As a technique for infection prevention SDD has a number of limitations.
1. MRSA is frequently resistant to the tobramycin in the PTA regimen and may be selected under SDD. Therefore this technique should not be used in an environment where MRSA is endemic unless appropriate measures are taken, for example adding vancomycin to the regimen.
2. SDD has no effect on exogenous infections. If infections occur despite effective oral and intestinal decontamination, the origin of the infection is probably exogenous and appropriate measures should be taken. This may explain the apparent lack of effect of SDD in some studies.
3. Oropharyngeal decontamination using Orabase® containing 2 per cent PTA and decontamination of the stomach and upper gastrointestinal tract takes effect within 24 h. However, decontamination of the lower part of the gastrointestinal tract, the cecum, and the colon may take more than a week owing to the presence of a paralytic ileus. The risk of infection is high until the bowel is effectively decontaminated. Enemas or prokinetic drugs may accelerate the onset of decontamination.
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