Significantly higher doses of penicillin are used in foreign clinics with good results, and the average effective daily dose for prolonged septic endocarditis with positive hemoculture of penicillin-sensitive non-hemolytic streptococcus is set at approximately 2,000,000-2,500,000 units with a treatment duration of 4 to 6 weeks. Short-term treatment courses for 10-17 days of combined penicillin and streptomycin therapy with a daily dose of penicillin from 5000000 to 16 000 000 units are also used with good results. and streptomycin from 1 to 2 g .
If the time for receiving hemoculture and adaptation is too long, the sensitivity value decreases — the doctor cannot wait, he treats the patient with high doses of penicillin. If the effect is not achieved, and the determination of sensitivity has become practically possible, it can only be used to make rational adjustments to the treatment of severe cases of prolonged septic endocarditis that do not respond quickly to conventional therapy. However, such a "clarification" is also of relative importance: after all, we are talking about determining the sensitivity of the pathogen to penicillin in vitro, which may not fully correspond to the data in vivo (in the patient's body). In a practical approach to the treatment of prolonged septic endocarditis, the basis for monitoring the rational treatment of this disease is primarily clinical criteria: temperature drop, the dynamics of the stem reaction, the dynamics of blood parameters, urine tests, etc. Upon recovery, these indicators steadily return to normal; in remission (false recovery), one or more indicators (anemia, hematuria) They persist in the status quo, although the patients feel good and the temperature drops to normal. Then there is the question of raising the doses, of long-term treatment. But only in some cases does this lead to recovery, and for the most part, to the postponement of death. From the point of view of rational antibiotic therapy, cyclical course therapy is generally useful for preventing the development of microbial resistance to antibiotics: after an active course, which usually lasts 1-1.5 months, treatment intervals are made; during the intervals, microbes that have developed an addiction to an antibiotic become more sensitive and react more strongly after a new course of treatment on antibiotics.
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