Surgical treatment and enzymotherapy
The cornerstone of treatment for purulent conditions is surgical intervention: opening the focus, radical removal of pus and dead tissue, followed by adequate drainage.
Complex treatment widely incorporates enzymotherapy—the use of enzymatic and antienzymatic drugs. Proteinases play a special role. They do not have direct antimicrobial activity, but they powerfully enhance (potentiate) the effect of antibiotics. This occurs by increasing drug concentration in tissues, increasing microbial sensitivity to them, and breaking down protective bacterial enzymes (e.g., penicillinases) and toxins. The use of enzymes is particularly indicated in the presence of resistant microflora.
Infusion-transfusion and nutritional support
In severe cases, infusion-transfusion therapy (ITT) is performed to correct volemic, electrolyte, and metabolic disorders. Inflammation is also accompanied by a hormonal response—the release of cortisol and somatotropic hormone.
Particular attention is paid to nutrition, which must be balanced. If enteral feeding is impossible (e.g., in peritonitis), parenteral nutrition is prescribed aiming to provide about 3000 kcal/day. Dextrose solutions and lipid emulsions are used to cover caloric needs, while protein hydrolysates and amino acid mixtures serve as plastic material.
Detoxification methods
To remove toxins from the body and prevent their absorption, extracorporeal detoxification methods are used:
- Lymphosorption: passing lymph through a sorbent. The method effectively reduces the levels of urea, creatinine, bilirubin, and immune complexes, but leads to the loss of lymphocytes, which can suppress immunity.
- Hemofiltration and hemodialysis: removal of toxins through semipermeable membranes while preserving blood formed elements. Hemofiltration clears a broader spectrum of substances, whereas hemodialysis ("Artificial Kidney") is more commonly used in renal failure to eliminate metabolites.
Immunotherapy
In severe infections, immunocorrection under laboratory monitoring is indicated. The following are evaluated:
- Phagocytosis: a high level indicates good resistance, while suppression is an unfavorable sign.
- Serum bactericidal activity (SBA): normal range is 80–100%. Important: this indicator is reliable only before the start of antibiotic therapy.
- T- and B-lymphocytes, immunoglobulins (IgG, IgA, IgM): their decrease indicates clinical deterioration, while an increase indicates a normal response. Elevated circulating immune complexes (CIC) indicate a distorted immune response.
Class and exam questions
What is the rationale for using proteinases in the treatment of purulent infections?
Proteinases potentiate the action of antibiotics, increase their concentration in the focus, enhance flora sensitivity, and destroy bacterial defense enzymes and toxins.
What amount of energy must be provided to a patient receiving parenteral nutrition?
The target volume is about 3000 kcal per day.
Why must serum bactericidal activity be determined before prescribing antibiotics?
During antibacterial drug therapy, the SBA indicator is distorted and does not reflect the true resistance of the body.
What else to study on this topic
- Criteria for selecting transfusion media in purulent inflammation
- Detailed composition of media for parenteral nutrition
- Mechanisms of the hormonal response to inflammation
- Comparative characteristics of humoral and cellular immunity in infection
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Other topics from the section "CHAPTER 11. SURGICAL INFECTION (PURULENT-INFLAMMATORY DISEASES)"
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