If light burns of 1 degree are characterized only by superficial injuries of the epidermal layer, accompanied by pain, redness and insignificant edema of the tissues, then at 2 (medium) degree of severity of the burns epidermal damage occurs up to the basal layer with the formation of blisters filled with liquid.
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Antibiotics for burns 2 and 3 degrees
If such a burn occupies an area less than 10% of the entire surface of the body, its treatment can be done at home, observing sterility, in order to prevent infection in the wound. Antibiotics for burns of the 2nd degree in most cases do not apply, because our body and itself is able to resist the infection.
The most common in everyday life are thermal burns, in particular, a burn with boiling water, which affects both adults and children. Most often, after a brief exposure to boiling water, light burns of the 1st degree remain. But if the action of boiling water was quite long, and we are dealing with tender baby skin, even burns of 2 and 3 degrees of severity are not excluded.
When burned with boiling water, antibiotics are used only in case of infection of the wound, which is possible at 3 and sometimes at the second severity level, if the sterility condition of the lesion is not observed.
With extensive thermal and chemical burns of 2 and 3 A degree, and also if the burn is localized on the legs, face, groin or on the hands and is accompanied by the formation of a large number of fluid bubbles, treatment is advisable to be carried out in a medical institution and often with the use of antibiotics. Large wounds weaken the immune system of the body, and she is already struggling to cope with her duties. But antibiotics are exactly what they are called upon to help in the fight against pathogenic microorganisms, which in severe cases can provoke dangerous complications in the form of sepsis, pneumonia, myocarditis, pathway infections, lymphadenitis, and the like.
If the burn takes a small area, preference is given to external antibacterial agents, which are available in the form of solutions (most often they are used to prepare the wound for medical procedures) and wound healing ointments.
For burns of considerable depth and area with a high probability of infection of the wounds, systemic therapy with antibacterial agents of a wide spectrum of action (semisynthetic drugs of the penicillin series, cephalosporins of the third generation, fluoroquinolones and other antimicrobial agents effective against most known and unknown medicine pathogens microorganisms).
Antibiotics for burns of degree 3 B, when all layers of the skin are affected to the most subcutaneous fat, are prescribed regardless of the size of the affected area, since tissue necrosis simply attracts the infection, being an ideal environment for the life and reproduction of bacteria that cause serious health disorders.
Antibiotics of a wide spectrum of action for burns are considered to be the most effective, since most often there is a mixed infection. This point is taken into account when appointing local drugs (for example, take chloramphenicol and sulfadiazine silver, which are antibiotics of a broad spectrum of action), and in systemic antibiotic therapy, which is strictly individual.
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Antibiotics for external use for burns
Most often, with extensive burns of moderate severity (2 and 3A), they are limited only to antimicrobial agents for topical application, which include:
- 1% solutions of iodopyron or iodovidone, which are used to treat the wound after washing with antiseptics (solutions of chlorhexidine, miramistine, furacilin, hydrogen peroxide, etc.) or the imposition of medical dressings,
- ointments based on chloramphenicol ("Levomekol", "Cloromikol", "Levomycetin", "Chloramphenicol", "Levosin", etc.)
- antimicrobial agents in the form of ointments with sulfadiazine of silver ("Sulfadiazin", "Dermazin", "Silvederm", "Argosulphan", etc.)
- sulfanilamide ointment from burns with antibiotic nitazole "Streptonitol"
- antibacterial preparations for topical application "Gentamicin Ointment", "Dioxydin", etc.
- artificial coatings for burn wounds with bactericidal agents.
Antibiotics for burns accompanied by the appearance of bubbles filled with liquid are prescribed only after opening the blisters to prevent infection of the wound under the film. Until that time, there is no need for antibacterial drugs.
Fighting a possible infection with extensive burn lesions of the skin can be carried out using special insulators or beds "Klinitron", reducing the pressure on damaged tissue.
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Antibiotics for systemic use for burns
As already mentioned, with severe burns occupying a large area, as well as large depth burns that are prone to infection, in which the likelihood of developing a burn disease, the treating doctor may be prescribed antibiotics not only for topical use, but also preparations for internal reception with a wide spectrum actions.
Since the list of such drugs is large enough, the choice of an effective medication remains entirely within the competence of the doctor. In spite of the fact that the selection criteria listed above are sufficiently transparent, only an expert can choose a suitable preparation, taking into account the group membership of the drug, its action and application features.
With a mild course of the infection, antibiotic therapy is carried out through oral administration of drugs or intramuscular administration of antibacterial solutions, and intravenous infusions are used by doctors only in very severe cases.
Among broad-spectrum antibiotics, the most effective in treating moderate to severe burns are:
- Antibiotics from a series of cephalosporins 1 or 2 generations, which have minimal nephrotoxicity and activity against gram-positive bacteria ("Cephalexin", "Cefazolin", "Cefuroxime", "Zeclor", etc.). They are used in the first and second period of burn disease - with burn shock and toxicemia.
- Natural and semisynthetic preparations of the penicillin series. Their use is indicative for extensive burns (20 and more percent of the skin) in the first, second and third period of burn disease - with burn shock (natural penicillins), acute toxicemia and septicotoxicemia (semisynthetic drugs).
- and the use of penicillins:
- as a preventive measure of infectious complications use natural penicillin called "Bicillin"
- when infected with a burn wound - "Amoxicillin", "Carbenicillin disodium salt"
- with the development of sepsis - "Ampicillin"
- for intravenous infusions - "Methicillin sodium salt", etc.
- Aminoglycosides of the 2nd generation are combined antibiotics containing a beta-lactam antibiotic plus a defensive medication that does not allow bacteria that produces beta-lactamase to reduce the effectiveness of the antibiotic. These include: Unazine, Sulacillin, Gentamycin, Brulamycin, Tevomycin, Sizomycin, etc. They are effective in the third (with Pseudomonas aeruginosa) and the fourth period of burn disease - in acute toxicemia and septicotoxicemia.
- Cephalosporins of the third generation ("Cefixime", "Ceftriaxone", "Cefotaxime", etc.) are used in the third period of burn disease after determining the causative agent of the infectious process.
- Fluoroquinolones 2 and 3 generations ("Ciprofloxacin", "Levofloxacin", "Ofloxacin", "Pefloxacin", etc.) are fighting with gram-negative bacteria, as well as with infections resistant to penicillins.
- "Lincomycin" is a drug from the group of lincosamides. It is prescribed if the infectious process with a burn injury has spread to the bone structures.
- "Clindamycin" is a lincosamide, shown when anaerobic infection is attached, prone to rapid spread throughout the body.
- Other antibiotics:
- "Metronidazole" - for the same indications as "Clindamycin".
- "Nystatin", "Fluconazole" - with a fungal infection, recently often found in burn centers.
The doctor's appointments can vary depending on the indicators of microbiological research, which allow to control the relevance of antibiotic therapy. With a generalized or mixed infection, the doctor can prescribe not one but several drugs. Among them will be antibiotics for both topical and internal administration (systemic drugs).
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Antibiotics of cephalosporin series
Pharmacodynamics. Many drugs in this group usually have a prefix "cef-", so they are easily identified among others. The use of these antibiotics for burns is due to their bactericidal action. Cephalosporins are considered antibiotics of a wide spectrum of action, their influence is not amenable only to chlamydia, mycoplasma and some enterococci.
During the growth and development of a bacterial cell, among many processes, one can distinguish the formation of a rigid (rigid) shell with the participation of a penicillin-binding protein. Cephalosporins are able to bind to this protein and interfere with the synthesis of the cell membrane of microorganisms. They also activate proteolytic enzymes in bacterial cells that destroy bacteria tissues and kill the microorganism itself.
Bacteria for self-defense in turn produce a special enzyme beta-lactamase, whose action is aimed at combating antibiotics. Each type of bacteria secrete its specific enzyme.1 The generation of cephalosporins is resistant to the action of beta-lactamase of gram-positive bacteria, which include staphylococci and streptococci, which are associated with processes occurring in the wound at the first stages of burn disease, 2nd generation - gram-positive and some Gram-negative bacteria, 3 and 4 generation - gram-negative bacteria.
Pharmacokinetics. Bioavailability of cephalosporins, depending on the generation, ranges from 50 to 95%. The maximum concentration in the blood plasma is observed after 1-3 hours (with oral intake) or in the interval from 15 minutes to 3 hours (with intramuscular injection). The time of action ranges from 4 to 12 hours.
The bulk of cephalosporins penetrate well into various tissues and body fluids and are excreted in the urine ("Ceftriaxone" is also derived from bile).
Cephalosporin antibiotics for burns are tolerated well by most patients. They have relatively few contraindications to the use and side effects. The least toxic one generation of cephalosporins is considered.
Form of issue. The most common forms of cefalosporin drugs used for burns are tablets (capsules) for adults and syrups for children. Most antibiotics are also available as a powder, from which a solution used for intramuscular injections is then prepared (less often for intravenous administration).
A number of preparations are also available in the form of granules or powder for the preparation of a suspension for oral administration.
Contraindications. Mainly individual intolerance of drugs of this group.
The use of cephalosporins is considered acceptable during pregnancy, in neonatal therapy and even in breastfeeding, although some concentration of the drug is observed in breast milk. With renal failure, dose adjustment is required.
Side effects. Undesirable reactions during the reception of cephalosporins are rare, and they are usually associated with the individual characteristics of the body.
Most often you can see allergic reactions (skin rashes, fever, bronchospasm, edematous syndrome, anaphylactic shock) against the background of individual intolerance of the drug components.
Sometimes there may be changes in blood composition, convulsive syndrome (with violations of kidney function), microflora disorders, manifested in the form of candidiasis, covering the oral mucosa and the vagina in women.
Oral reception can be accompanied by nausea and pain in the abdomen, diarrhea, sometimes with an admixture of blood.
Method of administration and dose. Dosage regimen preparations can always be found in the instructions to them. Here are just a few of the above drugs.
- "Cefalexin" (1st generation).
Oral reception: from 0.5 to 1 g with an interval of 6 hours (daily dosage for children is 45 mg per kilogram of the patient's weight, the frequency of reception is 3 times a day).
- "Cefuroxime" (2nd generation).
Oral reception: from 0.25 to 0.5 grams with an interval of 12 hours (daily dose for children is 30 mg per 1 kg of weight, the frequency of reception is 2 times a day). It is taken with meals.
Intravenous and intramuscular injection: from 2.25 to 4.5 grams per day with a multiplicity of 3 administration (children - from 50 to 100 mg per 1 kg of weight, multiplicity - 3 or 4 times a day).
- "Cefixim" (3rd generation).
Oral administration: daily dose - 0.4 g. The frequency of admission - 1 or 2 times a day. Children, starting with six months: 8 mg per 1 kg of weight.
- "Ceftriaxone" (3rd generation).
Intravenous and intramuscular administration: 1 to 2 grams once a day. Children older than 1 month: from 20 to 75 mg per 1 kg of weight (two-fold administration).
Overdose. Non-compliance with the dosing regimen and long-term use of drugs can cause a phenomenon such as drug overdose. In the case of cephalosporins, it is accompanied by nausea, often accompanied by vomiting, and diarrhea.
First-aid measures: gastric lavage when taken orally, taking large amounts of fluid and activated carbon or other enterosorbents.
Interaction with other drugs. It is undesirable to perform oral administration of cephalosporins simultaneously with the use of antacids, which reduce the acidity of the stomach. The interval between taking medication should be at least 2 hours.
Nephrotoxicity of cephalosporins increases if they are taken together with aminoglycosides. This should be taken into account in the therapy of patients with impaired renal function.
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Antibiotics of penicillin series
Pharmacodynamics. Natural and semi-synthetic penicillins are considered active against gram-positive and gram-negative microorganisms. With respect to bacterial cells have a bactericidal effect in the phase of their growth.
The disadvantage of penicillins is that some of them are not resistant to the effects of beta-lactamase produced by many bacteria.
Pharmacokinetics. Antibiotics penicillin series, used for burns, easily attached to most tissues and body fluids. Excreted mostly by the kidneys. The half-life period ranges from half an hour to an hour.
Form of issue. Penicillin antibiotics are produced in the same forms as cephalosporins.
Contraindications. Depending on the drug, individual intolerance to penicillins and cephalosporins, infectious mononucleosis, ulcerative colitis, increased bleeding, lymphatic leukemia, severe liver and kidney pathologies, pregnancy, breast-feeding may be contraindications. Some penicillins are not used in pediatrics, and others may require dose adjustments and close monitoring of a small patient.
Penicillins have the property of passing through the placental barrier, so during pregnancy they are appointed with great care.
Method of administration and dose. They are used strictly according to the prescription of the doctor with a frequency of reception from 2 to 4 times a day.
Side effect. Penicillins among antibiotics are considered the least toxic drugs. Nevertheless, their reception is a common cause of allergic reactions regardless of the dose and form of release.
In addition to manifestations of allergy, penicillin antibiotics can cause an increase in sensitivity to sunlight, neurotoxic effects in the form of hallucinations, seizures, fluctuations in blood pressure, a violation of the body's microflora. Natural penicillins can cause vascular complications.
Interaction with other drugs. It is forbidden to mix penicillins and aminoglycosides in one syringe, as these groups are considered incompatible.
"Bicillin" and "Ampicillin" in combination with "Allopurinol" cause the appearance of a specific rash.
The use of penicillins with antiplatelet agents and anticoagulants increases the risk of bleeding. A parallel reception with sulfonamides reduces the bactericidal effect of the drugs.
"Kolestyramin" reduces the bioavailability of penicillins when taken orally. At the same time, oral penicillins themselves can reduce the effectiveness of certain drugs, in particular oral contraceptives.
Penicillins slow down metabolism and excretion of methotrexate.
If penicilins that have a bactericidal effect, to be used in conjunction with other drugs with the same effect, the effect of taking medication is enhanced. If bacteriostatic drugs are used in parallel with bactericidal agents, the treatment can be reduced to "no."
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Pharmacodynamics. Aminoglycosides, like the above-described groups of antibiotics, have a pronounced bactericidal effect. They are combined preparations, since they contain antibiotic, which is subject to destruction by beta-lactamases, and a protective component to it, which also has little antimicrobial activity. Such components include sulbactam, tazobactam, clavulanic acid.
The drugs are effective against Gram-positive and Gram-negative bacteria, with the exception of non-spore-forming gram-negative anaerobes. 2 generation of the above antibiotics is effective against Pseudomonas aeruginosa, which makes them particularly useful for burns.
Aminoglycosides have a bactericidal effect not only on growing cells, but also on mature bacteria.
Pharmacokinetics. When administered orally, aminoglycosides have very low bioavailability, so effective ways of taking the drug are: intravenous and intramuscular injection and external application (preparations in the form of ointments).
With intramuscular injection, the maximum concentration in the blood plasma is reached after half an hour, but sometimes this time can be prolonged and up to 1.5 hours. The duration of the action will vary from 8 to 12 hours.
Aminoglycosides are excreted in practically unchanged form by means of the kidneys. The half-life is 2 to 3.5 hours (for newborns, from 5 to 8 hours).
The disadvantage of aminoglycosides is that after 5-7 days of therapy, the drug may become addicted, and its effectiveness will noticeably decrease. The advantage is a painless introduction and greater efficacy against most bacteria.
Form of issue. Since oral administration of drugs of this group is considered ineffective, antibiotics are released in the form of solutions placed in ampoules with a certain dosage, or in the form of a powder for the preparation of an injection solution. Some antibiotics aminoglycosides (for example, "Gentamycin") are also produced in the form of ointments for external use, which is especially important for burns, when the fight against infection is carried out from the outside, and from the inside.
Contraindications. Antiglycosides are not as safe drugs as penicillins or cephalosporins. They can adversely affect the work of the kidneys and the vestibular apparatus. It is clear that such drugs and contraindications to use will be more.
So, aminoglycosides are not used for hypersensitivity to the components of the drug, severe kidney disorders, shortness of breath, vestibular apparatus and hearing disorders, neutropenia, myasthenia gravis, parkinsonism. Do not use these drugs and botulism.
Side effects. The intake of aminoglycosides can cause the following disorders: hearing problems (noise and ringing in the ears, ejaculation and hearing impairment), thirst, changes in the volume of urine output, glomerular filtration worsens (with kidney pathologies), shortness of breath until paralysis of the respiratory muscles, problems with coordination of movements, dizziness. Allergic reactions with the use of aminoglycosides are very rare, and are manifested in the form of rashes on the skin.
Method of administration and dose. In the treatment of burns, aminoglycosides 2 generations are used in a daily dosage of 3 to 5 mg per kg of body weight with a multiplicity of 1 or 2 times (in newborns, 5 to 7.5 mg 2 or 3 times a day). Drugs are administered parenterally. With a single admission, it is advisable to administer the medication with a dropper.
Overdose. Side effects of drugs of this group arise either against the background of existing pathologies, or due to taking large doses of the drug, which leads to an overdose. If there are undesirable reactions, you need to cancel the drug and take measures to eliminate unpleasant symptoms. It should be noted that hearing disorders after taking aminoglycosides are irreversible, but the kidneys will need to be treated.
Patients with neuromuscular blockade, in which there are problems with breathing and paralysis of the respiratory muscles, the antidote is calcium chloride, which is administered intravenously.
Drug interaction with other drugs. When aminoglycosides are used in combination with penicillins or cephalosporins, all drugs are enhanced. But this does not mean that they need to be injected into one syringe. After mixing in the syringe aminoglycosides and beta-lactam antibiotics leads to a marked decrease in the effectiveness of antibiotics. The same goes for heparin.
Negative effects on the kidney and vestibular apparatus is enhanced if aminoglycosides are used in conjunction with other drugs with increased nephro- and ototoxicity.
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Pharmacodynamics. These are synthetic antibiotics, which have excellent bactericidal action, which is also quite long. Most bacteria are sensitive to them. The high efficacy of fluoroquinolone antibiotics has been repeatedly proven in the treatment of severe infectious pathologies, including deep and extensive burns.
The drugs have a unique pharmacological effect, suppressing the production of vital enzymes for microorganisms, which leads to the reduction of DNA synthesis. Negative effects drugs and ribosomes of cells. All this leads to the death of microorganisms.
Some of them are effective against pneumococci, non-spore forming anaerobes and staphylococci that are not sensitive to penicillin.
Pharmacokinetics. Fluoroquinolones are well absorbed by the gastrointestinal mucosa, providing high concentrations of the active substance in tissues and body fluids. A large half-life of the drugs provides them with a prolonged effect.
The drawback of the drugs in this group is the ability to penetrate the placental barrier and into breast milk, and therefore their use during pregnancy and breastfeeding is limited.
Form of issue. Fluoroquinolones of 2 generations, which are used for burns, are available in the form of tablets and an injection solution in ampoules or vials.
Contraindications. In addition to individual intolerance, pregnancy, lactation and childhood (for some drugs), fluoroquinolones have several contraindications. These include: atherosclerosis of the blood vessels and a deficiency in the patient's body of glucose-6-phosphate dehydrogenase.
Side effects. Undesirable reactions resulting from the administration of fluoroquinolones are usually not associated with serious organ damage. This can be as a reaction from the gastrointestinal tract (dyspeptic phenomena, heartburn and abdominal pain), and reversible hearing and vision impairment, deterioration in sleep quality, headaches and dizziness, paresthesia, convulsions, tremor, increased heart rate, violation of microflora in body, increasing photosensitivity.
In rare cases, inflammation of the tendons and joints, violations of the kidneys and liver, vascular thrombosis.
Method of administration and dose. Consider several popular drugs.
- "Ciprofoloxacin." Oral reception: adults - from 0.5 to 0.75 grams with an interval of 12 hours (children - 10 to 15 mg per 1 kg of weight in 2 divided doses).
Intravenous administration. Drip from 0.4 to 0.6 grams with an interval of 12 hours (children - from 7.5 to 10 mg per 1 kg of weight divided into 2 divided doses).
- "Ofloxacin." Oral reception: 0.4 g every 12 hours (children - 7.5 mg per 1 kg of body weight, divided into 2 doses).
Intravenous administration. Drip on 0.4 g at intervals of 12 hours (children - 5 mg per 1 kg of weight divided into 2 divided doses).
- "Levofloxacin". Oral administration and intravenous drip introduction: 0.5 g with an interval of 12 hours. Not applicable in pediatrics.
- Pefloxacin. Oral administration and intravenous administration in the form of droppers with 5% glucose: an initial dose of 0.8 g, followed by 0.4 g with an interval of 12 hours. It is not used to treat children.
All preparations can be taken at any time of the day, adhering to a 12-hour interval. Eating does not affect the effectiveness of the antibiotic.
Interaction with other drugs. Food intake does not affect the absorption of fluoroquinolones, but antacids, sucralfate and drugs containing compounds of aluminum, zinc, magnesium, calcium and iron reduce the absorption of antibiotics in the digestive tract.
Some fluoroquinolones increase the concentration of theophylline in the blood.
Parallel administration of fluoroquinolones and non-steroidal anti-inflammatory drugs increases the risk of neurotoxicity, which leads to the appearance of a convulsive syndrome.
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Burns in children are no less rare than in adults. But even the same "popular" among kids burn with boiling water can be a serious disease that requires the use of antibiotics. The immune system in the child is not yet sufficiently formed, so even a small area burn (2-5%) is more severe than in adults, often causing complications. To prevent complications after burns, caused by wounded infection, just apply antibiotics.
Many will say, but how is it, there is an opinion that these drugs are dangerous for children and you need to try to do without them by any means. This is fundamentally wrong. There are many drugs that help a small organism cope with the infection, and when used correctly, they do not cause significant harm to the child's body. Moreover, these are not special, children's drugs, but general antimicrobial drugs.
When asked what antibiotics are prescribed for children with burns, it can be answered that in almost all groups of antimicrobial agents there are drugs that are allowed for use in pediatrics (Ampicillin, Cefuroxime, Ceftriaxone, Ofloxacin, Gentamicin, ).
The appointment of antibiotics to children requires special attention and knowledge of the drugs from the doctor. After all, not all drugs can be used to treat newborns and infants. Some antibiotics for children are prescribed only from the age of 12 or 14 years. An important aspect is taking into account the body weight of the child, because this depends on an effective and safe dose of the drug. All this must be taken into account when prescribing antibiotics.
In the treatment of small children, preference, of course, is given to preparations in the form of ointments, suspensions for oral administration or syrup. Older children with burns can be given antibiotics in the form of tablets.
Intramuscular and intravenous administration of drugs is allowed only in severe cases. But later small patients are transferred to therapy with other forms of drugs.
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