Pathogenetic effects of antibiotic resistance on a woman’s reproductive health
Authors: Hryshchenko О.V. 
Published: July 2021

Background. Over the last decade, women in many countries around the world have seen an increase in the number of urogenital infections, which occupy the first place in the structure of obstetric and gynecological morbidity. Risk factors for the development of inflammatory diseases include the invasive procedures and irrigations, sexual activity, unreasonable treatment, refusal to restore eubiosis after antimicrobial and antifungal therapy, the presence of intrauterine devices, etc.

Objective. To characterize the influence of the spread of antibiotic-resistant pathogens on the course of gynecological diseases.

Materials and methods. Analysis of literature data on this issue.

Results and discussion. Peculiarities of the vaginal infections course’ nowadays include prevalence of self-treatment, uncontrolled antibiotics (AB) use, the development of AB resistance, and the presence of extragenital pathology. Pelvic inflammatory disease (PID) comprise 75 % of all gynecological diseases. PID cause such complications as chronic pelvic pain syndrome, purulent tubo-ovarian tumors, cervical neoplasia, and infertility. The risk of the latter increases depending on the number of episodes of PID. Principles of PID treatment include comprehensiveness, etiopathogenetic orientation, individualization and recurrence prevention. Antibacterial therapy (ABT), nonsteroidal anti-inflammatory drugs, infusions, transfusions, detoxification therapy, medications aimed at the improvement of hemodynamics and microcirculation, immunotherapy, and topical therapy are used in the treatment of PID. The consequences of irrational ABT include an increase in the resistance of pathogenic flora, disruption of the normal body biocenosis, increased risk of adverse reactions, impaired immune function and increased treatment costs. Macrolides, cephalosporins, fluoroquinolones and aminoglycosides are the main groups of AB used for the systemic ABT in PID. Tobramycin (one of the latter group) is active against 83.4 % of pathogens that cause urogenital infections. Other advantages of tobramycin include synergism with β-lactams and high activity against Pseudomonas aeruginosa – a bacterium with a high and dangerous potential for AB resistance. In turn, fluoroquinolones are active against 94 % of pathogens that cause urogenital infections; they are able to penetrate cell membranes and have a low potential for the formation of AB resistance. The combination of fluoroquinolone levofloxacin with ornidazole (Grandazole, “Yuria-Pharm”) can improve the general condition and reduce pain on the 3rd day of treatment of PID, normalize the temperature, reduce hospital stay. Co-administration of levofloxacin and ornidazole as part of an infusion solution is more rational than their separate use. Such treatment minimizes the risk of allergic reactions and side effects. For local sanitation of vagina and vulva, it is advisable to use decamethoxine (Dekasan, “Yuria-Pharm”) – a basic antiseptic that acts on various types of bacteria, viruses, fungi and protozoa. Additional benefits are anti-inflammatory, desensitizing and antispasmodic action. Decamethoxine also effectively reduces the adhesion of staphylococci and Escherichia coli. One of the main advantages of decamethoxine is the lack of effect on human cells.

Conclusions. 1. PID are the most common diseases in the field of obstetrics and gynecology. 2. Care should be taken when choosing a drug for ABT. 3. The combination of levofloxacin and ornidazole can effectively treat PID, reducing the duration of inpatient treatment. 4. For local sanitation of the vagina and vulva, it is advisable to use decamethoxine.