Antibiotics (Properties, Applications, Interactions) - M.P. Cherenko 1999

Use of antibiotics in surgery

Antibiotics are widely used in surgery to treat and prevent infections, and their efficacy is unquestionable. Prescribing antibiotics to patients with acute and chronic infections is essential in the vast majority of cases. Their effectiveness depends on The Nature of the infection and the appropriateness of the chosen Treatment regimen. The general rules of antibiotic therapy are:

1) justifying the necessity of prescribing antibiotics;

2) if the CAUSATIVE AGENT OF the infection is known, prescribing the appropriate antibiotics that are the least toxic, most accessible, and most affordable—such as Penicillins for a streptococcal infection;

3) if the pathogen is unknown and the clinical course is severe, initially using broad-spectrum antibiotics: Aminoglycosides (gentamicin), Cephalosporins (mefoxin, rocephin), Semisynthetic penicillins (ampicillin, augmentin/amoxiclav), tienam, etc.; identifying the pathogen and its antibiotic susceptibility as quickly as possible, followed by adjusting the antibiotic therapy if necessary;

4) strictly adhering to the administration schedule of the antibiotic (dosage, duration, etc.);

5) switching to another antibiotic if the current one proves ineffective within the recommended instruction period;

6) avoiding pairs of antibiotics that mutually weaken each other's effects (e.g., chloramphenicol and Tetracyclines), act antagonistically (penicillin group drugs,

chloramphenicol), or mutually enhance their toxic properties, such as two aminoglycosides (gentamicin and kanamycin; monomycin or streptomycin, etc.);

7) assessing the patient's sensitivity to antibiotics—primarily the penicillin group—prior to administration (using anamnestic data and dermal tolerance tests: intradermal injection of 0.1 mL of the solution, or, in case of a history of allergic reactions, placing a drop on the Skin with or without scarification);

8) avoiding the topical application of systemic antibiotics;

9) avoiding The Use of antibiotics to treat abscesses (except for pulmonary ones) prior to surgical drainage;

10) avoiding the prophylactic use of antibiotics in clean superficial operations (hernia repair, strumectomy, mastectomy, etc.);

11) administering prophylactic antibiotics primarily during surgeries on the digestive tract—mainly the intestines involving the opening of the lumen—as well as cardiac and thoracic surgeries, organ transplantation, and vascular xenoprosthetics (1–2 hours before surgery, ensuring peak concentration is reached during the operative Procedure);

12) using antibiotics in combination with other antimicrobial agents (sulfonamides, quinolones/fluoroquinolones, etc.);

13) selecting the most appropriate routes of parenteral antibiotic administration (intramuscular, intravenous, intra-arterial, endolymphatic, intrathecal/endolumbar) based on the nature, localization, and clinical course of the infection. The endolymphatic route for certain forms of infection, such as Peritonitis, is considered by many authors to be even more effective than the intravascular route due to the prolonged presence of the drugs in the body.

Adhering to the rules outlined above will help avoid the potential adverse effects associated with many antibiotics, especially when monitoring of their use is insufficient.

It is important to remember that almost all antibiotics suppress The Immune System. Immune resilience is higher in individuals who have not used antibiotics, which likely explains the more frequent recurrence of infections in patients treated with antibiotics. Therefore, the prescription of antibiotics must be well-reasoned. However, antibiotics also have numerous other side effects. Chief among these are allergic reactions, particularly to penicillin group drugs. Allergic reactions range from mild ones—limited to skin and mucosal rashes, edema, and dyspeptic symptoms—to severe and even fatal ones (anaphylactic Shock). Consequently, before prescribing antibiotics, a patient's history regarding drug tolerance in general and antibiotics in particular (especially penicillins) must be obtained. Furthermore, in patients with hypersensitivity, skin testing for penicillin should be performed (intradermal, injection, or superficial scratch test).

Antibiotics also exert toxic effects on specific Organs and systems. For example, penicillins have a toxic effect on The Nervous system, specifically the Brain AND SPINAL cord. Therefore, their intrathecal administration is permissible only in a highly purified form, highly diluted, and under absolute indications.

Aminoglycosides (gentamicin, neomycin, kanamycin) exhibit ototoxic effects, meaning they cause auditory nerve neuritis (with irreversible Hearing loss), and also affect The Liver and Kidneys.

Tetracyclines cause damage to the digestive tract mucosa, allergies, and photosensitization.

Chloramphenicol (levomycetin), synthomycin, and ristomycin have toxic effects on the Blood and hematopoiesis—sometimes causing reticulocytopenia, granulocytopenia, or anemia—as well as on the mucous membranes and skin (rashes, dyspepsia, etc.).

Macrolides (erythromycin, oleandomycin, oletetrin) are hepatotoxic.

In addition to these direct effects, prolonged use of antibiotics also causes A number of indirect adverse consequences. Among them, the most dangerous is the so-called superinfection, which refers to The Development of candidiasis in the body against the Background of dysbiosis, primarily caused by *Candida albicans* (both local and in the form of candidal Sepsis). Local infection is observed mainly in the oropharyngeal cavity as glossitis, stomatopharyngitis, and vulvovaginitis.

To prevent these complications, it is necessary not only to follow the recommended dosing schedules for each antibiotic but also to combine antibiotics with Vitamins, Enzymes, and Hormones (small doses of corticosteroids, or large doses in septic shock), as well as to prescribe antifungal agents (nystatin, levorin, diflucan, pimafucin, etc.) alongside antibiotics active against pyogenic infections.