Treatment of plague

Etiotropic treatment of plague should be started when this disease is suspected, without waiting for bacteriological confirmation of the diagnosis. It includes the use of antibacterial drugs. When studying natural strains of the plague bacterium in Russia, no resistance to common antimicrobial drugs was found. Etiotropic treatment of plague is carried out according to approved schemes.

Scheme of application of antibacterial drugs in treatment of bubonic plague

Preparation	Directions for use	Single dose, g	Frequency of use per day	Duration of the course, days
Doxycycline	Inside	0.2	2	10
Ciprofloxacin	Inside	0.5	2	7-10
Pefloxacin	Inside	0.4	2	7-10
Ofloxacin	Inside	0.4	2	7-10
Gentamicin	V/m	0.16	3	7
Amikacin	V/m	0.5	2	7
Streptomycin	In,m	0.5	2	7
Tobramycin	V/m	01	2	7
Ceftriaxone	V/m	2	1	7
Cefotaxime	V/m	2	3-4	7-10
Ceftazidime	V/m	2	2	7-10
Ampicillin/sulbactam	V/m	2.1	3	7-10
Aztreonam	V/m	2	3	7-10

Scheme of application of antibacterial drugs in treatment of pulmonary and septic forms of plague

Preparation	Directions for use	Single dose, g	Frequency of use per day	Duration of the course, days
Ciprofloxacin	Inside	0 75	2	10-14
Pefloxacin	Inside	0.8	2	10-14
Ofloxacin	Inside	0.4	2	10-14
Doxycycline	Inside	0.2 for the 1st dose, then 0.1	2	10-14
Gentamicin	V/m	0 16	3	10
Amikacin	V/m	05	3	10
Streptomycin	V/m	0.5	3	10
Ciprofloxacin	I/V	0.2	2	7
Cefotaxime	I/m, IV	3	3	10
Ceftazidime	I/m, IV	2	3	10
Chloramphenicol (chloramphenicol sodium succinate)	I/m, IV	25-35 mg/kg	3	7
Ceftriaxone	I/m. IV	2	2	7-10

Schemes for the use of combinations of antibacterial drugs in the treatment of pulmonary and septic forms of plague

Preparation	Directions for use	Single dose, g	Frequency of use per day	Duration of the course, days
Ceftriaxone - streptomycin (or amikacin)	I/m, IV	1-0 5	2	10
Ceftriaxone gentamicin	I/m, IV	1+0.08	2	10
Ceftriaxone - rifampicin	IV, orally	1-0.3	2	10
Ciprofloxacin - rifampicin	Inside	0.5+0.3	2	10
Ciprofloxacin + streptomycin (or amikacin)	Inside, intravenously, intramuscularly	0.5-0.5	2	10
Ciprofloxacin + gentamicin	Inside, intravenously, intramuscularly,	0.5+0.08	2	10
Ciprofloxacin - Ceftriaxone	I/V, I/M	0 1-0.2-1-1	2	10
Rifampicin and gentamicin	Inside, intravenously, intramuscularly	0.3-0.08	2	Yu
Rifampicin - streptomycin (or amikacin)	Inside, intravenously, intramuscularly	0.3-0.5	2	10

In severe cases, it is recommended to use compatible combinations of antibacterial agents in the doses specified in the schemes during the first four days of illness. In the following days, treatment is continued with one drug. The first 2-3 days, the drugs are administered parenterally, then they switch to oral administration.

Along with specific treatment, pathogenetic treatment of plague is carried out, aimed at combating acidosis, cardiovascular and respiratory failure, microcirculation disorders, cerebral edema, and hemorrhagic syndrome. Detoxification therapy consists of intravenous infusions of colloidal (rheopolyglucin, plasma) and crystalloid solutions (5-10% glucose, polyionic solutions) up to 40-50 ml/kg per day. Previously used anti-plague serum and specific gamma globulin proved to be ineffective during observation, and are currently not used in practice, nor is plague bacteriophage used. Patients are discharged after complete recovery (for the bubonic form, not earlier than the 4th week, for the pulmonary form - not earlier than the 6th week from the day of clinical recovery) and a three-fold negative result obtained after culture of the bubo puncture, sputum or blood, which is carried out on the 2nd, 4th, 6th days after the end of treatment. After discharge, medical observation is carried out for 3 months.

Regimes and diet

Treatment of plague should be combined with an appropriate regimen and diet. Bed rest during the febrile period. No special diet is prescribed. A gentle diet (table A) is advisable.

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