Aminoglycosides in Intensive Therapy: Lost Hopes or Unused Opportunities?

Ya.M. Pidgirnyy

Abstract


Background. Any new group of antibiotics is not forthcoming in the nearest 10–15 years. Taking into account increasingly multiple resistant strains of bacteria we’ll also face the global problem of choosing the appropriate technology of antibiotic therapy. Materials and methods. We have studied 22 patients (6 women and 16 men) with acute pancreatitis. They all admitted to Lviv Regional Hospital from 2012 to 2014. Cholelithiasis was the reason of pancreatitis in 14 patients, alcohol abuse in 4 patients and 2 patients suffered from idiopathic pancreatitis. The patients were observed for acute pancreatitis, its severity verification according to the Standards for Diagnosis and Treatment of Acute Pancreatitis (guidelines, Kyiv, 2005), Protocols for Diagnosis and Treatment of Acute Pancreatitis (Guideline for doctors, Kyiv, 2007) and International Guidelines for Management of Severe Sepsis and Septic Shock 2012. Bacterial complications were verified by bacteriological studies and procalcitonin determination. In case of infectious complications we’ve started intensive the­rapy according to the protocol of treatment of sepsis/severe sepsis and toxic-septic shock, but this therapy recently was also extrapolated on other critical patients (Surviving Sepsis Compaign, SSC-Guidelines, 2012). The aspiration puncture of parapancreatic fluid was held to all of the patients under ultrasound control. The bacteriological investigation revealed E. coli 104–105and Ps. aeruginosa 106–105. Twelve patients (retrospective group) with bacterial complications used meropenem (1 g three times per 24 hours). Ten patients (prospective group) received meropenem + tobramycin 5 mg/kg/24h (single dose). We’ve took into consideration, that the level of aminoglycosides activity depends on their simultaneously created concentration in patients’ blood (dose-dependent effect) and their post antibiotic effect. Results. Pancreatitis severity (4–5 points by Ranson scale), severity of patients’ state (22–24 points by APACHE ІІ) and multiple organ dysfunction (SOFA, 6–7 points) were comparable in both groups. The signs of SIRS and multiple organ dysfunction regressed 3–4 days earlier in prospective group. In retrospective group 9 patients of 12 had nosocomial pneumonia and in the basic group it was diagnosed only in 3 patients. Conclusions. As follows, combination of carbapenems (meropenem) and aminoglycosides (tobramycin) shows synergism in the treatment of the patients with purulent septic processes that are caused by non-fermentative gram negative bacilli (Ps. aeruginosa).


Keywords


acute pancreatitis; aminoglycosides; tobramycin

References


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Bahnenko SF, Tolstoy AD, Krasnorohov VB, Kuryhyn AA. Protocols of diagnostics and treatment of acute pancreatitis: a manual for physicians. Kyiv; 2007. 12 p. (in Russian).

Konovalov SP, Terlets'kyy VP, Roshchin HH. Standards for diagnostics and treatment of acute pancreatitis: guidelines. Kyiv; 2005. 27p. (in Ukrainian).

Mal'tseva LO, Kutovyy OB, Kobelyats'kyy YY. Acute pancreatitis. Dnipropetrovs'k: LizunovPres; 2014. 192 p. (in Russian).

Rybytskyy Z. Antibiotic treatment of problems of hospital infections. Lyublyn: MAKMED; 2014. 350 p. (in Russian).

Tolstoy AD, Pavlov VP, Zakharova EV, Bekbauov SA. Shock in acute pancreatitis: a manual for physicians. Kyiv; 2007. 76p. (in Russian).

Cruz-Santamaría DM, Taxonera C, Giner M. Update on pathogenesis and clinical management of acute pancreatitis. World J Gastrointest Pathophysiol 2012; 3(3): 60-70; doi: http://dx.doi.org/10.4291/wjgp.v3.i3.60

Dellinger RP,Levy MM,Rhodes A et al. Surviving Sepsis Campaign: international Guidelines for Management of Severe Sepsis and Septic Shock, 2012. Intensive Care Med. 2013; 38 (1): 296-327; doi: 10.1007/s00134-012-2769-8. Epub 2013 Jan 30.




DOI: https://doi.org/10.22141/2224-0586.8.79.2016.90381

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