We have found that oral Flagyl is poorly tolerated by many children because of its metallic taste and have, therefore, utilized the same dose of Flagyl given in the daily irrigation, and have found this to be very effective. Its goal is to treat the colonic bacteria causing the enterocolitis, most specifically, Clostridium difficile. The irrigation overcomes the stasis of the stool and allows for more frequent emptying of the colon.
500 mg Flagyl (intravenous solution) in 100 ml normal saline solution*
*For infants and children, not > 30 mg/kg/day.
Ideally, a patient should be irrigated first with normal saline solution beginning with 10-20 ml at a time for a total of 20 ml/kg. The rationale is to clean the colon of stool before instilling Flagyl irrigation.
To begin Flagyl irrigations, proceed as follows:
- Access the Flagyl solution with a Pentothal pen.
- Gently squeeze the bag of Flagyl solution into a non-sterile basin (emesis basin).
- Using a 60 ml catheter tip syringe, draw up 20 ml of Flagyl solution at a time.
- Gently insert appropriately-size lubricated silicone catheter into the rectum, approximately six inches (size of the catheter is dependent on the size of the child).
- Place the catheter tip syringe into the end of the silicone catheter and inject 20 ml of Flagyl solution into the rectum.
- Disconnect syringe from the end of the catheter; allow irrigant to drip into an empty emesis basin, which will be used for your discarded Flagyl solution.
- Repeat this process until the total amount of Flagyl solution ordered as been instilled
Note: It will be important in between instillations of the 20 ml of Flagyl solution to allow the solution to drain from the catheter into the emesis basin with the discarded solution. For example, if you are giving 100 ml of Flagyl solution, you should have the same amount of solution plus stool in the basin.