The use of antimicrobials in the treatment of dermatoses
Antibacterial agents form one of the main drug groups in the therapeutic arsenal of dermatologists. These include, first of all, various antibiotics (AB).
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Antibiotics are widely used in the treatment of various skin disorders. Among the variety of dermatoses pustular skin disease, pyoderma, is the most widely spread one. However, the scope of the ABs in dermatology is much broader, thus they are applied in acne, rosacea, lupus, leishmaniasis, scleroderma, psoriasis, lichen planus, angiitis of the skin, skin sarcoidosis, chronic benign familial pemphigus Guzhero-Hailey-Hailey, Lyme disease, and many others. In addition, the complications caused by secondary infection, accompanied by itching, such as atopic dermatitis, scabies, eczema or bullous dermatosis should also be kept in mind.
The mechanism of action of ABs is quite complex and depends on the chemical structure of the drug and the group to which it belongs. Most currently semi-synthetic or fully synthetic compounds are used, which are sometimes considerably more active than their natural counterparts.
Given the rather frequent occurrence of resistance to ABs, before prescribing the drug carrying out an antibiogram is recommended to figure out the sensitivity to different strains of microorganisms allocated in patients.
Wrong selection of ABs, the dose or duration of treatment can lead to chronic disease, the formation of specific bacteria to antibiotic ABs, as well as frequent significant side effects have mainly allergic nature.
In dermatological practice representatives of virtually all the groups of ABs are used (penicillins, tetracyclines, streptomycin, cephalosporins, aminoglycosides, macrolides, and others.). Semisynthetic penicillins are highly effective in infectious dermatoses caused by staphylococci and streptococci, as well as in cases when the latter complicate the course of noncommunicable dermatoses. In recent years an increase in the number of staphylococci resistant to penicillin and semi-synthetic derivative of tetracycline is observed. In such cases rifampicin and fusidic acid use, as well as the combination of gentamicin and amikacin with cephalosporins is recommended. Indeed, cephalosporin drugs are superior in anti-bacterial and anti-inflammatory effects. In dermatology ceftriaxone, ceftazidime, cefotaxime, cefuroxime and others are also well known instruments.
In recent years, combinations of ABs, for example a mixture of equal amounts of erythromycin and oxytetracycline dihydrate, are successfully used. The reason for high activity of the combined use of therapeutic AB components is simultaneous acting on separate structural elements, enzyme systems and biochemical processes in the cells of microbial pathogens. In addition, the use of a combination of ABs of broad direction inhibits the development of antibiotic resistance of microorganisms to help restore their sensitivity to ABs. This explains the good therapeutic effect of erycyclinum appointed in chronic pyoderma, in combination with immunomodulators.
ABs, especially broad-spectrum, long-term use can cause candidiasis of different localization. The primary cause of candidiasis in the treatment of AB is goiter, resulting from the suppression of intestinal microorganisms - yeasts competitors, thereby disrupted the formation of these bacteria vitamin B complex, especially B1 and B2. At the same time, the AB has a stimulating effect on the growth of yeasts in the digestive tract and elsewhere. The toxic effect on the AB of the digestive tract mucosa, which facilitates the introduction and development of resistant fungi, is also possible; however, a long-term treatment with ABs of a wide spectrum of action aimed a patient must take antifungal drugs.
Other antimicrobal drug types
In addition to ABs, antimicrobials also include sulfonamides, sulfones, metronidazole and fluoroquinolones.
Sulfa drugs, especially with prolonged effect can be used in the treatment of skin infections and diseases, sexually transmitted diseases, but lately they are much less frequently used in comparison with ABs. In addition, these funds often cause erythema sulfa.
Sulfones are mainly used in leprosy and dermatitis herpetiformis, although the spectrum of diseases in which sulfones give good therapeutic effect extends; for example, producing impressive results in hives.
Fluoroquinolones (ofloxacin, norfloxacin, ciprofloxacin, and many others) is a modern antimicrobial drug with a wide spectrum of action, allowing them to use a variety of infections, especially resistant to other antibacterial agents.
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