- With what pathogens should "fight" antibiotics?
- Which cholecystitis is not indicated for antibiotics?
- How is the indication for prescribing antibiotics?
- Antibiotic treatment rules
- What antibiotics are needed for cholecystitis?
- The use of combined treatment of
- What complications should I fear when treating with antibiotics?
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On the gallbladder for its localization, anatomical and functional connections spread inflammation from the intestine, liver, stomach by contact. It is possible to drift infection from distant foci with blood in chronic tonsillitis, carious teeth, sinusitis. The cause of cholecystitis is most often bacteria, less often - fungi, viruses. Special attention should be paid to the activation of conditionally pathogenic flora.
Antibiotics for cholecystitis are included in the mandatory treatment regimen. Drugs of this group are appointed by the doctor depending on the type of pathogen, the severity of the patient's condition. The possibility of complications, the transition of the inflammatory process from acute to chronic course, depends on which antibacterial agents are used in treatment.
With what pathogens it is necessary to "fight" antibiotics?
Studies of the contents of the gallbladder in patients with clinical manifestations of cholecystitis show the presence of growth of bacterial microflora in 1/3 of patients on the first day of the disease or exacerbation, and after three days - in 80%.
The most common pathogens of cholecystitis when infected from the intestine are:
- E. coli.
If there is a distant chronic focus, then from it through the lymph and blood flow into the gallbladder fall:
- of staphylococci;
Very rare pathogens include:
- typhoid fever and paratyphoid bacillus;
- fungi Candida.
In 1/10 of the patients, chronic cholecystitis causes hepatitis B and C viruses on or after the active process in the liver. When choosing a drug, it should be borne in mind that in the non-calculous chronic course of inflammation in the gallbladder, a mixed flora is often found.
In the emergence of chronic cholecystitis, the importance is given to parasitic infection:
- by opisthorchiasis;
Giardia is currently considered as a disinfectant:
- 5-fold enhancing the infectious properties of Escherichia coli;
- reducing immunity;
- causing disruption of bile duct function.
But they are not considered causative agents of cholecystitis, because:
- lamblia can not live long in the bladder, perish in bile;
- is very likely that they come from the duodenum;
- did not receive morphological results proving penetration into the wall of the gallbladder.
The role of lamblia is reduced to supporting inflammation of
The best antibiotic is one that:
- is as sensitive to the identified flora;
- when ingested can penetrate into the bladder and accumulate in the bile.
Which cholecystitis is not indicated for antibiotics?
In recognition of the causes of inflammation of the gallbladder, the condition of the pancreas must be taken into account. The fact is that in chronic pancreatitis, a violation of the production of enzymes leads to an insufficient closure of the sphincter of Oddi and an increase in pressure in the duodenum.
In such conditions duodenobiliary reflux is formed( throwing the contents of the duodenum into the gallbladder).Activated enzymes of the pancreas cause non-bacterial inflammation, "fermentative cholecystitis."This option does not require a mandatory course of antibiotics.
The reflux mechanism needs to be considered as the cause of stagnation of bile, the growth of the possibility of penetration of infection
How is the indication for prescribing antibiotics determined?
Indications for the use of antibiotics are clarified starting with the questioning and examination of the patient. Usually the patient is disturbed:
- unstable, but quite intense pain in the hypochondrium on the right;
- colic along the bowel;
- frequent loose stools;
- nausea, vomiting is possible;
- temperature is increased more than 38 degrees.
In blood tests revealed:
- leukocytosis with a shift of the formula to the left;
- growth of ESR.
The decision on the advisability of using antibiotics, the choice of dosage and the route of administration of the medicine is taken only by the doctor. Pay attention to the great harm of self-treatment.
Rules for antibiotic treatment
In its choice, the physician is guided by certain requirements for antibiotic treatment.
- It is best to prescribe a drug with proven sensitivity to the identified cholecystitis pathogen. In the absence of time or opportunity to wait for the results of the tank.analysis to apply antibiotics of a wide spectrum of action, then at receipt of the conclusion and inefficiency of the previous therapy to replace with another.
- The dose is calculated based on the severity of the patient's condition, age and weight.
- The advantage is the intravenous and intramuscular route of administration. Take pills on the background of vomiting and dyspepsia can not.
- The course of treatment should be at least 7-10 days. Interruption and lengthening are equally harmful and threatens the development of resistant forms of pathogens.
- On the background of antibiotic therapy, it is necessary to prescribe vitamins( groups B, C).Being coenzymes in many biochemical processes of the body, these drugs have a supporting anti-inflammatory effect.
- In the presence of mixed flora, associated chronic diseases, it is possible to prescribe antibiotic combinations with other drugs. In this case, contraindications and compatibility should be considered.
Before starting antibiotic therapy, it is necessary to put an intradermal test to detect an increased sensitivity of the body.
. What antibiotics are needed for cholecystitis?
The following drugs are the most effective in cholecystitis. Erythromycin, a macrolide pharmacological group, is close in action to penicillins, slows down the multiplication of streptococci and staphylococci.
Gives a cross-allergic reaction with other drugs of the group( Oleandomycin), is enhanced by tetracyclines. The disadvantage is production only in a tablet form, they are drunk only with mild inflammation.
Ampicillin - from the group of semisynthetic penicillins, kills bacteria, destroying their cell membrane. Effective against staphylococci, streptococci, enterococci, salmonella, E. coli. Quickly penetrates into the gallbladder and intestines. Suitable for intravenous and intramuscular administration. When combined, enhances the properties of aminoglycosides and anticoagulants. It is necessary to monitor blood clotting tests.
Levomycetin is an antibiotic of a wide spectrum of action, but with cholecystitis it makes sense to prescribe only with an established pathogen( rod of typhoid and paratyphoid, salmonella, dysentery bacterium).Has a weak activity against clostridia, protozoa, Pseudomonas aeruginosa. Use in tablets and injections.
The drug is poorly compatible with such anti-inflammatory drugs as:
- anticoagulant drugs;
- barbiturates( hypnotics).
Amoxiclav - as a preparation of the penicillin series is enhanced by clavulanic acid, therefore it has a wide spectrum of action. Applied even when identifying strains resistant to Ampicillin. Destroys bacteria through binding of the receptor apparatus of cells, blocking of enzymes.
Produced in the form of tablets and suspensions for internal use. It can not be used together with tetracycline antibiotics and macrolides, with sulfonamides due to a decrease in the effectiveness of the drug.
To the group of "protected" penicillins( clavulanic acid and tazobactam, which inhibit the enzymes of microorganisms) are:
- Timentin( Ticarcillin + clavulanic acid);
- Tazocine( Piperocillin + tazobactam).
Ampioks - belongs to the combined form of antibiotics, is available in capsules and solution for injection, is a mixture of salts Ampicillin and Oxacillin in a liquid form in the proportion of 2: 1.Suitable for intravenous administration. Quickly gets into the gallbladder. It affects a wide range of infections.
Gentamicin - belongs to the group of aminoglycosides, destroys pathogenic microorganisms by destroying protein synthesis, is effective in cases of etiology of cholecystitis caused by:
- with E. coli;
- by staphylococci;
- shigellas and others.
The drug is poorly absorbed through the intestines, the main use in the injection form of
In the bile does not create sufficient concentration, therefore it is used in combinations. Has a negative effect on the kidneys, nervous system. All antibiotics are contraindicated:
- during pregnancy and lactation;
- in case of damage to the liver, kidney;
- require caution in blood diseases.
The use of combined treatment
Even modern preparations of the class cephalosporins II and III generation do not always have sufficient efficacy in severe cholecystitis. The threat of the formation of empyema( ulcer) in the gallbladder, peritonitis with a breakthrough into the abdominal cavity causes the use of combinations of antibiotics with other anti-inflammatory drugs or two drugs from different groups.
So, with metronidazole form active combinations of cephalosporins:
Another option: Ampicillin + Gentamicin + Metronidazole. In this case, some drugs are administered intravenously, others - intramuscularly. Instead of Gentamycin, Sizomycin is used, as hospital-acquired strains of microorganisms give up to 90% resistance to Gentamicin.
For the purpose of avoiding the side effects of aminoglycosides, combinations of cephalosporins of the third generation and the newest penicillins are recommended:
- Ceftazidime( can be replaced by Fortum or Tazitsef) + Flukloxacillin.
- Cefipim( refers to the IV generation of cephalosporins) can be replaced with Maxipim, used in combination with Metronidazole.
What complications should be avoided when treating antibiotics?
Each organism has individual sensitivity and features of assimilation of medicines that can not be foreseen in advance. Against the background of the necessary doses of antibiotics and after the course of treatment, the following undesirable complications may arise:
- allergic manifestations of different severity, from urticaria( skin rash) to anaphylactic shock;
- bouts of bronchospasm with suffocation;
- significant reduction in immunity;
- attachment of fungal infection;
- intestinal dysbacteriosis, manifested by unstable stool, constant bloating.
Allergic reaction of general type is one of the possible complications of
To prevent possible negative effect, patients should follow the doctor's recommendations. If unusual signs appear, tell the doctor. In no case can not tolerate such phenomena.
Nystatin helps to get rid of fungi. Sometimes it is prescribed in parallel with antibiotics. To restore the intestinal flora help probiotics and diet after the elimination of acute symptoms of cholecystitis.
Antibiotic therapy is subject to careful comparison of indications and mechanism of action of drugs. Therefore, it requires special knowledge and experience. Independent application is not only inconclusive, but also causes significant harm to human health.