Antibiotic Stewardship Through Standardized Diagnosis and Treatment of Small Bowel Bacterial Overgrowth in Pediatric Patients With Short Bowel Syndrome Reduces Antibiotic Exposure and Improves Cost of Health Care

J Dr Nurs Pract. 2020 Nov 1;13(3):187-194. doi: 10.1891/JDNP-D-19-00080.


Background: Small bowel bacterial overgrowth (SBBO) is difficult to diagnose in pediatric patients with short bowel syndrome due to the invasive nature of the gold standard testing. Alternative testing methods also have barriers leaving providers to diagnose clinically. This has led to antibiotic overprescribing in this population. An algorithm for SBBO identification and standardized treatment is proposed.

Objective: Standardize SBBO identification and treatment in pediatric short bowel syndrome.

Methods: 1-year retrospective chart review and literature review.

Results: Final analysis of 146 admissions revealed diagnostic and antibiotic prescribing inconsistencies. In total, 28% (n = 41) received antibiotics for SBBO including those who continued home antibiotic (n = 27), those prescribed an antibiotic based on clinical suspicion (n = 12), and those prescribed an antibiotic based on duodenal aspirate (n = 2). In 10.2% (n = 15) patients, antibiotics were prescribed without clear clinical indication resulting in 342 antibiotic exposed days and $24,000 in prescription costs.

Conclusion: Clinical research is greatly needed as it relates to SBBO. In the meantime, the proposed algorithm guides providers through diagnosis and treatment decision-making. Thoughtful antibiotic prescribing is key to optimizing outcomes while minimizing adverse effects of antibiotics.

Implications for nursing: The algorithm empowers nursing to minimize antibiotic overuse through collaborative teamwork.

Keywords: antibiotic stewardship; pediatric; short bowel syndrome; small bowel bacterial overgrowth.

MeSH terms

  • Anti-Bacterial Agents / adverse effects
  • Antimicrobial Stewardship*
  • Child
  • Health Care Costs
  • Humans
  • Retrospective Studies
  • Short Bowel Syndrome* / diagnosis


  • Anti-Bacterial Agents