Antibiotics for adnexitis
A strict clinical rationale and rationality of antibiotic therapy is required. Justified is the use of drugs with antibacterial action in acute inflammation. In the chronic stage (in the period of remission and during exacerbation without signs of acute inflammation) antibiotics are not used. The exception to the chronic process is two clinical situations where antibacterial drugs are still used:
- if they were not taken by this woman, or if they were used irrationally (insufficient dose, incorrect selection of antibiotic, irrational route of administration);
- during exacerbation of the inflammatory process, occurring according to the type of toxic-infectious inflammation, if the subjective signs are accompanied by objective symptoms (exudation, pain during the two-handed study, fever, increase in the number of leukocytes).
Antibacterial therapy is carried out:
- antibiotics proper,
- a group of nitrofuran preparations (furadonin, furazolidone),
- the group of sulfanilamide preparations (short, medium and prolonged periods of action) does not have an independent meaning;
- drugs metronidazole group (metronidazole, trichopol).
Antibiotics will occupy the main place in the medical complex, however, it is necessary to follow the traditional rules of rational antibacterial therapy:
- the dose of the antimicrobial agent should be high enough to achieve the expected effect, but not the maximum, to avoid side effects;
- the duration of therapy is at least 7 days; if necessary, the course can be extended to 14 days;
- if positive dynamics are not observed, the antibiotic should be canceled and another should be assigned.
At the onset of the disease, if there is no result of the antibiogram, it is recommended to prescribe antibiotics based on the estimated etiology of the disease.
Preference should be given to bactericidal antibiotics, rather than bacteriostatic. It is advisable to use an antimicrobial agent with a long half-life in order to maintain a constant concentration in the blood. Such an approach will avoid the formation of a chronic focus of infection and the development of antibiotic resistance.
Assign semi-synthetic penicillins (methicillin - 6-12 g / day; oxacillin - 3-6 g / day; ampicillin - 4-6 g / day, ampiox - 2-4 g / day); 3rd and 4th generation cephalosporins (ceftriaxone 4-6 g / day); aminoglycosides (kanamycin - up to 2 g / day, gentamicin - 1.60-2.40 g / day.). Such antibacterial agents as the 3rd and 4th generation fluoroquinolones group (gatifloxacin) enjoy increasing confidence from modern doctors. Routes of administration can be different: intramuscularly, intravenously, directly to the appendages through the posterior vaginal vaults. In severe cases, a combination of several antibiotics from different pharmacological groups is required.
Given the high frequency of the combination of aerobic and anaerobic flora, it is recommended to prescribe metronidazole preparations (Trichopol 4 tablets per day for 5 days, metrogyl intravenously 100 ml) and hyperbaric oxygenation (HBO).
Some principles of antibiotic therapy are controversial. For example, in practice, the doctor often prescribes several antibiotics at the same time, given the associativity of the flora that causes the disease. However, there is a glance - it is advocated by microbiologists - about a more expedient combination of antibiotics in time: after 4 days, if the flora begins to get used to the antibiotic, it should be replaced with another one.
A woman should understand that the choice of antibiotic, the duration of treatment should be determined by the doctor. Self-treatment, the purchase of an antibiotic in the nearest pharmacy on the basis of the packaging or television advertisement you like may aggravate the process or make it impossible to restore the reproductive function of a woman after adnexitis.