Treatment of trophic leg ulcers with antibiotics

Each of us at least once in life was injured with a violation of the integrity of the skin. Usually, even the deepest wound, if properly treated, heals within a month. The situation with trophic ulcers, which are formed mainly on the site of damage to blood vessels, is quite different. Such wounds heal much longer, and therefore the probability of their infection is much higher, which means that antibiotics for trophic ulcers in most cases are a harsh necessity, and not a whim of doctors wishing to be reinsured. It is another matter whether antimicrobial agents are always justified.

Trophic ulcers and their treatment

Trophic ulcer - this is not a simple wound, resulting from an injury. Doctors consider such ulceration as a result of tissue trophism, hence the name of long-term non-healing wounds. About the trophic ulcer is said, if the wound located on the lower (usually on the shin or foot), less often on the upper limbs does not tighten for 6 or more weeks 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 became a consequence of thrombophlebitis. In other cases, tissue damage is of an arterial or mixed nature.

Humanity has known the 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 appreciable losses. The high probability of infection in a long-term non-healing wound often led to infection of blood (sepsis) and gangrene, which required urgent and serious measures, including blood transfusions and limb amputations.

Antibiotics, prescribed for trophic ulcers, can avoid such unfortunate consequences. Depending on the condition of the wound, doctors prescribe various external drugs and preparations for internal ingestion in the form of injections and tablets.

Ideally, an antibiotic should be administered after bacteriological examination and detection of an infectious agent. However, this will take a lot of time, but in an acute period of the disease, when the wound becomes inflamed and suppurate, delay is fraught with complications (sepsis and spread of infection to other tissues of the body), and the local reaction can easily go into the systemic one, when alone with creams and solutions for the local application is indispensable.

In order not to lose valuable time, doctors prefer to immediately prescribe antibiotics, which are active against a large number of pathogens. The most commonly used drugs to which are sensitive are Staphylococcus aureus, Art. Epidermidis, Pseudomonas aeruginosa, Proteus, non-spore forming anaerobes and some other bacteria that are found in most cases in wounds. Preference is given to protected penicillins, cephalosporins, sulfonamides, chloramphenicol, and in severe cases of purulent wounds - fluoroquinolones.

In some cases, it is also possible to observe the attachment of a fungal infection, which is no longer controlled by antibiotics, but by special antifungal agents (often still combined with antibacterial agents).

Some of the above-described microorganisms are considered conditionally pathogenic and can live for a long time on the patient's body, not manifesting themselves in any way. Healthy skin has a sufficient protective barrier, allowing us to coexist peacefully with microbes, without experiencing any discomfort. Reducing the cellular immunity of the largest of the human organs allows bacteria not only to enter the organism through the wound, but also to multiply actively, causing pathological processes in them.

The whole problem is that more strains of pathogenic bacteria acquire resistance to antibiotics according to the principle: what does not kill us, it makes stronger. If antibiotics are used at every opportunity, especially without being puzzled by the question of whether they are effective against a particular microorganism, there is a high probability of aggravating the problem. It was the problem of antibiotic resistance that forced scientists to look for a way out of the situation in the form of combined drugs (for example, protected penicillins). However, the emergence of new resistant strains requires special attention from physicians to the problem.   

You can not prescribe antibiotics without bacteriological analysis. Moreover, the treatment of trophic ulcers should be carried out with constant monitoring of microflora in the wound. If the wound is not complicated by infection, it makes no sense to prescribe antibiotics, enough antiseptic dressings (in case of varicose veins - compression with the use of elastic bandages) and observance of hand and body hygiene.

Antibiotics prescribe only if the ulcer becomes inflamed, begins to increase in size, there is a purulent discharge. If the bacteriological analysis showed the presence of a strain resistant to the prescribed antibiotic strain, it is necessary to urgently change the drug for one that will be effective against the identified pathogen. It can be an antibiotic of both narrow and wide spectrum of action, after all, doctors often encounter the fact that the pathogenic microflora in the wound is characterized by enviable diversity.

It should be understood that trophic ulcers are a special kind of damage to body tissues. And it does not matter, only the skin and subcutaneous tissue are affected or the muscles and bones are drawn into the process. 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 cicatrization of the ulcer. They only prevent complications and spread of the infection through the body. So, they need to be used only if there is a real risk of infection.

Taking antimicrobials just in case, the patient risks to earn other complications in the form of eczema, contact dermatitis, severe allergic reactions, disruption of the functioning of various organs and systems. It is also not necessary to resort to internal administration of antibiotics if the reaction is local and can be limited to external antimicrobial agents in the form of ointments and solutions.

Indications for use of antibiotics

So, as we have already understood, taking antibiotics with trophic ulcers should be done with extreme caution and only according to the doctor's prescription. Doctors should prescribe antibiotic therapy only in certain situations, when it is necessary to struggle with the infection that has got into the wound and to prevent its spread.

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

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

In principle, antibiotics can be prescribed both for complicated trophic ulcers of the lower and upper extremities, and for other long-term non-healing wounds that are the result of a heavy current of phlegmon, carbuncle, erysipelas, etc. And, of course, with the development of any systemic inflammation, no matter what path the infection has penetrated into the body.

Depending on the condition of the wound and the degree of spread of the infectious process, various forms of release of antibacterial drugs are prescribed. External funds will be effective in any case, but tablets and solutions for injecting it is worthwhile to appoint if there are signs of a systemic reaction or the pathological process began actively spreading to nearby tissues, occupying an increasing area. In medical practice, there have been cases when, with the ineffectiveness of local antibiotic therapy, a small sore, the size of a penny, in a few days turned into a huge wound covering most of the patient's shin. Identical situation can be seen with ill-appointed systemic antibiotic therapy.

And most importantly, whatever antibacterial agents are, their purpose should be carried out taking into account the causative agent of the disease, otherwise the treatment will not bring the desired result, but it can easily worsen the patient's condition.

The names of popular antimicrobial agents used to treat trophic ulcers

Treatment of trophic ulcers implies a comprehensive and very serious approach to this issue. For a long time, an unhealed wound is always a great risk of infection, because the protective forces of this area of the skin are very weakened, which means that even conventionally pathogenic microorganisms that are almost always near us are dangerous.

Let's say at once that no matter how strong the locally applied antibiotic, it is necessary to prepare a wound for its application. Clear the wound from dirt, dust, waste products of bacteria and necrotic masses can be done with antiseptic solutions, which, in general, also have a noticeable antimicrobial effect.

The advantage of such drugs as "Yodopirone", "Miramistin", "Chlorhexidine", "Betadine", "Lavasept", "Prontosan", etc. Is that the resistance to them in bacteria does not develop, 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 antiseptic antimicrobial agents, which may also have bacteriostatic and bactericidal effects.

After cleaning the wound from contamination and partial decontamination of microbes, it is time to apply local antibiotics. Popular antibiotics used for trophic ulcers: Dioxydin, Argosulfan, Levomekol, Synthomycin, Baneocin, Bactroban, etc.

If necessary systemic antibacterial therapy, patients may be prescribed Dioxydin in the form of a dropper, as well as broad-spectrum antibiotics from groups of protected penicillins, cephalosporins, fluoroquinolones (as injections, infusions or tablets) commonly used in trophic ulcers. Less often, if the pathogen is precisely defined, antibiotics with a narrow spectrum of action are prescribed. Which exactly antibiotic will be appointed in each case, the attending physician decides, taking into account the spectrum of antimicrobial activity of the drug and the results of bacteriological research.

Antiseptics with a pronounced antimicrobial effect

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

Preparations of iodine

The most popular drug in the treatment of trophic ulcers is the antiseptic "Iodopirone". The main active substance of the drug, as the name implies, is iodine. But if alcoholic tincture of iodine can not be used undiluted to treat open wounds, then 1% solution of "Yodopirone" can be treated not only the wound 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 processed nails, fingers and the space between them, which prevents the attachment of a possible fungal infection.

Form of issue. 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 desired concentration, prepacked in opaque bags, and a ready dark brown solution in vials are then prepared.

Indications for use. The drug is prescribed both for the treatment of infectious and inflammatory skin lesions, and for the treatment of mucous membranes with angina, atrophic rhinitis, purulent form of otitis. In addition, with a solution of "Yodopirone", medical personnel can conduct disinfection of hands, medical gloves, and a special tool.

Contraindications. Contraindications to the use of "Yodopirone" are mainly associated with a peroral method, which can be prescribed in connection with the treatment of syphilis and atherosclerosis. For trophic ulcers, the drug is used topically if there are no hypersensitivity reactions to the antiseptic containing iodine.

Use during pregnancy. During pregnancy and lactation, according to the instructions to the drug, it should not be taken orally. There are no such remarks about the external use of the remedy, however it is still worth consulting with a doctor about this.

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

The use of the solution also in some cases can cause skin irritation reactions. If the trophic ulcer occupies a large surface, then applying the solution over a long period of time can lead to a condition such as 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 dose. The powder "Yodopirona" is used in the form of a 1% solution, which is prepared directly at the pharmacy. The prepared solution is moistened with gauze wipes folded in several layers and treating the ulcer, as well as the adjacent healthy surfaces. A moistened napkin can be applied to the wound for a certain period of time, after which it is possible to remove and lubricate the wound with an antibiotic or wound healing agent.

Interactions with other drugs. The solution of the drug can not be simultaneously with the compositions containing ammonia and essential oils. Treatment of wounds containing fat, pus and blood is better done by other means, because these substances weaken the action of the antiseptic.

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

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

Yodopirone

Replace the solution of "Iodopirone" with an ointment with the same name, diluted with purified water with an alcohol solution of iodine, the drug "Iodinol", "Betadine" (which is also known to many as "Povidone-iodine").

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

In addition to the bactericidal action, Betadine is characterized by antifungal and antiviral activity, and also contributes to the improvement of tissue trophism and the early healing of wounds.

To treat trophic ulcers, you can use a 10% solution, which is sold in pharmacies. In the future, the composition is diluted with purified cool water, isotonic solution or Ringer's solution. You can divide the drug in different proportions: 1 to 2, 1 to 10 or more, depending on the purpose of use. The wound surfaces are treated with a gauze swab dipped in a solution of the desired concentration 2-3 times a day.

Among the side effects of the drug can be identified: skin flushing, itching, the development of contact dermatitis, the appearance of a specific acne. If an antiseptic is used for a long time or treated with large trophic ulcers, generalized reactions associated with the penetration and accumulation of iodine in the body are possible: anaphylactic shock, development of hyperteriosis, impaired renal function, changes in quantitative and qualitative blood indices, development of metabolic acidosis.

Contraindications to the use of the drug is much broader than that of "Jodopiron". Antiseptic "Betadine" is not prescribed for hyperthyroidism, adenoma thyroid, serious pathologies of the heart, kidneys and liver with a violation of their functions, herpetiform dermatitis Dühring. In pediatrics, the use of the drug is allowed from 1 year. Do not prescribe an antiseptic before or after a course of treatment with radioactive iodine.

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

With prolonged use of the drug in large areas of the lesion, there may be an overdose phenomenon, manifested by drooling, symptoms of renal insufficiency, cyanosis, tachycardia, hypertension, or, conversely, a sharp drop in pressure (collapse). In rare cases, patients fell into a coma. Antidote in this case is starch, diluted in milk. However, further treatment is still recommended to see a doctor.

During the application of the antiseptic "Betaden" or "Povidone-iodine" it is necessary to take into account the drug interaction with other drugs. This solution can not be administered simultaneously with external enzyme preparations, lithium and mercury-based drugs. Do not use it and together with other antibacterial agents for topical application: with silver preparations (for example, popular in the treatment of trophic ulcers with the antibiotic "Argosulfan"), hydrogen peroxide, antimicrobial drugs based on chloramphenicol, etc.

The storage conditions for the preparation are also slightly different from the "Yodopirone". Keep it in cooler conditions. The temperature should be within 5-15 degrees. This will prevent premature damage to the medicine.

Miramistine

Another popular antiseptic that is active against most pathogens that can be found in the open wound of a trophic ulcer. The preparation is already available as a ready-made solution. Apply it in surgery for the treatment of infected wounds, and for the treatment of burns, and in dentistry, and to combat pathologies of the ear-throat-nose. The drug is also popular in terms of treatment of sexually transmitted infections.

Pharmacodynamics. The antibacterial properties of Miramistine are due to its ability to destroy the bacterial cell membranes, which causes the inhibition of the processes of their vital activity. Crom of this drug has a certain antifungal effect against fungi from the Candida group and some others.

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

Pharmacokinetics. With local use, the drug does not penetrate deeply into the tissue and does not enter the systemic circulation. This feature of the antiseptic makes it possible to use it during pregnancy and lactation.

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

Side effects. The application of an antiseptic may be accompanied by a brief burning sensation, which itself passes. In rare cases, there are reactions of hypersensitivity to the drug in the form of redness of the skin, a feeling of overdrying and itching on it.

Method of administration and dose. Miramistin solution can irrigate the surface of open wounds, as well as carry out tamponation of the wound, fixing in it tampons moistened with a solution. The procedure is recommended to be performed 2 or 3 times a day for 4-5 days.

Overdose. No cases of overdose were reported.

Storage conditions. Keep the drug preferably in its original packaging away from children no more than 3 years from the date of release. 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 accession of pathogenic microorganisms, antiseptics can be safely applied for preventive purposes to prevent inflammatory reactions and relapses of inflammation at the site of the cured trophic ulcers.

Antibiotics for the treatment of complicated trophic ulcers

If the antiseptic solutions were not enough, the disease began to progress, as indicated by reddening and swelling of the edges of the wound, an increase in its size, the appearance of a purulent exudate inside the wound, it's time to resort to the help of more serious antimicrobial drugs - antibiotics.

Antibiotics for trophic ulcers are mainly appointed for local action if the process has not acquired a generalized character. To fight infection, antibacterial ointments, creams, and solutions are used.

[8], [9], [10], [11], [12], [13]

Dioxydin

"Dioxydin" - an antibiotic, which was widely used 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 therapy of severe purulent-inflammatory pathologies of soft tissues.

Form of issue. The drug is produced in the form of a 1% solution in ampoules of 10 ml each, a solution with twice lower dosage in ampoules of 10 and 20 ml and 5% ointment for external use.

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

Rinsing of wounds and application of dressings is carried out with undiluted solution. A piece of bandage is moistened with a composition from the opened ampoule and used according to the purpose. Practice is also the imposition of sterile dressings with Dioxydin ointment.

Injection syringe in the wound is administered from 10 to 50 ml of undiluted antibiotic. This should be done 1-2 times a day, but not more than 70 ml.

Intramuscularly, the antimicrobial solution is administered only in severe cases, if the microbes with blood flow were spaced across the body, and the infection acquired a systemic character. For droppers use a 0.5% solution, diluting the composition of the ampoules with a solution of glucose or saline (approximately 1: 3). In a day spend from 2 to 3 infusions. The minimum daily dose is 600 mg of the medicinal composition, the maximum - 900 mg.

Contraindications. "Dioxydin" is a drug that should be used only in the most severe cases, when other drugs do not help. Assigning it to yourself is dangerous to health, because it is capable of causing mutations in genes and the development of associated pathologies.

Do not prescribe the drug in case of adrenal insufficiency and hypersensitivity to the active substance. In diseases of the kidneys with a violation of their functionality, correction of the therapeutic dose is carried out.

Application in pediatrics is limited.

Use during pregnancy. Pregnant women do not prescribe this drug, because its effect extends to the fetus, causing disruption of its development and various mutations. An antibiotic can provoke fetal death in the womb and premature birth.

Side effects. Intramuscular and intravenous administration of the drug may be accompanied by headache, chills, hyperthermia, allergic reactions, abnormalities of the digestive tract (dyspepsia). Sometimes jerking of muscles is noted. When treating the wound with an antibiotic solution and applying bandages with a solution or cream, side effects are mostly limited to allergic manifestations.

The drug is withdrawn only with a high severity of side effects, in other cases resort to dose adjustment and antihistamine drugs. As an antidote, calcium-based drugs can be used.

Storage conditions and shelf life. Keep the drug away from children in a dark place at room temperature (not more than 25 degrees). Use an antibiotic for 2 years from the date of release.

Argosulfan

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

Form of issue. The preparation 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 sulfatiazole, the preparation has a pronounced bactericidal effect, which enhances the silver particles. The antibiotic not only has a harmful effect on Gram-positive and Gram-negative bacteria, but also prevents the wound from re-infection, creating a stable protective film on the surface.

Another important feature of the drug is the ability to stimulate the 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 application of the drug does not exclude the penetration of a 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.

Mode of application. The drug may be applied either directly to the wound surface, or to the skin around it. It is permissible to cover the area treated with cream with an occlusive dressing.

Before applying the cream, the wound must be cleaned, in the presence of exudate necessarily treated with antiseptic (solution miramistina, chlorhexidine or boric acid). The cream is applied in a thick layer (at least 2 mm) from 1 to 3 times a day by a therapeutic course of no more than 2 months. During this period, the wound should be permanently covered with cream.

The daily flow of the cream should not exceed 25 g. Prolonged treatment with the drug requires monitoring the content of the active substance of the antibiotic in the blood.

Contraindications. Antimicrobial cream with silver salts is not prescribed for hypersensitivity to its components, in the absence of glucose-6-phosphate dehydrogenase, during breast-feeding (according to indications during the treatment with an antibiotic the child is transferred to artificial feeding). Do not prescribe medicine to babies up to 2 months of age and premature babies (great risk of malfunctioning of the liver and development of jaundice).

Use during pregnancy. An 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 future mother.

Side effects. Usually the drug is not accompanied by unpleasant symptoms. Single cases of complaints of skin irritation and burning in the area covered with cream, and the appearance of non-severe allergic manifestations in the form of itching and rashes on the skin are documented.

Long-term antibiotic therapy can make changes in the work of the hematopoiesis 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 preparations containing folic acid, as this will negatively affect the effectiveness of the antimicrobial component of the drug.

Storage conditions and shelf life. Keep the drug can be no more than 2 years from the date of release in a cool place with a temperature of not more than 15 degrees (do not freeze!), Where does not get moisture and direct sun rays.

[14]

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, which are trophic ulcers.

Form of issue. In pharmacies, the drug can be found in the form of a whitish liniment (ointment) with a faint odor, placed in a tube with a capacity of 25 grams and a cardboard package.

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

Resistance to this substance develops rarely and slowly, which makes it possible to use the drug against strains of bacteria resistant to a large number of antibiotics.

Pharmacokinetics. Enough is not studied.

Method of administration and dose. Liniment can be applied a thin layer on the surface of the wound and the area around it or put tampons of gauze impregnated with cream on the wound. On top of the wound is recommended to cover with a sterile bandage. The ointment, depending on the condition of the wound, is left for 1-5 days, after which the dressings are made. The duration of treatment is determined by the doctor.

Use only as directed by a doctor.

Contraindications. Liniment is not used for hypersensitivity to the components of the drug, with psoriasis, eczema and fungal pathologies of the skin.

In pediatrics apply from 4-week-old age.

Use during pregnancy. The use of a local antibiotic for the treatment of pregnant women is acceptable, but since its pharmacokinetics is not fully understood, it 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 ointment for therapeutic purposes and during lactation. In this case, only thorough cleaning of the nipples from the remnants of the medicine is required if cracks are applied to them.

Side effects. There are cases of development of light allergic reactions in the form of burning, itching, redness and swelling of the treated tissues, as well as skin rashes. When an overdose of the drug occurs, there is an increase in the symptoms described above.

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

Incompatibility of the drug is also observed with sulfonamides, cytostatics, dementylbarbiturates. The same list can also include pyrazolone derivatives and ethanol.

Storage conditions and shelf life are similar to Argosulfan cream.

Levomexol

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

Pharmacodynamics. In the composition of the ointment we find 2 active ingredients: chloramphenicol and methyluracil, thanks to which the drug can boast a powerful antimicrobial and anti-inflammatory effect. Effective fights against manifestations of inflammation and promotes tissue regeneration.

Pharmacokinetics. The drug very quickly and easily prinikaet deep into the wound. Has been widely used in the treatment of purulent wounds, since pus and exudate inside the lesion focus does not affect its antimicrobial activity.

Method of administration and dose. The ointment is applied to the cleaned surface of the wound with the help of soaked napkins or inserted through a syringe into the cavity with pus. Daily dressings are required. A day can use no more than 3 g of ointment.

Usually, the drug is administered for a period of no more than 4 days, as a longer application of the agent can trigger an osmotic shock in healthy cells.

Contraindications. Ointment is not used in the treatment of people who have in the past had hypersensitivity reactions to the active substances of the antibiotic. In pediatrics it is used from the age of 3.

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

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

In addition to the local antimicrobial agents described above, nonspecific antibiotics can also be used for trophic ulcers, for example, "Bactroban" and "Baneoocin" ointments.

"Bactoban" - ointment for external use, which is used in the therapy 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 parts of the body with a thin layer. This is recommended 3 times a day. The course of treatment is not more than 10 days.

The cream should be used alone, simultaneous application with other local products its effectiveness is reduced.

Antibiotic is not used in children under 1 year and in patients with increased sensitivity to the components of the drug. In pregnancy, the drug is used only strictly according to the doctor's prescription because of insufficient information about its effect on pregnancy and fetal health.

Among the side effects of the drug can be identified allergic reactions (extremely rarely severe), skin irritation, headaches and dizziness, nausea and abdominal pain, stomatitis.

You can store the drug for more than 1.5 years from the date of release at a temperature below 25 degrees. You can not freeze the cream. Keep away from children.

Baneocin

Cream "Baneocin" - a combined antimicrobial preparation for topical application. It has in the composition of 2 active substances bacitracin and neomycin, which enhance the bactericidal action of each other. The drug is inactive against viruses and fungi. It is used to treat infected wounds.

Contraindications to the use of a combined antibiotic is hypersensitivity to its components and other AMPs from the group of aminoglycosides. Do not apply the drug on large areas of the affected skin.

Absorption of the drug alternating damaged skin with trophic ulcers makes it undesirable to use it for pathologies of the heart, kidneys, vestibular apparatus.

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

Ointment is applied to the cleansed wound 2 or 3 times a day with 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 reduced to rare allergic reactions, symptoms of toxic effects on the kidneys and hearing (nephro- and ototoxicity), malfunction in the neuromuscular and vestibular system, single cases of photosensitization.

Interaction with other drugs. The simultaneous use of antibiotics from the group of cephalosporins and "Baneocin" in the field of open wounds increases the risk of nephrotoxic reactions. The same can be said for some diuretics (for example, furosemide).

Violations of neuromuscular conduction were diagnosed in the case of antibiotic and analgesic drugs or muscle relaxants.

Ointment "Baneocin" can be stored for 3 years at room temperature, not exceeding 25 degrees.

[15], [16]