Treatment of trophic leg ulcers with antibiotics

Each of us at least once in our lives has received an injury with a violation of the integrity of the skin. Usually, even the deepest wound heals within a month under appropriate conditions. The situation is completely different with trophic ulcers, which are formed mainly at the site of damage to blood vessels. Such wounds heal much longer, which means that the probability of their infection is significantly higher, which means that antibiotics for trophic ulcers in most cases are a harsh necessity, and not a whim of doctors who want to play it safe. Another question is whether the use of antimicrobial agents is always justified.

Trophic ulcers and their treatment

A trophic ulcer is not a simple wound caused by trauma. Doctors consider such ulcerations to be the result of a violation of tissue trophism, hence the name of long-term non-healing wounds. A trophic ulcer is said to be a wound located on the lower (usually on the shin or foot), less often on the upper extremities, does not heal within 6 weeks or more or has a tendency to relapse of inflammation.

More than half of all cases of trophic ulcers are associated with varicose veins (varicose ulcers), in 7 patients out of 100 ulcers were a consequence of thrombophlebitis. In other cases, tissue damage is arterial or mixed.

Mankind has been familiar with trophic ulcers for many years. During this time, many more or less effective methods of treating this pathology have been developed. However, before the advent of antibiotics, the problem was solved with great difficulty and significant losses. The high probability of infection in a long-term non-healing wound often led to blood poisoning (sepsis) and gangrene, which required urgent and serious measures, including blood transfusion and amputation of the limb.

Antibiotics prescribed for trophic ulcers help avoid such sad consequences. Depending on the condition of the wound, doctors prescribe various external agents and drugs for internal use in the form of injections and tablets.

Ideally, an antibiotic should be prescribed after a bacteriological examination and identification of the infectious agent. However, this will take a lot of time, but in the acute period of the disease, when the wound becomes inflamed and suppurates, delay is fraught with complications (sepsis and the spread of infection to other tissues of the body), and a local reaction can easily become systemic, when creams and solutions for local use alone will not be enough.

In order not to waste precious time, doctors prefer to immediately prescribe antibiotics that are active against a large number of pathogens. Most often, they use drugs to which Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Proteus, non-spore-forming anaerobes and some other bacteria that are found in wounds in most cases are sensitive. Preference is given to protected penicillins, cephalosporins, sulfonamides, chloramphenicol, and in severe cases of purulent wounds - fluoroquinolones.

In some cases, a fungal infection can also be observed, which is no longer treated with antibiotics, but with special antifungal drugs (often in combination with antibacterial agents).

Some of the above-described microorganisms are considered conditionally pathogenic and can live on the patient's body for a long time without showing any signs of themselves. Healthy skin has a sufficient protective barrier, allowing us to calmly coexist with microbes without experiencing any discomfort. A decrease in cellular immunity of the largest human organ allows bacteria not only to penetrate the body through wounds, but also to actively multiply, causing pathological processes in them.

The whole problem is that more and more strains of pathogenic bacteria are becoming resistant to antibiotics according to the principle: what doesn't kill us makes us stronger. If antibiotics are used at every opportunity, without particularly bothering with the question of whether they are effective against a specific microorganism, there is a high probability of aggravating the problem. It is the problem of antibiotic resistance that has forced scientists to look for a way out of the situation in the form of combination drugs (for example, protected penicillins). However, the emergence of new resistant strains requires doctors to pay special attention to the problem.

Antibiotics cannot be prescribed without conducting a bacteriological analysis. Moreover, treatment of trophic ulcers should be carried out with constant monitoring of the microflora in the wound. If the wound is not complicated by infection, there is no point in prescribing antibiotics, antiseptic dressings are sufficient (in the case of varicose veins - compression with the use of elastic bandages) and maintaining hand and body hygiene.

Antibiotics are prescribed only if the ulcer has become inflamed, has begun to increase in size, and purulent discharge has appeared. If a bacteriological analysis has shown the presence of a strain in the wound that is resistant to the prescribed antibiotic, it is necessary to immediately change the drug to one that will be effective against the identified pathogen. This can be an antibiotic of both a narrow and a broad spectrum of action, because doctors often encounter the fact that the pathogenic microflora in the wound is distinguished by an enviable diversity.

It is important to understand that trophic ulcers are a special type of tissue damage. And it does not matter whether only the skin and subcutaneous tissue are affected or muscles and bones are involved. Healing of such a wound is a long process even without the absence of an infectious factor in it. In fact, antibiotics do not particularly affect the rate of ulcer scarring. They only prevent complications and the spread of infection throughout the body. This means that they should be used only if there is a real risk of infection.

By taking antimicrobial drugs just in case, the patient risks developing other complications in the form of eczema, contact dermatitis, severe allergic reactions, and dysfunction of various organs and systems. You should also not resort to internal administration of antibiotics if the reaction is local and you can limit yourself to external antimicrobial agents in the form of ointments and solutions.

Indications for the use of antibiotics

So, as we have already understood, antibiotics for trophic ulcers should be taken with special caution and only as prescribed by a doctor. Doctors should prescribe antibiotic therapy only in certain situations when it is necessary to fight an infection that has entered the wound and prevent its spread.

Among the indications for prescribing antibiotic therapy, it is worth highlighting the following situations:

• pronounced inflammatory reaction in the wound,
• redness and swelling of the tissues around the ulcer, indicating progressive inflammation of the soft tissues,
• the appearance of signs of microbial eczema,
• the presence of purulent exudate in the wound,
• addition of erysipelas,
• numerous small round ulcers with purulent contents ( pyoderma ),
• the appearance of symptoms (worsening of the patient's condition, increased body temperature, leukocytosis, etc.) indicating the development of a systemic inflammatory reaction,
• a large number of pathogenic microorganisms in the wound (antimicrobial drugs in this case are prescribed for prophylactic purposes even in the absence of an inflammatory reaction),
• acute soft tissue necrosis.

In principle, antibiotics can be prescribed for complicated trophic ulcers of the lower and upper extremities, as well as other long-term non-healing wounds that are the result of severe phlegmon, carbuncle, erysipelas, etc. And, of course, with the development of any systemic inflammation, no matter how the infection penetrated the body.

Depending on the condition of the wound and the extent of the spread of the infectious process, various forms of antibacterial drugs are prescribed. External agents will be effective in any case, but tablets and solutions for injection make sense to prescribe if signs of a systemic reaction have appeared or the pathological process has begun to actively spread to nearby tissues, occupying an increasingly large area. In medical practice, there have been cases when, with the ineffectiveness of local antibiotic therapy, a small ulcer, smaller than a kopeck in size, in a few days turned into a huge wound covering most of the patient's shin. An identical situation can be seen with incorrectly prescribed systemic antibiotic therapy.

And most importantly, no matter what the antibacterial agents are, they must be prescribed taking into account the pathogen, otherwise the treatment will not bring the desired result, but can easily worsen the patient's condition.

Names of popular antimicrobial agents used to treat trophic ulcers

Treatment of trophic ulcers involves a comprehensive and very serious approach to this issue. After all, a wound that has not healed for a long time is always a high risk of infection, because the protective forces of this area of the skin are very weakened, which means that even opportunistic microorganisms, which are almost always near us, can pose a danger.

Let's say right away that no matter how strong the antibiotic applied locally is, the wound must be prepared for its application. The wound can be cleaned of dirt, dust, bacterial waste products and necrotic masses using antiseptic solutions, which generally also have a noticeable antimicrobial effect.

The advantage of such drugs as "Iodopyron", "Miramistin", "Chlorhexidine", "Betadine", "Lavasept", "Prontosan" and others is that bacteria do not develop resistance to them, unlike antibiotics. As for the effectiveness of these two groups of drugs, it is often very difficult to draw a line between antibiotics and good antiseptics with antimicrobial action, which can also have both bacteriostatic and bactericidal action.

After cleaning the wound from dirt and partially deactivating microbes, it is time to apply local antibiotics. Popular antibiotics used for trophic ulcers: "Dioxidine", "Argosulfan", "Levomekol", "Synthomycin", "Baneocin", "Bactroban", etc.

If systemic antibacterial therapy is required, patients may be prescribed "Dioxidine" in the form of a dropper, as well as broad-spectrum antibiotics from the groups of protected penicillins, cephalosporins, fluoroquinolones (in the form of injections, infusions or tablets), usually used for trophic ulcers. Less often, if the pathogen is precisely identified, antibiotics with a narrow spectrum of action are prescribed. Which antibiotic will be prescribed in each specific case is decided by the attending physician, taking into account the spectrum of antimicrobial activity of the drug and the results of bacteriological testing.

Antiseptics with pronounced antimicrobial action

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Iodine preparations

The most popular drug for treating trophic ulcers is the antiseptic "Iodopyron". The main active ingredient of the drug, as the name suggests, is iodine. But if the alcohol tincture of iodine cannot be used undiluted to treat open wounds, then a 1% solution of "Iodopyron" can be used to treat not only the skin surrounding the wound, but also the inside of the ulcer. If the trophic ulcer is located on the feet or hands, the same solution can be used to treat the nails, fingers and the space between them, which will prevent the addition of a possible fungal infection.

Release form. This drug is intended for external use. In pharmacies, it can be found in the form of a powder, from which a solution of the required concentration is subsequently prepared, packaged in light-proof bags, and a ready-made dark brown solution in bottles.

Indications for use. The drug is prescribed for the treatment of infectious and inflammatory skin lesions, as well as for the treatment of mucous membranes in cases of angina, atrophic rhinitis, and purulent otitis. In addition, medical personnel can disinfect hands, medical gloves, and special instruments with the Iodopyrone solution.

Contraindications for use. Contraindications for the use of "Iodopyrone" are mainly associated with oral administration, which may be prescribed in connection with the treatment of syphilis and atherosclerosis. In case of trophic ulcers, the drug is used locally, if there are no hypersensitivity reactions to the antiseptic containing iodine.

Use during pregnancy. During pregnancy and lactation, according to the instructions for the drug, it cannot be taken internally. There are no such comments on external use of the product, but it is still worth consulting a doctor about this.

Side effects. The use of powder for the preparation of a medicinal composition may be accompanied by a short-term burning sensation of the affected area, itching, dry skin, allergic reactions accompanied by a rash and redness of the skin.

The use of the solution may also in some cases cause skin irritation reactions. If the trophic ulcer occupies a large surface, then applying the solution for a long time may lead to a condition called iodism, which is characterized by the appearance of an allergic rash and runny nose, Quincke's edema, increased salivation and lacrimation.

Method of administration and dosage. Iodopyrone powder is used as a 1% solution, which is prepared directly in the pharmacy. The prepared solution is used to moisten gauze napkins folded in several layers and to treat the ulcer, as well as the healthy surfaces adjacent to it. The moistened napkin can be applied to the wound for a certain period of time, after which it can be removed and the wound can be lubricated with an antibiotic or wound-healing agent.

Interactions with other drugs. The solution of the drug cannot be used simultaneously with compositions containing ammonia and essential oils. It is better to treat wounds containing fat, pus and blood with other means, since these substances weaken the effect of the antiseptic.

Storage conditions. Store the antiseptic in a dry place with limited access to light. Keep away from children. The storage temperature of the powder should not exceed 30 degrees, the solution – 25 degrees.

The shelf life of the solution and powder is 2 and 3 years, respectively, from the date of manufacture.

Iodopyrone

You can replace the solution "Iodopyrone" with an ointment of the same name, an alcohol solution of iodine diluted with purified water, the drug "Iodinol", "Betadine" (also known to many as "Povidone-iodine").

Let's dwell a little on the last drug, which is an organic compound of iodine with polyvinylpyrrolidone. The drug "Betadine" has a pronounced antiseptic and bactericidal effect, similar to antibiotics. Its effect is longer in relation to inorganic iodine compounds, and with prolonged use, resistance to the drug in microorganisms does not develop.

In addition to its bactericidal action, Betadine has antifungal and antiviral activity, and also helps improve tissue trophism and speed up wound healing.

To treat trophic ulcers, you can use a 10% solution, which is sold in pharmacies. Then the composition is diluted with purified cool water, isotonic solution, or Ringer's solution is used. The drug can be diluted in different proportions: 1 to 2, 1 to 10, and more, depending on the purpose of use. Wound surfaces are treated with a gauze swab soaked in a solution of the required concentration 2-3 times a day.

Side effects of the drug include: hyperemia of the skin, itching, development of contact dermatitis, and the appearance of specific acne. If the antiseptic is used for a long time or large trophic ulcers are treated with it, generalized reactions associated with the penetration and accumulation of iodine in the body are also possible: anaphylactic shock, development of hyperthyroidism, impaired renal function, changes in quantitative and qualitative blood parameters, development of metabolic acidosis.

Contraindications for use of the drug are much wider than those of "Iodopyrone". The antiseptic "Betadine" is not prescribed for hyperthyroidism, thyroid adenoma, serious pathologies of the heart, kidneys and liver with impaired functions, Duhring's herpetiform dermatitis. In pediatrics, the use of the drug is permitted from 1 year. The antiseptic cannot be prescribed on the eve of or after a course of treatment with radioactive iodine.

Use during pregnancy. Since the drug is able to penetrate tissues into the body, and its metabolites easily penetrate even through the placenta, there is a risk of developing hyperthyroidism in the fetus, so the use of the antiseptic during pregnancy and lactation is considered undesirable.

With prolonged use of the drug on large affected areas, an overdose may occur, manifested by salivation, symptoms of renal failure, cyanosis, tachycardia, hypertension or, conversely, a sharp drop in pressure (collapse). In rare cases, patients fell into a coma. The antidote in this case is starch diluted in milk. However, it is still recommended to consult a doctor for further treatment.

When using the antiseptic "Betadene" or "Povidone-iodine", it is necessary to take into account the drug interaction with other drugs. This solution cannot be prescribed simultaneously with external enzyme preparations, lithium- and mercury-based drugs. It is also not used together with other antibacterial agents for local use: silver preparations (for example, the antibiotic "Argosulfan", popular in the treatment of trophic ulcers), hydrogen peroxide, antimicrobial drugs based on chloramphenicol, etc.

The storage conditions of the drug are also somewhat different from "Iodopyrone". It should be stored in cooler conditions. The temperature should be within 5-15 degrees. This will prevent premature deterioration of the drug.

Miramistin

Another popular antiseptic, active against most pathogenic microorganisms that can be found in an open wound of a trophic ulcer. The drug is already available as a ready-made solution. It is used in surgery to treat infected wounds, and to treat burns, and in dentistry, and to combat ear-throat-nose pathologies. The drug is also popular in terms of treating sexually transmitted infections.

Pharmacodynamics. The antibacterial properties of Miramistin are due to its ability to destroy bacterial cell membranes, which causes inhibition of their vital processes. In addition, the drug has a certain antifungal effect on Candida fungi and some others.

An interesting feature of Miramistin is that this antiseptic does not affect human cell membranes, and is also capable of reducing the resistance of bacterial pathogens to the action of antibiotics used for trophic ulcers, due to which it is actively used as part of antibiotic therapy.

Pharmacokinetics. When used locally, the drug does not penetrate deep into tissues and does not enter the systemic bloodstream. This feature of the antiseptic allows it to be used during pregnancy and lactation.

Contraindications for use. The drug is not used only if hypersensitivity reactions to it occur. The use of the drug in pediatrics is limited due to insufficient research in this area.

Side effects. The application of the antiseptic may be accompanied by a short-term burning sensation, which goes away on its own. In rare cases, hypersensitivity reactions to the drug occur in the form of reddening of the skin, a feeling of overdrying and itching on it.

Method of administration and dosage. The Miramistin solution can be used to irrigate the surface of open wounds, as well as to tampon the wound by fixing tampons soaked in the solution in it. The procedure is recommended to be performed 2 or 3 times a day for 4-5 days.

Overdose: There have been no reports of overdose.

Storage conditions. It is advisable to store the drug in its original packaging out of reach of children for no more than 3 years from the date of manufacture. The storage temperature should not exceed 30 degrees.

Unlike antibiotics, the use of which is justified only when a bacterial infection is detected, i.e. when the disease is complicated by the addition of pathogenic microorganisms, antiseptics can be safely used for prophylactic purposes to prevent inflammatory reactions and relapses of inflammation at the site of healed trophic ulcers.

Antibiotics for the treatment of complicated trophic ulcers

If antiseptic solutions are not enough, the disease begins to progress, as indicated by redness and swelling of the edges of the wound, an increase in its size, the appearance of purulent exudate inside the wound, it is time to resort to the help of more serious antimicrobial drugs - antibiotics.

Antibiotics for trophic ulcers are mainly prescribed for local action, if the process has not become generalized. Antibacterial ointments, creams, and solutions are used to combat infection.

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Dioxidine

"Dioxidine" is an antibiotic that has become widespread in the treatment of trophic ulcers. It is active against most bacteria that can cause inflammation and suppuration of soft tissues. Many strains resistant to other antimicrobial agents also remain sensitive to it. It is successfully used in the treatment of severe purulent-inflammatory pathologies of soft tissues.

Release form. The drug is released as a 1% solution in ampoules of 10 ml each, a solution with half the dosage in ampoules of 10 and 20 ml, and a 5% ointment for external use.

Method of administration and dosage. The solution can be used for wound washing, antimicrobial dressings and intramuscular injections, as well as in the form of a dropper.

Washing of wounds and application of bandages is carried out with an undiluted solution. A piece of bandage is moistened with the composition from the opened ampoule and used according to the purpose. Application of sterile bandages with the ointment "Dioxidine" is also practiced.

From 10 to 50 ml of undiluted antibiotic is injected into the wound using a syringe. This should be done 1-2 times a day, but not more than 70 ml.

Intravenous antimicrobial solution is administered only in severe cases, if microbes have been carried throughout the body with the bloodstream, and the infection has become systemic. For IV drips, a 0.5% solution is used, diluting the composition from the ampoules with a glucose solution or saline (approximately 1:3). 2 to 3 infusions are administered per day. The minimum daily dose is 600 mg of the medicinal composition, the maximum is 900 mg.

Contraindications for use. "Dioxidine" is a drug that should be used only in the most severe cases, when other drugs do not help. Prescribing it to yourself is dangerous to health, since it can cause gene mutations and the development of associated pathologies.

The drug is not prescribed for adrenal dysfunction and hypersensitivity to the active substance. In kidney diseases with impaired functionality, the therapeutic dose is adjusted.

Use in pediatrics is limited.

Use during pregnancy. Pregnant women are not prescribed this drug, since its effect extends to the fetus, causing developmental disorders and various mutations. The antibiotic can provoke the death of the fetus in the womb and premature birth.

Side effects. Intramuscular and intravenous administration of the drug may be accompanied by headache, chills, hyperthermia, allergic reactions, gastrointestinal disorders (dyspepsia). Muscle twitching is sometimes observed. When treating a wound with an antibiotic solution and applying dressings with a solution or cream, side effects are mainly limited to allergic manifestations.

The drug is discontinued only if the side effects are severe; in other cases, the dose is adjusted and antihistamine therapy is used. Calcium-based drugs can be used as an antidote.

Storage conditions and shelf life. The drug should be stored away from children in a dark place at room temperature (no more than 25 degrees). The antibiotic should be used within 2 years from the date of manufacture.

Argosulfan

Another antibiotic popular in the treatment of complicated trophic wounds is "Argosulfan". Its popularity is based on the fact that the drug contains silver sulfathiazole, and in the case of trophic wounds, silver compounds are more effective in combating the bacterial causative agent of inflammation. Silver salts dissolve poorly in liquids, which makes it possible to maintain the necessary concentration in the wound for a long time.

Release form. The drug is produced in the form of a cream for external use, which is packaged in tubes with a capacity of 15 and 40 g.

Pharmacodynamics. Due to sulfathiazole, the drug has a pronounced bactericidal effect, which is enhanced by silver particles. The antibiotic not only has a detrimental effect on gram-positive and gram-negative bacteria, but also additionally prevents re-infection of the wound, creating a stable protective film on the surface.

Another important feature of the drug is considered to be the ability to stimulate recovery processes in the wound, which contributes to its rapid healing. The drug also has an effect similar to NSAIDs: it has a noticeable analgesic effect and stops the development of the inflammatory process in damaged tissues.

Pharmacokinetics. External use of the drug does not exclude the entry of part of the active substance into the systemic bloodstream (the larger the wound surface, the greater the absorption of the drug), with which it enters the liver, where its metabolism occurs. Metabolites are excreted by the kidneys.

Method of application. The preparation may be applied both directly to the wound surface and to the skin around it. It is permissible to cover the area treated with the cream with an occlusive dressing.

Before applying the cream, the wound must be cleaned; if there is exudate, it must be treated with an antiseptic (miramistin, chlorhexidine or boric acid solution). The cream is applied in a thick layer (at least 2 mm) from 1 to 3 times a day for a therapeutic course of no more than 2 months. During this period, the wound must be constantly covered with cream.

The daily consumption of the cream should not exceed 25 g. Long-term treatment with the drug requires monitoring the content of the active substance of the antibiotic in the blood.

Contraindications for use. Antimicrobial cream with silver salts is not prescribed in case of hypersensitivity to its components, in case of glucose-6-phosphate dehydrogenase deficiency, during breastfeeding (according to indications, during antibiotic treatment, the child is transferred to artificial feeding). The medicine is not prescribed to babies under 2 months of age and premature babies (there is a high risk of liver failure and jaundice).

Use during pregnancy. The antibiotic can be prescribed during this period, but only in severe situations, if there is a great danger to the life and health of the expectant mother.

Side effects. Usually, the use of the drug is not accompanied by unpleasant symptoms. Isolated cases of complaints of skin irritation and burning in the area covered with the cream, and the appearance of mild allergic reactions in the form of itching and rashes on the skin have been recorded.

Long-term antibiotic therapy may alter the functioning of the hematopoietic system or provoke the development of desquamative dermatitis.

Overdose: There have been no reports of such cases.

Interaction with other drugs. The cream is not recommended to be used simultaneously with other external agents and drugs containing folic acid, as this will negatively affect the effectiveness of the antimicrobial component of the drug.

Storage conditions and shelf life. The drug can be stored for no more than 2 years from the date of manufacture in a cool place with a temperature of no more than 15 degrees (do not freeze!), where moisture and direct sunlight do not get.

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Synthomycin

"Synthomycin" is another antibiotic for external use, intended for purulent-inflammatory lesions of soft tissues, including those that do not heal for a long time, such as trophic ulcers.

Release form. In pharmacies, the drug can be found in the form of a whitish liniment (ointment) with a faint odor, placed in a 25 g tube and cardboard packaging.

Pharmacodynamics. The main active ingredient of the drug is chloramphenicol, which has an antimicrobial and bacteriostatic effect on a wide range of infectious agents. The bacteriostatic effect of the antibiotic is based on the disruption of protein synthesis in pathogenic microorganisms.

Resistance to this substance develops rarely and slowly, which allows the drug to be used against bacterial strains that are resistant to a large number of antibiotics.

Pharmacokinetics: Not sufficiently studied.

Method of application and dosage. The liniment can be applied in a thin layer to the surface of the wound and the area around it, or gauze tampons soaked in cream can be placed in the wound. It is recommended to cover the wound with a sterile bandage on top. Depending on the condition of the wound, the ointment is left for 1-5 days, after which a bandage is applied. The duration of treatment is determined by the doctor.

Use only as directed by your physician.

Contraindications for use. The liniment is not used in case of hypersensitivity to the components of the drug, psoriasis, eczema and fungal pathologies of the skin.

In pediatrics it is used from 4 weeks of age.

Use during pregnancy. The use of a topical antibiotic for the treatment of pregnant women is allowed, but since its pharmacokinetics have not been fully studied, this should be done with extreme caution and only if the risk to the mother is higher than the possible consequences for the fetus.

It is allowed to use the ointment for therapeutic purposes and during lactation. In this case, only thorough cleaning of the nipples from the remains of the medicine is required if therapy is carried out for cracks on them.

Side effects. There are known cases of mild allergic reactions in the form of burning, itching, redness and swelling of the treated tissues, as well as skin rashes. In case of overdose of the drug, an increase in the above symptoms is observed.

Interaction with other drugs. The drug can be used together with such antibiotics as Erythromycin, Nystatin, Oleandomycin, Levorin. This will only enhance the antimicrobial properties of Synthomycin. But benzylpenicillin salts, on the contrary, weaken the effect of chloramphenicol.

The drug is also incompatible with sulfonamides, cytostatics, and diphenylbarbiturates. Pyrazolone derivatives and ethanol can also be included in this list.

Storage conditions and shelf life are similar to those of Argosulfan cream.

Levomekol

An incomplete analogue of the above-described medicine can be considered the ointment "Levomekol", which is actively used by many to heal wounds even without consulting a doctor (which is not always justified and safe).

Pharmacodynamics. The ointment contains 2 active ingredients: chloramphenicol and methyluracil, thanks to which the medicine can boast a powerful antimicrobial and anti-inflammatory effect. Effectively fights inflammation and promotes tissue regeneration.

Pharmacokinetics. The drug penetrates deep into the wound very quickly and easily. It is widely used in the treatment of purulent wounds, since pus and exudate inside the lesion do not affect its antimicrobial activity.

Method of application and dosage. The ointment is applied to the cleaned wound surface using ointment-soaked napkins or injected into the cavity with pus using a syringe. Daily dressings are required. No more than 3 g of ointment can be used per day.

Typically, treatment with the drug is carried out for no more than 4 days, since longer use of the drug can provoke osmotic shock in healthy cells.

Contraindications for use. The ointment is not used in the treatment of individuals who have had hypersensitivity reactions to the active substances of the antibiotic in the past. In pediatrics, it is used from the age of 3.

The possibility of use during pregnancy is discussed with a doctor and depends on the severity of the condition.

Side effects. Usually, the use of antibacterial ointment may be accompanied by either mild allergic reactions or skin irritation (discomfort, burning and hyperemia of tissues in the area of application), which requires a revision of the prescription.

In addition to the local antimicrobial drugs described above, non-specific antibiotics can also be used for trophic ulcers, for example, Bactroban and Baneocin ointments.

"Baktoban" is an ointment for external use, which is used in the treatment of secondary bacterial complications of traumatic wounds. The active substance of the drug is mupirocin, depending on the concentration in the wound, it can exhibit both bacteriostatic and bactericidal action.

The cream should be applied to the damaged areas of the body in a thin layer. It is recommended to do this 3 times a day. The course of treatment is no more than 10 days.

The cream should be used alone; its effectiveness is reduced when used simultaneously with other local remedies.

The antibiotic is not used in children under 1 year of age and in patients with hypersensitivity to the components of the drug. During pregnancy, the drug is used only strictly as prescribed by a doctor due to insufficient information about its effect on the course of pregnancy and the health of the fetus.

Side effects of the drug include allergic reactions (very rarely severe), skin irritation, headaches and dizziness, nausea and abdominal pain, stomatitis.

The preparation can be stored for more than 1.5 years from the date of manufacture at a temperature below 25 degrees. The cream cannot be frozen. Keep out of reach of children.

Baneocin

Baneocin cream is a combined antimicrobial preparation for local application. It contains 2 active ingredients, bacitracin and neomycin, which enhance each other's bactericidal action. The preparation is inactive against viruses and fungi. It is used to treat infected wounds.

Contraindications to the use of the combined antibiotic include hypersensitivity to its components and other AMPs from the aminoglycoside group. The drug is also not used on large areas of affected skin.

Absorption of the drug through damaged skin in trophic ulcers makes its use undesirable in pathologies of the heart, kidneys, and vestibular apparatus.

The possibility of using an antibiotic during pregnancy must be discussed with a doctor. Penetration of the antibiotic into the mother's blood can harm the fetus, since aminoglycosides (neomycin) easily penetrate the placenta and can cause hearing impairment in the baby in the future.

The ointment is applied to the cleaned wound 2 or 3 times a day in a thin layer and covered with a sterile bandage. The course of treatment is 1 week. A longer course of therapy requires a reduction in the daily dose.

Side effects of the drug are limited to rare allergic reactions, symptoms of toxic effects on the kidneys and hearing organs (nephro- and ototoxicity), disruptions in the functioning of the neuromuscular and vestibular systems, and isolated cases of photosensitivity.

Interaction with other drugs. Simultaneous use of cephalosporin antibiotics and Baneocin in the area of open wounds increases the risk of nephrotoxic reactions. The same can be said about some diuretics (for example, furosemide).

Neuromuscular conduction disorders were diagnosed in cases of antibiotic use and painkillers or muscle relaxants.

Baneocin ointment can be stored for 3 years at room temperatures not exceeding 25 degrees.

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