Раціональна терапія гнійно-запальних захворювань малого таза

Abstract

The objective: to evaluate the efficacy of Tazpen® (piperacillin/tazobactam) for the treatment of chronic inflammatory diseases of the pelvic organs. Materials and methods. 67 women of reproductive age with exacerbation of chronic inflammatory diseases the pelvic organs (salpingitis, salpingoophoritis) were examined. Antimictobal therapy was different in two groups: first that include 35 patients was treated with third generation cephalosporine ceftriaxone (2.0 grams daily: 1.0 gram each 12 hours intravenously), for the second group with 32 women Tazpen® (piperacillin/tazobactam) was prescribed (4.5 grams each 6–8 hours intravenously). Efficacy assessment was based on analysis of duration the hospitalization and the pain level according to The Visual Analogue Scale (VAS) on the admission day, 3rd, 6th day and the day of discharge, duration of hyperthermia, leucocyte level with number of band neutrophils on the admission day, 3rd day and the day of discharge. Results. Clinical signs of exacerbation of chronic inflammatory diseases of the pelvic organs included general weakness, hyperthermia, pelvic pain, pathological discharges, dyspareunia. During the treatment the intensity of pelvic pain decreased, difference of pain levels according to VAS between two groups of study was statistically significant on the 6th day of hospitalization and the day of discharge, that accounts 33.7±1.9 mmand 29.7±2.4 mmon the 6th day in first and second group respectfully, and on the day of discharge –14.0±0.8 mmin first group and 8.8±1.3 mmin second group (p<0.05). Duration of hyperthermia from the day of admission was 3.09±0.17 days in the group of ceftriaxone that is statistically greater than in the group of Tazpen – 2.16±0.21 days (p<0.05).The number of leukocytes and band neutrophils were measured before the treatment, this marker was also decreased in the process of treatment and reached reference intervals on the day of the discharge in both groups. Duration of hospitalization differed in two groups with statistical significance: it accounted 10.71±0.42 days in the first group, treated with ceftriaxone, and 7.34±0.32 days in the second group, treated with piperacillin/tazobactam. One patient (2.9%) from the first group has developed such complication as tubo-ovarian abscess while no one from the second group had such complication. Conclusions. Combination drug Tazpen® (piperacillin/tazobactam) demonstrate comparable or even superior efficacy of treatment of chronic inflammatory diseases of the pelvic organs in comparison with medications of classical schemes. Diminished systemic indicators of inflammatory process alongside with decreased duration of hospitalization evidences the perspective of widening the clinical indicators for Tazpen® prescription and shows an importance of further clinical researches. Key words: chronic inflammatory diseases of the pelvic organs, pelvic pain, broad-spectrum antibiotics, piperacillin, tazobactam, treatment.