For a study, researchers sought to assess the effects of antibiotic treatment for small bowel bacterial overgrowth (SBBO) on the symptoms, enteral tolerance, growth, and antibiotic regimens in pediatric intestinal failure (IF) patients.

Review of endoscopic cultures from children aged 0 to 18 with IF that showed >105 CFU/mL from 2010 to 2017 at a single site. At the endoscopy 6 months later, symptoms, enteral tolerance, growth, and antibiotic regimens were assessed.

In the intestinal rehabilitation program, 505 patients were monitored. Of them, 104 had upper gastrointestinal endoscopy, and 78 had positive duodenal cultures. Clinical data pre- and post-endoscopy were provided for 56 individuals. Children showed significant improvement in emesis or feeding intolerance (58.9% vs 23.2%, P<0.001), abdominal pain (16.1% vs 7.1%, P=0.02), high stool output (42.9% vs 19.6%, P=0.002), and gross GI bleeding (19.6% vs 3.6%, P=0.003) in the 6 months after receiving targeted antibiotic treatment. Mean BMI-for-age z scores substantially rose after treatment (-0.03±0.94 vs. 0.27±0.82, P=0.03), while height-for-age z scores, weight-for-age z scores, and the percentage of calories from enteral intake did not change significantly. The use of antibiotics continued to vary greatly.

The symptoms and BMI-for-age z scores of children with IF and culture-positive SBBO significantly improved following duodenal culture and subsequent targeted antibiotic treatment. Improvements in linear growth and the percentage of calories from enteral meals may require longer follow-up. The use of antibiotics was still quite individualized. Antibiotic resistance and other long-term effects of prolonged antimicrobial treatment were unclear. Prospective studies were needed to evaluate trends of antibiotic resistance, correlate culture and histology data, and standardize the duodenal sampling procedure.