causes cardiogenic shock. Extreme insufficiency of the contractile function of the heart or cardiogenic shock: are there any chances? Mechanisms for the development of pathology

Burns do not always require the use of antibacterial drugs. Many people make the mistake of using these: antibiotics - potent substances having strict indications and contraindications.

Why use antibiotics for burns?

Antibacterial therapy is used in the treatment and prevention of various types of infections. The latter easily penetrate the body through open wounds. Dead tissue at the site of injury is an ideal breeding ground for pathogens.

Bacteria interfere with wound healing, contribute to excessive scarring, and sometimes pose a threat to the life of the victim.

However, strong drugs are not always appropriate. Human skin has powerful protective properties and in most cases can deal with infections on its own.

But in some cases, antibiotic therapy is necessary:

1. Deep and large-scale lesions of mucous membranes, skin, internal organs. Loss large area tissues leads to disruption of the metabolic functions of the body, immune protection, in particular anti-infectious;
2. Elderly age;
3. Availability chronic infections;
4. Diabetes;
5. Lack of burn treatment and, as a result, its complication.

But antibiotics are not used in the following situations:

• deep but limited damage;
• the burn is less than 10% of the body surface;
• 1st degree burns (epidermal).

The doctor, assessing the need for antibiotic therapy, takes into account the following factors:

1. Depth, vastness of the wound;
2. Burn degree;
3. The presence of complications;
4. Age, immune status of the victim;
5. Type, severity of complications;
6. The sensitivity of the patient to antibacterial agents.

What antibiotics are used for burns?

The vast majority of drugs based on silver sulfadiazine are used.

Therapy can be local (external), systemic and, in especially severe cases, combined.

External treatment involves dressings with solutions of iodopyrone and iodovidone 1%. Ointments based on dioxidine and levomycetin are also used.

Systemic therapy involves oral and/or intravenous/intramuscular administration of drugs. Such treatment is carried out only in a hospital under the supervision of doctors.

Systemic therapy is carried out only if there is deep wounds occupying more than 10% of the body area. If the infection is mild, limited to intramuscular injections.

Otherwise, apply intravenous administration medicines. Systemic treatment is carried out with the following medicines:

• semi-synthetic penicillins;
• sulbactam and cefoperazone (often a combination);
• aminoglycosides and fluoroquinolones;
• latest generation cephalosporins;
• lincomycin for bone disease;
• « Nystatin" or " Fluconazole» with a fungal infection.

Refusal of antibiotic treatment of burns

Without therapy, the infection will not disappear without a trace. If the doctor prescribed antibiotic therapy, and the patient refused them, the following complications may occur:

• lymphadenitis;
• sepsis;
• myocarditis;
• purulent arthritis;
• lung/bronchial diseases;
• urinary tract infections.

Basically, therapy involves the use of a drug of one type. Several different medicines are prescribed only when there is an infection, it severe course.

Local treatment of burns: basic principles

The funds used are divided into several groups according to the current principle:

Modern means: antibacterial / antiseptic drugs

Ointment "Betadine"

Based on povidone-iodine - a modern alternative to traditional iodine. "Betadine" is a broad-spectrum agent, active against many pathogens. Treatment involves treating the wound with a thin layer of ointment several times a day.

"Katapol"

It includes a copolymer with crotonic acid and benzalkonium chloride in the composition of povidone. Like the previous drug, it is active against many bacteria. Burns are treated aqueous solution 1% (dilute the solution with 10% distilled water). Medicinal solution soak tampons, wipes and gauze bandages to protect the wound.

Silvederm

Broad spectrum antibacterial drug. For ease of use, it is produced in the form of an aerosol, cream and ointment. The drug belongs to sulfanilamide, the active substance in the composition is sulfadiazine. Antibacterial activity provided by silver ions.

Healing agents

Solcoseryl

At the moment he is the most popular means to accelerate the regeneration of damaged tissues. In the treatment of burns, two forms of the drug are used: ointment and gel. The healing edges of the wound are treated with ointment, and the wound surface itself is treated with gel. Processing is carried out up to 2 times a day. After the wetness has passed, you can use only the ointment.

"Panthenol"

Another popular tissue regeneration stimulant. The composition of the drug includes B vitamins and dexpanthenol. " Panthenol» improves cell regeneration, stimulates metabolic processes in tissues, and also has a slight anti-inflammatory effect. You can use a cream or spray. The cream is easily absorbed, so it is more convenient to use for painful sunburns and light burns. The aerosol is sprayed from a short distance.

Composite medicines

"Argakol"

The drug is in the form of a hydrogel, based on antiseptic substances: catapole, dioxidine, poviargol (silver preparation). " Argakol"- a potent antibacterial agent that can treat not only burns, but also abrasions / cuts.

After treatment, an air- and water-permeable elastic film is formed on the body, which is easily washed off with water.

Aerosol "Amprovizol"

Includes menthol, anestezin, propolis and vitamin D. Thanks to the combination active substances, the drug has a cooling, antiseptic, anti-inflammatory effect, accelerates regeneration. The aerosol is recommended for use in sunny / thermal burns 1 degree.

Olazol

Positioned as a wound healing agent; combined foam preparation, which includes sea buckthorn oil. " Olazol» is available in aerosol form for ease of use. The agent has an antibacterial and anesthetic effect, and also improves regeneration, accelerates epithelialization and reduces exudation.

For non-infected 2nd degree burns, atraumatic and wet-drying dressings with antiseptic or antibiotic solutions are required. You can also use hydrogel coatings.

Grade 2 lesions can be treated with ointments/emulsions that provide pain relief and bactericidal action(pr. "Agrosulfan", silver sulfazine 1%, "Levosin", "Levomekol").

For citation: Alekseev A.A., Krutikov M.G., Yakovlev V.P. ANTIBACTERIAL THERAPY IN COMPLEX TREATMENT AND PREVENTION OF INFECTIOUS COMPLICATIONS IN BURN // BC. 1997. No. 24. S. 6

Infectious complications of burn disease are the most common cause burnt deaths. In addition to the danger to life, the infection leads to a delay in the healing process of burn wounds. The article deals with the issues of antibiotic therapy infectious complications in burn patients and its place in the complex treatment of burn disease.

Infectious complications of burns are the most common cause of death of the burned. Addition to life threats, infection retards burn wound healing. The paper considers the antibacterial therapy of infectious complications in the burnt and its role in the multimodality treatment of burns.

A.A. Alekseev, M.G. Krutikov, V.P. Yakovlev Institute of Surgery. A.V. Vishnevsky RAMS, Moscow
A.A. Alekseyev, M.G. Krutikov, V.P. Yakovlev

A.V. Vishnevsky Institute of Surgery, Russian Academy of Medical Sciences, Moscow

Introduction

Currently, the frequency of burns in developed countries reaches 1:1000 of the population per year, and mortality from burns ranges from 1.5 to 5.9%. At the same time, the most common cause of death in burn victims is infection, which, according to some authors, accounts for 76.3% of the mortality rate in burn victims.
In addition to the immediate danger to the life of the patient, the prolonged existence of infection leads to a delay in the healing process of burn wounds and contributes to excessive scarring, which continues as a result of chronic stimulation. inflammatory cells. Infection creates difficulties for timely autodermoplastic closure of burn wounds, and the issues of infection remain relevant during early excision of a burn wound. Significant difficulties are caused by infection when using such modern methods closing burn surface as keratocyte transplantation and culture of allofibroblasts.
Necrotic tissues formed in the area of ​​burn damage are a favorable environment for invasion and reproduction of microorganisms. Thus, any burn injury of any severity creates conditions for the development of a wound infection. With extensive and deep burns in the body, a number of pathological processes, manifested by the clinical picture of burn disease and creating additional prerequisites for the development of the infectious process and its generalization. In addition to the loss of a protective skin cover over a large surface area of ​​the body, which creates entrance gate for microbial invasion, it is the disintegration of the most important neurotrophic and metabolic functions of the body, leading to a violation of factors anti-infective protection.

The course of a burn disease

The course of a burn disease is divided into several periods: burn shock, acute burn toxemia, septicotoxemia and convalescence. Such a subdivision, although it can be considered rather arbitrary, facilitates the understanding of pathogenesis and contributes to the development of systematic treatment tactics.
Thus, in the period of burn shock, microcirculation disturbances, plasma loss and associated protein loss lead to alterative-dystrophic changes in the organs of immunogenesis. Immunosuppression is aggravated during the period of burn toxemia, which is associated with the accumulation in the body of medium molecular weight peptides and other toxic products of histiogenic, bacterial origin, nonspecific metabolites and biologically active substances. Waste products of microorganisms support immunosuppression during the period of septicotoxemia. The prolonged existence of burn wounds leads to the development of exhaustion, the progression of protein deficiency and, as a result, immunodeficiency.
A decrease in the protective and compensatory capabilities of the body predetermines the development of infection and its generalization.
The above aspects of the pathogenesis of burn wounds and burn disease make the development of a complex of methods for the prevention and treatment of infection and infectious complications in burned patients is one of the priority areas for the development of modern combustiology. In the complex of measures aimed at the prevention and treatment of infections in burned patients, an important place belongs to antibacterial therapy.

Antibacterial therapy

Experience in the treatment of burned patients scientific and practical center thermal lesions of the Institute of Surgery. A.V. Vishnevsky RAMS made it possible to develop basic approaches to antibiotic therapy in these patients.
Prescribing antibacterial drugs to burn patients should be based on integrated assessment their condition, taking into account the extent of damage, its depth, the stage of burn disease, its complications, the degree of microbial contamination of burn wounds, immune status, as well as the age of the patient, the nature and severity of concomitant pathology.
Victims with II-III A degree burns, as well as patients with limited deep burns, occupying no more than 10% of the body surface, the appointment of systemic antibacterial drugs in most cases seems inappropriate. The exception is patients of the elderly and old age suffering diabetes, chronic infections, as well as victims admitted for treatment late after injury with severe general and local signs of infection, when local antibacterial drugs have no effect. The rest of the patients are shown local antibiotic therapy: dressings with a 1% solution of iodovidone or iodopyrone, water-soluble ointments containing levomycetin or dioxidine, silver sulfadiazine preparations. The combination of Levomekol ointment dressing with gentamicin or neobacitracin powder in gram-negative flora has proven itself well. The use of synthetic coatings containing antibacterial drugs is promising. In the treatment of such patients in regional bacterial isolators, daily treatment of wounds with a solution of iodopyrone or iodovidone is sufficient.
Performing early surgical necrectomy with simultaneous autodermoplasty in patients with limited deep burns requires prophylactic administration of systemic antibacterial drugs in a course of 3-5 days, starting from the day of surgery. In this case, it is enough to take drugs orally or intramuscularly. Preference should be given to popusynthetic penicillins or cephalosporins of I, II generations, and with gram-negative microflora - aminoglycosides.
With the development of burn disease in victims with extensive deep burns, antibiotic therapy is integral part a whole range of measures aimed at the prevention and treatment of infection of burn wounds and infectious complications. In the complex of measures to prevent infectious complications of burn disease, an important place is occupied by timely and effective treatment burn shock. Adequate detoxification therapy and correction of homeostasis disorders should continue during periods of acute burn toxemia and septicotoxemia. One of the important measures is early immunotherapy and immunoprophylaxis. Great importance has a local conservative treatment of burned patients. This should be understood not only as medications, but also treatment in an abacterial environment using Clinitron beds or abacterial isolators, as well as physical methods treatment: UVI, laser therapy, ozone therapy, etc. The use of these methods of general and local treatment severely burned is designed to ensure, as a result, necrectomy and plastic restoration skin. Antibacterial therapy with this chain is carried out in two directions: topical application antibiotics and systemic antibiotic therapy.
From local antimicrobials solutions of polyvinylpyrollidone iodine (iodopyrone or iodovidone), polyethylene glycol (PEG)-based ointments (levosin, levomekol, dioxycol, 5% dioxidine ointment), silver sulfadiazine preparations, etc. have proven themselves well. Features of the wound process require individual approach to the choice of drug for local treatment. So, with a wet scab, it is preferable to use wet-drying dressings with an antiseptic solution, of which 1% solutions of iodopyrone or iodovidone are the most effective. These solutions are also used to treat the wound surface when open method management of the burnt. After chemical or surgical necrectomy, treatment is carried out with PEG-based ointments; after autodermoplastic closure of burn wounds, a bandage with a solution of furacillin and a cotton-gauze bandage with a PEG-based ointment are applied to the transplanted flaps.
Indications for the appointment of systemic antibiotic therapy in patients with extensive deep burns depend on both the severity of the injury and the period of the burn disease.
Patients with an area of ​​deep burns of more than 10% of the body surface, as a rule, are given systemic antibiotic therapy, and strictly individually, depending on the contamination of the burn wound, the degree of intoxication and the parameters of the immunological reactivity of the body. It should be emphasized that in victims with burns of 10–20% of the body surface, it is possible to limit the intake of drugs orally or intramuscularly, resorting to intravenous infusions only in severe infections.

With an increase in the area of ​​deep damage, the risk of developing generalized infectious complications of burn disease increases significantly. In this regard, for victims with extensive deep burns of more than 20% of the body surface, antibacterial therapy for the purpose of prevention, and then the treatment of complications of burn disease, is included in complex therapy immediately after the patient is removed from the state of burn shock. All antibacterial drugs are administered to these patients intravenously.
An absolute indication for immediate and intensive antibiotic therapy is the development of infectious complications of burn disease.
The use of antibacterial drugs in severe and extremely severe burn shock seems inappropriate due to difficult-to-correct circulatory disorders, disorders excretory function kidneys and liver. The exception is cases of combined skin damage with thermal inhalation injury, which in most cases leads to the rapid development of purulent diffuse tracheobronchitis and pneumonia and requires immediate antibiotic therapy. In this case, preference should be given to drugs with a minimal nephrotoxic effect, and therapy should be carried out under strict control of drug concentrations in blood serum. As a rule, the causative agents of infection in those burned in early dates after trauma are gram-positive microorganisms, mainly S. epidermidis and S. aureus, therefore, during the period of burn shock, it is advisable to prescribe cephalosporins of I or II generations.
During an acute burn toxemia the main role in the prevention of burn wound infection and infectious complications of burn disease belongs to detoxification therapy using forced diuresis or extracorporeal detoxification. Absolute indications for antibiotic therapy during this period of burn disease are early development infectious complications and the onset of purulent fusion of the burn scab, in most cases associated with the development of Pseudomonas aeruginosa.
With deep extensive burns of more than 20% of the body surface in the period of toxemia, prophylactic administration of systemic antibacterial drugs is possible. Antibiotic prophylaxis in the period of acute burn toxemia is preferably carried out with broad-spectrum drugs from the group of semi-synthetic penicillins or cephalosporins of the I and II generations, using aminoglycosides for Pseudomonas aeruginosa. Application more modern drugs, such as fluoroquinolones and cephalosporins III and IV generations, in the period of acute burn toxemia is inappropriate, except in cases of generalization of infection. Our experience shows that in about 50% of cases, the use of these highly effective antibiotics does not prevent the development of suppuration under the scab. At the same time, the further selection of antibacterial drugs in connection with the selection of multiresistant strains of microorganisms becomes much more complicated.
In the period septicotoxemia systemic antibiotic therapy in victims with deep and extensive burns is carried out both to combat wound infection and to prevent its generalization, which is inextricably linked to one another. Indications for the appointment of systemic antibacterial drugs during this period of burn disease depend on the area of ​​a deep burn, the nature of the infectious process, the threat or development of infectious complications and are determined by clinical data, taking into account the level of microbial contamination of burn wounds and the state of the immune status.
As a rule, antibiotic therapy should be carried out in all patients with developed immunosuppressive syndrome, as well as in those who have been burned with seeding of burn wounds exceeding the critical value of 10 CFU per 1 g of tissue.
Usually, during the period of septicotoxemia in burn wounds, the pathogen changes, the wounds are colonized by polyresistant, hospital strains microorganisms, represented in most cases by associations of gram-positive and gram-negative flora. In this regard, it is especially important to carry out antibacterial therapy during this period strictly on the basis of antibiograms, taking into account the sensitivity of the isolated microflora. If the microflora is multicomponent and not all of its representatives are sensitive to antibacterial drugs, therapy should be carried out, focusing on the sensitivity of the main causative agents of burn infection, using the principle of sequential exposure to the components of the association. This makes it possible to achieve the elimination of part of the association components and reduce the level of microbial contamination of the wound, and, accordingly, the risk of possible complications.
Subsequently, antibiotic therapy is carried out according to the sensitivity of the isolated microflora with broad-spectrum drugs. The drugs of choice are semi-synthetic penicillins (ampicillin, carbenicillin) and their combination with beta-lactamase inhibitors (amoxicillin + clavulanic acid, ampicillin + sulbactam), cephalosporins III generation(cefotaxime, ceftazidime, ceftizoxime, ceftriaxone, cefoperazone), combination of cefoperazone with sulbactam, aminoglycosides (gentamicin, tobramycin and sisomycin), fluoroquinolones (ofloxacin, pefloxacin and lomefloxacin). With deep burns with damage to bone structures, it is advisable to prescribe lincomycin, if an anaerobic non-clostridial infection is detected - clindamycin and metronidazole.

In recent years, the frequency of infections caused by fungi of the genus Candida has been growing in foreign burn centers, and the number of such infections is also increasing in domestic hospitals. Detection of a fungal infection requires the administration of nystatin, amphotericin B, or fluconazole. Prophylactic administration of nystatin is necessary for all burned patients who are receiving systemic antibiotic therapy with broad-spectrum drugs.
Some antimicrobials should be considered as reserve drugs that can be used when the above antibacterial drugs and their combinations are ineffective. These drugs include: ureidopenicillins - piperacillin, meelocillin and aelocillin; combination of piperacillin with tazobactam; 4th generation cephalosporin - ceflir; aminoglycosides - amikacin and netilmicin; fluoroquinolones - ciprofloxacin; rifampicin; ristomycin and vancomycin; dioxidine and fusidine.
The infectious process, which began in a burn wound, can generalize and lead to the development of such severe complications burn diseases like pneumonia and sepsis. The likelihood of this increases in patients with extensive deep burns. In addition to a severe generalized infection, the course of a burn disease can be complicated by tracheobronchitis, urinary tract infection, purulent arthritis, myocarditis, endocarditis, lymphangitis and lymphadenitis, etc.
Sepsis is the most formidable infectious complication of burn disease. The etiology of sepsis in burned patients is diverse: all types of microorganisms inhabiting a burn wound can cause its development.
The most common causative agents of sepsis are S.aureus and P.aeruginosa, which are isolated from burn wounds in 70 - 80% of patients, also predominating in the blood cultures of patients with sepsis. When studying blood cultures, most researchers note the “advantage” of gram-positive flora: the ratio of the inoculation of S.aureus and P.aeruginosa strains in blood cultures of patients with burn sepsis is 2: 1. Less commonly, the causative agent of sepsis is E. coli, Acinetobacter spp., Citrobacter spp., Enterobacter spp., beta-hemolytic streptococcus, non-sporogenic anaerobic bacteria. When these microorganisms are isolated from wounds, and even more so in blood culture, the prognosis is usually unfavorable. In recent years, cases of sepsis caused by pathogenic fungi have become more frequent, mostly of the genus Candida, less often Actinomycetes, Phycomycetes, Zygomyc ets. The most severe course of sepsis is observed when an association of microorganisms is isolated in the blood culture. Established sepsis or high risk its development require the immediate start of a comprehensive intensive care, taking into account all the links in the pathogenesis of this complication.
The main form of lung injury in burn disease is pneumonia. According to our data, with an increase in the area of ​​deep burns, the frequency of infectious complications, especially pneumonia, increases significantly: the incidence of pneumonia in deep burns of more than 40% of the body surface reaches 65%. Pneumonia was detected in 205 (76.5%) of 268 severely burned patients.
etiological factor pneumonia, as well as sepsis, can be any microorganisms inhabiting a burn wound. With the development of pneumonia in the early stages after injury, mainly against the background of thermal inhalation lesions, endogenous infection with microorganisms from the oral cavity, nasopharynx, etc. is possible. with pneumonia and thermoinhalation injury in 84.3 and 81.8% of cases, respectively.
In the fight against generalized infection, rational systemic antibiotic therapy is of primary importance. The choice of an antibacterial drug should be based on antibiogram data with mandatory consideration of the sensitivity of microflora isolated from blood or burn wounds. Antibacterial therapy should be carried out for a long time, in maximum doses with a timely change of drugs. All drugs are administered intravenously. Microbiological monitoring is carried out every 7-10 days. In severe infections, combined antibiotic therapy with two or three drugs is carried out. At sepsis or pneumonia caused by gram-positive flora, the antibiotics of choice are semi-synthetic broad-spectrum penicillins, cephalosporins of the 1st or 2nd generation, lincomycin, and fusidine and dioxidine. Reserve antibiotics are fluoroquinolones and vancomycin. With gram-negative microflora, treatment is carried out with carbenicillin, gentamicin, tobramycin or sisomycin in maximum doses. A combination of carbenicillin with an aminoglycoside is preferred. Reserve antibiotics - piperacillin, meelocillin, ciprofloxacin, amikacin and netilmicin. Combinations of ciprofloxacin with metronidazole or dioxidine, carbenicillin with gentamicin and dioxidine or metronidazole have proven themselves well. Sepsis due to nonsporogenic anaerobic bacteria, requires therapy with clindamycin or metronidazole. In fungal sepsis, the drugs of choice are amphotericin B and fluconazole.

“Local” antibiotic therapy in the form of inhalations is carried out for all patients with pneumonia. The composition of inhalations includes solutions of an antiseptic (dioxidin 10 ml of a 1% solution) or semi-synthetic penicillins (100 - 200 thousand U / ml), bronchodilators (eufillin 3 ml of a 2.4% solution), proteolytic enzymes (trypsin, terrilitin or panhipsin), heparin , as well as anti-inflammatory drugs (prednisolone, hydrocortisone).In severe lesions, therapeutic bronchoscopy is performed, ending with the introduction of antibacterial drugs into the tracheobronchial tree in combination with anti-inflammatory and bronchodilator drugs.
Systemic antibiotic therapy for severe pneumonia is carried out on the basis of a microbiological study of sputum cultures or swabs from the tracheobronchial tree. If it is impossible to obtain material, based on the fact that the infectious process in the lung tissue is caused by the same pathogen that is found in the wound contents, antibiotic therapy is carried out on the basis of a study of the wound microflora. In this case, the control of the microflora of burn wounds with the determination of the sensitivity of bacteria to antibiotics should be carried out at least 1 time in 7-10 days. This approach allows you to timely change the antibacterial drug, if necessary, taking into account the sensitivity of the microflora.
Tracheobronchitis is mainly the result of thermoinhalation defeats respiratory tract rarely occur as exacerbations chronic processes in the tracheobronchial tree. Treatment is similar to that of pneumonia.
Issues of prevention and treatment of urinary tract infections in those who have been burned in recent years, they are practically not discussed. On the one hand, this is due to their relatively low frequency (1 - 4.5%), on the other hand, with the objective difficulties of their diagnosis in this category of patients.
Inflammatory changes in the kidneys in most cases occur during the burn period. septicotoxemia and are manifested by pyelonephritis associated with ascending urinary tract infection (more often in the form of cystitis phenomena). The most common cause of an ascending urinary tract infection is prolonged catheterization. Bladder and inadequate care of the catheter.
Our observations confirm low frequency development of pyelonephritis in burned patients. So, in the period from 1990 to 1995, the frequency of detection of pyelonephritis varied from 0.5 to 1.2%. At the same time, in 5 - 9% of those burned, clinical picture cystitis.
With the development of urinary tract infection, complex therapy is carried out depending on its nature and severity of the course. For acute nonspecific urethritis and cystitis in complex therapy include furagin 0.1 g 3-4 times a day or 5-NOC 0.1 g 4 times a day, antispasmodics are prescribed, plentiful drink. In most cases, such a set of measures leads to a rapid relief of the symptoms of the disease. If these drugs are ineffective, fluoroquinolones may be included in complex therapy. The development of pyelonephritis requires a longer targeted antibiotic therapy, the use of antispasmodics, diet, correction of metabolic acidosis that develops in some cases.
Infectious lesions of the joints or purulent In the past, arthritis occupied a significant place in the structure of infectious complications of burn disease. The frequency of these complications was, according to different authors, from 1 to 7%. At the same time, in most cases, purulent arthritis developed 2–4 months after the injury against the background of burn exhaustion or sepsis. At present, the widespread introduction of active combustiology into practice surgical tactics led to a significant reduction in the frequency of purulent arthritis.
In treatment purulent arthritis Antibacterial therapy and daily punctures of the joint with washing of its cavity with solutions of antiseptics or antibiotics are of primary importance. If therapy is ineffective, the joint is drained and a system for continuous flow-through lavage is installed. Since the beginning of treatment, immobilization of the joint is carried out. When prescribing systemic antibacterial drugs, preference should be given to drugs with targeted osteotropic action.

Conclusion

The rational use of antibiotic therapy in the complex treatment of burn patients can reduce the frequency and severity of infectious complications of burn disease, but to this day they are a serious threat to the lives of victims with thermal injury. That is why the constant improvement of methods for the prevention and treatment of infection remains one of the priority tasks of combustiology.

Literature:

1. Yudenich V.V. // "Treatment of burns and their consequences". Moscow. "Medicine" 1980, 191s.
2. McManus W.F. Arch Surg 1989;124(6):718-20.
3. Hunt TK. J. Trauma 1979;19(11):890-3.
4. Atyasov N.I., Matchin E.N. // “Restoration of the skin heavily burned with mesh grafts”. Saransk. 1989. 201s.
5. Deitch EA. Burns 1985;12(2):109-14.
6. Teepe RGC, Kreis RW, Koebrugge EJ, et al. J Trauma 1990;30:269-775.
7 . Sarkisov D.S., Alekseev A.A., Tumanov V.P. etc. // Surgery. 1993.3.8-12.
8. Sapata-Sirvent RL, Xue-Wei-Wang, Miller G, et al. Burns 1985;11:330-6
9. Alekseev A.A. // “Burn sepsis: diagnosis, prevention, baking.” Abstract diss. doc. honey.Sciences. Moscow. 1993.
10. Alekseev A.A., Krutikov M.G., Grishina I.A. and etc. // Clinical pharmacology and therapy. 1996,2,40-4.

Antibiotics for burns are drugs that are prescribed to heal the affected areas of the skin. They are aimed at suppressing infection in the wound. The spread of microbes slows down the restoration of the integument of the epidermis and leads to the formation of scars, which later remain unchanged.

Antibiotics are recommended only for 1-2 degree burn injuries. This method of treatment is inappropriate for stages 2-3, as well as with deep lesions, the localization of which exceeds 10-15% on the body.

You can not use drugs on their own, without a doctor's prescription. This can aggravate the situation and cause backfire, scars and scars.

In a hospital, the doctor will determine the stage of thermal damage to the epidermis and will make a comprehensive treatment.

The doctor decides whether to prescribe antibiotics for, referring to the following factors:

• age;
• chronic diseases (diabetes), infections;
• the extent of thermal damage and the area of ​​localization;
• sensitivity and the presence of an allergy to a particular drug.

Features of use for burns 2 and 3 degrees

Antibiotics for burns of 2 and 3 degrees are allowed to be used if the affected area is small. For home treatment, it is necessary to observe sterility, to prevent infection.

In everyday life, antibiotics are used for. Unpleasant incidents are common in young children, less often in adolescents.

Treatment should consist of several methods. Damage to the mucous membranes of the body, as well as burns in the groin, genitals, and face are considered dangerous.

Antibiotics help strengthen the immune system, fight pathogens. If they are not used, then it is possible to get complications in the form of pneumonia, sepsis, lymphadenitis.

For quick healing of wounds, they take external antibacterial ointments and creams, home tinctures, solutions.

Antibiotics for external use

Topical antibiotics (those that pass through the esophagus) have an antimicrobial effect. Here is a list of the most popular drugs:

1. Ointments containing silver sulfadiazine. These include drugs such as Sulfadiazine, Silvederm, Dermazin.
2. Yodopirone and Yodovidone. They have a strengthening effect on the immune system, most often such solutions are prescribed with a 1% concentration. Apply after sunburn treatment antiseptics such as Furacilin, Miramistin and Chlorhexidine.
3. , Levosin, Clormikol.
4. Drugs that eliminate the source of infection when the burn blisters begin to burst. These include Dioxidin, Streptonitol (contains nitazole) and gentamicin ointment.

All products are suitable for external use at home. Before use, it is necessary to consult a doctor for contraindications and allergic reactions.

Preparations for systemic use

Internal preparations have more strong action than topical treatments.

With burns, the body's immunity decreases, as a result of which complications appear in the form of nausea and high fever, and scars may not heal for a long time. Antibiotics for internal use are needed to normalize functions immune system. They are prescribed by a doctor in a compartment with antiseptic ointments and creams.

Medicine offers many drugs in tablet form. We do not recommend taking pills on your own, consult your doctor.

List of the most effective antibiotics for various degrees of thermal and chemical skin damage:

1. Ceclor, Cefuroxime, Cefazolin. The drugs are non-toxic and practically have no contraindications, they are used in the first and second stages, as well as in case of toxicemia.
2. Bicillin. Kills the root of the infection in the wound due to the main component in the composition - penicillin. Relieves swelling and itching.
3. Amoxicillin and disodium salt, Ampicillin. Prevent the development of sepsis and promote speedy recovery skin on hands and feet.
4. Aminoglycosides, which belong to the second generation, contain a beta-lactam substance. In a pharmacy they are found under the name Unazin and Sulacillin.
5. Cefixime, Cefotaxime, Ceftriaxone. Treat the third stages of burn injuries.
6. Nystatin, Fluconazole. They are used for complications after healing, such as a fungal infection.
7. Clindamycin and Metronidazole. It is prescribed for an infection that quickly spreads throughout the body.

This is not the whole list of funds that are prescribed for burn injuries. More often, the doctor recommends undergoing course therapy, which consists of taking several drugs. In the third stage of burns, when the wound localization area is too large, hospitalization is advised. home treatment in such cases will be ineffective and life-threatening.

Contraindications

If you act incorrectly with burn injuries, you can cause irreparable harm to health and appearance. To prevent this from happening, consider a few general contraindications:

• it is forbidden to lubricate the wounds with greasy creams or oils;
• it is not recommended to apply ice cubes to burns, this can cause frostbite of tissue integuments;
• it is forbidden to press or independently open blisters on the body;
• prescriptions are not allowed. alternative medicine without a doctor's approval;
• it is forbidden to use external means for the eyes, throat and other mucous membranes;
• It is not recommended to give antibiotics to a child under three years of age.

Antibiotics for burns are prescribed for speedy healing without complications. The purpose of their action is the elimination and prevention of infections in the wound surface. Thanks to this, inflammation is excluded, tissues recover faster, scars and scars are absent.

When are antibiotics prescribed?

External means are considered mandatory for injuries of the 2nd degree. These drugs are prescribed for deep wound surfaces, whose area exceeds 10% of the body.

Antibiotics for burns are offered in the following cases:

• Electrical injury (shock).
• Damage from steam, hot objects, burns with boiling water, oil.
• Wounds received chemicals: acids, alkalis, cleaning products, mustard plasters, iodine, etc.

Antibiotics for burns of the 2nd degree are necessarily prescribed when blisters, open wounds appear. To prevent reproduction bacterial infection or fighting inflammation.

There is no need to apply antibacterial agents for grade I injuries, when the integrity of the skin is not broken.

An antibiotic for burns should be prescribed exclusively by a doctor, based on comprehensive examination. In this case, the attending therapist considers:

• Depth and area of ​​damage.
• The stage of development of the injury.
• The occurrence of complications.
• Age and clinical characteristics of the victim.
• Associated skin pathologies.
• Sensitivity and the presence of allergies.

Use of drugs

Antibiotics for burns suppress pathological infectious processes with deep and extensive injuries. This contributes to improved, rapid regeneration of the skin, elimination of inflammation.

It is best to ask your doctor which antibiotics to take, especially if the burnt areas are extensive and deep. Depending on the medical indications, convenience, medicines can be used in the form of ointments, tablets, special dressings.

Outdoor use

Most Effective medications with thermal wounds, in the form of aerosols, ointments, creams that have an antimicrobial, anesthetic effect.

Among the most effective antibiotics are:

1. Ointments developed on the basis of silver sulfadiazine: Dermazin, Silvederm.
2. Antibacterial creams "Levomekol", "Kloromikol", help in cleansing festering wounds and their speedy recovery.
3. Levosin ointment, Olazol aerosol, in addition to antibiotics, these preparations include analgesic components with local anesthetic properties, which are essential for deep and extensive injuries.
4. The most affordable and effective antibiotics for burns are Levomycetin gel and Tetracycline ointment, they are broad-spectrum drugs that are active against many pathogenic microorganisms. Most of the antibacterial agents recommended for use after a deep burn are based on these active substances, but have different commercial names and pharmaceutical companies manufacturer.
5. To eliminate the first symptoms developing infection(when blisters appear) use "Dioxidin", "Gentamicin ointment", "Streptonitol".

Medicines for internal use

To enhance the effect of antibiotic ointments, an appropriate course of tablets is prescribed. When burns of the epidermis of the III-IV degree of severity occur, the body temperature rises, nausea, vomiting and a sharp weakening of the immune system appear, the body is not able to cope with various infections. Due to this, recovery is slow, wounds heal for a long time. Antibacterial drugs with such symptoms, they can prevent or eliminate inflammation, speed up recovery.

Most effective antibiotics for burns for various degrees skin lesions:

1. Medicines prescribed at stage II-III of wounds, with toxicemia - "Ceklor", "Cefazolin". The drugs have a minimum level of toxicity, have no restrictions on use, are used for deep burns of more than 10-15% of the total body area.
2. For the qualitative elimination of the infection at the very beginning, preparations based on penicillin, for example, "Bicillin", are needed. This medicine is effective in the symptoms of inflammation: swelling, redness, pain, exudate.
3. To enhance the properties of the regeneration of the skin, appoint "Amoxicycline", "Ampicillin".
4. For burn injuries III degree drugs such as Ceftriaxone, Cefixime are better suited.
5. To prevent and exclude complications, the development of a bacterial infection is suitable for Nystatin, Fluconazole, Metronidazole.

Any antibiotics for skin burns should be prescribed by a doctor, independent application can bring Negative consequences. Particularly careful should be sensitive groups of patients: the elderly, children, pregnant women and during breastfeeding.

Important! There is no need to use antibiotics inside for burns of the 2nd degree. With such symptoms, external application of an antibacterial agent is sufficient to prevent infection.

Anti-burn applications

Ready-made dressings with anesthetic, antibacterial components are offered for sale, which significantly accelerate the healing process and prevent scarring:

• The bandage "Branolind" includes Peru balsam, due to which it has a strong antiseptic effect, it is often used as topical antibiotics for burns with boiling water, steam.
• Mesh "Voscopran" with ointment Levomekol based on beeswax guarantees speedy healing, and high-quality outflow of exudate.
• Antibacterial dressing material "Activtex", has high analgesic characteristics. One such dressing protects against infectious complications in case of burns for 72 hours.

The use of special dressings for the treatment of infection is not recommended, in most cases they are designed to prevent the reproduction of pathogenic microflora. They should be selected taking into account contraindications and hypersensitivity to the components, according to the instructions.

Contraindications

Using antibiotics for burns can avoid serious complications. These are effective and strong drugs, which have some restrictions on reception. They will help you call side effects, overdose.

• Do not use antibiotics for first degree burns. When the integrity of the skin is not broken, there are no blisters and open wounds, it is enough to use a specialized drug, for example, Panthenol.
• Do not use greasy creams and oils to treat the burnt skin layer.
• Do not press on blisters, do not open in unsanitary conditions.
• It is not recommended to use any drugs for children under 3 years of age without consulting a pediatrician.

The use of antibiotics in complex therapy a burn makes it possible to reduce the severity of the course of symptoms, to prevent complications. Which antibiotics to take for burns is chosen by the attending physician after diagnosis, depending on the level of damage.

Hello dear friends! Are you taking antibiotics? What for? Some resort to such treatment for any slightest reason, making a serious mistake.

Antibiotics are dangerous drugs addictive and having many negative effects. The more you drink them, the less they help you.

Knowing the danger of such drugs, the question arises: why then are antibiotics prescribed for burns? It would seem that a burn is often a minor injury that is not life-threatening and passes quickly enough.

Why, then, treat him with such serious medicines? You will find the answer to the question in the article.

Antibacterial drugs are intended for the prevention and control of various types of infections. Infections can easily enter the body through an open wound.

Dead soft tissues present in place burn injury, serve ideal nutrition for pathogenic microbes.

So why inject antibiotics after burns? To prevent infection of an open wound.

The vital activity of pathogenic microbes slows down wound healing, contributes to excessive scarring, and even poses a threat to life.

Is it advisable to use antibiotic preparations to treat all burns? Of course not. Our skin has powerful protective functions.

In most cases, it is able to protect itself from infections on its own. I suggest that you familiarize yourself with the situations in which antibacterial treatment is really necessary.

Who is eligible for antibiotic therapy?

The reason for the appointment of such therapy are deep and large-scale lesions of the skin, mucous membranes, respiratory system or internal organs.

During the loss of a significant area of ​​the above soft tissues in the body, a violation of the most important metabolic functions occurs. At the same time, the protective functions of the immune system, in particular anti-infective ones, are violated.

Antibiotics are useful: for thermal burns; for chemical damage.

These types of injuries are considered the most common. In addition, bacterial burns of pears, apple trees, plums and other useful plants are treated with antibiotic drugs of a certain group.

Grade 2 and 3 burn injuries rarely require antibiotic treatment. In addition, antibiotic drugs are not used for:

• deep but limited wounds;
• wounds, the size of which is less than 10% of the surface cover;
• burns of the 1st degree (epidermal) in children and adults.

An exception is a certain group of victims, which includes: the elderly; owners of chronic infections; diabetics; people who triggered the injury and provoked the infection in this way.

Who prescribes antibiotics and why?

Serious treatment can only be prescribed by a traumatologist or dermatologist. I want to note once again that the treatment of burns of the 2nd degree is not carried out in this way.

If the severity of the injury is higher, then therapy with an antibacterial effect may be prescribed, but only after a thorough examination of the victim. During the survey, the following factors are determined:

• the depth and extent of the injury;
• degree;
• the presence of complications;
• the age and level of immune protection of the victim;
• type and severity of complications;
• sensitivity to antibiotic drugs.

What medicines are used for burns?

What antibiotic medicines are used to treat injuries caused by boiling water, fire, steam, acid, or alkali? Only the attending specialist after a thorough examination is able to answer this question. I strongly do not recommend that you self-medicate!

In most cases, drugs based on silver sulfadiazine are used after a burn.

In addition, the treatment is carried out with the help of local (external) drugs: dressings with 1% solutions of iodovidone and iodopyrone; ointments from chloramphenicol and dioxidine.

Preparations for oral intake and for intramuscular / intravenous administration are prescribed to victims in exceptional cases, if the wound is deep and occupies more than 10% of the skin area.

If the infectious concomitant process proceeds easily, then it is enough only intramuscular injections. In more severe cases, intravenous injections are prescribed.

Systemic antibiotic therapy is carried out with the help of medicines that have a wide range actions. These medicines include:

• cefoperazone and sulbactam (often drugs are combined);
• semi-synthetic penicillins;
• 3rd generation cephalosporins;
• aminoglycosides and fluoroquinolones.

If the injury has spread to bone structures, then lincomycin is prescribed. For the treatment of fungal infections of the wound, it is customary to use fluconazole or nystatin.

What happens if you refuse antibiotic treatment?

Infectious processes that develop in a burn wound never pass without a trace without treatment. By refusing the antibiotics prescribed by the attending specialist, you can start the situation so much that serious complications arise:

• sepsis;
• pulmonary and bronchial ailments;
• purulent arthritis;
• infections of the genitourinary system;
• myocarditis;
• lymphadenitis.

Relatively mild burns are treated with one specific antibiotic. Several antibiotic medications can be prescribed only if the wound has already become infected and the disease is severe.

That's all, dear readers. Treatment with antibacterial drugs can indeed be prescribed for burn injuries.

Now you know which ones are drunk and which ones are used for topical treatment for similar purposes. I remind you that superficial burns of 1-3 degrees are not treated with such serious drugs.

Take care of your health, do not drink antibiotics in vain! Share what you read with your friends on social media. networks, and do not forget to subscribe to site updates. All the best!