Antiseptics for treating wounds are in every home medicine cabinet. But do people always choose the right way to treat a wound? It is no accident that there are several different solutions, each of which should be used to treat certain wounds and sores. Today we will find out what an antiseptic is for? Consider the 9 most popular and inexpensive tools and understand their differences.
What is an antiseptic?
Let's immediately turn to the Greek translation of the term: anti - against, septikos - putrid. And an antiseptic is really called any agent that is able to fight bacteria caused by decomposition processes, and also serves to prevent their reproduction.
Antiseptics have been known since antiquity. The embalming of corpses was carried out with means that prevent decay processes, otherwise some of the finds would not have survived to contemporaries. But antiseptic drugs began to be popularized only from the middle of the 19th century, when the first attempts to conduct surgical operations using carbolic acid began.
By the way! Antiseptics are used not for healing wounds, but for disinfecting them, i.e. to kill infection and prevent inflammation.
Antiseptics are used today not only in medicine, but in other areas as well. For example, in the woodworking industry for the impregnation of wood in order to avoid the development of putrefactive processes. Logs for a bath, which will constantly be in a humid environment, necessarily need pretreatment with antiseptic impregnations. So, what are the antiseptics?
9 best antiseptics
Carbolic acid, which was first used as an antiseptic for the body, is not used today because of its danger. In fact, it is a harmful phenol that can cause toxicity in large quantities. But over 150 years, many different antiseptic agents have been invented that meet all the necessary requirements, namely:
All these requirements are met to varying degrees by at least 9 antiseptics, which are considered the most effective and affordable.
The antiseptic effect of ethyl alcohol does not last long. As soon as the alcohol evaporates (30-40 seconds), the effect stops. But usually it is enough to destroy the most active microbes. Ethanol is primarily used to treat small fresh wounds and cuts, but it cannot be used constantly. Alcohol dries out the skin and, with frequent use, can provoke microtrauma. The cost of one bottle of ethanol (100 ml) is small: about 30 rubles.
Furacilin aqueous solution
Furacilin belongs to a wide spectrum of antimicrobial agents. It is used more often in the form of an aqueous solution, although it is possible to prepare it with alcohol. An aqueous solution of Furacilin is good for treating wounds and sores on the mucous membrane: in the oral cavity, nose, vagina. But it also works great as a skin antiseptic (ulcers, burns).
Furacilin is sold in the form of ready-made solutions (60-70 rubles per 100 ml), tablets that need to be ground into powder before dissolving (80-90 rubles per 10 pcs.), As well as effervescent self-dissolving tablets (110-120 rubles per 10 pcs.) ).
It is a so-called antioxidant antiseptic that releases oxygen upon contact with the skin. This is indicated by the bubbles that appear when peroxide is applied to the wound. The more bubbling, the stronger the pollution. Treatment of a wound with hydrogen peroxide is very effective on postoperative sutures, as the resulting foam automatically rinses off the dirt without the need to wipe the wound.
Despite the seeming aggressiveness of hydrogen peroxide, it is a fairly mild antiseptic that can also be used for mucous membranes. For example, it can be moistened with a cotton swab and inserted into the nostril to stop bleeding and treat the damaged vessel. At the same time, it is an excellent drying agent. The cost of a bottle of peroxide (10 ml) is about 40 rubles.
Potassium permanganate solution
Possesses antimicrobial and disinfectant effect due to the oxidizing ability of manganese. Potassium permanganate is used to treat wounds, ulcers, burns. But it is important to prepare just a weak solution, because a highly concentrated one can cause a chemical burn to the skin.
At home, it is not recommended to use potassium permanganate precisely because of ignorance of the exact concentration for certain wounds and non-compliance with the technique of its preparation. But pink water is suitable, for example, for wetting a dried-on dressing. In the pharmacy, potassium permanganate is sold in the form of burgundy crystals and is called "Potassium permanganate". The cost of a five-gram bubble is 60-70 rubles.
Good old antiseptic, which is almost in every home. A 5% solution is used to treat wounds, although in some cases it is necessary to dilute it to a less concentrated one. Iodine is good for treating fresh cuts and shallow wounds.
It is not recommended to use iodine solution for treating wounds received more than 5 days ago, as well as acne, bedsores and thermal burns. Also, iodine should be used with caution in people suffering from endocrine diseases. 10 ml of iodine costs only 10-15 rubles.
Or simply brilliant green, which is so disliked in the United States, believing that it is toxic. But in Russia this antiseptic is the most popular. Perhaps there is no person who has never encountered brilliant green. It has an excellent antimicrobial effect, but it does not damage tissue or cause burns, such as iodine. The content of ethyl alcohol in brilliant green makes the antiseptic even more effective for use for both fresh and old wounds.
The brilliant green solution is able to fight not only gram-positive and gram-negative bacteria, but also the dangerous Staphylococcus aureus and diphtheria bacillus. Another plus of brilliant green: the ability to stimulate tissue regeneration. And this is the cheapest antiseptic: the cost of a bottle (10 ml) is 10 rubles. Against the background of all the pluses, there is only one minus: a rich green color, which is washed off for a very long time. And in order not to stain yourself and everything around with brilliant green, you can use not a standard bottle, but a special pencil. It costs 50-60 rubles.
Otherwise, it is called "red brilliant green", although its properties are somewhat different from those of a brilliant green solution. Fukortsin also contains ethyl alcohol, boric acid and phenol. Therefore, you need to use it with caution.
Fukortsin is used to disinfect wounds, prevent their suppuration and stop the process that has already begun. Suitable for the treatment of purulent and fungal skin diseases. It is used for abrasions, erosive wounds, pimples on the face. The cost of a bottle of Fukortsin (25 ml) is about 40 rubles.
Chlorhexidine bigluconate
An antiseptic that is rarely found in a home medicine cabinet because it is not universal. Chlorhexidine bigluconate (or as it is called more simply - Chlorhexidine) is prescribed by a doctor, and in a certain concentration.
For example, 0.05% is used to rinse the throat and rinse the nose, and a more concentrated solution is needed to treat wounds on the skin: from 0.1 to 0.5%. Chlorhexidine is good for purulent wounds and burns. It is suitable for the prevention of sexually transmitted diseases (a solution of 0.1% can be used to treat the genitals).
Important! For open wounds and mucous membranes, an aqueous solution of Chlorhexidine is used. Alcohol is used by surgeons to wipe hands before operations, processing tools and devices.
Depending on the concentration of Chlorhexidine, it is able to fight various types of bacteria and infections. The cost of a bottle of 0.05% aqueous solution costs less than 10 rubles per 100 ml. Alcohol will cost 10-15 rubles more.
A universal antiseptic, which appeared relatively recently and immediately became popular. Its base is a complex monohydrate. Those who have tried Miramistin once rarely return to other remedies. It has a very broad spectrum of action, it fights well against infections of the throat, nose, and genital tract, and is suitable for processing sutures. The plus is that it is absolutely tasteless and does not sting, even if you handle heavy and deep wounds.
Minus Miramistin is its price. This is the most expensive antiseptic presented earlier. A 150 ml bottle costs 340-350 rubles. But it is economically used thanks to the spray nozzle.
There are also antiseptic ointments that also work effectively (Ichthyol ointment, Vishnevsky ointment, Tetracycline, Erythromycin, Levomekol, etc.) and antibacterial wounds (Gentaxan, Baneocin, Streptocid, Xeroform, Galagran).
How to properly treat an open wound
Any, even minor, wound requires antiseptic treatment. A cat scratched, a burr came off, was damaged during shaving - it is imperative to treat the wound in order to avoid its infection and the development of gangrene. There are cases when neglect of oneself led to serious consequences, and, for example, due to a squeezed and untreated pimple, an infection entered the body.
Having received a wound (any damage to the skin that provoked bleeding), you must immediately exclude any touching it. Then take an antiseptic and apply it to the wound with a piece of cotton wool or a bandage, or simply by spraying the product. Then, if the damage is serious, you should see a doctor. If not serious, you can stick a plaster on top or bandage it.
Attention! Before treating a deep wound with an antiseptic, you need to stop profuse bleeding. This is done with a pressure bandage or by pulling the vessel with a tourniquet in accordance with all the rules of first aid.
It turns out that of the nine listed antiseptics, it is optimal to use Miramistin, brilliant green or hydrogen peroxide. These are the three most versatile tools to meet the maximum number of requirements. They perfectly disinfect wounds, do not cause pain in the victim, do not cause irritation and toxic poisoning of the body.
For citation: Cherkashin M.A. Local antiseptics in surgical practice // BC. 2007. No. 22. S. 1648-1650
Prevention and treatment of surgical infections is currently one of the most difficult tasks. The widespread prevalence and availability of antimicrobial chemotherapy agents contributes to the growth of resistant forms of microorganisms. Nosocomial infections are acquiring an increasingly important role. Sometimes a dramatic situation develops - after a seemingly small intervention, rather severe and unpleasant wound complications develop, which often require surgical treatment. In the postoperative period, 30% of surgical patients develop infectious complications of various localization (the area of the surgical incision, respiratory organs, organs of the urinary system). The problem of reinfection of wound surfaces with hospital strains from the hands of medical personnel, bed linen, sutures and dressings in intensive care units, in groups of patients with limited mobility (after cerebrovascular accidents) seems to be important. Among other things, the period of inpatient treatment is lengthened, which reduces both the patient's ability to work and the quality of his life, not to mention the pharmacoeconomic indicators. So, according to E.A. Oganesyan et al. (2003), A.A. Beloser et al. (2003), the length of hospital stay for patients is increased by 15-18 days.
One of the important aspects of solving this problem is the impact on the pathogen. The leading role in this, undoubtedly, belongs to the means of antimicrobial chemotherapy.
Rational antibiotic therapy is the cornerstone in the treatment of any infectious process. Especially when it comes to nosocomial pathogens.
But the second part of the treatment strategy should not be forgotten either. Local treatment also plays an important role.
Topical preparations include topical antiseptics and topical forms of antibiotics.
At present, a huge amount of antiseptic agents are used in domestic health care. At the same time, it is not a secret for anyone that many drugs are obsolete due to the fact that:
pathogenic microorganisms have developed resistance mechanisms;
for many years of use, medical personnel have developed allergic reactions;
there is an inconvenience on the part of logistics - heavy, bulky and fragile containers;
many drugs need to be prepared "on demand" because there are no long-term stored dosage forms.
So, for example, many antiseptic agents intended for the treatment of the operating field, the surgeon's hands, the skin before injections, the introduction of vascular catheters, the elbow bends before the puncture of the vessels, do not always provide reliable sterility. Recent studies show that hospital strains of microorganisms are resistant to traditional antiseptics (furacilin, chlorhexidine aqueous solution, potassium permanganate solution). In a solution of furacilin Ps. aeruginosa remains at 106 CFU / ml.
The most widely used in the treatment of wound infections are chemical antiseptics.
Chemical antiseptics in our country are usually classified as follows:
I. Group of halogens:
1. Chloramine B
2. Iodine alcohol solution 5-10%
3. Iodine preparations: iodonate 1% solution, iodinol 1% solution, iodopyrone 1% solution
II. Oxidants:
1. P – p hydrogen peroxide
2. Perhydrol, contains about 30% hydrogen peroxide, is used to prepare a solution of pervomur
3. Potassium permanganate
III. Acids:
1. Boric acid
2. Formic acid
3. Hydrochloric acid
IV. Aldehydes:
1. Formaldehyde
2. Lysoform
3. Formalin
V. Phenols:
1. Carbolic acid
2. Ichthyol
Vi. Alcohols
Vii. Hypertonic solutions:
1. Hypertonic solution - 10% solution of sodium chloride
2.30% solution of urea
3.40% rr glucose
VIII. Dyes:
1. Methylene blue 1-3% alcohol solution
2. Brilliant green (brilliant green)
3. Rivanol
IX. Heavy metal salts:
1. Silver nitrate
2. Sublimate (mercury dichloride)
3. Silver salts: collargol and protargol
H. Detergents:
1. Chlorhexidine bigluconate
2. Zerigel
3. Rockcal - 10% and 1% aqueous solution
XI. Derivatives of nitrofurans:
1. Furacillin - for treating wounds, instruments, washing cavities
2. Furadonin, furazolidone
3. Furagin
In practical surgery, traumatology, military field surgery, drugs that can be used directly in the wound play an important role. Based on this, rather stringent requirements should be imposed on such antiseptics:
non-toxicity
hypoallergenic
high bactericidal activity
ease of use in any conditions (a finished dosage form in a convenient package is desirable).
Traditionally, antiseptics from the group of halogens (alcohol solution of iodine), oxidants (hydrogen peroxide), dyes (brilliant green) are used to treat wound surfaces.
Currently, there are a number of drugs created on the basis of high technologies. Silver-based preparations, various long-term wound dressings, media for moist wound healing, etc. are very promising.
One of the modern local antiseptic agents is polyvinylpyrrolidone iodine (Vokadin and others).
What are its advantages?
Polyvinylpyrrolidone itself is a biologically inert polymer molecule.
Polyvinylpyrrolidone binds halides to form galexes, which have a strong disinfecting effect. The complex of PVP with iodine was first obtained by Shelansky, who showed that polyvinylpyrrolidone forms a reddish-brown, odorless complex with iodine in aqueous solution. In combination with polyvinylpyrrolidone, iodine loses its ability to burn tissue, but retains a high bactericidal activity, which made it possible to expand the scope of iodine use as an antiseptic. Thanks to the polymer molecule, iodine penetrates deep into the wound into the inflamed tissue, under the scab, etc.
The drug has a wide spectrum of antimicrobial action: bactericidal, fungicidal, selective virucidal, tuberculocidal, protocidal.
Contraindications to the use of polyvinylpyrrolidone-iodine are:
iodine sensitivity
hyperthyroidism
thyroid adenoma
dermatitis
renal failure
The drug can be used both for treating the hands of a surgeon before surgery (there is a form of Vokadin in the form of soap), for treating the operating field, and for local treatment of wounds (1% solution for local use and 5% ointment for external use) and prevention of infection before surgery or diagnostic procedures in the vagina (vaginal suppositories and tablets).
Polyvinylpyrrolidone iodine can be used in all phases of the wound process.
A huge problem in almost all hospitals (not only surgical, but also neurological, therapeutic) are bedsores that form in patients with limited mobility. Traditional methods of preventing the formation of pressure ulcers by treating problem areas of the skin (sacrum, scapula, heels and other areas) with a solution of potassium permanganate today can be considered as an ineffective method that promotes the involvement of deep anatomical structures in the purulent process. A solution of potassium permanganate is not active against the main causative agents of nosocomial infection. A dense scab that forms as a result of daily skin treatments with this antiseptic creates ideal greenhouse conditions for the development of deep phlegmon. At the same time, when using a solution or a water-soluble ointment polyvinylpyrrolidone-iodine, favorable conditions for the reproduction of microorganisms are not created, since thanks to PVP, the conductor of iodine, the drug penetrates well under the scab.
A serious problem of modern health care both in our country and in the whole world is the treatment of severe forms of venous insufficiency, accompanied by trophic disorders.
It is now generally accepted that venous trophic ulcers occur in 2% of the adult population of industrially developed countries.
In our country, insufficient development of the system of public phlebological care leads to the fact that often patients turn to a specialist with a long-standing trophic ulcer. Many patients prefer to be treated for a long time on their own using various systemic and local means, which in no way improves their condition.
In general, there is such a situation that patients most often seek qualified help for purulent inflammation.
Wound infection plays an important role in stimulating local autoimmune processes, thus turning on "negative feedback" and chronic inflammation exists for a long time, creating, in turn, conditions for the persistence of the infection.
A feature of the treatment of venous ulcers is the impossibility and senselessness of using most topical forms of antibiotics, because in an acidic environment, they break down very quickly and do not have the desired therapeutic effect. In this regard, local antiseptics and antibiotics that work at low pH values should be used. In the exudation phase, antiseptics are one of the important components of treatment, since it is necessary to achieve maximum cleansing of the ulcer from necrotic tissues and suppress the infection. It would be logical to use a PVP-iodine solution (this allows you to wash the wound). In the repair phase, one of the goals of treatment is the prevention of reinfection, and here, too, antiseptics cannot be dispensed with. In this phase, it is possible to use the ointment form of the drug.
In the outpatient practice of outpatient surgeons, a large place is occupied by the treatment of purulent-destructive processes in the soft tissues of the hand and foot (panaritium, paronychia, phlegmon). The most important condition for successful treatment is drainage of the focus, evacuation of purulent discharge, systemic antibiotic therapy and, of course, local treatment, which is unthinkable without the use of antiseptics. In such cases, polyvinylpyrrolidone-iodine is indispensable, since the polymer molecule allows iodine to penetrate into inflamed tissues.
Thus, the polyvinylpyrrolidone-iodine complex is a highly effective, safe and convenient local antiseptic agent. Vokadin can be widely used in surgical practice for the treatment of various wounds, surgical infections, burns, bedsores, trophic ulcers. Iodophores must necessarily be included in the medication kit when recruiting supplies for emergency medicine teams, military medical service.
Literature
1. Blatun L.A. Modern iodophores are effective drugs for the prevention and treatment of infectious complications. Consilium medicum. 2005, volume 7 No. 1.
2. Oganesyan E.A., Pavlov S.I., Petkova V.A. Epidemiological surveillance of nosocomial infections in the Kaluga region. In collection: Modern problems of epidemiology, diagnosis and prevention of nosocomial infections. SPb., 2003; with. 61-63.
3. Belozer A.A., Smirnov O.A., Petkova V.A. Infection control of nosocomial infections in an emergency hospital. Modern problems of epidemiology, diagnosis and prevention of nosocomial infections. SPb., 2003; with. 75-77.
4. Novikova N.F., Mordovtsev V.N., Parenkova T.V. New possibilities for the treatment of trophic ulcers, skin and soft tissue wounds, bedsores and fistulas. - Consilium provisorum, 2001, vol. 1, N4. - p.30.
5. Phlebology. A guide for doctors under. ed. V.S.Saveliev. M., Medicine. 2001.
6. Lode H. Catheter-associated infections in the ICU. Materials of the International Conference “Nosocomial infections in intensive care units”. 1998; with. 15-16.
We give a brief description of the individual chemical classes of antiseptics and disinfectants.
1. Alcohols. Aliphatic alcohols, denaturing protein, have an antimicrobial effect to varying degrees.
Ethyl alcohol (wine alcohol) is a fermentation product of sugars. The State Pharmacopoeia provides for alcohol of the following concentrations: absolute alcohol contains at least 99.8 vol. %> ethyl alcohol, ethyl alcohol 95% contains 95-96 vol. % ethyl alcohol, ethyl alcohol 90% - 92.7 parts of ethyl alcohol 95% and 7.3 parts of water, ethyl alcohol 70%), respectively 67.5 and 32.5 parts, ethyl alcohol 40% - 36 and 64 parts.
It is widely used in surgical practice for the treatment of the operating field, wounds, surgeon's hands (70%), for alcohol compresses (40%), disinfection of instruments, suture material. 70% alcohol has an antiseptic effect, and 96%) also tanning.
2. Halides... Chloramine - 0.1-5% aqueous solution, contains active chlorine (25-29%), has an antiseptic effect. When interacting with tissues, active chlorine and oxygen are released, which determine the bactericidal properties of the drug. A solution of sodium hypochlorite is used, its 5% solution contains 0.1 g of active chlorine in 1 dm 3 and can be used for irrigation, cleaning and disinfection of contaminated wounds.
Iodine- an effective bactericidal substance. A solution containing iodine in a ratio of 1: 20,000 causes the death of bacteria within 1 minute, and spores within 15 minutes, while the toxic effect on tissue is insignificant. Alcohol tincture of iodine contains 2% iodine and 2.4% sodium iodide, it is the most effective antiseptic for treating the skin before surgery, venipuncture.
Iodinol- 1% solution. Antiseptic substance for external use. Used for washing wounds, rinsing the throat.
Iodonate and iodopyrone- organic compounds of iodine. Use a 1% solution. It is widely used as an antiseptic for the skin, especially during the preoperative preparation of the operating field.
Lugol's solution- contains iodine and potassium iodide, water and alcohol solutions can be used. The drug is of combined action. As a disinfectant it is used to sterilize catgut, as a chemotherapeutic agent - to treat thyroid diseases.
3. Heavy metals... Mercury oxycyanide- disinfectant. At concentrations of 1: 10,000, 1: 50,000, they are used for sterilizing optical instruments. Ammonium mercury ointment contains 5% of the active insoluble mercury compound, it is used to treat skin and heal wounds as a disinfectant.
Silver nitrate- a solution of inorganic silver salts, has a pronounced bactericidal effect. 0.1-2% solution is used to wash the conjunctiva, mucous membranes; 2-5-10% solution - for lotions; 5-20% solutions have a pronounced cauterizing effect and are used to treat excess granulations.
Protargol, collargol (colloidal silver) - have pronounced bactericidal properties. Protein silver containing 20% silver is used as a local antiseptic for treating mucous membranes. They have an astringent and anti-inflammatory effect. They are used for lubricating mucous membranes, washing the bladder for cystitis, urethritis, for washing purulent wounds, for sepsis, lymphangitis and erysipelas.
Zinc oxide- an antiseptic agent for external use, is part of many powders and pastes. It has an anti-inflammatory effect, prevents the development of macerations.
Copper sulfate - has pronounced antimicrobial properties.
4. Aldehydes... Formalin- 40% formaldehyde solution in water. Disinfectant. 0.5-5% solution is used to disinfect gloves, drains, tools; 2-4% solution - for disinfection of patient care items. Dry formaldehyde is used for sterilizing optical instruments in gas sterilizers. 1-10% formalin solution causes the death of microorganisms and their spores within 1-6 hours.
Lysol- strong disinfectant. A 2% solution is used for disinfection of care items, premises, soaking contaminated instruments. Currently, it is practically not used.
5. Phenols. Carbolic acid- has a pronounced disinfectant effect. It is used as part of a triple solution. To obtain an antimicrobial effect, at least a concentration of 1-2% is required, while at a concentration of 5% it already significantly irritates tissues.
Triple solution - contains 20 g of formalin, 10 g of carbolic acid, 30 g of soda and up to 1 liter of water. Strong disinfectant. Used for processing tools, care items, cold sterilization of cutting tools.
6. Dyes.Brilliant green- has a pronounced antimicrobial effect, especially against fungi and gram-positive bacteria (Pseudomonas aeruginosa, staphylococcus), an antiseptic for external use. 1-2% alcohol (or water) solution is used to treat superficial wounds, abrasions, oral mucosa, pustular skin lesions.
Methylene blue - antiseptic agent against Escherichia coli, pyogenic microbes. 1-3% alcohol (or aqueous) solution is used to treat superficial wounds, abrasions, oral mucosa, skin, 0.02% aqueous solution - for washing wounds.
7. Acids.Boric acid - 2.5% solution only inhibits the growth and reproduction of all types of bacteria. 2-4% solution is used for washing wounds, ulcers, rinsing the mouth.
Salicylic acid - antiseptic. It is used as a fungicide on leather. It has a keratolytic effect. It is used in the form of crystals (for tissue lysis), is a part of powders, ointments.
8. Alkalis.Ammonia alcohol- an antiseptic agent for external use. Previously, a 0.5% aqueous solution of ammonia was used to treat the hands of surgeons (Spasokukotsky-Kochergin method).
9. Oxidants.Hydrogen peroxide solution - contains 27.5-31% hydrogen peroxide, antimicrobial effect is due to oxidizing properties. 3% solution - the main preparation for washing purulent wounds during dressings, rinsing, lotions, does not penetrate into the tissue. It is used for bleeding from mucous membranes and decaying cancerous tumors, etc. It is included in the composition of Pervomur and is an effective disinfectant ( 6% solution).
Potassium permanganate - refers to strong oxidants, has a deodorant and astringent effect. In the presence of organic substances, especially the products of decay and fermentation, it splits off atomic oxygen with the formation of manganese oxides, which is the reason for the antiseptic effect. It is used in the form of 0.02-0.1-0.5% solutions for washing wounds.
10. Detergents (surfactants).Chlorhexidine bigluconate- an antiseptic agent that acts on gram-positive microbes and Escherichia coli. 0.5% alcohol solution is used to treat the hands of the surgeon and the operating field. 0.1-0.2% aqueous solution - one of the main drugs for washing wounds and mucous membranes, treating purulent wounds. It is part of solutions for the treatment of hands and the operating field (plivasept, AHD-special). Antiseptic soap with the addition of chlorhexidine is used to treat the hands of the surgeon and the operating field. The systematic use of chlorhexidine-containing soap leads to the accumulation of this substance on the skin and to the accumulation of antimicrobial action.
Zerigel- an antiseptic agent for external use. It is used for the treatment (film-forming antiseptic) of the hands and the operating field.
Degmin, degmicide - antiseptic agents for external use. Used to treat hands and the surgical field.
11. Derivatives of nitrofuran... Furacilin - antimicrobial agent acting on various gram-positive and gram-negative microbes. An aqueous 0.02% solution (1: 5000) is used to treat purulent wounds, ulcers, bedsores, burns. An alcoholic (1: 1500) rinse solution can be used, as well as an ointment containing 0.2% of the active substance. Does not interfere with the wound healing process.
Lifusol- contains furacilin, linetol, resins, acetone (aerosol). Antiseptic agent for external use. It is applied in the form of a film. It is used to protect postoperative wounds and drainage holes from exogenous infection and to treat superficial wounds.
Furadonin, furagin, furazolidone- have a wide antimicrobial spectrum of action. In addition to urinary tract infections, they are used in the treatment of intestinal infections (dysentery, typhoid fever).
12. Derivatives of 8-hydroxyquinoline... Nitroxoline (5-NOK) - chemotherapeutic agent, "uroantiseptic". It is used to treat urinary tract infections.
Enteroseptol, Intestopan- chemotherapeutic agents used for intestinal infections.
13. Quinoxaline derivatives... Dioxidine- an antiseptic agent for external use. 0.1-1% aqueous solution is used for washing purulent wounds, mucous membranes, especially when antibiotics and other antiseptics are ineffective. With sepsis and severe infections, intravenous drip can also be administered.
14. Derivatives of nitroimidazole.Metronidazole (metragil, flagil, trichopolum) - a broad-spectrum chemotherapeutic agent. Effective against protozoa, bacteroids and a number of anaerobes.
15. Tar, tar... Birch tar- a product of dry distillation of pine trunks and branches or pure selected birch bark. It is a mixture of aromatic hydrocarbons: benzene, toluene, phenol, creols, resins and other substances. It is used in the form of 10-30% ointments, pastes, liniment, is part of Vishnevsky's balsamic ointment (tar - 3 parts, xeroform - 3 parts, castor oil - 100 parts), is used to treat wounds, ulcers, bedsores, burns, frostbites. When applied topically, it has a disinfectant effect, improves blood circulation and stimulates tissue regeneration.
Currently, preparations based on birch tar are used much less frequently.
16. Quinolones (nalidixic acid, pipemidic acid, oxolinic acid). The mechanism of their action is associated with the ability to inhibit the synthesis of bacterial DNA by inhibiting the activity of enzymes of the microbial cell.
Fluoroquinolones (ciprofloxacin, ofloxacin, norfloxacin and others) - are active against gram-positive microbes, highly active against enterobacteria, mycobacterium tuberculosis. They are mainly used for infections of the intestines, abdominal cavity and small pelvis, skin and soft tissues, sepsis.
17. Sulfonamides (sulfadiazine, sulfadimezin, sulfadimethoxin, sulfamonomethoxin, sulfamethoxazole, sulfalene). They disrupt the synthesis of folic acid by a microbial cell and act bacteriostatically on gram-positive and gram-negative bacteria, chlamydia, toxoplasma. Combined preparations of sulfonamides with trimethoprim (bactrim, biseptol, septrin, sulfaton) are widely used in clinical practice for the treatment of bacterial infections of various localizations.
18. Antifungal agents. Allocate drugs of the polyene series: nystatin, levorin, amphotericin B; imidazole series: clotrimazole, miconazole, bifonazole; triazole series: fluconazole, itraconazole; and others: griseofulvin, flucytosine, nitrofungin, decamine.
They act on yeast-like fungi of the genus Candida, dermatophytosis. They are used to prevent complications and treat fungal diseases (simultaneously with broad-spectrum antibiotics).
19. Antiseptics of plant origin. Phytoncides, chlorophyllipt, ektericid, baliz, calendula - are mainly used as antiseptic agents for external use for washing superficial wounds, mucous membranes, skin treatment. They have an anti-inflammatory effect.
Bacteriophages(bacterium + Greek phagos - devouring, synonym: phage, bacterial virus) - a virus capable of infecting a microbial cell, reproducing in it, forming numerous offspring and causing lysis of a bacterial cell. Antistaphylococcal, antistreptococcal and anti-coli bacteriophages are used mainly for washing and treating purulent wounds and cavities after identification of the pathogen.
Antitoxins- specific antibodies formed in the human and animal body under the influence of toxins, microbes, plant and animal poisons, with the ability to neutralize toxic properties. Antitoxins play a protective role in toxinemic infections (tetanus, diphtheria, gas gangrene, some staphylococcal and streptococcal diseases).
Immunoglobulin preparations- γ-globulins - purified γ-globulin fraction of human serogenic proteins, containing in concentrated form antibodies against measles, influenza, poliomyelitis virus, tetanus γ-globulin, as well as increased concentrations of antibodies against certain infectious agents or toxins secreted by them.
Antistaphylococcal hyperimmune plasma- has a pronounced specificity due to the high content of antibodies to antigens with which donors were immunized. Highly effective in the prevention and treatment of purulent septic diseases caused by staphylococcus. Antipseudomonal hyperimmune plasma is also used.
Proteolytic enzymes(trypsin, chymotpsin, chymoxin, terrilitin, iruksol) - when applied locally, they cause lysis of necrotic tissues and fibrin in the wound, dilute purulent exudate, and have an anti-inflammatory effect.
Biological antiseptics also includes methods for increasing the nonspecific and specific resistance of the organism.
Non-specific resistance and non-specific immunity can be influenced in the following ways:
Ultraviolet and laser irradiation of blood (phagocytosis, complement system, oxygen transport are activated);
The use of a suspension of cells and xenoperfusate of the spleen, perfusion through the whole or fragmented spleen (pigs), while counting on the effect of lymphocytes and cytokines contained in the spleen tissue;
Transfusion of blood and its components;
The use of a complex of vitamins, antioxidants, biostimulants;
The use of thymalin, T-activin, prodigiosan, levamisole (stimulate phagocytosis, regulate the ratio of T- and B-lymphocytes, increase the bactericidal activity of the blood), interferons, interleukins, roncoleukin, roferon, etc. (have a pronounced activating targeted effect on immunity).
Antibiotics- substances that are products of the vital activity of microorganisms (natural antibiotics), suppressing the growth and development of certain groups of other microorganisms. Chemical derivatives of natural antibiotics (semi-synthetic antibiotics) are also isolated.
The main groups of antibiotics:
1. B-Lactam antibiotics:
1.1. Natural penicillins;
Semi-synthetic penicillins:
Penicillins resistant to penicillinase;
Aminopenicillins;
Carboxypenicillins;
Ureidopenicillins;
B-lactamase inhibitors;
1.2. Cephalosporins:
1st generation;
2nd generation;
III generation;
IV generation.
2. Antibiotics of other groups:
Carbapenems;
Aminoglycosides;
Tetracyclines;
Macrolides;
Lincosamides;
Glycopeptides;
Chloramphenicol;
Rifampicin;
Polymyxins.
Penicillins - All drugs of this group act bactericidal, their mechanism of action is the ability to penetrate the cell membrane of microbes and bind to "penicillin-binding proteins", as a result, the structure of the cell wall of the microbe is disrupted.
Natural penicillins. These include:
Benzylpenicillin (penicillin C);
Procaine-penicillin (novocaine salt of penicillin O);
Benzatinpenicillin (Bicillin);
Phenoxymethylpenicillin (penicillin V).
These antibiotics are active against streptococci of groups A, B, C, pneumococci, gram-negative microorganisms (gonococci, meningococci), as well as some anaerobes (clostridia, fusobacteria) and are inactive against enterococci. Most strains of staphylococci (85-95%) produce B-lactamases and are resistant to the action of natural penicillins.
Penicillins resistant to penicillinase:
Methicillin;
Oxacillin;
Cloxacillin;
Flucloxacillin;
Dicloxacillin.
The spectrum of antimicrobial action of these drugs is similar to the spectrum of action of natural penicillins, but they are inferior to them in antimicrobial activity. The advantage of these drugs is stability against staphylococcal B-lactamases, and therefore they are considered the drugs of choice in the treatment of staphylococcal infection.
Aminopenicillins:
Ampicillin;
Amoxicillin;
Bacampicillin;
Pivampicillin.
They are characterized by a wide spectrum of antimicrobial action. They are highly active against some gram-negative bacteria, mainly of the intestinal group (Escherichia coli, Proteus, Salmonella, Shigella, Haemophilus influenzae). Bacampicillin and pivampicillin are ampicillin esters, which, after absorption in the intestine, are de-esterified and converted into ampicillin, absorbed better than ampicillin, and create high blood concentrations after taking the same doses.
Aptispseudomonas penicillins:
Carboxypenicillins (carbenicillin, ticarcillin);
Ureidopenicillins (piperacillin, azlocillin, mezlocillin). This group has a wide spectrum of action on gram-positive cocci, gram-negative bacilli, anaerobes.
Preparations containing penicillins and B-lactamase inhibitors:
Ampicillin and sulbactam - unazine;
Amoxicillin and clavulanic acid - amoxiclav, augmentin;
Ticarcillin and clavulanic acid - tymentin;
Piperacillin and tazobactam - tazocin.
These drugs are fixed combinations of broad-spectrum penicillins with B-lactamase inhibitors. They have the property of irreversibly inactivating a wide range of B-lactamases - enzymes produced by many microorganisms (staphylococci, enterococci, Escherichia coli), bind enzymes and protect the broad spectrum penicillins contained in their composition from the action of B-lactamases. As a result, microorganisms resistant to them become sensitive to the combination of these drugs.
Cephalosporins of I, II, III and IV generations. They rank first among antibacterial agents in terms of frequency of use in inpatients. They have a wide spectrum of antimicrobial action, which covers almost all microorganisms, with the exception of enterococci. They have a bactericidal effect, have a low frequency of resistance, are well tolerated by patients and rarely cause side effects.
Their classification is based on the spectrum of antimicrobial activity. In clinical practice, the most commonly used cephalosporins of the I, II and III generations. In recent years, two drugs have appeared, which, on the basis of their antimicrobial properties, have been attributed to IV generation cephalosporins.
Generation I cephalosporins - cephaloridin, cephalothin, cefapirin, cefradine, cefazolin, cephalexin.
II generation cephalosporins - cefamandol, cefuroxime, cefoxitin, cefmetazole, cefotenan. They have a wider spectrum of action than drugs of the 1st generation.
Third generation cephalosporins - cefotaxime, cefodizime, cefoperazone, ceftibuten, cefixime, latamoxef, etc. Some drugs are active against Pseudomonas aeruginosa.
Cefodizim - the only cephalosporin antibiotic with an immunostimulating effect.
They are widely used to treat nosocomial infections.
IV generation cephalosporins - cefpirome, cefepime - have a wider spectrum of action than III generation cephalosporins. Their high clinical efficacy has been established in the treatment of various nosocomial infections.
Carbapenems. Carbapenems (imipenem, meropenem) and combined carbapenem thienam (imipenem + sodium cilastatin) are characterized by the widest spectrum of antibacterial activity. They are used to treat severe infections, mainly hospital ones, especially with an unknown causative agent of the disease. The wide spectrum and high bactericidal activity allow using these drugs as monotherapy, even in the treatment of life-threatening infections.
Aminoglycosides. All of them act only on extracellular microorganisms. There are three generations of aminoglycosides, but only II generation (gentamicin) and III (sisomycin, amikacin, tobramycin, netilmicin) aminoglycosides are used.
Tetracyclines. They inhibit protein synthesis in a microbial cell, have high activity against gram-positive and gram-negative microorganisms (aerobic and anaerobic), chlamydia, rickettsia, cholera vibrio, spirochetes, actinomycetes. The most active drugs are doxycycline and minocycline.
Doxycycline circulates in the body for a long time and is well absorbed (95%) when taken orally.
Macrolides(erythromycin, clarithromycin, spiramycin, azithromycin, midecamycin). The spectrum of their action is similar to that of natural penicillins. Depending on the type of microorganism and the concentration of the antibiotic, macrolides act bactericidal or bacteriostatic. They are the drugs of choice in the treatment of croupous pneumonia, atypical pneumonia, streptococcal infections (tonsillitis, erysipelas, pharyngitis, scarlet fever).
Lincosamides(lincomycin, clindamycin). The mechanism of action of lincosamides is to suppress the protein synthesis of bacteria. They are active against anaerobes, staphylococci and streptococci. They are the drugs of choice in the treatment of infections caused by anaerobic microorganisms (infection of the abdominal cavity and small pelvis, endometritis, lung abscesses and other localization). As an alternative agent, they are used for staphylococcal infections.
Glycopeptides(vancomycin, teicoplanin). They disrupt the synthesis of the cell wall of bacteria, have a bactericidal effect. Active against streptococci, pneumococci, enterococci, corynebacteria.
Chloramphenicol. Broad-spectrum antibiotic. It is active against gram-positive cocci (staphylococci, streptococci, pneumococci, enterococci), some gram-negative bacteria (colibacillus, hemophilus influenzae), anaerobes, rickettsia.
Rifampicin. The mechanism of action is associated with the suppression of RNA synthesis in the microbial cell. Active against mycobacterium tuberculosis, gonococci, meningococci.
Polymyxins[polymyxin B, polymyxin E (calistin)]. The mechanism of action is associated with damage to the cytoplasmic membrane of the microbial cell. They are used only in cases of severe gram-negative infection (Pseudomonas aeruginosa, Klebsiella, Enterobacter) with resistance to all other antibacterial agents.
What is an antiseptic used for? This is one of those topics that require a special, careful approach. The fact is that there are many types of antiseptics. All of them should be used as directed, in a strictly defined dosage. The article presents the main types of antiseptics and their areas of application. Let's start with the definition.
What is an antiseptic?
Destroys putrefactive bacteria and prevents decomposition. The origin of the word is Greek. In translation "άντί" means "against", a "σηπτικός" translates as "putrefactive" or "Festering".
Some antiseptics are germicidal and capable of destroying microbes, while others are bacteriostatic and can only prevent or suppress their growth.
An antiseptic is a drug that has already been proven to be effective. Microbicides that have the ability to destroy viral particles are called "antiviral drugs".
Action
In order for bacteria to grow, they need a favorable nutrient medium (temperature, oxygen, moisture). Every housewife in her life is faced with these conditions when preserving food. Another example is the ancient practice of embalming the dead. Why do scientists find perfectly preserved mummies after many centuries? The answer is simple: even then antiseptics were used.
Before the concept of microbes was formed, attention was focused on preventing decay. Initially, the amount of the required agent was determined, as they say, "by eye". This method was inaccurate, but experience, as you know, comes with time and in practice. Today antiseptics are evaluated according to their effect on clean culture of a certain type of microbes or spore and vegetative forms. To compare the strength of action, a phenol solution (aqueous) taken as a standard is used.
So, an antiseptic is an antiseptic disinfectant. Now let's figure out in which areas it is most often used.
Antiseptic in medicine
In this area, disinfection is especially important. Before the advent of modern high-quality antiseptics, "mechanical cleaning" was widely used, which consists in opening purulent formations. By the second half of the 18th century. Lister studied the "microbial theory of putrefaction" written by Louis Pasteur. Inspired by the idea, he soon published a paper revealing antiseptic principles in surgery.
Particular attention was paid to It was a new way of treating pustules and open fractures. Its essence was to apply dressings with a solution of this acid. Lister became the founder of antiseptics, which helps to effectively fight infection. Moreover, a 5% solution was applied to wounds, and a 2% solution was used for suture and dressing materials, operating fields, and hands.
Lister's antiseptic had not only supporters, but also ardent opponents. This was due to pronounced irritating and toxic effects both on the patient's tissue and on the hands of the surgeon himself. Therefore, work in this area continued intensively. A quarter of a century later, the aseptic method was discovered. The results of the discovery were impressive. And so much so that proposals were made to abandon antiseptics. However, it turned out to be impossible to do this. The work continued.
Soon, new ones, less toxic to the body, were proposed. Surgical instruments and objects surrounding the patient began to be treated with the same substances. Thus, antiseptic and aseptic are intertwined, and very tightly.
Types of antiseptics
Physical(dressing, application of drying powders, laser, ultraviolet rays).
Chemical. It is very important not only in the treatment of wound infections, but also in their prevention. Has a detrimental effect on microorganisms.
Biological. It is based on the use of a rather diverse and large group of drugs that affect both the microbial cell itself and its toxins, thereby increasing the defenses of the whole organism (bacteriophages, antibiotics, antitoxins (most often serums), proteolytic enzymes).
Mixed. The most common, includes several types at once (for example, primary treatment of wound surfaces (mechanical), and introduction (biological)).
The number of antiseptics today is enormous. But their application is almost always complex. In other words, the statement "an antiseptic is an antibiotic" is, in fact, correct. However, today's medicine cannot do without "additional support" in the form of wound treatment and disinfection of premises.
Now let's consider the most common antiseptics in medicine.
Alcohols
Ethanol, isopropyl, propyl. Concentration from 60% to 90%. They are used both in pure form and in mixed form. Allows you to disinfect the skin before injection and surgery. Often these alcohols are combined with tincture of iodine or with cationic surfactants (chlorhexidine, benzalkonium chloride, octenidine dihydrochloride).
Ammonium compounds
Another common name is HOUR. Contain a number of chemicals (benzalkonium chloride (BAC), cetyltrimethylammonium bromide (CTMB), benzethonium chloride (BZT), cetylpyridinium chloride (CPC or Cetrim)). added to some disinfectants. Essential for treating the skin before surgery. Used to impregnate antiseptic towels. The antimicrobial effects of QAC are inactivated by anionic surfactants (eg, soap).
Boric acid
It is added to suppositories designed to treat fungal infections of the vagina. perfectly fights against herpes virus attacks. Also added to burn creams and lens solutions.
Chlorgeskidine gluconate
Brilliant green
Popularly referred to as "brilliant green". A very common drug. Used to treat wounds, small abscesses. It has a detrimental effect on gram-positive bacteria.
Hydrogen peroxide
It is an antiseptic used to deodorize and cleanse ulcers and wounds. In everyday life, they are most often treated with scratches, an umbilical cord. 6% and 3% solutions are available.
Iodine
Most often used in alcohol pre- and postoperative antiseptic. It is not recommended to disinfect small wounds with it, as it promotes scarring. Among the main advantages is high antimicrobial activity. With prolonged exposure, it kills the main pathogens, including spores of complex forms of microorganisms.
Means "Miramistin"
This is a new generation drug. Medication "Miramistin" is an antiseptic that is used in the treatment (or for the prevention) of infections of a fungal, viral and bacterial nature. Russian production. For the treatment of a number of infectious (colds) diseases, this particular antiseptic is often recommended. Most of the reviews about him are very positive. The drug is active against a wide range of microbes that cause inflammation and suppuration of wounds, sore throat, fungal diseases, chlamydia, herpes, etc. The activity of Miramistin does not depend on the location of the pathogen.
ASD
The second name is a stimulant antiseptic. Has pronounced antimicrobial and stimulating properties. Helps to increase the overall tone, reduces intoxication. It is active against staphylococci, tubercle bacillus, etc. It has a rather unpleasant pungent odor, therefore it is more often used for veterinary purposes.
Phenol
In the form of a solution, it is used to treat the doctor's hands immediately before the operation. Recommended for mouth and throat gargles. Phenol powder is sprinkled on the navel during healing. It has both antiseptic and analgesic effects.
Antiseptics outside of medicine
They are in demand in the food industry. As a rule, these are preservative antiseptics, most often acids (for example, the well-known acetic acid). It is thanks to them that it is possible to store canned food for a long time. Antiseptics are very actively used in construction. They are added to most paints and varnishes. This allows you to neutralize the saprophytic microflora. Wood antiseptic is a powerful weapon against blue stain, mold, rotting, fire. In addition, it extends the shelf life of freshly cut trees.
The glazing antiseptic is especially in demand. What it is? This is the name of a drug that allows you to preserve the texture of wood and at the same time emphasizes its beauty. reduces the harmful effects of moisture, ultraviolet rays, temperature changes, and is effective against insects. Antiseptics are also used in everyday life. They are added to detergents, rooms are treated with them.
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