Antibiotics after surgery

In clinical practice, antibiotics after surgery are used to avoid purulent postoperative complications associated with bacterial infection of the surgical intervention zone.

Patients are wondering if antibiotics are needed after the operation? Doctors give an affirmative answer and argue it by the fact that, in addition to having many localized local infection sites, one should take into account the presence of opportunistic infections (which develop against the background of a decrease in immunity), as well as infections of nosocomial (i.e., nosocomial), which quickly attack the body, weakened by surgery.

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Indications for use of antibiotics after surgery

Mandatory courses of antibiotics after surgery are prescribed for extensive interventions for penetrating injuries or purulent inflammation of the abdominal and thoracic cavities.

Antibiotics after a cavitary operation - with pyogenic abscesses and necrosis of any internal organs, peritonitis, perforation of the intestine, etc. - designed not to allow the development of bacteremia and the most dangerous postoperative complications - abdominal or general sepsis.

In any operation, it is difficult to prevent microbial contamination - getting nosocomial infections: Staphylococcus aureus, Streptococcus, Pseudomonas aeruginosa, enterobacteria, pseudomonas, etc. Indications for the use of antibiotics after surgery - elimination of existing inflammation foci and reducing the likelihood of secondary infection during surgical interventions on the organs of the gastro- intestinal tract (especially on the blind, thick and rectum); on the gallbladder, bile duct and liver; on the kidneys (during nephrostomy or nephrectomy); on the organs of the small pelvis (with surgical treatment of urological and gynecological diseases); on the lungs (in thoracic surgery); on the heart (in cardiosurgery); in vascular and neurosurgery.

In this case, antibiotics should be prescribed after the operation in case of purulent-inflammatory complications taking into account the place of their development, the intensity of the inflammatory process, the specific nature of the infectious agent and its resistance (resistance) to certain antibacterial agents. Physicians give preference to the most effective and quick-acting drugs with a wide spectrum of antimicrobial activity, with less risk of side effects and easier perception of operated patients.

In the surgical and resuscitation departments, a form of antibiotic release is used for systemic application by parenteral administration - powders for the preparation of injectable solutions (antibiotics of the group of cephalosporins and carbapenems) or a ready solution in ampoules. Do not exclude the appointment of tablets, and for children - in the form of suspensions (if the patient's condition and the degree of inflammation can be insignificant). And how many days the antibiotics are pricked after the operation, as a rule, does not depend on its kind or localization: the species of bacteria and the condition of the patients matter. The drugs of this pharmacological group have a strictly regulated and biochemically valid duration of application (at least six to seven days), but in the presence of extensive purulent inflammation, bacteremia or sepsis, antibiotic courses after surgery may be longer and more intense - with a combination of several drugs whose synergistic effect will provide targeted and effective antibiotic therapy.

Pharmacodynamics

Like all antibiotics-cephalosporins, Cefotaxime, Cefazolin and Ceftriaxon act bactericidal due to their ability to penetrate the cells of aerobic and anaerobic microorganisms and modify their protein enzymes (transpeptidases), which inhibits the synthesis of the peptide of the wall of the bacterial cell wall and prevents the division of their cells.

The pharmacodynamics of Amikacin aminoglycoside differs from the mechanism of action of cephalosporins: the drugs of this group do not penetrate the inside of the bacterial cells, but they disrupt the synthesis of proteins in the ribosomes, irreversibly binding to the protein enzymes of the 30S subunit of the cellular ribosome. That is, the mitosis of cells becomes impossible, and the bacteria die.

Due to the smaller size of the molecules, the antibiotic group of carbapenems, Merapenem quickly penetrates into bacterial cells and also disrupts the synthesis of proteins necessary for the propagation of microbes. In addition, carbapenems can suppress the synthesis of toxins by gram-negative bacteria, and this gives an additional therapeutic effect of Merapenem and all antibiotics of this group.

The drug Amoxiclav is a combination of a penicillin agent amoxicillin and clavulanic acid. Amoxicillin acts by reducing the enzymatic activity of transpeptidases of bacteria and blocking the formation of their cell membranes. A clavulanic acid (in the form of potassium clavulanate), getting into microbial cells, neutralizes their beta-lactamase - enzymes, through which microorganisms are protected from antibacterial agents

Pharmacokinetics

From 25 to 40% of the injected Cefotaxime binds to blood plasma proteins, penetrates into the tissues of internal organs and fluids and has a bactericidal effect for 12 hours. Two thirds of the drug is excreted unchanged through the kidneys and intestines (with a half-life of 60-90 minutes). One third of the drug is transformed into the liver into active metabolites, which have an antibacterial effect.

The pharmacokinetics of Cefazolin are identical to Cefotaxime, but the half-life is approximately two hours.

Bioavailability of Ceftriaxone even with intramuscular injection is almost 100%, and binding to plasma proteins is up to 95% (with a maximum concentration 90 minutes after injection). Ceftriaxone also penetrates into all tissues of the body, from which it is excreted in the urine and bile: the half-life is 6-9 hours, in old age - twice as much, and in children - up to 7-8 days. Bad kidney work contributes to the accumulation of the drug.

The high bioavailability is different and Meropenem; it enters the tissues and body fluids, while no more than 2% of the drug binds to blood plasma proteins. 12 hours after the administration, up to 70% of this drug is unchanged and is excreted by the kidneys, the rest is metabolized in the liver.

Aminoglycoside antibiotics after the operation (Amikacin) are concentrated in liquids and in the intercellular space of the tissues of the lungs, liver and kidneys, the membrane of the brain (with craniocerebral localization of infectious inflammation); binding to plasma proteins does not exceed 11%. The maximum content in the blood is noted about 90 minutes after the introduction into the muscle. In the body Amikacin is not decomposed and excreted by the kidneys (half-life is approximately two hours).

Active substances Amoxiclva (Augmentin) - amoxicillin and clavulanic acid - enter tissues and fluids; bind to plasma proteins (by 20-30%); maximally concentrated in the secretion of the maxillary cavity, the middle ear cavity, the pleural cavity and lungs, the cerebrospinal fluid, the uterus and the ovaries. From the body, amoxicillin is excreted in the urine, practically without being metabolized; clavulanic acid is transformed in the liver and excreted by the kidneys, intestines and through the respiratory tract.

Names of antibiotics after surgery

The following list includes those names of antibiotics after surgery, which are more often than other medications of this class used in today's domestic surgery. These are such drugs as:

• antibiotics-cephalosporins: Cefotaxime (other trade names: Claforan, Intathaxime, Kefotex, Clafotaxime, Talcef, Cefosin), Cefazolin (Cefamesin, Kefzol), Ceftriaxone (Longacef, Rocefin), etc .;
• antibiotics of the aminoglycoside group: Amikacin (other trade names: Amikacin sulfate, Amicil, Amitrex, Amycoside, Lycasin, Fartsiklin);
• antibiotics of the carbapenem group Meropenem (synonyms: Mepenem, Mepenam, Meronem, Mesonex Meronoxol, Meropenabol, Propinem, Cyronem);
• preparations of the penicillin group: Amoxiclav (other trade names: Amoxicillin, potentiated with clavulanate, Augmentin, Amoxil, Klavocin, A-Clave-Farmex, Flemoclav).

All these drugs are related to beta-lactam antibiotics. Antibiotics after the operation of the cephalosporin series are named first not casually: their high activity against most gram-negative and many gram-positive bacteria allows successfully to fight with infectious inflammations after surgical interventions and hospital infections with minimal negative side effects.

Method of administration and dose of antibiotics after surgery

The most expedient way of using antibiotics after the operation is injection.

So, Cefotaxime, Cefazolinum, Ceftriaxone and other cephalosporin antibiotics are injected intramuscularly either by jet and drip into a vein. A single dose for adults is determined by the severity of the condition: 0.25-0.5 g every 8 hours, 1 g every 12 hours, 2 g every 6-8 hours. There is a need to adjust the dose of antibiotics after surgery to the side of the decrease after improving the condition of patients.

Amicacin is injected intramuscularly (within 7-10 days) or injected intravenously (for 3-7 days); The daily dose of the drug is calculated by body weight (10-15 mg per kilogram) and is divided into two or three injections.

Antibiotic Meropenem should be administered bolus intravenously or by prolonged intravenous infusion (infusion). Dosage varies with different severity of the condition after the operation: 0.5 g three times a day (with inflammatory foci in the lungs, urogenital system, in soft tissues and skin); for 1-2 g - with bacterial contamination, including in the form of sepsis. The dose for patient-children is calculated by their weight (30-60 mg per kg).

Amoxiclav in the form of a solution for injection is used intravenously (slowly): a dose for adults and children over 12 years old - for 1.2 g (three times a day); children older than 3 months and up to 12 years - 30 mg per kilogram of weight. The standard course of treatment after surgery is two weeks.

Children under 6 years can be given Amoxiclav in the form of a suspension: in a daily dose of 40 mg per kilogram of body weight (three meals); children under three months - 30 mg per kilogram. Any changes in dosage are made by the doctor, assessing the patient's condition.

Use of antibiotics after surgery during pregnancy

According to official instructions, Cefotaxime, Cefazolin and Amoxiclav during pregnancy and lactation may be used exclusively on strict indications (doctors should evaluate the ratio of benefits for women and the risk of adverse effects of the drug on the fetus).

Ceftriaxone is not used in the first three months of pregnancy, and when using this drug during lactation, breastfeeding is temporarily suspended, as the antibiotic enters the mother's milk.

During pregnancy, use antibiotics Meropenem and Amikacin is contraindicated.

Contraindications for use

Contraindications to the use of Cefotaxime include hypersensitivity to cephalosporins and penicillin antibiotics, bleeding and the presence in the history of inflammation of the small and large intestine (enterocolitis).

Cefazolin and Ceftriaxone are also not used in patients with hypersensitivity; Ceftriaxone is contraindicated in patients with kidney or liver failure.

Amikacin has such contraindications as inflammation of the auditory nerve (neuritis), hyperuricemia, liver and kidney insufficiency, the period of newborn babies. Do not use the drug Meropenem for the first three months.

Amoxiclav is contraindicated in the treatment of patients who are highly sensitive to clavulanic acid, amoxicillin and all penicillins, as well as for hepatitis and mechanical jaundice, which is due to cholestasis.

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Side effects of antibiotics after surgery

The use of almost all antibacterial drugs can be accompanied by nausea, vomiting, diarrhea, abdominal pain and intestinal microflora (dysbacteriosis).

In addition, the side effects of antibiotics after surgery - with the use of Cefotaxime and Cefazolin - can be expressed in allergic reactions, headache, lowering of white blood cells and platelets in the blood, inflammation of tissues and walls of veins at the injection site.

Ceftriaxone, in addition to the already listed side effects, can cause inflammation of the renal pelvis and the development of fungal infection (candidiasis). The use of Amicacin can damage the kidneys and worsen the hearing.

Amoxiclav (Augmentin) can cause hematuria, and the side effects of Meropenem include seizures.

Overdose

Overdose of cefotaxime, cefazolin, ceftriaxone and meropenem is expressed in the increased side effects of these drugs. Overdose of Cefotaxime is neutralized with the help of desensitizing agents (antihistamines). If the dose of Cephazoline and Ceftriaxone is exceeded, accelerated hemodialysis can be used.

In case of Amicacin overdose, dizziness, nausea and vomiting, hearing loss, dysuria, thirst, violation of coordination of movements and breathing are noted. It may require intensive antitoxic therapy with hemodialysis and artificial ventilation.

As noted in the instructions, an overdose of Amoxiclav (Augmentin) can manifest itself in the form of dizziness, sleep disturbances, mental overexcitation and seizures. Prescribed symptomatic treatment.

Interactions with other drugs

For these antibacterial agents used after the operation, the following interactions with other drugs are noted.

Antibiotics-cephalosporins (Cefotaxime, Cefazolin, Ceftriaxone, etc.) can not be used concomitantly with diuretics and antibiotics of the aminoglycoside group - because of the increased adverse effects on the kidneys. Also, use of NSAIDs should be avoided in order not to increase the risk of bleeding.

Amikacin is incompatible with antibiotics such as kanamycin, neomycin, and monomycin. With the simultaneous use of Amikacin with Levomycetin, tetracyclines and sulfanilamide agents, the effect of all drugs is greatly enhanced. Means for anesthesia in combination with aminoglycosides can lead to a halt in breathing.

Storage conditions and shelf life

Antibiotics after surgery should be stored in a place protected from light, at a temperature not higher than + 24-25 ° C.

The shelf life of Cefotaxime, Ceftriaxone, Amicacin, Meropenem, Amoxiclav is 2 years, Cefazolin is 3 years.