Antibiotics for and after appendicitis

The leading approach in the treatment of appendicitis is still exclusively surgical intervention. Antibiotics for and after appendicitis are prescribed except for the prevention and treatment of postoperative infectious complications.

Treatment of appendicitis with antibiotics

Acute appendicitis can not be treated with antibiotics alone - medication therapy only complements the procedure for surgical treatment of the disease.

Indications of the antibiotics with appendicitis

Among the indications: prevention of the occurrence of anaerobic infectious processes developing after operations on the peritoneal organs, and in addition intra-abdominal infections, including abscesses in the peritoneum, as well as peritonitis. 

[1], [2]

Antibiotics after removal of appendicitis

At the beginning of the postoperative period (the first 2 days), the patient is prescribed antibiotics to prevent the possibility of infection.

[3], [4], [5], [6]

Release form

Zinacef is an antibiotic from the category of the newest generation of drugs. It helps to eliminate pathogenic microbes of a variety of species. It is injected - in / m or in / in.

Dalatsin is an antibiotic that effectively affects various types of bacteria, which are the causative agents of purulent-inflammatory processes. It can be taken orally, or injected in / m or / in ways.

Metrogil is an antibiotic with a powerful effect on the simplest single-celled bacteria and microbes that live in conditions of lack of oxygen. The drug is often used in the treatment of acute appendicitis.

Tienam combines antibiotic and enzyme, which prevents the destruction of the antibiotic. This allows the drug to avoid cleavage during passage through the kidneys, as well as destruction under the influence of bacterial enzymes. Effectively affects pathogenic microbes of various types. Used in the treatment of the acute stage of appendicitis, taking place in a severe form.

Imipinem is an antibiotic that effectively eliminates most varieties of pathogenic bacteria. Has a resistance against bacterial enzymes that destroy other antibiotics. It is prescribed for the transition of appendicitis to severe form, in cases when other antibacterial drugs do not give a result.

Meronem has similar properties to Imipin, but it is less prone to destruction when passing through the kidneys, therefore it is considered a more effective means.

The properties of antibiotics for and after appendicitis are examined using the example of Zinacef.

[7], [8], [9], [10], [11]

Pharmacodynamics

The medicine is an antibiotic from the category of cephalosporin (2nd generation). Its active ingredient is cefuroxime, which possesses bactericidal properties. This component acts on individual gram-negative and gram-positive anaerobes and aerobes (among them also microbes producing b-lactamase).

[12], [13], [14]

Pharmacokinetics

After the administration of the active substance in / m peak concentration in the blood serum, it reaches 30-45 minutes, and after intravenous administration - after 10-15 minutes. Cefuroxime is able to actively pass into all liquids and tissues. In therapeutic concentrations, it accumulates in bones, soft tissues, sputum, skin and bile, and in addition to pleural and intraocular fluid and myocardium.

The binding of the active ingredient to plasma proteins is 35-50%. Cefuroxime does not pass the path of metabolism, and its half-life is 1.2 hours. It should be noted that in newborns and elderly people, as well as patients who have disorders in the work of the kidneys, this period can be 4-5 times longer.

The medicine is delivered through the kidneys, practically unchanged (85-90%), throughout the day. But most of the active substance is excreted in the first 6 hours.

[15], [16], [17], [18]

Dosing and administration

The dosage of Zinacef for adults is 0.5-1.5 g three times a day every 8 hours. For children, the dosage is calculated in a ratio of 30-100 mg / kg every 6-8 hours.

Dalacin for oral administration - for adults, the dosage is 0.15-0.6 g after every 6 hours. For children, it is 10-20 mg / kg. When administered in / in or in / m for adults, the dosage is 0.3-0.6 g at intervals of 8-12 hours, and for children - 10-40 mg / kg with an interval of 6-8 hours.

Metrogyl can be used both in injectable solutions and in tablets. The dosage is chosen by the attending doctor - it depends on the degree of aggravation of appendicitis, as well as the age of the patient.

Thienam for adults with iv administration is given in a dosage of 0.5 g of the drug (this is 50 ml of the injection solution) at intervals of 6 hours. In the case of I / m administration, the dosage is 0.75 g of the drug at an interval of 12 hours.

Imipenem is required to be administered iv in a way. For adults, the dosage of the medicine is 2 g per day.

Meronem is introduced in / in the method. For adults, the dosage is 0.5 grams of medication at intervals of 6 hours or 1 g at intervals of 8 hours. For children, the dosage is calculated in a ratio of 20-30 mg / kg body weight. With the / m introduction, the dosage for an adult is 0.3-0.75 g 2-3 times per day.

How many days are the antibiotics pricked after appendicitis

The duration of therapy with the use of antibiotics during the rehabilitation after an operation to remove appendicitis depends on several factors.

If the infectious focus is remote, the course of antibiotic treatment is 24 hours after the procedure. Similar complications arise in such cases:

• when removing appendicitis having a gangrenous form.

A weak infectious process involves the appointment of a 48-hour course of taking antibiotics. It can occur under the following conditions:

• development of intra-abdominal infectious process of various etiology with local purulent foci;
• Late (after more than 12 hours) intestinal trauma or gastroduodenal ruptures, in which pronounced peritonitis does not develop.

A moderate infectious process requires a 5-day course of antibiotic treatment. Can develop in such cases:

• a pronounced infectious process (mixed type) in the peritoneum.

The severe form of the infectious process requires a course of 5+ days. It can occur due to such violations:

• a severe infectious process in the peritoneum, originating from a hard-to-control source (eg, due to the development of an infected form of pancreatic necrosis);
• postoperative infectious process in peritoneum.

[25], [26], [27], [28], [29], [30]

Use of the antibiotics with appendicitis during pregnancy

In pregnancy, you can not prescribe the drug Dalacin.

Metrogil is contraindicated in the first trimester, but if necessary, taking into account possible negative consequences for the fetus, the doctor may prescribe it on the 2nd and 3rd trimesters.

Zinacef is also prohibited for use in the first trimester. At the 2nd and 3rd trimesters, and also during the lactation period, the drug should be administered with caution.

Contraindications

Contraindication for all medicines is the individual intolerance of individual components and active substances of drugs. Dalacin and Metrogil can not be taken in the presence of severe disorders in the work of the kidneys with the liver.

Zinatsef can not be prescribed if the patient has a tendency to develop bleeding or gastrointestinal pathologies (eg, ulcerative colitis).

Metrogil is banned for children under 2 years old, and in addition, with organic lesions of the central nervous system (such as epilepsy) and the tendency to develop convulsive seizures. It can not also be prescribed if the patient has blood diseases (also in history). Patients under the age of 18 can not combine the drug with amoxicillin.

Dalacin is not prescribed for infants until the 1st month after birth, but also for colitis, triggered by the use of antibacterial drugs (also in history).

[19], [20], [21], [22]

Side effects of the antibiotics with appendicitis

Among the adverse reactions associated with the administration of such antibiotics, dizziness, headache, convulsions, vomiting with nausea, diarrhea, and also rashes on the skin, urticaria and pruritus, anaphylaxis, thrombocyto- and leukopenia, and thrush are most often observed.

Due to the use of Zinatsef sometimes such reactions may occur:

• organs of the National Assembly: hearing impairment;
• organs of the gastrointestinal tract: pain in the epigastric region, and in addition pseudomembranous colitis;
• organs of the genitourinary system: disorders in the work of the kidneys;
• organs of the hematopoietic system: eosinophilia, as well as hemolytic form of anemia;
• allergies: Quincke edema, bronchial spasms, Lyell's syndrome;
• among local reactions: pain and redness, as well as the appearance of an abscess at the site of injection of the / m injection; in the case of intravenous administration, phlebitis or thrombophlebitis may develop.

The use of Metrogil can lead to the appearance of such adverse reactions:

• organs of the National Assembly: problems with orientation in space and coordination of movements, disturbance of wakefulness and sleep regimes, and sensation of confusion. In addition, there may be a feeling of weakness or irritability, as well as increased excitability, hallucinations are possible. In a few cases, polyneuropathy develops;
• organs of the digestive tract: constipation, metallic taste or dryness in the oral cavity, the development of anorexia, glossitis or stomatitis. Also, the appearance of pancreatic function disorders (diseases such as pancreatitis);
• organs of the genitourinary system: the appearance of burning, itching, as well as redness in the perineum, the development of polyuria or dysuria, as well as darkening of the urine;
• Other reactions: an allergic rhinitis, an increase in temperature, and in addition a change in ECG and neutropenia.

The use of Meronem usually does not cause an adverse reaction, but in some cases, symptoms such as dyspepsia, anemia, Quincke edema, and changes in liver function may occur.

[23], [24]

Overdose

In case of an overdose with Zinatsef, development of such signs (organs of the National Assembly) is possible: the appearance of convulsions, the state of overexcitation, the appearance of a tremor. To eliminate these manifestations of the disorder requires symptomatic treatment. If there was a severe overdose, to reduce the concentration of the active substance in the body will require peritoneal dialysis or hemodialysis.

As a result of Metrogil overdose, patients develop symptoms such as vomiting with nausea, headaches with dizziness, and ataxia. As a result of acute overdose (in severe form) metronidazole may develop an attack of epilepsy or polyneuropathy. To eliminate the symptoms it is necessary to perform the procedure of gastric lavage and give the patient enterosorbents.

[31], [32]

Interactions with other drugs

Due to the combination of Zinatsef and other nephrotoxic drugs (for example, "loop" diuretics or aminoglycosides), their poisoning effect on the kidneys increases, especially for elderly patients or those who have previously experienced disorders in the functioning of the kidneys. The active substance of Zinatsef suppresses the synthesis of the vitamin K group. As a result, when the drug is combined with the NSAID, the platelet aggregation process deteriorates, resulting in an increased risk of bleeding. A similar effect is evident due to the combination of cefuroxime and anticoagulants.

When connecting Metrogil with anticoagulants of indirect effects, the duration of prothrombin time increases. In addition, this drug causes intolerance to ethanol. In the case of a combination of the active component Metrogil (metronidazole) with disulfiram, the risk of complications of a neurological nature may increase. Therefore, it is necessary to dilute the intake of these drugs in time - at the end of the course of treatment with disulfiram to begin treatment Metrogil can be at least 2 weeks later.

The compound with cimetidine weakens the rate of metabolism of the active substance in the liver, so that the rate of its accumulation in the blood plasma increases. This causes an increased risk of adverse reactions. Drugs that stimulate the enzymes of microsomal oxidative processes in the liver increase the rate of excretion and metabolism of metronidazole.

If Metrogil is used with lithium drugs, the concentration of lithium in the blood increases. The properties of metronidazole are enhanced when combined with sulfonamides, as well as other drugs that have an antimicrobial effect.

Dalacin can not be combined with ampicillin, erythromycin, and in addition calcium gluconate, barbiturates, magnesium sulfate, and also aminophylline. In the case of a combination with antidiarrhoeal drugs, the risk of pseudomembranous colitis may increase. Dalatsin also improves the properties of muscle relaxants, as a result of which it is possible to combine these drugs only under the supervision of the attending physician.

Tienam in combination with a probenicide is not recommended, as in this case there is a slight increase in the half-life of Tienam and its concentration in the plasma. When the drug is combined with valproic acid, its serum concentration level is lowered. As a result, convulsive activity may increase - therefore, it is required to carefully monitor the level of valproic acid concentration when combined with Tienam. Mixing in one syringe Tienam and other antibiotics is not allowed, but isolated simultaneous administration with aminoglycosides is allowed.

The combination of Meronem and potentially nephrotoxic drugs can cause side reactions. In addition, Meronem is able to significantly reduce the concentration of valprobic acid, so its indicators should be carefully monitored with the combined use of these drugs. Probenecid is able to influence the duration of the half-life of Meronem, because of which the concentration of the latter in the blood increases.

[33], [34], [35], [36]

Storage conditions

Medicines should be kept in standard conditions - in a dark dry place, at a temperature within 15-30 degrees.

[37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47]

Shelf life

Antibiotics for and after appendicitis are allowed to be used for 2-5 years from the date of manufacture.

[48], [49], [50]