Treatment of wounds with antibiotics: ointments, tablets

An injury to the skin or mucous membrane with a breach of integrity throughout its entire thickness or more, opening access for microbes from the environment, is called an open wound. Modern medicine considers any accidental wound to be a priori infected - containing a certain number of pathogenic microorganisms. The following conditions favor the development of purulent infection: sufficiently deep and extensive damage; blood clots, foreign bodies, areas of dead tissue and a large accumulation of microbes in the wound cavity. Particularly dangerous are deep wounds infected with anaerobic bacteria that enter its cavity along with manured soil from agricultural lands. Antibiotics for wounds are used both to prevent bacterial infection and to treat purulent wounds.

The choice of antibacterial drug and its use often determines the successful healing of the injury. Thanks to the treatment of wounds with antibiotics, it is possible to avoid the inflammatory process or sepsis.

The wound received must be treated as soon as possible, since the probability of its suppuration and the speed of healing depend on this. The wound is not treated with antibiotics, since antibiotics are active only against bacteria, and the wound can be infected with various pathogens - fungi, viruses, parasites. Antiseptics are used for primary and subsequent external treatment of wounds. These are chemicals that exhibit activity against a wide range of pathogenic agents that remain sensitive to the antiseptic for a long time. Antiseptic substances do not directly affect the healing process, their indirect effect is that they significantly reduce the number of pathogenic microorganisms in the wound, slowing down the restoration of damaged tissues.

Indications antibiotics for wounds

In case of accidental wounds, especially deep ones, there is a high probability of infection. To avoid suppuration, after treatment with an antiseptic, external preparations with a broad-spectrum antibiotic are usually prescribed (Baneocin and Gentaksan powders, Syntomycin emulsion), since it usually takes two to three days to identify the pathogen. Such tactics often help to avoid the accumulation of pus in the wound, and the tissues of the clean wound surface are restored much faster.

If it is not possible to avoid wound suppuration, antibiotics are prescribed for purulent wounds. In this case, both local and systemic treatment can be prescribed. Antiseptics used to treat a wound destroy various microbes on its surface, however, their significance for healing is very indirect. In case of deep purulent wounds with a high probability of infection or significant tissue loss, they are left open (not sutured) to restore new tissue. In this case, antibiotics are indicated for wound healing, destroying or stopping the development of microbial flora in the wound cavity and simultaneously promoting reparative processes (Levomekol ointment, Gentaksan powder).

This is especially true if the wound has become inflamed and the causative agent of the inflammatory process has been identified. Its established sensitivity to certain drugs is the basis for prescribing specific antibiotics for wound inflammation.

Gaping wounds with uneven edges and walls require surgical treatment, when all non-viable and necrotic tissue areas are removed. In the case of an extensive lacerated wound, different phases of epithelialization often occur in different areas simultaneously - on one side the wound is already scarring, and on the other - it can fester. Antibiotics for a lacerated wound are prescribed without fail, since the probability of infection is very high.

In case of a wound caused by a piercing object, especially localized on the sole of the foot or heel, you also cannot do without an antibiotic, and its systemic use. The thin wound channel and rough skin in these places prevent the release of wound discharge. Conditions are created for the development of colonies of anaerobic bacteria, including gangrene, tetanus, phlegmon of the foot. An antibiotic for puncture wounds is used orally or parenterally, and preference is given to groups of drugs characterized by activity against anaerobes.

The same criteria are used by the doctor when he prescribes antibiotics for gunshot wounds. In this case, primary surgical care is also necessary, much depends on the location and type of injury.

An antibiotic prescribed for external use for an open wound should be in the form of a gel or solution. Ointments with a fat base are not suitable at the initial stage of healing, since the resulting fatty film prevents normal breathing and nutrition of deep tissues, and also delays the release of wound discharge.

Antibiotics for weeping wounds can have a water-soluble base, and also - after the initial treatment of the wound, powders with antibiotics are used; in severe cases, systemic use of antibacterial agents is often prescribed.

A modern alternative to antibiotics are dressings made of hygroscopic materials that absorb wound exudate, remove and neutralize microbes. They do not have a toxic effect on wound tissue, while maintaining a moist environment and promoting self-cleaning of wounds.

Bacteriophages are also used, destroying pathogens of a specific type or several types (complex). Externally, they are used as irrigations and lotions.

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Release form

Antibacterial drugs are available in a variety of forms. Mostly, preference is given to external agents: patches, powders, solutions and ointments (gels, creams). They do not have a systemic effect, acting locally at the site of application.

Treatment of a wound with antibiotics requires the participation of a doctor who, based on the location and type of damage (for each wound there is a presumed association of microorganisms sensitive to certain groups of drugs), will prescribe the most suitable drug and the form of its preferred use. In addition, in a medical institution, it is possible to determine the type of pathogen by making a bacteriological culture.

However, it is not always possible to quickly seek medical help and shift responsibility to the doctor. When going on a hike away from civilization for a few days, it is recommended to stock up on a first aid kit, including gels, ointments and creams for wounds with antibiotics. When choosing medications for a first aid kit, preference is given to external preparations, you can also take tablets containing broad-spectrum antibiotics. For wounds received accidentally far from medical institutions, both may be useful.

Many antibiotics used to treat wounds come in different forms, for example, Gentamicin sulfate can be found in the form of an ointment, powder, and injection solution.

In severe cases with extensive and deep lesions, antibiotics are used in tablet and injection forms. The doctor may prescribe antibiotics in tablets for purulent wounds with inflammation and hyperemia of adjacent tissues, edema, and an increase in body temperature. Sometimes in severe cases with a threat of sepsis, intramuscular or intravenous injections of antibiotics are used; if it is impossible to immediately perform surgical treatment of a lacerated wound, it is injected with a broad-spectrum antibiotic to saturate the adjacent tissues with the drug and prevent the spread of infection. Such treatment can be carried out for 48 hours.

Antibacterial powders are also used. Antibiotic powder for wound healing (Gentaxan, Baneocin) is sold in pharmacies and consists not only of bactericidal components. It also includes substances that provide detoxification and regeneration of damaged tissues.

A small abrasion or scratch can be washed with an antiseptic, sprinkled with streptocide powder and sealed with a bactericidal plaster to prevent re-infection.

To prevent microbes from the environment from getting into the wound, modern pharmacy offers a large arsenal of antiseptic hydrocolloid, collagen, hydrogel dressings that are fixed to the skin with bandages, regular or round, and also glued to healthy skin around the wound. A plaster for wound healing with an antibiotic, or more precisely, an antiseptic, for example, containing silver ions (Cosmopor), antibacterial honey or more traditional drugs - furacilin, novocaine, dimexide and others. Dressings and plasters have different sizes.

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Names of the most popular antibacterial agents for wounds

Treatment of any wound begins with cleaning it. If the wound is small and not deep, it is enough to treat it with an antiseptic and apply a bandage to prevent re-infection.

Alcohol and alcohol solutions (iodine, brilliant green, salicylic and boric acid, medicinal herbs), hydrogen peroxide, chlorhexidine, and miramistin have long been used as antiseptics. The faster the wound is washed with water (possibly with laundry soap) and treated with an antiseptic, the less likely it is to become infected and inflamed. Lacerated, punctured, gunshot and other deep wounds contaminated with soil and rust must be surgically cleaned. Such injuries require antibacterial therapy. Antibiotics must be used if there is a long break between receiving a wound and receiving medical care, or in purulent, inflamed wounds.

After the initial treatment, the wound is covered with a bandage. The choice of bandages and plasters is very large and depends on the presence of established allergies to medications in the patient and the need for further surgical intervention.

Small wounds can be sealed with a regular bactericidal adhesive plaster after treatment. Its outer surface is permeable to air and allows moisture to evaporate from the wound surface. The inner base of the plaster is fabric (cotton, viscose, polymer materials), its impregnation usually contains brilliant green, chlorhexidine, synthomycin. For example, antiseptic plaster Band-Aid, Uniplast, Cosmos and others.

If the wound is more extensive, you can use the antiseptic bandage-plaster Cosmopor. Its base is a non-woven soft material impregnated with silver ions (an alternative antiseptic). Sizes from 7x5 to 20x10 cm. It is easy to stick and holds well on different parts of the body.

Arma-Gel sterile dressings effectively protect against secondary infection, allow the wound to breathe, repeat the contours of the wound surface and surrounding skin, do not stick and are easily removed, and can be left on the skin for up to two days. The hydrogel structure of the impregnation acts prolongedly, gradually releasing the drug into the wound and absorbing toxic substances secreted by bacteria. Dressings are available in several types: painkillers (in addition to the antiseptic, they contain novocaine or lidocaine); antimicrobial - with dimexide for wounds complicated by pyogenic infection; cleansing - with nanocremnevit or bentonite; wound healing - with methyluracil or furacilin; hemostatic and anti-burn.

For poorly and long-healing wounds, biograding plates Belkozin with collagen and methyluracil are used. The plate is applied to a wound previously cleaned of pus and dead tissue particles. For purulent wounds, it is recommended to pre-wet it with an antiseptic. Dressings are done every two to three days. During this time, the plate is completely absorbed. If it has not lysed, and there is no pain, burning, accumulation of pus or allergic reaction, then the plate is left until the wound is completely healed.

The Vita Vallis antimicrobial self-adhesive dressing (plaster) does not contain any drugs. It is made of a sorbent cloth impregnated with aluminum hydroxide particles treated with colloidal silver. It prevents infection, does not injure the wound and does not cause allergies, provides good absorption and hemostatic action. It is not toxic. It promotes renewal and restoration of the cellular structure of the tissue, prevents the formation of scars. It is removed without leaving any residue in the wound and without causing discomfort or pain.

Medihani antibacterial honey dressings are presented by the manufacturer as a new word in wound healing. They are intended for adults and children, a reference to a randomized study of the drugs noted very rapid wound healing (only one dressing is required). The dressing applied to the wound surface, in contact with sodium salts contained in the fluid secreted by the wound, forms a jelly-like mass that creates a moist environment in the wound, which has a cleansing, healing and restorative effect. The wound is filled with granulation tissue. The elasticity of the dressing makes it possible to tamponade deep wounds and pockets.

Modern plasters and bandages are an alternative to conventional antibacterial agents, however, antibiotics are still quite relevant. When treating infected wounds, with a high risk of suppuration and other more severe complications, antibiotics of different groups are used. The patient's age, the presence of chronic pathologies - diabetes, varicose veins, thrombophlebitis, alcoholism, drug addiction, liver disease, kidney disease and other organs are also taken into account.

Antibacterial gel Tyrosur is used externally in case of infected wounds, scratches, abrasions. Its active substance (tyrothricin) is a compound of tyrocidins and gramicidins in a ratio of 8:2 (7:3) and is a toxin of an aerobic saprophytic spore-forming bacillus called Bacillus brevis. The most common pathogens sensitive to the ointment are gram-positive bacteria: staphylococci (including golden), streptococci, enterococcus faecalis, clostridia, corynebacteria, fungi, trichomonads and some others.

Tyrocidin has the ability to act on the cell membranes of microorganisms, reducing their surface tension. Gramicidins form cation channels in them, through which bacterial cells lose potassium, and also block the phosphorylation process, which disrupts cellular respiration.

The specific action of tyrothricin, which is not typical for systemic antibiotics, prevents the development of cross-resistance in pathogens to the gel, which accelerates the granulation process and restoration of the skin surface.

The pharmacokinetics of the active substance has not been studied, but high concentrations have been found in the adjacent stratum corneum of the dermis and in the wound cavity. Therefore, the use of this gel during pregnancy and lactation is only possible with the permission of a doctor on small areas of the skin surface and for a short time, taking into account the benefit/risk ratio. It is allowed for use in pediatric practice, there are no age restrictions.

Contraindicated in sensitized patients. Do not apply to the nasal mucosa as there is evidence that such use may adversely affect the sense of smell.

Side effects are manifested by local symptoms of dermatitis.

A thin layer of Tyrosur gel is applied to the wound twice or three times a day. This is sufficient for small scratches or abrasions, while wet or deep wounds are covered with a protective bandage, which is changed approximately once a day. The duration of use depends on the condition of the wound. If there is no therapeutic effect after seven days of treatment, the drug must be changed.

Cases of overdose and interactions with other drugs are unknown.

Bactroban cream and ointment are highly active against a fairly wide range of bacteria. The active ingredient (mupirocin) of these drugs was intentionally created for topical application. Staphylococci, streptococci, in particular, and methicillin-resistant strains of these bacteria are sensitive to it, as well as gonococci, meningococci, Haemophilus influenzae, the causative agent of hemorrhagic septicemia, gram-negative cocci and rod-shaped bacteria. It is inactive against enterobacteria, corynebacteria and micrococci. Mupirocin inhibits the enzymatic activity of isoleucyl-transfer-RNA synthetase, which catalyzes the production of proteins in the cells of the pathogenic microorganism. Cross-resistance with other antibiotics has not been noted. The action is dose-dependent: from bacteriostatic to bactericidal.

When used externally, mupirocin is absorbed insignificantly, but on the skin surface with damage to its integrity, absorption increases. Part of the drug absorbed into the general bloodstream is broken down and excreted in the urine.

Use of this gel during pregnancy and breastfeeding is possible only with the permission of a doctor on small areas of the skin surface and for a short time, taking into account the benefit/risk ratio.

Bactroban is contraindicated in case of sensitization to the ingredients of the cream, do not apply to the mucous membranes of the nose and eyes. In pediatric practice, the ointment is used from two months of age, and the cream - after reaching one year. With caution, a course of treatment with Bactroban is prescribed to elderly people, as well as to those with renal dysfunction.

Side effects were mainly local in nature, such as dermatitis, however, in rare cases, systemic symptoms were observed: headache or stomach pain, nausea, ulcerative stomatitis, and development of recurrent infection.

The cream and ointment are applied to the previously cleaned wound with a cotton swab one to three times a day. The treatment lasts from a week to ten days. It is allowed to apply under a bandage. After treating the wound, it is necessary to wash your hands thoroughly.

There are no known cases of overdose.

If there is a need to combine Bactroban therapy with other local wound treatments, the time interval between treatments should be at least half an hour.

Syntomycin emulsion is intended for the treatment of purulent wounds. Chloramphenicol (syntomycin) is active against many types of bacteria, in particular against some strains of Pseudomonas aeruginosa and other bacilli resistant to penicillin, streptomycin, sulfonamides, the action is bacteriostatic, based on the disruption of the synthesis of bacterial cellular proteins. If the wound is painful, you can use Syntomycin emulsion with novocaine. This combination of an antibiotic with an anesthetic component will suppress the growth and reproduction of microbes, and also reduce pain.

With this active ingredient, Levomycetin gel can be purchased in pharmacies, which is used for inflamed infected wounds in the first phase of the process (it is no longer prescribed in the second). Its base contains ingredients that have an anti-inflammatory effect and improve the outflow of wound secretions.

Bacterial resistance to chloramphenicol develops slowly.

The pharmacokinetics of these external agents has not been studied; it is assumed that when applied externally, only a small portion of the applied drug enters the general bloodstream, which is eliminated mainly through the urinary organs and partially through the intestines.

Pregnant and lactating women should use on small surfaces as directed by a doctor.

Contraindications for use: hypersensitivity to the components, hematopoiesis disorders, eczema, psoriasis, fungal infections, for the gel additionally: the third trimester of pregnancy, children under nine months of age.

Side effects appear locally: rash, itching, burning, redness, swelling.

The emulsion is applied to the wound in a thin layer or in the form of a tampon soaked in it, covered with a bandage on top, it can be applied under a compress. The frequency of dressings and the duration of treatment are determined by the doctor.

The gel is applied to the wound or to a bandage, which is then applied to the wound - once a day, to burned skin - once every three days. In case of weeping wounds, they are blotted with a gauze rag before application.

If necessary, wound treatment can be combined with oral or parenteral administration of an antibiotic prescribed by a doctor.

There have been no reports of overdose.

Combination with erythromycin, oleandomycin, nystatin and levorin potentiates the effect of chloramphenicol, with natural penicillins – reduces. Incompatible with sulfanilamide drugs, cytostatics, barbiturates, alcohol, biphenyl, pyrazolone drugs.

All the above preparations can be used for cracked nipples in nursing mothers. It is necessary to go to the toilet before feeding - remove the remains of the product with a napkin and wash the breast thoroughly with soap and plenty of water so that even a minimal dose of the medicine does not get into the baby's mouth.

There is a fairly wide selection of antibiotic ointments that can be used to treat infected wounds.

An alternative to antibiotic ointments is Mafenide ointment, a representative of sulfonamides, inactivating many pathogenic bacteria, including Pseudomonas aeruginosa and gas gangrene pathogens (anaerobic bacteria). Mafenide acetate does not lose its qualities in an acidic environment, its 10% concentration is fatal for pyogenic infection.

Penetrating into the systemic bloodstream through damaged tissue areas, it is detected there three hours after the wound is treated. It is quickly broken down, the metabolic product has no activity, and is eliminated by the kidneys. The active ingredient and its metabolite inhibit the enzymatic activity of carbonic anhydrase, which can cause metabolic acidification of the blood.

Use during pregnancy and breastfeeding is not recommended.

Contraindicated for sensitized patients. Side effects are local dermatitis, burning, pain syndrome, sometimes very strong, lasting from half an hour to three hours. Painkillers may be prescribed for relief.

The ointment is spread in a layer of two to three millimeters, it can be used as a tamponade for the wound cavities, or applied to a bandage. Dressings are changed daily in case of abundant purulent discharge, and every other day or two in case of scanty discharge.

Antibacterial powders are a convenient form for treating wounds. They are used to treat both fresh and healing wounds. Before treatment, the wound must be cleaned of pus, wound secretions, and dead particles.

Gentaxan powder is a successful combination of the antibiotic gentamicin sulfate, the sorbent polymethylxyloxane and zinc compound with levotryptophan. The aminoglycoside antibiotic inhibits the activity of many gram-positive and gram-negative bacilli, its action is potentiated by the sorbent, while carrying out detoxification activity, neutralizing the products of bacterial metabolism. The compound of tryptophan with zinc prolongs the action of the antibiotic and promotes recovery and granulation of the wound. Applications of this powder already on the second or third day reduce the number of pathogenic microorganisms in the wound to a minimum, the first phase of healing passes into the second, and complications are prevented - inflammation, lymphadenitis, sepsis.

Pharmacodynamics of Gentaxan is associated not only with blocking protein production in bacterial cells, but also with disruption of the fatty component of the bacterial membrane due to complex action. The powder reduces symptoms of not only local but also systemic intoxication, improves wound drainage, promotes swelling reduction, restores normal blood circulation, gas exchange and acid-base balance in the wound. The wound surface is actively freed from exudation and necrosis products, local inflammatory process is stopped, thereby accelerating wound healing. The use of powder prevents the formation of scars and cicatrices.

The drug acts superficially and does not have clinically significant systemic effects.

Use during pregnancy and breastfeeding has not been studied, if there is such a need, the powder is used on the recommendation of a doctor. It is allowed to use in pediatric practice without age restrictions.

Contraindicated in patients sensitized to the powder components.

Side effects are in the nature of local dermatological reactions.

Gentaksan powder is used to treat the wound surface from the moment of injury until it heals. In the first stage of the wound process, dressings are done one to two times daily. The wound is pre-treated, washed with an antiseptic and necessarily dried. In case of weeping wounds, partial leakage of powder together with ichor can be compensated by drying the wound surface with gauze swabs and adding powder, without additional treatment.

The powder is applied to the entire surface of the wound to a height of 0.5-1 mm, after which it is bandaged, ensuring the necessary drainage.

After the inflammation has subsided and the wound has been cleansed of any remaining pus and dead tissue, dressings are applied once a day or every other day.

In cases where primary surgical treatment cannot be performed in full, the wound surface is covered with powder and bandaged, however, surgical assistance must be provided no later than 24 hours later.

The drug interactions of the powder have not been studied, but with the parallel use of other bactericidal agents, the effect may be potentiated.

Baneocin powder combines two antibiotics that potentiate each other's action. Neomycin sulfate has a very broad spectrum of antimicrobial activity, most gram-positive and gram-negative bacteria are sensitive to it. Bacitracin zinc (a polypeptide antibiotic) acts to a greater extent on gram-positive bacilli, however, Neisseria and Haemophilus influenzae, actinomycetes and fusobacteria are also sensitive to this agent. Strains resistant to bacitracin are extremely rare.

It is easier to list the microorganisms that are insensitive to Baneocin. These are pseudomonads, actinomycetes of the genus Nocardia, viruses and most fungi.

External application directly to the wound reduces the systemic action of two antibiotics and, accordingly, reduces the risk of allergic reactions. The maximum concentration is determined at the site of application; absorption is more active with open wounds. The portion of the drug that has penetrated into the systemic bloodstream is determined after 2-3 hours.

Use by pregnant and lactating women is not recommended; when prescribing, the benefit of use by the mother should be assessed against the risk to the health of the child.

Contraindications include sensitization to the components of the drug and other aminoglycosides. It is also not recommended to use on large wound surfaces, in severe diseases of the cardiovascular and urinary systems, damage to the receptors of the cochlea and disorders of the autonomic nervous system. Do not use for skin lesions around the eyes.

Side effects when using according to the rules are expressed by local dermatological manifestations (photosensitivity is possible). With uncontrolled absorption into the general bloodstream (use on open wounds of large areas) nephro- and ototoxic effects of the drug, as well as damage to the autonomic nervous system, may be observed.

Baneocin powder is used on small wound surfaces. It can be used from the first days of a child's life if there is no alternative in the form of a safer drug. All age categories of patients are prescribed powder two to four times a day for a week. The entire surface of the wound is covered with powder, which activates the sweating process, due to which pain and burning are reduced and a calming effect is achieved. The wound can be covered with a gauze bandage.

The maximum dose of powder applied to the wound surface per day is 200 g. After a week, treatment with Baneocin is interrupted. If a repeat course is necessary, the dose is halved.

Overdose (with systemic absorption) is fraught with toxic effects on the hearing organs and urinary system.

Interaction effects appear only in case of active absorption into the general bloodstream. When interacting with antibiotics of the same group or cephalosporins, as well as diuretics, the nephrotoxic effect is potentiated.

Interaction with painkillers and muscle relaxants can lead to neuromuscular conduction disorders.

Baneocin is also available in ointment form.

Systemic antibiotics can be prescribed in parallel with external agents, especially for accidental deep infected wounds. Taking antibiotics in tablets or injections can prevent such severe wound complications as sepsis or gas gangrene, which can be fatal. Systemic drugs should be taken only as prescribed by a doctor. Antibiotics of almost all groups are used to treat infected wounds. Preference is given to drugs that are active against the causative agent of the infection. To identify it, wound secretions are cultured on media, and the sensitivity of the bacteria to antibiotics is determined. In addition, the patient's tolerance to antibiotics of a particular group is taken into account.

In purulent infections, β-lactam bactericidal antibiotics of the penicillin and cephalosporin series are used, suppressing the enzymatic activity of transpeptidase by binding to a protein located on the inner membrane of the microbe's cell membrane. Inactivation of this enzyme interrupts the process of producing peptide glycan, the basis of the bacterial membrane, which gives it rigidity and protects the bacterium from death. The cell membranes of the human body do not contain peptide glycan, so these antibiotics are relatively low-toxic.

The drugs differ from each other in their spectrum of action and side effects, as well as in their pharmacokinetic properties.

Penicillins are well absorbed and quickly distributed in tissues and body fluids, reaching optimal therapeutic concentrations there. They are excreted through the urinary organs.

The most active and low-toxic drugs of the penicillin group are benzylpenicillin salts, which neutralize mainly gram-positive cocci (streptococci). Their main disadvantage is a narrow spectrum of action and instability to β-lactamases, so they are not suitable for the treatment of staphylococcal infection.

If infection with penicillinase-producing staphylococci is detected, oxacillin may be prescribed.

Semi-synthetic drugs of this group (ampicillin, flemoxin) have a broader spectrum of action.

The combination drug Ampiox, which is a combination of ampicillin and oxacillin, inhibitor-protected penicillins - combinations with clavulanic acid (Amoxiclav, Augmentin) or with sulbactam (Ampisid, Unasin) are broad-spectrum drugs, active against the most common pyogenic bacteria. However, these drugs are not active against Pseudomonas aeruginosa.

Penicillins penetrate the placenta, however, teratogenic effects have not been recorded. Inhibitor-protected forms of the drug are used when necessary to treat pregnant women without registered complications.

The drugs are found in breast milk, so nursing women take penicillin and its derivatives only as prescribed by a doctor for vital indications.

Penicillins most often of all antibiotics cause hypersensitivity reactions, and if an allergy is caused by one of the penicillins, then there is a high probability that sensitization will also occur to the others. Most side effects are associated with hypersensitivity reactions.

Penicillins and other bactericidal antibiotics mutually enhance each other's effects, while with bacteriostatic ones they weaken them.

Cephalosporins (derivatives of 7-aminocephalosporinic acid) have, in general, a wider range of bactericidal activity than penicillins, and higher resistance to β-lactamases. There are four generations of these drugs, with each generation the spectrum of action becoming wider and the resistance higher. The main feature of the drugs belonging to the first generation is their antagonism to staphylococci, in particular, to β-lactamase-forming ones, and to almost all streptococci. The drugs of this group of the second generation are also highly active against the main pyogenic bacteria (staphylococci and streptococci), as well as Klebsiella, Proteus, Escherichia.

The third generation of cephalosporins has an even broader spectrum of action, but is more active against gram-negative bacteria. Antibiotics belonging to the fourth generation are highly active against almost all types of anaerobes and bacteroids. All generations are resistant to plasmid β-lactamases, and the fourth generation is also resistant to chromosomal ones. Therefore, when prescribing penicillins and cephalosporins, a test for the type of pathogen and its sensitivity to antibiotics is of great importance. The drugs may belong to earlier generations, but if the infection is caused by staphylococcus, then there is no point in prescribing third or fourth generation drugs, which are also more toxic.

Cephalosporin drugs often cause allergic reactions in people who are allergic to penicillin antibiotics.

In recent years, macrolides and fluoroquinolones have come to the fore. This is due to the occurrence of frequent cross-allergic reactions, as well as the development of resistance in bacteria associated with the incorrect use of penicillins and cephalosporins.

The structural basis of macrolide antibiotics is a macrocyclic lactone ring with 14, 15, 16 carbon atoms in it. According to the method of production, they are divided into natural (erythromycin, oleandomycin - obsolete and practically not used) and semi-synthetic (azithromycin, clarithromycin, roxitomycin). They have mainly bacteriostatic action.

Erythromycin is the first drug in this group, which is a reserve drug and is used when the patient is sensitized to other antibiotics. It is one of the least toxic antibiotics, causing the least amount of side effects. It is active against staphylococci, streptococci, and some other gram-positive and gram-negative bacteria. It is applied locally as an ointment, and can be prescribed in tablets. The bioavailability of orally administered erythromycin depends on food intake; there are already resistant strains of bacteria to it.

The other drugs in this group (roxithromycin, midecamycin, josamycin) surpass erythromycin in the spectrum of action, create higher concentrations of the drug in tissues, their bioavailability does not depend on food intake. A characteristic feature of all macrolides is good tolerability and the absence of cross-sensitization reactions with β-lactam antibiotics, the concentration of antibiotics in tissues significantly exceeds plasma.

Erythromycin and spiromycin may be prescribed to pregnant women.

Fluorinated quinolones of the second generation (ciprofloxacin, norfloxacin, ofloxacin) are active mainly against staphylococci, the third (levofloxacin) and, especially, the fourth (moxifloxacin) are used for infected wounds as broad-spectrum antibiotics, including intracellular parasites. Moxifloxacin is active against almost all anaerobes.

The drugs of this group have a bactericidal effect, disrupting the construction of bacterial deoxyribonuclease by inhibiting the enzymatic activity of the main participants in this process – DNA gyrase and topoisomerase-IV.

Contraindicated for patients with acute porphyria, as well as pregnant and lactating women, since they penetrate the placental barrier and are found in breast milk. Fluoroquinolones are well absorbed from the gastrointestinal tract, characterized by a large distribution volume, high tissue and organ concentrations. The highest is determined after an hour-three hour interval from the moment of oral administration. Patients with severe renal failure need to adjust the dose of all fluorinated quinolones.

Adverse effects characteristic of quinolones include dyspepsia, central nervous system dysfunction, sensitization reactions such as dermatitis or edema, and photosensitivity during drug administration. All drugs in this group are characterized by the development of cross-allergic reactions.

The bioavailability of quinolones is reduced when combined with antacids and medications containing magnesium, zinc, bismuth and iron.

The combination of some fluoroquinolones with theophylline, caffeine and other methylxanthines increases their toxicity, since it prevents the elimination of the latter from the body.

Concomitant use with non-steroidal anti-inflammatory drugs and nitroimidazole derivatives increases the likelihood of neurotoxic effects.

Do not combine with nitrofurans.

Antibiotics of the aminoglycoside group are widely known as components of external agents for healing suppurating wounds. This group includes streptomycin, neomycin, gentamicin, amikacin. These antibiotics are very toxic when used systemically, resistance to them develops quickly, so they are chosen as systemic drugs only if the patient has allergic reactions to antibiotics of other groups.

Antibiotics are used for wounds almost always. An accidental wound is rarely clean. For small wounds, abrasions, scratches, you can independently apply external means with an antibiotic to heal wounds. They are sold in pharmacies without a prescription. For the treatment to be effective, it is worth observing the storage conditions and expiration date indicated on the package. The choice of antibiotics for systemic use for infected wounds is the prerogative of the doctor. The method of application and dosage of drugs are also determined by the doctor, and patients should strictly follow the recommended treatment, which will avoid serious complications.