Modern antibiotic therapy of individual nosological forms begins with empirical treatment, when antibiotics are administered immediately after the diagnosis of the disease, taking into account possible pathogens and their sensitivity to drugs. When choosing a drug for initial therapy, data from the literature on its spectrum of action on microorganisms, pharmacokinetic features, etiological structure of this inflammatory process, and structure of antibiotic resistance are taken into account. Before starting therapy, one should receive material from the patient for microbiological examination.
From the first days of the disease, it is advisable to prescribe an antibiotic or a combination of antibiotics that best cover the spectrum of possible pathogens. To do this, it is necessary to use combinations of synergistically acting antibiotics with an action spectrum that complements each other, or one drug with a broad spectrum of action. In case of positive dynamics of the disease, based on the results of microbiological research, it is possible to switch to drugs of a narrower spectrum of action. After isolating the pathogen and determining its sensitivity to antimicrobial drugs in the absence of clinical effect from the initiated empirical therapy, it is advisable to continue the treatment with the drug to which, according to the analysis, the causative agent of the disease is sensitive. Purposeful monotherapy is often more effective, it is more profitable and economically. Such tactics of antibiotic therapy is used in the treatment of the GDH in obstetrics and gynecology.
The combination of antibacterial drugs is indicated in the treatment of diseases of polymicrobial etiology in order to reduce the possibility of the development of antibiotic resistance of certain types of bacteria, to take advantage of the combined effect of antibiotics, including reducing the dose of drugs used and their side effects. However, it should be borne in mind that combination therapy is usually less economically advantageous than monotherapy.
Antibacterial therapy of the GDH in obstetrics and gynecology should be systemic, and not local. With systemic treatment, it is possible to create the necessary concentration of antibiotics in the blood and the lesion focus, maintaining its required time. Local use of antibacterial drugs does not allow to achieve this effect, which in turn can lead to the selection of resistant strains of bacteria and the lack of effectiveness of local antibiotic therapy.