Abstract
Selective decontamination of the digestive tract (SDD) is an antimicrobial prophylaxis using parenteral (e.g. third-generation cephalosporin) and enteral antimicrobials (polymyxin E, tobramycin and amphotericin B) for the control of severe infections in critically ill patients [1].
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References
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Summary Table
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Clinical summary | |||||
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Drugs | Indications | Cautions | Side effects | Dosage | Notes |
Selective decontamination of the digestive tract (SDD) | Critically ill patients requiring mechanical ventilation for ≥72 h Surgical patients scheduled for oesophageal, gastric, intestinal surgery and radical cystectomy with urinary diversion Transplant recipients Other conditions (apart from mechanical ventilation) in which a critical illness-related overgrowth of potentially pathogenic microorganisms is present (e.g. pancreatitis, burns, neurological impairment) | Critically ill patients with renal failure and/or receiving renal replacement therapy should be routinely checked for serum tobramycin levels Proteus species are intrinsically resistant to polymyxin E. In this case the efficacy of tobramycin should be checked, and in case of tobramycin resistance, another aminoglycoside should be used (e.g. amikacin, paromomycin) | SDD has not been designed to cover methicillin-resistant S. aureus (MRSA) In case of MRSA endemicity, SDD may select this pathogen and vancomycin should be added to the SDD protocol (see next column) Resistance: present data show that SDD does not increase resistance; it may reduce the resistance problem, if present | Parenteral antibiotic (e.g. cefotaxime 80–100 mg/kg/day for 4 days) 0.5 g of 2 % polymyxin E/tobramycin/amphotericin B paste or gel four times a day in the oral cavity 100 mg polymyxin E + 80 mg tobramycin +500 mg amphotericin B in the gut four times a day 0.5 g of 4 % vancomycin paste or gel 4 times a day in the oral cavity and/or 500 mg vancomycin in the gut four times a day (in case of MRSA endemicity) | Surveillance cultures of throat and rectum are part of the technique and should be taken on admission and afterwards twice a week to monitor the efficacy of SDD, and to detect resistance in an early stage High level of hygiene is required to control exogenous infections In tracheostomized patients identical antimicrobials of PTA and/or vancomycin as gel/paste are indicated for topical use on the tracheostomy to control exogenous lower airway infections |
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Silvestri, L., van Saene, H.K.F. (2017). Selective Decontamination of the Digestive Tract. In: Landoni, G., Ruggeri, L., Zangrillo, A. (eds) Reducing Mortality in the Perioperative Period. Springer, Cham. https://doi.org/10.1007/978-3-319-46696-5_11
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