Anti-inflammatory drugs.

Anti-inflammatory drugs are often the first step in treating inflammatory bowel disease. They include:

Sulfasalazine. Although this drug is not always effective in treating Crohn's disease, it may help treat other inflammatory diseases of the colon. It has a number of side effects, including nausea, vomiting, heartburn and headache. Do not take this drug if you are allergic to drugs that contain sulfur.

Mesalamine. This drug is generally better tolerated by patients and has fewer side effects than sulfasalazine, but can cause nausea, vomiting, heartburn, diarrhea and headache. It is taken in tablet form or administered rectally (into the rectum) in the form of enemas or suppositories, depending on which part of the large intestine is affected. Mesalamine is generally effective in 90 percent of people with mild ulcerative colitis. Patients with proctitis tend to respond better to combination therapy with mesalamine tablets and suppositories. For left-sided colitis of mild or moderate severity, the combination of taking mesalamine tablets and mesalamine enemas is more effective than using each of these methods separately.

Corticosteroids . Hormones - Corticosteroids can reduce inflammation anywhere in your body, but they have many side effects, including excessive facial hair growth, night sweats, insomnia and hyperactivity. More serious side effects include: high blood pressure, type 2 diabetes, osteoporosis, bone fractures, cataracts, and increased susceptibility to infections. Long-term use of corticosteroids in children may slow their growth.
Doctors usually use corticosteroids only if you have severe bowel disease that doesn't respond to other treatments.

Corticosteroids are not suitable for long-term use. But, they can be used for short courses (three to four months) to reduce symptoms and achieve remission. Corticosteroids may also be used together with immunosuppressant medications. Corticosteroids help achieve remission of the disease, while immunosuppressants help maintain it for a long time.
Sometimes a doctor may prescribe steroids for rectal use (into the rectum), suppositories, or enemas if the lower colon or rectum is affected. They are also intended for short-term use only.

Immunosuppressants.

They also reduce inflammation, but indirectly through the immune system. When the immune response is suppressed, inflammation also decreases. Immunosuppressants include:

Azathioprine (Imuran) and mercaptopurine (Purinethol). Since the first effects of their use may appear only after two or three months from the start of therapy, they are often prescribed in combination with glucocorticosteroid hormones, which begin to act much faster.

If you are taking any of these drugs, you should strictly follow your doctor's instructions and have regular blood tests to check for possible side effects.

Side effects may include: allergic reactions, bone marrow suppression, infection, liver and pancreas inflammation. The risk of developing cancer in the future also increases slightly. If you are taking any of these medications, you should strictly follow your doctor's instructions and have regular blood tests to help detect possible side effects. If you have had cancer before, you should tell your doctor before starting treatment with these drugs.

Cyclosporine (Sandimmune, Neoral). This potent drug is often used in patients with severe ulcerative colitis who have not responded to other therapies or who are candidates for surgical treatment. Thanks to the use of Sandimmune, in such patients, surgery can be delayed until the patient is prepared for surgery. In other cases, sandimmune is used for a short period to wait for the effect of less toxic drugs that begin to act later than sandimmune. Cyclosporine “works” starting from one to two weeks from the start of therapy. It is very effective, but there may be serious side effects with its use, such as impaired kidney and liver function, high blood pressure, seizures, severe infections and an increased risk of cancer.

Infliximab (Remicade). This drug is for adults and children with moderate to severe disease who do not respond to or cannot tolerate other treatments. It works by neutralizing a protein produced by the immune system known as tumor necrosis factor (TNF). Infliximab finds TNF in the blood and neutralizes it before the protein causes inflammation in the gastrointestinal tract.

Some patients with heart failure, multiple sclerosis, or cancer cannot take infliximab and other derivatives of this class (adalimumab and certolizumab pegol). Talk to your doctor about the potential risks of infliximab therapy. Using these drugs may pose a risk of contracting tuberculosis and other serious infections because they suppress the overall immune system. If you have an active infection, you should not take these medications. You must have a TB skin test (Mantoux test) and a chest x-ray before you start taking infliximab.

Additionally, because infliximab contains mouse protein, it may cause serious allergic reactions in some people. This reaction may occur several days or weeks after starting treatment. Infliximab is often used as long-term therapy, although its effectiveness may decrease over time.

Nicotine patches . It has been noted that nicotine patches (the same ones used when a person quits smoking) may provide some people with short-term relief from a mild flare-up of ulcerative colitis. How this happens is still not entirely clear, and there is currently no evidence that the patches work better than other treatments. What is clear is that the overall health risks of smoking far outweigh any potential benefits from nicotine. So don't start smoking hoping to cure your ulcerative colitis! Before starting treatment with nicotine patches, you should consult your doctor.

Other medicines.

In addition to medications that reduce the inflammatory response in the intestinal wall, some medications may help relieve symptoms. Depending on the severity of your ulcerative colitis, your doctor may recommend one or more of the following:

antibiotics. For patients with ulcerative colitis who develop a fever, the doctor may prescribe a course of antibiotics to fight the infection.

antidiarrheal drugs (stool hardeners). The use of antidiarrheals should be done with caution and only after consultation with a doctor, as they increase the risk of toxic megacolon (acute dilatation and disturbance of colon tone) - a life-threatening inflammation of the large intestine . To treat severe diarrhea, your doctor may prescribe loperamide (Imodium).

painkillers. For moderate pain, your doctor may recommend acetaminophen (Tylenol) and other pain relievers. Avoid taking non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen or naproxen. There is a possibility that they may worsen your illness.

iron supplements . If you have chronic intestinal bleeding, iron deficiency anemia may develop over time. Taking iron supplements will help maintain normal blood iron levels and eliminate iron deficiency anemia after intestinal bleeding has stopped.

Surgical treatment of nonspecific ulcerative colitis.

If diet, lifestyle changes, medications, or other treatments do not improve the disease or reduce symptoms, your doctor may recommend surgery to remove the part of the digestive tract damaged by inflammation. About 25-40% of patients with ulcerative colitis will ever require surgery.

Surgical treatment leads to the disappearance of ulcerative colitis. But such treatment usually means removing the entire colon and rectum (proctocolectomy) and creating a permanent or temporary ileostomy. An ileostomy is the creation of an opening in the abdominal wall to allow the remaining small intestine to drain out. Through the ileostomy, stool is collected in a special sealed bag. In the subsequent second stage, it is possible to perform an ileoanal anastomosis (the lower end of the small intestine is connected to the anus), this operation eliminates the need to wear a sealed bag to remove feces. Instead, the surgeon uses the cecum and part of the small intestine to create a pocket to collect stool, which connects to the anus. This allows stool to pass through a natural opening, although stools may be more frequent, soft, or watery because water is mostly absorbed in the large intestine that has been surgically removed.

Diet for UC.

It has not been conclusively proven that there is a clear connection between the foods you eat and the incidence of inflammatory bowel disease. But certain foods and drinks can make symptoms worse, especially during a flare-up. Try keeping a food diary to keep track of what you eat as well as how you feel. If you find that certain foods make your symptoms worse, you can try eliminating them from your diet. Here are some tips that may help you:

Limiting the consumption of certain foods . Like many people with inflammatory bowel disease, you may find that symptoms such as diarrhea, abdominal pain and bloating improve when you limit or eliminate your dairy intake. You may be lactose intolerant, a condition where your body cannot digest the milk sugar (lactose) found in dairy products. If this is the case, then you should limit your consumption of dairy products and take enzyme preparations with lactase (an enzyme that breaks down lactose) with meals. You may need to completely eliminate dairy products from your diet. In such cases, a nutritionist will help you create a healthy diet low in lactose. Keep in mind that when eliminating dairy products from your diet, you will need to use dietary supplements as sources of calcium.

Alimentary fiber. For most people, high-fiber foods such as fresh fruits, vegetables and whole grains are the foundation of a healthy diet. But if you have inflammatory bowel disease, consuming too much fiber can lead to diarrhea (loose stools), pain, and bloating. If eating raw fruits and vegetables gives you trouble, try steaming, baking or sautéing them. Legumes, nuts, cabbage, seeds, whole grains and popcorn are also poorly tolerated. Consult your doctor to adjust your diet.

"Prohibited" products . Eliminate all foods from your diet that may aggravate your symptoms. These may include "gas-forming" foods such as beans, cabbage (any kind), raw fruit juices and fruits - especially citrus fruits, spicy foods, corn, alcohol, chocolate and drinks containing caffeine and soda (sparkling water).

Eat small meals . You may feel better if you eat five or six small meals a day rather than two or three large meals.

Drink plenty of fluids . Try drinking more fluids per day, preferably water. Alcohol and caffeinated drinks stimulate your bowel movements and can increase diarrhea, while carbonated drinks often lead to bloating.

Multivitamins. Because ulcerative colitis can impair the ability to absorb nutrients and due to dietary restrictions, multivitamin and mineral supplements are often necessary. Check with your doctor before taking any vitamins or supplements.

Consultation with a nutritionist . If you begin to lose weight, or your diet has become very restrictive, you need to consult a nutritionist.

Stress management.

Although stress does not cause nonspecific ulcerative colitis, it can aggravate the disease and cause a flare-up. Stressful situations can range from minor annoyances to psychological shocks such as the loss of a job or the death of a loved one.
When a person experiences stress, the digestion process is disrupted. The stomach empties more slowly and secretes more gastric juice. Stress can also speed up or slow down the passage of food through the intestines, as well as cause changes in the tissue of the intestinal wall itself. While it's not always possible to avoid stress, you can learn ways to help manage it. Some of them are given below:

Physical exercise . Even moderate exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your doctor about exercise therapy that's right for you.

Regular relaxation and breathing exercises . One way to combat stress is to relax regularly. You can take yoga classes, meditation classes, or use books or CDs at home.

Pregnancy with nonspecific ulcerative colitis.

Women with ulcerative colitis, as a rule, successfully carry a pregnancy to term, especially if the disease is in remission throughout pregnancy. There is a slight increase in the risk of preterm birth and low birth weight. Some medications cannot be used to treat ulcerative colitis during pregnancy, especially during the first trimester. The effects of some drugs may continue even after you stop using them. As you prepare for pregnancy, talk to your doctor about the best way to prevent the condition from getting worse. The risk of developing ulcerative colitis in a child is thought to be less than 5 percent unless your partner has ulcerative colitis.

Alternative medicine.

Many people with ulcerative colitis or Crohn's disease have used some types of alternative therapy, such as: herbal treatments and the use of nutritional supplements; probiotics (preparations that contain live microorganisms that are representatives of the normal human microflora); fish fat; aloe vera; acupuncture.

Side effects and ineffectiveness of conventional therapy are the main reason for seeking an alternative approach. Most alternative treatments are not approved by the FDA. Manufacturers may claim that their drugs are safe and effective, but this has not been proven by serious research. In some cases, this means that you may be spending money on something that won't really benefit you. For example, studies on fish oil and probiotics for the treatment of ulcerative colitis have not noted any improvement in the course of the disease. Moreover, even medicinal herbs and supplements can have side effects and interact dangerously with each other. If you decide to try any herbal supplements, tell your doctor. Unlike probiotics (which are live bacteria), prebiotics are natural compounds found in plants such as artichokes that mimic the growth and reproduction of beneficial gut bacteria. Initiated studies on the effectiveness of prebiotics have yielded the first promising results. Additional research is ongoing. Some people with ulcerative colitis benefit from acupuncture or hypnosis, but these treatments have not been thoroughly studied.

If ulcerative colitis is suspected, it is very important to conduct a competent examination, since acute forms of ulcerative colitis differ little from a number of infectious diseases. Patients suffering from ulcerative colitis are at high risk of developing colorectal cancer.

Last consultation

Ilvira asks:

Good afternoon Please tell me whether it is possible to take the drug Celebrex if diagnosed with ulcerative colitis (in remission)

Elena asks:

Hello. I have been diagnosed with UC, please tell me in detail about the diet during exacerbations of the disease and recession. With proper treatment and diet, when should we expect the first recession after a severe form of left-sided UC? Thank you.

Answers Ventskovskaya Elena Vladimirovna:

Hello. In case of severe exacerbation of UC, the most gentle, slag-free diet is used. It does not consist of products (in the usual sense of the word), but of vital, easily digestible substances (amino acids, glucose, minerals, multivitamins, peptides). In severe cases, parenteral nutrition is prescribed in the hospital.
In case of severe exacerbation of the disease, diet No. 4 is prescribed, but with some features (more on them below). This is a diet with mechanical, chemical and thermal sparing of the intestines. Food is given pureed, boiled or steamed, the diet is fractional (5-6/s). The protein content in the diet is increased to 120g per day (lean meat, fish, steamed omelettes, dairy products are not recommended) Carbohydrates are limited to 250g/s with a maximum limitation of fiber (mashed porridge in water, white bread crackers, legumes and pasta are excluded). Fats are limited to 60 g/s; you can add 5 g of butter per serving. As the improvement progresses, diet 4b is prescribed - for 3-4 weeks (with fats and carbohydrates brought to normal, low-fat cottage cheese, kefir, vegetables and fruits that do not cause fermentation are allowed), then diet 4c - in remission (physiological nutritious nutrition, but preparations are being made steamed, boiled, baked, fractional dishes, spicy spices and sauces are excluded, vegetables and fruits that cause fermentation are limited) As for your question about the waiting period for remission, it would be unprofessional to give such forecasts, especially without knowing detailed research data and symptoms of the disease ; Yes, and in each organism everything is very individual. Good luck!

Marina asks:

Hello! I have ulcerative colitis, I have been ill for two years, it was in a severe stage, after several months of treatment with salofalk, during checks they write that the colitis is in remission, but I have an exacerbation about every 2 months. Help, why is this? At the same time, I am taking medication I don’t stop! And what is the probability of getting cancer if you are undergoing treatment and constantly consult a doctor? please tell me what percentage of patients (UC) develop intestinal cancer? Thanks in advance!

Answers Tkachenko Fedot Gennadievich:

Good evening, Marina.
In your situation, it is impossible to answer all the questions accurately, since the cause of the development of ulcerative colitis is unknown, like many systemic autoimmune diseases, and therefore our drug treatment options are limited, since we are not treating the cause, but the effect. The fact that you constantly take maintenance therapy correctly is a standard that applies in all civilized countries.
Taking maintenance therapy, in your situation this is salofalk, is recommended even if remission develops.
Why are you experiencing exacerbations of the disease even while taking maintenance therapy? I cannot say, and it is unlikely that anyone can. Usually, according to statistics, this happens in the autumn-spring period, against the background of errors in the diet, against the background of various stresses.
Regarding the malignancy of UC, this is quite individual, and it is impossible to foresee this situation and calculate it, you just need to regularly visit a proctologist, perform FCS and, if necessary, conduct biopsies of the mucous membrane with an assessment of inflammatory processes and, most importantly, dysplasia processes - an indicator of a possible process of degeneration into malignant growth.
In addition to the above, I can say the following that with increasing duration of the disease, if a patient has been suffering from UC for 15-20 years, this figure is about 5-10%, with a longer duration of the process it increases to 20%.
Sincerely, Tkachenko F.G.

Dmitry asks:

Hello!
I have been sick for 4 months. The diagnosis is nyak. The condition is serious. I went to the toilet 15-20 times. Blood, pus. Temperature 39-40. The sigmoid colon is affected. Treatment: salofalk, prednisolone, tigeron drops. Among the antibiotics, alpha-normix (ordered in Moscow). Probiotics - lactovit-forte. After a month of such treatment, pulse therapy was introduced. There has been a noticeable improvement. The blood and pus are gone. The temperature is normal. However, the number of trips to the toilet is approximately 10 times. Tenesmus. At 4 months of treatment, I was diagnosed with paraproctitis. On March 1 I was operated on. The operation worsened. My weight dropped from 96 kg to 72. This was during the entire period of illness (4.5 months), weakness. I follow my diet strictly. Now the questions:
Is it appropriate to do a colonoscopy during an exacerbation?
How can I diversify my diet in my situation? I have a persistent aversion to food.
Can you tell me more about the drug Remicade? Do you have any experience using it?
Thanks in advance.
Best regards, Dmitry.

Answers Tkachenko Fedot Gennadievich:

Good afternoon, Dmitry. During an exacerbation of ulcerative colitis, it is possible, and sometimes necessary, to perform fibrocolonoscopy, since according to the endoscopic picture, in addition to the general condition of the patient, one can judge the degree of activity of the inflammatory process in the colon. However, the final decision on the feasibility and possibility of fibrocolonoscopy ultimately rests with the attending physician. Regarding diet, against the background of exacerbation of the inflammatory process, it is impossible to expand and diversify the diet. Remicade is a drug that belongs to the so-called biological therapy of inflammatory bowel diseases (UC, Crohn's disease). It is a monoclonal antibody to tumor necrosis factor, one of the main inflammatory factors that damage the colon wall in patients with UC or Crohn's disease. The world has already accumulated quite a lot of experience in using this drug, and the data obtained show that if it is used correctly (according to indications), good results can be obtained. However, this drug is not a panacea; it is impossible to cure a patient with UC with it, just like with any other drug. Therefore, the decision to use this drug in the treatment of each specific patient must be made carefully and individually, taking into account both the individual characteristics of the patient’s condition and the indications and contraindications for prescribing Remicade.

Leila asks:

Hello!
Please tell me how many people live with UC?
I have had UC for 2 years now! How can I stop exacerbations? And can anyone help me?

Answers Lukashevich Ilona Viktorovna:

Dear Leila!

UC (nonspecific ulcerative colitis) is a chronic autoimmune disease that has periods of exacerbation and remission. From the above, it follows that a chronic disease will be curable only with complete removal of the rectum and colon if conservative (drug) therapy is ineffective. Like any autoimmune disease, UC is still a disease whose course is difficult to predict even with proper and timely treatment, limiting stress factors and following a diet. But still, the course is most often characterized by the presence of remissions, which the patient achieves against the background of proper treatment and internal “restructuring” in the body.

There is no evidence that a patient with UC has a shorter life span than other patients or absolutely healthy people! It’s just that a patient with inflammatory bowel disease must always adhere to certain rules.

You need to be seen by 1 proctologist. In case of exacerbation, take a therapeutic course of drugs (including 5-aminosalicylic acid drugs in a therapeutic dose, vitamin therapy, infusion therapy if indicated), with a transition to maintenance therapy.

Once a year it is necessary to do a colonoscopy, even without exacerbations of the disease, since with a long history of the disease (more than 10 years), there is a risk of malignancy (malignant degeneration and intestinal cancer).

You need to adhere to dietary recommendations (dietary table No. 4), only with endoscopic and clinical remission, in agreement with the treating doctor, expand your diet. Do not consume fresh fruits, berries and vegetables, milk, chocolate, spices, or alcohol. Diet violations and food poisoning provoke exacerbations.

It is necessary to minimize the number of stress factors in life, no matter how unrealistic it may seem to you! Stress factors provoke exacerbations!

Be careful with pregnancy planning and abortions. Pregnancy, childbirth, abortion can provoke a serious exacerbation. Therefore, family planning issues must be agreed upon with the attending doctor (proctologist) and gynecologist.

Be careful with colds and sexually transmitted diseases, as concomitant infections and their treatment can affect the course of UC.

Remember that UC is a serious disease, but NOT a death sentence. Follow the recommendations for basic and maintenance therapy given by your treating proctologist. Stick to your diet. Worry less. And do a colonoscopy once a year.

Anna asks:

I have ulcerative colitis and am 27 weeks pregnant. I was forbidden to take any medications. Now I have an exacerbation, maybe something can be done?

Answers:

Chief proctologist of the Kyiv region, head of the proctology department of the Kyiv regional clinical hospital, proctologist surgeon of the highest category, member of the board of the Association of Coloproctologists of Ukraine, member of the European Association of Coloproctologists

Good afternoon If the process worsens, it is, of course, necessary to be treated, and to be treated under the guidance of a doctor, and not by correspondence. If gynecologists are afraid of prescribing medications, contact proctologists. You can follow a diet, take vitamins and medications that normalize intestinal microflora. You can also choose herbal remedies and homeopathy. You are indicated for local treatment using wound healing agents, this can reduce the severity of the disease. Salofalk can be taken during pregnancy; the minimum permissible dose of the drug does not affect the development of the fetus, and the method of administration (suppositories, enemas or tablets) depends on the localization of the process. Dexamethasone during pregnancy is also used taking into account the expected therapeutic effect and negative effect on the fetus. With long-term therapy during pregnancy, the possibility of fetal growth disturbances cannot be excluded. If used at the end of pregnancy, there is a risk of atrophy of the adrenal cortex in the fetus, which may require replacement therapy in the newborn. So, be sure to find a smart doctor as soon as possible and, under his guidance, cope with the exacerbation. Your baby needs a healthy and strong mother! Get well and don't get sick anymore!

Victor asks:

I was examined and diagnosed with ulcerative colitis. Treatment was prescribed: saline solution, solcoseryl, trental, rheosorbilate, vit. B1, B6, B12, salofalk, pancreatin, trichopolum, tavegil, methyluracil. I am interested in how true this is and the urgency of taking medications. What diet should be given for this diagnosis? Recommendations, advice from traditional medicine.

Answers Tkachenko Fedot Gennadievich:

Hello, Victor. The treatment regimen for a disease such as ulcerative colitis includes the drugs you indicated. The main medicinal drug in this list is salofalk. The effectiveness of treatment depends on the dose of the drug, as well as on the form of its release - these can be tablets, granules, microenemas and suppositories. The choice of form and dose of the drug depends on the extent of the lesion. Regarding diet, the preferred diet is table 4. It is necessary to exclude from the diet raw vegetables, fruits, fatty meat and fish, smoked foods and spices, fermented milk products, with the exception of low-fat cottage cheese. Prepare boiled and stewed food. Try to avoid intense physical activity and stress. Regarding the urgency of treatment, international treatment standards require constant maintenance therapy and, in addition, you must realize that this is a serious chronic disease that cannot be cured - provided that it is indeed UC. When the disease lasts more than 15-20 years, about 20-30% of patients undergo surgery. In this regard, I would like to recommend that you monitor your health and take treatment very seriously.

Vladimir asks:

Hello
I have been suffering from diabetes for 2 years now. I constantly take salofalk, and besides it I tried budenofalk, various dietary supplements, etc. Unfortunately, over the past 1.5 years, the maximum duration of remission was a week, i.e. I constantly live with a sluggish disease and drink salofalk. At the moment, only my rectum is damaged, but my fellow sufferer over time also had his rectum damaged.
I recently read that you can cut out the rectum, and the rectum will partially take over its functions. Please tell me how life goes without the rectum: is it possible to “teach” its functions to the large intestine, as it was written on one website?
With respect and great gratitude, Vladimir

Answers Tkachenko Fedot Gennadievich:

Hello Vladimir. After reading your letter, I got the impression that you have somewhat incorrect ideas about such a disease as UC. UC is a chronic disease affecting the colon, and the inflammatory process always begins in the rectum and, as the inflammatory process progresses, spreads to the proximal parts of the colon towards the cecum. Therefore, surgical treatment aimed at removing the rectum for UC will not be effective and is not currently used. During surgical treatment of ulcerative colitis, the entire colon is removed, sometimes the anal canal is preserved. If the anal canal is preserved, it can be used in the future for reconstructive surgery - a reservoir is created from the small intestine, which is sutured to the anal canal. Crohn's disease is another matter - with this disease, surgical interventions are actually carried out aimed at partial or complete removal of the rectum. Thus, removing only the rectum will not solve the problem of curing UC. Moreover, if only your rectum is affected, then there is hardly any talk about surgical treatment. It is necessary to optimize treatment as much as possible. Budenofalk is not used in tablet form if only the rectum is affected by UC. For rectal forms of UC, suppositories, enemas with mesalazine (salofalk, pentasa, assacol, etc.), as well as budenofalk in the form of foam should be used (available only outside of Ukraine, my patients get this drug in Germany).
Tablets of salofalk or pentasa can be used, but only with the above forms of drugs. In addition to the above, I want to say that in addition to the drugs mesalazine and 5-aminosalicylic acid (sulfasalazine), other drugs (immunosuppressants, hormones, Remicade, etc.) are used for the treatment of inflammatory diseases of the colon - each of them has its own indications and indications. contraindications. The treatment of any disease always has its own nuances, and the same applies to the treatment of a disease such as UC. I think that your questions regarding the treatment of UC should be discussed with a qualified proctologist, undergo an adequate examination if necessary, and develop further treatment tactics.

Sveta asks:

Hello. Thank you Fedot Gennadievich for the consultation. My exacerbation manifests itself differently each time. This time I stool up to 20 times (before I just didn’t leave the toilet for 3 steps and back) with water, blood, mucus. I did not agree to the examination because the bleeding began suddenly and profusely. (although the tests are normal, hemoglob. 138, ROE 30) Currently, I have changed the microcl. salof. + prednisolone to the microcl. salof. + budenofalk. All other medications are the same.
Best regards, Svetlana.

Answers Tkachenko Fedot Gennadievich:

Hello Svetlana. In principle, such a combination of drugs as budenofalk and salofalk in enemas is possible. If there is a positive trend against the background of the prescribed treatment, that is, you notice an improvement, which is manifested in improved general well-being, a decrease in the number of bowel movements, the appearance of more formed stools, etc., then it hardly makes sense to change anything in the treatment. However, you must understand that budenofalk acts only on the terminal part of the small intestine, the cecum and the ascending colon, and salofalk enemas act only on the left parts of the large intestine. That is, if you have a total (whole colon) or subtotal lesion of the colon, then medicinal drugs do not affect all parts of the colon. In this regard, I would like to recommend that you do the necessary additional examinations (perhaps this will be fibrocolonoscopy or irrigography). But these issues should be resolved with your doctor. It may be necessary to continue taking budenofalk as a “mild” replacement for previously discontinued prednisolone - hormones cannot be abruptly withdrawn. Sincerely, Tkachenko F.G.

Alexander asks:

Good afternoon, dear doctors! I have UC, I’m 22 years old, I heard that UC is successfully treated with stem cells in Donetsk. Please tell me what you think about this. Have any of your patients tried this method? Do you think it’s worth going to the Morshyn sanatorium? The condition is normal, but there is blood in the stool, I drink salofalk. Thank you very much in advance.

Answers Tkachenko Fedot Gennadievich:

Hello, Alexander. The Proctology Center of Ukraine, where I have the honor of working, has been using embryonic stem cell transplantation since 1996. There is no scientifically proven evidence of the effectiveness of this method in the treatment of a disease such as UC. From my personal experience, I can say that there were patients who showed significant effectiveness of the transplant, but at the same time, there were cases where no significant effectiveness was noted from such treatment. Recently, we have been using this technique less frequently, which is primarily due to the significant cost of transplantation. If I'm not mistaken, then the cost of one dose of embryonic stem cells is about 600-700 USD, and in addition to this, the main treatment must be continued. In this regard, I will probably formulate my attitude towards this method of treatment this way - if your financial capabilities allow, then you can try this method of treatment, but you should not hope that the transplant will radically solve the problem of treating your disease. If this technique were really so effective, then it would probably be used everywhere, including abroad.

Lyudmila asks:

Thank you in advance for your answers to my questions.

Answers Tkachenko Fedot Gennadievich:

Alexander asks:

Good afternoon I am 21 years old, diagnosed with UC, moderate degree of activity, acute form. I have been taking Salofalk 500 mg per day for 40 days and I feel good. Question: how much Salofalk should you drink? Maybe it’s enough? Is it possible to work in a mine? Are there any cheaper tablets than salofalk, except sulfasalazine (not suitable)? Are there any traditional methods of treating and maintaining remission? Thank you very much in advance.

Answers Tkachenko Fedot Gennadievich:

Good afternoon Alexander. Try Pentasa instead of Salofalk. It's somewhat cheaper. But if sulfasalazine is not suitable for you, then the choice of drugs is small. These are all foreign-made drugs containing mesalazine: salofalk, pentasa, asacol, etc. Try taking sulfasalazine produced by KRKA Slovakia. Perhaps it is more purified and will be more easily tolerated by you. Regarding the timing of taking mesalazine drugs (Salofalk, Pentasa), there is the concept of maintenance therapy - if a diagnosis of UC is established, even during non-exacerbation, it is constantly recommended to take a maintenance dose of mesalazine drugs at a dose of 1.5-2.5 g per day. It is clear that this is a very expensive pleasure, but this is the recommended norm. Regarding traditional methods, I cannot tell you anything on this score. Try to maintain a strict diet, avoid stress and intense physical activity, and constantly see proctologists and gastroenterologists. Sincerely, Tkachenko F.G.

Tatiana asks:

HELLO DOCTOR. Thank you for your answers. Please answer some more questions. My husband has been sick with UC for a year. There were ulcers in the intestines, now they are gone, when examined in the fall, the large intestine was hyperemic and for 3 weeks the husband took salofalk, biogaia, Hillak-Forte, and herbs. Now spring is coming and bronchitis has worsened and antibiotics are prescribed. Tell me what kind of antibiotics you can use? or other additional medications? How long can remission last? How aggressive is the disease? Is the disease genetically transmitted? The information is different and very scarce, so why wait for 5-7-10... years and only cancer? Why is there so little research into a disease that is not interesting?

Answers Lukashevich Ilona Viktorovna:

Dear Tatyana, if it is necessary to prescribe antibacterial drugs, the risk of developing an exacerbation of UC is very high. Most authors and practicing doctors speak about the need to start taking salofalk in a minimum therapeutic dose in tablets (4 g/day) for the period of taking the antibiotic + 2 weeks. Other authors recommend not prescribing salofalk, simply following a diet, taking preparations of normal microflora, enzyme preparations, and only in case of exacerbation symptoms, starting treatment with salofalk. It is extremely difficult for me to advise you anything without an in-person examination, so I will limit myself to only recommending the need for an in-person examination by your proctologist of the rectum before prescribing antibiotics and monitoring during the treatment process. To treat bronchitis, by the way, antibiotics are not always prescribed; more often it is a combination of mucolytics, expectorants, vitamins and anti-inflammatory drugs. The period of remission for this disease can be from a month to several years. The activity of the disease depends on the number of “genomic damages” and the activity of provoking factors - stress, food poisoning, massive antibacterial therapy, severe trauma, severe infectious disease, etc. It is not the disease itself that is transmitted, but genes with “breakdowns”, because The child receives only half of the genetic information from his mother, and he receives the second from his mother; it is possible that your baby will not have enough damage to develop this disease. But if someone in your family suffered from similar diseases, the risk of developing such a disease in your child increases. It is not necessary that the disease develop into cancer after 10 years, but the risk of developing a cancerous tumor in the intestine with chronic inflammation is simply higher than in an ordinary person. This disease is not just being studied, it is being studied very carefully, in all countries and for decades. Where do you think the information presented above came from?

Asks Evgeniy Ivanovich:

For the last three months I have been suffering from pain in the lower abdomen. Initially, he went to the emergency room. Hospitalized in surgery. Nothing was found when doing a fluoroscopy of the gastrointestinal tract. They discharged me home and advised me to see a urologist and proctologist. I saw a urologist. After an ultrasound of the bladder and prostate gland (they did TRUS and even donated blood for X-ray), they said there was nothing serious. I went to see a proctologist. He looked, did a SICTOMANOSCOPI and said there was nothing. But the pain does not go away. Appointed for IRIGOSCOPY. And then after it they discovered DEVIRTICULOSIS with suspicion of DEVIRTICULISIS. Why, I don’t know, I didn’t see this during romanoscopy, that’s on the conscience of the proctologist, but he sent me to a gastroenterologist, who recommended that I take SALOFALK. I would like to know your opinion whether it is worth drinking it, will it help with this disease. I ask because I learned the opinions of some patients that it does not always help. But I, a 72-year-old pensioner, can’t afford to buy it; it’s very expensive and it’s not on the list of subsidized medications. And the gastroenterologist says to drink, maybe it will help. There is no certainty. It is with these doubts that I turn to you. Thank you for your consultation.

Answers Lukashevich Ilona Viktorovna:

Dear Evgeniy Ivanovich, diverticula of the colon cannot be seen during sigmoidoscopy, because this is an examination of the rectum, and they are localized higher - in the colon, so the proctologist’s conscience is clear and he follows the protocol for examining the proctological patient 100%, because ordered you the following study, which made the diagnosis. Further, for your illness, taking Salofalk medications is really indicated; this drug is really not the cheapest. Since August, we have the opportunity to prescribe you Salofalk free of charge in the required dosage under outpatient supervision of one of the employees of the Department of Faculty Surgery No. 1 of NMU named after. A.A. Bogomolets - Tatyana Georgievna Kravchenko (I think you can come for an initial consultation in the next working days in the morning at the address: KGKB No. 18 (Shevchenko Boulevard 17, surgical building, Department of Faculty Surgery No. 1 or study room on the 5th floor (next to the dome operating room). Before this, you can undergo a standard anti-inflammatory course with intestinal antispasmodics, metronidazole tablets, normal microflora preparations, etc. - a detailed regimen must be selected during an in-person consultation. As you say, the uncertainty in the words of your gastroenterologist is not due to ignorance of the pathology , but with the fact that, unfortunately, in older patients the inflammatory process, although not clearly expressed, is of a very persistent chronic nature, which is why a step-by-step scheme of prescribing drugs is necessary (different drugs with different durations of administration) and their long-term use (i.e. .because the effect takes months to form, and this is not due to the drugs, but to the characteristics of the disease and the characteristics of the tissues of elderly patients). If standard treatment is ineffective or low in effectiveness without enhancing it with anti-inflammatory drugs acting on the colon wall, the next stage is long-term use of 5-ASA (salofalk) drugs.

Dear Sergey!

UC is a chronic autoimmune disease characterized by periods of exacerbation and remission. For treatment to be effective (that is, the onset of long-term remission without exacerbation), it is necessary to constantly be observed by one proctologist whom you trust. Trusting the treating doctor means that if there are any deviations in the general condition or a change in the course of the disease or side effects when taking old or new medications, you should contact this doctor, and not get information from different sources and then adjust the treatment yourself. You can adjust the dose of the drug or change medications only in consultation with your doctor!

In case of exacerbation of UC, the therapeutic dose of 5-amino-salicylic acid (5ASA) (salofalk) is not less than 4.0 g per day (that is, 2 tablets * 4 times a day), the issue of reducing the dose is decided individually in consultation with the attending physician . During exacerbation of UC, a dose less than 4.0 g/day is ineffective.

In my practice, there were patients who could not tolerate one 5ASA drug, but tolerated other 5ASA drugs. The reactions you describe can occur when taking 5ASA medications. You should discuss this issue with your doctor immediately. These complaints can also occur with pathology of other organs and systems (bronchial asthma, pleurisy, spinal pathology, etc.).

Among the 5ASK drugs, in addition to the drug Salofalk, there are other drugs - Pentasa, Asacol, Sulfasalazine, Mesalazine, balsalazine, which differ in the degree of purification, additional ingredients of the drug, other structural features of the drug, and price. Discuss the issue of poor tolerability of the drug with your doctor and the possibility of replacing it with another 5ASA drug in an equivalent dose.

Asks Pavlikova Sofya Vladimirovna:

Good day!
I was diagnosed with UC in 2008, at the age of 56. Before that, I had seen traces of blood in my stool for 3-4 years, but it didn’t cause any inconvenience, so I didn’t go to the doctors, especially not to hire a specialist in the town.
In 2007, a diagnosis of proctosigmoiditis was made and sulfasalosine was prescribed; the treatment helped. The remission lasted a year, during which time she took a maintenance dose of sulfasalosin (3 tablets per day)
In 2008, it was not possible to relieve the exacerbation with sulfasalosin; in the hospital, in the therapeutic department, rectal hydrocortisone, intravenous metragil and other supporting drugs were given. The treatment helped little; At a consultation in the regional center, they recommended budenofalk, which led to remission within 4 weeks (I took 3 capsules of 3 mg per day).
In 2012, in November, there was a relapse again. Increased doses of sulfasalosin did not help, I switched to budenofalk from January 1 (I still used 4 and even 8 mg of sulfasalosin per day), but two months of use did not give anything. In the hospital they treated metrogyl again, helped restore hemoglobin from 80 to 100, used a little prednisolone intravenously, there was an improvement in the hospital, but when I left the hospital, everything returned to normal. At the same time, I continue to use budenofalk, although I have already realized that it does not help me.
What other treatment methods do you recommend? Should I stop taking Budenofalk since it doesn’t help? The general practitioner said that there is no need to stop taking it yet. I know that it needs to be reduced gradually.
I've heard of cyclosporine. I am ready for any dose of prednisolone, which, on the doctor’s advice, was replaced with budenofalk, but if it helped the first time, now it doesn’t. Maybe the dose should be increased?
Now I’m waiting in line for a consultation in the area, but I really hope for your advice.

Answers Tkachenko Fedot Gennadievich:

Hello, Sofya Vladimirovna. In order to give you some useful advice, it is necessary to know at least some data from an examination of the condition of the colon. Namely, the condition of the rectal mucosa according to sigmoidoscopy data, fibrocolonoscopy data, and, if necessary, irrigography. I think that you should conduct these examinations in the regional center. As for treatment tactics, the drug "Budenofalk" is little used for the treatment of patients with UC. It is more indicated for patients with Crohn's disease. For UC, the main drugs of basic therapy are aminosalicylates (salofalk, pentasa, assacol, etc.), which combine administration in the form of enemas and tablet preparations. If they are ineffective, hormonal drugs (prednisolone, methylprednisolone, etc.) and (or) immunosuppressants (azathioprine) are prescribed. There are also drugs called biological therapy - Remicade. In this regard, I would like to recommend that you soon consult a qualified proctologist or gastroenterologist who has experience in treating inflammatory bowel diseases. And under the supervision of a specialist, continue conservative treatment.

Traditional therapy for ulcerative colitis. The use of other promising drugs in the treatment of ulcerative colitis. Surgical treatment of nonspecific ulcerative colitis. Methods of extracorporeal hemocorrection in the treatment of nonspecific ulcerative colitis

Enabling Technology Extracorporeal hemocorrection in the treatment of nonspecific ulcerative colitis makes it possible to:

• suppress the activity of nonspecific ulcerative colitis in a short time
• prevent the development of relapses of the disease
• remove toxic metabolites
• reduce the severity of dyspeptic disorders
• reduce doses of immunosuppressive drugs
• increase the body's sensitivity to traditional medications used in treatment
• reduce the likelihood of developing complications from the use of traditional drugs
• improve the prognosis of the disease
• improve the quality of life of patients with ulcerative colitis

This is achieved through:

• application of technologies Extracorporeal Immunocorrection, allowing you to change the activity of the immune system in the desired direction without reducing the potential of the immunological defense of the body as a whole
• technologies Extracorporeal Pharmacotherapy, making it possible to deliver drugs directly to the site of the pathological process
• technologies Autoplasma cryomodifications, capable of removing inflammatory mediators, circulating immune complexes, auto-aggressive antibodies, ballast and toxic substances from the body

Part VI. Treatment of ulcerative colitis

Treatment of an uncomplicated form of ulcerative colitis begins with conservative therapy.

Patients with newly diagnosed ulcerative colitis or clinical exacerbation of the disease require treatment in a hospital setting. Hospitalization of this category of patients with nonspecific ulcers is carried out in order to determine the scope of therapeutic measures and due to the frequent presence of metabolic and hematological disorders.

Drug treatment of active ulcerative colitis is also the main method of combating its extraintestinal manifestations.

Surgical treatment of nonspecific ulcerative colitis is indicated only for complications of the disease and when conservative treatment is ineffective.

Treatment of nonspecific ulcerative colitis is carried out against the background of diet therapy, which has the following features:

• in the hospital, the basis of the diet is the diet of the 4th table
• meals are fractional, every 2 - 3 hours in small portions
• food temperature within 30 – 35 o C
• dairy products are excluded
• balanced diet of proteins, fats, carbohydrates and vitamins
• exclusion of fresh fruits, vegetables, canned food
• food must be mechanically and chemically gentle

Vitamin imbalance and malabsorption of microelements are compensated by prescribing complex tablet preparations.

When treating patients with severe forms of ulcerative colitis in the phase of severe exacerbation, with a decrease in body weight, parenteral nutrition can be prescribed. The decision on parenteral nutrition is made depending on the degree of exhaustion and the predicted duration of the exacerbation.

The main role in the treatment of ulcerative colitis is played by anti-inflammatory drugs - sulfasalazine and glucocorticoids. These drugs are used in the treatment of ulcerative colitis to induce and maintain remission.

Sulfasalazine, first used by Nanna Schwartz in 1943 in the treatment of ulcerative colitis, was essentially the first effective drug that not only stopped the activity of the inflammatory process in the colon, but also prevented its exacerbation.

Sulfasalazine is a derivative of sulfapyridine and 5-aminosalicylic acid.

Sulfasalazine taken orally, with the participation of enzymes of intestinal microflora, in particular azoreductases, breaks down into 5-aminosalicylic acid (5-ASA) and sulfapyridine. Sulfapyridine inhibits the growth of anaerobic microflora in the intestine, including clostridia and bacteroides.

However, the main active principle of sulfasalazine in the treatment of ulcerative colitis is precisely 5-aminosalicylic acid. Thanks to 5-ASA, sulfasalazine modulates immune reactions and blocks mediators of the inflammatory process. The use of 5-ASA in the treatment of nonspecific ulcerative colitis allows to limit tissue damage, prevent further development of the immune response and restore the functions of the intestinal epithelium.

In Russia, various mesalazine preparations with three types of coating are used to treat inflammatory bowel diseases, providing pH-dependent release of mesalazine in various parts of the gastrointestinal tract. The most effective 5-ASA drug used in the treatment of ulcerative colitis is Salofalk.

Salofalk is coated with euhydrate-L, which ensures a gradual release of mesalazine throughout the intestine with an optimum pH > 6.0. In this case, 25 - 30% of the drug is released in the terminal ileum and 70 -75% in the colon.

When treating nonspecific ulcerative colitis, the drug is prescribed in a dose of 2 - 6 g per day for the entire period of active inflammation. When the colitic syndrome subsides, the dose of sulfasalazine is reduced gradually, bringing it to maintenance. The latter may vary from patient to patient and average 1 - 1.5 tablets per day. A number of authors recommend long-term (up to 2-3 years) administration of maintenance doses of the drug, but this method does not always prevent the occurrence of relapses of the disease.

The use of 5-aminosalicylic acid derivatives is a basic method and can be used as monotherapy in the treatment of mild and moderate forms of ulcerative colitis.

A number of studies have demonstrated that 5-ASA selectively induces apoptosis of tumor cells, and therefore it can be considered as an effective means of cancer prevention.

Side effects when using sulfasalazine and 5-aminosalicylic acid preparations include interstitial nephritis and pancreatitis. Renal impairment, assessed by increased creatinine and proteinuria, occurs 8 times more often with mesalazine than with sulfasalazine.

The second group of drugs used in the treatment of ulcerative colitis are glucocorticoids.

Among these drugs, the following are used in the treatment of ulcerative colitis:

• prednisolone – orally, parenterally and in the form of microenemas
• hydrocortisone – parenterally and in the form of microenemas

Unfortunately, long-term therapy with systemic corticosteroids may be accompanied by side effects such as:

• obesity (before the development of Cushingoid syndrome)
• arterial hypertension
• osteoporosis (up to pathological fractures)
• diabetes
• erosive and ulcerative lesions of the stomach and intestines (acute ulcers and erosions) with the development of bleeding

Significant progress in the treatment of ulcerative colitis has been achieved with the introduction of “new” steroids into medical practice. They are represented by synthetic drugs with changes in C16, C17 and C21. Among these drugs used in the treatment of ulcerative colitis are known:

• Budesonide
• Fluticasone
• Prednisolone-21 phosphate
• Betamethasone-17 valerate, etc.

These drugs have high receptor affinity, low absorption capacity and high first-pass metabolism, as a result of which they significantly less inhibit the hypothalamic-pituitary-adrenal system.

The development of side effects when using topical corticosteroids in the treatment of ulcerative colitis is observed much less frequently.

In the treatment of ulcerative colitis, attempts are being made to use antibacterial drugs that have the properties of inhibiting the anaerobic intestinal flora and modulating the body's immune response.

Metronidazole, in particular, has these properties. However, the need for long-term therapy for inflammatory bowel diseases with metronidazole significantly increases the likelihood of side effects. A safer method is to prescribe this antibiotic rectally in the form of a suspension at a dose of 40 mg 1 - 4 times a day for 2 - 3 days. When metronidazole is administered rectally, its concentration in the blood is either not traceable or is determined in minimal quantities.

If there is a threat of development of toxic intestinal dilatation, antibiotics such as clindamycin, cephobid, ampicillin are added to the treatment of ulcerative colitis.

It has now been proven that cytomegalovirus infection is a common cause of severe ulcerative colitis, refractory to steroid treatment. Prescription of antiviral therapy with ganciclovir or foscarnet is mandatory in such cases and contributes to the onset of remission in more than 70%.

The autoimmune nature of the disease determines the increased interest of clinicians in the use of cytostatics in the treatment of ulcerative colitis.

A promising immunosuppressant in the treatment of ulcerative colitis is Cyclosporine (Sandimmune). Cyclosporine also modulates the response of B cells by indirectly inhibiting the synthesis of T-helper activating factors.

Data from most controlled studies indicate that high-dose intravenous cyclosporine (4 mg/kg) induces remission in 60 to 80% of patients with severe ulcerative colitis.

Most of the side effects of using Cyclosporine in the treatment of ulcerative colitis are mild and are leveled out by reducing the dose of the administered drug. Side effects with short-term use can manifest themselves in the development of paresthesia, convulsions, Pneumocystis pneumonia, lung abscess, and herpetic lesions of the esophagus.

However, in some cases, the development of fatal opportunistic infections caused by mycotic flora (Pneumocystis carinii) is possible, which significantly limits the use of cyclosporine A.

Maintenance therapy with cyclosporine in the treatment of ulcerative colitis is not used due to a significant number of side effects.

An attempt is being made to use recombinant human antibodies to the tumor necrosis factor TNF (TNF) to treat ulcerative colitis. Thus, in the treatment of patients with ulcerative colitis, the use of infliximab, a drug that inhibits the activity of TNFα, has been shown to be effective and recommended.

Treatment regimen for mild forms of ulcerative colitis

Prednisolone 20 mg/day orally for 1 month with gradual withdrawal. Microclysters with hydrocortisone (125 mg) 2 times a day for 1 week. Sulfasalazine 2 g (or salazopyridazine 1 g, or mesalazine 1 g per day) orally for a long time for many years).

Features of treatment of moderate forms of ulcerative colitis

When treating a moderate form of ulcerative colitis, total parenteral nutrition is not used, but a strict diet with limited fiber, dairy products and a high protein content is required. Prednisolone is prescribed orally at an initial dose of 20–40 mg per day. Often, in the treatment of moderate forms of ulcerative colitis, hormones are effective when administered rectally in microenemas. The latter method of administration has undoubted advantages over oral administration, as it produces less pronounced side effects. Sulfasalazine and its analogues, which are taken orally or administered in microenemas and suppositories into the rectum, can be added to treatment. The initial dose of sulfasalazine is 1 g per day, then it is increased to 4 - 6 g. Higher dosages cause the inherent side effects of sulfasalazine, described above.

Features of treatment of severe forms of ulcerative colitis

In severe forms of ulcerative colitis, treatment is carried out against the background of parenteral nutrition, during which biochemical control and strict calculation of intravenously administered substances are important.

Infusion-transfusion therapy is carried out for the purpose of:

• detoxification
• correction of electrolyte disturbances
• replenishing fluid deficiency in the body
• correction of anemia and plasma protein composition

The following are used as infusion and transfusion media:

• glucose-salt solutions
• plasma, albumin, erythrocyte mass
• parenteral nutrition preparations

As an auxiliary treatment method, herbal decoctions that have anti-inflammatory and hemostatic effects (burnet root, nettle leaf, lichen, gray alder cones, licorice root) can be used. Herbal medicine often makes it possible to reduce the dose of salazal preparations and prolong remission.

In patients with mild or moderate manifestations of ulcerative colitis, it is recommended to use omega-3-polyunsaturated fatty acids (fish oil) orally or in the form of enemas. The basis for the use of omega-3-polyunsaturated fatty acids was epidemiological studies indicating an extremely low incidence of ulcerative colitis in individuals whose diet includes large amounts of fish oil.

The use of hemosorption for the elimination of toxins and circulating immune complexes has been reported.

Surgical treatment of nonspecific ulcerative colitis is indicated in case of ineffectiveness of drug therapy and in urgent situations, in severe (fulminant) forms of nonspecific ulcerative colitis.

Among the indications for surgical treatment of nonspecific ulcerative colitis, absolute and relative indications are distinguished.

Absolute indications for surgical treatment of nonspecific ulcerative colitis

Among the absolute ones, in turn, they distinguish (urgent) and non-urgent.

Urgent indications for surgical treatment of nonspecific ulcerative colitis include:

• suspected perforation
• acute toxic dilatation of the colon that does not resolve within 6 - 24 hours
• profuse intestinal bleeding

Non-urgent indications for surgical treatment of nonspecific ulcerative colitis include:

• paracolic infiltrates
• strictures of the colon with symptoms of intestinal obstruction
• colon cancer
• severe perianal lesions
• fulminant course of ulcerative colitis lasting more than 7-10 days in the absence of effect from conservative therapy.

Relative indications for surgical treatment of ulcerative colitis

• chronic continuously relapsing course of ulcerative colitis for 10 years without positive dynamics in the morphology of the colon wall

Types of surgical interventions in the surgical treatment of ulcerative colitis

Surgical interventions for nonspecific ulcerative colitis include:

• palliative operations - ileostomy (colostomy is not used in the surgical treatment of ulcerative colitis)
• radical operations - subtotal resection of the colon with the application of ileo- and sigmostoma, colproctectomy with ileostomy according to Brooke (Brooke) or retaining ileostomy according to Coke (Coek)
restorative and reconstructive operations

Palliative surgery in the surgical treatment of nonspecific ulcerative colitis, they come down to temporary or permanent shutdown of all (ileostomy) or part (colostomy) of the colon. In recent years, ileostomy is performed more often, since in nonspecific ulcerative colitis the inflammatory process can recur above the stoma. Surgical practice indicates that Brooke's ileostomy is considered the most adequate - end eversion (“inverted”) ileostomy. It is optimal for patients over 50 years of age for whom the appearance of an ileostomy is not an obstacle. With this type of surgical intervention, the development of complications (fistulas, peristomal abscesses, hernias and retraction of the removed intestine) is minimal. In addition, the ileostomy is easy to care for and can be used with different types of colostomy bag.

In obese patients, the operation of choice is a double-barreled ileostomy with one protrusion above the skin according to Turnbull. However, after its implementation, significant difficulties arise in regulating the release of liquid intestinal contents and gases. The “holding” ileostomy according to Coccus, developed in recent years, allows us to minimize these disadvantages.

From planned radical operations in the surgical treatment of nonspecific ulcerative colitis The optimal option is subtotal colectomy with reservoir small intestinal ileorectal anastomosis. Often this surgical intervention is performed with the imposition of a temporary (unloading) ileostomy.

In young patients with fulminant ulcerative colitis, the operation of choice is total colectomy with the formation of an ileorectal pouch.

Extracorporeal antibacterial therapy makes it possible to effectively influence the infectious component of the disease and thereby block pathogenetic mechanisms that lead to disruption of the immune system and prevents the development of infectious complications of ulcerative colitis.

Technologies Extracorporeal immunopharmacotherapy allow you to selectively suppress the activity of autoimmune processes in the body without suppressing the activity of the immune system as a whole.

In general, extracorporeal hemocorrection technologies make it possible to suppress the activity of nonspecific ulcerative colitis and prevent the development of relapses of the disease, remove toxic metabolites, reduce the severity of dyspeptic disorders, reduce doses of immunosuppressive drugs, increase the body’s sensitivity to traditional drugs used in treatment, and reduce the likelihood of complications from their use and thereby improve the prognosis and quality of life of patients with ulcerative colitis.

Treatment of nonspecific ulcerative colitis is carried out by us in accordance with the general principles of the “Program for the Treatment of Autoimmune Diseases” and indications for the inclusion of Extracorporeal Hemocorrection technologies in the treatment of nonspecific ulcerative colitis are:

1. Insufficient effectiveness of drug therapy
2. Resistance to traditional drugs used in the treatment of ulcerative colitis
3. Severe side effects from traditional medications that limit their further use
4. Frequent exacerbations of the disease
5. Preparation for the upcoming surgical treatment of nonspecific ulcerative colitis in order to reduce the activity of the disease and increase the likelihood of expected positive results of surgical treatment of nonspecific ulcerative colitis

Antibiotics for colitis are part of complex therapy, which also includes dietary nutrition and spa treatment. Antibiotics are drugs that kill bacteria that cause various infectious diseases. Each type of antibiotic targets different types of bacteria. This group of medications is not used to treat diseases caused by viruses and many types of fungi.

Certain types of colitis respond well to antibiotics, and some antibiotics can kill beneficial bacteria in the colon and cause colitis. The choice of antibiotic to treat colitis depends on the type of disease. For example, in infectious colitis, antibiotics are used to prevent the growth of bacteria in the body. A combination of antibiotics and anti-inflammatory drugs is used to treat ulcerative colitis.

Antibiotics are prescribed based on laboratory tests, often combining such therapy with the use of sulfonamides, which are necessary for moderate and mild colitis. Antibiotics should be prescribed by a doctor, taking into account the specifics of the patient’s body, the course and severity of the disease. If antibacterial therapy is long-term, or two or more drugs are used in treatment as a combination therapy, the patient in most cases develops dysbiosis.

To prevent this situation, drugs that normalize the state of intestinal microflora are used in parallel with antibiotics. At the same time or after therapy, probiotics or products containing lactic acid starters are prescribed. It is relevant to use drugs that act on pathogenic fungi (Nystatin) or contain live E. coli (Colibactrin).

Self-medication using this group of drugs can cause serious complications associated with the colon and destruction of its microflora.

The use of antibiotics for colitis is necessary to inhibit the growth of pathogenic bacteria, and their combination with anti-inflammatory drugs can reduce irritation and swelling of the intestinal mucosa.

The indication for the use of antibiotics is the presence of an infection in the body that causes inflammatory changes in the colon mucosa. Antibiotics are also used when the following symptoms develop:

• body temperature is significantly increased;
• cutting pains in the abdomen are recorded;
• diarrhea lasts more than 10 days;
• vomiting does not stop;
• dehydration appears.

Names of the best

Colitis is an inflammation of the mucous membrane of the colon. The reasons for the development of the disease are different, starting with dietary disorders, stress, congenital pathologies of the intestinal structure and infections.

The pathogenic bacterial environment that develops during infectious lesions is treated using a course of antibiotics, which are selected and prescribed by a gastroenterologist in a special dosage. Some antibiotics are effective in treating colitis; such drugs are more often included in the course of therapy than others.

Enterofuril

Enterofuril is an intestinal antiseptic and antidiarrheal agent. The active component of the drug is nifuroxazil. The medication is effective against gram-positive enterobacteria, promotes the regeneration of intestinal eubiosis, and prevents bacterial superinfections when the body is infected with enterotropic viruses. The drug slows down the synthesis of proteins in pathogenic bacteria, due to which the therapeutic effect is achieved. After use, complete absorption in the digestive tract is not recorded. The effect of the drug begins after it enters the intestinal lumen. The drug is excreted through the gastrointestinal tract; the rate of elimination is related to the dose used. It is rarely used to treat pregnant women, when the benefits of taking it outweigh the likely risks.

Olethetrin

Olethethrin has low toxicity and is an antibacterial drug with a wide spectrum of action. The medication contains two active ingredients: tetracycline and oleandomycin. The drug interferes with protein synthesis in bacterial cells by affecting ribosomes. The product is effective against staphylococci, streptococci, gonococci, whooping cough bacteria, chlamydia, ureplasma, mycoplasma.

The drug is absorbed in the intestines, after which it is distributed throughout all tissues and fluids of the body. The highest concentration is achieved in a short time. The medicine is excreted by the kidneys and intestines, and accumulates in tumors, tooth enamel, liver, and spleen. Use during pregnancy and under the age of 12 years is not allowed. It is not allowed to use if the kidneys and liver are impaired, if there is leukopenia, heart failure, or a lack of vitamins K and B. Bacterial resistance to Oletethrin develops more slowly than to tetracycline.

Furazolidone

Use during pregnancy and breastfeeding is not permitted. Use is not recommended for hypersensitivity to nitrofurans, late-stage renal failure, under the age of one year, or glucose-6-phosphate dehydrogenase deficiency. Furazolidone should not be used with other monoamine oxidase inhibitors. Tetracyclines and aminoglycosides enhance the effect of the drug. After drinking it, the body's sensitivity to alcoholic beverages increases. The use of the medication with Ristomycin and Chloramphenicol is not allowed.

Tsifran

The drug is a broad-spectrum antibiotic. Belongs to the group of fluoroquinols. It has a bactericidal effect, affects the processes of replication and synthesis of proteins contained in bacterial cells, which leads to the destruction of pathogenic elements. The medication is active against gram-positive and gram-negative flora. High activity is recorded against bacteria that are resistant to drugs from the group of tetracyclines, macrolides, aminoglycosides, and sulfonamides.

After entering the body, the drug is absorbed from the gastrointestinal tract, the maximum concentration is observed within 2 hours after administration. It is eliminated from the body in 3 hours; in case of kidney problems, the process is longer. More than 1% of the drug is excreted in bile. It is not allowed to use during pregnancy and breastfeeding, under the age of 18 years, with hypersensitivity to the components of the product, with pseudomembranous colitis. Simultaneous use with zinc, aluminum, magnesium and iron preparations is not allowed.

The drug has a wide spectrum of action. Taking the medication allows you to slow down the process of protein synthesis in bacterial cells. The drug is effective against pathogenic microorganisms. Resistance to tetracycline, penicillin, and sulfonamides is recorded. Levomycetin destroys gram-positive and gram-negative microbes. It has no effect on lactic acid bacteria, some types of staphylococci and protozoan fungi. The bioavailability of the drug is about 80%. Absorbed almost completely, the maximum concentration is recorded within 5 hours after administration. It is excreted from the body after 48 hours mainly by the kidneys. Not recommended for use during pregnancy and breastfeeding.

The drug can cause dysfunction of hematopoiesis, it is not recommended to use it for liver diseases, glucose-6-phosphate dehydrogenase deficiency, fungal skin diseases, eczema, psoriasis, porphoria, ARVI, sore throat and under the age of 3 years. The use of Levomycetin with sulfonamides, Ristomycin, and cytostatic medications is not allowed. The drug weakens the effect of taking contraceptive medications. With the simultaneous use of Levomycetin with Penicillin and Erythromycin, Clindamycin, Nystatin, a mutual weakening of the effects of the drugs is observed. The drug increases the toxicity of Cycloserine.

Neomycin sulfate

The drug belongs to the group of aminoglycosides. The drug contains neomycins A, B, C, which are waste products of a certain type of radiant fungus. The drug acts on bacterial cellular ribosomes, inhibiting protein synthesis in them, which leads to the destruction of the pathogenic cell.

Mycotic microorganisms, viruses, Pseudomonas aeruginosa, streptococci, and anaerobic bacteria are resistant to the drug. Resistance develops in an inactive manner.

The drug is absorbed very poorly in the intestines, 97% is excreted unchanged in the feces. When the intestinal mucosa is damaged, the drug is absorbed in large quantities. The drug is excreted by the kidneys in unchanged form, the half-life is 3 hours. During pregnancy, the drug is rarely used when there is a risk to life. There are no instructions for breastfeeding. There are certain contraindications to the use of the drug. It is not recommended to use if you have kidney problems, dry nerve disease, or allergies. The simultaneous use of Neomycin sulfate with Fluorouracil, Methotrexate, vitamins A and B12, cardiac glycosides and contraceptives reduces the effect of these drugs. The drug is incompatible with Streptocide, Monomycin, Gentamicin and other antibacterial drugs.

Alpha Normix

Alpha Normix is ​​a broad-spectrum antibiotic. It has a pronounced bactericidal property. Promotes the formation of a connection with bacterial enzymes, inhibiting the synthesis of bacterial proteins and RNA, which determines the effect of the drug in relation to the bacterial flora sensitive to it.

Alpha Normix acts aimed at suppressing the pathogenic environment of the intestine, which causes the pathological condition of colitis.

The drug helps to inhibit the synthesis of ammonia manifested by the bacterial flora, reduces the number of pathogenic bacteria in the colon, and reduces the increased level of proliferation. The medication neutralizes antigenic stimulation, reducing the risk of infectious complications, and also prevents the development of complications after intestinal surgery.

When used orally, the drug is not absorbed or only slightly absorbed, creating a high concentration of the drug in the gastrointestinal tract. Not detected in the blood, no more than 0.5% is detected in urine. The excretion is carried out together with the feces. Use is not allowed during pregnancy and breastfeeding, with intestinal obstruction, intestinal ulcers, or under the age of 12 years.

Streptomycin sulfate

The drug belongs to the group of aminoglycosides. Inhibits protein synthesis in bacterial cells. The medication is active against mycobacteria tuberculosis, salmonella, E. coli, Shigella, Klebsiella, gomnococci, plague bacillus and some other gram-negative bacteria. Staphylococci and corynebacteria are also sensitive to the drug. Enterobacteriaceae and streptococci are less sensitive to it.

Anaerobic bacteria, Proteus, Rickettsia, spirochete and Pseudomonas aeruginosis do not respond completely to Streptocide Sulfate.

After administration, the drug actively penetrates into the blood plasma, the maximum concentration is recorded after 2 hours. The therapeutic dose in the blood is fixed 8 hours after administration. The medication accumulates in the liver, kidneys, lungs, and intracellular fluids. Streptocide is excreted by the kidneys; the half-life is about 4 hours. If the patient has a kidney problem, the concentration of the drug increases. The use of the drug during pregnancy and breastfeeding is not recommended. The drug is contraindicated in case of cardiovascular failure, renal failure, disorders of the auditory and vestibular system. The use of the drug is not allowed in case of interruptions in the blood supply to the brain, obliterating endarteritis, myasthenia gravis, or hypersensitivity to the components of the drug. Use simultaneously with other antibiotics and curare-like drugs is not allowed. Mixing the drug with penicillins, heparin, and cephalosporins in one syringe is not allowed.

Polymyxin – m – sulfate

The medicine is a group of polymixes produced by different types of soil bacteria. It acts in a targeted manner, disrupting bacterial membranes, and is active against gram-negative microorganisms (Escherichia coli and dysentery coli, paratyphoid A and B, Pseudomonas aeruginosa and typhoid bacteria). It has no effect on staphylococci and streptococci, on the causative agents of meningitis and gonorrhea, Proteus, tuberculosis, fungi and diphtheria bacillus. Most of the drug is excreted in feces and is not absorbed into the gastrointestinal tract, which makes it possible to use it for the treatment of intestinal infections. Use during pregnancy is not allowed. Do not use for disorders of the liver or kidneys.

It is prohibited to use the drug together with a solution of Ampicillin, Tetracycline, sodium salt, Levomycetin, with cephalosporins, with an isotopic solution of NaCl, with a solution of amino acids, with Heparin. The effectiveness of the drug increases with the simultaneous administration of Erythromycin.

The drug represents a group of sulfonamides. The active ingredient of the drug is phthalylsulfathiazole. Taking the drug allows you to inhibit the synthesis of folic acid in the membranes of microbial cells, actively destroying pathogenic flora. Phthalazole has both antibacterial and anti-inflammatory effects. The drug acts primarily in the intestines. It practically does not appear in the bloodstream, is metabolized in the liver, and excreted by the kidneys and gastrointestinal tract during defecation along with feces. It is not allowed to use during pregnancy and breastfeeding.

Contraindications for use are individual sensitivity to the components of the drug, blood diseases, renal failure (chronic course), diffuse toxic goiter, acute stage of hepatitis, glomerulonephritis, age under 5 years, intestinal obstruction. The use of Phthalazol together with barbiturates and para-aminosalicylic acid enhances the effect of the drug. When the drug is combined with Oxacillin, the effect of the latter is reduced. It is not allowed to use acid-correcting drugs, Epinephrine solution, Hexamethylenetetramine together with Phthalazol. The antibacterial activity of Phthalazol is enhanced by the parallel use of other antibiotics (Procaine, Tatracaine, Benzocaine).

Polymyxin - b - sulfate

The medicine belongs to the group of polymyxins. Active against gram-negative bacteria. Gram-positive microbes, Proteus, are resistant to the drug.

The drug is not completely absorbed into the gastrointestinal tract and is excreted in the feces in its original form. The drug is not fixed in the blood, in biological fluids and in tissues, and has a toxic effect on the kidneys. Used during pregnancy only when there is a risk to life. Use is not allowed for kidney problems, myasthenia gravis, a tendency to allergies, or individual sensitivity to the components of the drug. The simultaneous administration of Polymyxin - in - sulfate with Ampicillin, Levomycetin and other antibacterial drugs is not allowed. The medication reduces the concentration of Heparin in the blood.

Monomycin

It is a natural antibiotic of the aminoglycoside group. Effective against staphylococci, shigella, E. coli, Friedlander's pneumobacillus, Proteus. Gram-positive bacteria are sensitive to the drug. The medication has no effect on streptococci and pneumococci, anaerobic microorganisms, viruses and fungi. About 15% of the drug is absorbed in the intestine. The other part is excreted along with feces. In the blood serum, the drug is fixed at no more than 3 mg/l; about 1% of the taken amount is excreted in the urine.

The drug is administered intramuscularly, absorption occurs actively, after 30 - 60 minutes the highest concentration is recorded in the blood plasma. The therapeutic concentration is maintained in the body for about 8 hours, regardless of the dose administered. Accumulation is observed in the intracellular space, in the kidneys, spleen, gall bladder, and lungs. The maximum dose is recorded in the liver and myocardium. After parenteral administration of the drug, excretion occurs through the kidneys (60%).

The use of the drug during pregnancy is not allowed. The medication is also contraindicated for degenerative diseases of the liver and kidneys, auditory neuritis, and allergies. The use of the drug with antibiotics of the aminoglycoside group, with cephalosporins and polymyxins, and with curare-like drugs is not allowed. Use with Levorin and Nystatin is allowed.

Tetracycline

Tetracycline is a drug from the tetracycline group. The use of the drug makes it possible to slow down the formation of new complexes between ribosomes and RNA, as a result of which protein synthesis does not occur in bacterial membranes, causing their death. The drug is active against staphylococci, streptococci, listeria, clostridia. Tetracycline is not effective against Pseudomonas aeruginosa, Proteus and Serratia. Group A betalytic streptococcus is not susceptible to the drug. The drug is absorbed by 77%. Protein binding is about 60%. After consumption, the maximum concentration in the body is recorded after 3 hours. The level begins to decrease over 8 hours. The maximum content of the drug is recorded in the kidneys, liver, lungs, spleen, and lymph nodes. The volume of the drug in the blood is much less than in the bile. It is cumulative in nature, accumulation is observed in tumor tissues and bones. Part of the metabolism of the drug occurs in the liver; during the first 12 hours after administration, about 20% of the dose taken is excreted by the kidneys. Together with bile, 10% of the drug enters the intestines, where it is absorbed and distributed throughout the body. About 25% of Tetracycline is excreted through the intestines. Not allowed to use during pregnancy and lactation.

It is not recommended to use Tetracycline if you are hypersensitive to the drug. Kidney failure, fungal infections, leukopenia, liver problems, allergies, under 8 years of age. When taking anthocyanins, the absorption of tetracycline decreases. When taken simultaneously with Tetracycline, the effectiveness of cephalosporins and penicillins is reduced.

Methods of application

When a doctor prescribes antibiotics to treat colitis, he must find out what medications the patient is currently taking, since some of them, in combination with antibacterial agents, can cause serious side effects.

To support intestinal function during the use of antibiotics, in order to prevent gastrointestinal dysfunction, it is recommended to combine antibiotic therapy with the use of Nystatin orally (500,000 - 1,000,000 units), which will make it possible to maintain the intestinal microflora. You can replace Nystatin with Colibactrin (100 - 200 g daily, after meals).

Antibiotics can worsen existing diarrhea as a result of their effect on pathogenic flora in the intestines. In this condition, you should stop taking the drug and consult a doctor.

Antibiotics are generally not used to treat ulcerative colitis. Use may be due to the ineffectiveness of other treatment methods.

When colitis is caused by prolonged use of antibiotics, the drugs should be stopped immediately. The patient is prescribed a special course of treatment aimed at restoring intestinal microflora.

All medications should be used according to the prescribed dose.

Enterofuril is used in the form of capsules and syrup. The suspension is given to a child at 1-6 months 2.5 ml 2-3 times a day, at 7-24 months - 2.5 ml 3 times a day, at 3-7 years - 5 ml 3 times a day.

Dose for adults: 2 capsules (100 mg capsule dosage) 4 times a day.

The drug Oletetrin is taken orally, 30 minutes before meals. Dose – 1 capsule, 4 times a day. The course of treatment is 5 – 10 days.

It is recommended to take furazolidone with meals, at a dose of 0.1 - 0.15 g 4 times a day. The maximum daily dose should not exceed 0.8 g; 0.2 g is taken at a time. The pediatric dose is calculated based on weight (10 mg/kg). The duration of treatment is 5 – 10 days.

Cifran is taken 250–750 mg twice a day. The duration of treatment is from a week to a month. The maximum daily dose is 1.5 g.

Levomycetin is taken orally (tablets) with water half an hour before meals. The course of treatment is prescribed by the doctor, based on the course and severity of the disease. Dose for adults – 250 – 500 mg, three times a day. The highest daily dose is 4 g. For children, the drug is administered intramuscularly.

The dose of Neomycin sulfate for adults is 100–200 mg, the maximum daily dose is 4 g. For children, the dose is 4 mg/kg body weight, twice a day. The course of treatment is 7 days.

Alpha Normix is ​​taken with water, starting with 1 tablet every 6 hours. Course duration: 3 days, for traveler's diarrhea. Dose: 2 tablets every 8 to 12 hours for intestinal inflammation. It is not allowed to use the drug for more than a week in a row. The course of treatment can be repeated after 20 - 40 days.

Streptocide sulfate is available in powder form for the preparation of a solution for injection. When administered intramuscularly, the dose is 50 mg - 1 g. The maximum daily dose is 2 g. The maximum dose for children is 25 mg/kg body weight. Children are allowed to administer no more than 0.5 g per day, and adolescents - no more than 1 g of the drug. The adult dose of the drug taken orally is about 75 mg per day. The dose is taken 4 times a day, with breaks of 8 hours. The course of treatment is 10 days.

Polymyxin - m - sulfate is used in a dose of 500 ml - 1 g, 6 times a day. The daily dose should not exceed 2 - 3 g. The course of treatment is no more than 10 days.

Phthalazole is prescribed to children under 5 years of age at 0.1 g per kg of body weight per day on the first day of treatment, every 4 hours (not given at night). In subsequent days, the dose is 0.25 - 0.5 g every 8 hours. The dose for adults is 1 – 2 g every 6 hours, and then half the norm.

Polymyxin - b - sulfate is used intramuscularly, at a dose of 0.5 - 0.7 mg/kg body weight, 4 times a day. The pediatric dose is 0.3 – 0.6 mg/kg body weight. For oral administration, use an aqueous solution of the medication. The dose for adults is 0.1 g every 6 hours, for children – 0.004 g/kg, three times a day.

Monomycin is used for injection. When administered intramuscularly, the dose for adults is 250 mg, three times a day. Children are prescribed 5 mg/kg body weight three times a day. When used orally, the dose for adults is 220 mg, taken 4 times a day. For children, the dose is 25 mg/kg body weight three times a day.

Tetracycline is administered orally. The adult dose is 250 mg, every 6 hours, the daily dose should not exceed 2 g. Children over 7 years old are prescribed 6.25 – 12.5 mg/kg, 4 times a day.

Contraindications

Antibiotics for the treatment of colitis should be taken with caution if you are prone to allergic reactions, with increased sensitivity to the components of a particular medication, as well as in the presence of fungal infections, liver and kidney dysfunction, and problems with hematopoiesis.

Use during pregnancy

The use of antibiotics during pregnancy and breastfeeding is not permitted. For example, Tetracycline penetrates into mother's milk and negatively affects the development of the baby's bones and teeth. The drug can cause candidiasis of the oral cavity and genitals, as well as a photosensitivity reaction.

In some cases, the use of some of them is allowed if there is a risk to the life of the expectant mother. Such drugs include Polymyxin - in - sulfate, which can be used during pregnancy only in extreme cases under the supervision of a doctor.

Side effects

The use of antibiotics to treat colitis can cause increased diarrhea, since this group of drugs acts directly on the intestinal microflora. The patient may experience:

• breathing problems;
• dizziness;
• joint pain;
• swelling of the lips or throat;
• bleeding.

All antibiotics used to treat colitis have contraindications, and there is also a risk of certain side effects when using them:

• Enterofuril can cause nausea, vomiting, allergic reactions;
• Olethetrin can cause abdominal pain, nausea, vomiting, neutropenia, candidiasis of the mucous membranes;
• Furazolidone may cause allergies, nausea and vomiting;
• When using Cifran, side effects are possible in the form of dyspepsia, headaches, increased levels of leukocytes, eosinophils and neutrophils in the blood, heart rhythm disturbances, increased blood pressure, candidiasis, glomerulonephritis, vasculitis, frequent urination;
• When consuming Levomycetin, negative reactions of the body are likely in the form of anemia, headaches, allergies, fever, dermatitis, cardiovascular collapse, Jarisch-Herxheimer reaction;
• Neomycin sulfate may cause diarrhea, nausea, and vomiting. Hearing impairment and candidiasis of the skin and mucous membranes are also observed. Such side effects may increase when taken simultaneously with inhalational anesthetics, polymyxins, and other aminoglycosides;
• Alpha Normix can cause a negative reaction of the body in the form of shortness of breath, dry throat, nasal congestion, abdominal pain, flatulence, tenesmus, weight loss, ascites, failure to urinate, and dyspeptic disorders;
• Streptocide sulfate may cause certain side effects, such as drug fever, allergies, headache, tachycardia, diarrhea, hematuria, and deafness as a result of using the drug. With parietal administration there is a risk of respiratory arrest, especially in patients with myasthenia gravis or neuromuscular diseases, aponoe;
• Polymyxin - m - sulfate can cause changes in the kidney parenchyma with prolonged use of the drug and an allergic reaction;
• Phthalazole can cause headaches, dizziness, dyspeptic disorders, nausea and vomiting, glossitis, hepatitis, cholangitis, gastritis, kidney problems (stone formation), eosinophilic pneumonia, myocarditis, allergies. In some cases, problems with the hematopoietic system may occur;
• Polymyxin - b - sulfate can cause various pathological conditions associated with kidney function, paralysis of the respiratory muscles, decreased appetite, and abdominal pain. Ataxia, drowsiness, visual impairment, candidiasis, phlebitis, thrombophlebitis, meningeal symptoms (with intrathecal administration) are also possible;
• When using Monomycin, side effects may occur in the form of inflammation of the auditory nerve, kidney failure, dyspeptic symptoms, allergies;
• Tetracycline can cause negative reactions in the body. Nausea and vomiting, intestinal dysbiosis, and enterocolitis are likely. There is a risk of nephrotoxic effect, azotemia, hypercreatinemia, cutaneous candidiasis, glassitis, proctitis, vitamin B hypovitaminosis, and increased bilirubin levels in the body.

Antibiotics are used to treat colitis only when the disease is caused by infections. Independent choice and use of drugs can complicate the treatment process and lead to serious consequences.