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Selective Decontamination of the Digestive Tract
- Frank R. Cockerill III, MD;
- Sharon R. Muller, MD; and
- Rodney L. Thompson, MD
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IN RESPONSE:
We agree that cefotaxime is a systemic antimicrobial that, when administered parenterally, can selectively decontaminate the digestive tract of a large variety of aerobic and facultatively anaerobic organisms with little effect on strict anaerobes [1-4]. Theoretically, cefotaxime may both treat and prevent nosocomial infections in patients until their digestive tracts can be adequately decontaminated of potentially pathogenic microorganisms using the oral nonabsorbable antimicrobics.
It is interesting to note that one recent study of antimicrobial prophylaxis in the intensive care setting that did not use a systemic antimicrobial at the beginning of oral decontamination did not show statistically significant reductions in nosocomial infection [5]. We attempted to limit the provision of cefotaxime prophylaxis to approximately 72 hours, the time required in our experience to decontaminate the digestive tract of potential pathogenic microorganisms as assessed by surveillance cultures. In our study, 2 of 12 (17%) and 6 of 36 (17%) infections occurred in the first 72 hours in cefotaxime-treated and non-cefotaxime-treated patients, respectively.
We agree with Dr. Johnson that our study does not distinguish which agent or agents were responsible for the infection reduction and that controlled, blinded, prospective studies are needed.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
