Antibiotics for sepsis: what are the effective ones?

Sepsis is a serious disease, which causes infection of the whole organism, including blood, urine, and others in the norm of sterile biological fluids with a bacterial microflora. Distribution occurs directly from the source of infection in the event that the bacteria have received unlimited growth and their number is sharply exceeding all permissible limits. This means that the focus of infection, where the main infectious-inflammatory process occurs, is completely colonized by pathogenic microflora, and it began to colonize free biotopes, that is, the infection progresses. As practice shows, antibiotics for sepsis are the only possible way to save a person. In the absence of treatment, a person dies.

Treatment of sepsis with antibiotics

Cure is possible only in the course of intensive antibiotic therapy, in which antibiotics are used. This is a group of drugs that aims to eliminate the infectious process in the body. Acts in two ways: either kills the bacterium completely, or stops its growth and reproduction. To date, the pharmaceutical market is represented by a huge number of antibacterial agents, which show different activity against different groups of microorganisms. So, some of them can act only against one group of microorganisms, others - against another.

For example, preparations are known that show activity only against Gram-positive microorganisms and are purposefully killed. They are active in relation to such microorganisms as staphylococcus, streptococcus, pneumococcus, Pseudomonas aeruginosa, but will be absolutely ineffective, for example, against E. Coli.

Other antibiotics are highly active against gram-negative groups at the time. As they do not have any effect on gram-positive microorganisms. For example, they can show a high degree of activity in relation to E. Coli, salmonella, klebsiella, and will be absolutely ineffective in the treatment of diseases caused, for example, by staphylococci.

In order to select an antibiotic that will maximally meet the needs for treatment and will have the maximum effect in a short time, special microbiological studies are carried out. Most often resort to bacteriological inoculation and a test for the determination of antibiotic susceptibility.

To do this, the biological fluid of a person is taken for the study, first it is sown to a universal nutrient medium. The culture is incubated under a thermostat at a certain temperature for several days. After that, the crops are scanned. Blood, urine, liquor, and many other human biological fluids should normally be sterile, that is, no growth of microorganisms should be detected. But with sepsis, microflora grows.

Further, the largest colony is taken and its sowing is performed on selective nutrient media and on special "jambs" for further research. It is aimed at isolating the causative agent of the disease into a separate pure culture. The culture is again incubated for several days under optimal conditions. Then further identification is carried out, the generic and specific belonging of the microorganism is determined. This gives us the opportunity to determine the exact cause of the disease and to choose the treatment as precisely as possible.

The next step determines the sensitivity of the selected pathogen to antibiotics. This makes it possible to identify the sensitivity spectrum and select an antibiotic that will exert maximum activity against the given microorganism. Also, the optimal dosage is determined at which the bacterial growth completely stops.

The only problem is that this study is conducted long enough - at least a week, because it is determined by the growth rate of the microorganism. In patients with sepsis, there is often not so much time, because the disease progresses very quickly, and the patient can die within 1-2 days.

Therefore, in the initial stages often resort to the use of broad-spectrum antibiotics. This is a group of drugs that have an effect against all groups of microorganisms: both against gram-positive and against gram-negative. The effectiveness and selectivity of the action of such antibiotics is much lower, but this gives the opportunity to gain time and to stop or slow the progression of the infectious process. Usually, after the analysis is ready, a second course of antibiotic therapy is prescribed, which is directed exclusively against the causative agent of the disease.

Broad-spectrum antibiotics are effective, however they are very dangerous due to the fact that they have antibacterial action against all microorganisms that are present in the body. They also kill the normal human microflora, resulting in numerous side effects and complications, which are based on dysbiosis. Also, broad-spectrum antibiotics are used if it is found that the cause of the disease is several microorganisms belonging to different groups. It can be a mixed, or so-called, mixt-infection, biofilm forms of coexistence of bacteria, their associations.

It should be borne in mind that bacteria can mutate and are able to develop resistance against certain antibiotics, and even whole groups, so some antibiotics may be ineffective. To avoid such situations, you must follow the basic rules of antibiotic therapy. So, the basic rule says that you need to take antibiotics course, in a strictly selected dosage. You can not reduce dosage on your own, or stop treatment, even if the symptoms do not show themselves. Otherwise, it will end by the fact that the bacterial microflora will not be completely killed. Surviving microorganisms necessarily mutate, and will acquire resistance not only to this antibiotic, but to the entire group.

Also, antibiotics should not be taken for prophylaxis, since this does not have a positive effect, but will only lead to the development of dysbacteriosis and the development of resistance from pathogenic strains. The exception is postoperative states, because at this time the immune system is too weak to resist any infection.

Do not take too strong. If the weakest antibiotic is effective, you need to start with it, since if the microorganism develops resistance to a minimum dosage, you can always resort to the use of a stronger agent. Then the opposite is impossible. It should be remembered that there is an individual intolerance to medicines, and the components that make up their composition. Also it is necessary to take into account that a repeated course of antibiotic therapy can lead to an allergic reaction.

Indications of the antibiotics for sepsis

Antibiotics are used in all diseases of bacterial etiology. Sepsis is the main and unconditional indication for taking antibiotics. Sepsis is the most difficult condition - this is the final stage of the infectious process, in which blood is contaminated. If there is no help, a person will die, since the reverse development has no illness, it can only progress.

Also mandatory antibiotics for bacteremia - a condition in which in the blood and other human biological fluids are detected by a small number of microorganisms, or their individual forms. This is a stage that can always develop into sepsis, which in no case should be allowed.

Antibiotics are taken after surgery, organ transplants for prevention, as this is a condition in which the body is defenseless before any infection.

[1], [2], [3],

Release form

Antibiotics are released in various forms. For oral administration can be released in the form of tablets and capsules. Available antibiotics in the form of suspensions and solutions. For parenteral administration, antibiotics are released in the form of ampoules for injections, vials for intravenous infusions. There are antibiotics in the form of suppositories for rectal, less often intravaginal administration. Local preparations can be produced in the form of sprays, drops, ointments, etc.

Titles

There are many commercial names for antibiotics. Names are often changed by manufacturing firms. The main antibiotics commonly used in sepsis: oxacillin, amoxiclav, gentamicin, vancomycin, rifampicin, ciprofloxacin, amoxicillin, penicillin, levomycetin, flexine, tetracycline, doxycycline

[4], [5], [6]

Antibiotics for blood sepsis

With sepsis of blood, various antibiotics and their combinations can be used, depending on the pathogen that caused the disease. To begin with, it is expedient to carry out a bacteriological study, to determine the causative agent of the disease. After this, it is recommended to perform an antibiotic susceptibility test, determining which antibiotic will be most effective against the identified pathogen, and to select the optimal dosage. But in practice, often, with sepsis there is not so much time, because the disease very quickly progresses. The patient can die for even a few hours, if no action is taken.

Therefore, often with sepsis, antibiotics of a wide spectrum of action are prescribed. With severe sepsis, infusion therapy is performed. When moderately expressed - prescribe drugs intramuscularly and orally. Parenterally, those antibiotics that do not stand the acidic environment of gastric juice and are neutralized under its action are administered.

Among broad-spectrum antibiotics, the following groups of drugs are widely used for blood poisoning: penicillins, tetracyclines, amphinicols, cephalosporins, fluoroquinolones, aminoglycosides. When they are ineffective resort to carbapenems. The best of them are imipenem, meropenem. From the group of penicillin drugs, benzylpenicillin is prescribed, which is based on penicillin and is a first-line drug. Also from the penicillin series, ampicillin and amoxicillin are well established.

Often, with such a severe form of infection, as sepsis, one drug does not always cope. Therefore, there is a need for a complex of drugs. Basically, combined preparations in their composition contain several antibiotics and an auxiliary substance, which has a stabilizing effect, enhances their activity and duration of action, protects against digestion by gastric juice and other enzymes.

Most often used amoxicillin in combination with clavulanic acid. This is one of the most common combinations. A complex of amoxicillin and sulbactam, ampicillin and sulbactam is also used. In severe infections, ticarcillin and clavulanic acid, as well as piperacillin and tazobactam, are used.

[7], [8]

Antibiotics for treatment of sepsis caused by staphylococcus

When sepsis of staphylococcal etiology is prescribed primarily penicillin group drugs, as well as tetracyclines, cephalosporins, fluoroquinolones. Well-proven drugs such as oxacillin. In cases of severe infection and location of the focus of infection in hard-to-reach places, for example, inside the bone, gentamicin is prescribed. Often it is used in combination with oxacillin.

Staphylococcus occurs , which is resistant to the methicillin group. This is typical, for example, of intrahospital strains that persist in hospital departments, mainly in the operating and surgical departments, and have developed multiple resistance against many antibacterial drugs and antiseptics. In this case, Raffampin remains effective. But bacteria adapt very quickly to it, losing sensitivity. Therefore, it is often taken in conjunction with ciprofloxacin.

[9], [10], [11], [12]

Antibiotics for the treatment of sepsis caused by Pseudomonas aeruginosa

Pseudomonas aeruginosa shows a high level of resistance to many antibiotics, it is difficult to cure. They show resistance to tetracycline group drugs. Of this group, such drugs as tetracycline and doxycycline remain effective today.

Doxycycline is more active, but at the same time it has more pronounced side effects, causes numerous complications and negatively affects the state of normal human microflora. It has a high bioavailability and prolonged action.

[13], [14]

Antibiotics for the prevention of sepsis

With the prophylactic purpose after operations and transplantation prescribe mainly preparations of new generation, such as fluoroquinolones, aminoglycosides, carbapenems. They show high activity against many gram-negative, anaerobic forms of microorganisms that develop mainly in postoperative wounds, with limited access to oxygen.

Of fluoroquinolones, norfloxacin, ciprofloxacin, ofloxacin have proved to be well established. Quite often levofloxacin is used, the active ingredient of which is lomefloxacin. Analogues of the drug are left-handed, flexin, and other drugs, which include lomefloxacin.

Among aminoglycosides, there are drugs that have an antibacterial effect against both gram-positive and gram-negative forms.

Quite often, streptomycin is used from this group, which is used more often in the form of injections for sepsis. The advantage is given to intramuscular injection. Has a high degree of antibacterial activity.

Amikacin is a third generation drug. Applied also as injections. Most often, its use is resorted to ineffectiveness of other means, since it has a powerful effect.

Amphinicols are a group of drugs that contain various antibiotics. Most often, levomycetin is used in this group. When sepsis can be used in the form of injections, as well as in the form of ointments for various purulent, purulent-septic diseases.

Carbapenems are effective against many microorganisms, including those that exhibit multiple drug resistance. Most often used for the treatment and prevention of nosocomial infections. Of this group most often used drugs such as meronem, invenza, imipenem. The peculiarity of the drugs of this group is that they are administered exclusively intravenously.

[15], [16], [17]

Pharmacodynamics

Most of them have a bactericidal effect when the active substance is reached in the blood plasma in an amount exceeding the minimum threshold level - IPC. Once the concentration of the active substance drops below the permissible level, the bacteria begin to multiply again. Moreover, they acquire stability not only to this substance, but also to the whole group. Therefore, it is important to adhere to the prescribed dosage and not to stop treatment, even if the symptoms have already disappeared. Also, resistance appears if you take longer breaks between injections. Therefore it is important to observe a strictly defined form and mode of admission.

The maximum lysis of bacteria is observed when the concentration of the active substance in the plasma is exceeded by 4-5 times compared with the MIC. Further increase is ineffective. It was found that to achieve bacteriostatic action, at which the growth of microorganisms is suspended, it is necessary that the concentration of antibiotic in the blood exceed the MIC by 20%. To achieve bactericidal action, in which microorganisms die, the concentration of antibiotic should exceed MPC by 40%. For penicillins, this figure is 20-40%, whereas for carbapenems - 100%, which determines their high efficiency.

[18], [19], [20], [21], [22],

Pharmacokinetics

In patients with sepsis, pharmacokinetics is different from that in patients with a local infection. In particular, they have a sharp decrease in the amount of antibiotic in the blood. Accordingly, septic patients require the introduction of higher dosages of the drug. The data of numerous studies confirm that intravenous infusions are the most effective method of treating sepsis.

The bactericidal action of antibiotics is determined by its group affiliation. Thus, some of them can suppress the ability of microorganisms to reproduce, others inactivate the cellular enzyme, which is responsible for the overall biochemical state of the microorganism, as a result of which it dies. There are drugs that disrupt the integrity of the cell membrane, which also entails the death of the microorganism.

[23], [24], [25]

Dosing and administration

With sepsis, antibiotics are used in a variety of ways. The choice of one or another method depends on the severity of the disease, the degree of bacterial contamination, the sensitivity of microorganisms to the drug. Also, individual characteristics of a person, concomitant diseases are taken into account. Dosage is also determined by individual antibiotic sensitivity indicators. The general condition of the body.

Antibiotics of a wide spectrum are prescribed in large dosages. With sepsis, the parenteral route of administration is predominantly used, since most of the drug is inactivated through the gastrointestinal tract, accordingly, large dosages need to be administered, and this, in turn, causes complications and side effects.

With intravenous or intramuscular injection, the drug penetrates directly into the blood, unchanged, whereas when passing through the digestive tract of the body the drug undergoes changes. In addition, in order for the drug to be absorbed through the walls of the stomach and intestine into the blood, a certain time must pass. When injected into the blood, the drug begins to act immediately, which is especially important for sepsis.

Dosage is different for each drug. It is important to create a high concentration of the drug in the blood plasma, which will achieve the desired effect. For example, ampicillin is prescribed at a dosage of 50 mg / kg body weight. Oxacillin is prescribed 2 grams intravenously every 4 hours for severe sepsis of staphylococcal and pneumococcal etiology. Penicillins are administered intravenously for 20-40 million units for 2 weeks. Gentamicin is prescribed at 1 mg / kg every 8 hours.

With sepsis of Pseudomonas aeruginosa, cardenicillin is prescribed for 2-3 grams every 4 hours. Levomycetin - 1 gram every 6 hours intramuscularly, erythromycin - 0.5 grams every 4-6 hours. In the treatment of gram-negative microorganisms, ciprofloxacin is administered 750 mg three times a day.

[35], [36], [37]

Use of the antibiotics for sepsis during pregnancy

In general, during pregnancy, antibiotics are not recommended, but sepsis is an exception. Without treatment, sepsis ends with a fatal outcome, as there is an intensive suppression of the immune system and uncontrolled reproduction of bacterial microflora. It is important to choose the right antibiotic, in which the risks will be minimized, both for the mother and the child.

Contraindications

Antibiotics are used even in the presence of contraindications, because without them a person will inevitably die. The question is how to minimize the consequences of admission. Apply hepatoprotectors, which allow to protect the liver from destructive effects, probiotics and prebiotics, which restore the normal microflora. It is important to choose the right dosage, group and type of drug, the method of its administration, the frequency and duration of treatment, which will ensure maximum effectiveness with minimal complications and side effects.

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

Side effects of the antibiotics for sepsis

Antibiotics can have numerous side effects on virtually all organs and systems. But they need to be accepted, because the positive result exceeds possible risks. Without treatment, a person will die exactly, and the side effects can almost always be cured or prevented.

In general, side effects develop with long-term treatment or when taking highly effective drugs. The main complications are kidney and liver. It can develop severe intoxication, damage, inflammation, up to insufficiency. The stress is tested by the gastrointestinal tract, so it is best to administer the drug parenterally if possible.

Dangerous disorders of the immune system. Quite often, neutropenia develops, a violation of the number of leukocytes. Also, the load on the heart, blood vessels increases.

[31], [32], [33], [34]

Overdose

Overdosing leads to liver and kidney damage, up to the development of functional deficiency. Significantly increases the load on the heart, blood vessels. The composition of the blood, its function is disturbed. There is a risk of heart attacks, strokes. There is a violation of respiratory processes, digestion. There may be allergic reactions, intoxication.

[38], [39], [40], [41]

Interactions with other drugs

Antibiotics for sepsis can not be combined with medicines that contain ethyl alcohol in their composition. Take with caution in combination with hormonal agents. It is not recommended to take with antiviral drugs. To increase activity, many antibiotics are used in a complex way, combining several drugs from different groups. In this case, it is necessary to study well the properties of each and to know the mechanism of their interaction.

[42], [43], [44]

Storage conditions

The preparation is stored in the original packaging. The storage method is specified in the instructions, and is determined by the characteristics of the active substance and the form of release. In any case, they should be stored in a dark place, inaccessible to children and animals. At the same time, it is necessary to observe the optimum temperature and humidity.

[45], [46], [47], [48]

Shelf life

The expiration date depends on the type and form of the release. In general, unpacked products are suitable for use for 2-3 years. Unpacked tablets can be stored for up to several months. The opened ampoules are stored no more than 1-2 hours, the prepared suspensions - up to several days.

[49], [50], [51], [52], [53], [54],