Method of selecting initial scheme of antibacterial therapy in treatment of patients with perforation of gastric and duodenal ulcer

FIELD: medicine.

SUBSTANCE: invention relates to medicine and is intended for the treatment of patients with the perforation of gastric and duodenal ulcer. A laparotomy is performed, operative aid concerning the ulcer perforation is realised, during the operation an exudate is sampled from the abdominal cavity, pH of the exudate is determined. If Ph of the said material is 6.6 and lower, a conclusion about the presence in it of anaerobic flora is made and serves the basis for the administration of an antibacterial preparation, influencing the anaerobic flora, into the scheme of initial antibacterial therapy.

EFFECT: method makes it possible to administer specific antibacterial therapy without waiting for culture results.

1 ex

 

The invention relates to medicine, namely to surgery, and can be used in the treatment of patients with perforated ulcers of the stomach and duodenum.

Currently, the standard treatment for patients with surgical infection is a complex method. The vast majority of such patients one component of treatment is surgery. Mandatory in the treatment of these patients is the appointment of antibacterial therapy. While the doctor tries to prescribe antibiotics that impact most effectively on the pathogen of surgical infection.

There is a way selection circuit antimicrobial therapy for perforation of gastric ulcer and duodenal ulcers, including the appointment of cephalosporins I generation (Gelfand, E. B., Burnevich S. Z., Soto T. B. Antibacterial therapy abdominal surgical infections - www/rmj.ru/articles_988.htm).

The disadvantages of the prototype lies in the fact that the results of the crop on flora and sensitivity to antibiotics in a few days. All this time the patient receives therapy ex uvantibus. The seeding on flora and sensitivity to antibiotics during the holidays, the night time leads to an even more recent results of sowing. Furthermore, the performance of the crop on flora and sensitivity�ness to antibiotics cannot be performed in all hospitals (Central hospital, low surgical Department). All this leads to delays in appointment of specific antibiotic therapy. It is known that "a crucial role for the results of complex treatment of patients with abdominal infection plays adequate therapy to the receipt of microbiological data from a specific patient" (Gelfand, E. B., Burnevich S. Z., Soto T. B. Antibacterial therapy abdominal surgical infections www/rmj.ru/articles_988.htm). It was well known that to assign it adequate antibiotic therapy, admission of a patient with peritonitis is not always possible.

To address these shortcomings, we developed the method of choice of primary schemes of antibiotic therapy in the treatment of patients with perforated ulcers of the stomach and duodenum.

The invention consists in the fact that perform a laparotomy the patient with perforation of gastric ulcer and duodenal ulcer, produce operational manual regarding perforating ulcer during surgery take the exudate from the abdominal cavity, determine the pH of the exudate. When the pH of the exudate 6.6 and less state that it has anaerobic flora and based on this, put the indications for the prescription of metrogyl - an antibacterial drug that affect anaerobic flora. We conducted and�following showed that all patients with a pH value of exudate 6.6 and less in the exudate was present anaerobic flora and the appointment of metrogyl affecting anaerobic flora, has had a marked clinical effect in all patients.

The method is as follows: perform a laparotomy the patient with perforation of gastric ulcer and duodenal ulcer, produce operational manual regarding perforating ulcer during surgery take the exudate from the abdominal cavity, determine the pH of the exudate. When the pH of the exudate 6.6 and less state that it has anaerobic flora and based on this, put the indications for the prescription of metrogyl - an antibacterial drug that affect anaerobic flora. The time spent on the procedure for determining the pH of the exudate, does not exceed 10 minutes and enables even during the operation to start specific antibiotic therapy.

Example. Patient M., 48 years old, was admitted on an emergency basis in GKB №1 21.11.12 G. with severe abdominal pain. From history - ill about 18 hours ago. At admission the General condition heavy. In the lungs vesicular breathing. BH=21 in 1 minute. BP=100/60 mmHg. article Pulse 102 in 1 minute. Tongue dry, coated with white bloom. Abdomen somewhat swollen, palpation tense and sharply painful in all departments, symptom Shchetkina-Blumberg positive. Hepatic the�spine is missing. General blood analysis: hemoglobin 128 g/l, erythrocytes - 4,33·1012/l, leukocyte count of 18.2·109/L. the Diagnosis of perforation of a hollow organ. Operative treatment. The operation started after 5 hours from the time of admission to the hospital after preoperative preparation. Verkhnesadinsky laparotomy. In the abdominal cavity approximately 200 ml of purulent effusion. The fluid in an amount of 5 ml was taken for analysis, the pH of the exudate was 6.6. On the anterior wall of duodenal bulb ulcer with perforation hole about 0.5 cm in diameter. Intraoperative diagnosis: exacerbation of duodenal ulcer disease complicated by perforation. Generalized purulent peritonitis. The patient performed the operation of excision of the ulcer edges and suturing perforations, the abdominal cavity sanitized with an antiseptic solution and drained 4 tubular drains in a typical outlets. Given the pH of fluid equal to 6.6, diagnosed the presence of anaerobic flora in the exudate and in the scheme of primary antibiotic therapy included metrogyl in addition to Ceftriaxone. The postoperative period was uneventful. Body temperature during the first 3 days were kept on subfebrile, and then normalized. The wound healed by primary intention. Was discharged on the 9th postoperative day.

This method of selection schemes of antibiotic therapy in the treatment of patients with perf�walkie ulcers of the stomach and duodenum applied in 2 patients.

The metrogyl active against most gram-positive and gramotritsatelnyh obligate anaerobic bacteria, spore-forming and nonsporeforming, and anaerobic cocci (www/rmj.ru/articles_3853.htm). It is important that this drug will have the least cost among antimicrobial drugs with activity against the same microorganisms, not yielding to them in effectiveness.

Thus, the proposed method allows you to quickly, accurately and objectively put indications for specific antimicrobial therapy in these patients, without waiting for culture results. All this will lead to the early appointment of specific antibiotic therapy and, as a consequence, the reduction of the economic costs of treatment of patients with perforated ulcers of the stomach and duodenum. In addition, metrogyl is an inexpensive but effective against anaerobic flora, causing surgical infection of the abdominal cavity.

Selection method primary schemes of antibiotic therapy in the treatment of patients with perforated ulcers of stomach and duodenum, including laparotomy, operational manual about the perforation of ulcer, characterized in that during the operation to take the exudate from the abdominal cavity, determine the pH of the biological material and if the value�research Institute pH 6.6 and less state, what is present in the exudate of anaerobic flora and based on this, in the scheme of primary antibiotic therapy is prescribed an antibacterial drug that affect anaerobic flora (metrogyl).



 

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