How and when should I use antibiotics in pancreatitis?

Inflammation of the pancreas is not only an unpleasant, but also quite dangerous phenomenon, which, in the absence of treatment or inadequate therapy, can even deprive a person of life. As with any inflammation in pancreatitis, there is a high risk of bacterial infection, which causes a serious course of the disease in every fifth patient. When a bacterial infection comes into play to stop inflammation with NSAIDs, enzyme preparations and a sparing diet regulating the pancreas are almost impossible. An organism weakened by the disease is unlikely to be able to fight with such a strong, actively multiplying enemy, and therefore, special drugs are needed - antibiotics, which will provide antimicrobial action. But antibiotics in pancreatitis doctors prefer to use very carefully, because these are unsafe drugs that can cause additional problems.

Treatment of pancreatitis with antibiotics

Pancreatitis is a disease of fans of alcohol and admirers of dishes with pronounced taste (spicy, salty, fried foods, use of food additives and strong seasonings). Of course, you can include people with excess weight, and patients with chronic infectious pathologies, and those who are too addicted to taking medications. But still the first two groups of people are the main part of patients with pancreatitis, with more than 90% of patients with acute illness - alcoholics and people who abuse alcohol. Thus, it can be said that our bad habits turn into serious diseases through our own fault.

An acute inflammatory process in the pancreas is always accompanied by a malfunction of the organ. Therefore, the treatment of pancreatitis is primarily aimed at ensuring that the digestive process does not suffer. After all, the efficiency of digesting proteins, fats and carbohydrates directly depends on the performance of the pancreas of its functions.

By loading the diseased organ, i.e. Using heavy for digestion of food, which requires the production of more pancreatic juice, one can only exacerbate the situation (the same applies to alcohol, which stimulates the production of digestive secretions). After all, inflammation is always associated with stagnation, and the development of aggressive enzymes will cause even more irritation of the mucous organ. To prevent this, patients are prescribed enzyme preparations ("Pancreatin", "Mezim", "Creon", "Festal", etc.) and a low-calorie diet with restriction of fatty and carbohydrate-containing foods.

This is the basis on which the treatment of the pancreas is based. But it is not always possible to limit ourselves to this part of therapy. The acute form of the disease can not do without a constant strong pain syndrome, which the doctors try to stop with the help of antispasmodics (No-shpa, Drotaverin, Spazmil, Spazmolgon, etc.). If antispasmodics do not help, the treatment regimen includes strong painkillers (Tempalgin, Ketanol, Ketanov, Ketoral, etc.).

Alas, even strong analgesics are not always able to help a person with acute pancreatitis, especially if the disease has caused complications. And complications in most cases are explained by the spread of inflammation to other organs and by the attachment of a bacterial infection. Here it is just antibiotics for pancreatitis and will play a decisive role in saving the patient's life.

Is it really that scary? Yes, there is a danger and it is quite real. The inflammatory reaction is always accompanied by the release of exudate in significant amounts (it is by him that one can explain the swelling of the inflamed organs). And the exudate itself is considered a nutrient medium for bacteria, which, having got there, begin active reproduction, which is the meaning of their life.

Part of the exudate leaves on the surface of the inflamed organ (in our case of the pancreas) and falls on the nearby digestive organs and the abdominal cavity. If even one microbe enters the inflammatory fluid, the time will be so long that the inflammation begins already in the abdominal cavity (peritonitis), and this is a pathology with a high level of mortality.

But sometimes, pancreatitis is initially caused by a bacterial infection. This happens quite often, and the cause for everything becomes in most cases cholecystitis and cholelithiasis. Not only that the pancreas and gallbladder are in close proximity to each other, which means that inflammation from one organ can easily go to another. So these organs have, moreover, a common duct through which bile and pancreatic juice enter the duodenum.

Violation of the normal outflow of bile due to inflammation or cholelithiasis leads to stagnation in the gallbladder, requiring the use of antibiotics, and often surgical treatment. Along with bile, pathogenic bacteria can be thrown into the pancreas, causing inflammation of the organ. This explains the fact that pancreatitis often develops against the background of cholecystitis and vice versa.

And since the infectious factor in both cases of the same species, antibiotics for pancreatitis and cholecystitis appoint the same. Most often these are protected penicillins, cephalosporins and macrolides, less often tetracyclines and other types of antibiotics with a predominantly broad spectrum of action.

In some cases, it is necessary to consistently assign 2 and 3 types of antibacterial drugs if treatment with the first antibiotic is ineffective. The reason for such a failure is often the antibiotic resistance of bacteria, which every year becomes an increasing problem. Even microscopic organisms struggle for survival through mutations and the development of new properties that help them lose sensitivity to antibiotics. And not knowing the enemy (bacterium) in person, it is difficult to say which antibacterial drug is able to cope with it.

It would be most logical to immediately analyze the pathogen and its sensitivity to antibiotics. But the technique of instantaneous determination of the type of bacteria and its properties has not yet been developed, and the usual analysis requires quite a long time, which is not so much in an acute, difficult situation. When it comes to human life, before receiving the results of laboratory studies, it is treated with broad-spectrum antibiotics, with which the chance to affect the causative agent is greater than in the case of narrowly directed drugs. In addition, often there is a complex effect of not one, but several types of pathogens of inflammation.

With the chronic course of pancreatitis, everything is a little different. Usually this inflammation is not a bacterial plan, and therefore, it does not make sense to treat it with antibiotics. But the chronic course always proceeds with relapses, which can be caused both by the use of "forbidden" food, and by the activation of the opportunistic microflora, which for a time hides even inside a healthy organism.

Long-term illness is a blow to the immune system, so chronic pathologies always lead to a decrease in immunity. And this is exactly the conditions that are necessary for conditionally pathogenic microorganisms to begin active activities and become pathogenic, because the more bacteria, the more toxic products of their vital activity accumulate in the body, which provoke inflammatory processes and intoxication of the body.

Thus, antibiotics for chronic pancreatitis can also be prescribed if there is a suspicion of the bacterial nature of the exacerbation. For example, a person goes to the hospital with complaints of pain and heaviness in the pancreas, but at the same time he adhere to the diet without breakdowns, did not abuse alcohol, did not overeat, led a healthy lifestyle. In this case, the cause of exacerbation of pancreatitis with a high probability can be considered activation of opportunistic bacteria or penetration into the organ of pathogenic microbes.

On the lymphatic system, the bacterial factor, localized even in one organ or its site, is able to spread throughout the body, and this is another fact that speaks in favor of antibiotic therapy of bacterial pancreatitis of any form.

After using antibiotics, the pain and inflammation fall down literally within the next 2-3 days, but this does not mean that pancreatitis is cured. Getting rid of this disease is not so simple. In most cases, after the acute phase occurs chronic, characterized by periods of remission and exacerbation. In any case, a hard blow to the pancreas, which is acute pancreatitis, does not pass without a trace, so doctors after discharge from the hospital recommend to adhere to the diet and always have with them enzyme preparations.

Indications of the antibiotics for pancreatitis

As we have already understood, in pancreatitis, unlike cholecystitis, antibiotics are not first-line drugs. Rather, even, on the contrary, they are used when the situation gets out of control of the drugs used before. It is not recommended to apply them without special need, all the same we are talking about potent drugs with a lot of side effects.

The practice of preventive use of antibiotics in inflammatory pathologies of internal organs has sunk into oblivion. The location and functions of the pancreas are such that it is very problematic to penetrate the infection from the outside, so in most cases the inflammation of the organ is triggered by the aggressive action of its own enzymes, organ trauma, excesses. Previously, it was thought that the use of antibiotics would reduce the percentage of deaths from pancreatitis, but lengthy studies confirmed that these antimicrobials, despite their ability to quickly alleviate the condition of patients and prevent the spread of infection, do not affect the number of deaths in pancreatitis. After all, they themselves are able to cause severe symptoms that appear during and after their application.

To prescribe antibiotics should be a good reason. For example, severe pain in acute pancreatitis, which do not go away after taking powerful painkillers. Already this fact itself shows that the pain syndrome is caused not by simple inflammation, the process is supported by pathogenic bacteria that do not allow to alleviate the condition of the patient with the help of traditional therapy used in the case of non-bacterial nature of inflammation in the pancreas.

At the first reference to the hospital or in case of an exacerbation of chronic pancreatitis, the physician must first identify the cause of the acute pancreatic gland failure that occurred. In order to immediately suspect a bacterial infection, it is necessary to exclude any non-bacterial causes of the disease, including malnutrition and trauma.

Complications of pancreatitis can also be indicated by symptoms such as persistent severe nausea (a symptom of an organism's intoxication with bacterial secretions and decay products), an increase in temperature to critical parameters, a violation of respiratory function and kidney function. This suggests that the pathology takes a systemic character, and therefore, without the help of a bacterial infection, this has not been done.

In itself, inflammation is unlikely to pass from one organ to another unless it receives support from the outside. Usually the inflammatory process is localized on a small part of the organ, and that the process begins to spread further, it is necessary that someone supports it. This is what bacteria do. As soon as there are symptoms indicating that the inflammation has spread to the gallbladder, 12-colon and other digestive organs, the competent doctor will suspect the effect of bacterial infection and prescribe effective antibiotics. And here it does not matter in what form the disease was taking place.

So, let's summarize. Antibiotics for pancreatitis in adults (in children such a pathology is rare, and even in most cases, before the use of potent antibacterial drugs does not reach) is prescribed in the following cases:

• with acute pancreatitis,
• in case of exacerbation of chronic pancreatitis.

Antibiotics for acute pancreatitis appoint:

• if there were symptoms indicating a bacterial contribution to inflammation,
• when it is impossible to relieve painful sensations with antispasmodics and strong analgesics,
• if the inflammation spreads to nearby (parapancreatitis) and other organs (12-colon, small intestine, abdominal cavity and organs inside it),
• when generalizing the process ( sepsis, abscesses),
• in case of rupture of the pancreatic duct,
• with the development of complications in the form of necrotizing (dying off) the tissues of the pancreas, cholangitis, the appearance of cystic formations in the area of the organ, etc.,
• if pancreatitis develops on the background of cholecystitis, which shows antibiotic therapy,
• if the pathology is caused by dyskinesia of the bile ducts, resulting in stagnation of the bile with the formation of concrements in it, overlapping the ducts and provoking the transfer of bile and the bacterial component into the pancreas.

Antibiotics for exacerbation of pancreatitis are prescribed in the same cases, as well as when a person appealed to the hospital for worsening of the condition, but can not name any cause not of a bacterial nature.

[1],

Release form

With pancreatitis, antibiotics are applied either orally and injectively, which is facilitated by various forms of release of the drugs used. To injection injection, doctors resort when a person is in serious condition and can not take tablets and capsules through the mouth. According to the appointment of a specialist doctor (gastroenterologist), injections to the patient are done intramuscularly or intravenously. It is not excluded and infusion of the drug (dropper).

Different forms of release may differ. So, the popular protected penicillins "Amoxiclav" and "Augmentin" the pharmaceutical industry produces only in the form of tablets. The same can be said about the two-component preparation Ampiox. If you need intravenous penicillin drugs, you can use Penicillin, Ampicillin, Timentin, Tizacin, and other similar antibiotics that are in the form of an ampoule or powder to make an injection.

Help in this regard, and cephalosporins, because many of these drugs have an appropriate form of release. For example, "Ceftriaxone" is sold as a powder from which a medicinal solution is prepared for intramuscular injection, diluted with lidocaine. For intravenous administration (injections and droppers) the powder is diluted with fizrazastvorom, solution for injections and some other permitted formulations. The same form of release has preparations "Cefutaxim", "Hepatsef" and many other cephalosporins.

Injection can be administered and drugs tetracycline ("tetracycline", "Dixycycline") and fluoroquinolone ("Ciprofloxacin") series. Often used in severe infections, a drug of the fluoroquinolone group "Abaktal" is available in the form of tablets and an infusion solution. This is very convenient because intravenous administration of drugs is recommended only for a short period of time (2-3 days), after which it is necessary to switch to tablets.

Popular macrolides are produced mainly in tablet form (tablets and capsules). But "Oleandomycin", as one of the representatives of macrolide antibiotics used in pancreatitis, has the form of release both in the form of tablets, and in the form of bottles with powder complete with distilled water. Next, the solution is diluted with novocaine and injected with intramuscular injection. If the drug is planned to be administered intravenously, a 5% glucose solution or saline solution is used for dilution.

The situation is the same with the favorite of many doctors - Sumamed. This drug can be found on sale in various forms: tablets, capsules, powder, from which the solution is prepared for ingestion, concentrate for the preparation of the infusion solution.

Names of effective drugs

Today we are faced with a wide variety of effective antibacterial agents. But how to understand what exactly this particular drug will help in the infectious complication of pancreatitis? Moreover, in such a situation, when this pathology is not indicated in the instructions for the use of the drug.

If you carefully read the annotations to many antibacterial drugs, you can see that such an indication for use as pancreatitis, unlike cholecystitis, does not appear there, which suggests that antibiotics should not be used in pancreatitis at all. In fact, this is not so. It should be understood that antibiotics for inflammation of the pancreas are a secondary medicine, the rationale for their administration is in many cases called into question, therefore, drug manufacturers do not consider it necessary to emphasize such an application of an antimicrobial drug.

But without antibiotics sometimes just can not do. To say that specific drugs somehow stood out among others in the treatment of pancreatitis, it would be incorrect. After all, it's not even the name of the drug, but what pathogenic microorganisms are sensitive to it. The same drug can help one patient and in no way improve the condition of another, if it is a drug-resistant strain of bacteria. Therefore, in each case, we need an individual approach to the selection of effective drugs.

It is simpler if an analysis is made for sensitivity, but this is not always possible. In most cases, you have to act by trial and error, based on knowledge of the most likely pathogens of pancreatitis.

Most often bacterial pancreatitis and complications of non-bacterial inflammation cause: Escherichia coli, Proteus, Clostridium, i.e. Anaerobic representatives of pathogenic microflora that live in the intestines, but do not miss the opportunity to travel around the body. Treatment of such infection is rather difficult, but it spreads inside the body very much even actively.

Inflammation can also provoke or exacerbate opportunistic microorganisms (streptococci, staphylococcus, etc.), which usually happens in the chronic course of the disease against a background of reduced immunity. But even in this case, without the result of the analyzes, one can not exclude the presence of other bacteria, for example, the same anaerobes.

All these points should be taken into account when selecting effective drugs. The drug of a wide spectrum of action should cover the entire spectrum of possible pathogens of inflammation in the pancreas.

Such requirements are met by many penicillins: Penicillin, Ampicillin, Amoxicillin, Benzylpenicillin Sodium Salt, etc. But the whole problem is that many bacteria have learned to synthesize a special enzyme beta-lactamase, which negates the action of the antibiotic. Therefore, doctors prefer the later generations of penicillin drugs, which are resistant to the enzyme due to an additional component (most often clavuonic acid), in particular drugs: Amoxiclav, Augmentin, Ampiox, and others.

Among drugs cephalosporin series are very popular: "Cephalexin", "Ceftriaxone", "Cefutaxim", "Hepacef", etc. Despite the fact that these drugs also remain inactive with respect to many strains of bacteria producing inactivating enzymes, most of these drugs can be administered intramuscularly or intravenously, which gives a better and faster effect. In addition, cephalosporins are considered to be more effective in the case of the development of severe infectious complications, and therefore, with acute complicated pancreatitis with a high degree of lethality these drugs will be more preferable.

Macrolides also have a similar spectrum of action. These drugs, according to experts, cause the least amount of side effects. In addition, they are active even in relation to those bacteria that are "armed" against penicillins and cephalosporins.

Preparations "Erythromycin", "Azithromycin", "Oleandomycin", "Summamed", etc. Macrolides prescribe with intolerance drugs penicillin and cephalosporin series, which is not a rare phenomenon.

When exacerbation of chronic pancreatitis, which in most cases is caused by a conditionally pathogenic microflora, doctors can prescribe antibiotics of the tetracycline series. Most often, the drug "Doxycycline" is used, which is characterized by a pronounced bacteriostatic effect (it does not kill bacteria, but does not allow them to multiply) and is effective against most cocci, as well as Escherichia coli, chlamydia, clostridia and other pathogenic microflora. Alas, Proteus and Pseudomonas aeruginosa remain resistant to this drug.

Some doctors with mild infections prefer to use new types of antibiotics, for example, the drug "Rifampicin", which also will not allow the infection to multiply, and in large doses will show a noticeable bactericidal effect against many cocci, Escherichia coli, and some varieties of Clostridium and Proteus.

In severe cases of purulent inflammation, doctors prescribe stronger drugs from the group of fluoroquinolones. The most effective treatment for severe complications of acute pancreatitis is the drug "Abaktal", the active substance of which is pefloxacin (2nd generation of fluoroquinolones). Pefloxacin has a pronounced bactericidal action (inhibits the process of cell division and protein synthesis necessary for building a bacterial membrane) and acts even on those bacteria that other antimicrobial agents can not cope with.

[2], [3], [4], [5]

Description of commonly used antibiotics

So, the most beloved group of drugs is penicillins. And although these antibiotics have long passed from the category of natural to semi-synthetic and synthetic, and their use in pancreatitis does not always bring the expected result, it is still not worth underestimating their effectiveness.

We will not dwell on unprotected penicillins, because there are already a lot of strains of bacteria that make these drugs ineffective. Consider a couple of popular drugs from the category of protected penicillins.

[6], [7], [8], [9], [10], [11]

Augmentin

Let's start with the drug "Augmentin" (analog - "Amoxiclav"), which is a complex of amoxicillin (semisynthetic penicillin) and clavuonic acid, which makes it effective against penicillase-forming strains of bacteria.

As for the pharmacokinetics of the drug, for tablets (and this is the only form of release of the drug), it very easily and quickly enters the blood from the digestive tract, reaching a maximum concentration in various tissues in less than an hour. Almost as quickly antibiotic and is excreted (the half-life is usually no more than 1.5 hours). Derive the components of the drug and metabolites mainly kidney. A comparatively small proportion of the metabolites of clavuonic acid can be detected in the feces.

You can not use the medicine in all cases. Like any penicillin, "Augmentin" can provoke reactions of intolerance. If there is such a possibility, the drug is not prescribed.

There are other contraindications to the use of the drug. For example, infectious mononucleosis, most often caused by the Epstein-Barr virus, and lymphocytic leukemia. It is not recommended to prescribe the drug and to those patients who, in the past, had problems with the liver when taking medications with identical components.

As we see, in contraindications there is no point about the danger of the drug for expectant mothers. Producers argue that the use of the drug during pregnancy is entirely acceptable if the doctor finds it necessary. As for breastfeeding, it is better to be careful here, knowing about the ability of amoxicillin to easily penetrate into various physiological fluids.

Despite the warnings about the large number of side effects of antibiotics, the drug "Augmentin" they are not so much. In addition, only 4-5 people from 100 patients complain of them. Prevalence of complaints of nausea and diarrhea, which, incidentally, may be the usual symptoms of pancreatitis. There are also allergic reactions of varying severity. If you do not take measures to restore microflora, then the development of thrush (vaginal candidiasis) is not ruled out.

Method of administration and dose. Tablets "Augmentin" manufacturers recommend taking one of the following ways:

• dissolve in water (half a cup) and drink,
• chew and drink water in the same amount.

At a time you need to take 1 tablet. Tablets may have a different dosage. The drug at a dosage of 325 mg should be taken every 8 hours. If the dosage is higher (625 mg), then the time interval between tablets is increased to 12 hours (in severe cases, the interval is kept the same).

For children, the drug is released in the form of a suspension, which is useful for adult patients who have problems with swallowing tablets.

If you take too high doses of drugs or reduce the interval between doses, there may be symptoms of overdose, which are limited to abdominal pain, diarrhea, vomiting, dizziness. Sleep disturbances can also be noted (insomnia, early awakening). In mild cases helps wash the stomach and take sorbents, in severe resort to hemodialysis.

When prescribing and taking medications, you should not forget about the possible interaction with other drugs. Drugs that reduce blood viscosity, diuretics, NSAIDs, as well as drugs based on probenecid, disulfiram, allopurinol, phenylbutazone and methotrexate in the composition with "Augmentin" can give serious side effects.

During the period of treatment, "Augmentinom" is recommended to switch from oral to other methods of contraception.

Not the best way to affect the effectiveness of therapy "Augmentin" such drugs as antacids, laxatives, glucosamine. As for antibiotics, the risk group for reducing the effectiveness of treatment include sulfonamide preparations, antibacterial agents with bacteriostatic action.

Store the medicine in room temperature conditions for no more than 2 years from the date of release.

[12], [13], [14]

Ampiox

"Ampioks" is also a two-component antimicrobial agent, both components of which are bactericidal penicillins. Ampicillin is not resistant to beta-lactamase, but the second component of the drug - oxacillin - is able to cope even with penicillin-resistant strains, which broadens the spectrum of action of the drug.

Pharmacokinetics. The drug is excreted mainly with urine. A small amount of it can be found in bile, and then in feces. It is not able to accumulate in the body, which gives the right to consider it relatively safe for long-term use.

Contraindications to the use of the drug are no different from those of "Augmentin" »" Amoxicillin "and many other antibiotics of the penicillin series, which can be taken with bacterial pancreatitis. In pregnancy, it is permissible to prescribe the drug in the usual dosage as prescribed by the doctor.

As for side effects, besides allergic manifestations of different severity, there are other possible symptoms: fever, joint pain (arthralgia), increased eosinophil levels in the blood. Less often patients complain of nausea and vomiting, deterioration of taste perception, diarrhea, development of dysbiosis or thrush.

Method of administration and dose. Take the drug in the form of capsules inside, between meals, with a glass of water.

At a time, 500 to 1000 mg of medication is prescribed (2 to 4 capsules). Multiplicity of admission is usually 4 or 6 times a day. Treatment can last from 5 days to 2 weeks.

Children's dose (from 0 to 14 years) is calculated based on the mass of the child's body.

And now a little about the drug interaction with other drugs. Applying the drug simultaneously with other drugs that have a bactericidal effect, you can achieve a specific effect (synergism), but bacteriostatic antibiotics, on the contrary, will weaken the effect of "Ampioxa" (antagonism).

Food, drugs to reduce the acidity of the stomach, constipation, sorbents, glucosamine should be taken at an interval of 2 hours before or after taking "Apioks", because they inhibit the absorption of the drug, which can not be said of ascorbic acid, which has the opposite effect.

Other interactions are identical to "Augmentin".

The storage conditions of the drug are the same for penicillin tablets. This temperature is not higher than 25 degrees and protection from the sun is desirable. Protect from children. The shelf life of tablets is also 2 years.

Pharmacodynamics of cephalosporins is similar to the mechanism of action of penicillins - stopping the production of protein by the cell. The absence of protein in the shell of a young bacterial cell formed in the process of division leads to its death, which is responsible for the bactericidal effect. In this case, cephalosporins do not require the introduction of additional components to control penicillin-resistant strains of bacteria.

[15], [16]

Cefotaxime

The use of cephalosporin drugs in pancreatitis is considered using the example of the antibiotic of the third generation, called "Cefotaxime. "

Pharmacokinetics. The active substance of the drug is not able to be absorbed effectively in the digestive tract, so the drug is produced in the form of a powder for parenteral administration (injections and droppers). With intramuscular injection, the maximum concentration of the drug in the blood can be seen after 30 minutes. With intravenous administration, everything depends on the dose administered. The elimination half-life is usually not more than one and a half hours. At the same time, the antibacterial effect lasts up to half a day.

With parenteral administration, it easily penetrates most physiological tissues and fluids. Withdrawal of the drug involved in the kidneys, but some of the metabolites can be found in the stool, where they fall along with bile.

Preparations cephalosporin series because of their high toxicity and penetrating abilities doctors do not tend to prescribe during pregnancy. Breastfeeding for the period of treatment with the drug is discontinued.

In / m injections are not allowed for babies who have not reached the age of 2 years, as well as patients with hypersensitivity to lidocaine, which are diluted with powder. The main contraindication to use remains hypersensitivity to cephalosporins and penicillins.

Caution with the drug should be observed with severe damage to the kidneys and the development of enterocolitis.

The drug may exhibit multiple side effects, and the appearance of phlebitis on the spot in / in the injection is far from the worst. Patients can complain of headaches and dizziness, heart rhythm disturbances (arrhythmias), various unpleasant symptoms from the digestive tract, including intestinal dysbacteriosis, kidney and liver problems, allergic reactions of varying severity.

Method of administration and dose. A single dose of medication is contained in a single vial of powder, which is diluted depending on the needs of lidocaine, saline or water for injection. Enter the drug every 12 hours.

In severe infections, the dose may be doubled, and the interval between administrations should be reduced to 6 hours.

Do not exceed the permissible dose, since an overdose is fraught with the development of encephalopathy, even if reversible.

Interaction with other drugs. It is forbidden to mix 2 different antibiotics in one syringe or a vial of infusion.

Caution should be observed with the simultaneous administration of "Cefutaxim" and aminoglycosides. This can adversely affect the condition of the kidneys. An increase in the toxic effect of cephalosporins is also observed with diuretic therapy.

The drug is stored at room temperature. It is advisable not to remove the vials from their original packaging without the need. Shelf life of hermetically sealed bottles is 2 years. A solution prepared for injection or infusion can be used for 6 hours. When placed in a cold place with a temperature of 2 to 8 degrees, the shelf life is extended to 12 hours.

Macrolides in pancreatitis, although considered an effective substitute for penicillins, still have a different mechanism of action. These are representatives of bacteriostatic antibiotics that inhibit the synthesis of protein and nucleic acids in bacterial cells, in which genetic information is stored that stores the properties of the cell. Bacteria do not die, but cease to be divided, i.e. Become inactive. The use of such drugs will be of little use if a person has low immunity, as in many cases of chronic infections, because inactive bacteria can regain their former activity after a while, if the body does not fight them.

[17], [18], [19], [20], [21], [22]

Sumamed

The most loved and often prescribed for various pathologies drug is "Sumamed" with the active substance azithromycin.

Pharmacokinetics. The drug is not as fast as previously described, reaches a maximum concentration in the blood. The highest rates can be seen after 2 or even 3 hours after taking the medication. In the tissues, the content of azithromycin will be greater than in various liquid media.

The drug is excreted through the intestine and partly by the kidneys.

Macrolides are considered the least toxic antibiotics, so they are often prescribed even during pregnancy. In maternal milk, the concentration of azithromycin is considered to be insignificant, but if it is possible to switch to artificial nutrition, it is better to be reinsured once again.

Among the contraindications to the use of the drug are: increased sensitivity to macrolides, severe disruption of the kidneys and liver.

Side effects during the use of antibiotics are considered a very rare phenomenon. No more than 1 person out of 100 can complain of dyspepsia, constipation or diarrhea, lack of appetite, stomach pain, heart and headaches, worsening of sleep. There are rare cases of kidney problems or candidiasis (the latter is more typical for bactericidal drugs).

Method of administration and dose. Any form for oral administration is recommended only once a day. Tablets and capsules are swallowed whole. Take the medicine better for an hour and a half before eating.

Depending on the severity of the patient's condition, he is prescribed a dose of 0.5-1 g for a course of 3 to 5 days.

A solution for intravenous infusions is prepared in 2 stages. Concentrate is subsequently mixed with the solution for injection, and then with a solution of sodium chloride or other permitted composition. Droppers are placed in a hospital for a slow injection (at least 3 hours).

When an overdose of the drug, there are side effects that require symptomatic treatment.

Interaction with other drugs. Drugs of ergot with simultaneous treatment with azithromycin can cause severe intoxication.

It is not recommended to take Sumamed along with lincosamides and antacids, which reduce its effectiveness. But the reception simultaneously with tetracyclines and chloramphenicol preparations will give an enhanced bacteriostatic effect.

Anticoagulants of indirect action make azithromycin more toxic. It is not necessary to take macrolides on its basis in combination with warfarin, heparin, felodipine, ergotamine, methylprednisolone and cycloseril.

The storage conditions of the preparation are not unique. Store the medicine in a room temperature away from children. Capsules and tablets should be used within 3 years, other forms of the drug are stored for no more than 2 years. The ready suspension should be used within 5 days, after which it will become unusable.

Oleandomycin

Another one popular with pancreatitis antibiotics-macrolides is called "Oleandomycin", consonant with the active substance of the drug. It is a low-toxic drug that does not accumulate in the body with prolonged use, has good absorption and a wide spectrum of action. It is successfully used for cholecystitis and pancreatitis.

Do not prescribe the drug in 2 cases: with hypersensitivity to the composition of the drug and macrolides in general and with severe damage to liver cells. At pregnancy the preparation is appointed taking into account possible or probable danger for a fetus. Breastfeeding is recommended to be discontinued when treated with any antibiotic, even the safest.

Side effects of the drug is very small and they are rarely seen in the form of allergic reactions.

Method of administration and dose. The form for oral administration is taken after a meal. The minimum daily dose for adults is 1 g, the maximum - 2 g. The daily dose is recommended for 4-6 receptions. The therapeutic course can last from 5 days to 1 week.

Intramuscularly and intramuscularly, the drug is administered in the same dosage, previously mixing the powder with a solution of novocaine (for intravenous injections) or saline (iv administration). In the latter case, a 5% solution of glucose can be used instead of saline.

Overdosing with the drug as a whole is not dangerous, but it can negatively affect the work of the liver and cause the appearance of allergic reactions.

Interaction with other drugs. It is not recommended to prescribe a bacteriostatic antibiotic in combination with bactericidal, with the exception of aminoglycosides.

The drug is well combined with chloramphenicol, tetracycline antibiotics, nitrofurans. A combination with antifungal agents based on levorin and nystatin, bacteriostatics sulfanilamides is possible.

The storage conditions are simple. It is enough to store any form of the drug at a temperature of no more than 20 degrees in a darkened place, protected from moisture penetration.

Shelf life of the drug is 3 years.

Doxycycline

Tetracyclines are also referred to as drugs with bacteriostatic action. A bright representative of the drugs of this group is Doxycycline, which can be found in drugstores in the capsule vials for oral administration and infusion solution in ampoules.

Pharmacokinetics. A useful feature of the drug is light and rapid absorption in the gastrointestinal tract with oral administration and slow excretion from the body, so that the bacteriostatic effect of the drug remains almost a day. Even eating can not prevent doxycycline from doing its job. It penetrates into various environments, including bile, which makes it effective not only in pancreatitis, but also in cholecystitis. It is mostly excreted through the intestine. A little less unchanged doxycycline is found in the urine.

The drug has its contraindications for use. These include: porphyria, severe kidney disease and a violation of their functionality, leukopenia. Do not apply antibiotic and hypersensitivity to tetracyclines. Do not appoint children under 8 years.

The use of tetracyclines during pregnancy is dangerous for the development of the fetus, since they negatively affect the condition of the teeth and bones of the baby, and also can cause fatty dystrophy of the liver. For the same reason, during the treatment with tetracyclines, it is not necessary to breast-feed the baby.

Side effects of the drug are the development of anemia, porphyria, blood clotting disorders, allergic reactions of various types, rashes and itching of the skin, migraines, impaired vision, drowsiness. Patients may complain of tinnitus, hot flashes, nausea, abdominal pain, liver problems, joint and muscle pain, development of superinfection. These and other symptoms can appear with varying frequency, but rarely exceed 5% threshold.

Method of administration and dose. In acute infections, the antibiotic is prescribed in a dosage of 100 mg per reception. In the first day you need to take 2 single doses with an interval of 12 hours, in the following days are limited to 1 dose.

In severe cases, the daily dosage of 200 mg is maintained for the entire therapeutic course (7-14 days, depending on the severity of the patient's condition).

The solution in ampoules is intended for intravenous infusion with the help of the system. It is first diluted in 10 ml of water for injection, and then the formulation is mixed with 1 liter of saline. Time infusions - from 1 to 2 hours. Repeat the procedure every 12 hours.

The cases of acute overdose with the drug are very rare, but they are dangerous not only for the intensification of side effects, but also for the negative effects on the pancreas and kidneys, as well as temporary loss of hearing. After washing the stomach, you can take an antidote - a calcium salt.

Interaction with other drugs. Food does not affect the absorption of the drug in the digestive tract, which can not be said about the drugs that reduce the acidity of the stomach. They should be taken no later than 4 hours before the application of Doxycycline.

Doxycycline intensifies the action of curare-like drugs and indirect anticoagulants.

Do not take the drug in combination with bactericidal antibiotics. It is unacceptable to take alcohol and vitamin A.

Doxycycline increases the toxic effects of cyclosporine and methotrexate. Theophylline is able to provoke a negative effect of doxycycline on the pancreas and other organs of the digestive system.

Storage of the drug is recommended under normal conditions. In this case, the expiration date of the drug will be 3 years.

As you can see, tetracycline in pancreatitis should be taken with extreme caution, however, like fluoroquinolones, considered to be one of the strongest and rather toxic drugs with a pronounced bactericidal effect.

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

Abaktam

The drug "Abaktam", the most commonly used for severe infections of the gallbladder and pancreas, is famous for its wide spectrum of antibacterial activity. It is ineffective only in relation to Gram-positive bacteria, which are at rest, not presenting any particular danger. A wide range of the drug can cover all possible pathogens of bacterial pancreatitis and cholecystitis. But to apply this medicine all over the place doctors are not in a hurry because of its high toxicity. It's another matter if a person's life is in great danger and such a strong means is needed.

The active substance pefloxacin belongs to the second generation of fluoroquinolones, which has a strong bactericidal effect.

Pharmacokinetics. Even with oral administration, the antibiotic shows good absorption and almost 100% bioavailability. The maximum concentration in the blood is observed after 1.5 hours after the application of the drug. In many body fluids, including bile, its concentration exceeds that in blood plasma. It is excreted through the intestines and kidneys.

The drug has many limitations on the use. It is not prescribed for children and pregnant women (it breaks the development of cartilage). During treatment, "Abaktal" in no case can breastfeed. It is forbidden to prescribe a drug to patients with hypersensitivity to fluoroquinolones, as well as people who have had tendon injuries against the background of taking medications of this group.

Caution in appointments should also be observed with patients diagnosed with organic CNS lesions or severe impairment of liver and kidney function.

Here are the most common side effects of the drug (from 1 to 10%): severe sleep disorders, headaches and dizziness, stomach pain, nausea and vomiting, diarrhea, skin rashes, increased photosensitivity, muscle and joint pain (myalgia and arthralgia ).

Method of administration and dose. Take the drug in the form of tablets is recommended during or after meals, in order to reduce the irritating effect on the stomach.

The usual dose of the drug for severe complications of pancreatitis and with cholecystitis is 800 mg. The daily dose is recommended to be divided into 2 divided doses.

In particularly severe cases and with violations of the liver, the drug is prescribed in the form of a solution that is used for intravenous drippers in a hospital. The ampoule contains 400 mg pefloxacin. It is bred in 250 ml of 5% glucose solution and administered as a 1-hour infusion.

The initial single dose can be doubled. Then the patient is administered 400 mg pefloxacin at intervals of 12 hours. Do not administer to the patient more than 1.2 grams per day.

Patients with impaired liver and kidney function, as well as the elderly, may need a dose adjustment.

If possible, the transition from intravenous administration of the drug to oral tablets.

An overdose of the drug may occur if high doses of the drug are used. It manifests itself in the form of nausea, confusion, fainting and convulsions. It is possible to help a person by rinsing the stomach and giving enterosorbents. Then symptomatic therapy is carried out.

Interaction with other drugs. It is unacceptable to prescribe pefloxacin preparations in combination with tetracyclines and chloramphenicol, which will reduce the antibacterial effect of fluoroquinolone, as well as with steroid preparations.

Antacids and pefloxacin should be taken at intervals of at least 3 hours.

Pefloxacin is able to increase the blood levels of such drugs based on cyclosporine, theophylline and NSAIDs.

Pefloxacin in some cases helps to reduce the toxic effects on the kidneys and hearing organs of antibiotics aminoglycosides.

Concentrate for infusion should not be mixed with solutions that contain chloride ions, for example, with saline solution.

To keep the bactericidal properties during the expiration date, which is 3 years, the following storage conditions should be observed: to save tablets and ampoules at a temperature within 15-25 degrees, protecting them from sun rays and damage.

[28]

Pharmacodynamics

Pharmacodynamics of drugs of this series is generally similar. Medicines show a good bactericidal effect, as they destroy the membrane of a bacterial cell and interfere with the synthesis of protein for its construction. The drugs help in most cases of exacerbation of chronic pancreatitis, as well as with the primary complicated acute pathology.

[29], [30], [31], [32],

Antibiotics for pancreatitis are not used as often as it might seem at first glance. Still, the severe course of pancreatic inflammation is observed only in 20% of cases. And then to the help of potent drugs that adversely affect the beneficial microflora of the body (well, they do not have such selective effects as bacteriophages), they do not resort in all cases. But if antibiotics helped save even one patient with complicated pancreatitis, they should already be talked about as useful in this disease.

[33], [34], [35],