Selective decontamination

Nosocomial pneumonia is commonly preceded by colonization of the oropharynx by Gram-negative aerobes. Selective digestive decontamination (SDD) may use an oral antifungal agent (e.g. amphotericin B) and two non-absorbable antibiotics, such as tobramycin and polymyxin B, given both as an oral paste and by mouth. Rapid reduction in the Gram-negative flora is ensured by administration of a systemic antibiotic, usually cefotaxime, for the first 4 to 5 days. Although some trials have suggested that SDD prevents both nosocomial pneumonia and mortality, few were placebo controlled or blinded. Double-blind placebo-controlled trials show reductions in the number of episodes of pneumonia, urinary infection, and sinusitis, but usually not in mortality or costs ( Si!v®L.a..n.d Bone 1993). Surprisingly, emergence of resistant bacteria during SDD is either rare or not easily demonstrated.

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