Treatment of plague

Etiotropic treatment of plague should be started if there is a suspicion of this disease, without waiting for bacteriological confirmation of the diagnosis. It includes the use of antibacterial drugs. When studying natural strains of plague bacteria on the territory of Russia, resistance to common antimicrobial agents was not detected. Etiotropic treatment of plague is carried out according to the approved schemes.

Scheme of antibacterial drugs in the treatment of bubonic plague form

A drug	Mode of application	Single dose, g	Multiplicity of application per day	Duration of the course, day
Doxycycline	Inside	0.2	2	10
Ciprofloxacin	Inside	0.5	2	7-10
Pefloxacin	Inside	0.4	2	7-10
Ofloxacin	Inside	0.4	2	7-10
Gentamicin	In / m	0.16	3	7th
Amikacin	In / m	0.5	2	7th
Streptomycin	In, m	0.5	2	7th
Tobramycin	In / m	01	2	7th
Ceftriaxone	In / m	2	1	7th
Cefotaxime	In / m	2	3-4	7-10
Ceftazidime	In / m	2	2	7-10
Ampicillin / Sulbactam	In / m	2.1	3	7-10
Azrethon	In / m	2	3	7-10

Scheme of antibacterial drugs in the treatment of pulmonary and septic forms of the plague

A drug	Mode of application	Single dose, g	Multiplicity of application per day	Duration of the course, day
Ciprofloxacin	Inside	0 75	2	10-14
Pefloxacin	Inside	0.8	2	10-14
Ofloxacin	Inside	0.4	2	10-14
Doxycycline	Inside	0.2 on the 1st reception, then on 0.1	2	10-14
Gentamicin	In / m	0 16	3	10
Amikacin	In / m	05	3	10
Streptomycin	In / m	0.5	3	10
Ciprofloxacin	In / in	0.2	2	7th
Cefotaxime	V / m, in / in	3	3	10
Ceftazidime	V / m, in / in	2	3	10
Chloramphenicol (levomycetin sodium succinate)	V / m, in / in	25-35 mg / kg	3	7th
Ceftriaxone	In / m. In / in	2	2	7-10

Schemes of application of combinations of antibacterial drugs in the treatment of pulmonary and septic forms of plague

A drug	Mode of application	Single dose, g	Multiplicity of application per day	Duration of the course, day
Ceftriaxone - streptomycin (or amikacin)	V / m, in / in	1-0 5	2	10
Ceftriaxone gentamicin	V / m, in / in	1 + 0.08	2	10
Ceftriaxone - rifampicin	In / in, inside	1-0.3	2	10
Ciprofloxacin-rifampicin	Inside	0.5 + 0.3	2	10
Ciprofloxacin + streptomycin (or amikacin)	Inside, in / in, in / m	0.5-0.5	2	10
Ciprofloxacin + gentamicin	Inside, in / in, in / m,	0.5 + 0.08	2	10
Ciprofloxacin-ceftriaxone	In / in, in / m	0 1-0.2-1-1	2	10
Rifampicin and gentamicin	Inside, in / in, in / m	0.3-0.08	2	Yu
Rifampicin - streptomycin (or amikacin)	Inside, in / in, in / m	0.3-0.5	2	10

In severe cases, the use during the first four days of the disease of compatible combinations of antibacterial agents in the doses indicated in the schemes is recommended. In the following days, the treatment is continued with a single drug. The first 2-3 days of the drug are injected parenterally, and then switch to oral administration.

Along with the specific pathogenic treatment of plague, aimed at combating acidosis, cardiovascular insufficiency and respiratory failure, microcirculation disorders, edema of the brain, hemorrhagic syndrome. Disintoxication therapy consists of intravenous infusions of colloid (reopolyglucin, plasma) and crystalloid solutions (glucose 5-10%, polyionic solutions) to 40-50 ml / kg per day. The anti-plague serum used earlier, specific gamma-globulin in the course of observation proved to be ineffective, and at present they are not used in practice, nor do they use the plague bacteriophage. Patients are discharged after complete recovery (with bubonic form not earlier than the 4th week, with pulmonary form - not earlier than the 6th week from the day of clinical recovery) and a triple negative result obtained after sowing the bubble, sputum or blood, th, 4 th, 6 th days after the cessation of treatment. After discharge, medical supervision is carried out for 3 months.

Diet and diet

Treatment of plague should be combined with appropriate regimen and diet. Bed rest during the fever period. A special diet is not provided. It is advisable to have a sparing diet (table A).

[1], [2]