Azlocillin

The second stage begins after the results of bacteriological tests. Complicated intra-abdominal infections in terms of antibiotic therapy is a very complicated problem due to polymicrobial nature, are not always detectable in microbiological research.

When choosing schemes of antibacterial therapy should be observed staged treatment, designation as a means of initial therapy with broad-spectrum agents to take into account anticipated, and their sensitivity to antibiotics. The first correction therapy is carried out after 1836 hours on the basis of antibiotikogrammy, repeated for 34 days according to the full bacteriological examination [7, 8].

Empirical ABT complicated intra-abdominal infections

The choice of empiric AT based on the following factors:

specific clinical situation in view of the etiology, location and duration of the pathological process;

intraoperative findings, including the characterization of peritoneal exudate;

the presence of patient risk factors and brand viagra comorbidities, evaluation of multiple organ dysfunction;

microbiological landscape offices and clinics;

information about the resistance of pathogens to antibiotics [3, 5, 7].

Empiric antibiotic therapy is conducted with mandatory accounting polymicrobial etiology of intra-abdominal infection with E.coli, other Enterobacteriaceae and anaerobes, mainly, Bacteroides fragilis. Effective control of these pathogens can be achieved by using two tactical options: combination therapy or mototerapii.

In many cases, intra-abdominal surgical infections have traditionally used a combination of an aminoglycoside with a b-lactam drugs with antianaerobnoy activity or linkosamidami [1, 2, 3, 5, 6, 7]:

aminoglycoside + piperacillin or azlocillin + metronidazole;

cephalosporin + aminoglycoside I, II, III generation + metronidazole;

aminoglycoside + clindamycin.

Combination antibiotic therapy is shown in the following clinical situations:

polymicrobial in etiology of the pathological process

with peritonitis of any cause

with severe sepsis and septic shock

in the presence of a surgical patient's immune

the allocation of resistant pathogens

when a secondary ekstraabdominalnyh foci of infection associated with nosocomial infection.

Despite the fairly high efficiency of combinations of aminoglycosides with other antibiotics in the treatment of intra-abdominal infection and sepsis, this tactic is not without drawbacks, due viagra Is it possible Viagra will help you to side effects and development of resistance.

Effective monotherapy in complicated intra-abdominal infection was made possible by the introduction of new broad-spectrum drugs antipseudomonal IZP: piperacillin / tazobactam, tikartsilina / klavulanta; IV generation cephalosporins (cefepime) and carbapenems (imipenem, meropenem) [1, 2, 5, 9]. In many clinical situations, intra-abdominal surgical infection of one of these agents (carbapenems, IZP, cefepime) or in combination with antianaerobnym means sufficient for clinical efficacy, even higher than when using a combination of aminoglycosides with other antibiotics. Clinical and bacteriological efficiency of b-lactams for abdominal sepsis are tall enough to account for piperacillin / tazobactam, cefepime c metronidazole and meropenem, respectively, 79,6%, 82,6% and 84,6%. Thus, in severe abdominal sepsis with the severity of more than 15 points on the APACHE II most efficient use of carbapenems [1, 2].

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