be given when they begin to improve and | *[[Metronidazole]] is usually given. In older children, oral [[antibiotics]] can be given when they begin to improve and when they are no longer NPO. | ||
===Empiric antimicrobial therapy=== | ===Empiric antimicrobial therapy=== | ||
* Preferred regimen (1)-Ampicillin (Marcillin, Omnipen, Principen) IV/IM: 1-2 g q4-6hr, or 50-250 mg/kg/day divided q4-6hr | * Preferred regimen (1)-[[Ampicillin]] ([[Marcillin]], [[Omnipen]], [[Principen]]) IV/IM: 1-2 g q4-6hr, or 50-250 mg/kg/day divided q4-6hr, not to exceed 12 g/day. | ||
* Preferred regimen (2)-Gentamicin (Garamycin, Jenamicin)IV/IM: 3-5 mg/kg/day divided q8hr. | * Preferred regimen (2)-[[Gentamicin]] ([[Garamycin]], [[Jenamicin]])IV/IM: 3-5 mg/kg/day divided q8hr. | ||
* Preferred regimen (3)-Metronidazole, PO/IV: (children) 30 mg/kg/day divided q6h | * Preferred regimen (3)-[[Metronidazole]], PO/IV: (children) 30 mg/kg/day divided q6h, maximum 4000 mg/day. | ||
==References== | ==References== | ||
Revision as of 15:12, 4 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical therapy only plays a supportive role in the management of Hirschsprung's disease. Medical therapy indications include preventing complications of Hirschsprung's disease, preventing infections during reconstructive surgery, and managing postoperative bowel function. Intravenous fluid resuscitation and maintenance, nasogastric decompression, and administration of intravenous antibiotics (as indicated) remain the cornerstones of initial medical management.[1][2]
Medical Therapy
Supportive therapy
- All patients should be kept nothing by mouth (NPO)
- Patients should receive intravenous fluids
- A large tube (20-24 F) is introduced through the rectum, and small amounts of saline solution (10-20 mL) are instilled through the lumen of the rectum in order to clear it.
- The liquid rectal and colonic content is expected to drain through the lumen of the tube. The tube is then rotated in different directions and moved back and forth.
- The operator continues to instill small amounts of saline solution, allowing the evacuation of gas and liquid stool through the tube.
- Metronidazole is usually given. In older children, oral antibiotics can be given when they begin to improve and when they are no longer NPO.
Empiric antimicrobial therapy
- Preferred regimen (1)-Ampicillin (Marcillin, Omnipen, Principen) IV/IM: 1-2 g q4-6hr, or 50-250 mg/kg/day divided q4-6hr, not to exceed 12 g/day.
- Preferred regimen (2)-Gentamicin (Garamycin, Jenamicin)IV/IM: 3-5 mg/kg/day divided q8hr.
- Preferred regimen (3)-Metronidazole, PO/IV: (children) 30 mg/kg/day divided q6h, maximum 4000 mg/day.
References
- ↑ Langer JC, Rollins MD, Levitt M, Gosain A, Torre L, Kapur RP, Cowles RA, Horton J, Rothstein DH, Goldstein AM (2017). "Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease". Pediatr. Surg. Int. 33 (5): 523–526. doi:10.1007/s00383-017-4066-7. PMID 28180937.
- ↑ Burkardt DD, Graham JM, Short SS, Frykman PK (2014). "Advances in Hirschsprung disease genetics and treatment strategies: an update for the primary care pediatrician". Clin Pediatr (Phila). 53 (1): 71–81. doi:10.1177/0009922813500846. PMID 24002048.