Antibiotics for Ammonia
Antibiotics Ammonia - Ammonia Antibacterial Cleaner
Adverse Effect of Ammonium Salts on the Antibacterial Activity
Ammonia Toxicity Medication
Management of toxic exposure to ammonia is largely supportive, and medical therapy is directed at hypoxia, bronchospasm, acute lung injury (ALI), hypovolemia, and burns of the skin and eyes.
Antibiotics and corticosteroids are controversial therapies following ammonia inhalation and ingestion exposures.
Although antibiotics and corticosteroids are often used in the acute treatment of patients with inhalation injury, neither has been shown to improve outcome and many believe that corticosteroids may actually increase morbidity. Corticosteroids are recommended to treat bronchospasm in patients with underlying reactive airways disease and acute inhalation injury or for chronic respiratory complications that follow an acute inhalation injury. Patients experiencing signs of airway edema after caustic exposure may benefit from IV administration of dexamethasone (adults: 10 mg; children: 0.6 mg/kg up to 10 mg max).
Use of steroids for the treatment of caustic injuries after caustic ingestion is still very controversial. Intravenous corticosteroids and antibiotics administration can be considered in symptomatic patients following ammonia ingestion with grade IIb (near-circumferential) caustic injuries. Presumably, corticosteroids are administered in order to decrease the incidence and severity of esophageal strictures that occur during healing from significant alkaline injuries. Antibiotics are given because of increased risk of mediastinitis associated with full-thickness esophageal alkaline corrosive burns and steroid use. Although controlled animal studies do support the use of these therapies, no well-controlled human trials have been performed; thus, corticosteroids and antibiotics should be administered in consultation with a GI specialist and surgeon.
If steroids are administered, the recommended dose is 1-2 mg/kg/d of methylprednisolone for 3 weeks followed by gradual tapering. If antibiotics are administered, a broad-spectrum antibiotic (eg, second-generation cephalosporins) is appropriate.
The decision to continue or stop corticosteroid and antibiotic therapy is based on endoscopic findings. Discontinue steroid and antibiotic therapies for patients with no injury or mild mucosal inflammation or ulceration, as they are not at risk for stricture formation. Furthermore, patients with severe transmural burns are at risk for stricture formation, but steroid therapy will not alter their risk. Thus, antibiotic therapy alone is recommended for this group to diminish their risk of mediastinitis. Patients with extensive superficial ulceration or deep discrete or circumferential ulcerations are at risk for stricture formation and may benefit from steroid administration. Consider administering corticosteroids and antibiotics to this group of patients.
The effect of antibiotics on ammonia accumulation and protein digestion in the rumen
A study was made of the feasibility of using antibiotics to reduce ruminal deamination of protein that comprised 27% of the organic matter in a diet of lucerne hay and casein. Six sheep were each dosed with a different antibiotic. At the levels given, penicillin and erythromycin reduced rumen ammonia levels by about 35%, but also reduced food intake. Chloramphenicol reduced rumen ammonia by about 50% but neomycin, oxytetracyclene, and streptomycin had little effect.
When all six sheep were subsequently dosed with chloramphenicol at 1 g/day the levels of rumen ammonia were reduced only to 85% of the control. The antibiotic had little effect on the extent of digestion of protein, organic matter, and cellulose, both in the stomach and in the whole alimentary tract, and on parameters associated with the movement of digesta through the stomach
The quantity of nitrogen passing from the stomach in forms other than ammonia was 52–54% of intake during both the control and treatment periods. Much of this nitrogen probably passed from the stomach in the form of microbial protein, which indicated that the dietary protein was extensively digested. In consequence of the loss of nitrogen from the stomach, the protein apparently digested in the intestines was equivalent to only about 14.5 g/100 g digestible organic matter.
Although expensive, topical Silvadene has antipseudomonal properties in addition to coverage for most gram-positive organisms.
For eye exposures, antibiotic eye preparations will reduce risk of infection secondary to tissue injury.
Administering an antibiotic by the oral route, rather than intravenously, restricts the antibacterial action to only the gastrointestinal tract where it's needed. The primary goal is to reduce ammonia-producing bacteria from the intestine. Three of those antibiotics are neomycin, vancomycin and rifaximin. Occasionally, both an antibiotic and lactulose are given to reduce bacteria and improve clearance in the intestine. Administering at separate intervals prevents lactulose from removing the antibiotic too quickly.
Silver sulfadiazine 1% (Silvadene)
Wash burn before application to remove previously applied agent.
Not for ophthalmic and facial use.
Other products may be used instead of silver sulfadiazine for partial thickness burns; these include TransCyte, Acticoat, or Biobrane.
Ciprofloxacin ophthalmic (Ciloxan)
Neomycin 5% is described in much of the literature on ammonia-related eye injury; however, newer broad-spectrum antibiotics have fewer adverse effects
Erythromycin ophthalmic (E-Mycin)
Effect of three antibacterial drugs in lowering blood & stool ammonia production in hepatic encephalopathy.
Neomycin (700 mg/8 h), ampicillin (500/6 h) and metronidazole (400 mg/8 h), were compared for their effect, on oral administration for 4 days, in reducing blood ammonia in 27 patients with stable chronic liver disease. It was found that there was 38.2, 38.5 and 8.7 m mol/litre mean reduction in blood ammonia in the neomycin, ampicillin and metronidazole treated groups respectively. The difference in blood ammonia was statistically significant for both neomycin (P = 0.01) and ampicillin (P = 0.03) but there was no significant change after metronidazole treatment (P = 0.6). The total stool enzyme activity at optimum pH was maximally reduced by ampicillin and minimally with metronidazole. The reduction was noted to be 3.51 m mol/1 (P = 0.01), 3.87 m mol/1 (P = 0.08) and 2.8 m mol/1 (P = 0.02) of NH3/g dry weight of stool for neomycin, ampicillin and metronidazole respectively. The main bacterial gut enzymes responsible for ammonia production, urease and protease, were found to be very sensitive to stool pH. At pH 6 their activity was around 20 per cent of what was found in optimum pH of 7.4 and at pH 5 it is only about 8 per cent of optimum activity. None of the three antibacterial agents changed the stool pH significantly. It can be concluded that oral neomycin and ampicillin are superior to oral metronidazole in lowering blood ammonia.