Classification and mechanism of action
Biological antisepsis is subdivided into local and systemic agents. The main mechanism consists in activating the body's antimicrobial factors. There are three main groups of agents depending on their site of action:
- Specific direct-action agents. Based on the administration of preformed antibodies, which provides passive immunization of the body. These include hyperimmune plasmas, gamma globulins, and sera.
- Stimulating agents. Aimed at the active production of the patient's own antibodies.
- Non-specific immune defense agents. Stimulate the synthesis of cellular immune factors (phagocytosis, leukopoiesis) and humoral responses.
Immunological profile agents
The surgeon's arsenal includes a wide range of biological agents affecting the immune system:
- Hyperimmune plasmas. Obtained from donors. Used intravenously for severe infections (peritonitis, sepsis). For example, antistaphylococcal plasma contains at least 6 IU of toxoid.
- Gamma globulins (immunoglobulins). Contain antibodies from donor blood. Administered intramuscularly (antistaphylococcal, antitetanus) or intravenously (human normal polyvalent immunoglobulin).
- Heterologous immune sera. Manufactured from horse blood, therefore carrying a high risk of anaphylaxis (administered according to Besredka's method). Examples: tetanus and gas gangrene (against gas gangrene clostridia) sera.
- Immunostimulants and non-specific factors. Prodigiozan and levamisole stimulate phagocytosis and T-lymphocyte function. Lysozyme exerts a bactericidal effect, while thymus extract regulates the number of lymphocytes.
Antibiotics
Antibiotics play a key role in suppressing bacterial flora, but their use is complicated by the rise of drug resistance and the emergence of antibiotic-dependent strains. The main pathogens of purulent infection are staphylococci and gram-negative flora, as well as opportunistic non-spore-forming anaerobes (e.g., Bacteroides), which are naturally resistant to many drugs.
Antibiotics with a broad spectrum active against both Gram(+) and Gram(-) flora include:
- Semisynthetic penicillins;
- Cephalosporins (4 generations);
- Aminoglycosides (exhibit oto- and nephrotoxicity);
- Fluoroquinolones.
Proteolytic enzymes and bacteriophages
In addition to immunologics and antibiotics, biological antisepsis includes enzymes and phages:
Proteolytic enzymes (of animal, plant, or bacterial origin) lyse necrotic tissues and fibrin, reduce edema, and improve antibiotic penetration. Locally, they are used as powders, compresses, or ointments (e.g., ointment with clostridiopeptidase) on purulent wounds. Intracavitary administration, electrophoresis, and tissue infiltration (blockades) are also possible.
Bacteriophages are viruses that specifically penetrate bacteria and cause their lysis. They can be specific (antistaphylococcal, anticoli) or polyvalent. They are administered into wounds, purulent cavities, endotracheally, or even intravenously (in sepsis).
Briefly: answers to topical questions
Which specific drugs are used for active immunization (stimulating action) in surgery?
Toxoids and autovaccines are used for active immunization (stimulating action) in surgery.
Specific drugs include:
- Sextanatoxin — a mixture of toxoids (C. perfringens, C. novyi, tetanus, and botulinum types A, B, E).
- Adsorbed tetanus toxoid — used for emergency prophylaxis in trauma.
- DTP vaccine — adsorbed diphtheria, tetanus, and pertussis vaccine.
- DT-adsorbed-M — toxoid with a reduced antigen content.
- Pentaxim — a multi-component combination drug.
Which antibiotics are considered reserve drugs in the treatment of resistant surgical infection?
Reserve drugs in the treatment of resistant infection include:
- Fourth-generation cephalosporins — cefepime.
- Carbapenems — imipenem, meropenem (meronem).
- Aminoglycosides — amikacin.
In life-threatening conditions, the use of fluoroquinolones — ciprofloxacin and levofloxacin — is permitted. For enterococcal infection, glycopeptides and oxazolidinones serve as the drugs of choice.
Which specific proteolytic enzymes of animal and plant origin are used to cleanse purulent wounds?
Proteolytic enzymes of animal and plant origin exhibiting necrolytic activity are used to cleanse purulent wounds.
Enzymes of animal origin:
- Trypsin.
- Chymotrypsin.
- Ribonuclease.
- Collagenase.
Enzymes of plant origin:
- Papain.
- Bromelain.
Class and exam questions
What is the difference between the use of plasma and serum?
Hyperimmune plasma is harvested from immunized human donors, whereas heterologous immune sera are derived from animal (horse) blood. Because of this, sera carry a high risk of anaphylactic reactions and are administered with strict precautions.
What is the effect of proteolytic enzymes in a wound?
They digest necrotic tissues, pus, and fibrin, ensuring wound cleansing, while also reducing edema and enhancing the effect of antibacterial agents.
What are polyvalent bacteriophages?
These are preparations containing multiple phage types. They are prescribed empirically when the exact causative agent of the infection has not yet been identified.
What else to study on this topic
- Detailed composition and administration of gas gangrene serum
- Dosage and administration regimens for immunostimulants (levamisole, prodigiozan)
- Cephalosporin generations and their activity spectrum
- Toxic effects of aminoglycosides and treatment monitoring
- Technique of retromammary blockade with enzymes for mastitis
Master the entire topic in the "General Surgery" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Biological antisepsis" and 3,335 more subject pages
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 70 video lessons on the subject
Other topics in the section "CHAPTER 2. ASEPSIS AND ANTISEPSIS"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.