Treatment of abscess with antibiotics

Whatever inflammation accompanied by necrosis and melting of tissues - abscess, abscess or abscess - is called inflammatory process and suppuration in 99% of cases are caused by a bacterial infection, which antibiotics with abscess help to cope with.

Indications of the antibiotics for abscess

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

The main cause of the formation of such foci of inflammation are gram-positive facultative anaerobic bacteria of the genus Staphylococcus spp., Primarily Staphylococcus aureus (Staphylococcus aureus). However, very often several species of bacteria are involved in the formation of the pyogenic abscess - Gram-positive and Gram-positive, aerobic and anaerobic.

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

Indications for the use of antibacterial agents for throat abscesses, near- pharyngeal space and lung, as well as odontogenic suppuration are also caused by the most probable presence of anaerobic bacteria and bacteroids, such as Peptostreptococcus spp., Clostridium perfringens, Clostridium septicume, Prevotella melaninogenica, Bacteroides fragilis and Bacteroides oralis.

[1], [2], [3], [4], [5], [6], [7], [8]

Release form

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

Form release Clindamycin: capsules (75, 150 and 300 mg), 15% solution of phosphate (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 the preparation of a suspension for oral administration and powder for the preparation of an injection solution.

Treatment of abscess with antibiotics: names of drugs

Correlation of the prescribed drug and localization of the purulent focus is minimal, but the definition of a particular pathogen is crucial. Antibiotics for lung abscess should be prescribed taking into account the fact that Staphylococcus aureus plays the main role in the development of abscessed pneumonia, therefore the third generation cyclosporin antibiotics and lincosamides will be most effective against it.

In addition, antibiotics for soft tissue abscesses may include preparations of the macrolide group.

Antibiotics in the abscess of the buttocks are not used when the inflammation occurred at the injection site and there is no bacterial infection, that is, the abscess is aseptic (and treated with corticosteroids). But in other cases, after the opening of the abscess and its drainage, antibiotics, usually penicillin derivatives, are used.

Preparations 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. It can be both penicillin antibiotics with an extended spectrum of effects, and macrolides. But antibiotics of the tetracycline group and aminoglycosides with ulcers in the throat are unlikely to help.

Antibacterial therapy of retrofaringueal abscess, that is, treatment of an abscess with antibiotics is performed taking into account the infection typical for this disease: staphylococci, peptostreptococcus and bacteroides. And in this case the maximum effect will be on cephalosporins and a combination of penicillins with clavulanic acid.

To the development of odontogenic abscesses (periodontal or periapical), as a rule, Pseudomonas aeruginosa (Pseudomonas aeruginosa) and anaerobes are involved. Therefore, when prescribing antibiotics for tooth abscess, doctors should keep in mind that aminoglycosides do not work for anaerobic bacteria, and P. Aeruginosa shows resistance not only to aminoglycosides, but also to penicillin beta-lactams.

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

• cephalosporin antibiotics of the third generation Cefotaxime, Cefoperazone (Cerazon, Cefobocid, Medotsef, Zeperon and other trade names);
• antibiotics of the group of lincosamides Clindamycin (Clindacin, Klinimycin, Cleocin, Dalacin), Lincomycin;
• macrolide Jozamycin (Wilprafen);
• tetracycline broad-spectrum antibiotic Doxycycline (Vibramycin, Doxacin, Doxilin, Novacyclin, Medomycin);
• Amoxiclav (Amoxil, Augmentin, Co-amoxiclav, Clavamox) from the group of penicillin beta-lactams.

[9], [10], [11], [12], [13], [14]

Pharmacodynamics

All cephalosporins, including Cefotaxime and Cefoperazone, kill microorganisms, blocking the bacterial enzymes necessary for the development of carbohydrate components of the walls of their cells - mukopeptides (peptidoglycans). Thus, the cells of bacteria lose their outer protection and die. The pharmacodynamics of Amoxiclav, protected against beta-lactamases of bacteria by clavulanic acid, is similar.

The basis of the action of lincosamides (Clindamycin), macrolides (Jozamycin), and tetracyclines (Doxycycline and other improved preparations of this group) lies in their ability to bind to RNA molecules (cytoplasmic ribosomes) on bacterial membranes with nucleotide subunits of 30S, 50S or 70S. As a result, there is a slowdown and almost complete cessation of protein biosynthesis in bacterial cells. In the first case, the drugs act as bacteriostatics, in the second - bactericidal.

[15], [16], [17], [18], [19], [20], [21],

Pharmacokinetics

After insertion into the muscle or v / c, Cefotaxime and Cefoperazone enter the systemic circulation with the maximum concentration achieved, respectively, in half an hour and five minutes (and persists for 12 hours after a single application); binding to plasma proteins does not exceed 40%. From the body cephalosporins are excreted by the kidneys and intestines from T1 / 2 - 60-90 minutes.

Biological availability of Clindamycin reaches 90%, and the drug enters all tissues and body fluids, and its highest level in the blood is noted on average two hours after parenteral administration and a maximum of one hour after ingestion.

The metabolism of the drug occurs in the liver; elimination through the intestine and kidneys; the half-life lasts from two to three hours.

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

Also rapidly absorbed and antibiotic Doxycycline, 90% of which binds to plasma proteins; Two hours after oral administration, the drug concentration is maximal. Excretion through the intestine, T1 / 2 may be 15-25 hours

Amoxiclav, consisting of amoxicillin and clavulanic acid, reaches a maximum level in the blood in an hour - with any method of use; the binding of amoxicillin with blood proteins - up to 20%, clavulanic acid - up to 30%. The drug penetrates and accumulates in the maxillary cavity, middle ear, lungs, pleura and tissues of internal genital organs. Metabolism of clavulanic acid occurs in the liver, and the products of its cleavage are excreted by the kidneys, intestines and lungs. Almost 70% of amoxicillin is excreted by the kidneys in uncleaved form.

[22], [23], [24], [25], [26], [27],

Dosing and administration

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

For adults, dosage is given 1 g three times a day (before meals), the course of treatment is 10 days; Children under 14 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 after 8 years (depending on the severity of the condition) - 2-4 mg of the drug for each kilogram of weight. Duration of treatment - at least 10 days.

Amoxiclav for intravenous administration is infuzionno - 1.2 g every 8 hours for 4-5 days; children under 12 years - 30 mg per kilogram of body weight. Then they switch to the tablet form of the preparation.

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

[35], [36], [37], [38], [39], [40],

Use of the antibiotics for abscess during pregnancy

Cefotaxime and Cefoperazone, as well as Jozamycin - as antibiotics for abscess during pregnancy - may be used only if there are strong indications.

Clindamycin is not used in the treatment of pregnant women.

Jozamycin Allowed for use during pregnancy and during breastfeeding after assessing the risk-benefit ratio of treatment.

And data on the teratogenic effects of Doxycycline and Amoxiclav preparations are not available, but Doxycillin is prohibited for long periods of pregnancy.

Contraindications

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

Jozamycin is also contraindicated in the presence of problems with the kidneys and liver.

In the list of contraindications Doxycycline indicated liver failure, elevated levels of leukocytes in the blood, porphyria and age up to 9 years.

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

[28]

Side effects of the antibiotics for abscess

Side effects of Cefotaxim or Cefoperazone include: nausea, vomiting, intestinal distress and abdominal pain; an allergic reaction (hives and itching of the skin); agranulocytosis, reduction of leukocytes and platelets in the blood; pain and inflammation of the vein walls at the injection site.

In addition to the listed side effects, ingestion of Clindamycin can cause a temporary disruption of the neuromuscular transmission, and with the intravenous administration of this antibiotic, a taste of metal in the mouth may appear, the blood pressure may drop sharply and the heart work (up to its stop).

Allergic reactions, temporary worsening of hearing, headache, loss of appetite, heartburn, nausea and diarrhea can trigger the use of Josamycin.

Doxycycline, like most antibiotics, disrupts the intestinal microflora, and its peculiarity, which manifests itself in cases of prolonged use, is increased sensitivity of the skin to ultraviolet and a persistent discoloration of the enamel of the teeth.

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

[29], [30], [31], [32], [33], [34]

Overdose

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

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

[41], [42], [43], [44], [45], [46]

Interactions with other drugs

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

The incompatibility of Clindamycin with such drugs as erythromycin, ampicillin, opioid analgesics, B group vitamins, barbiturates, calcium gluconate and magnesium sulfate has been identified.

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

Do not concomitantly use Doxycycline with antacids, indirect anticoagulants, iron preparations and alcohol-containing tinctures.

[47], [48]

Storage conditions

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

[49], [50], [51], [52], [53], [54], [55]

Shelf life

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

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