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Antiseptic solutions for trophic ulcers. Treatment with drugs of trophic ulcers of the lower extremities with the release

Trophic ulcers on the legs are not an independent nosological entity.

These long-term, non-healing deep defects of the skin and underlying tissues develop as complications of some serious pathologies:

varicose veins of the lower extremities;
lymphostasis;
diabetes mellitus;
erysipelas (an inflammatory process caused by streptococcal infection).

With these diseases, the blood supply to the skin is significantly disrupted (a trophic disorder develops). With varicose veins, stagnation of venous blood in the vessels of the lower extremities leads to insufficient supply of arterial blood. Statistics show that 20% of cases of varicose veins are complicated by the occurrence of trophic ulcers. The skin becomes thinner and more susceptible to traumatic factors. Damage easily occurs on it, the subsequent healing of which takes a long period of time.

Mechanical damage to the skin, burns, and frostbite can be a provoking factor for the formation of trophic ulcers. The defect is an open deep wound with bloody or bloody-purulent discharge, which takes more than one and a half months to heal. If the underlying disease is not treated sufficiently, the patient regularly develops trophic ulcers.

Leg ulcers form on the legs, ankles, toes, and heels. There is a high probability of infection of the defect due to its proximity to the surface of the earth.

Principles of treatment

Drug treatment is aimed at speedy healing of the defect and prevention of infection.

The list of medications directly depends on the stage of the pathological process:

When prescribing therapy for trophic disorders, the following conditions are met:

Therapy should not be interrupted. The patient receives treatment continuously.
Drugs are prescribed for complex treatment of the body: etiotropic drugs and drugs that affect the main pathogenetic links.
Treatment should continue if, if necessary, the attending physician is changed.

The main groups of medications used in the treatment of trophic disorders

Patients who have trophic ulcers on the legs are prescribed systemic medications and agents for local application to the skin of the lower extremities.

Systemic medications:

Antibiotics (fluoroquinolones and cephalosporins are most often recommended for vascular pathologies of the lower extremities).
Antimycotics (Nizoral, Diflucan).
Phlebotonics (synonym - venotonics) are preparations made from plant materials or obtained by chemical synthesis.
Flavonoids demonstrated good effectiveness. Isoquerticin, querticin glucuronide (trade name Antistax). Reduces the severity of edema of the lower extremities, has an anti-inflammatory effect, normalizes vascular tone, and reduces vascular permeability.
Diosmin, hesperidin (trade name Detralex). Improves the contractile activity of smooth muscle fibers of the venous walls, normalizes vascular tone, reduces capillary permeability and the production of pro-inflammatory cytokines. The drug also has a positive effect on lymphatic vessels.
Diosmin (trade name Phlebodia 600). The product is used for all manifestations of varicose veins (damage to blood vessels in the legs, hemorrhoids, varicose veins of the esophagus).
Derivatives of rutin (drugs Troxevasin, Troxerutin).
Ginkgo biloba extract (complex remedy Ginkor-Fort).
Grape seed extract (Endothelon). Increases the production of collagen fibers, normalizes venous tone, reduces capillary permeability.
Ergot alkaloids (Vasobral). Helps reduce large and small veins.
Treatment aimed at dilating peripheral blood vessels and normalizing microcirculation. The drugs affect the inner layer (endothelium) of blood vessels and blood cells.
Pentoxifylline (Trental). The tablet form is used, intravenous administration is also possible. Reduces the production of cytokines, dilates small peripheral vessels, reduces platelet aggregation.
Dipyridamole (Curantyl).
Nicotinic acid. Reduces the concentration of cholesterol in the blood, platelet aggregation and blood viscosity.
Non-steroidal anti-inflammatory drugs. Reduce the severity of pain, swelling, and inflammation. Affect platelet adhesive activity (reduce it). Produced in the form of rectal suppositories and tablets.
Antispasmodics: drugs in this group (papaverine, drotaverine, etc.) are used extremely rarely (for example, for pulmonary embolism).
Medicines affecting lipid metabolism.
FISHant-S is a sorbent of natural origin. It has a positive effect on the properties of bile and intestinal microflora, reduces deficiency of pancreatic enzymes, and improves intestinal motor function.
Statins.
Fibrates. Reduce the concentration of triglycerides and cholesterol in the blood.
Nicotinic acid in high doses.
Ion exchange resins. Binds bile acids, reduces the concentration of blood cholesterol.
Antioxidants.
Drugs affecting metabolism. For complex treatment of varicose veins of the lower extremities, Solcoseryl, Actovegin, Tanakan are prescribed.
Anticoagulants of direct and indirect action. Direct action: heparin, synthetic pentasaccharides, thrombin inhibitors, sulodexide.
Indirect action: coumarin derivatives, phenindione derivatives.
Fibrinolytics. Drugs used only in hospital settings to treat complications associated with the formation of blood clots.
Prostanoids. They reduce platelet activity, improve the elastic properties of red blood cells, reduce cholesterol concentrations, and normalize vascular tone.
Agents that reduce platelet aggregation. They improve microcirculation and are used to prevent the formation of blood clots. Examples: acetylsalicylic acid, ticlopidine, clopidogrel.
Enzymes.
Nutritional supplements.
Phytotherapy.

Every person who has at least once encountered pathologies of the legs knows that if trophic ulcers of the lower extremities are being treated, drugs should be chosen extremely carefully. This is largely due to the characteristics of the disease, in which a disruption of cell nutrition, that is, trophism, occurs. Deep defects occur in the skin epithelium, accompanied by inflammation.

Types of disease

Trophic ulcers of the lower extremities are divided into several types and can be:

venous;
atherosclerotic (arterial);
diabetic (caused by diabetes mellitus);
neurotrophic (due to damage to the spinal column or brain injury);
hypertensive (Martorell's ulcers);
pyogenic (infectious).

Venous ulcers most often form in the lower part of the inner surface of the leg. The factors leading to the pathology are disturbances in the venous blood supply (against the background of varicose veins). The appearance of a defect is preceded by the following symptoms:

a feeling of heaviness and swelling appears in the calf part of the leg;
convulsions are observed at night;
itching and vascular networks form on the skin;
the vein pattern merges into a common purple spot with a violet tint;
There is a thickening of the skin, its smoothness and shine.

If left untreated, a small ulcer forms, progressing every day. As the defect develops, pus with an unpleasant odor is released.

Diabetic trophic ulcer develops against the background of intermittent claudication syndrome, inherent in patients with diabetes mellitus. Most often it occurs on the big toes or on the front of the foot and heel. More often than others, it becomes infected, which often leads to gangrene and amputation of the limb.

Hypertensive ulcers are caused by spasmodic disorders of the lower extremities, resulting from a constant increase in blood pressure. At the beginning of the disease, a red spot with a bluish tint appears, transforming into ulceration. Typically, ulcers occur on both legs in proportion to each other.

Neurotrophic lesions of the skin are caused by injuries to the spinal cord or brain. Most often, ulcers occur on the lateral surfaces of the heel or in the area of the plantar tubercle. They have the shape of a deep crater, where the bottom is tendon or bone. They produce pus with an unpleasant odor.

Pyogenic defects are usually associated with poor personal hygiene. Caused by decreased immunity against the background of folliculitis, furunculosis, purulent eczema, etc. They can be located over the entire surface of the lower leg and be single or multiple. They are distinguished by their shallow depth and oval shape.

Therapeutic measures

Since the causes of trophic ulcers are different, which determines their pathogenesis, the treatment of different types of illness is approached individually. First of all, diagnostics is carried out, which uses both bacteriological and histological, as well as instrumental forms of research.

Based on the results of the measures, a set of treatment procedures is prescribed, which includes:

drug (general and local) therapy;
physiotherapeutic procedures;
surgery (as needed).

A course of medication is prescribed not only in the case of conservative treatment, but also during surgical interventions. As a rule, drug treatment of trophic ulcers is divided into several stages:

taking broad-spectrum antibiotics;
use of non-steroidal anti-inflammatory drugs;
administration of intravenous antiplatelet agents;
use of antihistamines.

Along with taking medications in oral and injectable form, local therapy is used, which aims to cleanse the ulcer of pus and dying cells and destroy pathogenic microorganisms. Local treatment of trophic ulcers of the lower extremities is carried out by washing the affected areas with antiseptic solutions: chlorhexidine, furatsilin, potassium permanganate, decoctions of chamomile, string or celandine. Therapeutic dressings are applied to the treated surfaces, for which the following drugs are used:

Streptolaven.
Dioxicol.
Levomekol et al.

Subsequent measures include the use of healing ointments (Actovegin, Solcoseryl, etc.) and drugs with antioxidant effects (Tocopherol). As the skin heals, Geshispon, Swiderm, Algipor and other collagen wound coverings are used.

The choice of treatment varies depending on the type of ulcer.

Treatment of varicose veins

If a trophic ulcer occurs against the background of venous insufficiency caused by varicose veins, the choice of medications and forms of treatment may be as follows:

Preparations based on the enzymes Himopsin, Trypsin, Chymotrypsin. Used to cleanse wounds.
Grazolind, Parapran, Gelevin, Tendervet Active dressings or impregnated with the above medications.
Piolysin and Levomekol ointments as a local remedy.
Chlorhexidine is used to wash a purulent wound. If there is no effect, replace with sodium hypochlorite or iodopyrone.
Acerbin spray shows a good effect.

Diabetes therapy

In the treatment of diabetic lower extremity lesions, the following drugs can be used:

As a topical treatment, apply a silver dressing until the ulcer is completely cleared.
Ointments Ebermin, Silvederma or Dermazin.
For washing, dioxidine is added to the chlorhexidine solution. For bleeding formations, use a mixture of the first and aminocaproic acid. To reduce pain, it is recommended to mix chlorhexidine with a small amount of novocaine or insulin.

The drugs Fusicutan, Delaskin and Vulnostimulin have a good effect. It is necessary to consider the characteristics of drugs in more detail.

Fusicutan is a topical antibiotic used to treat skin pathologies caused by microorganisms. The drug contains the main bioactive substance - fusidic acid, which has a detrimental effect on gram-positive bacteria: streptococci, staphylococci, etc. It is not recommended to use the drug for children under 1 month of age, with caution for pregnant and lactating women.

Delaskin powder is used to make lotions that have a tanning effect. A synthetic substance obtained as a result of the synthesis of phenol, methanal, urea and sulfonated polycondensate and being the basis of the drug, has properties similar to natural tannins. It has an astringent effect, eliminates inflammatory processes, and dries out moist skin tissue. It has pronounced antipruritic and local anesthetic properties, relieves swelling and redness.

Vulnostimulin is available in the form of a cream containing coriander and lavender oils, wheat germ extract, antiseptic agents and preservatives phenoxyethanol, polyethylene glycol, etc. It has a rapid wound healing effect. Used to treat open, infected or damp lesions. It has anti-inflammatory properties.

All of these drugs relieve tissue swelling, reduce itching and irritation, and suppress local inflammatory processes. As a result of research, it has been established that the use of agents alone or in combination is accompanied by the appearance of marginal epithelization after 7-8 days. After 2 weeks, granulation tissue appears.

The use of Vulnostimulin, Fusicutan and Delaskin in the treatment of trophic ulcers in patients with diabetes mellitus shows better results than the use of standard agents.

Preventive measures

Trophic disorders of the lower extremities, as a rule, occur against the background of more serious pathologies.

If a certain lifestyle is not followed, even completely healed ulcers can recur.

To avoid the appearance of wounds, you should maintain the overall tone of the body. Prevention may include the following measures:

dousing with cold water;
diet;
treatment of diseases that can become the root cause of the condition.

When normalizing your diet, you need to avoid dishes with a lot of spices and salt. You should include in your daily menu foods with vitamins A, E and C, which have regenerating properties: black and red currants, cabbage, broccoli, citrus fruits, nuts, whole milk and vegetable oils.

It is necessary to increase the consumption of carrots, pumpkin, tomatoes, egg yolks, caviar, cheese, etc. Brown rice, whole grain bread, cottage cheese, seafood, garlic, white chicken meat, fatty fish, flaxseed and olive oils will become suppliers of Omega fatty acids to the body -3, zinc and selenium.

Prevention after a cured trophic ulcer consists of caring for damaged limbs. It is necessary to monitor the condition of the blood vessels, lubricate the scars that have arisen at the site of ulcers with vegetable oils infused with chamomile, St. John's wort or calendula. These drugs support skin regeneration.

You should limit the load on your legs; you cannot stay in an upright position for a long time. It is recommended to use special underwear and bandages with a compression effect. Physical education classes will be extremely useful.

The most effective treatment for fresh superficial wounds is hydrogen peroxide. It has a hemostatic and antiseptic effect. When this drug penetrates the wound, oxidation of proteins (pus and blood) occurs, i.e. their destruction. As a result of significant foaming, mechanical cleansing of the wound occurs from small blood clots, particles and foreign bodies contaminating its surface. In addition, foaming stops bleeding and promotes the formation of blood clots.

You need to know that peroxide destroys the membranes of new granulation cells.

Therefore, hydrogen peroxide is not recommended for the septic treatment of trophic ulcers. And in case of diabetes, its use is strictly prohibited.

To treat and care for trophic ulcers, you should use drugs that do not have a detrimental effect on healthy cells. Drugs with this effect include Prontosan, Miramistin and Chlorhexidine. Local treatment of wounds can be carried out using such agents as Proteox-TM (used for suppuration of ulcers), Biaten (with silver), which is used in the treatment of highly exudating wounds. If the ulcer is clean, but does not heal for a long time, Multiferm is prescribed.

Trophic ulcers are difficult to treat. Treatment becomes complicated when an infection attaches to the wound surface. If the disease is ignored, ulcerations on the legs lead to the development of gangrene or amputation of the lower extremities. To avoid complications, patients are always prescribed antibiotics for trophic ulcers.

Pathogenic microorganisms that spread during trophic ulcers of the lower extremities are quite resistant to many drugs. Therefore, doctors prescribe antibacterial drugs. Depending on the form of release, antibiotics can be used orally, topically, or as an intramuscular injection. The form of the medicine directly depends on the severity of the pathology and the general condition of the patient. Taking antibiotics for a trophic ulcer on your own is prohibited; it is dangerous to health. Uncontrolled use of medications can lead to irreversible consequences. The dosage and course of treatment are prescribed by the doctor after a bacteriological examination.

For trophic ulcers, it is very important to carry out comprehensive high-quality treatment

Which antibiotic among all the variety of drugs is more effective? For trophic ulcers of the lower extremities, doctors prescribe broad-spectrum antibiotics:

"Amoxicillin";
"Oxacillin";
"Doxycycline";
"Heliomycin."

These are the latest generation drugs. They increase blood clotting and suppress infection. In severe cases of the disease, the medicine is administered as an injection into the perivenous tissue in large doses. Intramuscular administration of the drug is also possible.

Used for healing trophic wounds of the lower extremities

Antibiotics in the form of a solution are intended for external use. These drugs include: Miramistin, Chlorhexidine, Dioxidine and Levomycetin. The solution is applied to a gauze pad and applied to the affected area of the skin. Such compresses cleanse the wound surface of pathogenic microbes and speed up the healing process. This method of treatment is contraindicated in case of individual hypersensitivity, liver and kidney failure.

But using antibiotics alone is not enough. Treatment requires an integrated approach, so doctors also prescribe anticoagulants, antispasmodics, phyrinolytics and phlebotonic homeopathic remedies.

Ointments for trophic ulcers

Even if no pathogenic microflora was detected in the patient, he is still prescribed a short course of antibacterial agents for prevention. In this case, the following are effective:

"Levomekol";
"Argosulfan";

"Bepanten."

These agents have antibacterial, anti-inflammatory and adsorbent effects. Ointments cleanse the wound surface of pus and help strengthen local immunity. Active components stop the proliferation of pathogenic microbes, remove decay products of damaged tissues, reduce swelling and accelerate the healing process. The ointment should be applied as a compress. To do this, apply a thin layer of ointment to a sterile napkin or gauze and apply the compress to the affected area for 1 hour. Wounds should be treated every day. An overdose of ointment is unlikely. The course of treatment is prescribed depending on the degree of damage.

If you have a disease of the lower extremities, it is prohibited to use antibacterial ointments on your own (without a doctor’s advice), as this can lead to sensitization of the body. Treatment with potent ointments in this case will not only not bring the expected result, but will also lead to serious complications.

Each of us, at least once in our lives, has been injured with a violation of the integrity of the skin. Usually, even the deepest wound, under appropriate conditions, heals within a month. The situation is completely different with trophic ulcers, which form mainly at the site of damage to blood vessels. Such wounds take much longer to heal, which means that the likelihood of their infection is much higher, which means that antibiotics for trophic ulcers in most cases are a dire necessity, and not a whim of doctors who want to play it safe. Whether the use of antimicrobial agents is always justified is another matter.

Trophic ulcers and their treatment

Iodine preparations

The most popular drug for the treatment of trophic ulcers is the antiseptic “Iodopyron”. The main active ingredient of the drug, as the name suggests, is iodine. But if an alcohol tincture of iodine cannot be used undiluted for treating open wounds, then a 1% solution of “Iodopyron” can be used to treat not only the skin surrounding the wound, but also the inside of the ulcer. If the trophic ulcer is located on the feet or hands, the same solution can be used to treat the nails, fingers and the space between them, which will prevent the addition of a possible fungal infection.

Release form. This drug is intended for external use. In pharmacies it can be found in the form of a powder, from which a solution of the required concentration is subsequently prepared, packaged in light-proof bags, and a ready-made dark brown solution in bottles.

Indications for use. The drug is prescribed both for the treatment of infectious and inflammatory skin lesions, and for the treatment of mucous membranes with sore throat, atrophic rhinitis, and purulent otitis media. In addition, medical staff can disinfect hands, medical gloves, and special instruments with the “Iodopiron” solution.

Contraindications for use. Contraindications to the use of Iodopirone are mainly associated with oral administration, which may be prescribed in connection with the treatment of syphilis and atherosclerosis. For trophic ulcers, the drug is used topically if there are no hypersensitivity reactions to an antiseptic containing iodine.

Use during pregnancy. During pregnancy and lactation, according to the instructions for the drug, it should not be taken orally. There are no such comments about the external use of the product, but it is still worth consulting a doctor about this.

Side effects. The use of powder for the preparation of a medicinal composition may be accompanied by a short burning sensation of the affected area, itching, dry skin, allergic reactions accompanied by a rash and redness of the skin.

The use of the solution can also in some cases cause skin irritation reactions. If a trophic ulcer occupies a large surface, then applying the solution for a long time can lead to a condition such as iodism, which is characterized by the appearance of an allergic rash and runny nose, Quincke's edema, increased salivation and lacrimation.

Method of administration and dose. Iodopirone powder is used in the form of a 1% solution, which is prepared directly in the pharmacy. The prepared solution is moistened with gauze napkins folded in several layers and the ulcer, as well as the healthy surfaces adjacent to it, are treated. A moistened napkin can be applied to the wound for a certain period of time, then removed and lubricated with an antibiotic or wound healing agent.

Interactions with other drugs. The drug solution cannot be used simultaneously with formulations containing ammonia and essential oils. It is better to treat wounds containing fat, pus and blood using other means, since these substances weaken the effect of the antiseptic.

Storage conditions. The antiseptic should be stored in a dry place where access to light is limited. Keep away from children. The storage temperature of the powder should not exceed 30 degrees, the solution - 25 degrees.

The shelf life of the solution and powder is 2 and 3 years, respectively, from the date of issue.

Iodopyrone

Replace "Iodopirone" solution you can use an ointment with the same name, diluted with purified water, an alcohol solution of iodine, the drug “Iodinol”, “Betadine” (also known to many as “Povidone-iodine”).

Let's dwell a little on the last drug, which is an organic compound of iodine with polyvinylpyrrolidone. The drug "Betadine" has a pronounced antiseptic and bactericidal effect, similar to antibiotics. Its action is longer in relation to inorganic iodine compounds, and with long-term use, microorganisms do not develop resistance to the drug.

In addition to its bactericidal effect, Betadine has antifungal and antiviral activity, and also helps improve tissue trophism and speedy wound healing.

To treat trophic ulcers, you can use a 10% solution, which is sold in pharmacies. Subsequently, the composition is diluted with purified cool water, isotonic solution, or Ringer's solution is used. The drug can be diluted in different proportions: 1 to 2, 1 to 10 or more, depending on the purpose of use. Treatment of wound surfaces is carried out with a gauze swab soaked in a solution of the required concentration 2-3 times a day.

Side effects of the drug include: skin hyperemia, itching, development of contact dermatitis, and the appearance of specific acne. If an antiseptic is used for a long time or large trophic ulcers are treated with it, generalized reactions associated with the penetration and accumulation of iodine in the body are possible: anaphylactic shock, the development of hyperthyroidism, impaired renal function, changes in quantitative and qualitative blood parameters, and the development of metabolic acidosis.

The contraindications for use of the drug are much broader than those of Iodopirone. Antiseptic "Betadine" is not prescribed for hyperthyroidism, thyroid adenoma, serious pathologies of the heart, kidneys and liver with impairment of their functions, Dühring's dermatitis herpetiformis. In pediatrics, the use of the drug is permitted from 1 year of age. An antiseptic should not be prescribed on the eve of or after a course of treatment with radioactive iodine.

Use during pregnancy. Since the drug is able to penetrate through tissues into the body, and its metabolites easily penetrate even through the placenta, there is a danger of the fetus developing hyperthyroidism, therefore the use of an antiseptic during pregnancy and lactation is considered undesirable.

With prolonged use of the drug over large areas of the lesion, an overdose may occur, manifested by salivation, symptoms of renal failure, cyanosis, tachycardia, hypertension or, conversely, a sharp drop in pressure (collapse). In rare cases, patients fell into a coma. The antidote in this case is starch diluted in milk. However, it is still recommended to consult a doctor for further treatment.

When using the antiseptic Betadene or Povidone-iodine, it is necessary to take into account drug interactions with other drugs. This solution cannot be prescribed simultaneously with external enzyme preparations, drugs based on lithium and mercury. It is also not used together with other antibacterial agents for topical use: silver preparations (for example, the antibiotic Argosulfan, popular in the treatment of trophic ulcers), hydrogen peroxide, antimicrobial agents based on chloramphenicol, etc.

The storage conditions for the drug are also somewhat different from Yodopirone. It should be stored in cooler conditions. The temperature should be between 5-15 degrees. This will prevent premature deterioration of the medicine.

Miramistin

Another popular antiseptic, active against most pathogenic microorganisms that can be found in an open wound of a trophic ulcer. The drug is available in the form of a ready-made solution. It is used in surgery to treat infected wounds, and to treat burns, and in dentistry, and to combat pathologies of the ear, nose and throat. The drug is also popular in the treatment of sexually transmitted infections.

Pharmacodynamics. The antibacterial properties of Miramistin are due to its ability to destroy the cell membranes of bacteria, which inhibits their vital processes. In addition, the drug has a certain antifungal effect against fungi from the Candida group and some others.

An interesting feature of Miramistin is that this antiseptic does not affect human cell membranes, and is also capable of reducing the resistance of bacterial pathogens to the action of antibiotics used for trophic ulcers, due to which it is actively used as part of antibiotic therapy.

Pharmacokinetics. When used topically, the drug does not penetrate deep into tissues and does not enter the systemic bloodstream. This feature of the antiseptic allows it to be used during pregnancy and lactation.

Contraindications for use. The drug is not used only if hypersensitivity reactions to it occur. The use of the drug in pediatrics is limited due to insufficient research in this direction.

Side effects. Application of an antiseptic may be accompanied by a short-term burning sensation, which goes away on its own. In rare cases, hypersensitivity reactions to the drug occur in the form of redness of the skin, a feeling of dryness and itching on the skin.

Method of administration and dose. The Miramistin solution can be used to irrigate the surface of open wounds, as well as to pack the wound by fixing tampons soaked in the solution in it. The procedure is recommended to be carried out 2 or 3 times a day for 4-5 days.

Overdose. There were no reports of overdose cases.

Storage conditions. It is advisable to store the drug in its original packaging away from children for no more than 3 years from the date of release. Storage temperature should not exceed 30 degrees.

Unlike antibiotics, the use of which is justified only when a bacterial infection is detected, i.e. when the disease is complicated by the addition of pathogenic microorganisms, antiseptics can be safely used for prophylactic purposes to prevent inflammatory reactions and relapses of inflammation at the site of cured trophic ulcers.

Antibiotics for the treatment of complicated trophic ulcers

If the antiseptic solutions were not enough, the disease began to progress, as indicated by redness and swelling of the edges of the wound, an increase in its size, the appearance of purulent exudate inside the wound, it’s time to resort to the help of more serious antimicrobial drugs - antibiotics.

Antibiotics for trophic ulcers are mainly prescribed for local action, unless the process has become generalized. To combat infection, antibacterial ointments, creams, and solutions are used.

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Dioxidin

"Dioxidin" is an antibiotic that is widely used in the treatment of trophic ulcers. It is active against most bacteria that can cause inflammation and suppuration of soft tissues. Many strains that are resistant to other antimicrobial agents also remain sensitive to it. It is successfully used in the treatment of severe purulent-inflammatory pathologies of soft tissues.

Release form. The drug is produced in the form of a 1% solution in ampoules of 10 ml each, a solution with half the dosage in ampoules of 10 and 20 ml, and a 5% ointment for external use.

Method of administration and dose. The solution can be used for wound washing, antimicrobial dressings and intramuscular injections, and in the form of a dropper.

Washing wounds and applying bandages is carried out with an undiluted solution. A piece of bandage is moistened with the composition from the opened ampoule and used according to its intended purpose. It is also practiced to apply sterile dressings with Dioxidin ointment.

From 10 to 50 ml of undiluted antibiotic is injected into the wound with an injection syringe. This should be done 1-2 times a day, but no more than 70 ml.

An intravenous antimicrobial solution is administered only in severe cases, if microbes have been carried throughout the body through the bloodstream and the infection has become systemic. For droppers, use a 0.5% solution, diluting the composition from the ampoules with a glucose solution or saline solution (approximately 1:3). 2 to 3 infusions are given per day. The minimum daily dose is 600 mg of the medicinal composition, the maximum is 900 mg.

Contraindications for use. Dioxidin is a drug that should be used only in the most severe cases, when other medications do not help. Prescribing it to yourself is dangerous for your health, since it can cause gene mutations and the development of associated pathologies.

The drug is not prescribed for adrenal dysfunction and hypersensitivity to the active substance. For kidney diseases that impair their functionality, the therapeutic dose is adjusted.

Use in pediatrics is limited.

Use during pregnancy. This drug is not prescribed to pregnant women, since its effect extends to the fetus, causing developmental disorders and various mutations. An antibiotic can cause fetal death in the womb and premature birth.

Side effects. Intramuscular and intravenous administration of the drug may be accompanied by headache, chills, hyperthermia, allergic reactions, and gastrointestinal disturbances (dyspepsia). Sometimes muscle twitching is observed. When treating a wound with an antibiotic solution and applying bandages with a solution or cream, side effects are mainly limited to allergic manifestations.

The drug is discontinued only if side effects are severe; in other cases, dose adjustment and therapy with antihistamines are resorted to. Calcium-based preparations can be used as an antidote.

Storage conditions and expiration date. The drug should be stored away from children in a dark place at room temperature (no more than 25 degrees). The antibiotic must be used within 2 years from the date of issue.

Argosulfan

Another popular antibiotic in the treatment of complicated trophic wounds is Argosulfan. Its popularity is based on the fact that the drug contains silver sulfathiazole, and in the case of trophic wounds, silver compounds are more effective in combating bacterial inflammation. Silver salts are poorly soluble in liquids, which makes it possible to maintain the required concentration in the wound for a long time.

Release form. The drug is produced in the form of a cream for external use, which is packaged in tubes with a capacity of 15 and 40 g.

Pharmacodynamics. Thanks to sulfathiazole, the drug has a pronounced bactericidal effect, which is enhanced by silver particles. The antibiotic not only has a detrimental effect on gram-positive and gram-negative bacteria, but also additionally prevents re-infection of the wound, creating a stable protective film on the surface.

Another important feature of the medicine is the ability to stimulate restoration processes in the wound, which contributes to its rapid healing. The drug also has an effect similar to NSAIDs: it has a noticeable analgesic effect and stops the development of the inflammatory process in damaged tissues.

Pharmacokinetics. External use of the drug does not exclude part of the active substance from entering the systemic bloodstream (the larger the surface of the wound, the greater the absorption of the drug), with which it enters the liver, where its metabolism occurs. Metabolites are excreted by the kidneys.

Method of application. The drug can be applied directly to the wound surface and to the skin around it. It is acceptable to cover the area treated with cream with an occlusive bandage.

Before applying the cream, the wound must be cleaned; if there is exudate, it must be treated with an antiseptic (a solution of miramistin, chlorhexidine or boric acid). The cream is applied in a thick layer (at least 2 mm) 1 to 3 times a day for a therapeutic course of no more than 2 months. During this period, the wound should be constantly covered with cream.

The daily consumption of the cream should not exceed 25 g. Long-term treatment with the drug requires monitoring the content of the active substance of the antibiotic in the blood.

Contraindications for use. Antimicrobial cream with silver salts is not prescribed in case of hypersensitivity to its components, in case of glucose-6-phosphate dehydrogenase deficiency, or during breastfeeding (according to indications, during antibiotic treatment the child is transferred to artificial feeding). The medicine is not prescribed to babies under 2 months of age and premature babies (there is a high risk of liver failure and the development of jaundice).

Use during pregnancy. An antibiotic can be prescribed during this period, but only in difficult situations, if there is a great danger to the life and health of the expectant mother.

Side effects. Usually, the use of the drug is not accompanied by unpleasant symptoms. There have been isolated cases of complaints of skin irritation and burning in the area covered with the cream, and the appearance of mild allergic manifestations in the form of itching and rashes on the skin.

Long-term antibiotic therapy can alter the functioning of the hematopoietic system or provoke the development of desquamative dermatitis.

Overdose. There have been no reports of such cases.

Interaction with other drugs. The cream is not recommended to be used simultaneously with other external agents and medications containing folic acid, as this will negatively affect the effectiveness of the antimicrobial component of the drug.

Storage conditions and expiration date. The drug can be stored for no more than 2 years from the date of release in a cool place with a temperature of no more than 15 degrees (do not freeze!), away from moisture and direct rays of the sun.

Sintomycin

"Sintomycin" is another antibiotic for external use, intended for purulent-inflammatory lesions of soft tissues, including long-term non-healing ones, such as trophic ulcers.

Release form. In pharmacies, the drug can be found in the form of liniment (ointment) of a whitish color with a faint odor, placed in a 25 g tube and cardboard packaging.

Pharmacodynamics. The main active ingredient of the drug is chloramphenicol, which has an antimicrobial and bacteriostatic effect against a wide range of infectious pathogens. The bacteriostatic effect of the antibiotic is based on disruption of protein synthesis in pathogenic microorganisms.

Resistance to this substance develops rarely and slowly, which allows the drug to be used against strains of bacteria that are resistant to a large number of antibiotics.

Pharmacokinetics. Not studied enough.

Method of administration and dose. Liniment can be applied in a thin layer to the surface of the wound and the area around it, or gauze tampons soaked in cream can be placed into the wound. It is recommended to cover the wound with a sterile bandage. Depending on the condition of the wound, the ointment is left for 1-5 days, after which a dressing is performed. The duration of treatment is determined by the doctor.

Use only as prescribed by a doctor.

Contraindications for use. Liniment is not used in cases of hypersensitivity to the components of the drug, psoriasis, eczema and fungal pathologies of the skin.

In pediatrics it is used from 4 weeks of age.

Use during pregnancy. It is possible to use a local antibiotic to treat pregnant women, but since its pharmacokinetics have not been fully studied, this should be done with extreme caution and only if the risk to the mother is higher than the possible consequences for the fetus.

It is allowed to use the ointment for therapeutic purposes and during lactation. In this case, only thorough cleansing of the nipples from drug residues is required if therapy for cracks in them is carried out.

Side effects. There are known cases of the development of mild allergic reactions in the form of burning, itching, redness and swelling of the treated tissues, as well as skin rashes. In case of an overdose of the drug, an increase in the above-described symptoms is observed.

Interaction with other drugs. The drug can be used in conjunction with antibiotics such as Erythromycin, Nystatin, Oleandomycin, Levorin. This will only enhance the antimicrobial properties of Synthomycin. But benzylpenicillin salts, on the contrary, weaken the effect of chloramphenicol.

Incompatibility of the drug is also observed with sulfonamides, cytostatics, and dephenylbarbiturates. This list can also include pyrazolone derivatives and ethanol.

Storage conditions and shelf life are similar to Argosulfan cream.

Levomekol

An incomplete analogue of the above-described medicine can be considered an ointment "Levomekol", which is actively used by many for wound healing even without consulting a doctor (which is not always justified and safe).

Pharmacodynamics. The ointment contains 2 active ingredients: chloramphenicol and methyluracil, thanks to which the medicine can boast a powerful antimicrobial and anti-inflammatory effect. Effectively fights inflammation and promotes tissue regeneration.

Pharmacokinetics. The drug penetrates deep into the wound very quickly and easily. It is widely used in the treatment of purulent wounds, since pus and exudate inside the lesion do not affect its antimicrobial activity.

Method of administration and dose. The ointment is applied to the cleaned surface of the wound using napkins soaked in ointment or injected into the cavity with pus using a syringe. Daily dressings are required. You can use no more than 3 g of ointment per day.

Typically, treatment with the drug is carried out for no more than 4 days, since longer use of the drug can provoke osmotic shock in healthy cells.

Contraindications for use. The ointment is not used in the treatment of persons who have had hypersensitivity reactions to the active substances of the antibiotic in the past. In pediatrics it is used from 3 years of age.

The possibility of use during pregnancy is discussed with your doctor and depends on the severity of the condition.

Side effects. Typically, the use of antibacterial ointment may be accompanied by either mild allergic reactions or skin irritation (discomfort, burning and tissue hyperemia in the area of application), which requires a review of the prescription.

In addition to the local antimicrobial drugs described above, nonspecific antibiotics can also be used for trophic ulcers, for example, Bactroban and Baneocin ointments.

"Baktoban" is an ointment for external use, which is used in the treatment of secondary bacterial complications of traumatic wounds. The active ingredient of the drug is mupirocin; depending on the concentration in the wound, it can exhibit both bacteriostatic and bactericidal effects.

The cream should be applied to damaged areas of the body in a thin layer. It is recommended to do this 3 times a day. The course of treatment is no more than 10 days.

The cream must be used independently; simultaneous use with other local agents reduces its effectiveness.

The antibiotic is not used in children under 1 year of age and in patients with hypersensitivity to the components of the drug. During pregnancy, the drug is used only strictly as prescribed by a doctor due to insufficient information about its effect on the course of pregnancy and the health of the fetus.

Side effects of the drug include allergic reactions (very rarely severe), skin irritation, headaches and dizziness, nausea and abdominal pain, stomatitis.

The drug can be stored for more than 1.5 years from the date of release at temperatures below 25 degrees. The cream cannot be frozen. Keep away from children.

Baneocin

Cream "Baneotsin" is a combined antimicrobial drug for local application. It contains 2 active ingredients bacitracin and neomycin, which enhance the bactericidal effect of each other. The drug is inactive against viruses and fungi. Used to treat infected wounds.

Contraindications to the use of a combined antibiotic are considered to be hypersensitivity to its components and other AMPs from the aminoglycoside group. The drug should not be used on large areas of affected skin.

Absorption of the drug through damaged skin with trophic ulcers makes its use undesirable for pathologies of the heart, kidneys, and vestibular apparatus.

The possibility of using an antibiotic during pregnancy must be discussed with your doctor. The penetration of an antibiotic into the mother's blood can harm the fetus, since aminoglycosides (neomycin) easily penetrate the placenta and can cause hearing impairment in the baby in the future.

The ointment is applied to the cleaned wound 2 or 3 times a day in a thin layer and covered with a sterile bandage. The course of treatment is 1 week. A longer course of therapy requires a reduction in the daily dose.

Side effects of the drug include rare allergic reactions, symptoms of toxic effects on the kidneys and hearing organs (nephro- and ototoxicity), malfunctions of the neuromuscular and vestibular systems, and isolated cases of photosensitivity.

Interaction with other drugs. The simultaneous use of antibiotics from the cephalosporin group and Baneocin in the area of open wounds increases the risk of nephrotoxic reactions. The same can be said for some diuretics (for example, furosemide).

Neuromuscular conduction disorders were diagnosed in cases of antibiotic and analgesic or muscle relaxant use.

Baneocin ointment can be stored for 3 years at room temperatures not exceeding 25 degrees.

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