Antibiotics for acute and chronic cholecystitis: list and treatment regimens

The system of bile secretion is an important part of the digestive tract, when the function of digestion is disturbed, the process of digestion of food becomes much more complicated. For example, this occurs when the inflammatory process in the walls of the gallbladder - cholecystitis. In order to solve the problem and eliminate inflammation, sometimes enough conservative therapy, using cholagogue, anti-inflammatory, antispasmodic and other medicines. In addition, prescribe antibiotics for cholecystitis: such drugs help significantly speed up the process of recovery of patients.

[1], [2]

Indications of the antibiotics for cholecystitis

Among the many causes that lead to the development of cholecystitis, the infectious nature of the disease is not the last - for example, pathogenic bacteria can get into the system of bile secretion with blood or lymph from other organs, or on a descending or ascending path from the digestive tract.

If the cholecystitis is calculous-that is, accompanied by the formation of stones in the bladder and / or ducts, then the risk of damage and inflammation of the organ wall increases several times, since concrements can mechanically injure tissues.

Treatment of cholecystitis with antibiotics is often mandatory. If the source of the infectious process is not eliminated, the disease can be complicated by the formation of an abscess, the suppuration of the bladder and ducts, which can subsequently lead to even fatal outcome. To prevent this, treatment of cholecystitis should include a complex of drugs, among which - and antibiotics.

Immediate indications for antibiotic therapy for cholecystitis are:

• marked pain in the liver, with a tendency to build up;
• a significant increase in temperature (up to + 38.5-39 ° C);
• expressed digestive disorders, with diarrhea and repeated vomiting;
• spread of pain throughout the abdomen (so-called "spilled" pain);
• presence of other infectious diseases in the patient;
• signs of the infectious process, detected as a result of a blood test.

[3], [4], [5]

Antibiotics for cholecystitis and pancreatitis

Antibiotics are needed in order to get rid of the infection, which often contributes to the development of cholecystitis and pancreatitis.

In uncomplicated cases, the doctor prescribes outpatient treatment with antibiotics in tablets. Such tablets can be Tetracycline, Rifampicin, Sigmamicin or Oletetrin, in individual dosages. The average course of antibiotic therapy is 7-10 days.

If surgical treatment was used for cholecystopancreatitis, an injection course of antibiotics in the form of intramuscular or intravenous drip administration is mandatory. In this case, it is appropriate to use Kanamycin, Ampicillin or Rifampicin.

In case of a complicated course of the disease, two antibiotics can be used simultaneously, or a periodic replacement of the drug after determination of the resistance of microorganisms.

[6], [7], [8], [9]

Antibiotics for acute cholecystitis

In the acute course of cholecystitis, antibiotics can be useful in cases of suspected peritonitis and empyema of the gallbladder, as well as in septic complications. The doctor decides exactly which antibiotic is appropriate for acute cholecystitis. Typically, the drug is selected based on the results of sowing bile. Also of great importance is the property of the selected drug to enter the bile secretion system and concentrate in the bile to therapeutic indices.

In acute cholecystitis the most optimal 7-10-day course of therapy, with the preferred intravenous administration of medications. Recommended use of Cefuroxime, Ceftriaxone, Cefotaxime, as well as a combination of Amoxicillin and Clavulanate. Often use a treatment regimen, including cephalosporin and Metronidazole.

Antibiotics for exacerbation of cholecystitis are used according to similar schemes, with the possibility of prescribing alternative treatment:

• intravenous infusion Ampicillin 2,0 four times a day;
• intravenous infusion of gentamicin;
• intravenous infusion of metronidazole 0.5 g four times a day.

A good effect is provided by the combination of metronidazole and ciprofloxacin.

[10], [11]

Antibiotics for chronic cholecystitis

Antibiotics in the case of chronic course of cholecystitis can be prescribed when there are signs of activity of the inflammation process in the bile secretion system. Usually, antibiotic therapy is prescribed in the stage of exacerbation of the disease, in combination with choleretic and anti-inflammatory drugs:

• Erythromycin 0.25 g four times a day;
• Oleandomycin 500 mg four times a day after meals;
• Rifampicin 0.15 g three times a day;
• Ampicillin 500 mg four to six times a day;
• Oxacillin 500 mg four to six times a day.

Such antibiotics as benzylpenicillin in the form of intramuscular injections, Phenoxymethylpenicillin in tablets, tetracycline 250 mg 4 times a day, metacyclin 300 mg twice a day, oletetrin 250 mg four times a day have a pronounced effect.

[12]

Antibiotics for calculous cholecystitis

Stones in the gall bladder not only create a mechanical barrier for the outflow of bile, but also provoke a strong irritation of the walls of the ducts and gall bladder. This can lead first to an aseptic, and then to a bacterial inflammatory process. Often such inflammation gradually acquires a chronic course with periodic exacerbations.

Often the infection enters the biliary system with blood flow. It is for this reason that patients with diseases of the urinary system, intestines, etc. Also suffer from cholecystitis. Treatment in this case involves the use of strong antimicrobial agents with a broad spectrum of activity.

Powerful antibiotics are represented by Ampiox, Erythromycin, Ampicillin, Lincomycin, Ericyclin. Such drugs are prescribed about 4 times a day, in an individually selected dosage. Oletetrin, Metacyclin is more often prescribed in chronic course of cholecystitis.

[13], [14], [15], [16]

Release form

Antibiotics for cholecystitis are used in various dosage forms, which are selected according to several criteria:

• comfort of use;
• conformity of the stage of the disease.

For example, it is preferable for children to use antibiotics in the form of a suspension or oral solution.

In the acute stage of cholecystitis, it is preferable to prescribe an antibiotic in the form of injections - intramuscular or intravenous. At the stage of remission of symptoms, as well as chronic chronic circulation of cholecystitis, antibiotics can be taken in tablets or capsules.

The names of antibiotics, which are often prescribed for cholecystitis

• Azithromycin is an antibiotic that exists in the form of capsules or tablets. The drug is drunk between meals, at an average dosage of 1 g per reception.
• Zitrolide is an analog of Azithromycin, which is available in the form of capsules and has a prolonged effect - that is, it is enough to take one capsule of the drug per day.
• Sumalek - macrolide antibiotic, existing in the form of tablets or powder. The drug is convenient for use, as it requires a single dose during the day. The duration of therapy with Sumalek is determined by the doctor.
• Azikar is a capsular antibiotic that perfectly copes with combined inflammatory processes - for example, it is often prescribed for cholecystopancreatitis. The standard dosage of the drug is 1 g once a day, between meals.
• Amoxyl is a combined antibiotic, with active ingredients such as amoxicillin and clavulanic acid. Amoxil can be used in the form of tablets, or injected as injections and infusions, at the discretion of the doctor.
• Flemoxin Solutab is a special form of amoxicillin in the form of soluble tablets, which allows rapid and complete absorption of the drug in the gastrointestinal tract. Flemoxin Solutab is prescribed for cholecystitis, both for children (1 year) and adult patients.

[17], [18], [19]

Pharmacodynamics

The pharmacological action of antibiotics in cholecystitis can be visually examined by the example of such a common drug as Amoxicillin (also known as Amoxil).

Amoxicillin refers to semisynthetic aminopenicillins, which have antimicrobial activity in the spectrum most optimal for cholecystitis. The drug does not show sensitivity to the bacteria that produce penicillinase.

Amoxicillin exhibits the action of relatively large numbers of microbes. Thus, the spectrum of activity covers gram (+) aerobic bacteria (bacilli, enterococci, listeria, corynobacteria, nocardia, staphylococcus, streptococci), as well as gram (+) anaerobic bacteria (clostridia, peptostreptococci, peptococci), gram (-) aerobic bacteria Brucella, Bordetella, Gardnerella, Helicobacterium, Klebsiella, Legionella, Moracella, Proteus, Salmonella, Shigella, Cholera Vibrio), gram (-) anaerobic bacteria (bacteroides, fusobacteria, borrelia, chlamydia, pale treponema).

Amoxicillin may not show activity to microbes that produce β-lactamase - because of this, some microorganisms are insensitive to monotherapy with the drug.

[20], [21], [22], [23], [24]

Pharmacokinetics

At oral reception Amoxicillinum - an antibiotic which often appoint or nominate at a cholecystitis, almost at once is soaked up in a digestive path. The average concentration limit is 35-45 minutes.

The biological availability of an antibiotic is equivalent to 90% (when ingested).

The half-life is 1-1 ½ hours.

Binding to plasma proteins is small - approximately 20% in amoxicillin and 30% in clavulanic acid.

The processes of metabolism occur in the liver. The antibiotic has a good distribution in tissues and liquid media. It is excreted through the urinary system within six hours after oral administration.

[25], [26], [27]

Dosing and administration

Antibiotics for cholecystitis should be used with these recommendations:

• When choosing an antibiotic, among other things, it is necessary to take into account the age of the patient with cholecystitis. So, for a children's age there is a number of the resolved preparations.
• The main indication for the appointment of antibiotics in cholecystitis are signs of an inflammatory process.
• Antibiotics for cholecystitis can be administered in the form of injections or taken orally. As a rule, the choice of the form of the drug depends on the stage of cholecystitis.
• You can not take antibiotics for less than seven days and more than 14 days. Optimal to hold a 7-10-day therapeutic course.
• Incorrect antibiotic treatment, as well as ignoring the doctor's recommendations, can slow the onset of recovery and aggravate the course of the disease.

As for dosage and treatment regimen, it is set individually, taking into account the severity of the infectious process and the sensitivity of the pathogenic microorganism. For example, Amoxicillin in cholecystitis is prescribed most often at a dosage of 500 mg three times a day, but in severe cases the amount of the drug can be increased to 1 g three times a day. In childhood from five to ten years, Amoxicillin is prescribed to 0.25 g three times a day.

Scheme of treatment of cholecystitis with antibiotics

There are several standard antibiotic regimens for cholecystitis. We recommend that you familiarize yourself with them.

• Aminoglycosides in combination with ureidopenicillins and metronidazole. Antibiotics are injected: Gentamicin (up to 160 mg) in the morning and in the evening + Metronidazole 500 mg and Azlocillin 2.0 three times a day.
• Cephalosporin antibiotic with a penicillin group preparation: Ceftazidime 1.0 three times a day + Flukloxacillin 250 mg four times a day.
• Cephalosporin antibiotic and Metronidazole: Cefepime 1.0 morning and evening, in combination with Metronidazole 500 mg three times a day.
• Ticarcillin with Clavulanic acid 3 g once every 5 hours as an intravenous injection (no more than 6 times a day).
• Penicillin antibiotics in combination with fluoroquinolone group preparations: Ampicillin 500 mg 5-6 times a day + Ciprofloxacin 500 mg three times a day.

Treatment regimens can vary, combining other drugs that represent the proposed groups of antibiotics.

[35], [36], [37]

Use of the antibiotics for cholecystitis during pregnancy

Antibiotics for cholecystitis during pregnancy try not to prescribe, as many of these drugs overcome the placental barrier and can have a negative impact on the development of the fetus. However, there are cases of cholecystitis, when it is not possible to avoid taking antibiotics. If this happens, then the antibiotic should be selected only by a doctor, taking into account not only the sensitivity of bacteria, but also the duration of pregnancy.

For example, at the doctor's discretion, the use of such antibiotics in cholecystitis by pregnant women is allowed:

• preparations of the penicillin group (Amoxicillin, Ampiox, Oxacillin);
• antibiotics of the cephalosporin group (Cefazolin, Cefatoxime);
• antibiotics-macrolides (Azithromycin, Erythromycin).

In no case should you take antibiotics for cholecystitis and pregnancy at random - this can harm a future baby, and also cast doubt on the outcome of the pregnancy itself.

Contraindications

Antibiotics for cholecystitis are not prescribed only in certain cases, namely:

• with an increased reaction of the body to the antibiotics of a particular group;
• with infectious mononucleosis;
• at pregnancy and thoracal feeding (except for the preparations resolved to application at pregnant women);
• with a tendency to allergic reactions;
• with severe decompensated states of the body.

In any case, the possibility of prescribing antibiotics for cholecystitis should be evaluated by the treating doctor, since often contraindications are relative. For example, during pregnancy, certain types of medications can be prescribed, but their reception should be strictly coordinated with the doctor and they also be observed.

[28], [29], [30], [31], [32]

Side effects of the antibiotics for cholecystitis

All without exception, antibiotics, including those prescribed for cholecystitis, can have a number of side effects - especially if they are taken for a long time. Among the most common adverse symptoms are:

• development of resistance of pathogenic bacteria to the action of antibiotic;
• development of allergies;
• dysbacteriosis of the intestine, vagina, oral cavity;
• stomatitis;
• fungal lesions of the skin and mucous membranes;
• decreased immunity;
• hypovitaminosis;
• dyspepsia (diarrhea, vomiting, discomfort in the abdomen);
• bronchospasm.

When taking the usual dose of antibiotic prescribed by the doctor, adverse manifestations are rare, or manifest only slightly.

[33], [34]

Overdose

If an overdose of an antibiotic occurs with cholecystitis, then most often it manifests itself in the form of a digestive process disorder. So, nausea with vomiting, diarrhea or constipation, increased gas formation in the intestine, pain in the abdomen can be observed.

In addition, the balance of the liquid and electrolytes may be disturbed.

Depending on the symptoms, when taking excessive amounts of antibiotics, symptomatic treatment is performed, accentuated on taking a large volume of fluid to compensate for electrolyte disorders.

In some cases, initial renal failure may develop, which is explained by damage to the renal parenchyma due to crystallization of the antibiotic.

In severe cases, for rapid removal of the drug from the circulatory system, hemodialysis can be used.

Paradoxically, in rare cases, with an overdose or excessively long-term administration of drugs, cholecystitis can develop after antibiotics. Its development is associated with increased burden on the liver and hepatobiliary system, and is of a functional nature.

[38], [39]

Interactions with other drugs

Drug interaction of antibiotics in cholecystitis suggest you consider the example of the already known drug Amoxicillin - semisynthetic aminopenicillin.

Antibiotic may reduce the effect of oral contraceptives.

The combination of Amoxicillin with aminoglycoside antibiotics and cephalosporins can lead to a synergistic effect. The combination with macrolide, tetracycline antibiotics, lincosamides and sulfonamide preparations may lead to antagonistic action.

Amoxicillin improves the effectiveness of indirect anticoagulant drugs, worsens the production of vitamin K and lowers the prothrombin index.

The content of Amoxicillin in the serum can be increased under the influence of diuretics, non-steroidal anti-inflammatory drugs, Probenecid and Allopurinol.

Absorption of antibiotic in the digestive system can be hindered by the action of anti-acid drugs, laxatives, glucosamine and aminoglycosides.

Assimilation of antibiotic is improved in the presence of vitamin C.

[40], [41]

Storage conditions

Antibiotics for cholecystitis in most cases can be stored in rooms with room temperature. Some injectable preparations should be stored in cool places - for example, in a refrigerator.

Any medicines should be stored in the maximum inaccessibility for children.

[42], [43], [44], [45]

Shelf life

The shelf-life of an antibiotic is indicated on the package for a specific preparation. Be sure to pay attention to the date of production of the medication!

[46], [47], [48], [49]

The best antibiotic for cholecystitis

With all the shortcomings of antibiotic therapy, cure for cholecystitis without them is almost impossible. With cholecystitis, antibiotics are prescribed in relatively high dosages for 7-14 days.

Antibiotics for cholecystitis can be conditionally divided into subgroups, according to their principle of exposure.

First of all, the practice of antibiotics destroying the wall of a microbial cell is practiced: these are penicillin series medicines, as well as cephalosporin preparations (Cefazolin, Cefalexin).

Qualitatively, there are antibiotics that disrupt the exchange of proteins in the bacterial cell. Levomycetin can be classified as such. Similar to this drug and other antibiotics: Tetracycline, Erythromycin, Gentamicin.

Each antibiotic has its own fixed spectrum of activity, so the doctor can choose a drug based on the details of bacteriological inference. For example, if the diagnostic method determines that cholecystitis was triggered by streptococcus, enterococcus or E. Coli, then the appointment of Tetracycline, Linkomycin, Apmicillin, Cefazolin, Gentamycin, Erythromycin is appropriate.

Inflammation of the gallbladder is a complex disease, therefore it is not enough to take only antibiotics for cholecystitis. In addition to antibiotic therapy, it is mandatory to use other medications - for example, antispasmodics and cholagogue preparations.