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1-SIW Alibekova Zhasmin.pptx
1. SOUTH KAZAKHSTAN MEDICAL ACADEMY
SUBMITTED BY: ALIBEKOVA ZHASMIN
GROUP : 09-20
SUBMITTED TO: POLUKCHI T. V.
Department of «Infectious diseases and Dermatovenereology»
Topic :Features of the
curation of infectious sick
2. PRINCIPLES AND METHODS OFTREATMENT OF INFECTIOUS PATIENTS
Treatment of infectious patients should be comprehensive, etiologically and pathogenetically It is
reasonable and individualized, taking into account the state of the patient's body, the severity and phase
of the disease.
When conducting complex therapy, all interrelated factors involved in the development of an infectious
disease are taken into account. Various therapeutic agents are used, the action of which is aimed at
reducing the activity of the pathogen and neutralizing its toxins, increasing the body's defenses in the
fight against infection, etc.
3.
4. Impact on the pathogen it consists in the use of antibacterial
drugs (chemotherapy, antibiotic therapy), bacteriophages
(phage therapy), immune sera, specific immuno- or gamma
globulins (serotherapy), interferons.
By effects on the body immunomodulatory drugs are used, as
specific ones – vaccines (vaccinotherapy), and as non –
specific ones-vitamins, blood preparations (hemotherapy),
pyrimidine derivatives, cytomidines, glucocorticosteroid
medications hormones, etc.
5. Pathogenetic therapy is widely used in the clinic of infectious diseases, aimed at correcting violations of the
internal environment of the body (restoration of water-electrolyte and protein metabolism, acid-base balance,
elimination of hepatic, respiratory and cardiovascular insufficiency, reduction and elimination of allergic
manifestations, etc.).
Complex etiological and pathogenetic therapy requires a rational and deliberate approach to the selection and
administration of adequate doses of therapeutic drugs that only help the patient's body and its own protective
forces (physiological
devices, by S. P. Botkin) in the elimination of the infectious process. In order to avoid complications, using various
therapeutic methods, it is necessary to take into account the "limit of intervention in nature"
Principles and methods of treatment of infectious patients
6. Treatment of a specific patient in each case It requires taking into account the period,
form, severity of the course of the disease, a detailed pathogenetic diagnosis and
assessment of the characteristics of the patient's body (age, reactivity, concomitant and
previous diseases, etc.). Thus, modern medicine confirms and strengthens the thesis that
"healing does not consist in treating the disease. Healing consists of treating the patient
himself" (M. Y. MudrovImportant factors in the treatment of infectious patients are
compliance with the regime, dietary nutrition, body hygiene, impeccable maintenance of
care items, underwear and bed linen, maintaining the necessary sanitary level of the room
where the patient is located.
7. The peculiarity of many infectious diseases, which consists in a tendency to a prolonged, recurrent course,
causes the principle of succession treatment, which provides for a period of dispensary observation by a general
practitioner and(or) an infectious disease specialist in the infectious diseases office of the polyclinic for the
purpose of preventing, early detection and treatment of relapses and complications, medical and social
rehabilitation of those who have suffered an infectious disease.
In the treatment of infectious patients and especially in their post-treatment, rehabilitation convalescents so-
called non-traditional methods of therapy remain important: herbal medicine (for acute intestinal infections, flu,
acute respiratory infections), iglo– and laser reflexology (with cholestasis syndrome, consequences
neuroinfections), magnetic therapy (for prolonged convalescence of viral hepatitis), and so on. A rich arsenal of
physiotherapeutic agents is also widely used.
8. ETIOTROPIC THERAPY OF INFECTIOUS PATIENTS.
From the means of etiotropic therapy, drugs of specific action should be distinguished, i.e. actions aimed at a
single type of pathogen. These are immune sera, specific immunoglobulins, gamma globulins, therapeutic
vaccines, bacteriophages, and chemotherapy drugs.
Serotherapy. The use of immune sera in the treatment of infectious diseases was associated with the discovery of
pathogens of diphtheria and tetanus in 1884 and the development of technology for obtaining anti-diphtheria and
tetanus sera. In the future, immunoglobulins obtained from the blood sera of ill or vaccinated donors or from
placental blood were widely used, as well as heterologous ones gamma globulins derived from blood serum
hyperimmunized people animals.
There are antitoxic and antibacterial serums. Antitoxic serums contain specific antibodies against toxins –
antitoxins and are dosed with antitoxic units (AE). Their action is reduced to neutralizing the toxins produced by
pathogens. Antitoxic drugs are anti-diphtheria, tetanus, anti-botulinum, and anti-gangrenous, anti-anthrax serums.
Antibacterial serums contain antibodies against bacteria (agglutinins, bacteriolysins, opsonins). In most cases, sera
are administered intramuscularly and only in special cases intravenously.
9. The effect of using the serum depends on the dose and timing of its administration. The earlier the serum is
administered from the onset of the disease, the better the result. This is due to the fact that the serum inactivates
the toxin freely circulating in the blood. The duration of its circulation is limited to 1-3 days, in the future it binds
to cells and tissues.
Immunoglobulins and gamma-globulins play an important role in the treatment of patients with certain infectious
diseases. They have a high concentration of antibodies, are devoid of ballast proteins, better penetrate into tissues,
etc. Homologous immunoglobulins can be administered without prior treatment. hyposensitization patient's
sensitivity to foreign proteins, heterologous ones gamma globulins – only after appropriate preparation of the
patient (as with the introduction of heterologous ones sera).
At present Our medical practice has immunoglobulins (gamma globulins) against smallpox, influenza, measles,
tick-borne encephalitis, staphylococcal infection, anthrax, leptospirosis, whooping cough, herpes infection and
other diseases.
10. SEROTHERAPY COMPLICATIONS
Serotherapy complications infectious patients can be of two types – anaphylactic shock and serum sickness.
Shock develops immediately after administration of serum or gamma globulin.
Serum sickness develops 5-12 days after administration of the drug. Clinically, it is manifested by fever, edema of
the mucous membranes, lymphadenitis, spotty-papular rash and itching in the places of exanthema; sciatica,
neuritis are possible, synovitis. The disease lasts about 6-12 days, and the prognosis is usually favorable.
Sometimes the reaction to the serum can be only at the site of its administration in the form of edema, hyperemia
without an increase in body temperature. In recent years, due to the use of highly purified sera and
immunoglobulins and gamma-globulins derived from them, this complication is rare.
In order to avoid complications (especially anaphylactic shock) in response to the introduction of heterologous
ones sera and gamma globulins must be strictly observed in accordance with the relevant rules.
11. INTERFERONTHERAPY.
Interferons are currently considered as factors of non-specific resistance and as factors that have a regulatory
effect on the body's immune system. Interferons as drugs are characterized by universal antiviral activity and,
being etiotropic agents, they cannot be considered specific. Nevertheless, they are used with more or less success
in the treatment of patients with certain viral infections (influenza, herpetic infection, viral encephalitis, adenovirus
diseases, etc.). natural interferons, derived from white blood cells and fibroblasts, which have been widely used in
recent years.
(genoferons, or clonal services) interferons obtained by genetic engineering. Along with local usage native content
intramuscular, intravenous, and highly purified drugs are increasingly used in the spinal canal (reoferon). To
interferon therapy adjacent is the method of therapy (and prevention) of viral infections by inducing the human
body's own interferons. Among interferonogens it is necessary to name well-known drugs from the group of CNS
stimulants, adaptogens-tinctures of zamanikha, aralia, leuzei, rhodiola rosea, ginseng, eleutherococcus, Chinese
lemongrass. Synthetic ones have also been created interferonogens which are currently undergoing clinical trials.
12. VACCINOTHERAPY.
The therapeutic effect of vaccines is based on the principle of specific stimulation of the body's defenses. The
introduction of an antigenic irritant increases phagocytosis, promotes the production of specific antibodies. For
vaccine therapy, killed vaccines, individual antigens, and anatoxins are used. Autovaccines prepared from the
pathogen strain isolated from the patient are most effective. Vaccine therapy is indicated during the period of
subsiding of acute manifestations of the disease, with a prolonged or chronic course of the disease (brucellosis,
tularemia, dysentery) and less often in the midst of infection (typhoid fever), usually in combination with
antibiotic therapy. Individuals receiving antigenic drugs in the acute period of the disease have an increase in
antibody titers and the level of immunoglobulins. Vaccines provide and hyposensitizing agent action. In recent
years, interest in vaccine therapy has been declining, mainly due to the development of modern
immunomodulatory agents and drugs immunocorrecting agent actions.
13. CHEMOTHERAPY.
In most cases, chemotherapy plays a crucial role in the overall complex of therapeutic and preventive measures in
infectious practice. One cannot but agree that the success achieved in the fight against mass infectious diseases
was largely due to the use of chemotherapeutic drugs, in particular antibiotics. It is thanks to their use that cases of
recovery of patients with pulmonary plague have become possible, and mortality in diseases such as typhoid fever,
typhoid fever, meningococcal infection, etc. has sharply decreased.
The number of known chemotherapeutic agents, including antibiotics, is increasing every year. More than 2,000
antibiotics have been described, and 200 of them have had their mechanism of action studied in detail. In everyday
practice, general practitioners and hospital doctors use no more than 50 drugs with an antibacterial effect. Their
widespread use has revealed a number of undesirable consequences: a widespread increase in antibiotic resistance
and polyresistance factors micro-organisms and their selection, damage to certain organs and systems during
chemotherapeutic intervention (for example, suppression of the immune system function in some cases), the
development of non-specific sensitization, violation of complex ecological relations in the patient's biocenosis, and
an increase in the frequency of endogenous, mixed infections, and superinfections. The problem of overcoming the
negative consequences of antibiotic therapy is solved by creating new, more advanced, highly effective and non-
toxic drugs and developing ways to correct the side effects of the best available antibacterial agents, followed by
their rational use in accordance with the basic principles of chemotherapy.
14. THE BASIC PRINCIPLES OF ANTIBIOTICTHERAPY FOR INFECTIOUS DISEASES ARE
AS FOLLOWS.
1. Isolation and identification of pathogens, their study antibiotic chart.
2. Choosing the most active and least toxic drug.
3. Determination of optimal doses and methods of antibiotic administration.
4. Timely initiation of treatment and conducting courses of chemotherapy (antibiotic therapy) of the required
duration.
5. Knowledge of the nature and frequency of side effects when prescribing drugs.
6. Combination of antibacterial drugs to enhance the antibacterial effect, improve their pharmacokinetics and
reduce the frequency of side effects.
15. THESE PRINCIPLES OF ANTIBIOTIC THERAPY CAN CERTAINLY BE APPLIED IN ANTIVIRAL AND ANTIPARASITIC
THERAPY (EXCLUDING DETERMINING THE SENSITIVITY OF PATHOGENS TO DRUGS).
The choice of an antibiotic is determined primarily by the type of pathogen and, consequently, the etiological (nosological)
diagnosis of the disease. It is known that drugs of the penicillin group (salts benzylpenicillin, Bicillinum,
phenoxymethylpenicillin, oxacillin, ampicillin, carbenicillin highly effective against gram-positive (streptococci, staphylococci,
pneumococci) and gram-negative (gonococci, meningococci) cocci, as well as anthrax bacillus, clostridium, the causative agent
of diphtheria, treponemus, leptospira.
Cephalosporins are similar in structure and mechanism of action to penicillins (cephaloridin), or tseporin, cefazolin, or
cefamesin, cephalexin, cephalotin sodium salt. They have a broader spectrum of action: they are effective mainly against cocci,
but they have a pronounced effect on most gram-negative bacteria.
Streptomycin preparations have previously been highly effective against gram-negative bacteria (Escherichia coli, pathogens of
dysentery, plague, tularemia, brucellosis) and mycobacteria (pathogen of tuberculosis). Currently, these microorganisms have
partially lost their sensitivity to streptomycins, and therefore the use of these antibiotics, unfortunately, is limited.
Levomycetin is effective against many gram-negative and gram-positive bacteria, rickettsias and spirochetes, so it belongs to
the group of broad-spectrum antibiotics, is widely used in infectious practice, and in the treatment of typhoid patients remains
the drug of choice.
Tetracyclines (tetracycline, oxytetracycline, doxacycline hydrochloride, or vibramycin, metacycline hydrochloride, or
rondomycin) and rifampicin they also have a broad antibacterial spectrum of action, inhibit the growth of most gram-positive
and gram-negative bacteria, rickettsias, and chlamydia.
16. Aminoglycosides-antibiotics neomycin groups (neomycin sulphate, monomycin, kanamycin, gentamicin sulfate) -
act on most gram-positive and gram-negative bacteria; they are active against microorganisms resistant to
penicillin, levomycetin, tetracyclines.
Antibiotics-macrolides (erythromycin, oleandomycin phosphate)are effective against a large group of bacteria, but
mainly gram-positive. Their use is limited mainly to severe forms of the disease; first of all, they are prescribed to
patients with staphylococcal infections. Other antibiotics are also used for the same purpose (tseporin, kefzol,
ristomycin).
Polymyxins they have a devastating effect on gram-negative bacteria (shigella, salmonella, Escherichia,
Pseudomonas aeruginosa).
Antibiotics of other groups are also widely used in clinical practice, in particular: lincomycin hydrochloride. It is
active mainly against gram-positive cocci, mycoplasmas and, therefore, is especially indicated for the treatment of
complicated influenza, pneumonia, erysipelas, purulent lesions of bone and muscle tissue, Fusidine- sodium has a
narrow spectrum of action (staphylococci, meningococcus, gonococcus); polymyxin In sulfate (aerosporin) is used
almost exclusively for infections caused by Pseudomonas aeruginosa.
17. ANTIFUNGAL ANTIBIOTICS AND OTHER DRUGS FORTHETREATMENTOF FUNGAL
DISEASES
(nystatin, levorin, monistat, clotrimazole, mycoseptin, mycozolon, nitrofungin et al.) are effective against many
fungi-pathogens of mycoses. Some of them are used not only for the treatment, but also for the prevention of
candidiasis in children. immunocompromised individuals and patients who have received long-term courses of
massive antibiotic therapy using broad-spectrum drugs.
Recent events over the years, many traditional, natural antibiotics have been replaced by third-and fourth-
generation drugs, mainly represented by semi-synthetic penicillins (ampicillin, oxacillin, amoxicillin, ticarcillin,
cyclocillin, carbenicillin), cephalosporins (cephalotin, cephaloridin), aminoglycosides (amikacin, netilmecin,
dibecacin, tobramycin), tetracyclines (metacycline, doxycycline, monocycline), rifampicins (rifampicin,
rifadinCompared to natural antibiotics, they have many advantages: acidic–
and drug resistance It has an extended spectrum of action, improved distribution in tissues and body fluids, a
modified mechanism of action on the bacterial cell, and fewer side effects.
Along with antibiotics, other chemotherapeutic drugs are also used to influence the causative agent of the disease.
Derivatives have high antimicrobial activity nitrofuran (furazolidone, furadonin, furagin, furatsilin, etc.). They are
effective against many gram-negative and gram-positive bacteria, including those resistant to antibiotics and
sulfonamide preparations, as well as some protozoa (Trichomonas, giardia).
18. PREVENTION OF INFECTIOUS DISEASES
Separate public and individual prevention. Individual prevention includes: vaccinations, hardening, walking in the
fresh air, playing sports, proper nutrition, compliance with personal hygiene rules, giving up bad habits, everyday
life and recreation, and environmental protection. The public one includes a system of measures to protect the
health of employees: creating healthy and safe working and living conditions in the workplace.
19. In order to prevent, limit the spread and eliminate infectious diseases, immunoprophylaxis is carried out by
conducting preventive vaccinations. This type of prevention of infectious diseases is directly related to the creation
of immunity in the human body (immunity) to a certain infection through immunization and is called – specific
immunoprophylaxis of infectious diseases. There are two main types of immunoprophylaxis:
active immunization (vaccination) – after the introduction of a vaccine (pathogen antigen or live weakened
microorganisms) into the human body, specific antibodies are formed, which even when infected prevent the
development of an infectious disease. Currently, active immunization is carried out against such infectious diseases
as tetanus, pertussis, diphtheria, hepatitis B virus, polio, measles, rubella, epidparotitis ("mumps"), tuberculosis.
passive immunization – ready-made antibodies to a specific infection are introduced into the body, which is used
for emergency prevention of infectious diseases (emergency prevention of tetanus).
20. In order to prevent, limit the spread and eliminate infectious diseases, immunoprophylaxis is carried out by
conducting preventive vaccinations.This type of prevention of infectious diseases is directly related to the
creation of immunity in the human body (immunity) to a certain infection through immunization and is called –
specific immunoprophylaxis of infectious diseases.There are two main types of immunoprophylaxis:
active immunization (vaccination) – after the introduction of a vaccine (pathogen antigen or live weakened
microorganisms) into the human body, specific antibodies are formed, which even when infected prevent the
development of an infectious disease. Currently, active immunization is carried out against such infectious
diseases as tetanus, pertussis, diphtheria, hepatitis B virus, polio, measles, rubella, epidparotitis ("mumps"),
tuberculosis.
passive immunization – ready-made antibodies to a specific infection are introduced into the body, which is
used for emergency prevention of infectious diseases (emergency prevention of tetanus).
