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Применение топических антибиотиков в дерматологической практике
Применение топических антибиотиков в дерматологической практике
Вашкевич А.А., Резцова П.А. Применение топических антибиотиков в дерматологической практике. Дерматология (Прил. к журн. Consilium Medicum). 2019; 1: 15–22. DOI: 10.26442/24143537.2019.1.190206
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Аннотация
Бактериальные инфекции кожи (пиодермии) составляют от 17 до 36% причин обращений к дерматологам. Пиодермии могут возникнуть в любой возрастной группе, но чаще отмечаются у детей. Доминирующими патогенами пиодермий признаны Staphylococcus aureus (первое место во всех географических регионах) и Streptococcus pyogenes. В последнее время часто при посеве выявляется рост микст-флоры (Enterococcus spp., Proteus spp., Eschericia coli, Pseudomonas aeruginosa и пр.), чаще в ассоциации со стафилококками и стрептококками. Наиболее распространенной поверхностной бактериальной инфекцией кожи у детей является импетиго. Выделяют два основных типа импетиго: небуллезное и буллезное. В Российских и международных клинических рекомендациях использование топических антибиотиков для лечения поверхностных ограниченных пиодермий является 1-й линией этиотропной терапии. Также топические антибиотики могут эффективно использоваться для предотвращения присоединения инфекции при небольших ранах с высоким риском инфицирования (случайные травмы, рваные раны, порезы, ссадины и ожоги); профилактики вторичного инфицирования после необширных хирургических или косметических процедур и при лечении вторично инфицированных дерматозов. В зарубежных рекомендациях по профилактике вторичного инфицирования поверхностных ран отдается предпочтение комбинированным препаратам, содержащим в своем составе несколько антибиотиков. В настоящее время в Российской Федерации доступен препарат Банеоцин®, являющийся фиксированной комбинацией неомицина и бацитрацина.
Ключевые слова: инфекции кожи, вторичное инфицирование, топические антибиотики, резистентность, Банеоцин.
Key words: skin infections, secondary infections, topical antibiotics, resistance, Baneocin.
Ключевые слова: инфекции кожи, вторичное инфицирование, топические антибиотики, резистентность, Банеоцин.
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Key words: skin infections, secondary infections, topical antibiotics, resistance, Baneocin.
Полный текст
Список литературы
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6. Cole C, Gazewood J. Diagnosis and treatment of impetigo. Am Fam Physician 2007; 75 (6): 859–64.
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8. Amagai M, Matsuyoshi N. Toxin in bullous impetigo and staphylococcal scalded novel therapeutic choice in wound management and infection prevention: a practical perspective. Exp Rev Anti-Infective Ther 2007; 75 (5): 773–82.
9. Becker K, Friedrich AW, Lubritz G et al. Prevalence of genes encoding pyrogenic toxin superantigens and exfoliative toxins among strains of Staphylococcus aureus isolated from blood and nasal specimens. J Clin Microbiol 2003; 41: 1434–9.
10. Sila J, Sauer P, Kolar M. Comparison of the prevalence of genes coding for enterotoxins, exfoliatins, panton-valentine leukocidin and TSST-1 between methicillin-resistant and methicillin-susceptible isolates of Staphylococcus aureus at the University hospital in Olomouc. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2009; 153: 215–8.
11. George A, Rubin G. A systematic review and meta-analysis of treatments for impetigo. Br J Gen Pract 2003; 53 (491): 480–7.
12. Михеев Н.Г., Соколовский Е.В., Савичева А.М. Рациональная противомикробная терапия больных пиодермиями. Вестн. дерматологии и венерологии. 2017; 1: 68–75. / Mikheev N.G., Sokolovskii E.V., Savicheva A.M. Ratsional'naia protivomikrobnaia terapiia bol'nykh piodermiiami. Vestn. dermatologii i venerologii. 2017; 1: 68–75. [in Russian]
13. The Role of Topical Antibiotics in Dermatologic Practice. Medscape 2003. http://www.medscape.com/viewprogram/2501 (accessed December 19, 2004).
14. Katz S, McGinley K, Leyden JJ. Semipermeable occlusive dressings: Effects on growth of pathogenic bacteria and reepithelialization of superficial wounds. Arch Dermatol 1986; 122: 58–62.
15. Swartz MN, Pasternack MS. Cellulitis and subcutaneous tissue infection. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 6th ed. Philadelphia: Churchill Livingston, 2005.
16. Касихина Е.И., Абальян С.А. Бактериальные осложнения в косметологической практике: лечение и профилактика. Дерматология (Прил. к журн. Consilium Medicum). 2016; 2: 3–5. / Kasihina E.I., Abalyan S.A. Bacterial complications in cosmetic practice: treatment and prevention. Consilium Medicum. Dermatology (Suppl.). 2016; 2: 10–15. [in Russian]
17. Потекаев Н.Н. и др. Наружная терапия гнойных осложнений в косметологии. Клин. дерматология и венерология. 2010; 6: 57–61. / Potekaev N.N. i dr. Naruzhnaia terapiia gnoinykh oslozhnenii v kosmetologii. Klin. dermatologiia i venerologiia. 2010; 6: 57–61. [in Russian]
18. Welshhans JL, Hom DB. Soft Tissue Principles to Minimize Scarring. Facial Plastic Surg Clin NA 2017; 25 (1): 1–13.
19. Eaglstein WH, Mertz P, Alvarez OM. Effect of topically applied agents on healing wounds. Clin Dermatol 1984; 2: 112–5.
20. Berger RS, Pappert AS, Van Zile PS et al. A newly formulated topical triple-antibiotic ointment minimizes scarring. Cutis 2000; 65 (6): 401–4.
21. Jones RN, Li Q, Kohut B et al. Contemporary antimicrobial activity of triple antibiotic ointment: a multiphased study of recent clinical isolates in the United States and Australia. Diagn. Microbiol Infect Dis 2006; 54 (1), 63–71.
22. Suzuki M, Yamada K et al. Antimicrobial Ointments and Methicillin-Resistant Staphylococcus Aureus USA300. Emerg Infect Dis 2011; 17 (10): 1917–20.
23. Anderson V. Over-the-counter topical antibiotic products: data on safety and efficacy. Int J Dermatol 1976; 15 (Suppl. 2): 1–118.
24. Rodgers GL, Mortensen JE, Fisher MC, Long SS. In vitro susceptibility testing of topical antimicrobial agents used in pediatric burn patients: comparison of two methods. J. Burn Care Rehabil 1997; 18 (5): 406–10.
25. Grzybowska W, Wójcik A, Tyski S. Interaction of neomycin with other antibiotics on selected bacterial strains. Med Dosw Mikrobiol 2004; 56 (2): 187–98.
26. Белькова Ю.А., Козлов Р.С., Кречикова О.И. и др. Эффективность и безопасность местного использования комбинации бацитрацина и неомицина в сравнении с хлорамфениколом в терапии неосложненных хирургических инфекций кожи и мягких тканей у взрослых амбулаторных пациентов. Клин. микробиология и антимикробная химиотерапия. 2013; 15 (2): 131–42. / Bel'kova Iu.A., Kozlov R.S., Krechikova O.I. i dr. Effektivnost' i bezopasnost' mestnogo ispol'zovaniia kombinatsii batsitratsina i neomitsina v sravnenii s khloramfenikolom v terapii neoslozhnennykh khirurgicheskikh infektsii kozhi i miagkikh tkanei u vzroslykh ambulatornykh patsientov. Klin. mikrobiologiia i antimikrobnaia khimioterapiia. 2013; 15 (2): 131–42. [in Russian]
2. Ivanov O.L., Potakaev N.S. Kozhnye i venericheskie bolezni. M.: Meditsina, 1997. [in Russian]
3. Tamrazova O.B. Vozmozhnosti preodoleniia antibiotikorezistentnosti v terapii piodermii. Klin. dermatologiia i venerologiia. 2014; 12 (6): 64–73. [in Russian]
4. Lautz TB, Raval MV, Barsness KA. Increasing national burden of hospitalizations for skin and soft tissue infections in children. J Pediatr Surg 2011; 46: 1935–41.
5. Bonomo A, Peter S Van Zile, Qing Li et al. Topical triple-antibiotic ointment. Exp Rev Anti-Infective Ther 2007: 75 (6): 859–64.
6. Cole C, Gazewood J. Diagnosis and treatment of impetigo. Am Fam Physician 2007; 75 (6): 859–64.
7. Moran GJ, Amii RN, Abrahamian FM, Talan DA. Methicillin-resistant Staphylococcus aureus in community-acquired skin infections. Emerg Infect Dis 2005; 11 (6): 928–30.
8. Amagai M, Matsuyoshi N. Toxin in bullous impetigo and staphylococcal scalded novel therapeutic choice in wound management and infection prevention: a practical perspective. Exp Rev Anti-Infective Ther 2007; 75 (5): 773–82.
9. Becker K, Friedrich AW, Lubritz G et al. Prevalence of genes encoding pyrogenic toxin superantigens and exfoliative toxins among strains of Staphylococcus aureus isolated from blood and nasal specimens. J Clin Microbiol 2003; 41: 1434–9.
10. Sila J, Sauer P, Kolar M. Comparison of the prevalence of genes coding for enterotoxins, exfoliatins, panton-valentine leukocidin and TSST-1 between methicillin-resistant and methicillin-susceptible isolates of Staphylococcus aureus at the University hospital in Olomouc. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2009; 153: 215–8.
11. George A, Rubin G. A systematic review and meta-analysis of treatments for impetigo. Br J Gen Pract 2003; 53 (491): 480–7.
12. Mikheev N.G., Sokolovskii E.V., Savicheva A.M. Ratsional'naia protivomikrobnaia terapiia bol'nykh piodermiiami. Vestn. dermatologii i venerologii. 2017; 1: 68–75. [in Russian]
13. The Role of Topical Antibiotics in Dermatologic Practice. Medscape 2003. http://www.medscape.com/viewprogram/2501 (accessed December 19, 2004).
14. Katz S, McGinley K, Leyden JJ. Semipermeable occlusive dressings: Effects on growth of pathogenic bacteria and reepithelialization of superficial wounds. Arch Dermatol 1986; 122: 58–62.
15. Swartz MN, Pasternack MS. Cellulitis and subcutaneous tissue infection. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 6th ed. Philadelphia: Churchill Livingston, 2005.
16. Kasihina E.I., Abalyan S.A. Bacterial complications in cosmetic practice: treatment and prevention. Consilium Medicum. Dermatology (Suppl.). 2016; 2: 10–15. [in Russian]
17. Potekaev N.N. i dr. Naruzhnaia terapiia gnoinykh oslozhnenii v kosmetologii. Klin. dermatologiia i venerologiia. 2010; 6: 57–61. [in Russian]
18. Welshhans JL, Hom DB. Soft Tissue Principles to Minimize Scarring. Facial Plastic Surg Clin NA 2017; 25 (1): 1–13.
19. Eaglstein WH, Mertz P, Alvarez OM. Effect of topically applied agents on healing wounds. Clin Dermatol 1984; 2: 112–5.
20. Berger RS, Pappert AS, Van Zile PS et al. A newly formulated topical triple-antibiotic ointment minimizes scarring. Cutis 2000; 65 (6): 401–4.
21. Jones RN, Li Q, Kohut B et al. Contemporary antimicrobial activity of triple antibiotic ointment: a multiphased study of recent clinical isolates in the United States and Australia. Diagn. Microbiol Infect Dis 2006; 54 (1), 63–71.
22. Suzuki M, Yamada K et al. Antimicrobial Ointments and Methicillin-Resistant Staphylococcus Aureus USA300. Emerg Infect Dis 2011; 17 (10): 1917–20.
23. Anderson V. Over-the-counter topical antibiotic products: data on safety and efficacy. Int J Dermatol 1976; 15 (Suppl. 2): 1–118.
24. Rodgers GL, Mortensen JE, Fisher MC, Long SS. In vitro susceptibility testing of topical antimicrobial agents used in pediatric burn patients: comparison of two methods. J. Burn Care Rehabil 1997; 18 (5): 406–10.
25. Grzybowska W, Wójcik A, Tyski S. Interaction of neomycin with other antibiotics on selected bacterial strains. Med Dosw Mikrobiol 2004; 56 (2): 187–98.
26. Bel'kova Iu.A., Kozlov R.S., Krechikova O.I. i dr. Effektivnost' i bezopasnost' mestnogo ispol'zovaniia kombinatsii batsitratsina i neomitsina v sravnenii s khloramfenikolom v terapii neoslozhnennykh khirurgicheskikh infektsii kozhi i miagkikh tkanei u vzroslykh ambulatornykh patsientov. Klin. mikrobiologiia i antimikrobnaia khimioterapiia. 2013; 15 (2): 131–42. [in Russian]
2. Иванов О.Л., Потакаев Н.С. Кожные и венерические болезни. М.: Медицина, 1997. / Ivanov O.L., Potakaev N.S. Kozhnye i venericheskie bolezni. M.: Meditsina, 1997. [in Russian]
3. Тамразова О.Б. Возможности преодоления антибиотикорезистентности в терапии пиодермий. Клин. дерматология и венерология. 2014; 12 (6): 64–73. / Tamrazova O.B. Vozmozhnosti preodoleniia antibiotikorezistentnosti v terapii piodermii. Klin. dermatologiia i venerologiia. 2014; 12 (6): 64–73. [in Russian]
4. Lautz TB, Raval MV, Barsness KA. Increasing national burden of hospitalizations for skin and soft tissue infections in children. J Pediatr Surg 2011; 46: 1935–41.
5. Bonomo A, Peter S Van Zile, Qing Li et al. Topical triple-antibiotic ointment. Exp Rev Anti-Infective Ther 2007: 75 (6): 859–64.
6. Cole C, Gazewood J. Diagnosis and treatment of impetigo. Am Fam Physician 2007; 75 (6): 859–64.
7. Moran GJ, Amii RN, Abrahamian FM, Talan DA. Methicillin-resistant Staphylococcus aureus in community-acquired skin infections. Emerg Infect Dis 2005; 11 (6): 928–30.
8. Amagai M, Matsuyoshi N. Toxin in bullous impetigo and staphylococcal scalded novel therapeutic choice in wound management and infection prevention: a practical perspective. Exp Rev Anti-Infective Ther 2007; 75 (5): 773–82.
9. Becker K, Friedrich AW, Lubritz G et al. Prevalence of genes encoding pyrogenic toxin superantigens and exfoliative toxins among strains of Staphylococcus aureus isolated from blood and nasal specimens. J Clin Microbiol 2003; 41: 1434–9.
10. Sila J, Sauer P, Kolar M. Comparison of the prevalence of genes coding for enterotoxins, exfoliatins, panton-valentine leukocidin and TSST-1 between methicillin-resistant and methicillin-susceptible isolates of Staphylococcus aureus at the University hospital in Olomouc. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2009; 153: 215–8.
11. George A, Rubin G. A systematic review and meta-analysis of treatments for impetigo. Br J Gen Pract 2003; 53 (491): 480–7.
12. Михеев Н.Г., Соколовский Е.В., Савичева А.М. Рациональная противомикробная терапия больных пиодермиями. Вестн. дерматологии и венерологии. 2017; 1: 68–75. / Mikheev N.G., Sokolovskii E.V., Savicheva A.M. Ratsional'naia protivomikrobnaia terapiia bol'nykh piodermiiami. Vestn. dermatologii i venerologii. 2017; 1: 68–75. [in Russian]
13. The Role of Topical Antibiotics in Dermatologic Practice. Medscape 2003. http://www.medscape.com/viewprogram/2501 (accessed December 19, 2004).
14. Katz S, McGinley K, Leyden JJ. Semipermeable occlusive dressings: Effects on growth of pathogenic bacteria and reepithelialization of superficial wounds. Arch Dermatol 1986; 122: 58–62.
15. Swartz MN, Pasternack MS. Cellulitis and subcutaneous tissue infection. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 6th ed. Philadelphia: Churchill Livingston, 2005.
16. Касихина Е.И., Абальян С.А. Бактериальные осложнения в косметологической практике: лечение и профилактика. Дерматология (Прил. к журн. Consilium Medicum). 2016; 2: 3–5. / Kasihina E.I., Abalyan S.A. Bacterial complications in cosmetic practice: treatment and prevention. Consilium Medicum. Dermatology (Suppl.). 2016; 2: 10–15. [in Russian]
17. Потекаев Н.Н. и др. Наружная терапия гнойных осложнений в косметологии. Клин. дерматология и венерология. 2010; 6: 57–61. / Potekaev N.N. i dr. Naruzhnaia terapiia gnoinykh oslozhnenii v kosmetologii. Klin. dermatologiia i venerologiia. 2010; 6: 57–61. [in Russian]
18. Welshhans JL, Hom DB. Soft Tissue Principles to Minimize Scarring. Facial Plastic Surg Clin NA 2017; 25 (1): 1–13.
19. Eaglstein WH, Mertz P, Alvarez OM. Effect of topically applied agents on healing wounds. Clin Dermatol 1984; 2: 112–5.
20. Berger RS, Pappert AS, Van Zile PS et al. A newly formulated topical triple-antibiotic ointment minimizes scarring. Cutis 2000; 65 (6): 401–4.
21. Jones RN, Li Q, Kohut B et al. Contemporary antimicrobial activity of triple antibiotic ointment: a multiphased study of recent clinical isolates in the United States and Australia. Diagn. Microbiol Infect Dis 2006; 54 (1), 63–71.
22. Suzuki M, Yamada K et al. Antimicrobial Ointments and Methicillin-Resistant Staphylococcus Aureus USA300. Emerg Infect Dis 2011; 17 (10): 1917–20.
23. Anderson V. Over-the-counter topical antibiotic products: data on safety and efficacy. Int J Dermatol 1976; 15 (Suppl. 2): 1–118.
24. Rodgers GL, Mortensen JE, Fisher MC, Long SS. In vitro susceptibility testing of topical antimicrobial agents used in pediatric burn patients: comparison of two methods. J. Burn Care Rehabil 1997; 18 (5): 406–10.
25. Grzybowska W, Wójcik A, Tyski S. Interaction of neomycin with other antibiotics on selected bacterial strains. Med Dosw Mikrobiol 2004; 56 (2): 187–98.
26. Белькова Ю.А., Козлов Р.С., Кречикова О.И. и др. Эффективность и безопасность местного использования комбинации бацитрацина и неомицина в сравнении с хлорамфениколом в терапии неосложненных хирургических инфекций кожи и мягких тканей у взрослых амбулаторных пациентов. Клин. микробиология и антимикробная химиотерапия. 2013; 15 (2): 131–42. / Bel'kova Iu.A., Kozlov R.S., Krechikova O.I. i dr. Effektivnost' i bezopasnost' mestnogo ispol'zovaniia kombinatsii batsitratsina i neomitsina v sravnenii s khloramfenikolom v terapii neoslozhnennykh khirurgicheskikh infektsii kozhi i miagkikh tkanei u vzroslykh ambulatornykh patsientov. Klin. mikrobiologiia i antimikrobnaia khimioterapiia. 2013; 15 (2): 131–42. [in Russian]
________________________________________________
2. Ivanov O.L., Potakaev N.S. Kozhnye i venericheskie bolezni. M.: Meditsina, 1997. [in Russian]
3. Tamrazova O.B. Vozmozhnosti preodoleniia antibiotikorezistentnosti v terapii piodermii. Klin. dermatologiia i venerologiia. 2014; 12 (6): 64–73. [in Russian]
4. Lautz TB, Raval MV, Barsness KA. Increasing national burden of hospitalizations for skin and soft tissue infections in children. J Pediatr Surg 2011; 46: 1935–41.
5. Bonomo A, Peter S Van Zile, Qing Li et al. Topical triple-antibiotic ointment. Exp Rev Anti-Infective Ther 2007: 75 (6): 859–64.
6. Cole C, Gazewood J. Diagnosis and treatment of impetigo. Am Fam Physician 2007; 75 (6): 859–64.
7. Moran GJ, Amii RN, Abrahamian FM, Talan DA. Methicillin-resistant Staphylococcus aureus in community-acquired skin infections. Emerg Infect Dis 2005; 11 (6): 928–30.
8. Amagai M, Matsuyoshi N. Toxin in bullous impetigo and staphylococcal scalded novel therapeutic choice in wound management and infection prevention: a practical perspective. Exp Rev Anti-Infective Ther 2007; 75 (5): 773–82.
9. Becker K, Friedrich AW, Lubritz G et al. Prevalence of genes encoding pyrogenic toxin superantigens and exfoliative toxins among strains of Staphylococcus aureus isolated from blood and nasal specimens. J Clin Microbiol 2003; 41: 1434–9.
10. Sila J, Sauer P, Kolar M. Comparison of the prevalence of genes coding for enterotoxins, exfoliatins, panton-valentine leukocidin and TSST-1 between methicillin-resistant and methicillin-susceptible isolates of Staphylococcus aureus at the University hospital in Olomouc. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2009; 153: 215–8.
11. George A, Rubin G. A systematic review and meta-analysis of treatments for impetigo. Br J Gen Pract 2003; 53 (491): 480–7.
12. Mikheev N.G., Sokolovskii E.V., Savicheva A.M. Ratsional'naia protivomikrobnaia terapiia bol'nykh piodermiiami. Vestn. dermatologii i venerologii. 2017; 1: 68–75. [in Russian]
13. The Role of Topical Antibiotics in Dermatologic Practice. Medscape 2003. http://www.medscape.com/viewprogram/2501 (accessed December 19, 2004).
14. Katz S, McGinley K, Leyden JJ. Semipermeable occlusive dressings: Effects on growth of pathogenic bacteria and reepithelialization of superficial wounds. Arch Dermatol 1986; 122: 58–62.
15. Swartz MN, Pasternack MS. Cellulitis and subcutaneous tissue infection. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 6th ed. Philadelphia: Churchill Livingston, 2005.
16. Kasihina E.I., Abalyan S.A. Bacterial complications in cosmetic practice: treatment and prevention. Consilium Medicum. Dermatology (Suppl.). 2016; 2: 10–15. [in Russian]
17. Potekaev N.N. i dr. Naruzhnaia terapiia gnoinykh oslozhnenii v kosmetologii. Klin. dermatologiia i venerologiia. 2010; 6: 57–61. [in Russian]
18. Welshhans JL, Hom DB. Soft Tissue Principles to Minimize Scarring. Facial Plastic Surg Clin NA 2017; 25 (1): 1–13.
19. Eaglstein WH, Mertz P, Alvarez OM. Effect of topically applied agents on healing wounds. Clin Dermatol 1984; 2: 112–5.
20. Berger RS, Pappert AS, Van Zile PS et al. A newly formulated topical triple-antibiotic ointment minimizes scarring. Cutis 2000; 65 (6): 401–4.
21. Jones RN, Li Q, Kohut B et al. Contemporary antimicrobial activity of triple antibiotic ointment: a multiphased study of recent clinical isolates in the United States and Australia. Diagn. Microbiol Infect Dis 2006; 54 (1), 63–71.
22. Suzuki M, Yamada K et al. Antimicrobial Ointments and Methicillin-Resistant Staphylococcus Aureus USA300. Emerg Infect Dis 2011; 17 (10): 1917–20.
23. Anderson V. Over-the-counter topical antibiotic products: data on safety and efficacy. Int J Dermatol 1976; 15 (Suppl. 2): 1–118.
24. Rodgers GL, Mortensen JE, Fisher MC, Long SS. In vitro susceptibility testing of topical antimicrobial agents used in pediatric burn patients: comparison of two methods. J. Burn Care Rehabil 1997; 18 (5): 406–10.
25. Grzybowska W, Wójcik A, Tyski S. Interaction of neomycin with other antibiotics on selected bacterial strains. Med Dosw Mikrobiol 2004; 56 (2): 187–98.
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Авторы
А.А.Вашкевич*, П.А.Резцова
ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И.Мечникова» Минздрава России.
191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41
*Arina.Vashkevich@szgmu.ru
I.I.Mechnikov North-West State Medical University of the Ministry of Health of the Russian Federation. 191015, Russian Federation, Saint Petersburg, ul. Kirochnaia, d. 41
*Arina.Vashkevich@szgmu.ru
ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И.Мечникова» Минздрава России.
191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41
*Arina.Vashkevich@szgmu.ru
________________________________________________
I.I.Mechnikov North-West State Medical University of the Ministry of Health of the Russian Federation. 191015, Russian Federation, Saint Petersburg, ul. Kirochnaia, d. 41
*Arina.Vashkevich@szgmu.ru
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