Antibiotics after surgery: long does not mean good

An antibiotic (antibacterial drug, antimicrobial agent) is a drug that is effective in treating bacterial infections. Its effect is to directly affect the bacterium, it kills it. Its effect may also be to slow down the proliferation of bacteria, which allows the immune system to cope with it. The high prevalence of infections, a large selection of antibiotics for children, and the unjustified prescription of these drugs for diseases in children and adults have led to threatening consequences for human life—antibiotic resistance. According to the Eurasian recommendations, 25,000 deaths annually in the EU are associated with antibiotic resistance. At the moment, antimicrobial agents are an irreplaceable resource for humanity. Antibacterial resistance can be considered a threat to national security.

Before moving on to the choice of a children's antibiotic, consideration of dosage, duration of use, it is necessary to analyze and explain the main points in the formation of resistance to antibacterial agents. Only after this can one adequately judge the choice and approach to prescribing these medications.

Antibiotic resistance

Antibiotic resistance is the term for resistance to antibiotics. Who is to blame for this? The main reason is the excessive and uncontrolled use of antimicrobial agents. This applies not only to medicine.

Prescribing antibiotics should always be justified.

Causes

• Application in medicine. Unjustified prescription on an outpatient basis, in a hospital, self-medication (over-the-counter). The main emphasis is on counteracting the unjustified prescription of antibiotics in primary care (at the outpatient stage). For this purpose, clinical recommendations and algorithms for prescribing antibiotics to children are specially developed and implemented in practical healthcare. Also, through the media, explanations are provided to the population about the need for the judicious use of antimicrobial agents and the dangers of their independent use.
• Use of antibiotics in veterinary medicine.
• Application in the agricultural industry.

Basic rules for the correct use of antibacterial drugs

1. An antimicrobial agent is taken only in the presence of a bacterial infection that is suspected or documented.
2. When using the drug, you must adhere to the optimal regimen. The first is the correct choice of medicine. Otherwise, it is necessary to maintain an adequate dose and duration of use.
3. When choosing a drug, it is necessary to take into account the regional situation regarding antibiotic resistance of the most common pathogens and take into account the likelihood of infection of the patient with these bacteria.
4. Do not use low quality antibiotics with unproven effectiveness.
5. Do not use antibiotics for prophylactic purposes.
6. The effect of using an antibacterial agent is assessed 48-72 hours after the start of treatment.
7. Explain the harm of non-compliance with the medication regimen, and also explain the dangers of self-medication.
8. Promote the correct use of the drug by the patient.
9. In each case, it is necessary to use methods to determine the cause of the infection.
10. When prescribing an antibacterial drug, doctors must adhere to recommendations based on evidence-based medicine.

How to take antibiotics correctly

It is important to take antimicrobial medications correctly to prevent the development of resistance, a condition where a strain of bacteria no longer responds to treatment with one or more types of antibiotics. Therefore, self-medication in the case of antibiotics is not just harmful to health - it is dangerous!

Only a doctor should decide on the advisability of prescribing an antimicrobial agent, select a specific drug, dosage and determine the duration of use.

Antibiotics should be used strictly in the doses prescribed by the doctor. Oral forms (tablets, capsules, syrups) are drunk in accordance with the recommendations prescribed in the instructions: before/after meals. You cannot reduce or increase the dosage on your own: a low level of the active substance in the blood will not have the desired effect, and an excessive one will increase the risk of side effects.

It is very important to drink the entire prescribed course of antibiotics, even if the temperature has subsided and your health has improved. Stopping use risks the emergence of resistant forms of bacteria. You cannot skip taking the next dose: the effect of the medicine must be continuous, that is, one portion of the substance “clings” to another. Interruptions in admission are unacceptable. If you accidentally miss one dose, drink the medicine “as soon as you remember”, and then continue the course as usual. Do not take a double dose to make up for a missed dose.

Indications for antibiotics

A fairly common mistake is the use of antibiotics for diseases that develop as a result of a non-bacterial infection.

Antibiotics should not be used for viral infections.

Among these diseases:

• Acute pharyngitis.
• Acute laryngotracheitis.
• Rhinitis.
• SARS, only.
• Acute bronchitis. It is permissible to use antibiotics when bronchial constriction develops, as well as when fever lasts more than 5 days.

In these cases, the prescription of antibiotics is not justified, since the cause that led to these diseases is often viruses.

There are also controversial points when both viruses and bacteria can lead to the development of the disease. Such diseases include:

• Acute rhinosinusitis.
• Acute otitis media.
• Acute tonsillitis.

In such cases, an antibiotic is prescribed only after examination and observation by a doctor of the patient.

For viral infections (pharyngitis, rhinitis, laryngitis, tracheitis), the effectiveness of antibiotics is equal to the placebo effect. It is important to remember that the prescription of antibacterial agents does not prevent the development of bacterial superinfection (that is, the addition of a bacterial infection to an existing viral one). There are no effective remedies against ARVI. The use of antiviral immunostimulating agents common in pharmacy chains often does not have any effect. In this case, the antiviral agent can be considered as ascorbic acid or garlic. In such cases, adequate pathogenetic and symptomatic treatment is prescribed, which allows eliminating and eliminating the symptoms of ARVI. Used: paracetamol, ibuprofen, mucolytics (ambroxol, acetylcysteine, carbocysteine), vasoconstrictor nasal drops for a runny nose, nasal corticosteroid for rhinosinusitis. If there is a disease with a viral or bacterial cause (tonsillitis, sinusitis, otitis media), then in this case antibacterial therapy delayed by 2-3 days is recommended. Delayed antibiotic prescribing for upper respiratory tract infections has reduced the frequency of antibiotic prescriptions by 40%.

These statements are of an evidentiary nature and are described in more detail in the training manual “ Rational use of antimicrobial agents in the outpatient practice of doctors , written on the basis and evidence base of the 2021 Eurasian recommendations.

Myths and facts about antibiotics

Antibiotic therapy, like vaccinations, is shrouded in myths, fears and stories of how someone lost their hearing after treatment with antibiotics, got a persistent intestinal disorder, and in general, antibiotics are too dangerous because they kill all living things.

Briefly: yes, antibiotics have serious side effects and, if prescribed incorrectly, can actually cause hearing problems, etc. There are drugs prohibited for children and pregnant women, but in general modern drugs are safe if taken as directed. And now in more detail

For seriously ill patients

Express diagnostics at home. This includes not only taking diagnostic samples, if necessary, we perform ECGs and ultrasounds at home .

A little history:

At the end of the 19th century, several scientists immediately noticed that penicillin fungus mold accelerates the healing of wounds, but its use was difficult - even with short-term storage, the beneficial properties of the mold were lost. In 1938, scientists from Oxford isolated penicillin in its pure form, for which they received the Nobel Prize. And Zinaida Ermolyeva is considered the mother of domestic antibiotic therapy - in 1942 she developed the first Soviet antibiotic, Krustozin, which immediately found use in military hospitals - mortality from bacterial complications fell sharply. Today there are a great variety of antibiotics; there are even drugs with a cytostatic effect that stop the growth of tumor cells.

The most popular question: are antibiotics and alcohol compatible?

Briefly: there are antibiotics that can be taken with alcohol, and there are those where drinking alcohol is contraindicated. In general, it is better not to stop antibiotic therapy because of a glass of wine, but to abstain from alcohol throughout the entire treatment phase.

Read more: it is better to avoid drinking alcohol during treatment, but for most antibiotics it makes no difference whether you drank or not. However, there are exceptions: some drugs slow down the breakdown of alcohol, this increases the concentration of acetaldehyde, causing unpleasant symptoms, including vomiting. Previously, alcoholism was treated with such antibiotics. Where do the roots of this myth come from: during the war, the production of antibiotics was too expensive, they were isolated repeatedly from the urine of patients, and since beer increased the volume of urine and complicated the process, drinking was banned. Another opinion is that venereologists, when prescribing antibiotics, forbade drinking in order, firstly, to punish patients, and secondly, to reduce the likelihood of accidental contacts and further spread of infection.

Conclusion: it is better to give up alcohol so as not to increase the load on the liver and other organs.

Do you have to complete the course to the end?

Complex issue. Modern pharmacology strives to reduce the time of taking the drug while maintaining the effect. Today, single-dose antibiotics have been developed. Previously, it was believed that by not drinking the course to the end, we increase the resistance of microorganisms. But she appears anyway. Studies have confirmed that a short “impact” course is no different in effectiveness from a long one, and resistance is reduced. Most likely, this is due to the fact that resistant bacteria will remain so, but with long-term antibiotic therapy they will also learn to protect themselves from medicinal components, that is, they will gain additional benefits. At the same time, scientists discovered another interesting feature: bacteria from the walls of the cave, which was hidden from people for about 4 million years, were resistant to at least one modern antibiotic! Moreover, antibiotics are a product of the vital activity of microorganisms; bacteria have been using them for 2 billion years.

Not long ago it turned out that bacteria can destroy antibiotics and this feature is fixed at the genetic level, fixed in DNA - this is how superbugs are obtained. In addition, at the source of infection, bacteria are having their own “war” for territory. Some bacteria destroy others, picking up DNA residues that may contain a resistance gene. Does this mean we will all die from superbugs? No. We must not forget that we have an immune system, and scientists are also developing drugs that do not allow the resistance gene to attach to the transport components of bacteria - plasmids - it is the plasmids that are responsible for the transfer of genetic information.

Be sure to complete the course if an antibiotic is prescribed to treat a chronic infection or severe infections. In acute cases, when treating, for example, acute otitis media, if the condition significantly improves, consult a doctor to adjust your medication schedule; perhaps the doctor will stop the antibiotic, or perhaps not. Everything is individual.

Injections are better

No, injections are not better. Previously, the release of dosage forms that would retain the required bioavailability, storage properties and would not be destroyed in the stomach would be problematic, so doctors preferred injections, especially if the infectious process had gone too far. Today, even in hospitals they try to prescribe tablet forms whenever possible. Their bioavailability is practically not inferior to injectable forms, the only thing is that the tablets begin to act a little later. The exceptions are intravenous injections - the antibiotic acts almost instantly and drugs that are destroyed by enzymes. Injections are painful, stressful especially for children, there are the classic risks of infection, and there is also the risk of abscesses and other complications.

Do you take antibiotics for prevention?

Briefly: yes and no.

Taking a pack of pills to avoid getting sick after hypothermia is not prevention. The so-called preventive use of antibiotics is justified if there is a high risk of severe or dangerous infections. Thus, antibiotic prophylaxis is often prescribed in venereology and other areas of medicine. The norm is to take an antibiotic tablet before and after tooth extraction, installation of a dental implant, and during surgical interventions. Antibiotic prophylaxis is prescribed only by a doctor.

Antibiotics are evil for children and pregnant women

You can often find a pregnant woman who tries to treat infectious processes with home methods, believing that the medicine will harm the unborn child. You need to be aware of the risks first of all: the doctor, of course, tries to minimize the use of medications during this period, but pregnant women undergo operations, dental treatment, a lot of other procedures, and refusal of antibiotics where necessary can lead to infection of the fetus including. WHO regularly updates the list of drugs for pregnant women and children. There are recommended, controlled and spare ones. If you are worried, go to the WHO website - approved drugs are highlighted in green, prohibited drugs are in red, controlled and spare drugs are in yellow.

Without a sensitivity test, there is no point in taking antibiotics

In typical cases, conditions of moderate severity and for obvious reasons - some infectious processes have too typical a clinical picture, which is used as a diagnostic criterion; there is no practical sense in an antibiogram.

How an antibiogram is performed: the doctor takes material, for example, from a wound. In the laboratory, a microorganism is isolated that causes an infectious process (this takes at least 2-3 days), then a pure culture is isolated and, roughly speaking, confetti-sized disks are laid out, which are soaked in an antibiotic. Around the most effective ones there will be a maximum clean zone from bacterial colonies. On average, an antibiogram takes 3-7 days to prepare. Treatment ALWAYS begins immediately; during the course of treatment, the antibiotic may be changed, taking into account the antibiogram data. It is not done in all cases, but in the treatment of chronic infections, complex extensive infections. In typical cases, data show that the effectiveness of first-line antibiotics is not much lower than those selected using an antibiogram.

Do I need to take antibiotics for viral infections?

In short: sometimes you need it, sometimes you don’t.

Antibiotics do not act on viruses, but bacterial complications often develop against the background of viral infections. Often the doctor prescribes antibiotics because patients are waiting for appointments, although physical methods are almost always sufficient to treat acute respiratory viral infections, including influenza. Very rarely, an antibiotic for ARVI is prescribed prophylactically if the patient is weakened, has immunodeficiency, extremely low body weight (in children), or old age.

Antibiotics kill all living things and “burn out” the flora

In short: more likely no than yes.

Antibiotics do not kill any microbial cell; they act selectively, taking into account the biochemistry and characteristics of pathogenic agents - the drug either destroys the wall of the microbial cell, or stops reproduction, or acts on another target. The antibiotic only partially affects “its own” people, but already 3-5 days after the end of the course, and for the majority, after 1-2 days, the intestinal microflora is restored without additional intake of probiotics. There is an opinion that probiotics are useless: in case of serious violations of the flora, they do not help, and a conditionally healthy person recovers on his own after a course of antibiotics. Stories that someone once took a loading dose of an antibiotic and now has dysbiosis for life are fairy tales. But if you want to speed up the restoration of flora, drink kefir.

Antibiotics spoil the immune system and a healthy body is able to cope with infections on its own

Briefly: yes and no

Indeed, for some infections, the doctor does not prescribe an antibiotic. For example, for deep abrasions that have become inflamed, dressings and regular washing are enough, antibiotic therapy for bronchitis and pharyngitis is not always prescribed. But the body cannot cope with all infections on its own. Peritonitis, in general, occurs because you couldn’t handle it yourself. Antibiotics do not affect the immune system: the medicine works separately, and the immune cells work separately. Standard antibiotics do not affect the immune system, but there are antibiotics that are initially cytostatic, and they are called antitumor, and for a number of primary immunodeficiencies, antibacterial drugs are taken for several years.

Express replies:

Do antibiotics damage the liver? No. There are drugs that multiply the side effects of each other. Tell your doctor what medications you are taking so he can choose safe antibiotics.

How to drink it? Read the instructions or ask your doctor. Usually antibiotics are taken 1-2 hours after meals with water. You can’t use milk, kefir, jelly or anything else - the active substance is destroyed.

How to recycle? Expired medications should not be flushed down the drain - they have their own life there, which creates resistance to the drugs. Some cities have collection points for expired medications; if they are not available, pour the medications with sand or soil into a plastic container and dispose of them with household waste. This will reduce the risk of children or animals eating the pills.

Antibiotics should not be given to patients with allergies. Can. If an antibiotic provokes an attack, which most often ends at the level of urticaria and is stopped by a single dose of antihistamines, then another one is selected. Abscesses and purulent inflammations are much more dangerous than short-term urticaria. Modern drugs are synthetic and extremely rarely cause allergies; allergy symptoms often occur against the background of massive death of microorganisms.

Modern meat is laced with antibiotics and is dangerous . No. Antibiotics have always been used in animal husbandry; they in no way affect the human body. There are acceptable standards, farmers are obliged to comply with them.

Conclusion : the prescription of antibiotics must be justified, and the duration of the course is selected individually, taking into account the severity of the condition, danger and characteristics of the infectious process. When a doctor prescribes the same regimen for everyone, this is not entirely correct; drugs need to be selected individually - this concerns the dose, frequency of administration and other features. In our clinic you will find excellent specialists who select treatment in such a way as to cure you in the shortest possible time and without delayed risks to the body. We issue sick leave certificates, we have our own laboratory where you can test for sensitivity to antibiotics, including

The main types of antibiotics and their common representatives on the market

Below we consider the most popular and frequently used groups of antibacterial agents:

• Beta-lactams . Among them are penicillins, cephalosporins, and carbapenems. Among the penicillins, it is worth highlighting: amoxicillin, ampicillin, ticarcillin, carbenicillin, mezlocillin, mecillam. The most popular cephalosporins are: cefazolin, cephalexin, cefuroxime, cefotaxime, ceftriaxone, cefepime, ceftobiprole. Carbapenems are used much less frequently. Meropenem can be isolated.
• Macrolides . Macrolides include: clarithromycin, azithromycin (sumamed), josamycin.
• Tetracyclines . The most common: tetracycline, doxycycline, oxytetracycline.
• Aminoglycosides . Popular ones: gentamicin, amikacin, isepamycin.
• Levomycetins . Trade names: chloramphenicol, chloromycetin.
• Glycopeptide antibiotics . The most commonly used: vancomycin, bleomycin.
• Lincosamides . Used in medicine: lincomycin, clindamycin.
• Fluoroquinolones . Among them, the most commonly used are: ciprofloxacin, levofloxacin, gemifloxacin. They are a broad-spectrum antibiotic for children. These antibiotics are not contraindicated in pediatric practice, but their use in children is sharply limited.

It is important to remember that these drugs have their own indications and contraindications, and are also used against certain infections.

These drugs have their own indications and contraindications, and have a narrow or broad spectrum of activity against bacteria. Some of the listed drugs can be used by children under one year of age. Children's antibiotics are available in tablets, suspensions, and ampoules for intravenous and intramuscular administration. Calculation of the dose, dilution of antibiotics and administration of the required dose to the child should be carried out by medical personnel in order to avoid unwanted reactions, as well as complications during injections. They should be prescribed exclusively by a doctor.

Types of antibiotics

There are hundreds of different types of antibiotics, but most can be roughly divided into six groups:

1. Penicillins are widely used to treat various infections: skin, respiratory system, urinary tract.
2. Cephalosporins are used to treat a wide range of serious infections, including sepsis and meningitis.
3. Aminoglycosides are prescribed mainly in hospitals (outpatient - under the strict supervision of a doctor) for the treatment of severe pathologies. This group of drugs can cause serious side effects: hearing loss and kidney pathology. Aminoglycosides are used, usually in the form of injections or eye/ear drops.
4. Tetracyclines are used to treat a wide range of infections: skin (severe forms of acne and rosacea), urogenital.
5. Macrolides are prescribed for infectious processes in the lungs and/or as alternative drugs for patients with allergies to penicillin. They are also used to treat penicillin-resistant strains of bacteria.
6. Lincosamides are effective in the treatment of infectious bone lesions.

Duration of use of antibacterial agents

Parents often ask questions: “How many days are antibiotics given to children? What is the best antibiotic for children? What should I give my child when taking antibiotics? In most cases, 5-7 days of use are sufficient. There are exceptions in which the duration of use may increase to 10–28 days. The second question cannot be answered unambiguously. Each drug has its own indications and contraindications, so the use of a particular drug depends on the situation (age, diagnosis, concomitant pathology, etc.). To the third question, many doctors will answer the same: “Probiotics.” A probiotic will restore normal intestinal microflora that has been affected by an antibacterial agent. As a rule, they are prescribed in a course of 2 weeks to 1 month.

You can always consult your doctor if you have any questions regarding treatment.

According to the Eurasian recommendations, in order to overcome antibiotic resistance, experts emphasize the need to draw the attention of patients to strict adherence to the drug use regimen. It is necessary to use optimal dosage forms of antibiotics with high bioavailability, in particular, Solutab dispersible tablets, which is consistent with the current position of WHO and UNICEF. Advantages of Solutab dispersible tablets:

• Completely absorbed in the intestines. As a result, the effect is equal to the intravenous effect.
• Create a high concentration at the site of infection.
• Better portability.
• Good organoleptic properties.
• The ability to dissolve tablets, which allows the use of this dosage form in children.
• A minimal amount of liquid is required for swallowing.
• They have an advantage over a suspension - errors in preparation are eliminated.

Dispersible tablets recommended by WHO and UNICEF:

• Flemoxin Solutab
• Flemoklav Solutab
• Suprax Solutab
• Vilprofen Solutab
• Unidox Solutab

Parents of children should remember that an incomplete course of prescribed antibiotic treatment leads to the formation of bacterial resistance and a prolonged presence of the microbe in the body.

Are probiotics necessary?

Antibiotics kill bacteria, but they do not distinguish good microorganisms from bad ones. These powerful drugs destroy vital bacteria necessary for the normal functioning of the digestive and immune systems. The best way to replenish losses is to consume probiotics, which contain live bacteria that normally inhabit the intestines.

Probiotics are prescribed during and after a course of antibiotics to restore intestinal microflora and, therefore, immunity. It is important to “dilute” the intake of medications: it is advisable to take the probiotic a couple of hours before or several hours after the dose of the antibiotic. The duration of use of probiotics after a course of antibiotic therapy is determined by the doctor.

For detailed advice on how to take antibiotics correctly, please contact your healthcare provider.

Complications of antibiotic use

When using antibiotics, there is a risk of developing unwanted reactions. Such complications include:

• Hepatotoxicity – liver damage. Most often observed when taking moxifloxacin, macrolides, and clavulanate.
• Cardiotoxicity is damage to the heart. Such a reaction can occur when using fluoroquinolones, azithromycin, clarithromycin.
• Neurotoxicity is damage to the nervous system. Occurs with fluoroquinolones.
• Allergy . Characteristic of penicillins and cephalosporins.

In fact, the wider the spectrum of antimicrobial activity, the higher the risk of adverse reactions..

Choosing an antibiotic in a child

Previously, we reviewed the main diseases of the upper and lower respiratory tract, for which antimicrobial agents can be used. Now we will analyze the main drugs that can be used for this or that pathology, and also indicate the required dosage of the drug.

Do not take antibiotics without a doctor's prescription.

Do not use medications yourself! The medications and dosages listed below are for informational purposes only and are not equivalent to treatments prescribed by a physician.

Acute otitis media

The drug of choice is amoxicillin 40-90 mg/kg/day in 3 divided doses. Duration of therapy is 10 days in children <5 years old, 5-7 days in children >5 years old. The second-line drug is amoxicillin/clavulanate. The third-line drug is josamycin.

Acute rhinosinusitis

Similar to the use of antibacterial agents for acute otitis media.

Acute tonsillitis

The drug of choice is amoxicillin 45-60 mg/kg in 3 doses, phenoxymethylpenicillin 25-50 mg/kg 3-4 times a day. The second-line drug is cefixime. The third-line drug is josamycin. Duration of therapy is 10 days.

Community-acquired pneumonia

The therapy of choice is amoxicillin IV 45-90 mg/kg/day in 3 divided doses. The second line drug is amoxicillin/clavulanate, cefuroxime IM, ceftriaxone IM. The third line drug is josamycin 40-50 mg/kg/day in 2 doses.

Antibiotics are indispensable drugs in the fight against bacterial infection. These medications should be prescribed solely for medical reasons. It is very important to adhere to the prescribed regimen of using the antibacterial agent. Do not self-medicate. If signs of infection occur, contact your pediatrician, who will help establish the diagnosis, cause of the disease, and prescribe adequate treatment.