Short bowel syndrome is the congenital or surgical alteration of the small bowel resulting in a shorter than normal length of small bowel. This condition affects approximately 20,000 people in the Unites States and is diagnosed in 3-5 times per 100,000 live births annually. Patients with short bowel syndrome are at risk for the development of small bowel bacterial overgrowth, a serious consequence caused by overgrowth of bacteria in the small bowel resulting in symptoms of abdominal pain, abdominal distention, feeding intolerance, malabsorption, weight loss and increased risk of metabolic acidosis. Clinical studies assessing the role of antibiotic therapy in the pediatric population are nearly nonexistent forcing clinicians to rely on adult literature for guidance. Diagnostic testing methods are often invasive and difficult to perform in pediatric patients leaving clinicians to diagnosis this condition based on symptomology. Treatment is often prescribed based on clinical experience and published expert opinion. Inconsistency in the diagnosis and medical treatment of small bowel bacteria overgrowth is problematic and warrants further investigation. The purpose of the evidence-based project was to establish the role of antibiotic therapy in the treatment of small bowel bacterial overgrowth in pediatric patients with short bowel syndrome. A one-year retrospective chart review of pediatric iv patients admitted to the Gastroenterology/Lumen service at Cincinnati Children’s Hospital Medical Center between 5/1/2016-5/1/2017 was conducted. Final analysis of the data revealed inconsistency in antibiotic prescribing, however, the effectiveness of treatment was inconclusive due to lack of provider documentation. As a result of the findings, a best evidence statement (BESt) has been drafted for publication throughout the institution with the intent to standardize antibiotic prescribing practices for this population. Developing initiatives that stemmed from this evidence-based practice project include improved diagnosis by means of DNA mapping, revisions to nursing standards for central line care in patients with an ostomy, and a poster presentation at a national conference.
Heinzman, C. (2018). The Role of Antibiotic Therapy in the Treatment of Small Bowel Bacterial Overgrowth in Pediatric Patients with Short Bowel Syndrome. Wright State University, Dayton, OH.