Antacids

stevierae · Oct 29, 2003

Originally posted by Tenesma
this is a good discussion.... a few points

you don't treat aspiration pneumonias with antibiotics.... unless they become symptomatic... there is no evidence to show that prophylactically giving an antibiotic upon aspiration reduces the progression from aspiration event to full blown pneumonia... just talk to any pulmonologist or ID or ICU or Anesthesia attending... or review the literature..

True, you don't treat ASPIRATION with antibiotics--but, once it progresses to ASPIRATION PNEUMONIA, the guidelines as set forth by The American Thoracic Society say you DO.

Why WOULDN'T you treat aspiration pneumonia--and note I said PNEUMONIA, not just aspiration--as you would any other bacterial penumonia, with antibiotics recommended by The American Thoracic Society? What if the aspirate is enteric?

I don't work in OB any more, but that brings up another question: What about meconium aspiration in a newborn? Wouldn't you want to treat a known enteric aspiration agressively with antibiotics, and not wait until cultures confirmed the organism or until pneumonia set in?

Tenesma · Oct 29, 2003

i will re=phrase... you don't treat aspirations until they progress to aspiration pneumonias... then you do treat... (unless of course the aspiration event is in an immunocompromised patient then you treat empirically right away)... and you are right, once it becomes a pneumonia you treat it with antibiotics...

most aspirations that turn into pneumonias are gram negative bacilli (the enterics you refer to) or staph. aureus

meconium by definition is a sterile mixture of mucous glycoprotiens, gastrointestinal secretions, bile, pancreatic and liver enzymes, plasma proteins, minerals, and lipids... it mainly leads to airway blockage, chemical pneumonitis due to the bile salts, and depletes/inactivates surfactant... these 3 things lead to respiratory distress.... treatment is intubation, suctioning and positive pressure ventilation (some recommend surfactant infusion), and due to the high frequency of developing pulmonary hypertension you end up treating w/ Nitric Oxide or even progressing to ECMO... the rationale behind using Antibiotics is poor (but still done because on CXR it can look like a focal,sub-segmental pneumonia), and because it is believed that the stress that induced meconium passage is usually due to a bacterial infection (chorioamnionitis, etc...)... however there are a few studies (it is hard to study this population from a statistical point of view) that show that there is NO benefit from treating w/ antibiotics as it does not alter outcome (Krishnan et al. Neonatal Intensive Care, 1995)

the danger of treating everybody that you are worried about possibly developing an infection, is the high likelihood of developing further bacterial resistance to our drugs, exposing patients to side=effects of the antibiotics, etc...

stevierae · Oct 30, 2003

Originally posted by Tenesma
meconium by definition is a sterile mixture of mucous glycoprotiens, gastrointestinal secretions, bile, pancreatic and liver enzymes, plasma proteins, minerals, and lipids... it mainly leads to airway blockage, chemical pneumonitis due to the bile salts, and depletes/inactivates surfactant... these 3 things lead to respiratory distress.... treatment is intubation, suctioning and positive pressure ventilation (some recommend surfactant infusion), and due to the high frequency of developing pulmonary hypertension you end up treating w/ Nitric Oxide or even progressing to ECMO... the rationale behind using Antibiotics is poor (but still done because on CXR it can look like a focal,sub-segmental pneumonia), and because it is believed that the stress that induced meconium passage is usually due to a bacterial infection (chorioamnionitis, etc...)... however there are a few studies (it is hard to study this population from a statistical point of view) that show that there is NO benefit from treating w/ antibiotics as it does not alter outcome (Krishnan et al. Neonatal Intensive Care, 1995)

Thanks, Tenesma; great answer; great clarification. I always thought that meconium was considered fecal matter; did not realize it was sterile.

So, I guess the same plan (as you described above) would hold true for amniotic fluid aspiration, right? Makes sense.

I learn a lot from the CRNA discussion board--very smart people here!