Treatment of an abscess with antibiotics

Whatever the name of the inflammation accompanied by necrosis and tissue melting - abscess, abscess or abscess - the inflammatory process and suppuration in 99% of cases are caused by a bacterial infection, which can be dealt with by antibiotics for abscesses.

Indications antibiotics for an abscess

Inflammation in the form of an abscess - a cavity limited by a pyogenic membrane containing purulent exudate - is the result of the body's local defense reaction: tissue macrophages and leukocyte neutrophils rush to the site of infection and absorb bacteria, but in doing so they die and, together with dead cells, form pus.

The main cause of the formation of such foci of inflammation are considered to be gram-positive facultative anaerobic bacteria of the genus Staphylococcus spp., primarily Staphylococcus aureus. However, very often several types of bacteria are involved in the formation of a pyogenic abscess - gram-positive and gram-positive, aerobic and anaerobic.

And antibiotics for purulent abscesses are used when the following are detected in the purulent contents: Staphylococcus epidermidis, Streptococcus pyogenes, Streptococcus pneumoniae, Pseudomonas aeruginosa (Pseudomonas aeruginosa), Escherichia coli (Escherichia coli), Klebsiella pneumoniae, Proteus mirabilis.

Indications for the use of antibacterial agents for abscesses of the throat, peripharyngeal space and lung, as well as odontogenic suppurations are also due to the most likely presence of such anaerobic bacteria and bacteroids as Peptostreptococcus spp., Clostridium perfringens, Clostridium septicume, Prevotella melaninogenica, Bacteroides fragilis and Bacteroides oralis.

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Release form

Cefotaxime and Cefoperazone are available in powder form (in vials) for the preparation of a solution used for parenteral administration.

Clindamycin is available in the following forms: capsules (75, 150 and 300 mg), 15% phosphate solution (in ampoules of 2, 4 and 6 ml); granules (in vials) – for the preparation of syrup for children.

Josamycin - tablets and suspension, Doxycycline - capsules.

Amoxiclav: tablets (250 and 500 mg), powder for preparation of oral suspension and powder for preparation of injection solution.

Treatment of abscess with antibiotics: names of drugs

The correlation between the prescribed drug and the localization of the purulent focus is minimal, but the determination of a specific pathogen is of decisive importance. Antibiotics for lung abscess should be prescribed taking into account that Staphylococcus aureus plays the main role in the development of abscessing pneumonia, so third-generation cyclosporine antibiotics and lincosamides will fight it most effectively.

In addition to these, antibiotics for soft tissue abscesses may include drugs from the macrolide group.

Antibiotics are not used for a buttock abscess when inflammation occurs at the injection site and there is no bacterial infection, i.e. the abscess is aseptic (and is treated with corticosteroids). But in other cases, after opening the abscess and draining it, antibiotics are used, usually penicillin derivatives.

Medicines for the etiological treatment of paratonsillar abscess, i.e. antibiotics for throat abscess, should be active against Staphylococcus aureus, Streptococcus pyogenes, Klebsiella spp., Proteus spp., Escherichia coli. These can be either broad-spectrum penicillin antibiotics or macrolides. But tetracycline antibiotics and aminoglycosides are unlikely to help with abscesses in the throat.

Antibacterial therapy of retropharyngeal abscess, i.e. treatment of retropharyngeal abscess with antibiotics, is carried out taking into account the infection typical for this disease: staphylococci, peptostreptococci and bacteroids. And in this case, the maximum effect will be from cephalosporins and a combination of penicillins with clavulanic acid.

Pseudomonas aeruginosa and anaerobes are usually involved in the development of odontogenic abscesses (periodontal or periapical). Therefore, when prescribing antibiotics for a dental abscess, doctors should keep in mind that aminoglycosides do not act on anaerobic bacteria, and P. aeruginosa exhibits resistance not only to aminoglycosides, but also to penicillin beta-lactams.

This review presents the names of antibacterial drugs that are most often used in the treatment of abscesses:

• third generation cephalosporin antibiotics Cefotaxime, Cefoperazone (Cerazon, Cefobocid, Medocef, Ceperone and other trade names);
• antibiotics of the lincosamide group Clindamycin (Clindacin, Klinimicin, Cleocin, Dalacin), Lincomycin;
• macrolide Josamycin (Vilprafen);
• broad-spectrum tetracycline antibiotic Doxycycline (Vibramycin, Doxacin, Doxylin, Novacycline, Medomycin);
• Amoxiclav (Amoxil, Augmentin, Co-amoxiclav, Clavamox) from the group of penicillin beta-lactams.

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Pharmacodynamics

All cephalosporins, including Cefotaxime and Cefoperazone, destroy microorganisms by blocking bacterial enzymes necessary for the production of carbohydrate components of their cell walls – mucopeptides (peptidoglycans). Thus, bacterial cells are deprived of external protection and die. The pharmacodynamics of Amoxiclav, protected from bacterial beta-lactamases by clavulanic acid, is similar.

The action of lincosamides (Clindamycin), macrolides (Josamycin), and tetracyclines (Doxycycline and other improved drugs of this group) is based on their ability to bind to RNA molecules (cytoplasmic ribosomes) on bacterial membranes – to nucleotide subunits 30S, 50S or 70S. As a result, protein biosynthesis in bacterial cells slows down and almost completely stops. In the first case, the drugs act as bacteriostatics, in the second – bactericidal.

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Pharmacokinetics

After intramuscular or intravenous administration, Cefotaxime and Cefoperazone enter the systemic bloodstream, reaching maximum concentrations in half an hour and five minutes, respectively (and persist for 12 hours after a single administration); binding to plasma proteins does not exceed 40%. Cephalosporins are excreted from the body by the kidneys and intestines with a T1/2 of 60-90 minutes.

The bioavailability of Clindamycin reaches 90%, and the drug penetrates into all tissues and fluids of the body, and its highest level in the blood is observed on average two hours after parenteral administration and a maximum of one hour after oral administration.

The drug is metabolized in the liver; elimination is through the intestines and kidneys; the half-life is two to three hours.

The pharmacokinetics of Josamycin are characterized by rapid absorption in the stomach, high penetration and accumulation in soft tissues, skin and subcutaneous tissue, tonsils and lungs; the maximum concentration is noted on average 1.5 hours after taking tablets or suspension. At the same time, no more than 15% of the active substance of the drug binds to plasma proteins. Josamycin is broken down by liver enzymes and eliminated with feces and urine.

The antibiotic Doxycycline is also rapidly absorbed, 90% of which is bound to plasma proteins; the concentration of the drug is maximum two hours after oral administration. Elimination through the intestines, T1/2 can be 15-25 hours

Amoxiclav, consisting of amoxicillin and clavulanic acid, reaches its maximum blood level in an hour – with any method of administration; amoxicillin binding to blood proteins is up to 20%, clavulanic acid – up to 30%. The drug penetrates and accumulates in the maxillary sinus, middle ear, lungs, pleura and tissues of the internal genital organs. Clavulanic acid is metabolized in the liver, and its breakdown products are excreted by the kidneys, intestines and lungs. Almost 70% of amoxicillin is excreted by the kidneys in an undigested form.

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Dosing and administration

Cefotaxime and Cefoperazone are administered parenterally - intramuscularly or intravenously, 1-2 g every 12 hours. Clindamycin solution is administered intravenously - from 1.2 to 2.7 g during the day; capsules are taken orally - 150-300 mg every 6 hours for 6-7 days.

Adults are prescribed Josamycin 1 g three times a day (before meals), the course of treatment is 10 days; children under 14 years of age take the suspension in a daily dosage of 30-50 ml per kilogram of body weight (divided into three doses).

The optimal dose of Doxycycline is one capsule (100 mg) twice a day; for children over 8 years of age (depending on the severity of the condition) - 2-4 mg of the drug per kilogram of weight. The duration of treatment is at least 10 days.

Amoxiclav for intravenous use is administered by infusion - 1.2 g every 8 hours for 4-5 days; for children under 12 years old - 30 mg per kilogram of body weight. Then switch to the tablet form of the drug.

If only tablets are used, they are recommended to be taken during meals: one tablet three times a day (preferably every 8 hours). Children under 6 years of age are better off taking Amoxiclav in suspension form - 15 mg per kilogram of weight, the dose for infants is 10 mg / kg, taken three times a day. The maximum permissible daily dose in pediatrics is 45 mg / kg.

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Use antibiotics for an abscess during pregnancy

Cefotaxime and Cefoperazone, as well as Josamycin - as antibiotics for abscess during pregnancy - are allowed to be used only if there are strict indications.

Clindamycin is not used in the treatment of pregnant women.

Josamycin is permitted for use during pregnancy and breastfeeding after assessing the risk-benefit ratio of treatment.

There is no data regarding the teratogenic effects of Doxycycline and Amoxiclav, but the use of Doxycillin is prohibited in late pregnancy.

Contraindications

According to official instructions, contraindications to the use of Cefotaxime, Cefoperazone and Clindamycin, in addition to individual hypersensitivity to the drugs, include intestinal inflammation, bleeding, severe liver and kidney failure.

Josamycin is also contraindicated in the presence of kidney and liver problems.

The list of contraindications for Doxycycline includes liver failure, elevated white blood cell count, porphyria, and age under 9 years.

Amoxiclav is not prescribed for hepatitis, jaundice due to gallstones, phenylketonuria, and infectious mononucleosis.

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Side effects antibiotics for an abscess

Side effects of Cefotaxime or Cefoperazone include: nausea, vomiting, intestinal upset and abdominal pain; allergic reaction (urticaria and itchy skin); agranulocytosis, decreased white blood cells and platelets in the blood; pain and inflammation of the vein walls at the injection site.

In addition to the listed side effects, oral administration of Clindamycin can cause temporary disruption of neuromuscular transmission, and intravenous administration of this antibiotic can cause a metallic taste in the mouth, a sharp drop in blood pressure, and disruption of the heart (up to and including cardiac arrest).

Allergic reactions, temporary hearing loss, headache, loss of appetite, heartburn, nausea and diarrhea can be caused by the use of Josamycin.

Doxycycline, like most antibiotics, disrupts the intestinal microflora, and its peculiarity, which manifests itself in cases of long-term use, is an increase in the sensitivity of the skin to ultraviolet light and a persistent change in the color of tooth enamel.

Among the most common side effects of Amoxiclav are skin rash and hyperemia; nausea and diarrhea; leukopenia and hemolytic anemia; insomnia and muscle cramps; liver dysfunction (with increased levels of bile enzymes).

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Overdose

In cases of overdose of Cefotaxime and Cefoperazone, increased side effects of the drugs may be observed. Exceeding the dose of Clindamycin, Josamycin and Doxycycline increases the intensity of side effects from the gastrointestinal tract.

And with an overdose of Amoxiclav, there may be dizziness, insomnia, increased nervous excitement with convulsions. In severe cases, hemodialysis is recommended.

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Interactions with other drugs

When treating with Cefotaxime or Cefoperazone, the concomitant use of aminoglycoside antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), Furosemide and anticoagulants should be avoided.

Incompatibility of Clindamycin with the following drugs has been identified: erythromycin, ampicillin, opioid analgesics, B vitamins, barbiturates, calcium gluconate and magnesium sulfate.

Josamycin is not prescribed together with other antibiotics, theophylline, antihistamines. In addition, Josamycin reduces the effectiveness of hormonal contraceptives.

The simultaneous use of Doxycycline with antacids, indirect anticoagulants, iron preparations and alcohol-containing tinctures is not permitted.

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Storage conditions

All preparations listed in the review are recommended to be stored in a dry place, protected from light, at t< +25°C.

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Shelf life

According to the instructions, the shelf life of Cefotaxime and Cefoperazone is 24 months; Clindamycin, Amoxiclav, Doxycycline - 3 years; Josamycin - 4 years.

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