Do we need to administer antibiotics before enema reduction of intussusception?

When reading the chapter on intussusception in Grosfeld's Pediatric Surgery, I noticed that the authors recommended that antibiotics be administered to patients before attempts at air enema reduction. No good explanation was given for this practice, which we do not follow where I train. Patients go for their enema reduction, and if that fails, get preoperative antibiotics at the time of surgery, just like everyone else.

 

An article the May issue of JPS attempted to answer the question of the benefit of pre-contrast enema reduction antibiotics. The authors performed a retrospective, cohort study comparing outcome of patients form two different institutions; one that routinely gives pre-reduction antibiotics and one that does not.

 

The main end-points of this study were the incidence of post-reduction fever (as a marker of bacteremia) as well as adverse reactions to antibiotic administration. The authors noted no significant difference in either, suggesting (despite the usual shortcomings of a retrospective study) that antibiotics are not necessary.

 

Although it would take a prospective randomized study to better answer this question, it does not seem to make sense to give antibiotics before enema reduction.

 

Reference: Al-Tokhais et al. Antibiotics administration before enema reduction of intussusception: is it necessary? JPS (2012);47:928