Antibiotics for and after appendicitis

The leading approach to treating appendicitis is still exclusively surgical intervention. Antibiotics during and after appendicitis are prescribed only for the prevention and treatment of postoperative infectious complications.

Treatment of appendicitis with antibiotics

Acute appendicitis cannot be treated with antibiotics alone – drug therapy only complements the surgical treatment of the disease.

Indications antibiotics for appendicitis

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

[ 1 ], [ 2 ]

Antibiotics after appendectomy

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 latest generation of drugs. It helps to eliminate pathogenic microbes of various types. It is administered by injections - intramuscularly or intravenously.

Dalacin is an antibiotic that effectively affects various types of bacteria that cause purulent-inflammatory processes. It can be taken orally, or administered intramuscularly or intravenously.

Metrogyl is an antibiotic with a powerful effect on protozoan unicellular bacteria and microbes that live in conditions without oxygen. The drug is often used in the treatment of acute appendicitis.

Tienam combines an antibiotic and an enzyme that prevents the destruction of the antibiotic. This allows the drug to avoid splitting when passing through the kidneys, as well as destruction under the influence of bacterial enzymes. Effectively affects pathogenic microbes of various types. It is used in the treatment of acute appendicitis, which occurs in a severe form.

Imipenem is an antibiotic that effectively eliminates most types of pathogenic bacteria. It is resistant to bacterial enzymes that destroy other antibiotics. It is prescribed when appendicitis becomes severe, in cases where other antibacterial drugs do not give results.

Meronem has properties similar to Imipenem, but is less susceptible to destruction when passing through the kidneys, and is therefore considered a more effective drug.

The properties of antibiotics during and after appendicitis are discussed using the drug Zinacef as an example.

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

Pharmacodynamics

The drug is an antibiotic from the cephalosporin category (2nd generation). Its active ingredient is cefuroxime, which has bactericidal properties. This component affects individual gram-negative and gram-positive anaerobes and aerobes (including microbes that produce b-lactamase).

[ 11 ], [ 12 ], [ 13 ]

Pharmacokinetics

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

The binding of the active component to plasma proteins is 35-50%. Cefuroxime does not undergo metabolism, and its half-life is 1.2 hours. It should be noted that in newborns and the elderly, as well as patients with kidney disorders, this period may be 4-5 times longer.

The drug is excreted through the kidneys, practically unchanged (85-90%), within 24 hours. But most of the active substance is excreted in the first 6 hours.

[ 14 ], [ 15 ], [ 16 ], [ 17 ]

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 the ratio of 30-100 mg/kg every 6-8 hours.

Dalacin when taken orally - for adults, the dosage is 0.15-0.6 g every 6 hours. For children, it is 10-20 mg / kg. When administered intravenously or intramuscularly, for adults, the dosage is 0.3-0.6 g with an interval of 8-12 hours, and for children - 10-40 mg / kg with an interval of 6-8 hours.

Metrogyl can be used both in injection solutions and in tablets. The dosage is selected by the attending physician - it depends on the degree of exacerbation of appendicitis, as well as the age of the patient.

Tienam for adults, when administered intravenously, is prescribed in a dosage of 0.5 g of the drug (this is 50 ml of injection solution) with an interval of 6 hours. In case of intramuscular administration, the dosage is 0.75 g of the drug with an interval of 12 hours.

Imipenem must be administered intravenously. For adults, the dosage of the drug is 2 g per day.

Meronem is administered intravenously. For adult patients, the dosage is 0.5 g of the drug at 6-hour intervals or 1 g at 8-hour intervals. For children, the dosage is calculated at 20-30 mg/kg of weight. When administered intramuscularly, the dosage for an adult is 0.3-0.75 g 2-3 times a day.

How many days are antibiotics injected after appendicitis

The duration of antibiotic therapy during the recovery period after appendicitis surgery depends on several factors.

If the infectious focus is remote, the course of antibiotics is 24 hours after the procedure. Such complications occur in the following cases:

• when removing appendicitis, which has a gangrenous form.

A mild infectious process requires a 48-hour course of antibiotics. It may occur under the following conditions:

• development of an intra-abdominal infectious process of various etiologies with local purulent foci;
• late (occurring more than 12 hours later) intestinal injuries or gastroduodenal ruptures, in which severe peritonitis does not develop.

A moderate infectious process requires a 5-day course of antibiotics. It can develop in the following cases:

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

A severe form of the infectious process requires a course of 5+ days. It may occur as a result of the following disorders:

• a severe infectious process in the peritoneum that arises from a difficult to control source (for example, due to the development of an infected form of pancreatic necrosis);
• postoperative infectious process in the peritoneum.

[ 24 ], [ 25 ], [ 26 ], [ 27 ], [ 28 ], [ 29 ]

Use antibiotics for appendicitis during pregnancy

Dalacin should not be prescribed during pregnancy.

Metrogyl is contraindicated in the 1st trimester, but if necessary, taking into account possible negative consequences for the fetus, the doctor may prescribe it in the 2nd and 3rd trimesters.

Zinacef is also prohibited for use in the first trimester. In the 2nd and 3rd trimesters, and also during lactation, the drug is prescribed with caution.

Contraindications

Contraindications for all medications are individual intolerance to individual components and active substances of the drug. Dalacin and Metrogyl should not be taken in the presence of severe disorders in the functioning of the kidneys and liver.

Zinacef should not be prescribed if the patient has a tendency to develop bleeding or gastrointestinal pathologies (for example, ulcerative colitis).

Metrogyl is prohibited for children under 2 years of age, and in addition to this, in case of organic lesions of the central nervous system (such as epilepsy) and a tendency to develop seizures. It also cannot be prescribed if the patient has blood diseases (also in the anamnesis). Patients under 18 years of age cannot combine the drug with amoxicillin.

Dalacin is not prescribed to infants under 1 month of age, and also for colitis caused by the use of antibacterial drugs (also in the anamnesis).

[ 18 ], [ 19 ], [ 20 ], [ 21 ]

Side effects antibiotics for appendicitis

Among the side effects when taking such antibiotics, the most common are dizziness, headaches, convulsions, vomiting with nausea, diarrhea, and in addition, skin rashes, urticaria and itching, anaphylaxis, thrombocytopenia and leukopenia, as well as thrush.

As a result of using Zinacef, the following reactions may occasionally occur:

• nervous system organs: hearing impairment;
• gastrointestinal tract organs: pain in the epigastric region, and in addition pseudomembranous colitis;
• genitourinary system: kidney dysfunction;
• organs of the hematopoietic system: eosinophilia, as well as hemolytic anemia;
• allergies: Quincke's edema, bronchospasms, Lyell's syndrome;
• Local reactions include pain and redness, as well as the appearance of an abscess at the site of intramuscular injection; in the case of intravenous administration, phlebitis or thrombophlebitis may develop.

The use of Metrogyl may lead to the following side effects:

• NS organs: problems with orientation in space and coordination of movements, disturbances in sleep and wakefulness patterns, and a feeling of confusion. In addition, a feeling of weakness or irritability may occur, as well as increased excitability, and hallucinations are possible. In isolated cases, polyneuropathy develops;
• Gastrointestinal organs: constipation, metallic taste or dry mouth, development of anorexia, glossitis or stomatitis. Pancreatic dysfunction (diseases such as pancreatitis) may also occur;
• genitourinary system: the appearance of burning, itching, and redness in the perineum, the development of polyuria or dysuria, and darkening of urine;
• other reactions: allergic rhinitis, increased temperature, and also changes in ECG readings and neutropenia.

The use of Meronem usually does not cause side effects, but in some cases symptoms such as dyspepsia, anemia, Quincke's edema, and changes in liver function tests may occur.

[ 22 ], [ 23 ]

Overdose

In case of overdose of Zinacef, the following symptoms may develop (NS organs): seizures, overexcitation, tremor. Symptomatic treatment is required to eliminate these manifestations of the disorder. If there was a severe overdose, peritoneal dialysis or hemodialysis procedures will be required to reduce the concentration of the active substance in the body.

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

[ 30 ], [ 31 ]

Interactions with other drugs

As a result of the combination of Zinacef and other nephrotoxic drugs (for example, "loop" diuretics or aminoglycosides), their toxic effect on the kidneys increases, especially in elderly patients or those who have previously had kidney disorders. The active substance of Zinacef suppresses the synthesis of vitamin K. As a result, when the drug is combined with NSAIDs, the process of platelet aggregation worsens, resulting in an increased risk of bleeding. A similar effect occurs as a result of the combination of cefuroxime and anticoagulants.

When Metrogyl is combined with indirect anticoagulants, the duration of prothrombin time increases. In addition, this drug causes ethanol intolerance. In the case of a combination of the active component of Metrogyl (metronidazole) with disulfiram, the risk of neurological complications may increase. Therefore, the intake of these drugs should be separated by time - after the end of the course of treatment with disulfiram, treatment with Metrogyl can be started at least 2 weeks later.

The combination with cimetidine reduces the rate of metabolism of the active substance in the liver, as a result of which the rate of its accumulation in the blood plasma increases. This causes an increased risk of adverse reactions. Medicines that stimulate enzymes of microsomal oxidative processes in the liver increase the rate of excretion and metabolism of metronidazole.

When Metrogyl 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 should not be combined with ampicillin, erythromycin, and in addition calcium gluconate, barbiturates, magnesium sulfate, and aminophylline. In case of combination with antidiarrheal drugs, the risk of pseudomembranous colitis may increase. Dalacin also enhances the properties of muscle relaxants, as a result of which these drugs can only be combined under the supervision of the attending physician.

It is not recommended to prescribe Tienam in combination with probenecid, since 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, the level of its concentration in the serum decreases. As a result, seizure activity may increase - therefore, it is necessary to carefully monitor the level of valproic acid concentration when taken in combination with Tienam. Mixing Tienam and other antibiotics in one syringe is not allowed, but isolated simultaneous administration with aminoglycosides is allowed.

The combination of Meronem and potentially nephrotoxic drugs may cause adverse reactions. In addition, Meronem can significantly reduce the concentration of valproic acid, so its levels should be carefully monitored when using these drugs in combination. Probenecid can affect the half-life of Meronem, causing the concentration of the latter in the blood to increase.

[ 32 ], [ 33 ], [ 34 ], [ 35 ]

Storage conditions

Medicines must be kept under standard conditions - in a dark, dry place, at a temperature of 15-30 degrees.

[ 36 ], [ 37 ], [ 38 ], [ 39 ], [ 40 ], [ 41 ], [ 42 ], [ 43 ], [ 44 ], [ 45 ], [ 46 ]

Shelf life

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

[ 47 ], [ 48 ], [ 49 ]