Antibiotics for sepsis: which are effective?

Sepsis is a serious disease in which the entire body, including blood, urine, and other normally sterile biological fluids, are infected with bacterial microflora. Spread occurs directly from the source of infection if bacteria have received unlimited growth and their number sharply exceeds all permissible limits. This means that the source of infection, where the main infectious and inflammatory process occurs, is completely colonized by pathogenic microflora, and it has begun to colonize free biotopes, that is, the infection is progressing. As practice shows, antibiotics for sepsis are the only possible way to save a person. Without treatment, a person dies.

Treatment of sepsis with antibiotics

It can only be cured through intensive antibacterial therapy, which uses antibiotics. This is a group of drugs that are aimed at eliminating the infectious process in the body. It works in two ways: either kills the bacteria completely or stops its growth and reproduction. Today, the pharmaceutical market is represented by a huge number of antibacterial agents that exhibit different activity against different groups of microorganisms. Thus, some of them can act only against one group of microorganisms, others - against another.

For example, there are known drugs that are active only against gram-positive microorganisms and specifically kill them. They are active against such microorganisms as staphylococcus, streptococcus, pneumococcus, pseudomonas aeruginosa, but will be absolutely ineffective, for example, against E. coli.

Other antibiotics show high activity against gram-negative groups, while they have no effect on gram-positive microorganisms. For example, they can show high activity against E. coli, salmonella, klebsiella, and will be absolutely ineffective in treating diseases caused, for example, by staphylococci.

In order to select an antibiotic that will best meet the treatment needs and provide the maximum effect in a short time, special microbiological studies are carried out. Most often, they resort to bacteriological culture and antibiotic sensitivity testing.

To do this, a person's biological fluid is taken for examination, and it is first seeded on a universal nutrient medium. The culture is incubated in a thermostat at a certain temperature for several days. After that, the cultures are examined. Blood, urine, cerebrospinal fluid, and many other human biological fluids should normally be sterile, that is, no microbial growth should be detected. But with sepsis, microflora grows.

Next, the largest colony is taken and seeded on selective nutrient media and special "shoals" for further research. It is aimed at isolating the pathogen into a separate pure culture. The culture is again incubated for several days under optimal conditions. Then further identification is carried out, the genus and species of the microorganism are determined. This allows us to determine the exact cause of the disease and select the most accurate treatment.

The next step is to determine the sensitivity of the isolated pathogen to antibiotics. This makes it possible to identify the sensitivity spectrum and select an antibiotic that will have maximum activity against this microorganism. The optimal dosage is also determined, at which bacterial growth completely stops.

The only problem is that this study takes quite a long time - at least a week, since it is determined by the growth rate of the microorganism. Patients with sepsis often do not have that much time, since the disease progresses very quickly, and the patient can die within 1-2 days.

Therefore, at the initial stages, they often resort to the use of broad-spectrum antibiotics. This is a group of drugs that act against all groups of microorganisms: both gram-positive and gram-negative. The effectiveness and selectivity of such antibiotics is significantly lower, but this makes it possible to gain time and stop or slow down the progression of the infectious process. Usually, after the analysis is ready, a second course of antibiotic therapy is prescribed, which is aimed exclusively against the causative agent of the disease.

Broad-spectrum antibiotics are effective, however, they are very dangerous due to the fact that they have an antibacterial effect on all microorganisms present in the body. They also kill normal human microflora, resulting in numerous side effects and complications, which are based on dysbacteriosis. Broad-spectrum antibiotics are also used if it is discovered that the cause of the disease is several microorganisms belonging to different groups. This can be a mixed, or so-called mixed infection, biofilm forms of coexistence of bacteria, their associations.

It is necessary to take into account that bacteria can mutate and develop resistance to some antibiotics, and even entire groups, so some antibiotics may be ineffective. To avoid such situations, you need to follow the basic rules of antibiotic therapy. So, the main rule is that antibiotics must be taken in a course, in a strictly selected dosage. You cannot independently reduce the dosage or stop treatment, even if the symptoms of the disease no longer manifest themselves. Otherwise, this will end with the bacterial microflora not being completely killed. Surviving microorganisms will definitely mutate and acquire resistance not only to this antibiotic, but also to the entire group.

Antibiotics should also not be taken for prevention, as this does not have a positive effect, but will only lead to the development of dysbacteriosis and the development of resistance on the part of pathogenic strains. The exception is postoperative conditions, since at this time the immune system is too weak to resist any infection.

You cannot take too strong drugs. If the weakest antibiotic is effective, you need to start with it, because if the microorganism develops resistance to the minimum dosage, you can always resort to using a stronger drug. While the opposite is impossible. It is necessary to remember that there is an individual intolerance to drugs and the components that are part of them. It is also necessary to take into account that a repeated course of antibiotic therapy can lead to an allergic reaction.

Indications antibiotics for sepsis

Antibiotics are taken for any diseases of bacterial etiology. Sepsis is the main and unconditional indication for taking antibiotics. Sepsis is the most severe condition - this is the final stage of the infectious process, in which blood poisoning occurs. Without help, a person will die, since the disease has no reverse development, it can only progress.

Antibiotics are also mandatory for bacteremia - a condition in which a small number of microorganisms, or their single forms, are found in the blood and other biological fluids of a person. This is a stage that can always develop into sepsis, which should never be allowed.

Antibiotics are taken after surgeries and organ transplants for prevention, since this is a condition in which the body is defenseless against any infection.

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Release form

Antibiotics are available in various forms. For oral administration, they can be produced in the form of tablets and capsules. Available antibiotics are in the form of suspensions and solutions. For parenteral administration, antibiotics are produced in the form of ampoules for injections, vials for intravenous infusions. There are antibiotics in the form of suppositories for rectal, less often - intravaginal administration. Local drugs can be produced in the form of sprays, drops, ointments, etc.

Names

There are many commercial names of antibiotics. The names are often changed by the manufacturers. The main antibiotics often used for sepsis are: oxacillin, amoxiclav, gentamicin, vancomycin, rifampicin, ciprofloxacin, amoxicillin, penicillin, chloramphenicol, flexid, tetracycline, doxycycline

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Antibiotics for blood sepsis

In case of blood sepsis, various antibiotics and their combinations can be used, depending on the pathogen that caused the disease. To begin with, it is advisable to conduct a bacteriological study to determine the pathogen. After that, it is recommended to conduct an antibiotic sensitivity test to determine which antibiotic will be most effective against the identified pathogen and select the optimal dosage. But in practice, there is often not so much time with sepsis, since the disease progresses very quickly. The patient can die within a few hours if no measures are taken.

Therefore, broad-spectrum antibiotics are often prescribed for sepsis. Infusion therapy is used for severe sepsis. In moderate cases, drugs are prescribed intramuscularly and orally. Also, antibiotics that do not withstand the acidic environment of gastric juice and are neutralized by it are prescribed parenterally.

Among the broad-spectrum antibiotics, the following groups of drugs are widely used for blood poisoning: penicillins, tetracyclines, amphenicols, cephalosporins, fluoroquinolones, aminoglycosides. If they are ineffective, carbapenems are used. Of these, imipenem and meropenem work best. From the penicillin group of drugs, benzylpenicillin is prescribed, which is based on penicillin and is a first-line drug. Ampicillin and amoxicillin have also proven themselves well from the penicillin series.

Often, with such a severe form of infection as sepsis, one drug does not always cope. Therefore, there is a need to use a complex of drugs. Basically, combination drugs contain several antibiotics and an auxiliary substance that has a stabilizing effect, increases their activity and duration of action, protects against breakdown by gastric juice and other enzymes.

Most often, amoxicillin is used in combination with clavulanic acid. This is one of the most common combinations. Also used is a combination of amoxicillin and sulbactam, ampicillin and sulbactam. In severe infections, ticarcillin and clavulanic acid are used, as well as piperacillin and tazobactam.

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Antibiotics for the treatment of sepsis caused by staph

In sepsis of staphylococcal etiology, drugs of the penicillin group are mainly prescribed, as well as tetracyclines, cephalosporins, and fluoroquinolones. Such drugs as oxacillin have proven themselves well. In case of severe infection and the location of the infection in hard-to-reach places, for example, inside the bone, gentamicin is prescribed. It is often used in combination with oxacillin.

There is staphylococcus that exhibits resistance to the methicillin group. This is typical, for example, of hospital strains that persist in hospital departments, mainly in operating and surgical departments, and have developed multiple resistance to many antibacterial drugs and antiseptics. In this case, rafimpicin remains effective. But bacteria very quickly adapt to it, losing sensitivity. Therefore, it is often taken in combination with ciprofloxacin.

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Antibiotics for the treatment of sepsis caused by Pseudomonas aeruginosa

Pseudomonas aeruginosa exhibits a high level of resistance to many antibiotics, it is quite difficult to cure. They exhibit resistance to drugs of the tetracycline group. From this group, such drugs as tetracycline and doxycycline remain effective today.

Doxycycline is more active, but at the same time has more pronounced side effects, causes numerous complications and negatively affects the state of normal human microflora. It is characterized by high bioavailability and prolonged action.

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Antibiotics for the prevention of sepsis

For prophylactic purposes after operations and transplantation, mainly new generation drugs are prescribed, such as fluoroquinolones, aminoglycosides, carbapenems. They exhibit high activity against many gram-negative, anaerobic forms of microorganisms, which develop mainly in postoperative wounds, with limited access to oxygen.

Of the fluoroquinolones, the following drugs have proven themselves well: norfloxacin, ciprofloxacin, ofloxacin. Levofloxacin, the active substance of which is lomefloxacin, is used quite often. The analogs of the drug are levolet, flexid, and other drugs that contain lomefloxacin.

Among aminoglycosides there are drugs that have an antibacterial effect against both gram-positive and gram-negative forms.

Quite often, streptomycin is used from this group, which is most often used in the form of injections for sepsis. Preference is given to intramuscular administration. It has a high degree of antibacterial activity.

Amikacin is a third-generation drug. It is also used in the form of injections. Most often, it is used when other drugs are ineffective, since it has a very powerful effect.

Amphenicols are a group of drugs that include various antibiotics. Levomycetin is most often used from this group. In case of sepsis, it can be used in the form of injections, as well as in the form of an ointment for various purulent, purulent-septic diseases.

Carbapenems are effective against many microorganisms, including those that exhibit multiple drug resistance. They are most often used to treat and prevent hospital-acquired infections. The most commonly used drugs in this group are meronem, invanz, and imipenem. The peculiarity of drugs in this group is that they are administered exclusively intravenously.

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Pharmacodynamics

Most of them have a bactericidal effect when the active substance in the blood plasma reaches a level exceeding the minimum threshold level - MIC. As soon as the concentration of the active substance drops below the permissible level, the bacteria begin to multiply again. Moreover, they acquire resistance not only to this substance, but to the entire group. Therefore, it is important to adhere to the prescribed dosage and not to stop treatment, even if the symptoms have already disappeared. Resistance also appears if there are long breaks between administration of the drug. Therefore, it is important to strictly adhere to a specific form and regimen.

Maximum lysis of bacteria is observed when the concentration of the active substance in plasma exceeds the MIC by 4-5 times. Further increase is ineffective. It has been established that in order to achieve a bacteriostatic effect, in which the growth of microorganisms is suspended, it is necessary for the concentration of the antibiotic in the blood to exceed the MIC by 20%. In order to achieve a bactericidal effect, in which microorganisms die, the concentration of the antibiotic should exceed the MIC by 40%. For penicillins, this figure is 20-40%, while for carbapenems it is 100%, which determines their high efficiency.

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Pharmacokinetics

In patients with sepsis, the pharmacokinetics differs from that in patients suffering from a local infection. In particular, they experience a sharp decrease in the amount of antibiotic in the blood. Accordingly, septic patients require higher doses of the drug. Data from numerous studies confirm that intravenous infusions are the most effective method of treating sepsis.

The bactericidal action of antibiotics is determined by their group affiliation. Thus, some of them can suppress the ability of microorganisms to reproduce, others inactivate the cellular enzyme that is responsible for the general biochemical state of the microorganism, as a result of which it dies. There are drugs that disrupt the integrity of the cell membrane, which also entails the death of the microorganism.

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Dosing and administration

Antibiotics are used in sepsis in various ways. The choice of one or another method depends on the severity of the disease, the degree of bacterial contamination, the sensitivity of microorganisms to the drug. Individual characteristics of a person and concomitant diseases are also taken into account. The dosage is also determined by individual indicators of sensitivity to antibiotics. The general condition of the body.

Broad-spectrum antibiotics are prescribed in large doses. In sepsis, the parenteral route of administration is predominantly used, since most of the drug is inactivated when passing through the gastrointestinal tract, so large doses must be administered, which in turn causes complications and side effects.

When administered intravenously or intramuscularly, the drug penetrates directly into the blood, unchanged, whereas when passing through the gastrointestinal tract of the body, the drug undergoes changes. In addition, a certain amount of time must pass for the drug to be absorbed through the walls of the stomach and intestines into the blood. When administered into the blood, the drug begins to act immediately, which is especially important in sepsis.

The dosage differs for each drug. It is important to create a high concentration of the drug in the blood plasma, which will achieve the desired effect. For example, ampicillin is prescribed at a dosage of 50 mg / kg of body weight. Oxacillin is prescribed at 2 grams intravenously every 4 hours for severe sepsis of staphylococcal and pneumococcal etiology. Penicillins are administered intravenously at 20-40 million units for 2 weeks. Gentamicin is prescribed at 1 mg / kg every 8 hours.

In case of Pseudomonas aeruginosa sepsis, cardenicillin is prescribed at 2-3 grams every 4 hours. Levomycetin - 1 gram every 6 hours intramuscularly, erythromycin - 0.5 grams every 4-6 hours. In the treatment of gram-negative microorganisms, ciprofloxacin is prescribed at 750 mg three times a day.

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Use antibiotics for sepsis during pregnancy

In general, antibiotics are not recommended during pregnancy, but sepsis is an exception. Without treatment, sepsis is fatal, as the immune system is intensively suppressed and bacterial microflora grows uncontrollably. It is important to choose the right antibiotic, which will minimize the risks for both mother and child.

Contraindications

Antibiotics are used even if there are contraindications, because without them a person will inevitably die. The question is how to minimize the consequences of taking them. Hepatoprotectors are used, which help protect the liver from destructive effects, probiotics and prebiotics, which restore normal microflora. It is important to choose the right dosage, group and type of drug, method of administration, frequency and duration of treatment, which will ensure maximum effectiveness with minimal complications and side effects.

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Side effects antibiotics for sepsis

Antibiotics can have numerous side effects on almost all organs and systems. But they must be taken, because the positive result outweighs the possible risks. Without treatment, a person will definitely die, and side effects can almost always be cured or prevented later.

Side effects mainly develop during long-term treatment or when taking strong drugs. The main complications concern the kidneys and liver. Severe intoxication, damage, inflammatory processes, up to insufficiency, may develop. The gastrointestinal tract experiences the load, so if possible, it is better to administer the drug parenterally.

Disturbances of the immune system are dangerous. Neutropenia, a disturbance in the number of leukocytes, develops quite often. The load on the heart and blood vessels also increases.

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Overdose

Overdose causes liver and kidney damage, up to the development of functional insufficiency. The load on the heart and blood vessels increases significantly. The composition of the blood and its function are disrupted. There is a risk of heart attacks and strokes. Respiratory and digestive processes are disrupted. Allergic reactions and intoxications may occur.

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Interactions with other drugs

Antibiotics for sepsis cannot be combined with drugs that contain ethyl alcohol. Take with caution in combination with hormonal agents. It is not recommended to take with antiviral drugs. To enhance the activity, many antibiotics are used in combination, combining several drugs from different groups. In this case, you need to study the properties of each and know the mechanism of their interaction.

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Storage conditions

The drug is stored in the original packaging. The storage method is specified in the instructions and is determined by the characteristics of the active substance and the form of release. In any case, they should be stored in a dark place, inaccessible to children and animals. At the same time, it is necessary to maintain the optimal temperature and humidity.

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Shelf life

The shelf life depends on the type and form of release. In general, unopened products are suitable for use for 2-3 years. Unpacked tablets can be stored for up to several months. Opened ampoules are stored for no more than 1-2 hours, prepared suspensions - up to several days.

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