Antibiotic is an indispensable part of therapeutic therapy for pyelonephritis. The choice of a medicine and the way it is used depends on the severity of the ailment and the nature of the pathogen. Antibiotics are part of the basic therapy in the treatment of pyelonephritis. The substances can suppress the infection, which provokes the inflammation of the kidney tissue, that is, eliminate the main cause of the disease. In this case, each type of antibiotic affects only a certain group of pathogens. Treatment is carried out only under the supervision of a physician.
Antibiotics for chronic and acute pyelonephritis
Antibiotics are natural or semi-synthetic substances that can suppress some microorganisms, usually prokaryotic and protozoans. Those that do not damage the cells of macroorganisms, are used as medicines.
Fully synthetic substances that have a similar effect are called antibacterial chemotherapeutic drugs - fluoroquinolones, for example. Often they are also included in the category of antibiotics.
Why exactly are these substances needed for treatment?
To eliminate acute or chronic pyelonephritis, the following steps are taken:
- removal of the inflammation focus;
- immunocorrecting and antioxidant therapy;
- relapse prevention - this stage is realized in the chronic form of the disease.
Antibiotics are required at the first stage of treatment, as the cause of pyelonephritis is an infection.
As a rule, the treatment consists of two stages:
- empirical antibacterial therapy - the drugs of the widest spectrum of action are prescribed, capable of suppressing, if not eliminating, the majority of the pathogens. The development of infection in the kidneys is very fast, in addition, as practice shows, patients are slow to consult a doctor. So drugs are prescribed before an accurate study is performed;
- specialized therapy - antibiotics are not universal. In addition, the sensitivity of the body to the substances is individual. To find out which particular drug has the best effect and is safe for the patient, an analysis is carried out - sowing urine for antibiotic sensitivity. According to the data obtained, the drug is selected with a narrower effect, but also more effective.
What are the
? The spectrum of the pathogens of pyelonephritis is quite wide, but it is not infinite, which makes it possible to immediately designate an effective drug.
The list includes:
- morganella - microorganism of Escherichia coli group;
- enterobacteria - gram-negative spore-forming bacteria, refer to anaerobes;
- proteus - anaerobic spore-forming bacteria, is always present in the intestines in a certain amount, and can become a causative agent;
- E. coli is a gram-negative rod-shaped bacterium. Most strains are harmless, are a normal part of the intestinal flora and are involved in the synthesis of vitamin K. The virulent strain acts as an exciter;
- fecal enterococcus - Gram-positive cocci, cause a variety of clinical infections, including pyelonephritis;
- Klebsiella is a rod-shaped bacterium that rapidly multiplies against a background of decreased immunity.
As a matter of fact, each group of bacteria is suppressed by "its" antibiotic.
Requirements for
preparations Not only preparations that suppress microflora, but those that are relatively safe for men and women, are allowed to be treated. Antibiotics of wide action just and act as the most unsafe option, because they act on the whole microflora - both pathogenic and useful.
The drug must meet the following requirements:
- substance should not affect the condition and functionality of the kidney. The organ is already subjected to a heavy load and is not able to cope with its increase;
- antibiotic should be completely excreted from the body with urine. Its quantity in urine is one of the signs of the effectiveness of healing;
- with pyelonephritis, preference is given not to bacteriostatic, but to bactericidal preparations - aminoglycosides, penicillins, that is, those that not only destroy bacteria, but also contribute to the removal of decay products, otherwise the probability of relapse of the disease is high.
Treatment can be carried out both at home and in the hospital - it depends on the severity of the ailment. In any case, self-treatment and ignoring the doctor's recommendations lead to the most negative consequences.
"Starting" antibiotics
The general mechanism of the disease is as follows: pathogenic bacteria, appearing in the kidney tissue - from the bladder or circulatory system, multiply and synthesize specific molecules - antigens. The latter perceive the body as alien, which is why the response follows - the leukocyte attack. But the infected parts of the tissue are recognized as alien. As a result, inflammation develops, and it develops very quickly.
It is impossible to determine without specifying which bacteria caused inflammation in men or women.
These include the list of the following drugs:
- Penicillin - or rather, piperacillins, the fifth generation, since the sensitivity to conventional penicillins is often small or, conversely, excessive. This category includes ispen, piprax, piprazyl. They are used for intravenous and intramuscular injections. Suppress both gram-positive and gram-negative bacteria.
The semi-synthetic substances of the latest generation of the penicillin series are also used: penodyl, pentrexyl, all known ampicillin.
- Cephalosporins - cenofarm, cefemol, cefomax, cefim. They have a very wide spectrum of action, they are offered only in the form of injections, because they are very poorly digested in the digestive tract. The best drugs are considered to be 4 generations.
- Carbapenems are antibiotics of the beta-lactam group. Suppress anaerobic and aerobic bacteria, are administered only intravenously. This is jenem, meropenem, invasive.
- Levomycetin is a chloricide, nolycin, paraxin. The drug destroys the mechanism of protein production of bacteria, which stops growth. It is most often used in the treatment of the kidneys.
- More narrowly specialized group - minoglycoside aminocyclitols: tobramycin, sisomycin. They can act as starting antibiotics for purulent pyelonephritis. Are toxic, so the course of application is limited to 11 days.
- Fluoroquinolones are antibacterial chemotherapeutics: moxifloxacin, sparfloxacin. They differ in a wide range of actions, but they are toxic to humans. The course of using fluoroquinolones does not exceed 7 days.
The dose of the drug is calculated based on the patient's body weight. The ratio, that is, the amount of substance per kg, is different, and is calculated for each drug.
Antibiotics of narrow purpose
Urine sowing allows to define the originator of pyelonephritis and its sensitivity to this or that drug. According to these data, the doctor develops a further strategy. In this case, one must take into account the individual sensitivity of the patient to drugs.
General recommendations in this matter are not possible. Often prescribe a combination of drugs, because the pathogen may not be the only one. In this case, the compatibility of medicines must be considered. Thus, aminoglycosides and cephalosporins or penicillins and cephalosporins combine well. But tetracyclines and penicillins or macrolides and levomycetin are antagonists: it is forbidden to prescribe simultaneous reception.
Treatment is complicated by the fact that if there are standard doses for broad-spectrum antibiotics, then there are no such drugs for narrow drugs, therefore, for each patient, the physician should calculate the individual dose taking into account his condition.
In the acute form of pyelonephritis, these medications are usually prescribed.
If the causative agent is an E. coli, then the most effective are drugs that suppress Gram-negative bacteria: fluoroquinolones, aminoglycosides, cephalosporins. The course lasts at least 14 days, but the antibiotic changes, as these medications are nephrotoxic.
If the cause of the disease is proteus, prescribe antibiotics from the family of aminoglycosides, ampicillins, gentamycins. The former are used at the initial stage of treatment, but the following drugs are more specific. Levomycetin and cephalosporins are not so effective.
- Ampicillin is a semisynthetic antibiotic that is prescribed for mixed infections.
- Gentamicin is one of the variants of the aminoglycoside series, it is very active against gram-negative aerobic bacteria.
- Nitrofuran is an antibacterial chemical, inferior in effectiveness to antibiotics, but not toxic. Used for a mild course of ailment.
If the enterococcus pathogen is most often prescribed to drink a combination of medications: levomycetin and vancomycin - tricyclic glycopeptide, ampicillin and gentamicin. At enterococcus the most effective medicine is usual ampicillin.
- Enterobacteria - gentamicin, levomycetin and palin - the antibiotic of the chylonic series work best. Alternatively, cephalosporin, sulfonamide, can be administered.
- Pseudomonas aeruginosa - suppressed with gentamycin, carbenicillin, aminoglycosides. Levomycetin is not prescribed: it does not work on the synergic wand.
- In acute and chronic pyelonephritis, phosphomycin is often used. The substance is active in relation to both gram-negative and gram-positive microorganisms, but its main advantage is another: it is excreted in the urine unchanged, that is, it does not affect the state of the kidney tissue.
Accounting for the urine reaction
The pH of the blood and urine affects the effectiveness of the drug. Antibiotics are also susceptible to such an effect, so that the appointment is necessarily taken into account this indicator.
- If an acid reaction of urine is observed, then preparations of the penicillin series, tetracyclines, novobiocin are preferable, since their effect is enhanced.
- In the alkaline reaction, erythromycin, lincomycin, aminoglycosides exert a stronger effect.
- Levomycetin and vancomycin do not depend on the reaction of the medium.
Treatment during pregnancy
According to statistics, pyelonephritis is observed in 6-10% of expectant mothers. Its development is associated with the peculiarities of the condition: the kidneys are squeezed by the growing uterus, which worsens the outflow of urine. The liquid stagnates and creates favorable conditions for the development of the disease. Changing the hormonal background, too, unfortunately, provokes the development of pyelonephritis.
Paradoxically, acute pyelonephritis practically does not pose a threat to the fetus and does not affect the course of pregnancy - during its treatment, of course. The chronic form is amenable to healing where it is more difficult and often leads to the termination of pregnancy.
Antibiotics of tetracycline, levomycetin, and streptomycin are prohibited, since these drugs adversely affect the development of the fetus.
- One of the best options for pregnant women is furagin - a substance of the nitrofuran series. The reason is a complete removal with urine unchanged. However, its course is limited, since the drug on the background of renal failure provokes polyneuritis.
- If the source of inflammation is an anaerobic bacterium, lincomycin, clindamycin, and metronidazole are prescribed.
- Penicillin - ampicillin, ampioks and so on are widely spread. However, the sensitivity to at least one drug of the penicillin series excludes the use of all others.
- In severe cases, preference is given to cephalosporins. Usually they are combined with aminoglycosides.
- Antibiotics of the carbapenem group - thienes, meronem, are also prescribed for severe disease. On the effectiveness of one drug is equal to the combination of cephalosporin, aminoglycoside and metronidazole.
Antibiotic treatment is necessarily combined with procedures that help restore normal urine outflow.
Therapy in children
Pyelonephritis is most common in children 7-8 years old, but can even occur in infants. Inpatient treatment is indicated. Children of school age with mild form of illness can be treated out-patient.
Antibiotics are also included in the course of therapy, since another method to suppress the focus of inflammation - an infection, simply does not exist, and accordingly treatment of pyelonephritis without them is simply impossible. The methods used are the same: first the drug is given a wide action, and after the urinalysis for the sowing - a highly specialized antibiotic or a combination of the latter. At the first stage, the drug is administered intravenously or intramuscularly. Near the end or with a mild form, oral administration is possible.
When the number of leukocytes in the blood is less than 10-15, it is prescribed to take protected penicillins - augmentin, amoxiclav, and cephalosporins - suprax, zinnate. The course of treatment is continuous, the drug does not change.
Popular in pediatric urologists and a stepwise scheme:
- during the first week of injecting augmentin and zeidex - intravenously or intramuscularly;
- in the second week - amoksiklav and zinnat;
- in the third week is used supraks.
With acute pyelonephritis, cefixime can be used - its use is allowed starting from 6 months. With long-term treatment of acute form, it is possible to replace uroseptic.
Chronic pyelonephritis requires long treatment and is fraught with relapses. When the latter occur, a furagin is prescribed at a rate of 5 mg per 1 kg of body weight. The course lasts 3 weeks. Its effectiveness is determined by the results of bakposseva.
Nevigramon or nitroxoline is prescribed for chronic pyelonephritis. The medication is taken for 4 months by courses - 7-10 days at the beginning of each month.
The video on the treatment of pyelonephritis with antibiotics in children, men and women:
Efficacy of
There is no universal, 100% effective antibiotic that can cure the infection in 7 days. In practice, the treatment of pyelonephritis is carried out in some measure by experience, as it depends on the sensitivity to the medicine of pathogenic microflora, the nature of the bacteria, the state of the organism and so on.
The general rule is this recommendation: the action of the antibiotic should appear within 3 days. If, after a three-day course, the patient's condition has not improved and the analysis data has not changed, then the drug is not effective and should be replaced by another one.
It is possible to intensify the action of the drug by adding antimicrobial substances or phytotherapy. But you can not replace the antibiotic in the treatment of pyelonephritis.
Prolonged treatment with antibiotics of chronic or acute pyelonephritis leads to the destruction of beneficial microflora. So after the end of the course, often prescribed restorative therapy.
Overdose and too long taking drugs are not allowed. Not all antibiotics are safe, so their intake is limited. In addition, even the safest drug ceases to be effective over time.
The use of antibiotics ensures the cure of the disease, all other things being equal. However, the choice of medication, dosage and regimen are very individual and require high professionalism and knowledge of the subject.