Properties

What should I do? What are the ways and means to optimize antimicrobial therapy AU? Fundamental principles are well represented in the literature and known to specialists. Here we wish to submit material accumulated in our clinic in recent years. Table 5 outlines the main ways to optimize antimicrobial therapy AU.

Table 5

Ways to optimize antibiotic therapy of abdominal sepsis

- A targeted selection of drugs based polymicrobial etiology of the pathological process.

- Dynamic microbiological monitoring (microbiological monitoring).

- Observance of pharmacokinetic principles of therapy.

- The combination of systemic antibiotics with selective decontamination of the digestive tract and the local application of antibacterials.

- Correction of system breaches homeostasis (primarily - oxygen transport and metabolism).

- Detoxification (including enteric) and blockade tsitokinogeneza.

Implementation of these areas is based on a clear understanding of the polymicrobial etiology of AS, an objective assessment of the severity of the patient and thorough knowledge of the microbiological, pharmacokinetic and toxic characteristics of prescribed drugs. It should be borne in mind that the AU in surgical patients, in most cases requires a long (often up to 3-4 weeks) antibiotic therapy, which requires at least 2 or 3 times the regime change prescribing, ie retention of two-three-stage pool. The "gold standard" for the antimicrobial treatment of AS, especially in moderate condition of the patients (APACHE II - no more than 20 points, SAPS - up to 24), is the use of an aminoglycoside with a beta-lactam antibiotic and antianaerobnym drug.

In this clinical situation, as shown by our study, high-performance is a combination of tobramycin (nebtsina) II generation brand viagra cephalosporin - tsefamandola and metronidazole. "Covering" the whole range of pathogens of intra-abdominal infections, the combination is applied for 6-10 days, led by our data, to recovery in 82% of patients and to clinical improvement - in 11% of cases. In this case, 1.7 times (compared with the control group) decreased the frequency of wound infection complications and there was not a single case of nosocomial pneumonia. The latter circumstance is explained by good permeability of tobramycin in the lung tissue and tracheobronchial secretions (permeability tobramycin 0.65 - much higher than many other antibiotics), which provides good protection against nosocomial infections of the lungs.

Unfortunately, however, this standard is a combination antibiotic (tobramycin + tsefamandol + metronidazole) can not be used in all cases of AS. In particular, what to do in case of intra-abdominal catastrophe in the postoperative period (failure of anastomosis, pancreatic necrosis, ITSH intestinogennogo origin), so even after the treatment aminoglycosides or against it? What to do when the patient's condition (renal failure) can not prescribe without drug monitoring nephrotoxic aminoglycosides? What if a patient's treatment program is absolutely necessary to include selective decontamination of the digestive tract, a component of which is tobramycin? What to do when the patient's condition is so heavy that each additional drug, including a combined antibiotic therapy may exacerbate multiple organ damage, and the need to address polypharmacy becomes a "fixed idea" ATC searches?

In these situations appropriate to resort to the use of carbapenems antibiotics, and as to the drug of choice - Meron (meropenem). Meron, in contrast to the carbapenems I generation, tienama does not have neuro-and nephrotoxic properties [8]. Broad antimicrobial spectrum (including almost all of etiologically significant aerobic and anaerobic pathogens AU), the pharmacokinetic characteristics, the presence of the expressed postantibioticheskogo effect, low toxicity suggest this drug is very important and often life-saving treatment plant.

No need for a detailed characterization meronema [8]. Note extremely important for successful treatment of AS pharmacokinetic characteristics of the drug. Meron penetrates well into various tissues in a concentration exceeding the MIC for most pathogens. In particular, its fractional permeability in the peritoneal exudate was 83% of plasma concentrations in bronchial secretions (prevention and treatment of nosocomial pneumonia!) - 52%.

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