Ceftriaxone, 1 piece, 1 g, powder for solution for intravenous and intramuscular administration

An antibiotic (antibacterial drug, antimicrobial agent) is a drug that is effective in treating bacterial infections. Its effect is to directly affect the bacterium, it kills it. Its effect may also be to slow down the proliferation of bacteria, which allows the immune system to cope with it. The high prevalence of infections, a large selection of antibiotics for children, and the unjustified prescription of these drugs for diseases in children and adults have led to threatening consequences for human life—antibiotic resistance. According to the Eurasian recommendations, 25,000 deaths annually in the EU are associated with antibiotic resistance. At the moment, antimicrobial agents are an irreplaceable resource for humanity. Antibacterial resistance can be considered a threat to national security.

Before moving on to the choice of a children's antibiotic, consideration of dosage, duration of use, it is necessary to analyze and explain the main points in the formation of resistance to antibacterial agents. Only after this can one adequately judge the choice and approach to prescribing these medications.

Antibiotic resistance

Antibiotic resistance is the term for resistance to antibiotics. Who is to blame for this? The main reason is the excessive and uncontrolled use of antimicrobial agents. This applies not only to medicine.

Prescribing antibiotics should always be justified.

Causes

• Application in medicine. Unjustified prescription on an outpatient basis, in a hospital, self-medication (over-the-counter). The main emphasis is on counteracting the unjustified prescription of antibiotics in primary care (at the outpatient stage). For this purpose, clinical recommendations and algorithms for prescribing antibiotics to children are specially developed and implemented in practical healthcare. Also, through the media, explanations are provided to the population about the need for the judicious use of antimicrobial agents and the dangers of their independent use.
• Use of antibiotics in veterinary medicine.
• Application in the agricultural industry.

Composition and release form

Ceftriaxone is available in two dosage forms:

• powder for the preparation of a solution for intravenous or intramuscular injections with a concentration of the active substance of 0.5 or 1 g;
• powder for the preparation of a solution intended for IVs in hospitals, concentration of the main active ingredient is 2g.

White or slightly yellowish powder in the form of crystals is packaged in 10 ml ampoules. Sold in 1 or 10 pieces per box, complete with instructions for use.

The main substance is ceftriaxone disodium salt. It is not possible to buy Ceftriaxone syrup or tablets, since the drug is not available in such forms.

Basic rules for the correct use of antibacterial drugs

1. An antimicrobial agent is taken only in the presence of a bacterial infection that is suspected or documented.
2. When using the drug, you must adhere to the optimal regimen. The first is the correct choice of medicine. Otherwise, it is necessary to maintain an adequate dose and duration of use.
3. When choosing a drug, it is necessary to take into account the regional situation regarding antibiotic resistance of the most common pathogens and take into account the likelihood of infection of the patient with these bacteria.
4. Do not use low quality antibiotics with unproven effectiveness.
5. Do not use antibiotics for prophylactic purposes.
6. The effect of using an antibacterial agent is assessed 48-72 hours after the start of treatment.
7. Explain the harm of non-compliance with the medication regimen, and also explain the dangers of self-medication.
8. Promote the correct use of the drug by the patient.
9. In each case, it is necessary to use methods to determine the cause of the infection.
10. When prescribing an antibacterial drug, doctors must adhere to recommendations based on evidence-based medicine.

Mechanism of action of the drug

The pharmacological effect of the drug is determined by the class of Ceftriaxone as an antibiotic.

The substance has an effect on the vital activity of microbes: it inhibits the process of biosynthesis of their membranes and causes the death of pathogenic microflora.

Ceftriaxone has proven effective against a significant number of gram-negative, gram-positive and some anaerobic bacteria, including Staphylococcus aureus, Treponema pallidum.

When an injection is made into a muscle, the drug quickly enters the circulatory system and enters the tissues, organs and biological fluids present in the body. The concentration reaches its maximum 2-3 hours after injection into the buttock, and when infused into a vein, at the end of the procedure.

Indications for antibiotics

A fairly common mistake is the use of antibiotics for diseases that develop as a result of a non-bacterial infection.

Antibiotics should not be used for viral infections.

Among these diseases:

• Acute pharyngitis.
• Acute laryngotracheitis.
• Rhinitis.
• SARS, only.
• Acute bronchitis. It is permissible to use antibiotics when bronchial constriction develops, as well as when fever lasts more than 5 days.

In these cases, the prescription of antibiotics is not justified, since the cause that led to these diseases is often viruses.

There are also controversial points when both viruses and bacteria can lead to the development of the disease. Such diseases include:

• Acute rhinosinusitis.
• Acute otitis media.
• Acute tonsillitis.

In such cases, an antibiotic is prescribed only after examination and observation by a doctor of the patient.

For viral infections (pharyngitis, rhinitis, laryngitis, tracheitis), the effectiveness of antibiotics is equal to the placebo effect. It is important to remember that the prescription of antibacterial agents does not prevent the development of bacterial superinfection (that is, the addition of a bacterial infection to an existing viral one). There are no effective remedies against ARVI. The use of antiviral immunostimulating agents common in pharmacy chains often does not have any effect. In this case, the antiviral agent can be considered as ascorbic acid or garlic. In such cases, adequate pathogenetic and symptomatic treatment is prescribed, which allows eliminating and eliminating the symptoms of ARVI. Used: paracetamol, ibuprofen, mucolytics (ambroxol, acetylcysteine, carbocysteine), vasoconstrictor nasal drops for a runny nose, nasal corticosteroid for rhinosinusitis. If there is a disease with a viral or bacterial cause (tonsillitis, sinusitis, otitis media), then in this case antibacterial therapy delayed by 2-3 days is recommended. Delayed antibiotic prescribing for upper respiratory tract infections has reduced the frequency of antibiotic prescriptions by 40%.

These statements are of an evidentiary nature and are described in more detail in the training manual “ Rational use of antimicrobial agents in the outpatient practice of doctors , written on the basis and evidence base of the 2021 Eurasian recommendations.

Modern aspects of the treatment of inflammatory diseases of the pelvic organs in women

Inflammatory diseases of the pelvic organs are characterized by various manifestations, depending on the level of damage and the strength of the inflammatory reaction. The disease develops when a pathogen (enterococci, bacteroides, chlamydia, mycoplasma, ureaplasma, trichomonas) penetrates into the genital tract and in the presence of favorable conditions for its development and reproduction. These conditions occur in the postpartum or post-abortion period, during menstruation, during various intrauterine manipulations (introduction of intrauterine contraceptives (IUC), hysteroscopy, hysterosalpingography, diagnostic curettage) [1, 5].

Existing natural protective mechanisms, such as anatomical features, local immunity, the acidic environment of the vagina, the absence of endocrine disorders or serious extragenital diseases, can in the vast majority of cases prevent the development of genital infection.

In response to the invasion of a particular microorganism, an inflammatory response occurs, which, based on the latest concepts of the development of the septic process, is usually called a “systemic inflammatory response” [16, 17, 18].

Endometritis

Acute endometritis always requires antibacterial therapy. The basal layer of the endometrium is affected by the inflammatory process due to the invasion of specific or nonspecific pathogens. Endometrial protective mechanisms, congenital or acquired, such as T-lymphocytes and other elements of cellular immunity, are directly related to the action of sex hormones, especially estradiol, act in conjunction with the macrophage population and protect the body from damaging factors. With the onset of menstruation, this barrier on a large surface of the mucous membrane disappears, which makes it possible to become infected. Another source of protection in the uterus is the infiltration of the underlying tissues with polymorphonuclear leukocytes and the rich blood supply of the uterus, which promotes adequate perfusion of the organ with blood and nonspecific humoral protective elements contained in its serum: transferrin, lysozyme, opsonins [16].

The inflammatory process can spread to the muscle layer, and metroendometritis and metrothrombophlebitis occur with a severe clinical course. The inflammatory reaction is characterized by a disorder of microcirculation in the affected tissues, expressed by exudation; with the addition of anaerobic flora, necrotic destruction of the myometrium can occur [12].

Clinical manifestations of acute endometritis are characterized already on the 3rd–4th day after infection by an increase in body temperature, tachycardia, leukocytosis with a band shift, and an increase in the erythrocyte sedimentation rate (ESR). Moderate enlargement of the uterus is accompanied by pain, especially along its ribs (along the blood and lymphatic vessels). Purulent-bloody discharge appears. The acute stage of endometritis lasts 8–10 days and requires quite serious treatment. With proper treatment, the process ends, less often it turns into a subacute and chronic form, and even less often, with independent and indiscriminate antibiotic therapy, endometritis can take a milder abortive course [5, 12].

Treatment of acute endometritis, regardless of the severity of its manifestations, begins with antibacterial infusion, desensitizing and restorative therapy.

Antibiotics are best prescribed taking into account the sensitivity of the pathogen to them; the dose and duration of antibiotic use are determined by the severity of the disease. Due to the threat of anaerobic infection, additional use of metronidazole is recommended. Given the very rapid course of endometritis, the preferred antibiotics are cephalosporins with aminoglycosides and metronidazole. For example, cefamandole (or cefuroxime, cefotaxime) 1.0–2.0 g 3–4 times a day intramuscularly or intravenously drip + gentamicin 80 mg 3 times a day intramuscularly + metronidazole 100 ml intravenously drip.

Instead of cephalosporins, you can use semi-synthetic penicillins (for abortive cases), for example, ampicillin 1.0 g 6 times a day. The duration of such combined antibacterial therapy depends on the clinic and laboratory response, but not less than 7–10 days.

To prevent dysbacteriosis, from the first days of antibiotic treatment, nystatin 250,000 units 4 times a day or fluconazole 50 mg per day for 1–2 weeks orally or intravenously is used [5].

Detoxification infusion therapy may include the administration of infusion agents, for example: Ringer's solution - 500 ml, polyionic solutions - 400 ml, 5% glucose solution - 500 ml, 10% calcium chloride solution - 10 ml, unithiol with 5% ascorbic acid solution, 5 ml 3 times a day. In the presence of hypoproteinemia, it is advisable to carry out infusions of protein solutions (albumin), blood replacement solutions, plasma, red blood cells, and amino acid preparations [12].

Physiotherapeutic treatment occupies one of the leading places in the treatment of acute endometritis. It not only reduces the inflammatory process in the endometrium, but also stimulates ovarian function. When normalizing the temperature reaction, it is advisable to prescribe low-intensity ultrasound, inductothermy with a high-frequency or ultra-high frequency (UHF) electromagnetic field, magnetic therapy, and laser therapy.

• Nonsteroidal anti-inflammatory drugs (have anti-inflammatory, analgesic effects):
  – paracetamol + ibuprofen 1-2 tablets 3 times a day – 10 days;

  – diclofenac rectally in suppositories or orally 50 mg 2 times a day – 10–15 days;

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  – indomethacin rectally in suppositories or orally, 50 mg 2 times a day – 10–15 days;

  – naproxen 500 mg 2 times a day rectally in suppositories or orally – 10–15 days.

• Preparations of recombinant interferons (have an immunomodulatory, antiviral effect, enhance the effect of antibiotics): interferon a-2b or interferon a 500,000 IU 2 times a day rectally in suppositories - 10 days.
• Interferon inducers (have immunomodulatory, antiviral effects):
  – methylglucamine acridone acetate 250 mg intramuscularly every other day – 10 days;

  – sodium oxodihydroacridinyl acetate 250 mg intramuscularly every other day for 10 days.

is recommended .

• Combined enzyme preparation (has anti-inflammatory, trophic effect): Wobenzym 3-5 tablets 3 times a day.
• Homeopathic remedies (have an anti-inflammatory effect, in combination with other drugs normalizes ovarian function): gynecohel 10 drops 3 times a day.
• Traditional methods of therapy: physiotherapy, herbal medicine, hirudotherapy, acupuncture, physical therapy.
• Methods of gravitational blood surgery: plasmapheresis, endovascular laser irradiation of blood (ELBI), ultraviolet irradiation of blood, intravenous administration of ozonized 0.9% sodium chloride solution.
• Combined oral contraceptives (medium-, low-dose, monophasic) 1 tablet per day - from the 5th to the 25th day of the cycle for 3-6 months:
  – ethinyl estradiol 30 mcg + levonorgestrel 150 mcg (rigevidon);

  – ethinyl estradiol 35 mcg + norgestimate 250 mcg (Sileste);

  – ethinyl estradiol 30 mcg + gestodene 75 mcg (femoden);

  – ethinyl estradiol 30 mcg + desogestrel 150 mcg (Marvelon).

Additional treatment on menstrual days includes the following.

Tetracyclines (have a wide spectrum of action: gram-positive cocci, spore-forming bacteria, non-spore-forming bacteria, gram-negative cocci and bacilli, chlamydia, mycoplasma): doxycycline 100 mg 2 times a day.

Macrolides (active against gram-positive cocci, gram-negative bacteria, gardnerella, chlamydia, mycoplasmas, ureaplasmas):

– azithromycin 500 mg 2 times a day;

– roxithromycin 150 mg 2 times a day;

– clarithromycin 250 mg 2 times a day.

Fluoroquinolones (active against all gram-positive and gram-negative bacteria): ciprofloxacin 500 mg 2 times a day; ofloxacin - 800 mg once a day for 10-14 days.

Nitroimidazole derivatives (active against anaerobes, protozoa): metronidazole 500 mg 4 times a day.

Antifungal agents (active against fungi of the genus Candida):

– nystatin 250,000 units 4 times a day;

– natamycin 100 mg 4 times a day;

– fluconazole – 150 mg once.

Acute salpingoophoritis

It is one of the most common diseases of inflammatory etiology in women. Every fifth woman who has suffered salpingo-oophoritis is at risk of infertility. Adnexitis can cause a high risk of ectopic pregnancy and pathological course of pregnancy and childbirth. The fallopian tubes are the first to be affected, and the inflammatory process can involve all layers of the mucous membrane of one or both tubes, but more often catarrhal inflammation of the mucous membrane of the tube occurs - endosalpingitis. Inflammatory exudate, accumulating in the tube, often flows through the ampullary opening into the abdominal cavity, adhesions form around the tube, and the abdominal opening of the tube closes. A saccular tumor develops in the form of a hydrosalpinx with transparent serous contents or in the form of a pyosalpinx with purulent contents. Subsequently, the serous exudate of the hydrosalpinx resolves as a result of treatment, and the purulent pyosalpinx can perforate into the abdominal cavity. The purulent process can involve wider areas of the pelvis, spreading to all nearby organs [9, 10, 13].

Inflammation of the ovaries (oophoritis) as a primary disease is rare; infection occurs in the area of ​​the ruptured follicle, since the rest of the ovarian tissue is well protected by the covering germinal epithelium. In the acute stage, swelling and small cell infiltration are observed. Sometimes, in the cavity of the follicle of the corpus luteum or small follicular cysts, ulcers and microabscesses form, which, merging, form an ovarian abscess or pyovarium. In practice, it is impossible to diagnose an isolated inflammatory process in the ovary, and this is not necessary. Currently, only 25–30% of patients with acute adnexitis have a pronounced picture of inflammation; the remaining patients experience a transition to a chronic form, when therapy is stopped after a rapid subsidence of inflammation.

Acute salpingoophoritis is also treated with antibiotics (preferably third generation fluoroquinolones - ciprofloxacin, ofloxacin, pefloxacin), as it is often accompanied by pelvioperitonitis - inflammation of the pelvic peritoneum.

For mild forms, the following is prescribed.

1. Antibacterial therapy orally for 5–7 days.

• A combination of penicillins and b-lactamase inhibitors (have a wide spectrum of action (staphylococci, Escherichia coli, Proteus, Klebsiella, Shigella, gonococcus, bacteroides, salmonella): amoxicillin + clavulanic acid 625 mg 3 times a day.
• Tetracyclines (have a wide spectrum of action: gram-positive cocci, spore-forming bacteria, non-spore-forming bacteria, gram-negative cocci and bacilli, chlamydia, mycoplasma): doxycycline 100 mg 2 times a day.
• Macrolides (active against gram-positive cocci, gram-negative bacteria, gardnerella, chlamydia, mycoplasmas, ureaplasmas):
  – azithromycin 500 mg 2 times a day;

  – roxithromycin 150 mg 2 times a day;

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  – clarithromycin 250 mg 2 times a day.

• Fluoroquinolones (active against all gram-positive and gram-negative bacteria):
  – ciprofloxacin 500 mg 2 times a day;

  – ofloxacin – 800 mg once a day – 10–14 days.

2. Oral nitroimidazole derivatives (active against anaerobes, protozoa):

– metronidazole 500 mg 3 times a day;

– ornidazole 500 mg 3 times a day.

3. Oral antifungals (active against Candida fungi):

– nystatin 500,000 units 4 times a day;

– natamycin 100 mg 4 times a day;

– fluconazole – 150 mg once.

4. Oral antihistamines (prevent the development of allergic reactions):

– fexofenadine 180 mg 1 time per day;

– chloropyramine 25 mg 2 times a day.

Additional treatments include the following.

• Nonsteroidal anti-inflammatory drugs (have anti-inflammatory, analgesic effects):
  – paracetamol + ibuprofen 1-2 tablets 3 times a day;

  – diclofenac or indomethacin rectally in suppositories or orally, 50 mg 2 times a day – 10–15 days;

  – naproxen 500 mg 2 times a day rectally in suppositories or orally – 10–15 days.

• Preparations of recombinant interferons (have an immunomodulatory, antiviral effect): interferon α-2β or interferon α 500,000 IU 2 times a day in suppositories for 10 days.
• Multivitamin preparations with antioxidant effects: Vitrum, Centrum, Duovit, Supradin, 1 tablet for 1 month.

In severe cases, the following groups of drugs are prescribed.

1. Antibacterial therapy orally for 7–10 days. During antibacterial therapy, the clinical effectiveness of the drug combination is assessed after 3 days, and if necessary, drugs are changed after 5–7 days.

• Cephalosporins of the III, IV generations (active against gram-negative bacteria, staphylococci): cefotaxime, ceftriaxone, cefepime 0.5–1 g 2 times a day intravenously.
• A combination of penicillins and β-lactamase inhibitors (has a wide spectrum of action: staphylococci, Escherichia coli, Proteus, Klebsiella, Shigella, gonococcus, bacteroides, salmonella): amoxicillin + clavulanic acid 1.2 g 3 times a day intravenously.
• Fluoroquinolones (active against all gram-positive and gram-negative bacteria):
  – ciprofloxacin 1000 mg once a day;

  – pefloxacin, ofloxacin 200 mg 2 times a day intravenously.

• Aminoglycosides (have a wide spectrum of action: gram-positive cocci, gram-negative aerobes):
  – gentamicin 240 mg 1 time per day intravenously;

  – amikacin 500 mg 2 times a day intravenously.

• Carbapenems (active against gram-positive and gram-negative aerobes and anaerobes): imipenem/cilastatin or meropenem 500–1000 mg 2–3 times daily intravenously.
• Lincosamides (active against gram-positive aerobes and gram-negative anaerobes): lincomycin 600 mg 3 times a day intravenously.

2. Antifungal agents (active against fungi of the genus Candida): fluconazole 150 mg once orally.

3. Nitroimidazole derivatives (active against anaerobes, protozoa): metronidazole 500 mg 2 times a day intravenously.

4. Colloidal, crystalloid solutions (intravenous drip):

– rheopolyglucin 400 ml;

– reogluman 400 ml;

– glucose 5% solution 400 ml.

5. Vitamins and vitamin-like substances (have an antioxidant effect). Intravenous stream or drip in 0.9% sodium chloride solution:

– ascorbic acid 5% solution 5 ml;

– cocarboxylase 100 mg.

Additional treatments include the following.

• Human immunoglobulins - normal human immunoglobulin (contains immunoglobulin G, complements antibacterial therapy for severe infections), intravenously at a dose of 0.2–0.8 g/kg body weight.
• Preparations of recombinant interferons (have an antiviral, immunomodulatory effect, enhance the effect of antibiotics): interferon α-2β 500,000 IU 2 times a day rectally in suppositories - 10 days.
• Interferon inducers (have antiviral, immunomodulatory effects):
  – methylglucamine acridone acetate 250 mg intramuscularly every other day – 10 days;

  – sodium oxodihydroacridinyl acetate 250 mg intramuscularly every other day for 10 days.

• Methods of gravitational blood surgery (have detoxification, immunostimulating, antimicrobial, antiviral effects): plasmapheresis, intravenous administration of ozonated 0.9% sodium chloride solution.
• Laparoscopy, inspection and sanitation of the pelvic cavity, rinsing the pelvic cavity with ozonated 0.9% sodium chloride solution.

Treatment for chronic salpingoophoritis includes the following.

• Nonsteroidal anti-inflammatory drugs (have anti-inflammatory, analgesic effects):
  – paracetamol + ibuprofen 1-2 tablets 3 times a day after meals – 10 days;

  - diclofenac or indomethacin rectally in suppositories or orally 50 mg 2 times a day - 10-15 days;

  – naproxen 500 mg 2 times a day rectally in suppositories or orally – 10–15 days.

• Preparations of recombinant interferons (have an immunomodulatory, antiviral effect, enhance the effect of antibiotics): interferon α-2β or interferon α 500,000 IU 2 times a day rectally in suppositories (10 days).
• Interferon inducers (have an immunomodulatory, antiviral effect): methylglucamine acridone acetate or sodium oxodihydroacridinyl acetate 250 mg intramuscularly every other day - 10 days.

Additional treatment is recommended.

• Combined enzyme preparation (has anti-inflammatory, trophic effect): Wobenzym 3-5 tablets 3 times a day.
• Traditional methods of therapy: physiotherapy, herbal medicine, hirudotherapy, acupuncture, physical therapy.
• Methods of gravitational blood surgery: plasmapheresis, ELBI, ultraviolet irradiation of blood, intravenous administration of ozonized 0.9% sodium chloride solution.
• Combined oral contraceptives (medium-, low-dose, monophasic) 1 tablet per day - from the 5th to the 25th day of the cycle for 3-6 months:
  – ethinyl estradiol 30 mcg + levonorgestrel 150 mcg (rigevidon)

  – ethinyl estradiol 35 mcg + norgestimate 250 mcg (Sileste).

  – ethinyl estradiol 30 mcg + gestodene 75 mcg (femoden)

  – ethinyl estradiol 30 mcg + desogestrel 150 mcg (Marvelon).

Low-dose oral contraceptive drugs normalize the function of the hypothalamic-pituitary-ovarian system. With long-term use, monitoring of hemostasis and liver function is necessary.

• Homeopathic remedies (have an anti-inflammatory effect, in combination with other drugs normalize ovarian function): gynecohel 10 drops 3 times a day.

Pelvioperitonitis

Inflammation of the pelvic peritoneum most often occurs secondary to the penetration of infection into the abdominal cavity from an infected uterus (with endometritis, infected abortion, ascending gonorrhea), from the fallopian tubes, ovaries, from the intestines, with appendicitis, especially with its pelvic location. In this case, an inflammatory reaction of the peritoneum is observed with the formation of serous, serous-purulent or purulent effusion. The condition of patients with moderate pelvioperitonitis, the temperature rises, the pulse quickens, but the function of the cardiovascular system is slightly impaired. With pelvioperitonitis, the intestine remains unbloated, palpation of the upper half of the abdominal organs is painless, and symptoms of peritoneal irritation are determined only above the pubis and in the iliac regions. However, patients note severe pain in the lower abdomen, there may be retention of stool and gas, and sometimes vomiting. The level of leukocytes is increased, the leukocyte formula shifts to the left, the ESR is accelerated. Gradually increasing intoxication worsens the condition of patients [14, 15].

Treatment of salpingoophoritis with or without pelvioperitonitis begins with a mandatory examination of the patient for flora and sensitivity to antibiotics. The most important thing is to determine the etiology of inflammation. Today, benzylpenicillin is widely used for the treatment of specific gonorrheal process, although drugs such as ceftriaxone, perazone, ceftazidime are preferable.

The “gold standard” in the treatment of salpingoophoritis from antibiotic therapy is the administration of cefotaxime at a dose of 1.0–2.0 g 2–4 times a day intramuscularly or 1 dose - 2.0 g intravenously in combination with gentamicin 80 mg 3 times a day (Gentamicin can be administered once at a dose of 160 mg intramuscularly). It is imperative to combine these drugs with intravenous administration of metronidazole 100 ml 1-3 times a day. The course of antibiotic treatment should be carried out for at least 5–7 days and you can vary mainly the basic drug by prescribing cephalosporins of the second and third generation (cefamandole, cefuroxime, ceftriaxone, perazone, ceftazidime and others at a dose of 2–4 g per day) [14].

If standard antibiotic therapy is ineffective, ciprofloxacin is used at a dosage of 500 mg 2 times a day for 7–10 days.

In case of acute inflammation of the uterine appendages, complicated by pelvioperitonitis, oral administration of antibiotics is possible only after the main course, and only if the need arises. As a rule, there is no such need, and the persistence of previous clinical symptoms may indicate the progression of inflammation and a possible suppurative process.

Detoxification therapy is mainly carried out with crystalloid and detoxification solutions in an amount of 2–2.5 liters with the inclusion of solutions of rheopolyglucin, Ringer, polyionic solutions - acessol, etc. Antioxidant therapy is carried out with a solution of unithiol 5.0 ml with a 5% solution of ascorbic acid 3 times a day intravenously [14].

In order to normalize the rheological and coagulation properties of blood and improve microcirculation, acetylsalicylic acid 0.25 g/day is used for 7–10 days, as well as intravenous administration of rheopolyglucin 200 ml (2–3 times per course). Subsequently, a whole complex of resorption therapy and physiotherapeutic treatment is used (calcium gluconate, autohemotherapy, sodium thiosulfate, humisol, plasmol, aloe, fiBS) [3, 15]. Physiotherapeutic procedures for acute processes include ultrasound, which provides analgesic, desensitizing, fibrolytic effects, increased metabolic processes and tissue trophism, inductothermy, UHF therapy, magnetotherapy, laser therapy, and subsequently, sanatorium-resort treatment.

Purulent tubo-ovarian formations

Among 20–25% of inpatients with inflammatory diseases of the uterine appendages, 5–9% develop purulent complications requiring surgical interventions [9, 13].

The following features regarding the formation of purulent tubo-ovarian abscesses can be highlighted:

• chronic salpingitis in patients with tubo-ovarian abscesses is observed in 100% of cases and precedes them;
• the spread of infection occurs predominantly through the intracanalicular route from endometritis (with IUD, abortion, intrauterine interventions) to purulent salpingitis and oophoritis;
• there is a frequent combination of cystic transformations in the ovaries with chronic salpingitis;
• there is a mandatory combination of ovarian abscesses with exacerbation of purulent salpingitis;
• Ovarian abscesses (pyovarium) are formed mainly from cystic formations, often microabscesses merge with each other.

The following morphological forms of purulent tubo-ovarian formations are found:

• pyosalpinx - predominant lesion of the fallopian tube;
• pyovarium - predominant damage to the ovary;
• tubo-ovarian tumor.

All other combinations are complications of these processes and can occur:

• without perforation;
• with perforation of ulcers;
• with pelvioperitonitis;
• with peritonitis (limited, diffuse, serous, purulent);
• with pelvic abscess;
• with parametritis (posterior, anterior, lateral);
• with secondary lesions of adjacent organs (sigmoiditis, secondary appendicitis, omentitis, interintestinal abscesses with the formation of fistulas).

Clinically differentiating each of these localizations is practically impossible and impractical, since the treatment is fundamentally the same - antibacterial therapy occupies a leading place both in the use of the most active antibiotics and in the duration of their use. In purulent processes, the consequences of the inflammatory reaction in tissues are often irreversible. Irreversibility is due to morphological changes, their depth and severity. Severe renal dysfunction is common [3, 9].

Conservative treatment of irreversible changes in the uterine appendages is unpromising, since if it is carried out, it creates the preconditions for the occurrence of new relapses and aggravation of impaired metabolic processes in patients, increases the risk of upcoming surgery in terms of damage to adjacent organs and the inability to perform the required volume of surgery [9].

Purulent tubo-ovarian formations are a difficult diagnostic and clinical process. Nevertheless, characteristic syndromes can be identified.

• Clinically, intoxication syndrome manifests itself in the phenomena of intoxication encephalopathy, headaches, heaviness in the head and severity of the general condition. Dyspeptic disorders (dry mouth, nausea, vomiting), tachycardia, and sometimes hypertension (or hypotension during the onset of septic shock, which is one of its early symptoms, along with cyanosis and facial hyperemia against the background of severe pallor) are noted [4].
• Pain syndrome is present in almost all patients and is of increasing nature, accompanied by a deterioration in general condition and well-being, there is pain during a special examination and symptoms of irritation of the peritoneum around the palpable formation. Pulsating increasing pain, persistent fever with a body temperature above 38°C, tenesmus, loose stools, lack of clear contours of the tumor, ineffectiveness of treatment - all this indicates the threat of perforation or its presence, which is an absolute indication for urgent surgical treatment.
• The infectious syndrome is present in all patients, manifested in most of them by high body temperature (38°C and above), tachycardia corresponds to fever, as well as an increase in leukocytosis, ESR and leukocyte index of intoxication increase, the number of lymphocytes decreases, and the shift of the leukocyte formula to the left increases , the number of molecules of average mass increases, reflecting increasing intoxication.
• Kidney function often suffers due to impaired urine passage.
• Metabolic disorders manifest themselves in dysproteinemia, acidosis, electrolyte disturbances, and changes in the antioxidant system.

The treatment strategy for this group of patients is based on organ-preserving operations, but with radical removal of the main source of infection. Therefore, for each specific patient, both the time of the operation and the choice of its volume should be optimal. Clarifying the diagnosis sometimes takes several days, especially when differentiating it from an oncological process. Antibacterial therapy is required at each stage of treatment [1, 2].

Preoperative therapy and preparation for surgery include:

• antibiotics (use cefoperazone 2.0 g/day, ceftazidime 2.0–4.0 g/day, cefazolin 2.0 g/day, amoxicillin + clavulanic acid 1.2 g intravenous drip once a day, clindamycin 2.0 –4.0 g/day, etc.). They must be combined with gentamicin 80 mg intramuscularly 3 times a day and metronidazole infusion 100 ml intravenously 3 times;
• detoxification therapy with infusion correction of volemic and metabolic disorders;
• mandatory assessment of the effectiveness of treatment based on the dynamics of body temperature, peritoneal symptoms, general condition and blood counts.

The surgical stage also includes ongoing antibacterial therapy. It is especially advisable to administer one daily dose of antibiotics on the operating table, immediately after the end of the operation. This concentration is necessary and creates a barrier to further spread of infection, since penetration into the area of ​​inflammation is no longer prevented by dense purulent capsules of tubo-ovarian abscesses. β-lactam antibiotics (cefoperazone, ceftriaxone, ceftazidime, cefotaxime, imipinem/cilastatin, amoxicillin + clavulanic acid) pass these barriers well.

Postoperative therapy includes continuation of antibacterial therapy with the same antibiotics in combination with antiprotozoal, antimycotic drugs and uroseptics. The course of treatment is prescribed in accordance with the clinical picture and laboratory data; it should not be stopped earlier than 7–10 days. Infusion therapy should be aimed at combating hypovolemia, intoxication and metabolic disorders. Normalization of gastrointestinal motility (intestinal stimulation, hyperbaric oxygenation, hemosorption or plasmapheresis, enzymes, epidural blockade, gastric lavage, etc.) is very important. Hepatotropic, restorative, antianemic therapy is combined with immunostimulating therapy (ultraviolet irradiation, laser irradiation of blood, immunocorrectors) [2, 9, 11].

All patients who have undergone surgery for purulent tubo-ovarian abscesses require post-hospital rehabilitation in order to restore organ function and prevention.

Literature

1. Abramchenko V.V., Kostyuchek D.F., Perfileva G.N. Purulent-septic infection in obstetric and gynecological practice. St. Petersburg, 1994. 137 p.
2. Bashmakova M. A., Korkhov V. V. Antibiotics in obstetrics and perinatology. M., 1996. P. 6.
3. Bondarev N. E. Optimization of diagnosis and treatment of mixed sexually transmitted diseases in gynecological practice: abstract. dis. ...cand. honey. Sci. St. Petersburg, 1997. 20 p.
4. Ventsela R.P. Nosocomial infections. M., 1990. 656 p.
5. Gurtovoy B. L., Serov V. N., Makatsaria A. D. Purulent-septic diseases in obstetrics. M., 1981. 256 p.
6. Keith L. G., Berger G. S., Edelman D. A. Reproductive health. T. 2: Rare infections. M., 1988. 416 p.
7. Krasnopolsky V.I., Kulakov V.I. Surgical treatment of inflammatory diseases of the uterine appendages. M., 1984. 234 p.
8. Korkhov V.V., Safronova M.M. Modern approaches to the treatment of inflammatory diseases of the vulva and vagina. M., 1995. P. 7–8.
9. Kumerle X. P., Brendel K. Clinical pharmacology during pregnancy / ed. X. P. Kumerle, K. Brendel: trans. from English: in 2 volumes. M., 1987. T. 2. 352 p.
10. Serov V.N., Strizhakov A.N., Markin S.A. Practical obstetrics: a guide for doctors. M., 1989. 512 p.
11. Serov V.N., Zharov E.V., Makatsariya A.D. Obstetric peritonitis: Diagnosis, clinic, treatment. M., 1997. 250 p.
12. Strizhakov A. N., Podzolkova N. M. Purulent inflammatory diseases of the uterine appendages. M., 1996. 245 p.
13. Khadzhieva E. D. Peritonitis after cesarean section: textbook. allowance. St. Petersburg, 1997. 28 p.
14. Sahm DE The role of automation and molecular technology in antimicrobial susceptibility testing // Clin. Microb. And Inf.1997. 3; 2: 37–56.
15. Snuth CB, Noble V, Bensch R et al. Bacterial flora of the vagina during the mensternal cycle // Ann. Intern.Med. 1982: 948–951.
16. Tenover FC Norel and emerging mechanisms of antimicrobial resistance in nosocomial pathogens // Am. J. Med. 1991; 91: 76–81.

V. N. Kuzmin , Doctor of Medical Sciences, Professor MGMSU, Moscow

The main types of antibiotics and their common representatives on the market

Below we consider the most popular and frequently used groups of antibacterial agents:

• Beta-lactams . Among them are penicillins, cephalosporins, and carbapenems. Among the penicillins, it is worth highlighting: amoxicillin, ampicillin, ticarcillin, carbenicillin, mezlocillin, mecillam. The most popular cephalosporins are: cefazolin, cephalexin, cefuroxime, cefotaxime, ceftriaxone, cefepime, ceftobiprole. Carbapenems are used much less frequently. Meropenem can be isolated.
• Macrolides . Macrolides include: clarithromycin, azithromycin (sumamed), josamycin.
• Tetracyclines . The most common: tetracycline, doxycycline, oxytetracycline.
• Aminoglycosides . Popular ones: gentamicin, amikacin, isepamycin.
• Levomycetins . Trade names: chloramphenicol, chloromycetin.
• Glycopeptide antibiotics . The most commonly used: vancomycin, bleomycin.
• Lincosamides . Used in medicine: lincomycin, clindamycin.
• Fluoroquinolones . Among them, the most commonly used are: ciprofloxacin, levofloxacin, gemifloxacin. They are a broad-spectrum antibiotic for children. These antibiotics are not contraindicated in pediatric practice, but their use in children is sharply limited.

It is important to remember that these drugs have their own indications and contraindications, and are also used against certain infections.

These drugs have their own indications and contraindications, and have a narrow or broad spectrum of activity against bacteria. Some of the listed drugs can be used by children under one year of age. Children's antibiotics are available in tablets, suspensions, and ampoules for intravenous and intramuscular administration. Calculation of the dose, dilution of antibiotics and administration of the required dose to the child should be carried out by medical personnel in order to avoid unwanted reactions, as well as complications during injections. They should be prescribed exclusively by a doctor.

Can Ceftriaxone be used for children?

If there are serious reasons, the antibiotic is used in the treatment of children, including premature babies and newborns.

For babies born earlier than expected, the drug is prescribed with caution.

The dosages are as follows:

• for babies under 14 days of age, the daily dose is calculated based on 20-50 mg of medication per 1 kg of body weight;
• For infants and children under 12 years of age, the daily dose is determined based on 20-80 mg of medication per 1 kg of body weight;
• If a child weighs more than 50 kg, the dose of the drug does not differ from that of adults.

For some pathologies (for example, bacterial meningitis), higher doses of 100 mg per 1 kg of weight are required.

The course of treatment for children with Ceftriaxone is 4-14 days, depending on the pathogen and clinical picture.

Duration of use of antibacterial agents

Parents often ask questions: “How many days are antibiotics given to children? What is the best antibiotic for children? What should I give my child when taking antibiotics? In most cases, 5-7 days of use are sufficient. There are exceptions in which the duration of use may increase to 10–28 days. The second question cannot be answered unambiguously. Each drug has its own indications and contraindications, so the use of a particular drug depends on the situation (age, diagnosis, concomitant pathology, etc.). To the third question, many doctors will answer the same: “Probiotics.” A probiotic will restore normal intestinal microflora that has been affected by an antibacterial agent. As a rule, they are prescribed in a course of 2 weeks to 1 month.

You can always consult your doctor if you have any questions regarding treatment.

According to the Eurasian recommendations, in order to overcome antibiotic resistance, experts emphasize the need to draw the attention of patients to strict adherence to the drug use regimen. It is necessary to use optimal dosage forms of antibiotics with high bioavailability, in particular, Solutab dispersible tablets, which is consistent with the current position of WHO and UNICEF. Advantages of Solutab dispersible tablets:

• Completely absorbed in the intestines. As a result, the effect is equal to the intravenous effect.
• Create a high concentration at the site of infection.
• Better portability.
• Good organoleptic properties.
• The ability to dissolve tablets, which allows the use of this dosage form in children.
• A minimal amount of liquid is required for swallowing.
• They have an advantage over a suspension - errors in preparation are eliminated.

Dispersible tablets recommended by WHO and UNICEF:

• Flemoxin Solutab
• Flemoklav Solutab
• Suprax Solutab
• Vilprofen Solutab
• Unidox Solutab

Parents of children should remember that an incomplete course of prescribed antibiotic treatment leads to the formation of bacterial resistance and a prolonged presence of the microbe in the body.

Side effects of Ceftriaxone injections

Non-standard reactions of the body are manifested:

• eosinophilia, feverish conditions;
• dermatological rashes, obsessive itching;
• symptoms of urticaria, swelling;
• exudative erythema multiforme;
• serum sickness, anaphylactic shock;
• attacks of dizziness and headache;
• oliguria, flatulence, stomatitis;
• vomiting and nausea, glossitis;
• dysbacteriosis, pseudomembranous enterocolitis;
• leukocytosis, hematuria, spontaneous nosebleeds.

Laboratory diagnostics reveal a decrease in the number of leukocytes, lymphocytes, platelets, etc. With intravenous administration, inflammation of the internal walls of the vessel and painful sensations along their course are observed.

The drug affects the activity of liver transaminases, alkaline phosphatase, and urea concentration. May cause the development of hyperbilirubinemia and glucosuria. Intramuscular injections lead to muscle pain, weakness, skin rashes, obsessive itching, and dizziness.

Complications of antibiotic use

When using antibiotics, there is a risk of developing unwanted reactions. Such complications include:

• Hepatotoxicity – liver damage. Most often observed when taking moxifloxacin, macrolides, and clavulanate.
• Cardiotoxicity is damage to the heart. Such a reaction can occur when using fluoroquinolones, azithromycin, clarithromycin.
• Neurotoxicity is damage to the nervous system. Occurs with fluoroquinolones.
• Allergy . Characteristic of penicillins and cephalosporins.

In fact, the wider the spectrum of antimicrobial activity, the higher the risk of adverse reactions..

Choosing an antibiotic in a child

Previously, we reviewed the main diseases of the upper and lower respiratory tract, for which antimicrobial agents can be used. Now we will analyze the main drugs that can be used for this or that pathology, and also indicate the required dosage of the drug.

Do not take antibiotics without a doctor's prescription.

Do not use medications yourself! The medications and dosages listed below are for informational purposes only and are not equivalent to treatments prescribed by a physician.

Acute otitis media

The drug of choice is amoxicillin 40-90 mg/kg/day in 3 divided doses. Duration of therapy is 10 days in children <5 years old, 5-7 days in children >5 years old. The second-line drug is amoxicillin/clavulanate. The third-line drug is josamycin.

Acute rhinosinusitis

Similar to the use of antibacterial agents for acute otitis media.

Acute tonsillitis

The drug of choice is amoxicillin 45-60 mg/kg in 3 doses, phenoxymethylpenicillin 25-50 mg/kg 3-4 times a day. The second-line drug is cefixime. The third-line drug is josamycin. Duration of therapy is 10 days.

Community-acquired pneumonia

The therapy of choice is amoxicillin IV 45-90 mg/kg/day in 3 divided doses. The second line drug is amoxicillin/clavulanate, cefuroxime IM, ceftriaxone IM. The third line drug is josamycin 40-50 mg/kg/day in 2 doses.

Antibiotics are indispensable drugs in the fight against bacterial infection. These medications should be prescribed solely for medical reasons. It is very important to adhere to the prescribed regimen of using the antibacterial agent. Do not self-medicate. If signs of infection occur, contact your pediatrician, who will help establish the diagnosis, cause of the disease, and prescribe adequate treatment.

How is Ceftriaxone prescribed?

The choice of treatment regimen with this antibiotic is the responsibility of the doctor. Depending on the disease, the age of the patient and the severity of the condition, Ceftriaxone is prescribed as injections into the gluteal muscle, injections into a vein, or as intravenous drips.

An intramuscular injection is a painful procedure, therefore, before administering the medicine, 0.5 g of powder is dissolved in 2 ml of lidocaine, 1 g in 3.5 ml of an anesthetic drug.

For intravenous administration, 0.5 g of powder is mixed with 5 ml of water for injection. The prepared solution is introduced gradually over 3-4 minutes.

To prepare the medicine for slow infusion through a vein, take 40 ml of sodium chloride (0.9%), as well as levulose 5% or dextrose 5-10%. The antibiotic is administered as an infusion over 30 minutes.

The maximum dose of ceftriaxone for children over 12 years of age and adults is 4 g per day.

Standard therapy includes:

• dose 1-2 g per day once;
• dose 0.5-1 g twice a day with an interval of 12 hours.

If the prescribed dose exceeds 50 mg per 1 kg of body weight, then it is administered only in the form of systems over 30 minutes.

The duration of treatment is determined by the attending physician. The more severe the disease and the more dangerous the pathogen, the longer it lasts.

After the temperature drops to normal and dangerous symptoms pass, treatment is continued for another 3 days.