Gram-negative bacteria

The following treatment regimens are most common as empirical modes of antibiotic use: a combination of β-lactam antibiotics with aminoglycosides (preferably in cases of suspected or proven infection caused by gram-negative bacteria, in clinics where there is a high frequency of gram-negative bacteremia); two β-lactam antibiotics together (preferably in patients with MM with chronic renal failure). With a high probability of developing streptococcal infection, it is advisable to combine piperacillin / tazobactam or ticarcillin / clavula nat with an aminoglycoside . Monotherapy with a wide spectrum of β-lactam antibiotics (ceftazidime, imipenem, meropenem, maxipime, piperacillin / tazobactam) is also used. . Most strains of E. coli and Proteus are sensitive to carbenicillin and ampicillin given in large doses. Effective combinations of semi-synthetic penicillins with substances that interfere with the action of β-lactamase produced by microorganisms (clavulanic acid, sulbactam). Recently, many works have been devoted to β-lactamases, an extended spectrum of action, and modern β-lactam antibiotics in the treatment of severe infections, including the nose sock . The use of III generation cephalosporins, oxacephems and penicillins of the V generation is effective in patients with sepsis in the event of Friedlander sticks in blood and sputum, and most anaerobes are sensitive to benzene penicillin administered in high doses (up to 10 million U / day). Anti Biotic reserve for infections caused by strains of staphylococcus and other gram-positive pathogens, as well as anaerobic bacteria, is the combination of penicillin with clinda qin and lincomycin . Carbapenems are indicated in patients after bone marrow transplantation and infections caused by deep cytostatic myelodepression . The choice between monotherapy and combination therapy is based on which risk group the patients belong to and how long neutropenia is. In patients with a long duration of neutropenia, they are used for combined therapy .

In addition to bacterial infections, there are often fungal infections, as well as infections caused by protozoa. The number of patients who develop invasive mycoses is constantly increasing . Invasive mycoses develop against the background of a decrease in body resistance. The first step in the unprotectedness of patients from opportunistic fungi is neutropenia. Risk factors include violations of the integrity of the skin, the mucous membrane of the gastrointestinal tract, the use of broad-spectrum antibiotics, the use of glucocorticoids , and immunosuppressors . For candidal lesions, amphoglucamine or mycoheptin, amphotericin B, flucytazine or ketonazole are used, fluconazole (diflucan) is an effective antifungal drug .

The duration and severity of neutropenia can affect the outcome of the infectious process. The presence of long-term neutropenia and tissue infection (sepsis, pneumonia, abscess, etc.), with signs of infection of a vascular catheter, are grounds for adding hematopoietic colony-stimulating factors to anti-infective drugs .

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