How and when should antibiotics be used for pancreatitis?

Inflammation of the pancreas is not only unpleasant, but also quite dangerous, which, if left untreated or with inadequate therapy, can even take a person's life. As with any inflammation, there is a high risk of a bacterial infection in pancreatitis, which causes a severe course of the disease in every fifth patient. When a bacterial infection comes into play, it is almost impossible to stop the inflammation with NSAIDs, enzyme preparations and a gentle diet that relieves the pancreas. An organism weakened by the disease is unlikely to be able to fight such a strong, actively multiplying enemy on its own, which means special drugs are needed - antibiotics, which will provide an antimicrobial effect. But doctors prefer to use antibiotics with extreme caution in pancreatitis, because these are unsafe drugs that can cause additional problems.

Treatment of pancreatitis with antibiotics

Pancreatitis is a disease of alcohol lovers and admirers of dishes with a pronounced taste (spicy, salty, fried food, use of food additives and strong seasonings). Of course, this also includes overweight people, patients with chronic infectious pathologies, and those who are too fond of taking medications. But still, the first two groups of people are the main part of patients with pancreatitis, and more than 90% of patients with an acute form of the disease are alcoholics and people who abuse alcohol. Thus, we can say that our bad habits turn into serious diseases through our own fault.

An acute inflammatory process in the pancreas is always accompanied by a disruption of the organ's function. Therefore, the treatment of pancreatitis is primarily aimed at ensuring that the digestion process does not suffer. After all, the efficiency of digesting proteins, fats and carbohydrates directly depends on the pancreas performing its functions.

By overloading the diseased organ, i.e. by eating food that is difficult to digest and requires the production of more pancreatic juice, you can only worsen the situation (the same applies to alcohol, which stimulates the production of digestive juice). After all, inflammation is always associated with stagnation, and the production of aggressive enzymes will cause even greater irritation of the organ's mucous membranes. To prevent this, patients are prescribed enzyme preparations (Pancreatin, Mezim, Creon, Festal, etc.) and a low-calorie diet with limited fatty and carbohydrate-containing foods.

This is the basis on which the treatment of the pancreas is based. But it is not always possible to limit oneself to this part of the therapy. The acute form of the disease cannot do without constant severe pain syndrome, which doctors try to relieve with the help of antispasmodics (No-shpa, Drotaverin, Spazmil, Spazmolgon, etc.). If antispasmodics do not help, strong painkillers (Tempalgin, Ketanol, Ketanov, Ketoral, etc.) are included in the treatment regimen.

Unfortunately, even strong analgesics are not always able to help a person with acute pancreatitis, especially if the disease has caused complications. And complications in most cases are explained by the spread of inflammation to other organs and the addition of a bacterial infection. This is where antibiotics for pancreatitis will play a decisive role in saving the patient's life.

Is it really that scary? Yes, the danger exists and it is quite real. The inflammatory reaction is always accompanied by the release of exudate in significant quantities (it is this that can explain the swelling of the inflamed organs). And the exudate itself is considered a nutrient medium for bacteria, which, having got there, begin active reproduction, which is the meaning of their life.

Part of the exudate comes out on the surface of the inflamed organ (in our case, the pancreas) and gets on the nearby digestive organs and into the abdominal cavity. If even one microbe gets into the inflammatory fluid, after a while there will be so many of them that the inflammation will start in the abdominal cavity (peritonitis), and this is a pathology with a high mortality rate.

But sometimes, pancreatitis is initially caused by a bacterial infection. This happens quite often, and the cause of everything is in most cases cholecystitis and gallstone disease. Not only are the pancreas and gallbladder in close proximity to each other, which means that inflammation from one organ can easily spread to another. So these organs also have a common duct through which bile and pancreatic juice enter the duodenum.

Disruption of normal bile flow due to inflammation or cholelithiasis leads to stagnation in the gallbladder, requiring antibiotics and often surgical treatment. Together with bile, pathogenic bacteria can be thrown into the pancreas, causing inflammation of the organ. This explains the fact that pancreatitis quite often develops against the background of cholecystitis and vice versa.

And since the infectious factor in both cases is of the same type, the antibiotics prescribed for pancreatitis and cholecystitis are the same. Most often, these are protected penicillins, cephalosporins and macrolides, less often - tetracyclines and other types of antibiotics, mainly broad-spectrum.

In some cases, it is necessary to sequentially prescribe 2 or 3 types of antibacterial drugs if treatment with the first antibiotic is ineffective. The reason for such failure is most often antibiotic resistance of bacteria, which is becoming an increasing problem every year. Even microscopic organisms fight for survival through mutations and the development of new properties that help them lose sensitivity to antibiotics. And without knowing the enemy (bacteria) in person, it is difficult to say which antibacterial drug can cope with it.

The most logical thing would be to immediately conduct an analysis of the pathogen and its sensitivity to antibiotics. But the method of instantly determining the type of bacteria and its properties has not yet been developed, and the usual analysis requires quite a long time, which in an acute, serious situation is not so much. When it comes to a person's life, before receiving the results of laboratory tests, he is treated with broad-spectrum antibiotics, with which the chance of influencing the pathogen is greater than in the case of narrow-target drugs. In addition, there is often a complex effect of not one, but several types of inflammatory pathogens.

With chronic pancreatitis, everything is a little different. Usually, this inflammation is not of a bacterial nature, which means that it makes no sense to treat it with antibiotics. But chronic pancreatitis always occurs with relapses, the cause of which can be both the use of "forbidden" food and the activation of opportunistic microflora, which for the time being hides even inside a healthy organism.

A long-term illness is a blow to the immune system, so chronic pathologies always lead to a decrease in immunity. And these are exactly the conditions that opportunistic microorganisms need to begin active actions and become pathogenic, because the more bacteria, the more toxic products of their vital activity accumulate in the body, which provoke inflammatory processes and intoxication of the body.

Thus, antibiotics for chronic pancreatitis can also be prescribed if there is a suspicion of a bacterial nature of the exacerbation. For example, a person goes to the hospital with complaints of pain and heaviness in the pancreas, but at the same time he adhered to a diet without breakdowns, did not abuse alcohol, did not overeat, and led a healthy lifestyle. In this case, the cause of the exacerbation of pancreatitis can most likely be considered the activation of opportunistic bacteria or the penetration of pathogenic microbes into the organ.

Through the lymphatic system, a bacterial factor, localized even in one organ or its part, is capable of spreading throughout the body, and this is another fact that speaks in favor of antibiotic therapy for bacterial pancreatitis of any form.

After taking antibiotics, pain and inflammation subside literally within the next 2-3 days, but this does not mean that pancreatitis is cured. Getting rid of this disease is not so easy. In most cases, the acute phase is followed by a chronic phase, characterized by periods of remission and exacerbation. In any case, a severe blow to the pancreas, which is acute pancreatitis, does not pass without a trace, so after discharge from the hospital, doctors recommend following a diet and always having enzyme preparations with you.

Indications antibiotics for pancreatitis

As we have already understood, in case of pancreatitis, unlike cholecystitis, antibiotics are not first-line drugs. Rather, on the contrary, they are used when the situation gets out of control of the previously used drugs. It is not recommended to use them without special need, after all, we are talking about potent drugs with a lot of side effects.

The practice of prophylactic use of antibiotics for inflammatory pathologies of internal organs has sunk into oblivion. The location and functions of the pancreas are such that it is very problematic for infections to penetrate it from the outside, so in most cases, inflammation of the organ is provoked by the aggressive effect of its own enzymes, organ trauma, and excesses. Previously, it was thought that the use of antibiotics would reduce the percentage of deaths from pancreatitis, but long-term studies have confirmed that these antimicrobial drugs, despite their ability to quickly alleviate the condition of patients and prevent the spread of infection, do not affect the number of fatal outcomes in pancreatitis. After all, they themselves are capable of causing severe symptoms that appear during and after their use.

There must be a good reason for prescribing antibiotics. For example, severe pain in acute pancreatitis that does not go away after taking powerful painkillers. This fact alone indicates that the pain syndrome is not caused by simple inflammation, the process is supported by pathogenic bacteria that do not allow the patient's condition to be alleviated by traditional therapy used in cases of non-bacterial inflammation in the pancreas.

When first visiting a hospital or in case of exacerbation of chronic pancreatitis, the doctor must first identify the cause of the acute failure in the pancreas. In order to immediately suspect a bacterial infection, it is necessary to exclude any non-bacterial causes of the disease, including poor nutrition and injuries.

Symptoms such as persistent severe nausea (a symptom of intoxication of the body with bacterial secretions and decay products), an increase in temperature to critical values, and impaired respiratory function and kidney function may also indicate a complication of pancreatitis. This indicates that the pathology is becoming systemic, which means that a bacterial infection is involved.

Inflammation itself is unlikely to spread from one organ to another unless it receives support from the outside. Usually, the inflammatory process is localized in a small area of the organ, and in order for the process to spread further, it needs to be supported by someone. This is what bacteria do. As soon as symptoms appear indicating that the inflammation has spread to the gallbladder, duodenum, and other digestive organs, a competent doctor will suspect the influence of a bacterial infection and prescribe effective antibiotics. And here it does not matter in what form the disease proceeded.

So, let's sum it up. Antibiotics for pancreatitis in adults (in children, such a pathology is rare, and even then, in most cases, it does not come to the use of strong antibacterial drugs) are prescribed in the following cases:

• in acute pancreatitis,
• in case of exacerbation of chronic pancreatitis.

Antibiotics for acute pancreatitis are prescribed:

• if symptoms appear that indicate a bacterial contribution to the inflammation,
• if it is impossible to relieve pain with antispasmodics and strong analgesics,
• if the inflammation spreads to nearby (parapancreatitis) and other organs (duodenum, small intestine, abdominal cavity and organs inside it),
• in case of generalization of the process ( sepsis, abscesses),
• in case of rupture of the pancreatic duct,
• in the development of complications in the form of necrosis (death) of pancreatic tissue, cholangitis, the appearance of cystic formations in the organ area, etc.,
• if pancreatitis develops against the background of cholecystitis, for which antibiotic therapy is indicated,
• if the pathology is caused by dyskinesia of the bile ducts, as a result of which bile stagnation occurs with the formation of stones in it, blocking the ducts and provoking the reflux of bile and bacterial components into the pancreas.

Antibiotics for exacerbation of pancreatitis are prescribed in the same cases, as well as when a person has gone to the hospital due to a worsening condition, but cannot name a single non-bacterial cause.

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Release form

In case of pancreatitis, antibiotics are used both orally and by injection, which is facilitated by various forms of release of the drugs used. Doctors resort to injection when a person is in a serious condition and cannot take tablets and capsules orally. According to the prescription of a specialist doctor (gastroenterologist), injections are given to the patient intramuscularly or intravenously. Infusion administration of the drug (droppers) is also possible.

Different drugs may have different release forms. Thus, the popular protected penicillins "Amoxiclav" and "Augmentin" are produced by the pharmaceutical industry only in tablet form. The same can be said about the two-component drug "Ampiox". If you need intravenous administration of penicillin drugs, you can resort to the help of "Penicillin", "Ampicillin", "Timentin", "Tizacin" and other similar antibiotics, which are released in the form of ampoules or powder for the preparation of an injection solution.

Cephalosporins will also help in this regard, since many such drugs have a corresponding release form. For example, "Ceftriaxone" is sold as a powder, from which a medicinal solution is prepared for intramuscular administration, diluting it with lidocaine. For intravenous administration (injections and droppers), the powder is diluted with saline solution, injection solution and some other permitted compounds. The same release form is available for the drugs "Cefutaxim", "Gepacef" and many other cephalosporins.

Tetracycline (Tetracycline, Doxycycline) and fluoroquinolone (Ciprofloxacin) drugs can also be injected. The fluoroquinolone drug Abactal, which is often used for severe infections, is available in the form of tablets and an infusion solution. This is very convenient because intravenous administration of drugs is recommended only for a short period of time (2-3 days), after which you need to switch to tablets.

Popular macrolides are produced mainly in tablet form (tablets and capsules). But "Oleandomycin", as one of the representatives of macrolide antibiotics used for pancreatitis, is available both in tablet form and in vials with powder complete with distilled water. Then the solution is diluted with novocaine and intramuscular injections are made. If the drug is planned to be administered intravenously, a 5% glucose solution or saline solution is used for dilution.

The situation is identical with the favorite of many doctors - "Sumamed". This drug can be found on sale in various forms: tablets, capsules, powder from which a solution for oral use is prepared, concentrate for the preparation of an infusion solution.

Names of effective drugs

Today we are faced with a wide variety of effective antibacterial agents. But how can we understand that this particular drug will help with an infectious complication of pancreatitis? Especially in a situation where this pathology is not indicated in the instructions for use of the drug.

If you carefully read the annotations to many antibacterial drugs, you will notice that such an indication for use as pancreatitis, unlike cholecystitis, does not appear there, from which you can conclude that antibiotics should not be used at all for pancreatitis. In fact, this is not true. It is important to understand that antibiotics for inflammation of the pancreas are a secondary drug, the appropriateness of their use in many cases is questioned, so drug manufacturers do not consider it necessary to emphasize such use of an antimicrobial drug.

But sometimes you simply can't do without antibiotics. It would be incorrect to say that specific drugs somehow stand out among others in the treatment of pancreatitis. After all, it's not even about the name of the drug, but about which pathogens are sensitive to it. The same drug can help one patient and not improve the condition of another, if we are talking about a strain of bacteria that is not sensitive to the drug. Therefore, in each specific case, an individual approach to the selection of effective drugs is needed.

It is easier if a sensitivity test is performed, but this is not always possible. In most cases, you have to act by trial and error, based on knowledge of the most likely causative agents of pancreatitis.

Most often, bacterial pancreatitis and complications of non-bacterial inflammation are caused by: E. coli, Proteus, Clostridia, i.e. anaerobic representatives of pathogenic microflora that live in the intestines, but do not miss the opportunity to travel around the body. Treatment of such an infection is quite difficult, but it spreads inside the body very actively.

Inflammation can also be provoked or intensified by opportunistic microorganisms (streptococci, staphylococci, etc.), which usually occurs in chronic disease against the background of reduced immunity. But even in this case, without test results, the presence of other bacteria, such as the same anaerobes, cannot be ruled out.

All these points should be taken into account when selecting effective drugs. A broad-spectrum drug should cover the entire spectrum of possible inflammatory agents in the pancreas.

Many penicillins meet these requirements: "Penicillin", "Ampicillin", "Amoxicillin", "Benzylpenicillin sodium salt", etc. But the whole problem is that many bacteria have learned to synthesize a special enzyme, beta-lactamase, which negates the effect of the antibiotic. Therefore, doctors prefer later generations of penicillin drugs that are resistant to the enzyme due to an additional component (most often clavulanic acid), in particular the drugs: "Amoxiclav", "Augmentin", "Ampioks" and others.

Among the cephalosporin drugs, the following are very popular: "Cefalexin", "Ceftriaxone", "Cefutaxim", "Gepacef", etc. Despite the fact that these drugs also remain inactive against many strains of bacteria that produce enzymes that inactivate them, most of these drugs can be administered intramuscularly or intravenously, which gives a better and faster effect. In addition, cephalosporins are considered more effective in the case of severe infectious complications, which means that in acute complicated pancreatitis with a high mortality rate, these drugs will be more preferable.

Macrolides have a similar spectrum of action. According to experts, these drugs cause the least amount of side effects. In addition, they are active even against those bacteria that are “armed” against penicillins and cephalosporins.

The drugs "Erythromycin", "Azithromycin", "Oleandomycin", "Summamed" and other macrolides are prescribed for intolerance to penicillin and cephalosporin drugs, which is not a rare occurrence.

In case of exacerbation of chronic pancreatitis, which in most cases is caused by opportunistic microflora, doctors can prescribe tetracycline antibiotics. Most often, they resort to the help of the drug "Doxycycline", which is characterized by a pronounced bacteriostatic effect (it does not kill bacteria, but does not allow them to multiply) and is effective against most cocci, as well as E. coli, chlamydia, clostridia and other pathogenic microflora. Alas, Proteus and Pseudomonas aeruginosa remain resistant to this drug.

Some doctors, for mild infections, prefer to use new types of antibiotics, such as the drug Rifampicin, which will also prevent the infection from multiplying and, in large doses, will show a noticeable bactericidal effect against many cocci, E. coli, as well as some types of clostridia and Proteus.

In severe cases of purulent inflammation, doctors prescribe stronger drugs from the fluoroquinolone group. The most effective drug in terms of treating severe complications of acute pancreatitis is considered to be "Abactal", the active substance of which is pefloxacin (2nd generation fluoroquinolones). Pefloxacin has a pronounced bactericidal effect (inhibits the process of cell division and the synthesis of protein necessary for the construction of the bacterial membrane) and acts even on those bacteria that other antimicrobial agents cannot cope with.

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Description of commonly used antibiotics

So, the most beloved group of drugs by doctors is penicillins. And although these antibiotics have long since moved from the category of natural to semi-synthetic and synthetic, and their use in pancreatitis does not always bring the expected result, their effectiveness should not be underestimated.

We will not dwell on unprotected penicillins, because many strains of bacteria have already appeared that make these drugs ineffective. Let's consider a couple of popular drugs from the category of protected penicillins.

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Augmentin

Let's start with the drug "Augmentin" (analogue - "Amoxiclav"), which is a complex of amoxicillin (semi-synthetic penicillin) and clavulanic acid, which makes it effective against penicillase-forming strains of bacteria.

As for the pharmacokinetics of the drug, for tablets (and this is the only form of release of the drug), it very easily and quickly enters the blood from the gastrointestinal tract, reaching maximum concentration in various tissues in less than an hour. Almost as quickly, the antibiotic is excreted (the half-life is usually no more than 1.5 hours). The components of the drug and metabolites are excreted mainly by the kidneys. A relatively small part of the metabolites of clavulanic acid can be detected in feces.

The drug cannot be used in all cases. Like any penicillin, Augmentin can provoke intolerance reactions. If there is such a possibility, the drug is not prescribed.

There are other contraindications to the use of the drug. For example, infectious mononucleosis, most often caused by the Epstein-Barr virus, and lymphocytic leukemia. It is also not recommended to prescribe the drug to those patients who have had liver problems in the past while taking medications with identical components.

As we can see, the contraindications do not include a clause about the danger of the drug for expectant mothers. Manufacturers claim that the use of the drug during pregnancy is quite acceptable if the doctor finds it necessary. As for breastfeeding, it is better to be careful here, knowing about the ability of amoxicillin to easily penetrate into various physiological fluids.

Despite warnings about the large number of side effects of antibiotics, the drug "Augmentin" does not have so many. In addition, only 4-5 people out of 100 patients complain about them. Complaints of nausea and diarrhea prevail, which, by the way, can also be common symptoms of pancreatitis. Allergic reactions of varying severity are also possible. If measures are not taken to restore the microflora, then the development of thrush (vaginal candidiasis) is not excluded.

Method of administration and dosage. Manufacturers recommend taking Augmentin tablets in one of the following ways:

• dissolve in water (half a glass) and drink,
• chew and wash down with water in the same amount.

One tablet should be taken at a time. Tablets may have different dosages. The drug in a dosage of 325 mg should be taken every 8 hours. If the dosage is higher (625 mg), then the time interval between tablet intakes is increased to 12 hours (in severe cases, the interval remains the same).

For children, the medicine is produced in the form of a suspension, which is also useful for adult patients who have problems swallowing tablets.

If you take excessive doses of the drug or reduce the interval between doses, overdose symptoms may occur, which are limited to abdominal pain, diarrhea, vomiting, dizziness. Sleep disorders (insomnia, early awakening) may also occur. In mild cases, gastric lavage and sorbent intake help, in severe cases, hemodialysis is used.

When prescribing and taking medications, one should not forget about possible interactions with other drugs. Drugs that reduce blood viscosity, diuretics, NSAIDs, as well as drugs based on probenecid, disulfiram, allopurinol, phenylbutazone and methotrexate in combination with Augmentin can cause severe side effects.

During treatment with Augmentin, it is recommended to switch from oral to other methods of contraception.

Antacids, laxatives, and glucosamine will not have the best effect on the effectiveness of Augmentin therapy. As for antibiotics, sulfanilamide drugs and antibacterial agents with bacteriostatic action are at risk for reducing the effectiveness of treatment.

The medicine is stored at room temperature for no more than 2 years from the date of manufacture.

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Ampiox

"Ampiox" is also a two-component antimicrobial agent, both components of which are bactericidal penicillins. Ampicillin is not resistant to beta-lactamase, but the second component of the drug - oxacillin - is able to cope even with penicillin-resistant strains, which expands the spectrum of action of the drug.

Pharmacokinetics. The drug is excreted mainly in urine. A small amount of it can be found in bile, and then in feces. It is not able to accumulate in the body, which gives the right to consider it relatively safe for long-term use.

Contraindications to the use of the drug are no different from those of "Augmentin", "Amoxicillin" and many other penicillin antibiotics that can be taken for bacterial pancreatitis. During pregnancy, it is permissible to prescribe the drug in the usual dosage as prescribed by the doctor.

As for side effects, in addition to allergic reactions of varying severity, other symptoms are possible: fever, joint pain (arthralgia), increased eosinophil levels in the blood. Less frequently, patients complain of nausea and vomiting, deterioration of taste perception, diarrhea, development of dysbacteriosis or thrush.

Method of administration and dosage. Take the drug in capsule form orally, between meals, with a glass of water.

One dose is prescribed from 500 to 1000 mg of the drug (2 - 4 capsules). The frequency of administration is usually 4 or 6 times a day. Treatment can last from 5 days to 2 weeks.

The pediatric dose (0 to 14 years) is calculated based on the child's body mass.

Now a little about drug interactions with other drugs. Using the drug simultaneously with other drugs that have a bactericidal effect, you can achieve an increase in the specific effect (synergism), but bacteriostatic antibiotics, on the contrary, will weaken the effect of Ampiox (antagonism).

Food, drugs to reduce stomach acidity, anti-constipation agents, sorbents, glucosamine should be taken at intervals of 2 hours before or after taking Apioks, because they inhibit the absorption of the drug, which cannot be said about ascorbic acid, which has the opposite effect.

Other interactions are identical to Augmentin.

The storage conditions of the drug are the same for penicillin tablets. This is a temperature of no more than 25 degrees and preferably protection from the sun. Keep out of reach of children. The shelf life of the tablets is also 2 years.

The pharmacodynamics of cephalosporins is similar to the mechanism of action of penicillins - stopping the production of protein by the cell. The absence of protein in the membrane of a young bacterial cell formed during division leads to its death, which is what causes the bactericidal effect. At the same time, cephalosporins do not require the introduction of additional components to combat penicillin-resistant strains of bacteria.

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Cefotaxime

Let us consider the use of cephalosporin drugs for pancreatitis using the example of a 3rd generation antibiotic called Cefotaxime.

Pharmacokinetics. The active substance of the drug is not able to be effectively absorbed in the gastrointestinal tract, so the medicine is produced in the form of a powder for parenteral administration (injections and droppers). With intramuscular administration, the maximum concentration of the drug in the blood can be seen after 30 minutes. With intravenous administration, everything depends on the dose administered. The half-life is usually no more than one and a half hours. The antibacterial effect lasts up to half a day.

When administered parenterally, it easily penetrates into most physiological tissues and fluids. The kidneys excrete the drug, but some of the metabolites can also be found in the feces, where they enter with bile.

Due to their high toxicity and penetrating properties, doctors do not seek to prescribe cephalosporin drugs during pregnancy. Breastfeeding is stopped during treatment with the drug.

Intramuscular injections are not allowed for children under 2 years of age, as well as for patients with hypersensitivity to lidocaine, for whom the powder is diluted. The main contraindication for use remains hypersensitivity to cephalosporins and penicillins.

Caution should be exercised with the drug in cases of severe kidney damage and the development of enterocolitis.

The drug can have multiple side effects, and the appearance of phlebitis at the site of intravenous injection is not the worst thing. Patients may complain of headaches and dizziness, heart rhythm disturbances (arrhythmia), various unpleasant symptoms from the gastrointestinal tract, including intestinal dysbacteriosis, problems with the kidneys and liver, allergic reactions of varying severity.

Method of administration and dosage. A single dose of the drug is contained in one bottle with powder, which is diluted depending on the needs with lidocaine, saline or water for injection. The drug should be administered every 12 hours.

In severe infections, the dose may be doubled and the interval between administrations reduced to 6 hours.

Do not exceed the recommended dose, as overdose can lead to the development of encephalopathy, even if it is reversible.

Interaction with other drugs. It is prohibited to mix 2 different antibiotics in one syringe or infusion bottle.

Caution should be exercised when taking Cefutaxime and aminoglycosides simultaneously. This may adversely affect the kidneys. Increased toxicity of cephalosporins is also observed during diuretic therapy.

The medicine is stored at room temperature. It is advisable not to remove the vials from their original packaging unless necessary. The shelf life of hermetically sealed vials is 2 years. The solution prepared for injections or infusions can be used within 6 hours. If placed in a cold place with a temperature of 2 to 8 degrees, the shelf life is extended to 12 hours.

Macrolides for pancreatitis, although considered an effective replacement for penicillins, still have a different mechanism of action. These are representatives of bacteriostatic antibiotics that inhibit the synthesis of protein and nucleic acids in bacterial cells, which contain genetic information that stores the properties of the cell. In this case, bacteria do not die, but stop dividing, i.e. become inactive. The use of such drugs will bring little benefit if a person has low immunity, as in many cases of chronic infections, because inactive bacteria can regain their former activity after a while if the body does not fight them.

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Sumamed

The most beloved and frequently prescribed drug for various pathologies is considered to be "Sumamed" with the active substance azithromycin.

Pharmacokinetics. The drug does not reach its maximum concentration in the blood as quickly as previously described. The highest values can be seen 2 or even 3 hours after taking the drug. At the same time, the content of azithromycin in tissues will be higher than in various liquid media.

The drug is excreted through the intestines and partly by the kidneys.

Macrolides are considered the least toxic antibiotics, so they are often prescribed even during pregnancy. The concentration of azithromycin in breast milk is considered insignificant, but if there is an opportunity to switch to artificial feeding, it is better to be on the safe side.

Contraindications to the use of the drug include: hypersensitivity to macrolides, severe renal and hepatic impairment.

Side effects during antibiotic use are considered to be a very rare phenomenon. No more than 1 person out of 100 may complain of dyspepsia, constipation or diarrhea, loss of appetite, stomach pain, heart and headaches, and sleep deterioration. Rare cases of kidney problems or candidiasis (the latter is more typical for bactericidal drugs) are also reported.

Method of administration and dosage. Any forms for oral administration are recommended to be taken only once a day. Tablets and capsules are swallowed whole. It is better to take the medicine an hour and a half before meals.

Depending on the severity of the patient's condition, he is prescribed a dose of 0.5-1 g for a course of 3 to 5 days.

The solution for intravenous infusions is prepared in 2 stages. The concentrate is successively mixed with the injection solution, and then with a solution of sodium chloride or another approved composition. Droppers are placed in a hospital setting for slow administration (at least 3 hours).

In case of overdose of the drug, side effects may occur, requiring symptomatic treatment.

Interaction with other drugs. Ergot preparations may cause severe intoxication when used concomitantly with azithromycin.

It is not recommended to take Sumamed together with lincosamides and antacids, which reduce its effectiveness. But taking it simultaneously with tetracyclines and chloramphenicol preparations will give an enhanced bacteriostatic effect.

Indirect anticoagulants make azithromycin more toxic. You should not take macrolides based on it in combination with warfarin, heparin, felodipine, ergotamine, methylprednisolone and cycloseryl.

The storage conditions of the drug are not unique. The medicine is stored at room temperature away from children. Capsules and tablets should be used within 3 years, other forms of the drug are stored for no more than 2 years. The finished suspension should be used within 5 days, after which it will become unusable.

Oleandomycin

Another popular macrolide antibiotic for pancreatitis is called "Oleandomycin", which is similar to the active substance of the drug. This is a low-toxic drug that does not accumulate in the body with prolonged use, has good absorption and a wide range of action. It is successfully used for cholecystitis and pancreatitis.

The drug should not be prescribed in 2 cases: in case of hypersensitivity to the drug composition and macrolides in general and in case of severe liver cell damage. During pregnancy, the drug is prescribed taking into account the possible danger to the fetus. Breastfeeding is recommended to be interrupted during treatment with any antibiotics, even the safest ones.

The drug has very few side effects and they rarely manifest themselves in the form of allergic reactions.

Method of administration and dosage. The oral form is taken after meals. The minimum daily dose for adults is 1 g, the maximum is 2 g. The daily dose is recommended to be taken in 4-6 doses. The therapeutic course can last from 5 days to 1 week.

The drug is administered intravenously and intramuscularly in the same dosage, after mixing the powder with a solution of novocaine (for intramuscular injections) or saline (intravenous administration). In the latter case, it is permissible to use a five percent glucose solution instead of saline.

An overdose of the drug is generally not dangerous, but it can negatively affect the functioning of the liver and cause allergic reactions.

Interaction with other drugs. It is not recommended to prescribe a bacteriostatic antibiotic in combination with bactericidal ones, with the exception of aminoglycosides.

The drug is well combined with chloramphenicol, tetracycline antibiotics, nitrofurans. A combination with antifungal agents based on levorin and nystatin, bacteriostatic sulfonamides is possible.

The storage conditions for the medicine are simple. It is enough to store any form of the drug at a temperature of no more than 20 degrees in a dark place protected from moisture.

The shelf life of the medicine is 3 years.

Doxycycline

Tetracyclines are also classified as drugs with bacteriostatic action. A prominent representative of this group of drugs is "Doxycycline", which can be found in pharmacies in the form of capsules for oral administration and infusion solution in ampoules.

Pharmacokinetics. A useful feature of the drug is its easy and rapid absorption in the gastrointestinal tract when taken orally and slow excretion from the body, due to which the bacteriostatic effect of the drug lasts for almost a day. Even food intake cannot prevent doxycycline from doing its job. It penetrates into various environments, including bile, which makes it effective not only for pancreatitis, but also for cholecystitis. It is excreted mainly through the intestines. Slightly less unchanged doxycycline is found in the urine.

The drug has its own contraindications for use. These include: porphyria, severe kidney disease and impaired functionality, leukopenia. The antibiotic is not used in case of hypersensitivity to tetracyclines. It is not prescribed to children under 8 years of age.

The use of tetracyclines during pregnancy is dangerous for the development of the fetus, as they negatively affect the condition of the baby's teeth and bones, and can also cause fatty liver disease. For the same reason, you should not breastfeed during treatment with tetracyclines.

Side effects of the drug include the development of anemia, porphyria, blood clotting disorders, various types of allergic reactions, rashes and itching of the skin, migraines, blurred vision, drowsiness. Patients may complain of tinnitus, hot flashes, nausea, abdominal pain, liver dysfunction, joint and muscle pain, and the development of superinfection. These and other symptoms may appear with varying frequency, but rarely exceed the 5% threshold.

Method of administration and dosage. For acute infections, the antibiotic is prescribed at a dosage of 100 mg per dose. On the first day, you need to take 2 single doses at an interval of 12 hours, in the following days, limit yourself to 1 dose.

In severe cases, the daily dosage of 200 mg is maintained throughout the entire therapeutic course (7-14 days, depending on the severity of the patient's condition).

The solution in ampoules is intended for intravenous infusions using a system. It is first diluted in 10 ml of water for injection, and then the composition is mixed with 1 liter of saline. Infusion time is from 1 to 2 hours. The procedure should be repeated every 12 hours.

Cases of acute overdose of the drug are very rare, but they are dangerous not only because of the increased side effects, but also because of the negative impact on the pancreas and kidneys, as well as temporary hearing loss. After gastric lavage, you can take an antidote - calcium salts.

Interaction with other drugs. Food does not affect the absorption of the drug in the gastrointestinal tract, which cannot be said about drugs that reduce stomach acidity. They should be taken no later than 4 hours before using Doxycycline.

Doxycycline enhances the effect of curare-like drugs and indirect anticoagulants.

The drug should not be taken in combination with bactericidal antibiotics. Alcohol and vitamin A intake are not allowed.

Doxycycline increases the toxic effect of cyclosporine and methotrexate. Theophylline can provoke a negative effect of doxycycline on the pancreas and other organs of the digestive system.

It is recommended to store the drug under normal conditions. In this case, the shelf life of the drug will be 3 years.

As we can see, tetracycline for pancreatitis should be taken with special caution, as well as fluoroquinolones, which are considered to be some of the strongest and quite toxic drugs with a pronounced bactericidal effect.

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Abactam

The drug "Abactam", most often used for severe infections of the gallbladder and pancreas, is famous for its wide spectrum of antibacterial activity. It is ineffective only against gram-positive bacteria, which are in a dormant state, not posing much danger. The broad spectrum of action of the drug allows it to cover all possible pathogens of bacterial pancreatitis and cholecystitis. But doctors are in no hurry to use this drug everywhere due to its high toxicity. It is another matter if a person's life is in great danger and such a strong remedy is needed.

The active substance of the drug, pefloxacin, belongs to the second generation of fluoroquinolones, which have a strong bactericidal effect.

Pharmacokinetics. Even when taken orally, the antibiotic shows good absorption and almost 100% bioavailability. The maximum concentration in the blood is observed after 1.5 hours after taking the drug. In many body fluids, including bile, its concentration exceeds that in blood plasma. It is excreted through the intestines and kidneys.

The drug has many restrictions on use. It is not prescribed to children and pregnant women (impairs cartilage development). During treatment with Abactal, breastfeeding is prohibited. It is prohibited to prescribe the drug to patients with hypersensitivity to fluoroquinolones, as well as to people who have experienced tendon damage while taking drugs of this group.

Caution should also be exercised in prescribing to patients diagnosed with organic CNS lesions or severe liver and kidney dysfunction.

Here are the most common side effects of the drug (from 1 to 10%): severe sleep disturbances, headaches and dizziness, stomach pain, nausea and vomiting, diarrhea, skin rashes, increased photosensitivity, muscle and joint pain (myalgia and arthralgia).

Method of administration and dosage. It is recommended to take the drug in tablet form during or after meals to reduce the irritating effect on the stomach.

The usual dose of the drug for severe complications of pancreatitis and cholecystitis is 800 mg. The daily dose is recommended to be divided into 2 doses.

In particularly severe cases and in case of liver dysfunction, the drug is prescribed as a solution, which is used for IV drips in a hospital setting. One ampoule of the drug contains 400 mg of pefloxacin. It is diluted in 250 ml of 5% glucose solution and administered as a 1-hour infusion.

The initial single dose can be doubled. Then the patient is given 400 mg of pefloxacin at 12-hour intervals. The patient should not be given more than 1.2 g per day.

Patients with impaired liver or kidney function, as well as the elderly, may require dosage adjustment.

If possible, switch from intravenous administration of the drug to oral administration of tablets.

An overdose of the drug can occur if high doses of the drug are used. It manifests itself in the form of nausea, confusion, fainting and convulsions. A person can be helped by urgently washing the stomach and giving enterosorbents. Then symptomatic therapy is carried out.

Interaction with other drugs. It is unacceptable to prescribe pefloxacin drugs in combination with tetracyclines and chloramphenicol, which will reduce the antibacterial effect of the fluoroquinolone, as well as with steroid drugs.

Antacids and pefloxacin should be taken at least 3 hours apart.

Pefloxacin can increase the blood levels of drugs based on cyclosporine, theophylline and NSAIDs.

In some cases, pefloxacin helps reduce the toxic effects of aminoglycoside antibiotics on the kidneys and hearing organs.

The infusion concentrate must not be mixed with solutions containing chloride ions, such as saline.

In order for the drug to retain its bactericidal properties throughout its shelf life, which is 3 years, the following storage conditions must be observed: store tablets and ampoules at a temperature of 15-25 degrees, protecting them from sunlight and damage.

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Pharmacodynamics

The pharmacodynamics of the drugs in this series are generally similar. The drugs show good bactericidal action, since they destroy the membrane of the bacterial cell and prevent the synthesis of protein for its construction. The drugs help in most cases of exacerbation of chronic pancreatitis, as well as in primary complicated acute pathology.

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Antibiotics for pancreatitis are not used as often as it might seem at first glance. After all, severe inflammation of the pancreas is observed only in 20% of cases. And even then, not in all cases, they resort to the help of potent drugs that negatively affect the beneficial microflora of the body (they do not have such a selective action as bacteriophages). But if antibiotics helped save the life of even one patient with complicated pancreatitis, they should already be considered useful for this disease.

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