complications is difficult because in the occurrence and deve-
lopment of these processes, usually not one microbial patho-
gen, but a few – microbial associations are involved (from 3 to
6). When planning prophylactic antibiotics in outpatient it is
advisable to focus on the purpose of oral antibiotics with high
bioavailability, long half-life and minimal side effects of their
actions. In carrying out preventive measures for patients in a
hospital environment it is advisable to choose an antibiotic for
sequential therapy, i.e. antibacterial drug, which has forms for
the parenteral and oral routes of administration.
Requirements to the antibiotic that is used for the tre-
atment and prevention of inflammatory complications are:
–
The antibiotic should be active against microorganisms
groups, which are most often found in chronic odontoge-
nic inflammatory foci;
–
Spectrum of antibiotic activity must comply with possible
representatives of microflora characteristic of the treated
area;
–
The drug must have the least ability to induce resistance of
microorganisms;
–
Antibiotic should well penetrate into the tissues in which
surgery is performed (in operations for opening abscesses
and abscesses - in soft tissue, jaw operations – the bone);
–
The level of the antibiotic in abnormal foci must reach
minimum inhibitory concentration (MIC) and maintain
at that level for the required time;
–
Antibiotic should provide minimal side effects and does
not adversely interact with other medications that may be
concurrently used (anesthetics, analgesics, etc.).
It was found that the activity of antibiotics against patho-
genic microorganism is not constant; it decreases with time
due to formation of antibiotic resistance - microbial resistance
to antibacterial drugs.
An important requirement for adequate prophylactic
antibiotic therapy is the ratio of the value and effectiveness of
the antimicrobial agent. For the treatment and prevention of
inflammatory complications in maxillofacial region the paren-
teral route of administration of antibiotics is the most com-
monly used. At cost indicators, the frequency of side effects
and convenience of use oral dosage forms possess significant
advantage. In the last decade, we have increasingly observed
high efficiency of «stepped» antibiotic therapy (synonyms:
sequential, step-down, switch therapy), which occupies an
increasingly strong position in the practice of medicine. Under
step antibiotic therapy the gradual transition from parenteral
to oral route of administration for the improvement of the
patient’s condition is implied. The main criterion for the trans-
ition to the reception of the drug inside is the normalization of
body temperature or its significant reduction. The transition
to the oral route of administration has a number of advantages:
reducing the load on the medical staff, material savings (spent
on disposable syringes, intravenous systems), the disappearan-
ce of the risk of postinjective complications development
(inflammatory infiltrates, phlebitis, etc.) and others. However,
the antibiotic, which can be used for sequential therapy must
meet certain requirements. The main one is the maximum
range of the proximity antibacterial preparations for parente-
ral or oral route, as well as their high bioavailability (in the
serum virtually the same concentration of the drug, regardless
of its route of administration, to be created).
With prophylactic aim the antibiotics should be used in
the following surgical interventions: removal of impacted
teeth and dystopic, the apices of the teeth roots resection,
cystectomy, dental implant, removal of tumors and tumor-like
formations, uncomplicated fractures without displacement of
jaw fragments, plastic and reconstructive surgeries and other
diseases. Assuming division of operations in terms of surgical
wound purity, it should be noted that for prophylactic anti-
biotics for «clean», «relatively clean» and «contaminated»
(«potentially infected») operations are indicated. The
appointment of antibiotics for «purulent» operations (abscess,
phlegmons, etc.) is indicated for the prevention of secondary
complications that may arise as a result of the progression of
already developed chronic inflammatory diseases.
76
ЧЕЛЮСТНО]ЛИЦЕВАЯ ХИРУРГИЯ И ХИРУРГИЧЕСКАЯ СТОМАТОЛОГИЯ
СОВРЕМЕННАЯ СТОМАТОЛОГИЯ 3/2016
Профілактика запальних ускладнень
О.О. Тимофєєв, Є.І. Фесенко, Н.О. Ушко, М.О. Ярифа
Резюме.
Проведення профілактичної антибіотикотерапії у хворих після проведення оперативних втручань в хірургічній стоматології і щелепно-лицевій
хірургії сприяє зниженню частоти розвитку післяопераційних запальних ускладнень. Розглянуті загальні питання антибіотикопрофілактики, мікрофлори
порожнини рота. Дані рекомендації за методикою проведення профілактичної антибіотикотерапії в хірургічній стоматології і щелепно-лицевій хірургії.
Ключові слова:
антибіотики, профілактика, мікрофлора, ступінчаста антибактеріальна терапія, гнійно-запальні ускладнення, хірургічна стоматологія,
щелепно-лицева хірургія.
Профилактика воспалительных осложнений
А.А. Тимофеев, Е.И. Фесенко, Н.А. Ушко, М.А. Ярифа
Резюме.
Проведение профилактической антибиотикотерапии у больных после проведения оперативных вмешательств в хирургической стоматологии и
челюстно-лицевой хирургии способствует снижению частоты развития послеоперационных воспалительных осложнений. Рассмотрены общие вопросы
антибиотикопрофилактики, микрофлоры полости рта. Даны рекомендации по методике проведения профилактической антибиотикотерапии в хирургиче-
ской стоматологии и челюстно-лицевой хирургии.
Ключевые слова:
антибиотики, профилактика, микрофлора, ступенчатая антибактериальная терапия, гнойно-воспалительные осложнения, хирургиче-
ская стоматология, челюстно-лицевая хирургия.
Oleksii O. Tymofieiev
– Head of Maxillofacial Surgery Department of Shupyk National Medical Academy of Postgraduate Education,
Doctor of Medical Sciences, Full Professor, Honored Scientist and Technician of Ukraine.
Ievgen I. Fesenko
– PhD student of Maxillofacial Surgery Department of of Shupyk National Medical Academy of Postgraduate Education.
Natalia O. Ushko
– PhD, Associate Professor of Maxillofacial Surgery Department of Shupyk National Medical Academy of Postgraduate Education.
Maria O. Yarifa
– PhD, Associate Professor of Oral and Maxillofacial Surgery Department of Kyiv Medical University of UAFM.
1. Тимофеев А.А. Руководство по челюстно-лицевой хирургии и хирургической сто-
матологии. – 5-е изд., перераб. и доп. – Киев: ООО «Червона Рута Турс», 2012. – 1048 с.
2. Тимофеев А.А. Челюстно-лицевой хирургия. – Киев: «Медицина», 2015. – 800 с.
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