Our experience and data

Causal ABT abdominal sepsis

In the immediate major abdominal surgery through the AT is parenteral. Oral medications prescribed in addition to parenteral. This refers to the selective decontamination of the intestine (KFOR) to antifungal drugs, derivatives of imidazole. In diseases of moderate intramuscular injection with an adequate interval creates an effective drug concentration in the blood. However, in critical condition patients drug absorption from muscle significantly disturbed by the deterioration of tissue perfusion. In this regard, the most effective method of administration will be intravenous antibiotics.

Presented in the literature on endolymphatic and intra-arterial injection of antibacterial drugs in abdominal surgical infections can not be considered conclusive yet to draw definitive conclusions about their effectiveness, economic benefits, side effects and complications [7].

The effectiveness of intraperitoneal local administration of brand viagra antibiotics or irrigation of the abdominal cavity are questionable. Several comparative clinical trials convincingly demonstrated the absence of any effect of irrigation of the abdominal cavity aminoglycosides, cephalosporins, or chloramphenicol at the rate of postoperative infections [6]. At the same time, the use of antibiotics, without creating sufficient bactericidal effect in the abdominal cavity can lead to penetration of the drug into the systemic circulation, that the use of toxic antibiotics (especially aminoglycosides I generation) is dangerous additional damage to organs.

On the final performance of antibacterial therapy in intra-abdominal infections can only be judged by the complete elimination of all baseline symptoms of a pathological process that is extremely difficult in surgical patients. Systemic inflammatory response in the postoperative period may be caused by many factors related to the ongoing process in the abdominal cavity, the appearance of secondary ektraabdominalnyh foci of infection. It is necessary to follow the rule of advanced and alternative alertness. So, save for the background sound ABT systemic inflammatory reaction should induce the clinician not to a change in antibiotics (although this should think), but to the persistent search for the source of infection. This may be intra-abdominal (recurrent or recurrent source of infection) or an alternative source of infection outside the abdomen. In severe sepsis, the simultaneous presence of several sources of infection (gastrointestinal tract, lungs, etc.) lasting therapeutic effect is often observed when the duration of antibiotic therapy at least 34 weeks. However, the absence of any significant changes at an earlier date may indicate a lack of surgical intervention and inappropriate antibiotic therapy.

Selective decontamination of the gastrointestinal tract during abdominal sepsis

Studies conducted in the clinic of Surgery them. SI Spasokukotsky to evaluate the effectiveness of KFOR in combination with systemic administration of antibiotics for peritonitis, possible to establish the reduction in the incidence of pathological colonization of the gastrointestinal tract by 33%, the tracheobronchial tree by 35% reduction in the incidence of nosocomial pneumonia by 20% and the incidence of septic shock by 50% . Against this background, showed a viagra dose usage and myths trend toward reduced mortality from 43.8% to 34.1% [2].

It is now possible to distinguish groups of patients with complicated intra-abdominal infection, which based on our experience and data of world literature may be considered appropriate use of KFOR in combination with systemic AT [2, 6]:

1. Peritonitis of any cause.

2. Multiple abscesses of the abdominal cavity.

3. Prevention of septic complications in necrotizing pancreatitis.

4. Complex treatment of infected pancreatic necrosis, pancreatic abscess and peritonitis.

5. Intestinal obstruction of various etiologies.

6. Severe sepsis and MODS in complicated intra-abdominal infections of any etiology.

In all cases, pancreatic and postoperative peritonitis, infectious complications of pancreatic necrosis, tertiary peritonitis, it is expedient to selective decontamination of the intestine with the compulsory inclusion of fluconazole (or amphotericin B).

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