Is it possible to apply Levomekol to an open wound: use and contraindications

• Composition and effect of Levomekol ointment
• Indications and contraindications for the use of Levomekol ointment
• Levomekol ointment - instructions for use
• Levomekol during pregnancy and children
• Levomekol for acne
• Levomekol for lips
• Levomekol ointment for boils
• Levomekol ointment for stitches
• Levomekol ointment in gynecology
• Treatment of wounds with Levomekol ointment
• Treatment of balanoposthitis with Levomekol ointment
• Analogs of Levomekol ointment
• Voskopran with Levomekol

Levomekol ointment, “the doctor’s favorite assistant,” has long established itself as an effective antibacterial agent that accelerates wound healing and helps restore normal structures of damaged skin.

Composition and effect of Levomekol ointment

The composition of 1.0 g of Levomekol ointment includes chloramphenicol 7.5 mg, methyluracil 40 mg, the base is polyethylene oxide 1500 and polyethylene oxide 400. Chloramphenicol is a broad-spectrum antibiotic, methyluracil is a drug that improves tissue trophism and stimulates the regeneration process. The combination of these two components makes wound healing successful and fast: thanks to Levomekol, the site of injury is protected from infections and at the same time supported by an effect that stimulates healing. Polyethylene oxide 1500 and polyethylene oxide 400 are auxiliary components; they facilitate uniform application of the ointment and help the active ingredients penetrate the tissues of the human body.

The main forms of release of the ointment are an aluminum tube (25g, 30g and 40g) or a dark glass jar (100g and 1000g each). The structure of the ointment is homogeneous and of medium thickness.

Levomekol, having anti-inflammatory, antibacterial and regenerating effects, belongs to the drugs with a combined spectrum of action.

Thanks to chloramphenicol, the ointment is effective in the fight against resistant gram-negative microorganisms, such as Pseudomonas aeruginosa and Escherichia coli, staphylococcus spp., etc. Frequent or extensive use of the ointment can cause microorganisms to become resistant to the drug, but this process happens relatively slowly.

Thanks to methyluracil, which easily penetrates the surface layers of the skin and accelerates the growth of new cells and the regeneration of damaged ones, the healing rate of wounds, cuts and postoperative sutures increases significantly. Moreover, methyluracil is an immune stimulant, which helps increase the production of interferon, a natural antiviral substance.

Excipients from Levomekol ointment help the active components penetrate deep into cell membranes without damaging them, creating an anti-inflammatory, decongestant and therapeutic effect.

The presence of pus or a large number of dead cells in the wound does not affect the effectiveness of Levomekol ointment.

Levomekol ointment has virtually no contraindications, with the exception of increased sensitivity to the components included in its composition, which in rare cases causes external allergic reactions. Moreover, there are no known cases of drug overdose, which indicates the harmlessness of its use among wide groups of people (including pregnant women, children). The ointment is indicated exclusively for external use, which determines the scope of its use - the skin.

Composition of the drug

Levomekol is a local combination drug that is a homogeneous ointment of a white or slightly yellowish tint. Available in aluminum tubes with a volume of 25, 30, but more often - 40 grams. The average cost of a forty-gram tube is 108 rubles, which makes Levomekol affordable for the majority of the population.

The healing properties of the ointment are ensured by its special composition, which includes:

1. Chloramphenicol
   (antibacterial substance chloramphenicol) - exhibits activity aimed at disrupting the synthesis of proteins of pathogenic microorganisms such as streptococci and staphylococci, Escherichia coli and Pseudomonas aeruginosa.

2. Methyluracil
   - stimulates local immunity, promotes cell regeneration, accelerates the healing process, and has an anti-inflammatory effect.

3. Auxiliary components
   are macrogol 1500 and macrogol 400. By interacting with the main active ingredients, these components enhance their activity and also adsorb (draw out) exudate without damaging biological membranes.

Despite their secondary importance, additional substances serve as a kind of conductors that transfer active substances directly to the site of accumulation of pathogens. However, the degree of systemic absorption after application to wound surfaces, skin or mucous membranes is currently unknown.

To achieve the desired result and prevent unpleasant consequences when purchasing the drug, you need to pay attention to its shelf life, which is only 2 years.

The ointment should be stored in a place protected from children and direct sunlight, observing a temperature regime not exceeding 25°, and also not allowing the medication to be frozen.

Indications and contraindications for the use of Levomekol ointment

Frequent diseases and disorders for which Levomekol ointment is indicated are wounds with pus, wounds infected with mixed pathogenic microflora, and boils. The drug helps stop the inflammatory process, stop the infection zone, destroys dangerous microflora, and also relieves swelling at the site of the lesion.

The main indications for the use of Levomekol ointment are:

• Trophic ulcers.
• Boils.
• Purulent-inflammatory skin diseases.
• Second and third degree burns.

Prophylactic indications for the use of Levomekol:

• Seams.
• Wounds.
• Cuts.
• Calluses.
• Eczema.
• Bedsores.

The only reason for refusing to use Levomekol ointment may be increased sensitivity to the active substances included in the drug. It is worth noting that long-term use of the ointment can provoke an allergic skin reaction, but cases of allergies are scanty. Chronic diseases or other disorders are not a contraindication to use.

Active analogs and substitutes

Levomekol, when used correctly, copes well with itchy rashes, irritation and swelling of the skin. But in dermatological practice, no less effective external agents are used in the treatment of prickly heat. Their ingredients have a slightly different mechanism of action, so you should carefully study the composition before purchasing.

If necessary, for example, poor tolerance of the ingredients, Levomekol can be replaced with these drugs. They are often prescribed by dermatologists to patients when an infectious-inflammatory process is detected. Their effectiveness is not lower than the effectiveness of treating miliaria in adults with Levomekol.

Levomekol ointment - instructions for use

As already mentioned, Levomekol ointment is used exclusively externally. A thin layer of the drug is applied to the affected or damaged surface, after which the treated area of ​​skin is tightly covered with sterile gauze or bandage rolled up in several layers (4-5).

Treatment of the wound surface is repeated several times a day for 5–10 days until the injury site is completely cleared of pus.

If the wound is deep and large, abundantly filled with pus or located in a body cavity, then the ointment is used in the form of a tampon (also made from a sterile bandage or gauze), which is inserted into the wound surface. Before the procedure, Levomekol is heated to 35 degrees, after which the tampon is generously soaked in ointment and slowly, consistently immersed in the wound until it is completely loosely filled.

If the wound has a shape that does not allow the installation of a tampon, the ointment is administered through a drainage tube using a medical catheter. The ointment slowly fills the wound through the tube, after which a fixing bandage is applied to it. The frequency of changing a bandage, tampon, or flap depends on the rate of its filling with purulent masses and necrotic particles of human tissue.

Napkins with Levomekol are replaced with new ones as they become saturated with pus and the accumulation of necrotic masses in them. If the wound is not deep, dressing is indicated once a day; in other cases, with severe infection and the presence of a large amount of pus, the dressings are changed 4-6 times a day. If the dressing was skipped, treatment is continued according to the previously planned schedule.

Levomekol is often used for minor disorders, such as purulent pimples, cuts and torn calluses. The scope of indications for the ointment also includes the treatment of bedsores in bedridden patients.

Levomekol ointment is often used for inflammatory processes in the auditory canal of the external ear. To do this, make a thin gauze tourniquet, soak it in ointment and place it shallowly in the ear for twelve hours. In the same way, Levomekol on gauze tourniquets is injected into the nasal passages and sinuses for sinusitis.

For purulent acne rashes, it is recommended to lubricate the affected area (at night) with a small layer of Levomekol ointment. After rupture of the pustule or mechanical removal of pus, the procedure should be repeated.

When using Levomekol externally, it is not recommended When applying the ointment, you must be careful and avoid the eye area and mucous membranes. Internal use of Levomekol is prohibited. If caution has not been observed, if the drug gets into the eyes or mucous membranes, rinse them with plenty of clean water, and in case of ingestion, rinse the stomach with water and activated charcoal.

The benefits of external remedies in the treatment of prickly heat

Methyluracil from the ointment is a powerful stimulator of regeneration. When in contact with irritated itchy skin, it stimulates the normalization of nucleic acid metabolism. Due to this, tissue restoration and granulation is accelerated. Methyluracil stimulates leuko- and erythropoiesis, increases local immunity, and prevents scarring of the dermis in large festering rashes. Levomekol is characterized by numerous therapeutic effects for deep and red heat:

• retains water in cells and prevents its evaporation due to the formation of a thin film on the surface of the skin;
• stops inflammatory processes;
• stimulates tissue saturation with nutrients and bioactive substances, moisture and oxygen;
• reduces the severity of painful sensations, burning and itching;
• promotes the resorption of edema;
• restores damaged skin, increases its immunity to the negative effects of external and internal factors.

And chloramphenicol is indispensable for prickly heat, if pathogenic bacteria have invaded the damaged tissues. It inhibits the production of enzymes needed by pathogens to build membranes. Therefore, infectious agents lose their ability to grow and reproduce and soon die. For prickly heat in adults, Levomycetin is used both for therapy and to prevent the penetration of bacteria into the skin.

Levomekol during pregnancy and children

Since the drug does not have a systemic effect and does not penetrate into the blood, it is allowed to be used by pregnant and nursing mothers.

Frequent cases of using Levomekol during breastfeeding or pregnancy are:

• treatment of sinusitis, otitis;
• treatment of minor cuts, abrasions, insect bites;
• treatment of minor burns;
• treatment of complications of ingrown toenails;
• treatment of complications after sloppy manicure;
• treatment of acne on the face or other parts of the body.

However, when in a position, it is worth remembering the increased dangers of self-medication. In case of serious injuries, it is better to seek qualified medical help.

Levomekol ointment can also be used in the treatment of children of different ages, including newborns and infants.

For children, Levomekol is indicated for:

• treatment of the umbilical wound;
• treatment of the cut site;
• treatment of mosquito bites, midges;
• treatment of pustules;
• treatment of vaccination and injection sites;
• treatment of scratches, abrasions, bruises.

Due to the high frequency of injuries, wounds and injuries among children of different ages, as well as due to the absence of contraindications for use and good tolerability, Levomekol ointment is recommended to be kept in your home medicine cabinet. However, it is worth remembering that frequent or prolonged use of the ointment can provoke the manifestation, more often than not, of a local allergic reaction on the skin in the form of redness, rash or itching; rarely, an allergy can manifest itself in the form of urticaria (the appearance of blisters similar in appearance to blisters after a nettle burn). The component that causes these symptoms is chloramphenicol.

Is it possible to treat purulent acne with Levomekol?

A medicine based on methyluracil and chloramphenicol effectively fights the manifestations of pustular diseases. Formations with pus can be localized in different parts of the body: torso, limbs. A common problem among teenagers and adults is pustular rashes on the face. Blisters spoil a person's appearance. They become easily infected. After mechanical impact (puncture, squeezing), scars remain.

Levomekol will help solve the problem. It draws out pus from pathological formations on the face.

Under the influence of the ointment, the pimple is freed from its white contents. The ointment promotes the healing of skin defects. No scars remain. The drug effectively draws out purulent fluid when used daily. In 2-3 weeks, your facial skin will clear up.

The medication is applied in a thin layer to the affected area. It is rubbed in with light massage movements. The ointment is applied 2-3 times a day. The first result from using the drug appears after 4-5 days. Inflammatory phenomena in the form of hyperemia and soreness on the skin are reduced. Pimples with pus become small in size. When the ointment draws out the white contents, a small wound remains. The use of Levomekol cannot be stopped. Under the influence of its active components, closed and open skin defects will heal. Scars do not remain after applying the ointment.

Levomekol for acne

Teenage acne or acne, as well as pimples caused by other reasons, can be effectively treated with Levomekol ointment.

The methods of using the ointment in this case are quite varied and depend on the severity of the rash.

In case of a profuse rash all over the face, the ointment should be applied to the entire surface of the face before going to bed for several hours, for two weeks.

If the cases of acne appearing are isolated, then the product is applied in a small layer, leaving for two to three hours, after which it is washed off. After a few days of use, the redness around the pimple disappears, and the site of inflammation is significantly reduced in size. Levomekol is indicated for treating acne not only on the face, but also on other parts of the body - neck, arms, chest, stomach, back, shoulders, etc.

In cases of severe acne, Levomekol ointment is recommended to be applied for a longer period of time, from 8 to 12 hours. After two weeks, the acne will either disappear or be ready for “mechanical” removal. Recurrence of acne during treatment with Levomekol is unlikely. In case of spot reappearance of acne, the ointment should be applied only to the places where they appear.

Other uses of ointment

Levomekol can be smeared not only on open wound surfaces that have an inflammatory and purulent process. As a rule, this drug is used to treat various diseases, where it shows excellent and effective results.

In most cases, acne is eliminated using ointment. The medicine is applied in the evening to the entire surface of the facial skin in a thin layer, for example, if there are a huge number of small pimples or other rashes. The ointment can also be applied pointwise, if the elements are single and quite large. When squeezing out mature comedones, it is necessary to lubricate the places where they are located with the drug; it must be injected into the remaining holes to prevent infection and the inflammatory process.

Levomekol for lips

Some people use Levomekol ointment to treat herpes on the lips. But it is worth remembering that in this case, the use of the drug will be ineffective, since Levomekol has an antiseptic (antibacterial) rather than antiviral effect, and is not effective in the fight against herpes viruses.

However, at the stage of wound healing after a blister breaks, Levomekol ointment can speed up the process of tissue regeneration. But when applying the ointment to the lips, you should be careful to avoid getting it on the mucous membranes and swallowing it, since the ointment is intended exclusively for external use.

Useful tips

Following the recommendations of the instructions for use will help cure prickly heat as soon as possible and avoid the development of adverse reactions. Methyluracil and chloramphenicol have long been used in the treatment of infectious and inflammatory pathologies. But they are known not only for their high efficiency, but also for their pronounced side effects. Therefore, during the treatment process it is necessary to adhere to the following medical recommendations:

• do not exceed dosages in order to speed up recovery;
• do not use simultaneously with other medications for external use, but only after 20-30 minutes;
• Do not treat prickly heat for longer than the period determined by your doctor.

If Levomekol accidentally gets on the mucous membranes of the eyes, nose, or mouth, you should rinse them with plenty of water. If pain and burning or redness of the conjunctiva persist, you should seek medical help.

Levomekol combines well with other drugs for the treatment of prickly heat in adults - antiseptic solutions, antipruritic ointments, local analgesics.

If Levomekol is ineffective after 3-4 days of treatment, you should inform your doctor about this. He will clarify the diagnosis, adjust the therapeutic regimen, or replace the ointment with an external agent with another active ingredient.

Levomekol ointment for boils

As with other purulent skin lesions, with boils, ointment is an excellent remedy that helps eliminate inflammation.

Before using Levomekol in the treatment of a boil, the affected area should be treated with alcohol or hydrogen peroxide, then a spot-apply ointment and cover it with gauze or a bandage, the compress should be changed 2-3 times a day, and a fresh bandage should be applied before going to bed.

After opening the abscess, the wound must be treated with hydrogen peroxide and Levomekol ointment applied again. The procedure must be repeated 2 times a day until the site of the boil has completely healed.

Levomekol ointment for stitches

Due to the high effectiveness of Levomekol ointment in healing wounds and cuts, it is often used in the treatment of postoperative sutures.

Frequent cases of using Levomekol ointment on sutures are sutures on the perineum in women after birth ruptures, as well as in case of their divergence. The scheme for using the ointment in this case is as follows:

• The perineum is washed with water and treated with a weak solution of furatsilin or potassium permanganate, better known as potassium permanganate.
• Dry the seam area with a soft cloth or towel; wait another 10-15 minutes for the skin to dry completely.
• Levomekol ointment is applied in a generous layer to a gauze flap and applied to the sutures.
• To secure the bandage and to prevent it from moving, wear underwear with a pad.
• The bandage is left at the suture site for two to six hours, then removed.
• The procedure is repeated until the seam is tightened.

In the case of other types of sutures on different parts of the body, the scheme for using Levomekol is identical, with the exception of the method of securing the flap with ointment; in other cases, a bandage or adhesive plaster is used. The frequency of changing the dressing is from two to four times a day; in case of suppuration of the wound or infection, the frequency of changing the dressing should be increased to 5 or more times.

How to use for hemorrhoids?

Levomekol has an antibacterial effect and is also suitable for the treatment of hemorrhoids. A wound-healing, anti-inflammatory, detoxification effect is formed. It is important to follow the instructions for use to avoid side effects.

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1. When using the product for prophylactic purposes, the medicine is applied to the mucous membrane. There is no need to apply a bandage on top, but it is recommended to lie down for 5-10 minutes so that the drug is absorbed. The course lasts 1 week.
2. For formed nodes, a different method of application is used. Liniment is applied to a cotton pad or napkin. The layer should be thick. Press it to the anus, securing it tightly with underwear on top. The product is left in place until completely absorbed. The course of treatment is up to 10 days.
3. When internal hemorrhoids form, the ointment is preheated to room temperature. It becomes liquid. Gauze is impregnated with it, forming a soft cylindrical tampon. It is inserted into the rectum without damage. The course of treatment is 14 days.

The product is used after defecation and hygiene procedures. It is better to apply before bed. Then the healing of the wound will speed up.

Levomekol ointment in gynecology

Levomekol ointment is quite popular and is often used in gynecology for the following diseases:

• Cervical erosion.
• Inflammation of the ovaries, fallopian tubes.
• Dehiscence of the perineal sutures after childbirth.
• Bacterial vaginosis with inflammation.
• Vulvovaginitis with inflammation.

To treat all of the above diseases of the genital area of ​​women, Levomekol is used in the form of tampons.

A cotton swab of dimensions 15 mm X 15 mm, and a height of 5 mm with Levomekol ointment is inserted into the vagina before bed, in the morning the tampon is removed and the usual hygiene of the external genitalia is carried out. The duration of treatment with ointment is from 10 to 15 days with daily repetition of the procedure.

It is worth remembering that inflammatory diseases of the genitourinary system in women can provoke both temporary and complete infertility, and therefore delaying their treatment is dangerous. Moreover, the prescription of a course of treatment and medications should be carried out under the supervision of a gynecologist.

Treatment of wounds with Levomekol ointment

Thanks to the action of Levomekol ointment, its use is indicated in the treatment of various kinds of cuts, scratches, bites, abrasions and wounds. In case of a wound free from inflammation and pus, the ointment will help speed up healing and restoration of normal skin.

If the wound is filled with pus and has obvious signs of infection, then Levomekol, thanks to the presence of an antibiotic, will destroy pathogenic microflora, cleanse it of purulent and necrotic masses and speed up healing.

Before applying ointment to the wound, it should be treated with hydrogen peroxide or alcohol. The ointment is applied in a thin layer and, if necessary, covered with a bandage or gauze. The frequency of use of the ointment depends on the speed of wound healing.

In case of suppuration of the wound, before using Levomekol, the wound must be cleaned with a gauze pad with an antiseptic to remove superficial pus and dead tissue. After this, a bandage with ointment is applied and secured with a bandage or adhesive plaster; the bandage must be changed as it fills with wound particles (pus, necrotic tissue).

Pharmacological actions

The main active ingredients in Levomekol - chloramphenicol and methyluracil - provide the drug with several pharmacological effects, which include:

1. Anti-inflammatory effect – reducing the severity of inflammation.
2. Reducing tissue swelling by reducing the volume of free intercellular fluid.
3. Antimicrobial action. Chloramphenicol is considered an antibacterial agent, it stops the growth and spread, and also leads to the elimination of gram-positive and gram-negative bacteria, which, as a rule, lead to the occurrence of a purulent process.
4. Restorative effect, which is achieved due to the presence of methyluracil in the medicine. The ointment accelerates tissue regeneration in the area of ​​the disorder.

The severity of the effects of the drug "Levomekol" does not decrease in the presence of pus and necrotic masses.

After applying the drug "Levomekol" to the skin in the wound area, the ointment acquires a liquid mass and penetrates well into the damaged cells, where it has a pharmacological effect. There is no information about the absorption of the active components into the general bloodstream.

Treatment of balanoposthitis with Levomekol ointment

Balanoposthitis is an inflamed disease of the foreskin and glans penis of men. It can be caused by both bacteria and fungi, and can also serve as a manifestation of contact dermatitis.

If balanoposthitis is caused by bacterial microflora, then treating it with Levomekol ointment will be quick, successful and effective.

Treatment regimen for balanoposthitis with Levomekol:

• The penis is washed with a weak solution of furatsilin or potassium permanganate, better known as potassium permanganate.
• Dry with a soft cloth or towel, wait another 10-15 minutes for the skin to dry completely.
• Levomekol ointment is applied in a generous layer to the surface of the penis.
• The dressing is changed once or twice a day.
• After the main symptoms of the disease disappear, Levomekol should be applied to the penis once a day for another week.

Analogs of Levomekol ointment

Levomekol has synonymous drugs that contain the same active ingredients, chemical compounds and have the same range of indications.

Synonyms of Levomekol:

• Levomethyl ointment (applied to the affected areas of the skin in the form of aseptic dressings soaked in ointment, dressings are done every 2-3 days).
• Netran ointment (sterile gauze pads are impregnated with ointment, which loosely fill the wound; it can be administered through a catheter using a syringe; dressings are performed daily until the purulent-necrotic masses completely disappear).

analogue drugs are those drugs that contain different active substances, differ from each other in name, but are used to treat the same diseases .

Analogs of Levomekol ointment:

• Salicylic-zinc paste with chloramphenicol (for external use, applied to affected areas of the skin).
• Levosin ointment (dressings are carried out daily until the wound is completely cleansed of purulent, necrotic, dead tissue, it is possible to store the wound through a catheter).

• Lingesin ointment (used for the treatment of purulent-inflammatory diseases of the oral cavity and gums, rubbed into the gums after 1-2 days, after which 20-25 minutes later rinse the oral cavity with copious amounts of warm water).
• Protegentin ointment (used for the treatment of purulent-inflammatory diseases of the skin and soft tissues: boils, carbuncles, bursitis, burns, trophic ulcers of the lower leg, bedsores, purulent wounds in the first phase of the wound process).
• Streptonitol ointment (used for the treatment of purulent wounds of various origins: postoperative, after opening phlegmons and abscesses, etc., in phases of inflammation).
• Fastin 1 ointment (used for the treatment of burns, purulent wounds, pyoderma; externally, applied to sterile gauze pads and applied to the affected surface, the dressing is changed after 7–10 days).
• Fugentin drops (for instillation into the nasal passages and ears).

The problem of wound infection has become extremely relevant in recent years. The number of infectious complications from surgical wounds has sharply increased, resulting in severe sepsis caused by gram-negative microorganisms, as well as microorganisms resistant to almost all modern antimicrobial drugs.

Among all surgical patients, wound infection occurs in 35-45%. The number of postoperative purulent-septic infections in 1998 increased to 39% [14].

Simultaneously with the increase in bacterial infections, the frequency of candida and aspergillus fungi increases, most often due to the widespread, irrational use of antibacterial, corticosteroid, cytostatic drugs, as well as the lack of the concept of simultaneous prescribing of antifungal drugs with antibiotics for prophylactic purposes. The problem of intrahospital spread of both aerobic and anaerobic (clostridial and non-clostridial) infections remains relevant.

The reasons for the increase in the frequency and severity of purulent infections in surgery are varied and include the following factors:

— increasing the volume of surgical interventions, especially in high-risk patients;

- widespread use of instrumental examination and treatment methods accompanied by infection of the patient (intravascular and urinary catheters, endoscopic and tracheostomy tubes, endoscopic manipulations, etc.);

- traditional long-term regimens of prescribing certain groups of antibiotics for therapeutic and prophylactic purposes without regular monitoring of the dynamics of resistance of hospital strains to these drugs.

Depending on the pathogens that have invaded and the changes that occur in the wound, nonspecific (purulent, anaerobic, putrefactive) and specific (wound diphtheria, wound scarlet fever) wound infections are distinguished. In addition, a number of infectious diseases that do not have the nature of a wound infection enter the body through a wound, i.e. not accompanied by noticeable disturbances in the wound process. Some of these common infectious diseases are necessarily associated with the invasion of a pathogen into a wound (tetanus, rabies, rat bite disease); in others, the wound is only one of the possible routes of penetration of microbes (syphilis, anthrax). In practice, it is advisable to focus on the distribution of patients with wound infection into groups, taking into account the etiological and clinicopathological features:

- acute purulent diseases of the skin and soft tissues (abscessing boil, carbuncle, hidradenitis, mastitis, etc.);

— purulent post-traumatic wounds of soft tissues (with or without bone damage, with long-term soft tissue crush syndrome);

— postoperative purulent wounds of soft tissues;

— chronic purulent diseases of soft tissues (trophic ulcers of various origins, bedsores, etc.);

- hematogenous, postoperative or post-traumatic osteomyelitis;

- surgical sepsis.

Regardless of the origin of the wound process, the species composition of the wound microflora, the main methods of treatment are surgical and active complex effects on the purulent process, aimed at eliminating the tissue defect, suppressing the growth of microflora vegetating in the wound or preventing suppuration.

Along with timely surgical intervention on a purulent focus, the outcome of the disease is largely determined by adequate systemic and local antibacterial therapy, strictly focused on the data of bacteriological studies.

Only local drug treatment that is carried out strictly in accordance with the pathogenesis of the wound process can be considered reasonable, i.e. taking into account the phase of its flow [15].

Etiology of wound infections

In recent years, under the influence of various factors, primarily the powerful selective action of antibiotics, significant changes have occurred in the etiology of wound infections. Currently, the leading pathogens are:

— staphylococci (S. aureus, S. epidermidis);

- £, B, Y-hemolytic and non-hemolytic streptococci;

— representatives of the family Enterobacteriaceae (E. coli, Citrobacters

spp.,
Klebsiella
spp.,
Enterobacter
spp.,
Serratia
spp.,
Proteus
spp.,
Providencia
spp.);

- non-fermenting gram-negative bacteria (Pseudomonas

spp.,
Acinetobacter
spp.,
Moraxella
spp.,
Flavobacterium, Achromobacter).
The dependence of the species composition of wounds on their origin is clearly visible. So, for example, if in a group with acute purulent diseases staphylococcus in monoculture is detected in 69.5% of cases, then in patients with post-traumatic purulent wounds, chronic purulent diseases of the skin and soft tissues, as well as in patients with purulent wounds and developed sepsis, they are detected immediately several pathogenic microorganisms in 31.5, 48.8, 55.6% of cases, respectively. The rest are representatives of the family Enterobacteriaceae

in monoculture.

In recent years, fungi have begun to emerge from wounds much more often (9.9%), which is apparently due to insufficient attention to this problem and the lack of reliable prevention of fungal invasion (Table 1).

Obligate non-spore-forming anaerobic microorganisms, among which Bacteroides

spp.,
Fusobacterium, Peptococcus
spp.,
Peptostreptococcus
spp.,
F. nucleatum, P. melaninogenicus.
The proportion of pure non-clostridial and mixed aerobic-anaerobic microflora also depends on the location and origin of the purulent wound.

Currently, it is possible to significantly reduce the duration of systemic antibacterial therapy through the active introduction into practice of treating wounds under dressings with modern drugs focused not only on the phase of the wound process, but also on the species composition of wound microorganisms.

This tactic, with timely adequate surgical intervention and treatment with correctly selected drugs for local therapy, allows you to localize the purulent process and avoid generalization of the infectious process.

The use of modern drugs for local treatment of wounds at all stages of complex treatment makes it possible to reduce the time of systemic antimicrobial therapy, avoid the development of side effects, significantly reduce the cost of expensive antibacterial drugs, and avoid the formation of microflora resistance to the systemic antibiotics used.

Currently, several groups of drugs have been developed for local treatment of wounds in phases I and II of the wound process (Table 2).

The main groups of drugs are antiseptics, polyethylene glycol (PEG)-based ointments, modern biologically active dressings, enzyme preparations, and new antiseptics.

Antiseptics

When choosing antiseptics used for both preventive and therapeutic purposes, preference is given to drugs with a universal, broad spectrum of action, active against mixed microflora, and having a microbicidal or microbostatic effect.

Iodophors

In the practice of wound treatment, new complex compounds of iodine with polyvinylpyrrolidone (povidone-iodine, betadine, iodopirone, iodovidone, etc.), which have microbicidal and microbostatic effects, are widely used.

Drugs in this group suppress:

- gram-positive bacteria, including enterococci and mycobacteria;

- gram-negative bacteria, including pseudomonas, acinetobacter, Klebsiella, Proteus;

— bacterial spores, fungi, viruses, including hepatitis B and C viruses, entero- and adenoviruses, as well as anaerobic, spore-forming and asporogenic bacteria.

All pathogens of wound infections do not have either natural or acquired resistance to iodophors.

The activity of the complex with polyvinylpyrrolidone is not affected by the presence of blood, purulent discharge or necrotic tissue [4].

The most widely used in the practice of treating purulent-inflammatory processes are two dosage forms of complex compounds of iodine with polyvinylpyrrolidone - solution and ointment.

Ointments (1% iodopyrone ointment, povidone-iodine ointment) are used to treat purulent wounds with heavy exudation. Solutions (iodopirone, povidone-iodine) are used as antiseptics for prophylactic purposes for treating the surgical field, skin during punctures, closing surgical sutures, as well as for the treatment of wounds, trophic ulcers, bedsores, and diabetic foot syndrome in the absence of a large amount of wound separated.

Dioxidine

Dioxidin is one of two drugs derived from quinoxyline di-N-oxide, developed as a result of fundamental exploratory research in the period from 1960 to 1980 at the All-Union Scientific Research Chemical-Pharmaceutical Institute (currently the Center for the Chemistry of Medicines - TsKhLS VNIHFI , Moscow).

A number of drugs of this class of substances with high antimicrobial activity and a wide antimicrobial spectrum (quindoxine, mequidox, carbadox, temadox, olaquindox) have been developed abroad.

The drug is intended for the treatment of patients with wound infections caused by multidrug-resistant flora, Pseudomonas aeruginosa and non-clostridial anaerobic pathogens. This drug is most active against anaerobic bacteria (Clostridium

spp.,
Bacteroides
spp.,
P. melaninogenicus, Peptococcus
spp.,
Peptostreptococcus
spp., as well as aerobic gram-negative bacteria -
Ps.
aeruginosa, E. coli, Proteus spp.,
Klebsiella
spp.,
Serratia
spp.) [1-3].

It should be noted that strains of Pseudomonas aeruginosa, as well as gram-positive bacteria (staphylococci, streptococci), are more resistant to the drug. That is why, if the clinical situation allows, a 1% dioxidine solution without dilution is used for local treatment.

In the 70-90s, a solution of dioxidine in monotherapy and combination with other antibacterial drugs was considered as the drug of choice for the treatment of patients with sepsis, diffuse and local peritonitis, for the prevention and treatment of purulent-inflammatory processes in the liver and biliary tract, lungs, stomach, kidney allotransplantation, cardiac vascular prosthetics and coronary artery bypass grafting, under conditions of artificial circulation [11-13].

Currently, in Russian clinics for more than 25 years, various dosage forms of dioxidine have been used to treat various forms of purulent infection:

a) for local treatment

— 5% ointment, “Dioksikol” ointment containing 1% dioxidine, dioxidine aerosol (“Dioxisol”), polymer compositions with dioxidine (“Diovin”, “Diotevin”, Anilodiotevin”, “Colladiasob”, “Digispon A”, suture material ;

b) for introduction into cavities, for ultrasonic inhalations

— 1% aqueous solution in ampoules;

c) for intravenous administration

— 0.5% aqueous solution in ampoules.

Intravenous administration of dioxidine is carried out for health reasons. When justifying and determining the indications for the intravenous administration of dioxidine from the “benefit-risk” perspective, it should be taken into account that over the past 15-20 years, highly effective antibacterial agents have been created that have advantages over dioxidine in terms of toxicological properties. Therefore, dioxidin is prescribed intravenously only if other chemotherapeutic agents are ineffective or intolerable, strictly observing the recommended doses for the drug and the duration of each infusion.

Dioxidin is well compatible with other antimicrobial drugs. The clinical capabilities of dioxidin are expanded due to its ability to penetrate the blood-brain barrier, which makes it possible to use it in the treatment of patients with meningitis, brain abscesses and purulent cranial wounds.

Miramistin

The domestic antiseptic Miramistin belongs to quaternary ammonium compounds (cationic surfactants). Preclinical and clinical studies have shown that Miramistin has a pronounced antimicrobial effect against gram-positive and gram-negative, aerobic and anaerobic, spore-forming and asporogenic bacteria in the form of monocultures and microbial associations, including antibiotic-resistant hospital strains. The drug is most effective against hospital strains of staphylococcus and streptococcus. The drug has a detrimental effect on fungi, viruses, and protozoa.

Miramistin has been introduced into clinical practice since the early 90s of the last century. Currently, the drug is widely used in the complex treatment of purulent wounds and accompanying inflammatory complications in the bronchopulmonary system in the form of ultrasonic inhalations and the genitourinary system in the form of bladder instillations [5].

Lavasept

An antiseptic drug, the main active ingredient of which is polyhexanide, considered by experts as the drug of choice for the treatment of contaminated and infected wounds [16]. Polyhexanide belongs to the group of positively charged (cationic) polymers and contains surfactants, which reduce surface tension, which ensures easier removal of microbial biofilms.

Lavasept has a broad-spectrum bactericidal effect, is active against gram-positive and gram-negative bacteria (including Pseudomonas aeruginosa

), fungi, and MRSA.

Prontosan

A particular danger for the patient is a “dormant” infection, the aggressiveness of which is determined by the variability of the microflora, the reactivity of the body, the loss of activity of traditional systemic antibiotics and drugs for local medicinal treatment of wounds. This threat persists to a particular extent if the patient has foreign bodies, implanted devices, in patients with long-term non-healing wounds, trophic ulcers, diabetic foot syndrome, with post-traumatic and postoperative osteomyelitis, chronic post-traumatic and postoperative wounds.

It has been established that microorganisms and fungi, when they remain in a wound for a long time, thanks to the polymers they secrete, form a thin layer - a biofilm. Biofilm formed by bacteria and fungi provides reliable protection for pathogens from ultraviolet radiation, antibiotics, phagocytosis and other factors of the body’s immune system. Microbes in the biofilm can withstand concentrations of antibiotics 100-1000 times more than suppressive planktonic cells. Therapeutic effects on biofilms can be aimed at the mechanisms of initial adhesion of bacteria to the surface, blocking synthesis or destruction of the polymer matrix.

Currently, the attention of researchers on this problem is drawn to the possibility of using various medications that destroy the biofilm formed by bacteria and fungi. One of these drugs is prontosan, which contains polyhexanide, a polymerized biguanide derivative that acts as a local cationic antiseptic. The antimicrobial effect of polyhexanide is due to nonspecific affinity for the cell membranes of the microorganism, which contains a large amount of acidic phospholipids. Polyhexanide acts on bacterial cell membranes and increases their permeability.

Two dosage forms of Prontosan have been introduced into practice - 0.1%, 0.2% solution and gel, which contains 0.1% polyhexanide, 0.1% undecylenic amidopropyl betaine (surfactant), glycerol (humectant), hydroxyethylcellulose ( gelling agent), water.

PEG-based sorbents and ointments

It should be remembered that with abundant purulent exudation, the use of antiseptic solutions for local treatment of wounds in the form of gauze tampons is considered a flawed method, since tampons placed in the wound dry out quickly and do not have the long-term osmotic activity necessary to remove pus. In extreme cases, the wound can be filled with a combined tampon - a silicone tube is placed in the center of the gauze tampon, through which 10-20 ml of antiseptic is injected into the wound with a syringe 3-6 times a day.

For the treatment of superficial infected, purulent and purulent-necrotic wounds of various etiologies in the inflammatory phase, biologically active draining sorbents (anilovine, diovin, anilodiovin, diotevin, anilodyotevin, collasorb, colladiasorb), the main component of which is helevin, are successfully used. Dioxidin is used as an antimicrobial drug. The proteolytic effect of sorbents is due to the introduction of proteolytic enzymes into their composition (terrylitin, collagenase from hydrobionts). The analgesic effect is achieved due to the presence of a local anesthetic, anilocaine, in the composition [11].

Targeted use of biologically active dressings with a differentiated effect on the wound process, taking into account its phase and characteristics of the course, providing for sorption-application therapy in phase I of the wound process using biologically active sorbents or gel dressings with antimicrobial, analgesic and proteolytic effects, followed by wound treatment in phases II and III of the wound process with biologically active stimulating coatings with a specific effect on the processes of regeneration and epithelization.

In recent years, it has become possible to more successfully treat wounds using a new combination drug Baneocin, containing two highly active bactericidal components - bacitracin (a polypeptide antibiotic that inhibits the synthesis of bacterial cell walls) and neomycin (an aminoglycoside that inhibits protein synthesis), between which there is synergy. The results of numerous studies indicate the high activity of baneocin against gram-negative, gram-positive flora, aerobes and anaerobes. The components of the drug exhibit synergism against highly resistant hospital strains of Ps. aeruginosa, E. coli, S. aureus.

Baneocin is characterized by the ability to create high bactericidal concentrations in a purulent focus and not have a systemic effect. Numerous studies have shown that when treating wounds under bandages with Baneocin, complete eradication of pathogenic pathogens and reliable prevention of reinfection of the wound surface by hospital microorganisms is achieved in a short time without the traditional systemic antimicrobial therapy in such cases, prescribed for both therapeutic and prophylactic purposes.

The drug Baneocin is available in two dosage forms, focused on the phases of the wound process. For example, for the treatment of purulent wounds in the first phase of the wound process, Baneocin powder is used, which actively absorbs wound discharge within 5 hours.

For the treatment of wounds in the II phase of the wound process, Baneocin ointment is used, which exhibits a local bactericidal effect necessary to prevent reinfection of granulating wounds with hospital strains. The resulting thin film of the drug protects the thin layer of young epithelium from damaging factors.

The positive properties of two dosage forms of Baneocin - powder and ointment - are successfully implemented both at the outpatient and inpatient stages of complex treatment of patients of different groups:

- with focal skin infections (hidradenitis suppurativa, paronychia, boil, carbuncle);

- with burns, frostbite;

- with trophic ulcers;

- for the prevention of suppuration of household, sports and industrial wounds, abrasions (violations of the integrity of the skin);

— to prevent the development of an infectious process in the area of ​​donor wounds when collecting skin grafts in traumatology, surgery, and cosmetology.

Painless and non-traumatic application, deep penetration into tissue, and good tolerability of Baneocin make it possible to successfully treat patients with trophic ulcers even in cases of aggravated allergic history (intolerance to traditional local drugs) or the identification of highly resistant strains of Ps. aeruginosa

[6].

For the treatment of extensive and deep wounds with a purulent process in the first phase

over the past 25-30 years, PEG-based ointments have been successfully used (levosin, levomekol, 5% dioxidine ointment, dioxykol, 1% iodopyrone ointment, 1% povidone-iodine ointment, 0.5% miramistin ointment, iodometricylene, nitacid, streptonitol , 10% mafenide acetate ointment, streptolaven, stallanin-PEG 3%, oflomelide, etc.). The listed drugs have different osmotic activity for the differentiated treatment of wounds in the first phase of the wound process with copious or moderate amounts of wound discharge (boils, carbuncles, hidradenitis, mastitis, abscesses, phlegmons, suppurating lipomas, atheromas, purulent postoperative and post-traumatic purulent wounds, venous trophic ulcers , “diabetic foot” with a local purulent-necrotic process, etc.

These drugs have a fairly wide spectrum of activity against both aerobic and non-spore-forming anaerobic microorganisms.

Despite many years of intensive use of ointments containing chloramphenicol or dioxidin, their high antimicrobial activity remains against the main causative agents of surgical infection.

If there are gram-negative bacteria in the wound, in particular Pseudomonas aeruginosa, it is recommended to use 10% mafenide acetate ointment, 5% dioxidine ointment, dioxicol ointment, nitacid ointment.

For the treatment of non-sporogenous anaerobic infection in combination with aerobic infection, it is advisable to use the following drugs:

- with nitazol (Streptonitol and Nitacid ointments);

— foaming aerosol Nitazol;

- 5% dioxidine ointment, dioxikol ointment.

When using PEG-based ointments, side effects (clinically significant) are observed in 0.7% of cases, clinically insignificant - in 2.3% of cases. Most often they manifest themselves in the form of local symptoms of drug-induced dermatitis. In cases of intolerance to chloramphenicol, dioxidin, treatment can be carried out with oflomelid ointment or 5% miramistin ointment, which has not only a wide spectrum of antimicrobial activity, but also antiviral and antifungal effects, which is extremely important in the treatment of patients with trophic and long-term non-healing wounds.

Of the new ointments, the domestic drug streptolaven deserves special attention, which includes an enzyme of microbial origin (streptolysin), an antimicrobial drug miramistin and a base balanced in osmotic action that does not cause drying of wound tissue. This is the only ointment in the country with a necrolytic effect and is currently successfully used in the treatment of patients with diabetic foot syndrome, extensive burns, trophic ulcers, and bedsores [9].

The possibilities for successful treatment of patients with purulent wounds, trophic ulcers, bedsores, infected burns have significantly expanded with the advent of the new ointment Stellanin-PEG 3%, containing 1,3-diethylbenzimidazolium triiodide, low molecular weight polyvinylpyrrolidonium, dimexide, polyethylene oxide 400 and 1500. The bactericidal effect of the drug is due to the incoming it contains active iodine [9].

As can be seen from table. 3,

Stellanin-PEG ointment 3% is not inferior in antimicrobial activity to well-known drugs (levomekol, 5% dioxidine ointment).

Stellanin-PEG has high antimicrobial activity against both gram-positive and gram-negative microorganisms, including methicillin-resistant staphylococci (MRSA), E. faecalis, E. faecium,

as well as
E. coli
and
Klebsiella
spp., producing extended-spectrum beta-lactamases, and is also able to suppress the vital activity of fungi
(C. albicans).
In the treatment of wounds and trophic ulcers with severe pain, a high clinical effect is achieved using the new PEG-based ointment oflomelid, which contains lidocaine as an analgesic component and ofloxacin as an antimicrobial component.

Particular severity of the wound process occurs when the patient develops a polyvalent allergy. The solution in such clinical situations is the use of drugs containing silver (Argosulfan ointment - for light wound discharge) or Actisorb Plus dressings (non-woven nylon fiber with activated carbon and silver ions).

For the treatment of wounds with a moderate amount of wound discharge and a slow regeneration process (long-term non-healing wounds, trophic ulcers, diabetic foot syndrome, bedsores, etc.), the use of the original domestic drug 15% Dimephosphone, which has membrane-stabilizing, anti-acidotic, antimicrobial, anti-inflammatory activity, is indicated [10 ].

Treatment of wounds in phase II of the wound process

For the treatment of moderately or slightly exuding purulent wounds in the stage of transition to phase II of the wound process, as well as in the treatment of donor wounds during free skin grafting with autodermograft, the use of biologically active gel dressings Apollo PAK and Apollo PAA, which include iodovidone or miramistin, is indicated. also local anesthetic anilocaine. The hydrogel is based on a copolymer of acrylamide and acrylic acid.

If signs of a regenerative process are detected in the absence of profuse suppuration and mild symptoms of inflammation remain, it is possible to treat wounds under bandages using iodine-containing solutions: 10% Iodopirone, 1% Iodovidone, 1% povidone-iodine, Sulyodopirone.

After the acute purulent process has stopped and symptoms of intoxication have disappeared, confirmed by both clinical and laboratory tests, it is possible to cancel general antibacterial therapy. In these cases, local treatment of wounds at the stage of preparation for final closure with sutures or plastic surgery is carried out under bandages with drugs:

- biologically active stimulating wound coverings with antimicrobial and local anesthetic effects (Digispon-A, Algikol-FA, Kollakhit-FA, Anishispon);

— collagen-containing wound coverings (Gentatsikol);

— wound coverings based on alginates (Algipor, Algimaf);

— wound covering with silver based on collagen and regenerated cellulose (Promogran-Prisma);

— foaming aerosols (dioxysol, gentazol, nitazol);

- ointments with slight osmotic activity (Methyldioxylin, Argosulfan, Fuzimet, Streptonitol, Biopin 5%, 10%; Baneocin);

- oils (Miliacyl, sea buckthorn oil, rosehip oil).

The appearance in hospitals of a new Fuzimet ointment (a combination of fusidine sodium with methyluracil) makes it possible to successfully treat patients with methicillin-resistant S. aureus

(MRSA), without including vancomycin or linezolid in complex therapy [7, 8].

Prevention and treatment of fungal infections during systemic and local antimicrobial therapy of wound infections

Excessive enthusiasm for various antibacterial drugs in the treatment of infectious processes without mandatory simultaneously prescribed antifungal therapy has led to the fact that the problem of deep mycoses in recent years has become extremely urgent and difficult to solve. For example, the mortality rate for candidal pneumonia is 65-70%.

Disseminated candidiasis accounts for up to 10-15% of all nosocomial blood infections. With disseminated candidiasis, fungal infection of the skin is possible with the formation of subcutaneous abscesses, cellulite or individual muscle groups (candidal myositis). Fungal infections of the kidneys and lungs, nervous system, heart, spine, costal and sternoclavicular cartilages, stomach, intestines and bile ducts are extremely difficult to treat.

Candidaemia can be the direct cause of death in 75% of cases, and candidal sepsis as a cause of death can reach 88%.

Diabetes mellitus, antibiotic treatment, the presence of indwelling catheters, and severe neutropenia predispose to colonization of a fungal infection. Disseminated candidiasis is possible as a result of infection during surgical operations, invasive diagnostic procedures (puncture, biopsy, endoscopy), hemodialysis and peritoneal dialysis. Up to 40.2% of medical personnel may be carriers of Candida

spp., with 31.3% of them in association with
S. aureus,
43.7% with coagulase-negative staphylococci, and 25% in monoculture.
Prevalence of oropharyngeal carriage of fungi of the genus Candida
spp. among the medical staff of the general surgery department is 61.5%.

According to a study carried out at the Institute of Surgery named after. A.V. Vishnevsky, frequency of Candida albicans

from various biological media and catheters was detected in 8.6-12% of cases. The most dangerous source of the spread of fungi was a solution of furatsilin, from which fungi were detected in 58.8% of cases.

Traditionally, to prevent fungal infection, along with antibacterial drugs in such cases, ketoconazole or (in case of generalized infection) fluconazole, flucytosine or amphotericin B are prescribed. In case of generalized fungal infection, the duration of etiotropic therapy usually ranges from several weeks to a year.

Timely abandonment of long-term systemic antibacterial therapy, abandonment of traditional antiseptics (furatsilin solution), traditional absolutely ineffective fat-based ointments and active use of drugs such as 1% povidone-iodine solution, solutions of Prontosan, Lavasept (0.1%, 0. 2%) or 0.5% Miramistin ointment allows not only to avoid serious complications of the wound process, but also to successfully combat fungal invasion without resorting to systemic antifungal therapy.

Thus, the pharmaceutical industry currently has the opportunity to produce a fairly complete range of modern, highly effective drugs for successful local medicinal treatment of wounds, trophic ulcers, bedsores of various locations and origins. Timely active introduction of these drugs into the daily practice of practical healthcare can significantly reduce the cost of purchasing systemic expensive foreign drugs (there are no domestic drugs).

However, I would like to draw the attention of leading pharmaceutical manufacturers to the unacceptable cessation of production of such drugs as 5% dioxidine ointment, dioxicol, nitacid, streptonitol, 1% iodopyrone ointment, 0.5% quinifuril ointment, foaming aerosols (dioxysol, gentazol, nitazol, domestic hydrocolloids galagran and galactone, collagen coating with gentamicin gentacycol, wound dressings containing sodium alginate (algipor, algimaf).

The current situation requires an active position of all specialists involved in the treatment of surgical infections. It is extremely important to review the standards of wound treatment using modern drugs, since from the standpoint of evidence-based medicine, such standards can reduce mortality in patients with sepsis to an average of 26.5%, which is of extreme social significance.

Timely equipping of emergency medical teams, teams providing assistance to victims of natural and man-made disasters, military conflicts, outpatient clinic doctors, trauma centers and hospitals, specialized purulent surgery departments with modern drugs for local treatment of wounds will undoubtedly help reduce the development of severe purulent wounds. complications and diseases, will reduce the cost of antibacterial drugs by 2-3 times.

Voskopran with Levomekol

Voskopran is a wound-healing dressing impregnated with Levomekol ointment. Both of these tools effectively complement each other.

At the stage of an open wound, Voskopran does not stick to the site of the lesion, which makes it easier to change dressings, and at the stage of the beginning of healing, it adheres tightly to the skin, which provides protection from pathogenic microorganisms; at the end of healing, Voskopran easily moves away from the place where the wound was.

Indications for use of Voskopran with Levomekol:

• purulent wound surfaces;
• trophic ulcers;
• bedsores;
• diaper rash;
• thermal, chemical, and other burns of 1st – 3rd degree;
• frostbite;
• purulent and inflammatory skin lesions.