Antibiotic treatment of wounds: ointments, tablets

Trauma to the skin or mucous membrane with a violation of the integrity of the entire thickness and more, opening access for microbes from the environment is called an open wound. Modern medicine considers any accidental injury as a priori infected - containing a certain number of pathogenic microorganisms. The development of purulent infection is favored by the following conditions: sufficiently deep and extensive damage; blood clots, foreign bodies, areas of dead tissue and a large accumulation of microbes in the wound cavity. Of particular danger are deep wounds infected with anaerobic bacteria that enter its cavity along with fertilized land from agricultural land. Antibiotics for wounds are used both for the prevention of bacterial infections and for the treatment of purulent wounds.

Successful healing of damage often depends on the choice of an antibacterial drug and its use. By treating wounds with antibiotics, it is possible to avoid inflammation or sepsis.

The received wound needs to be processed as soon as possible, the probability of its suppuration and the speed of healing depends on it. Antibiotic treatment of the wound is not carried out, since antibiotics are active only against bacteria, and the wound can be infected with various pathogens - fungi, viruses, parasites. Antiseptics are used for the primary and subsequent external treatments of wounds. These are chemicals that are active against a wide range of pathogenic agents that remain susceptible to the antiseptic for a long time. Antiseptic substances do not directly affect the healing process, their indirect effect is that they significantly reduce the number of pathogenic microorganisms in the wound, which slow down the recovery of damaged tissues. 

Indications Antibiotics for wounds

In case of accidental wounds, especially deep ones, the probability of infection is high. To avoid suppuration, after treatment with an antiseptic, as a rule, external preparations with a broad-spectrum antibiotic are prescribed (Baneocin and Gentaxan powders, Sintomycin emulsion) since it usually takes from two to three days to determine the causative agent. Such tactics often prevent the accumulation of pus in the wound, and the tissues of the clean wound surface recover much faster.  

If the suppuration of the wound could not be avoided, antibiotics are prescribed for purulent wounds. In this case, both local and systemic treatment can be prescribed. The antiseptics used for treating wounds destroy a variety of microbes on its surface, however, their importance for healing is very mediated. With deep purulent wounds with a high probability of infection or significant tissue loss, they are left open (not sewn up) to restore new tissue. In this case, antibiotics are shown for wound healing, destroying or stopping the development of microbial flora in the wound cavity and at the same time promoting reparation processes (Levomekol ointment, Gentaxan powder).

This is especially true if the wound is inflamed and the causative agent of the inflammatory process is established. Its established sensitivity to certain drugs is reason to prescribe specific antibiotics for wound inflammation.

Gaping wounds with uneven edges and walls require surgical treatment when all non-viable and necrotic tissue is removed. With an extensive torn wound, different phases of epithelialization often occur in different areas simultaneously - on the one hand the wound is already cicatrizing, and on the other it can fester. Antibiotics for torn wounds are prescribed without fail, since the probability of infection is very high.

In the case of injuries caused by a piercing object, especially localized on the sole of the foot or the heel, it is also impossible to do without the antibiotic, and its systemic use. A thin wound channel and coarse skin in these places prevents the release of wound. Conditions are created for the development of colonies of anaerobic bacteria, including gangrene, tetanus, and phlegmon of the foot. An antibiotic for stab wounds is used orally or parenterally, with preference given to groups of drugs characterized by anaerobic activity.

The same criteria are used by the doctor when he prescribes antibiotics for gunshot wounds. In this case, primary surgical care is also needed, much depends on the location and type of injury.

An antibiotic prescribed for external use with an open wound should be in the form of a gel or solution. Ointments that have a fatty basis are not suitable at the initial stage of healing, since the oily film formed prevents normal breathing and nourishing of the deep tissues, and also delays the release of wound fluid.

Antibiotics for oozing wounds can have a water-soluble basis, and after the initial treatment of the wound, powders with antibiotics are used, in the case of a severe form, systemic use of antibacterial agents is often prescribed.

A modern alternative to antibiotics are dressings made from absorbent materials that absorb wound exudate and remove and detoxify microbes. They do not have a toxic effect on the tissue of the wound, while maintaining a moist environment and promote self-cleaning of wounds.

Also used bacteriophages that destroy pathogens of a particular type or several types (complex). Outwardly used as irrigation and gadgets.

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Release form

Drugs with antibacterial activity are available in various forms. Most preference is given to external agents: patches, powders, solutions and ointments (gels, creams). They do not have a systemic effect, acting locally at the site of application.

Treatment of wounds with antibiotics involves the participation of a doctor who, by location and type of damage (for each injury, there is a suspected association of microorganisms sensitive to certain groups of drugs) will prescribe the most suitable drug and the form of its preferred use. In addition, the medical institution can determine the type of pathogen by making bacteriological seeding.

However, it is not always possible to quickly seek medical help and transfer the responsibility to the doctor. Going on a campaign for a few days away from civilization, it is recommended to pack a first aid kit, including gels, ointments and creams for wounds with an antibiotic. When choosing medicines for the first-aid kit, preference is given to external medications; you can also take pills containing broad-spectrum antibiotics. In case of wounds received by chance away from medical institutions, both can be useful.

Many antibiotics used to treat wounds come in various forms, for example, Gentamicin Sulfate can be found in the form of ointment, powder, solution for injection.

In severe cases with extensive and deep lesions, tablets and injectable antibiotic release forms are used. The doctor may prescribe antibiotics in pills for purulent wounds with inflammation and hyperemia of the surrounding tissues, edema, with increasing body temperature. Sometimes in severe cases, with the threat of sepsis, intramuscular or intravenous injections of antibiotics are used, if it is impossible to immediately perform a surgical treatment of a torn wound, it is cut off with a broad-spectrum antibiotic to saturate the adjacent tissues with the drug and prevent the spread of infection. Such processing can be carried out for 48 hours.

Treatment with antibacterial powders is also used. Powder with an antibiotic for wound healing (Gentaxan, Baneotsin) is sold in a pharmacy and consists not only of bactericidal components. It also includes substances that provide detoxification and regeneration of damaged tissues.

A small abrasion or scratch can be washed with an antiseptic, powdered with streptocide and sealed with a bactericidal plaster to avoid reintroduction of infection.

To prevent microbes from getting into the wound from the environment, modern pharmacy offers a considerable arsenal of antiseptic hydrocolloid, collagen, hydrogel dressings, which are fixed on the skin with bandages, normal or round, and also are glued to healthy skin around the wound. Wound healing plaster with an antibiotic, or rather an antiseptic, for example, containing silver ions (Cosmopor), antibacterial honey or more traditional preparations - furatsilin, novocaine, dimexide and others. Bandages and patches have different sizes.

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The names of the most popular antibacterial agents for wounds

The treatment of any wound begins with its cleaning. If the wound is small and not deep, an antiseptic treatment and dressing is sufficient to prevent re-infection.

Alcohol and alcohol solutions (iodine, brilliant green, salicylic and boric acid, medicinal herbs), hydrogen peroxide, chlorhexidine, miramistin have long been used as antiseptics. The faster the wound will be washed with water (possible with soap) and treated with antiseptic, the less likelihood of infection and inflammation. Torn, stabbed, gunshot and other deep wounds contaminated with earth, rust must be subjected to surgical cleaning. Such injuries require antibiotic therapy. Antibiotics must be used for a long break between getting a wound and providing medical care, purulent, inflamed wounds.

After primary treatment, the wound is closed with a bandage. The choice of dressings and patches is very large and depends on whether the patient has established allergies to medicines and the need for further surgical intervention.

Slabs of small size after treatment can be sealed with a conventional bactericidal adhesive plaster. Its outer surface freely passes air and allows moisture to evaporate from the wound surface. The inner base of the plaster is fabric (cotton, viscose, made of polymeric materials), its impregnation usually contains brilliant green, chlorhexidine, and synthomycin. For example, Band-Aid antiseptic plaster, Uniplast, Cosmos and others.

If the wound is more extensive, you can apply an antiseptic dressing-patch Cosmopor. Its basis is silver non-impregnated non-woven soft material impregnated with silver ions (alternative antiseptic). Sizes from 7 × 5 to 20 × 10 cm. It is conveniently glued and keeps well on different parts of the body.

Arma-Gel sterile dressings effectively protect against secondary infection, allow the wound to breathe, follow the contours of the surface of the wound and the surrounding skin, without sticking and easily removing, can be on the skin for up to two days. The hydrogel impregnation structure acts prolonged, gradually giving the drug to the wound and absorbing toxic substances secreted by bacteria. Bandages are available in several types: painkillers (except for antiseptics contain novocaine or lidocaine); antimicrobial - with dimexide for wounds complicated by pyogenic infection; cleansing - with nano-silicon or bentonite; wound healing - with methyluracil or furatsilinom; hemostatic and antiburn.

In case of poorly and long-term healing wounds, plates are applied to biocoupling Belkozin with collagen and methyluracil. The plate is applied to a wound that has been previously cleaned of pus, dead tissue particles. For purulent wounds, it is recommended to pre-moisten it with an antiseptic. Dressings are done every two to three days. During this time, the plate is completely absorbed. If it is not lysed, and there is no pain, burning, accumulation of pus and an allergic reaction, then the plate is left until the wound is completely healed.

The bandage Vita Wallis antimicrobial self-adhesive (patch) does not contain drugs. Made of sorbent cloth impregnated with aluminum hydroxide particles treated with colloidal silver. Prevents infection, does not injure the wound and does not cause allergies, provides good absorption and hemostatic effect. Non-toxic. Promotes the renewal and restoration of the cellular structure of the tissue, prevents the formation of scars. It is removed without leaving residues in the wound and without causing discomfort and pain.

The dressings with Medihani antibacterial honey are presented by the manufacturer as a new word in wound healing. Designed for adults and children, a very rapid wound healing is noted in the reference to a randomized study of drugs (only one dressing is required). The dressing applied to the wound surface, in contact with the sodium salts contained in the secreted wound fluid, forms a gelatinous mass, creating a moist environment in the wound, which has a cleansing, healing and regenerating effect. The wound is filled with granulation tissue. The elasticity of the dressing makes it possible to tamp the deep wounds and pockets.

Modern patches and dressings are an alternative to the usual antibacterial agents, however, the relevance of antibiotics is still quite high. When treating infected wounds, at high risk of suppuration and other more serious complications, antibiotics of different groups are used. The patient's age and the presence of chronic pathologies such as diabetes, varicose veins, thrombophlebitis, alcoholism, drug addiction, diseases of the liver, kidneys and other organs are also taken into account.

Antibacterial gel Tyrosur - used externally in the case of infected wounds, scratches, abrasions. Its active ingredient (thyrothricin) - a compound of thyrocidins and gramicidins in the ratio of 8: 2 (7: 3) is the toxin of an aerobic saprophytic spore-forming bacillus, called Bacillus short. The ointment is mainly sensitive to very common infectious agents - gram-positive bacteria: staphylococcus (including golden), streptococcus, enterococcus fecal, clostridia, corynebacterium, fungi, trichomonads and some others.

Thyrocidin has the ability to act on the cell membrane of microorganisms, reducing their surface tension. Gramicidins form cation channels in them through which bacterial cells lose potassium, and also block the process of phosphorylation, which disrupts cellular respiration.

The specific effect of thyrothricin, which is not characteristic of systemic antibiotics, prevents the development of pathogens of cross-resistance to the gel, which accelerates the granulation process and the restoration of the skin surface.

The pharmacokinetics of the active substance has not been studied, but its high concentrations were found in the adjacent stratum corneum and in the wound cavity. Therefore, the use of this gel during pregnancy and lactation is possible only with the permission of a doctor in small areas of the skin surface and for a short time, taking into account the benefit / risk ratio. In pediatric practice to use is allowed, there are no age restrictions.

Contraindicated in sensitized patients. It can not be applied to the nasal mucosa, because there is evidence that such an application may adversely affect the sense of smell.

Side effects are manifested local symptoms of dermatitis.

A thin layer of Tyrosur gel is used to treat the wound twice or thrice throughout the day. For small scratches or abrasions, this is sufficient; moist or deep wounds are covered with a protective bandage, which is changed about once a day. The duration of use depends on the condition of the wound. In cases where there is no therapeutic effect after seven days of treatment, it is necessary to change the drug.

Cases of overdose and interactions with other drugs are unknown.

Cream and ointment Bactroban highly active to a fairly wide range of bacteria. The active ingredient (mupirocin) of these drugs was intentionally created for local application. Staphylococci, streptococci, in particular, methicillin-resistant strains of these bacteria, as well as gonococci, menningococci, haemophilus bacillus, the causative agent of hemorrhagic septicemia, gram-negative cocci and rod-shaped bacteria are sensitive to it. Does not show activity to enterobacteria, corynebacteria and micrococci. Mupirocin inhibits the enzymatic activity of isoleucyl-transfer-RNA synthetase, which catalyzes the production of proteins in the cells of a pathogenic microorganism. Cross-resistance with other antibiotics is not marked. The effect of dose-dependent: from bacteriostatic to bactericidal.

When used externally, mupirocin is absorbed slightly, but absorption increases on the surface of the skin with impaired integrity. Part of the drug, sucked into the general bloodstream, is broken down and excreted in the urine.

Use during pregnancy and breastfeeding of this gel is possible only with the permission of the doctor in small areas of the skin surface and for a short time, taking into account the benefit / risk ratio.

Bactroban is contraindicated in sensitization to the ingredients of the cream, not applied to the mucous membranes of the nose and eyes. In pediatric practice, the ointment is used from two months of age, and the cream - after one year. The treatment of Bactroban with the elderly is prescribed with caution, as well as with renal dysfunction.

Side effects were mostly localized dermatitis, however, in rare cases, the following systemic symptoms were observed: headache or stomach pain, nausea, ulcerative stomatitis, the development of re-infection.

Cream and ointment applied to a pre-cleaned wound with a cotton swab one to three times a day. The treatment is carried out with a duration of a week to ten days. Application under the dressing is allowed. Wash hands thoroughly after treating the wound.

Cases of overdose are not known.

If there is a need to combine therapy with Bactroban with other local drugs for the treatment of wounds, then the interval between treatments should be at least half an hour.

Syntomycin emulsion is intended for the treatment of purulent wounds. Chloramphenicol (synthomycin) is active against many types of bacteria, in particular, to some strains of Pseudomonas aeruginosa and other bacilli resistant to penicillin, streptomycin, sulfanilamides, a bacteriostatic action, based on a violation of the synthesis of bacterial cellular proteins. If the wound is painful, you can use Syntomycin emulsion with novocaine. This combination of antibiotic with anesthetic component will suppress the growth and reproduction of microbes, as well as reduce pain syndrome.

With this active ingredient in pharmacies you can buy chloramphenicol-gel, used in inflamed infected wounds in the first phase of the process (in the second it is no longer prescribed). Its base contains ingredients that have anti-inflammatory effect and improve the outflow of wound secretion.

Resistance of bacteria to chloramphenicol develops slowly.

The pharmacokinetics of these external agents has not been studied, it is assumed that when applied externally, an insignificant part of the applied preparation enters the general circulation, which is eliminated mainly through the urinary organs and partially through the intestines.

Pregnant and lactating women to use as prescribed by a doctor on small surfaces.

Contraindications to the use - hypersensitivity to the components, impaired blood formation, eczema, psoriasis, fungal infections, for the gel additionally - the third trimester of pregnancy, children younger than nine months.

Side effects occur locally: rash, itching, burning, redness, swelling.

The emulsion is applied to the wound with a thin layer or in the form of a tampon soaked in it, covered with a bandage on top, can be applied under a compress. The frequency of dressings and the duration of treatment is determined by the doctor.

The gel is applied to the wound or to a bandage, which is then applied to the wound - once a day, to the burned skin - once every three days. When weeping wounds before applying them promakuyut gauze patch.

Treatment of the wound, if necessary, can be combined with oral or parenteral antibiotic prescribed by a doctor.

Overdose has not been reported.

The combination with erythromycin, oleandomycin, nystatin and levorinum potentiates the effect of chloramphenicol, with natural penicillins - reduces. Not compatible with sulfa drugs, cytostatics, barbiturates, alcohol, biphenyl, pyrazolone drugs.

All the above drugs can be used for nipple cracks in nursing mothers. The toilet is obligatory before feeding - the remnants of the product are removed with a napkin and the breast is washed thoroughly with soap and plenty of water so that even the smallest dose of medication does not get into the baby’s mouth.

There is a fairly wide range of antibiotic ointments that can be used in the treatment of infected wounds.

An alternative to antibiotic ointments is Mafenide ointment, a representative of sulfonamides, which inactivates a multitude of pathogenic bacteria, including the blue of the blood bacillus and the causative agents of gas gangrene (anaerobic bacteria). Mafenida acetate does not lose its qualities in an acidic environment; its 10% concentration is fatal for pyogenic infection.

Penetrating into the systemic circulation through the damaged tissue, it is found there already after three hours from the moment of wound treatment. It is rapidly decomposed, the product of metabolism does not possess activity, is eliminated by the kidneys. The active ingredient and its metabolite inhibit the enzymatic activity of carbonic anhydrase, which can cause metabolic acidification of the blood.

Use during pregnancy and lactation is not recommended.

Contraindicated in sensitized patients. Side effects are local dermatitis, there is a burning sensation, pain, sometimes very strong, lasting from half an hour to three hours. Anesthetics may be prescribed for relief.

The ointment is smeared with a layer of two to three millimeters; it is possible to tampon the wound cavities and apply it on a bandage. Dressings are done daily with abundant purulent discharge, with scanty - every other day or two.

Antibacterial powders are a convenient form for treating wounds. They treat both fresh and healing wounds. Before treatment, the wound should be cleaned from residues of pus, wound secretion, dead particles.

Powder Gentaxan - is a successful combination of the antibiotic gentamicin sulfate, a sorbent of polymethylxiloxane and a compound of zinc with levotryptofan. Aminoglycoside antibiotic inhibits the vital activity of many gram-positive and gram-negative bacilli, its action potentiates the sorbent, while carrying out detoxification activity, neutralizing the products of bacterial metabolism. The combination of tryptophan with zinc prolongs the action of the antibiotic and contributes to the restoration and granulation of the wound. The application of this powder already on the second or third day reduces the number of pathogens in the wound to a minimum, the first phase of healing passes into the second, the prevention of complications - inflammation, lymphadenitis, sepsis.

The pharmacodynamics of Gentaxan is associated not only with blocking the production of protein in a bacterial cell, but also with the disruption of the fatty component of the bacterial membrane due to its complex action. The powder reduces the symptoms of not only local, but also systemic intoxication, improves wound drainage, contributes to the edema subsiding, restores normal blood circulation, gas exchange and acid-base balance in the wound. The wound surface is actively released from the products of exudation and necrosis, the local inflammatory process is arrested, thereby accelerating the healing of the wound. The use of powder prevents the formation of scars and scars.

The drug acts superficially and has no clinically significant systemic effects.

Use during pregnancy and lactation has not been studied, if there is such a need, the powder is used according to the recommendation of the doctor. Use in pediatric practice without age restrictions is allowed.

Contraindicated in patients sensitized to the components of the powder.

Side effects are local dermatological reactions.

Gentaxan powder is used to treat the wound surface from the moment it was injured to its healing. In the first stage of the wound dressing process, one to two treatments are done daily. Pre-wound is treated, washed with an antiseptic and must be dried. In case of weeping wounds, partial flow of the powder together with the ichor can be compensated by drying the wound surface with gauze tampons and adding powder, without additional treatment.

Powder cover the entire surface of the wound to a height of 0.5-1mm, after which it is tied up, providing the necessary drainage.

After reducing inflammation and cleansing the wound from the remnants of pus and dead tissue, ligation is done once a day or every other day.

In cases where the primary surgical treatment cannot be performed in full, the surface of the wound is filled with powder and bandaged, however, operational assistance should be provided no later than after a day.

Drug interaction powder has not been studied, but with the parallel use of other antibacterial agents, the effect can be potentiated.

Powder Baneotsin combines in its composition two antibitik, potentiating the action of each other. Neomycin sulfate has a very broad spectrum of antimicrobial activity; most gram-positive and gram-negative bacteria are sensitive to it. Bacitracin zinc (a polypeptide antibiotic) acts more on gram-positive bacilli, however, neisserii and hemophilic bacilli, actinomycetes and fusobacteria are also sensitive to this drug. Bacitracin-resistant strains are extremely rare.

It is easier to list the microorganisms that are insensitive to Baneocin. These are pseudomonads, actinomycetes of the genus Nocardia, viruses, and most fungi.

The use of the external form directly on the wound reduces the systemic effect of two antibiotics and, accordingly, reduces the risk of allergic reactions. The maximum concentration is determined at the site of application, with open wounds, absorption is more active. The part of the drug that has penetrated the systemic circulation is determined after 2-3 hours.

The use of pregnant and lactating women is not recommended, the appointment should assess the ratio of the benefits of the use of the mother to the risk to the health of the child.

Contraindication is sensitization to the components of the drug and other aminoglycosides. It is also not recommended to apply on extensive wound surfaces, in case of severe diseases of the cardiovascular and urinary system, damage to cochlea receptors of the ear and disorders of the autonomic nervous system. Not used for skin lesions around the eyes.

Adherence to the rules of application is expressed by local dermatological manifestations (photosensitization is not excluded). With uncontrolled absorption into the general bloodstream (using large areas in open wounds), nephro- and ototoxic effects of the drug can be observed, as well as damage to the autonomic nervous system.

Baneocin powder is used on small wound surfaces. Can be used from the first days of a child’s life if there is no alternative in the form of a safer drug. All age categories of patients powder prescribed from two to four times a day during the week. The whole surface of the wound is covered with powder, and the process of sweating is switched on, as a result of which pain and burning are reduced and a sedative effect is achieved. You can cover the wound with a gauze bandage.

The maximum dose of powder applied to the wound surface per day is 200g. A week later, Baneocin treatment is interrupted. If necessary, re-rate the dose is halved.

Overdose (with systemic absorption) is fraught with toxic effects on the organs of hearing and urinary system.

Interaction effects appear only in the case of active absorption into the general circulation. When interacting with antibiotics of the same name group or cephalosporins, as well as diuretics, the nephrotoxic effect is potentiated.

Interaction with painkillers and muscle relaxants can lead to neuromuscular conduction disorder.

Baneocin is also available in ointment form.

In parallel with external agents, systemic antibiotics can be administered, especially in case of accidental deep infected wounds. Taking antibiotics in pills or injections can also prevent such severe wound complications as sepsis or gas gangrene, which may be fatal. Systemic drugs should be taken only on prescription. In the treatment of infected wounds, antibiotics of almost all groups are used. Prefer drugs active to the causative agent of infection. To identify it, wound secretions are sown on the media, and the sensitivity of the bacterium to antibiotics is determined. In addition, they take into account the tolerance by the patient of antibiotics of a particular group.

For purulent infections, β-lactam bactericidal antibiotics of penicillin and cephalosporin are used, which suppress the enzymatic activity of transpeptidase by binding to a protein located on the inner membrane of the cell membrane of the microbe. Inactivation of this enzyme interrupts the process of producing peptidoglycan, the basis of the bacterial membrane, which gives it rigidity and protects the bacteria from death. The cell membranes of the human body do not contain peptidoglycan, so these antibiotics are relatively low toxic.

The drugs differ in the spectrum of action and side effects, as well as the pharmacokinetic properties.

Penicillins are well absorbed and quickly distributed in the tissues and body fluids, reaching optimal therapeutic concentrations there. Excreted through the urinary organs.

The most active and low-toxic drugs of the penicillin group are salts of benzylpenicillin, which neutralize mainly gram-positive cocci (streptococci). Their main disadvantage is the narrow spectrum of action and instability to β-lactamase, so they are not suitable for the treatment of staphylococcal infection.

Upon detection of infection with penicillin-forming staphylococci, oxacillin may be prescribed.

Semisynthetic drugs of this group (ampicillin, flemoxin) have already a wider spectrum of action.

The combined drug Ampioks, which is a combination of ampicillin and oxacillin, inhibitor-protected penicillins — combinations with clavulanic acid (Amoxiclav, Augmentin) or sulbactam (Ampisid, Unazin) are preparations of a broad spectrum of activity, active to the most common pyogenic bacteria. However, pseudomonas aeruginosa and these drugs are not active.

Penicillins penetrate the placenta, however, the teratogenic effect is not fixed. Inhibitor-protected forms of the drug are used, if necessary, for the treatment of pregnant women without registered complications.

Medicines are found in breast milk, so nursing women take penicillin and its derivatives only by prescription of a doctor for health reasons.

Penicillins most often of all antibiotics cause a hypersensitivity reaction, and if one of the representatives of penicillins causes an allergy, then there is a high probability that sensitization can also occur to the others. Most of the side effects are associated with hypersensitivity reactions.

Penicillins with other bactericidal antibiotics mutually reinforce each other's actions, and with bacteriostatic they weaken.

Cephalosporins (derivatives of 7-aminocephalosporic acid) have, in general, a wider range of bactericidal activity than penicillins, and a higher resistance to β-lactamases. Four generations of these drugs are distinguished, with each generation the spectrum of action is wider and resistance is higher. The main feature of drugs belonging to the first generation is their antagonism to staphylococci, in particular, to β-lactamase-forming, and to almost all streptococci. Drugs of this group of the second generation are also highly active against the main pyogenic bacteria (staphylococcus and streptococcus), as well as Klebsiella, Proteus, Escherichia.

The third generation of cephalosporins has an even wider spectrum of action, however, it is more active against gram-negative bacteria. Antibiotics belonging to the fourth generation are highly active in almost all types of anaerobes and bacteroids. All generations are resistant to plasmid β-lactamases, and the fourth, also to chromosomal. Therefore, when prescribing penicillins and cephalosporins, a test for the type of pathogen and its sensitivity to antibiotics is of great importance. Drugs may belong to earlier generations, but if the infection is caused by staphylococcus, it makes no sense to prescribe drugs of the third or fourth generation, which are also more toxic.

Cephalosporin preparations often cause allergic reactions in people who are allergic to penicillin antibiotics.

In recent years, macrolides and fluoroquinolones have come to the fore. This is due to the appearance of frequent cross-allergic reactions, as well as the development of resistance in bacteria associated with the incorrect use of penicillins and cephalosporins.

The structural basis of macrolide class antibiotics is a macrocyclic lactone ring with 14th, 15th, 16th carbon atoms in it. According to the method of production, they are divided into natural (erythromycin, oleandomycin - outdated and practically not used) and semi-synthetic (azithromycin, clarithromycin, roxitomycin). They are mainly bacteriostatic.

Erythromycin is the first drug from this group, which is a back-up drug used to sensitize a patient to other antibiotics. This is one of the most low-toxic antibiotics, causing the least amount of adverse reactions. Active to staphylococci, streptococci, some other gram-positive and gram-negative bacteria. It is applied topically in the form of ointment, may be prescribed in tablets. The bioavailability of orally administered erythromycin depends on food intake, resistant strains of bacteria already exist.

The remaining drugs from this group (roxithromycin, midecamycin, josamycin) are superior to erythromycin in the spectrum of action, create higher concentrations of the drug in the tissues, their bioavailability does not depend on food intake. A characteristic feature of all macrolides is a good tolerability and the absence of cross-reactions of sensitization with β-lactam antibiotics, the concentration of antibiotics in tissues significantly exceeds the plasma concentration.

Erythromycin and spiromycin can be prescribed to pregnant women.

Second-generation fluorinated quinolones (ciprofloxacin, norfloxacin, ofloxacin) are active mainly for staphylococcus, the third (levofloxacin) and, especially, the fourth (moxifloxacin) are used in infected wounds as broad-spectrum antibiotics, including intracellular parasites. Moxifloxacin is active in almost all anaerobes.

Preparations of this group have a bactericidal effect that violates the construction of the deoxyribonuclease of the bacterium by inhibiting the enzymatic activity of the main participants in this process, DNA gyrase and topoisomerase-IV.

Contraindicated in patients with acute porphyria, as well as pregnant and lactating women, as they penetrate the placental barrier and are determined in breast milk. Fluoroquinolones are well absorbed from the gastrointestinal tract, characterized by a large volume of distribution, high tissue and organ concentrations. The greatest is determined by the hour-three-hour time interval from the moment of oral administration. Patients with severe renal insufficiency need to adjust the dose of all fluorinated quinolones.

The undesirable effects typical of quinolones are observed in the form of dyspepsia, disturbances in the activity of the central nervous system, sensitization reactions according to the type of dermatitis or edema, photosensitivity while taking the drugs. For all drugs in this group is characterized by the development of cross-allergic reactions.

The bioavailability of quinolones decreases when they are combined with antacid drugs, medicines, which include magnesium, zinc, bismuth and iron.

The combination of some fluoroquinolones with theophylline, caffeine and other methylxanthines increases their toxicity, since it prevents the latter from being eliminated from the body.

Simultaneous use with non-steroidal anti-inflammatory drugs and nitroimidazole derivatives increases the likelihood of neurotoxic action.

Not compatible with nitrofurans.

The antibiotics of the aminoglycoside group are widely known as components of external remedies for the healing of festering wounds. This group includes streptomycin, neomycin, gentamicin, amikacin. These antibiotics are very toxic when systemically applied, resistance to them is rapidly developing, so they are chosen as systemic drugs only if the patient has allergic reactions to other groups of antibiotics.

Antibiotics for wounds are used almost always. An accidental wound is rarely clean. For small wounds, abrasions, scratches can be applied independently external means with an antibiotic for healing wounds. They are sold in pharmacies without a prescription. In order for the treatment to be effective, it is necessary to observe the storage conditions and shelf life indicated on the package. The choice of antibiotics for systemic use in infected wounds is the prerogative of the physician. Dosage and administration of drugs are also determined by the doctor, and patients should strictly follow the recommended treatment, thus avoiding the terrible complications.