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Khirurgii

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Year 2010 Vol. 18 No 1

LECTURES, REVIEWS

Z.A. DUNDAROV, V.M. MAYOROV

STRATEGY AND TACTICS OF ANTIBACTERIAL THERAPY AT ACUTE DESTRUCTIVE PANCREATITIS

The significance of the discussed problem is determined by progressively increasing number of patients with an acute destructive pancreatitis, high frequency of development of various intraperitoneal and extra-abdominal purulent-septic complications naturally determining high percentage of unfavorable outcomes. The fact that infecting of destruction foci in the pancreas and parapancreatic tissue occurs in 40-70% of patients with ADP in different terms of this disorder is well-known now. In the review the discussion of the range of questions is given linked with the problem of an adequate and rational intake of antibiotics at ADP depending on their penetrating capability in the pancreas tissue. The discussed problem gains more significance because of surgical tactics activation, of impossibility of single-stage sanitation of all purulent-necrotic foci, of using many-stage necrsequestrectomies and programmed interventions which are an additional risk factor of nosocomial infecting at ADP. On prescribing antibiotics one should take into consideration the circumstance that successes of à modern intensive therapy have permitted to decrease lethality in the acute phase of the pancreatogenic shock; however the possibility of purulent-septic post-necrotic complications development of the late period of ADP evolution increases in this case. The indications for two tactics approaches to antibacterial preparations use – preventive and medical – are studied in the review.

Keywords: acute destructive pancreatitis, conservative treatment, antibacterial therapy
p. 114 – 123 of the original issue
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