This route of antibiotic administration is not used. Routes of administration of antibiotics into the body
»» No. 4"99
Antibacterial therapy
N.V. Beloborodova
Moscow Children's City Clinical Hospital N13 named after. N.F. Filatova
The article outlines the author's position on the problem of the most rational approach to the use of injectable and oral forms of antibiotics in children. It has been shown (including on the basis of the author’s data) that the injection route of antibiotic administration is often used without proper justification in the treatment of common infectious diseases (acute bacterial infections of the respiratory system, etc.), and antibiotics are also used, the spectrum of action of which does not include the most common pathogens of these diseases. Specific recommendations for optimizing empirical antibiotic therapy are provided.
The most common diseases in children, as is known, are diseases of the nasopharynx and upper respiratory tract (otitis, sipusitis, pharyngitis, bronchitis, pneumonia), as well as infections of the skin and soft tissues. In this regard, special attention should be paid to the rational use of antibiotics, since they are etiotropic drugs and are prescribed most often. The correct choice of antibiotic determines the effectiveness of treatment, elimination of the pathogen and the speed of recovery. An antibiotic is most effective when prescribed at the onset of the disease, so it is most often selected empirically, without microbiological data. If the “starting” antibiotic is irrationally chosen, the course of the infectious process is delayed, complications or superinfections may develop, and repeated courses of treatment or hospitalization may be required.
It is no secret that the pain of antibiotic injections is one of the factors that traumatizes the unstable and vulnerable psyche of a child. In the future, this may lead to a number of undesirable behavioral characteristics of the “difficult child.” Most of our children, in addition to all the troubles associated with illnesses, are doomed from early childhood to experience the dubious “pleasure” of intramuscular injections. At the same time, this procedure is so painful that even many adult men have difficulty agreeing to it, and some refuse altogether.
Meanwhile, no one asks a small child if he agrees to be treated in this way. Loving parents cannot protect the baby either, since they are absolutely helpless in the face of the arguments of the local pediatrician, such as: the child has fallen ill again, he is weakened, the temperature is high, pills do not help, antibiotic injections are indicated. Sometimes it even seems that it doesn’t matter which antibiotic to use - the main thing is to use injections, since it is reliable and effective!
We must admit that we are captive to ideas that were formed a long time ago, which today absolutely do not correspond to reality. At the same time, we mislead parents who are blinded by fear for their child and have virtually no right to vote. Are we taking advantage of the helplessness of little sufferers who have no other arguments than huge eyes filled with tears? We are forced to deceive them (“It won’t hurt!”). So they grow up intimidated, distrustful, shrinking into a ball at the mere sight of a white coat. How can something that hurts be good?! But this is not only painful, but also unsafe. Post-injection infiltrates and abscesses today look like harmless complications compared to transinfusion infections - hepatitis, AIDS, etc.
Of course, all this could be neglected if the goal justified our actions, but this is not so. Here are just two of the most common misconceptions.
A serious infection can only be treated with injections. But the effect of treatment depends not on the method of administration of the drug, but on the spectrum of its activity and compliance with the characteristics of the pathogen. For example, penicillin, ampicillin or oxacillin will not be effective either in tablets or injections if the respiratory tract infection is caused by mycoplasmas (need macrolides) or microflora producing betalactamase enzymes (need co-amoxiclav or 2nd generation cephalosporins). For the same reason, injections of kefzol or cefamezine will not help. The child may eventually recover on his own, despite treatment, by mobilizing his defenses, but recurrence of the infection is highly likely. Then what, injections again?
When administered intramuscularly, the drug is more effective. This statement was true many years ago, before the advent of modern oral pediatric antibiotics with absorption rates of up to 90-95%. Numerous studies and clinical experience have proven that when taken orally, modern antibiotics create fairly high concentrations in all tissues and organs, many times exceeding the minimum inhibitory concentrations for major pathogens. Thus, in terms of pharmacokinetic parameters they are not inferior to injection forms, but in terms of the spectrum of action they have significant advantages in relation to many modern pathogens.
In addition, a number of drugs, including those indicated for pneumonia, generally exist only in oral form (for example, new macrolides - azithromycin, roxithromycin, etc.) and are successfully used all over the world. Moreover, in the vast majority of Western European countries, injections in outpatient practice are extremely rare. Injections at home concern only serious diseases that are being treated on an outpatient basis after a previous hospitalization (for example, bacterial endocarditis, etc.). As for infections of the respiratory tract and ENT organs, especially in children, only oral antibacterial drugs are used in treatment, including in a hospital setting. In the most severe cases, in children hospitalized in a state of severe intoxication, who refuse to eat, and with uncontrollable vomiting, the principle of step therapy is used, when intravenous infusion therapy is prescribed for 2-3 days, which is more gentle than intramuscular therapy, and then, as the condition stabilizes, - children's oral forms of antibiotics. This avoids unnecessary stress and unnecessary pain.
What do we have? According to a sample study, in Moscow, antibiotic injections are prescribed to children in 56% of cases for bronchitis, and in 90-100% of cases for pneumonia. In the hospital, when treating infections of the ENT organs in young children, injectable antibiotics also predominate (up to 80-90%).
One cannot help but mention an even more dangerous trend that characterizes the domestic practice of outpatient antibiotic therapy. In addition to the widespread use of injections, injectable antibiotics are often prescribed that are not intended for the treatment of infections of the respiratory tract and ENT organs. Moreover, not only not shown, but also prohibited! We are talking, first of all, about two drugs - gentamicin and lincamycin.
It is well known that aminoglycosides are intended for the treatment of gram-negative infections in a hospital setting under close laboratory control due to potential oto- and nephrotoxicity, and in our country gentamicin is often prescribed by the local pediatrician. This does not take into account that gentamicin (like all other aminoglycosides) does not include pneumococci in its spectrum of activity. Therefore, it has never been proposed anywhere as a drug for the treatment of outpatient infections of the respiratory tract and ENT organs. Apparently, this is not accidental, because pediatricians cannot treat against common sense if there is no result. Gentamicin gained popularity when strains of Haemophilus influenzae, resistant to ampicillin but sensitive to gentamicin, spread among pathogens that cause respiratory tract diseases in Russia. Empirically, pediatricians began to prescribe aminoglycosides at home, although there is a more rational solution to the problem - the use of oral “protected” penicillins (amoxicillin with clavulanic acid) and 2nd generation cephalosporins.
Lincomycin, a drug with very narrow indications and low efficiency, should be prescribed in a hospital only in the case of microbiologically confirmed sensitivity of the isolated pathogen, in particular staphylococcus, to it, and is not suitable for outpatient practice, where treatment is always carried out empirically. Having no effect on pneumococcus, it does not include Haemophilus influenzae in the spectrum of activity at all. In addition, lincomycin has another significant drawback: it has the most pronounced property of suppressing the bifido- and lactoflora necessary for the child, leading to dysbiosis and impaired colonization resistance of the gastrointestinal tract. (In this respect, only clindamycin and ampicillin are similar to it.) It is not difficult to understand why many Russian pediatricians prescribe gentamicin and lincomycin to children at home: doctors prefer injections to oral medications, so as to ensure the correct frequency of administration of beta-lactam antibiotics (penicillins or cephalosporins) 3 -4 times a day on an outpatient basis is not possible due to organizational difficulties. In the West, it is considered an unjustified extravagance for a procedural nurse to visit the patient at home 4 times a day and administer injections. We don’t feel sorry for anything for the children, but there aren’t enough nurses. Pediatricians came to a compromise solution: to prescribe injections of those antibiotics that can be administered only 2 times a day, i.e. lincomycin and gentamicin. As a result, the child loses: he is in pain, and the treatment is ineffective and unsafe.
In a sample study conducted by the author, it turned out that among 108 children hospitalized in a hospital with a respiratory tract infection (38 with bronchitis, 60 with pneumonia), 35% were young children. A thorough survey of parents revealed that almost 90% of children had previously received antibiotics, with the following drugs being prescribed most frequently in outpatient settings. (See Table 1.)
Table 1. Frequency of use of certain antibiotics in outpatient practice
For the drugs listed in table. 1, the following should be noted.
- Penicillin and ampicillin are inactive against many modern pathogens of respiratory infections, as they are destroyed by bacterial enzymes.
- Lincomycin does not include Haemophilus influenzae in its spectrum of activity at all, and gentamicin has no effect on pneumococcus.
- Ampicillin and lincomycin are known as drugs that suppress bifido- and lactoflora, with the highest incidence of dysbiosis in young children.
- Gentamicin is a potentially nephrotoxic aminoglycoside and should never be used in an outpatient setting as it requires inpatient laboratory monitoring.
Why have we developed such a vicious practice, when children from an early age not only receive painful and unnecessary injections, but are also given the wrong antibiotics? The reason, apparently, is that in our country the policy of antibiotic therapy, including in outpatient pediatrics, has always developed spontaneously, during the years of drug shortage, and has not been regulated by law. In Western countries, unlike Russia, documents regulating the rules of antibiotic therapy exist and are constantly updated.
Historically, “protected” penicillins and 2nd generation cephalosporins were not available to our doctors and patients in previous (pre-perestroika) years. When infections caused by beta-lactamase-producing flora became more frequent, and the “pills” really became ineffective, all hopes began to be pinned only on injections. But, as already mentioned, not being able to provide the required frequency of administration of beta-lactam antibiotics, they began to give preference to antibiotics with a 2-fold dosage regimen, despite the shortcomings in their spectrum and side effects.
Dear pediatricians! Let's leave all the problems in the past and state the fact that today our little patients live in a new Russia, in new conditions, where we cannot complain about a lack of information or a lack of medicines. Now we have all the conditions and opportunities to treat children no worse than abroad. Antibiotics from both European and American pharmaceutical companies are represented on the domestic market. All that remains is to abandon the old idea of the benefits of injections and in each specific case make the right choice of the pediatric form of the oral drug. The relevance of the problem presented is beyond doubt, since irrational antibiotic therapy adversely affects the health of children and their further development. Therefore, in 1998, on the basis of the Children's Clinical Hospital named after. N.F. Filatova (Chief Physician G.I. Lukin) on the initiative of the Department of Medical Care for Children and Mothers (Head of Department V.A. Proshin) of the Moscow Health Committee, the Cabinet of Rational Antibiotic Therapy was created. Patients are often referred to the Office with the consequences of inadequate and excessive therapy with antimicrobial drugs at an early age, which leads to allergization, dysbiotic disorders, the development of fever syndrome of unknown etiology and other diseases.
The primary task of the Cabinet is to optimize antibacterial therapy in outpatient pediatric practice. It was proposed to prohibit local pediatricians from using injections of gentamicin and lincomycin. In addition, guidelines have been developed focusing on effective and safe oral antibiotics for respiratory tract and ENT infections in children. These instructions are summarized in tables for brevity. (See Table 2-4.)
Table 2. Modern oral antibiotics for outpatient treatment of respiratory infections in children
| Group | Subgroup | Chemical name | Trade name of the pediatric oral form |
| Beta-lactam antibiotics - penicillins | Penicillins | Phenoxymethylpenicillin | Ospen, V-penicillin |
| Semi-synthetic penicillins | Oxacylain, Ampicilpin | Oxacyl, Ampicillin | |
| "Protected" penicillins - combined with clavulanic acid | Amoxicillin/clavulanate, or co-amoxiclav | Amoxiclav, Augmentin | |
| Beta-lactam antibiotics - cephalosporins | 1st generation cephalosporins | Cefadroxil, Cephalexin | Duracef, Cephalexin |
| 2nd generation cephalosporins | Cefuroxime, Cefaclor | Zinnat, Tseklor | |
| Macrolides | Macrolides | Azithromycin, Roxithromycin, Erythromycin | Sumamed, Rulid, Erythromycin |
Table 3. Differentiated approach to the initial choice of antibiotic for respiratory infections in children, depending on the localization of the process
Table 4. Algorithm for choosing a drug for protracted and recurrent respiratory infections of the nasopharynx and respiratory tract in children, depending on previous antibiotic therapy
| Pharyngitis, Tonsillitis | Otitis media, sinusitis | Bronchitis | Pneumonia | |
| Previous antibiotic | Recommended Antibiotic | |||
| Ospen, V-penicillin | Semi-synthetic or “protected” penicillins | Macrolides | ||
| Oxacyl, Ampicillin | 1st-2nd generation cephalosporins | Macrolides, 1st generation cephalosporins or “protected” penicillins | Macrolides | 2nd generation cephalosporins |
| Amoxiclav, Augmentin | Fusidine (Exclude mushrooms!) | Fusidine (Exclude mushrooms!) | Macrolides | Macrolides or 2nd generation cephalosporins |
| Duracef, Cephalexin | "Protected" penicillins | "Protected" penicillins | Macrolides | "Protected" penicillins or 2nd generation cephalosporins |
| Zinnat, Tseklor | Fusidine (Exclude mushrooms!) | Fusidine (Exclude mushrooms!) | Macrolides | Macrolides |
| Sumamed, Rulid Erythromycin | 1st-2nd generation cephalosporins | "Protected" penicillins | "Protected" penicillins | 2nd generation cephalosporins or “protected” penicillins |
For practice, it is very important that the majority of oral pediatric antibiotics (cephalosporins, macrolides, “protected” penicillins) are included in the List of free or preferential drugs, as is wisely done in Moscow. It should be noted that the implementation of the proposed recommendations promises not only children's gratitude, but also significant economic benefits. Foreign work and our randomized comparative studies conducted in real Russian conditions have proven that the use of seemingly more expensive imported drugs (modern macrolides, oral cephalosporins, “protected” penicillins) ultimately provides a significant economic effect due to the quality of treatment , reducing the duration of courses, no additional costs associated with injections, hospitalization, complications, etc. . With the correct targeted administration of oral drugs compared to traditional parenteral drugs (in a hospital setting), savings reach 15-25%.
Thus, at present, there is a real opportunity to almost completely abandon antibiotic injections in an outpatient setting due to the wide selection of oral pediatric forms of modern antibiotics, which in most cases are more effective than traditional parenteral ones. In a hospital, the modern gentle regimen for children should be considered the so-called step therapy, when in the first days, if the child is in a serious condition, he is prescribed an injectable antibiotic, and after 2-3 days they switch to the oral pediatric form of the drug.
In order to increase the level of knowledge of pediatricians in the field of modern possibilities of rational antibiotic therapy, for the second year now a permanent school-seminar has been operating in Moscow, organized by the Cabinet of Rational Antibiotic Therapy at the Children's City Clinical Hospital named after. N.F. Filatova. The number of students attending the school is growing from seminar to seminar, and we consider it advisable to recommend this form of information assistance to pediatricians in other regions of Russia.
We call on health care organizers, administrators and practicing doctors not only in Moscow, but also in other regions of Russia to declare war on conservatism and join the movement under the slogan “Happy childhood - without injections!”
Literature
1. Beloborodova N.V. Optimization of antibacterial therapy in pediatrics - current trends, Russian Medical Journal, 1997, vol. 5, N24, pp. 1597-1601.
2. Mothers of the symposium “Experience of using Sumamed in pediatric practice”, Moscow, March 18, 1995, 112 p.
3. Beloborodova N.V., Polukhina G.M. Advantages of the oral cephalosporin Cefaclor in the treatment of pneumonia in children (comparative randomized study with pharmacoeconomic analysis), Pediatrics, 1998, N1, pp. 49-54.
4. Samsygina G.A., Bratnina N.P., Vykhristyuk O.F. Rulid (roxithromycin) in the outpatient treatment of respiratory tract diseases in children, Pediatrics, 1998, N1, pp. 54-58.
5. Beloborodova N.V., Sorokin G.V. Clinical and pharmacoeconomic effectiveness of amoxicillin/clavulanate (Amoxiclav) in pediatric otorhinolaryngology, Bulletin of Perinatology and Pediatrics, 1998, v. 43, N5, pp. 49-56.
6. Strachunsky L.S., Rozenson O.L. Stepped therapy: a new approach to the use of antibacterial drugs, Clinical pharmacology and pharmacotherapy, 1997, vol. 6, N4, pp. 20-24.
The effectiveness of antibiotic therapy largely depends on the dose of the drug administered and the method of its administration. There are different methods of administration, for example, which have already become traditional - intramuscular, intravenous. In some cases, the optimal method of administering antibiotics is endolumbar, intraosseous. Endolymphatic. Recently, a new method has been developed - directed transport of antibiotics; the essence is that antibiotics are sent directly to the site of infection with the help of lymphocytes. To this day, oral administration of antibiotics and inhalation administration are also used (for example, for acute pneumonia, lung abscesses), although very rarely. The route of administration of antibiotics is largely determined by the severity of the inflammatory process. For example, for diseases of moderate severity or when antibiotics are prescribed for prophylactic purposes, intramuscular administration at an adequate interval will create an effective concentration of the drug in the blood. However, in severe patients, especially with peritonitis and sepsis, the absorption of drugs from the muscles is impaired due to deterioration in tissue perfusion. In this regard, intravenous antibiotics will be most effective. Preference should be given to jet administration of the drug (rather than drip), because With this method, an effective concentration of the drug in the blood is created faster.
In recent years, intra-aortic or intra-arterial and endolymphatic administration of antibiotics has become increasingly widespread. When drugs are administered into the arterial bed, most of the antibiotics go directly to the lesion. PET creates a high concentration of antibiotics in the lymph and blood, which persists for a long time. At the same time, the dose of the administered drug and the frequency of administration are reduced, which ultimately, in addition to a good therapeutic effect, also gives a certain economic effect.
The dose of antibiotic depends on the severity of the infection. For septic conditions, severe peritonitis, etc. they should be maximum, providing a bactericidal effect.
Considering the high risk and danger of developing dysbiosis during antibiotic therapy, it is especially necessary to use drugs that restore the normal intestinal biocenosis - drugs containing microorganisms of normal intestinal flora: colibacteria, bifidum bacteria, bificol. It is also advisable to use multienzyme drugs - panzinorm, festal.
To prevent superinfection and dysbiosis when prescribing broad-spectrum antibiotics, it is necessary to use nystatin or levorin. With the development of generalized candidiasis, parenteral use of amphotericin B is effective.
The administration of antibacterial agents intravenously or intramuscularly is used for moderate and severe disease. Parenteral administration allows:
- significantly increase the bioavailability of the product used;
- accelerate the achievement of maximum therapeutic concentrations in plasma and obtain a visible therapeutic effect much faster;
- exclude the effect of digestive system enzymes on the drug;
- provide first aid to unconscious patients with uncontrollable vomiting or dysphagia (impaired swallowing);
- use drugs that are poorly absorbed or destroyed in the gastrointestinal tract.
Antibiotic injections must be performed in a hospital setting. The attending physician must prescribe medications, as well as calculate the dosage of antibiotic required for administration. Antibiotic dosages are selected individually and depend on the age, weight and severity of the patient’s condition.
To prevent the development of allergic reactions (Quincke's edema, anaphylactic shock), all antibiotics are administered only after a sensitivity test.
Independent choice of the drug and selection of dosages can cause the development of severe side effects.
Before diluting the drug, the nurse should check the labels on the ampoule with the prescription sheet, and also check the expiration date of the ampoule. The packaging with the syringe must be checked for integrity and expiration date. Then a thorough hand hygiene is carried out. After the gloves are put on, they are treated with an alcohol ball.
The package with the syringe must be opened from the piston side. After opening the package, you should connect the needle to the syringe (the protective cap cannot be removed from the needle).
After opening the metal cap on the antibiotic bottle, you should also treat the rubber protective stopper with an alcohol ball.
Next, you need to remove the protective cap from the needle, draw the necessary solvent into the syringe (injection water, isotonic physiological solution). After piercing the rubber stopper with a needle, you need to carefully introduce the liquid into the bottle.
After disconnecting the syringe from the needle (the needle remains in the cap), the bottle must be thoroughly shaken until the antibiotic is completely dissolved.
The dissolved drug must be homogeneous, transparent and free of foreign matter. For some antibiotics, a yellowish tint of the solution is allowed.
After the antibiotic has completely dissolved, you need to connect the syringe back to the needle, turn the bottle over and draw out the required amount of medicine.
After collecting the solution, you need to make sure that there are no air bubbles in it. If necessary, turn the syringe over with the needle up, lightly tap the barrel (so that the bubbles rise up) and release the air bubbles.
How to calculate the dose of an antibiotic
Two dilution methods are used - 1:1 and 2:1.
In pediatric practice, a one-to-one dilution is used, and for adults, a two-to-one dilution.
To correctly calculate the dose, you must remember that 1,000,000 units of the drug is equal to 1,000 milligrams (1 gram). Accordingly, 0.5 grams = 500,000 units, 0.25 grams = 250,000 units.
When diluting an antibiotic using the one-to-one method, 1 milliliter of solvent is used per 100,000 units of antibiotic. Accordingly, to dilute 250 thousand units of the drug, add 2.5 milliliters, 500 thousand - five milliliters, 1 million units - 10 milliliters of solvent.
Dilution of antibiotics and calculation of the required dose in neonatology is also carried out on a one-to-one basis.
If an antibiotic is diluted at a rate of two to one, then 0.5 milliliters of solvent is used per hundred thousand units of the drug.
Accordingly, for 250 thousand units 1.25 of solvent is taken, for 500 thousand - 2.5 and for 1 million units - 5 milliliters of solvent.
Rules for diluting antibiotics
When using the one-to-one dilution method, it must be taken into account that each milliliter of the resulting solution will contain 100 thousand units or 100 milligrams of the drug. Accordingly, every 0.1 milliliter of solution contains 1000 units or ten milligrams of the drug.
The antibiotic solution must be prepared immediately before administration.
Calculation example:
Antibiotics– substances that are products of the vital activity of microorganisms that suppress the growth and development of certain groups of other microorganisms.
Main groups of antibiotics:
1. Penicillins:
benzylpenicillin (natural antibiotic);
semisynthetic penicillins: penicillase-resistant - oxacillin, methicillin, ampicillin, amoxicillin;
combined: ampiox, augmentin, unasin.
2. Cephalosporins: cefazolin, cefamandole, cefaclor, kefzol, cefuroxime, ceftriaxone, cefpirome.
3. Aminoglycosides: streptomycin, gentamicin, kanamycin, tobramycin, sisomycin, amikacin, netromycin.
4. Tetracyclines: tetracycline, metacycline, doxycycline.
5. Macrolides: erythromycin, oleandomycin, roxithromycin, azithromycin, clarithromycin.
7. Lincosamides: Levomecithin.
8. Rifampicins: rifampicin.
9. Antifungal antibiotics : levorin, nystatin.
10. Polymyxin c.
11. Lincosamines: lincomycin, clindamycin.
12. Fluoroquinolones: ofloxacin, ciprofloxacin, etc.
13. Carbapenems: impenem, meropenem.
14. Glycopeptides: vancomycin, eremomycin, teicoplanin
15. Monbaktams: Aztrenoam, karumonam.
16. Chloramphenicols : Levomecithin.
17 . Streptogramins: synercid
18 . Oxazolidinones: linezolid
Basic principles of antibacterial therapy
Use antibiotics only for strict indications.
Prescribe maximum therapeutic or, in severe forms of infection, subtoxic doses of antibiotics.
Maintain the frequency of administration throughout the day to maintain a constant bactericidal concentration of the drug in the blood plasma.
If long-term treatment with antibiotics is necessary, they must be changed every 5-7 days to avoid adaptation of the microflora to antibiotics.
Changes the antibiotic if it is ineffective.
When choosing an antibiotic, be based on the results of a microflora sensitivity study.
Consider synergism and antagonism when prescribing a combination of antibiotics, as well as antibiotics and other antibacterial drugs.
When prescribing antibiotics, pay attention to the possibility of side effects and drug toxicity.
To prevent allergic complications, carefully collect an allergic history; in some cases, it is mandatory to conduct an allergy skin test (penicillins) and prescribe antihistamines.
For long courses of antibiotic therapy, prescribe antifungal drugs to prevent dysbacteriosis, as well as vitamins.
Use the optimal route of antibiotic administration.
Routes of administration of antibiotics:
covering the wound with antibiotic powder;
introduction of tampons with antibiotic solutions;
administration through drainages (for irrigation of cavities);
administering antibiotics through an injection needle after puncture and removing pus from the cavities.
endotracheal and endobronchial administration through a catheter inserted into the nose and trachea, through a bronchoscope or by puncture of the trachea;
injection of an antibiotic solution into inflammatory infiltrates (injection under the infiltrate);
intraosseous administration (for osteomyelitis).
endolumbar injection (purulent meningitis);
intravenous administration;
intramuscular administration;
intra-arterial administration is used for severe purulent extremities and some internal organs - antibiotics are administered into the artery by puncture, and, if necessary, long-term intra-arterial infusion through a catheter inserted into the corresponding arterial branch;
taking antibiotics per os;
endolymphatic administration of antibiotics makes it possible to create a high concentration of them in organs and tissues during an inflammatory purulent process.
Methods used:
a) direct injection, when the lumen of the isolated lymph vessel is filled through a needle or permanent catheter;
b) by injection into large lymph nodes;
c) subcutaneously in the projection of the lymphatic collectors.
Endolymphatic administration of antibiotics creates a 10 times greater concentration at the site of infection compared to traditional routes of administration, which ensures faster relief of the inflammatory process.
Antibiotics can be administered orally, intramuscularly, or intravenously.
The route of administration of the drug can have a major impact on the effect.
The choice is usually made between the oral and parenteral routes. Oral antimicrobials are commonly used for mild and ambulatory infections due to variations in bioavailability associated with first pass through the liver with this route of administration.
More serious infections, as well as when the drug is poorly absorbed or destroyed in the gastrointestinal tract, are treated with parenteral (intramuscular or intravenous) administration to avoid absorption in the gastrointestinal tract, first pass through the liver and due to the rapid and reliable achievement of therapeutic concentrations of the drug in the blood. In severe cases of infection, intravenous administration of drugs is preferable, since the delivery of drugs into the blood does not depend on complex absorption pathways and the effect occurs quickly. This is especially important for life-threatening infections.
Aminoglycosides are practically not absorbed into the gastrointestinal tract, and penicillin is destroyed by hydrochloric acid of gastric juice. In this regard, these drugs are used parenterally.
Intravenous administration of an antibiotic can be carried out simultaneously (in the form of a bolus) or as a continuous injection throughout the day.
Local administration of antibiotics to sites of infection is rarely used. Since the drug cannot be retained at the injection site, it is lost, and the concentration of antibiotic in the blood may not be sufficient.
Local administration of antibiotics is practically not used clinically, since it does not guarantee the achievement of therapeutic concentrations and does not replace general treatment, which must be carried out when there are septic phenomena and there is a danger of generalization of the infection.
The risk of allergization with topical antibiotic use is higher than with parenteral use.
As a rule, antibiotics distribute well in tissues, and their local concentration in inflamed tissues differs little from the concentration in the blood. Many antibiotics pass the BBB during inflammation of the meningeal membranes, enter the cerebrospinal fluid when administered intravenously and are used in the treatment of meningitis.
When administered intravenously, the concentration of the antibiotic in the blood and peritoneal exudate is the same. Therefore, intraperitoneal administration of the antibiotic provides no benefit and is not used.
The choice of route of antibiotic administration also depends on the bioavailability of the drug.
Antibiotics with high bioavailability (more than 60%) can be used orally if the patient can swallow, there is no vomiting and there is no dysfunction of the gastrointestinal tract.
Antibiotics with a bioavailability of 30 to 60%, as a rule, do not create high concentrations in tissues and are used when bacteria are very sensitive to them (for example, macrolides), as well as for mild forms of infection.
Antibiotics with low bioavailability of less than 30% (for example, aminoglycosides, parenteral cephalosporins) are used parenterally to obtain a resorptive effect.
