Catad_tema Respiratory diseases - articles

Errors in antibiotic therapy respiratory tract infections in outpatient practice

Published in the magazine:
Attending doctor, 2003, №8 L. I. Dvoretsky, doctor medical sciences, Professor
S. V. Yakovlev, Doctor of Medical Sciences, Professor
MMA them. I. M. Sechenov, Moscow

The problem of rational antibiotic therapy of respiratory tract infections does not lose its relevance at the present time. The presence of a large arsenal of antibacterial drugs, on the one hand, expands the possibilities of treating various infections, and on the other hand, it requires the clinician to be aware of numerous antibiotics and their properties (spectrum of action, pharmacokinetics, side effects, etc.), the ability to navigate in issues of microbiology, clinical pharmacology and other related disciplines.

According to I. V. Davydovsky, “ medical errors- a kind of conscientious delusions of a doctor in his judgments and actions in the performance of certain special medical duties. Errors in antibiotic therapy of respiratory tract infections have the largest share in the structure of all medical and tactical errors made in pulmonological practice and have a significant impact on the outcome of the disease. In addition, the wrong prescription of antibiotic therapy can have not only medical, but also various social, deontological, economic and other consequences.

When choosing a method of antibiotic therapy in outpatient practice, it is necessary to take into account and solve both tactical and strategic tasks. The tactical tasks of antibiotic therapy include the rational choice of an antibacterial drug that has the greatest therapeutic and least toxic effects.

The strategic task of antibiotic therapy in outpatient practice can be formulated as a reduction in the selection and spread of resistant strains of microorganisms in the population.

In accordance with these provisions, tactical and strategic errors should be distinguished during antibiotic therapy of respiratory tract infections in outpatient practice (see Table 1).

Table 1. Mistakes in antibiotic therapy in outpatient practice.

Tactical errors of antibiotic therapy

1. Unreasonable appointment antibacterial agents

An indication for the appointment of an antibacterial drug is a diagnosed or suspected bacterial infection.

The most common mistake in outpatient practice is the prescription of antibacterial drugs for acute respiratory viral infections (ARVI), which occurs both in therapeutic and pediatric practice. At the same time, errors can be due to both an incorrect interpretation of the symptoms (the doctor takes ARVI for a bacterial bronchopulmonary infection in the form of pneumonia or bronchitis), and the desire to prevent bacterial complications of ARVI.

With all the difficulties in making a decision in such situations, it is necessary to be aware that antibacterial drugs do not affect the course of a viral infection and, therefore, their appointment in ARVI is not justified (see Table 2). At the same time, the supposed possibility of preventing bacterial complications viral infections with the help of prescribing antibacterial drugs does not find confirmation in clinical practice. In addition, it is obvious that the widespread unjustified use of antibacterial drugs in ARVI is fraught with the formation of drug resistance and an increased risk of adverse reactions in the patient.

Table 2. Infectious diseases of the respiratory tract of predominantly viral etiology
and do not require antibiotic therapy.

One of the common mistakes in antibiotic therapy is the appointment of antifungal agents simultaneously with antibiotics in order to prevent fungal complications and dysbacteriosis. It should be emphasized that with the use of modern antibacterial agents in immunocompetent patients, the risk of developing fungal superinfection is minimal, so the simultaneous administration of antimycotics in this case is not justified. The combination of an antibiotic with an antifungal agent is advisable only in patients receiving cytostatic or antitumor therapy or in HIV-infected patients. In these cases, the prophylactic administration of systemic antimycotics (ketoconazole, miconazole, fluconazole), but not nystatin, is justified. The latter is practically not absorbed in the gastrointestinal tract and is not able to prevent fungal superinfection of other localization - the oral cavity, respiratory or urinary tract, genitals. The often practiced prescription of nystatin to prevent intestinal dysbacteriosis does not find a logical explanation at all.

Often the doctor prescribes nystatin or another antimycotic if fungi of the genus Candida. At the same time, it focuses only on microbiological data and does not take into account the presence or absence of symptoms of candidiasis, as well as risk factors for the development of a fungal infection (severe immunodeficiency, etc.).

Isolation of fungi of the genus Candida from the mouth or urinary tract patients in most cases is evidence of asymptomatic colonization that does not require corrective antifungal therapy.

II. Mistakes in choosing an antibacterial drug

Perhaps, largest number errors that occur in outpatient practice is associated with the choice of antibacterial agent. The choice of antibiotic should be made taking into account the following main criteria:

spectrum of antimicrobial activity of the drug in vitro;

regional level of antibiotic resistance of pathogens;

efficacy proven in controlled clinical trials;

drug safety. The determining factor in the choice of the drug should be the spectrum of natural activity of the antibiotic: it is necessary that it covers the main causative agents of community-acquired respiratory tract infections (see table 3). Table 3. The most significant causative agents of community-acquired respiratory tract infections. In addition, when choosing a drug, one should take into account the level of acquired resistance of pathogens in the population. The main trends regarding the resistance of pathogens noted in last years are shown in Table 4. Table 4. Modern problems of resistance of the most common causative agents of community-acquired respiratory tract infections.

Microorganisms	Modern problems of treatment
Streptococcus pneumoniae	Decreased sensitivity to beta-lactams; resistance to penicillin in Russia does not exceed 2%, but strains with moderate sensitivity account for 10 - 20%. b-lactams (amoxicillin, ampicillin, III-IV generation cephalosporins, carbapenems) retain full clinical efficacy against penicillin-resistant pneumococci, while the effectiveness of I-II generation cephalosporins may be reduced. Low natural activity of third-generation oral cephalosporins, primarily ceftibuten. The growth of resistance to macrolides: in Europe from 8 to 35%, in Russia - about 12%; resistance is associated with clinical failure of therapy. High frequency of resistance in Russia to co-trimoxazole and tetracyclines (>50%). Low natural activity of early fluoroquinolones; in recent years, an increase in the frequency of resistant strains has been noted; high activity of new fluoroquinolones - minimal resistance.
Streptococcus pyogenes	Increasing resistance to macrolides: up to 50% in Europe, 10-20% in Russia. The increase in resistance is directly related to the increase in the frequency of consumption of macrolides, mainly long-acting drugs (azithromycin, clarithromycin). High resistance to tetracyclines (>50%). Low natural activity of early fluoroquinolones in. Resistance to penicillin and other b-lactams has not been described.
haemophilus influenzae	Production of b-lactamase in 1 - 40%, in Russia does not exceed 10%; clinically, amoxicillin is not inferior to protected penicillins. There is practically no resistance to amoxicillin / clavulanate, II-IV generation cephalosporins, fluoroquinolones. I generation cephalosporins are not active. The natural activity of macrolides is low, the risk of bacteriological treatment failure is high. Resistance to co-trimoxazole in Russia is about 20%.

The most significant problems associated with the use of basic antibacterial agents for respiratory tract infections can be formulated as follows. b-lactams:

high activity in vitro against the main pathogens, with the exception of atypical ones;

not high level resistance in Central Russia (however, the tendency to increase it is alarming);

reliable clinical and bacteriological efficacy. Macrolides:

resistance growth S. pneumoniae and S. pyogenes; resistance may be accompanied by a decrease in clinical efficacy;

low activity against H. influenzae- high frequency of bacteriological failure of therapy (persistence of pathogens). Early fluoroquinolones:

low natural activity against S. pneumoniae and S. pyogenes;

resistance growth S. pneumoniae. New fluoroquinolones:

high activity against S. pneumoniae, including strains resistant to penicillin and macrolides; stability is minimal. Co-trimoxazole:

high level of resistance S. pneumoniae and H. influenzas. Tetracyclines:

high level of sustainability S. pneumoniae. In view of the foregoing, β-lactam antibiotics and new fluoroquinolones can currently be recognized as the optimal agents for the treatment of community-acquired respiratory tract infections (see table 5). The use of macrolides should be limited - drugs can be prescribed for non-severe pneumonia in children or young patients, especially if there are signs of an atypical course (mycoplasma, chlamydial). Table 5. Significance of antibacterial agents in lower respiratory tract infections in outpatient practice. It should be emphasized that the appointment of some antibacterial drugs used in outpatient practice for respiratory infections cannot be considered rational. These drugs primarily include:

gentamicin - lack of activity against the most common pathogen S. pneumoniae and potentially high toxicity;

co-trimoxazole - high level of resistance S. pneumoniae and H. influenzae;

early fluoroquinolones (ciprofloxacin, ofloxacin, pefloxacin, lomefloxacin) - low activity against S. pneumoniae;

third-generation oral cephalosporins (ceftibuten) - low activity against S. pneumoniae;

ampioks is an irrational combination, the doses of ampicillin and oxacillin (0.125 mg each) are significantly lower than therapeutic ones. Table 6 shows modern recommendations on antibiotic therapy of community-acquired respiratory infections, taking into account all the required criteria and proven efficacy in controlled clinical research. Table 6. Antibacterial drugs recommended for the treatment of community-acquired respiratory infections. 1 Mainly in relapsing course
2 In case of atypical etiology ( Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumopriila) The recommendations presented are of the most general nature. At the same time, from a practical point of view, the choice of the optimal antibacterial drug should also be carried out taking into account the characteristics of the patient and the disease. So, for example, in patients with pneumonia of young and middle age without aggravating factors, amoxicillin, macrolides, protected penicillins and new fluoroquinolones have a therapeutic effect. However, in elderly patients, in the etiology of the disease, S. aureus and gram-negative bacteria, which explains the decrease in the effectiveness of amoxicillin and macrolides in this category of patients. Also a common mistake in medical practice is the refusal to prescribe antibiotic therapy for pneumonia to pregnant women due to fear of the negative effect of drugs on the fetus. It should be noted that the list of antibacterial drugs, the use of which is undesirable during pregnancy due to the risk of embryotoxic effects, is limited - tetracyclines, chloramphenicol, sulfonamides, co-trimoxazole, fluoroquinolones, aminoglycosides. Other antibiotics, in particular b-lactams, macrolides, may be used in pregnant women. Other possible factors influencing the choice of antibacterial drug are presented in Table 7. Table 7. Special clinical situations in community-acquired infections of the lower respiratory tract. Mistakes are not uncommon when choosing an antibacterial drug in case of ineffectiveness of the initial one. Here it is also necessary to dwell on the errors of antibiotic therapy, which relate to the untimely assessment of the ineffectiveness of the initial antibiotic. The generally accepted critical period for evaluating the effectiveness (or ineffectiveness) of antibiotic therapy is 48-72 hours from the moment of its appointment. Unfortunately, we often encounter such cases when the patient continues to receive the prescribed antibiotic for a week or more, despite the absence of an obvious clinical effect. Usually, the criterion for the effectiveness of antibiotic therapy is a decrease or normalization of the patient's body temperature, a decrease in signs of intoxication. In those cases (not so frequent), when there is no fever from the very beginning of the disease, one has to focus on other signs of intoxication ( headache, anorexia, cerebral symptoms, etc.), as well as the absence of disease progression during the period of treatment. Continuation of antibiotic therapy, despite its inefficiency, has many negative consequences. At the same time, the appointment of another, more adequate antibiotic is delayed, which leads to the progression of inflammation (especially important in severe pneumonia, in patients with concomitant pathology) and the development of complications, and also lengthens the treatment time. In addition, the risk of side (toxic) effects of drugs, as well as the development and strengthening of antibiotic resistance, increases. Continuation of treatment, despite the ineffectiveness of the therapy, undermines the confidence of the patient and his relatives in the attending physician. The uneconomical nature of such an erroneous tactics of antibiotic therapy is also obvious (waste consumption of ineffective AP, additional costs for the treatment of toxic effects, etc.). In addition, errors occur when replacing an ineffective antibiotic with another, i.e. when changing the drug. At the same time, the doctor forgets that the principle of choosing an antibacterial drug remains the same, that is, one should focus on the clinical situation, taking into account, however, the ineffectiveness of the initial drug and a number of other additional signs. The lack of effect of the initially prescribed antibiotic to a certain extent should serve as an additional guideline to justify the choice of the second drug. For example, the lack of effect from the use of b-lactam antibiotics (penicillins, cephalosporins) in a patient with community-acquired pneumonia suggests an atypical etiology of pneumonia (mycoplasmal, chlamydial or legionella), taking into account, of course, other clinical signs. Clinical signs of SARS caused by Mycoplasma pneumoniae or Chlamydia pneumonias:

gradual onset (within three to seven days);

often subfebrile temperature;

unproductive cough;

absence of purulent sputum;

extrapulmonary symptoms (pharyngitis, myalgia, headache, diarrhea);

interstitial infiltrates;

bilateral defeat. The presence of clinical signs of atypical pneumonia makes it reasonable to prescribe antibacterial drugs from the group of macrolides, doxycycline or fluoroquinolones (levofloxacin, moxifloxacin, ofloxacin). III. Errors in the choice of dosing regimen of an antibacterial drug Errors in choosing the optimal dose of an antibacterial agent may be in the appointment of both insufficient and excessive doses of the drug. Both those and other mistakes are fraught with negative consequences. If the dose of the antibiotic is insufficient and does not create a concentration in the blood and tissues of the respiratory tract that exceeds minimum dose to suppress the main pathogens of infection, which is a condition for the eradication of the corresponding pathogen, this can not only be one of the reasons for the ineffectiveness of therapy, but also creates real prerequisites for the formation of resistance of microorganisms. Errors in choosing the optimal dose can be associated with both the appointment of an insufficient single dose and the wrong dosing regimen (insufficient frequency of administration). An example of an inadequate antibiotic dosing regimen for community-acquired pneumonia is amoxicillin, which was previously recommended at a daily dose of up to 1 g. However, current recommendations suggest the appointment of amoxicillin at a daily dose of 1.5 and even 3 g to overcome possible resistance. S. pneumoniae. Examples of inadequate outpatient antibiotic dosing regimens for respiratory infections are summarized in Table 8. Table 8. Inadequate outpatient oral antibiotic dosing regimens for respiratory infections in adults.

Examples	expedient
Amoxicillin orally 0.75-1 g per day	0.5-1 g three times a day
Ampicillin IV 2 g per day	1 g four times a day
Amoxicillin/clavulanate by mouth 0.375 g three times a day	0.625 g three times a day or 1 g twice a day
Cefuroxime axetil orally 0.5 g per day	0.5 g twice a day
Erythromycin 1 g per day	0.5 g four times a day
Clarithromycin 0.5 g orally per day	0.5 g twice a day
Ciprofloxacin 0.5 g orally per day	0.5-0.75 g twice a day
Oxacillin orally 1-1.5 g per day	Not recommended
Ampioks inside 0.25-0.5 g three times a day	Not recommended

The wrong choice of intervals between the introductions of antibacterial drugs is usually due not so much to the difficulties of parenteral administration of drugs on an outpatient basis or the negative mood of patients, but to the lack of awareness of practitioners about some pharmacodynamic and pharmacokinetic features of drugs that should determine their dosing regimen. A typical mistake is the appointment of benzylpenicillin in outpatient pediatric practice for pneumonia with a frequency of administration twice a day, since its more frequent administration is inconvenient for the patient. It should be noted that in mild cases of pneumonia, the desire of some doctors to mandatory prescribe parenteral antibiotics is hardly justified. Modern antibacterial drugs are characterized by good oral bioavailability, as well as the same clinical efficacy with parenteral drugs, so in the vast majority of cases, treatment with oral drugs is justified. If parenteral antibiotics are indeed needed, an agent with a long half-life (eg, ceftriaxone) should be selected to allow once-daily administration. IV. Errors in the combined prescription of antibiotics One of the mistakes of antibiotic therapy for community-acquired respiratory infections is the unreasonable prescription of a combination of antibiotics. Doctors of the older generations remember the time (50-70s of the last century), when the treatment of pneumonia was considered obligatory to prescribe penicillin and streptomycin, as evidenced by many textbooks and manuals. It was a kind of standard treatment for pneumonia for that time. Somewhat later, along with antibiotics, the appointment of sulfonamides was recommended, taking into account the data obtained in due time by 3.V. Ermolyeva on the chemotherapeutic synergism of sulfonamides and penicillin. In the current situation, with a large arsenal of highly effective antibacterial drugs a wide range, the indications for combination antibiotic therapy are significantly narrowed, and the priority in the treatment of respiratory infections remains with monotherapy. Numerous controlled studies have shown the high clinical and bacteriological efficacy of adequate antibacterial agents in the treatment of respiratory infections in monotherapy (amoxicillin, amoxicillin / clavulanate, II-III generation cephalosporins, new fluoroquinolones). Combination antibiotic therapy has no real advantages in either the severity of the effect or in preventing the development of resistant strains. The main indications for combined antibiotic therapy are severe pneumonia - in this case, the combined prescription of a third-generation parenteral cephalosporin (cefotaxime or ceftriaxone) and a parenteral macrolide antibiotic (erythromycin, or clarithromycin, or spiramycin) becomes the generally accepted standard of treatment; the latter are included in the combination to act on likely atypical microorganisms (legionella or mycoplasma). It should be noted that at present, new antibacterial drugs (levofloxacin, moxifloxacin) with high activity against both typical and atypical pathogens have appeared in clinical practice, which makes it possible to prescribe them as monotherapy even in severe pneumonia. Another clinical situation that justifies the combined prescription of antibiotics is pneumonia in immunocompromised patients (treatment with cytostatics, AIDS), in which there is a high probability of association of pathogens (see table 7). Unfortunately, often in outpatient practice one has to deal with situations in which patients with a mild course of pneumonia, in the absence of complications, severe background pathology, are prescribed two antibiotics. There is no logical justification for this treatment strategy, and possible drug antagonism, a higher risk of adverse reactions and an increase in the cost of treatment should be taken into account. It should be noted that irrational combinations of antibacterial drugs also have official dosage forms that are produced by the domestic pharmaceutical industry, for example, ampioks, oletethrin. Of course, the use of such drugs is unacceptable. V. Errors associated with the duration of antibiotic therapy and criteria for clinical efficacy In some cases, unreasonably long antibiotic therapy is carried out. Such an erroneous tactic is primarily due to an insufficient understanding of the purpose of the antibiotic therapy itself, which is primarily to eradicate the pathogen or suppress its further growth, i.e., is aimed at suppressing microbial aggression. The actual inflammatory reaction of the lung tissue, which is manifested by various clinical and radiological signs (auscultatory picture, persistent radiological infiltration, accelerated ESR), regresses more slowly and does not require continued antibiotic therapy (see Table 9). In this regard, it should be considered an erroneous tactic, according to which, in a patient with persistent radiographic signs of pulmonary infiltration, crepitant wheezing (crepitacio redux), an increase in ESR with normalization of body temperature and the disappearance (or decrease) of signs of intoxication, antibiotic therapy continues. Table 9. Timing of symptom resolution with effective antibiotic therapy for community-acquired pneumonia. Even more erroneous is the tactic of replacing one antibiotic with another in such situations, regarded by the doctor as the ineffectiveness of the prescribed antibiotic therapy. In some patients, after the disappearance of signs of intoxication and even regression of inflammatory changes in the lungs, weakness, sweating, and subfebrile temperature may persist for a long time. The latter is regarded by the doctor as a manifestation of an incomplete bronchopulmonary infection, which is “confirmed” by x-ray data in the form of a change in the lung pattern or “residual effects of pneumonia” and usually entails the appointment of an antibacterial drug, despite the absence of changes in the blood. Meanwhile, such a clinical situation is often caused by autonomic dysfunction after a pulmonary infection (post-infectious asthenia) and does not require antibiotic therapy, although, of course, in each specific case, a thorough examination of the patient and a decoding of all available symptoms are necessary. The recommended duration of antibiotic therapy for bronchopulmonary infections is shown in Table 10. Table 10. Duration of antibiotic therapy for bacterial respiratory infections in outpatient practice.

*	The effectiveness of cefuroxime axetil, telithromycin and azithromycin has been shown in five-day courses; benzathinepenicillin is administered once intramuscularly
**	Ceftriaxone (50 mg/kg per day) has been shown to be effective for three days
***	Efficacy of new fluoroquinolones (levofloxacin, moxifloxacin) was shown in five-day courses
****	Usually, the recommended treatment time is three to four days after the temperature has returned to normal; the average treatment time is five to ten days. With staphylococcal pneumonia etiology, more long course antibiotic therapy - two to three weeks; in atypical pneumonia (mycoplasmal, chlamydial, legionella), the estimated duration of antibiotic therapy is 10-14 days.

In modern medicine, broad-spectrum antibiotics - Ciprofloxacin and Amoxiclav - are very popular. Characteristic medicines are especially effective against aerobic and anaerobic bacteria, strains. The main goal of antibacterial treatment is to exterminate the pathogenic flora, to ensure the removal of microbes from the body without harm to health.

Comparison of drugs

Many patients, for medical reasons, ask the main question, what is better to buy Ciprofloxacin or Amoxiclav, which antibiotic should you give your preference to? Both medications are indicated for angina, tonsillitis, pharyngitis, laryngitis, and others. infectious diseases lower respiratory tract.

These antibiotics fell into the category of " good medicine", are recommended for use by adults and children, according to the prescribed dosages. When prescribing an antibiotic agent, it is important to be guided not so much by the instructions for use as by the recommendations of the attending physician. Below are the main differences between the two medications that will help the patient make the right choice.

Main differences

1. Amoxiclav is a bright representative of the penicillin series, while the medical drug Ciprofloxacin belongs to the pharmacological group of broad-spectrum fluoroquinolone antibiotics.
2. The active components of Amoxiclav are amoxicillin and clavulanic acid, which maintains the therapeutic effect of the antibiotic. The active substance of ciprofloxacin is ciprofloxacin, which inhibits the activity of the enzyme responsible for the synthesis of bacterial DNA.
3. The appointment of Amoxiclav is appropriate for increased activity of staphylococci, streptococci, echinococci, proteus, shigella. Taking the medication Ciprofloxacin is more suitable for infection with gram-positive and gram-negative bacteria.
4. The use of Amoxiclav is appropriate when carrying a fetus when the daily dosages are agreed with the attending physician. The second broad profile antibiotic during pregnancy and breastfeeding is contraindicated.
5. Oral administration of Amoxiclav is allowed for use by patients from the age of 3 months, while treatment with Ciprofloxacin is allowed starting from the age of 18 years of the patient.

Reviews for Ciprofloxacin

These tablets help to successfully cure infectious lesions of the throat, and many patients over 18 years of age have turned to him for help. Doctors warn about side effects due to the systemic action of the antibiotic, but in practice such anomalies are extremely rare. Reviews from specialists are positive, but here is what patients write after the course of treatment:

- The drug Ciprofloxacin is reliable, improvements began already on the 3rd day after the start of the intake, although before that I could not get out of bed for almost a week, the temperature was very high, I constantly felt sick, I did not eat anything.

- Antibiotic when taken orally does not cause side effects helps to overcome angina. In this way, I cured tonsillitis in a week, it is still not recommended to take the medication inside for longer.

Reviews about Amoxiclav

Real notes about a characteristic medication on thematic forums are more often left by young parents who gave Amoxiclav to their children. There are no complaints about such home treatment, the antibiotic acts gently and purposefully. Here's what patients say:

- In this way, in 5 days, she cured a 2-year-old child with a sore throat, acted strictly according to the indications and recommendations of the pediatrician. Satisfied with the treatment, there were no complications.

- Amoxiclav removes the infection from the body, helps to normalize high temperature and remove inflammation. The action of the tablets is almost instantaneous.

What's better?

The answer to this question depends on medical indications, the age of the patient and the individual characteristics of each organism. For example, Amoxiclav or analogues of the drug are allowed to be given to young children who are pregnant with the obvious benefit of such an appointment. If it is not Amoxiclav, Flemoxin Solutab infections and Augmentin are successfully treated.

Ciprofloxacin is a more serious antibiotic with severe contraindications and an extensive list of side effects. Its complete analogue, identical in chemical composition, is Tsiprolet, produced in the form of tablets. Both medications should be prescribed by a doctor to patients over 18 years of age, while individually adjusting daily doses. Otherwise, overdose symptoms are observed, represented by increased side effects.

What is more efficient?

Both antibiotics are highly effective, but take them in the same regimen intensive care absolutely contraindicated. Increasing concentration active ingredients synthetic origin in the blood leads to poisoning of the whole organism. Due to the systemic action of both medications, side effects may affect the condition nervous system, gastrointestinal tract, cardiovascular and respiratory systems.

Each patient independently determines which antibiotic is best. Amoxiclav acts gently, but the therapeutic effect does not occur immediately. The action of Ciprofloxacin is more radical and targeted, but the number of complaints from patients about such an appointment is much larger in extensive medical practice. In the rest, the last word for the specialist.

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Antibiotics are widely used in the treatment of diseases of the respiratory system. fluoroquinolone row.

They are highly efficient and have wide spectrum of activity. Among the most popular drugs are Ciprofloxacin and Levofloxacin.

These analogue medicines are successfully used in the field of pulmonology and otolaryngology. With their help, ailments associated with inflammation of the ENT organs are treated, lung diseases and respiratory diseases. Respiratory infections are no exception.

Both drugs have been successfully used in the treatment progressive form of tuberculosis. To understand which remedy is better, it is advisable to consider in more detail the features of each of them and compare the effectiveness of the drugs.

Ciprofloxacin

Ciprofloxacin is a classic fluoroquinolone with increased activity against staphylococci and chlamydia. As for diseases that develop as a result of pneumococcal infection entering the body, the drug is ineffective in their regard.

Photo 1. Packing Ciprofloxacin in the form of tablets with a dosage of 250 mg. Producer "OZ GNTsLS".

Ciprofloxacin is prescribed for respiratory tuberculosis. In some cases, there is complex treatment With Pyrazinamide, Streptomycin and Isoniazid. It has been clinically proven that monotherapy against tuberculosis is less effective.

Indications for use

Absolute indications for the use of ciprofloxacin are:

• acute bronchitis, and exacerbation of the disease in chronic form;
• severe form of tuberculosis;
• pulmonary inflammation;
• infections that develop as a result of cystic fibrosis;
• inflammation of the middle ear - otitis;
• sinusitis;
• frontitis;
• pharyngitis;
• tonsillitis;
• complicated infections and inflammation of the urinary system;
• chlamydia;
• gonorrhea;
• infectious diseases of the gastrointestinal tract;
• infectious skin lesions, burns, ulcers and a number of others.

The drug can be used in the treatment postoperative infectious complications.

The main active ingredient of the drug is ciprofloxacin. The composition of the drug includes auxiliary components: starch, talc, titanium and silicon dioxide, magnesium stearate and lecithin. The drug has several forms of release: tablets, solutions for injections and infusions.

Ciprofloxacin has its contraindications and side effects. In most cases, the drug is well tolerated, but against the background of its reception may occur:

• allergic reactions;
• swelling of the vocal cords;
• anorexia;
• leukopenia;
• agranulocytosis;
• thrombocytopenia;
• kidney failure;
• the occurrence of pain in the abdomen;
• stool disorder;
• insomnia;
• violation of taste perceptions;
• headache;
• exacerbation of epilepsy.
• Contraindications to taking the drug are:
• individual intolerance to its individual components;
• hypersensitivity to ciprofloxacin.

Medicine not prescribed to women during pregnancy and lactation, as well as children up to 15 years. Antibiotics should be used with caution kidney failure.

Levofloxacin

Levofloxacin - fluoroquinolone third generation. The drug shows high efficiency in relation to pneumococcal, atypical respiratory and gram-negative bacterial infection. Even those pathogens that are fairly resistant to second-generation antibacterial fluoroquinolones are susceptible to Levofloxacin.

Photo 2. Packing of Levofloxacin in the form of tablets with a dosage of 500 mg. Producer "Teva".

The drug is used for pulmonary tuberculosis. The spectrum of its action in this regard is completely identical to Ciprofloxacin. During monotherapy, clinical improvement in patients is observed in about a month.

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Indications for use

Indications for the use of Levofloxacin are:

• exacerbation of bronchitis;
• inflammatory processes in paranasal sinuses nose, characterized by a complicated course, for example, sinusitis;
• pulmonary inflammation of any form;
• inflammatory processes of the infectious nature of the ENT organs;
• infections that develop against the background of cystic fibrosis;
• inflammation genitourinary system: pyelonephritis, inflammation of the prostate, chlamydia;
• soft tissue abscesses;
• furunculosis.

The active substance of the drug is the chemical component of the same name - levofloxacin. The medicine contains additional components: cellulose, sodium chloride, dihydrate, disodium edetate, titanium dioxide, iron oxide, calcium stearate.

Levofloxacin has several forms of release. Today in domestic pharmacies you can buy drops, tablets and solution for infusion.

Contraindications and side effects

Like any other medicine, the fluoroquinolone Levofloxacin has a number of side effects:

• allergy to individual components of the drug;
• violation of the functional features of the gastrointestinal tract;
• headache accompanied by dizziness;
• muscle and joint pain;
• feeling tired, drowsiness;
• inflammation of the tendons;
• acute liver failure;
• depression;
• rhabdomyolysis;
• neutropenia;
• hemolytic anemia;
• asthenia;
• exacerbation of porphyria;
• exacerbation of epilepsy;
• development of a secondary infection.

Important! Levofloxacin strongly not recommended to be taken without consulting a doctor.

Contraindications to taking the drug are:

• a tendency to develop an allergic reaction to individual medicinal components, i.e. individual intolerance;
• unhealthy kidneys;
• epilepsy;
• drug-induced tendon injury associated with treatment with fluoroquinolone antibacterial drugs.

Levofloxacin do not appoint women during pregnancy and while breastfeeding, as well as children and teenagers. Caution should be exercised by patients with renal pathologies and geriatric patients.

In case of drug overdose, it is suggested to carry out symptomatic treatment. Dialysis is not very efficient.

During the course of therapy it is not advisable to drive a car and engage in other activities that require a quick response and increased attention.

Considering the probability photosensitivity, it is recommended to be as little as possible under the influence of direct sun rays.

Which is better: Ciprofloxacin or Levofloxacin? How are antibiotics different?

In order not to make a mistake in the choice and purchase one of the above drugs, it is necessary to determine which one is better. Far from superfluous in resolving this issue will be the advice of a specialist. When evaluating an antibacterial agent, it is necessary based on the following criteria:

• degree of efficiency;
• safety;
• price range.

Comparison of drugs: which is more effective

Levofloxacin and Ciprofloxacin have a similar purpose, that is, they spectrum of action is the same but the first drug in terms of effectiveness has a number of advantages.

The active substance of Ciprofloxacin is ciprofloxacin, Levofloxacin contains the main component levofloxacin.

Unlike Ciprofloxacin, the antibacterial effect of Levofloxacin against pneumococcal infection and atypical microorganisms is more pronounced. The drug remains active against gram-negative bacteria.

It is known that some pathogens that are not sensitive to Ciprofloxacin show instability before exposure to Levofloxacin. The latter drug is more active against Pseudomonas (P.) aeruginosa.

The type of bacterium and the degree of its sensitivity is determining factor when choosing a drug.

Photo 3. Packaging of Levofloxacin in the form of a solution for intravenous infusion dosage of 5 mg/ml. Producer "Belmedpreparaty".

Both fluoroquinolones well tolerated by the body, have excellent oral absorption and are successfully used as effective remedy against tuberculosis. Levofloxacin shows greater effectiveness in this regard, because it is used in the form intravenous injections.

Concentration active substance in tablets less than in the second preparation. Levofloxacin is more commonly prescribed as single drug for monotherapy. Eating does not matter during treatment. Both those and other tablets can be taken both before and after meals.

Concerning adverse reactions, then they arise rarely and with the same frequency when taking both Levovloxacin and Ciprofloxacin. Undesirable effects are similar in their manifestations. In patients taking these fluoroquinolones, the following disorders may occur:

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In clinical practice, the use antimicrobial agents can be empirical (drugs are selected taking into account the spectrum of action on the alleged pathogen) or etiological, based on the results of bacteriological seeding on the sensitivity of the flora to antibacterial drugs.

Many infectious diseases, such as pneumonia or pyelonephritis, require a combination of antibiotics.

For good charting similar treatment, it is necessary to clearly understand the types of pharmacological interactions of drugs and know which drugs can be used together, and which are categorically contraindicated.

Also, when compiling complex therapy take into account not only the underlying disease and its pathogen, but also:

• the age of the patient, the presence of pregnancy and lactation;
• clinical contraindications and allergic reactions in history;
• kidney and liver function;
• chronic diseases and basic medications taken by the patient (antihypertensive therapy, correction diabetes, anticonvulsants etc.), prescribed antibiotics (hereinafter referred to as the abbreviation ABP) should be well combined with planned therapy.

The result of the pharmacodynamic interaction of drugs can be:

• synergism (increased pharmacological effect);
• antagonism (reduction or complete elimination of drug effects on the body);
• reduced risk of development side effects;
• increased toxicity;
• lack of interaction.

As a rule, pure bactericidal (destroying the pathogen) and bacteriostatic agents (suppressing the growth and reproduction of representatives of the pathogenic flora) do not combine with each other. This is primarily due to their mechanism of action. Bactericidal preparations most effectively act on organisms in the stage of growth and reproduction, so the use of bacteriostatics can cause the development of drug resistance.

It is important to understand that this division according to the type of action on bacteria is not absolute, and different ABPs can have different effects depending on the prescribed dose.

For example, an increase daily dose or duration of use of a bacteriostatic agent, leads to its bactericidal action.

Also, it is possible to selectively act on certain pathogens. Being bactericidal antibiotics, penicillins have a bacteriostatic effect against enterococci.

Table of antibiotic compatibility by type of action

bactericidal	Bacteriostatic

The combination of antibiotics with each other, taking into account the dosage and type of action on the flora, allows you to expand the spectrum of action and increase the effectiveness of the therapy. For example, in order to prevent antibacterial resistance in Pseudomonas aeruginosa, it is possible to combine antipseudomonal cephalosporins and carbapenems, or aminoglycosides with fluoroquinolones.

1. Rational combinations of antibiotics for the treatment of enterococci: the addition of penicillins with aminoglycosides or the use of trimethoprim, in combination with sulfamethoxazole.
2. The second-generation combined drug has an extended spectrum of action: combining and Tinidazole ®.
3. The combination of cephalosporins and metronidazole ® is effective. Tetracyclines are combined with gentamicin to enhance the effect on intracellular pathogens.
4. Aminoglycosides are combined with rifampicin to enhance the effect on serrations (often recurrent upper respiratory infections). Also combined with cephalosporins to increase effectiveness against enterobacteria.

Compatibility of antibiotics with each other: table

Combinations are strictly prohibited.
Cephalosporins and Aminoglycosides.	Due to the mutual potentiation of the nephrotoxic effect, it is possible to develop acute renal failure, interstitial nephritis.
Chloramphenicol ® and Sulfonamides.	Pharmacologically incompatible.
, , Aminoglycosides and Furosemide ® .	A sharp increase in the ototoxic effect, up to complete hearing loss.
Fluoroquinolones and nitrofurans.	Antagonists.
Carbapenem ® and other beta-lactams.	pronounced antagonism.
Cephalosporins and Fluoroquinolones.	Severe leukopenia, a clear nephrotoxic effect.
It is forbidden to mix and inject in one solution (syringe):
Penicillins are not mixed with ascorbic acid, B vitamins ®, aminoglycosides.
Cephalosporins (especially ceftriaxone ®) do not combine with calcium gluconate.
and hydrocortisone.
Carbenicillin ® with kanamycin ® , gentamicin ® .
Tetracyclines with sulfonamides are not combined with hydrocortisone, calcium salts, soda.
All antibacterial drugs are absolutely incompatible with heparin.

Penicillins

Antibiotics of this series are not prescribed simultaneously with allopurinol, in view of the risk of developing "ampicillin rash".

Additive synergism of antibiotics (summation of the results of action) occurs when administered with macrolides and tetracyclines. These combinations are highly effective in community-acquired pneumonia. Appointment with aminoglycosides is permissible - separately, since when the drugs are mixed, their inactivation is observed.

When prescribing oral medications, women need to clarify whether they use oral contraceptives because penicillins interfere with their action. In order to prevent unwanted pregnancy recommended the use of barrier methods of contraception for the duration of antibiotic therapy.

Penicillins are not prescribed with sulfonamides in mind sharp decline their bactericidal action.
It is important to remember that their administration to patients who use anticoagulants, antiplatelet agents and non-steroidal anti-inflammatory drugs for a long time is undesirable due to the potential for bleeding.

Benzylpenicillin salt is not combined with potassium and potassium-sparing diuretics, in view of the increased risk of hyperkalemia.

Penicillins and fluoroquinolones are compatible

Possibly as a combination of protected or extended-spectrum penicillins for oral administration, with local administration of fluoroquinolones (drops), and combined systemic use (Levofloxacin ® and Augmentin ® for pneumonia).

Cephalosporins

Due to the high risk of cross allergic reactions, do not prescribe the first generation together with penicillins. Be wary appoint patients with intolerance to beta-lactam antibiotics. in history.

The combination with anticoagulants, thrombolytics and antiplatelet agents reduces clotting, can cause bleeding, usually gastrointestinal due to hypoprothrombinemia.
Combined administration with aminoglycosides and fluoroquinolones leads to a pronounced nephrotoxic effect.

The use of antibiotics after taking antacids reduces the absorption of the drug.

Carbapenems

Ertapenem ® is categorically incompatible with glucose solution. Also, carbapenems are not prescribed simultaneously with other beta-lactam agents due to a pronounced antagonistic interaction.

Aminoglycosides

Due to physical and chemical incompatibility, they are not mixed in the same syringe with beta-lactams and heparin.

The simultaneous use of several aminoglycosides leads to severe nephro- and ototoxicity. Also, these drugs cannot be combined with polymyxin ® , amphotericin ® , vancomycin ® . Not co-administered with furosemide.

Joint use with muscle relaxants and opioid analgesics can cause neuromuscular blockade and respiratory arrest.

Non-steroidal anti-inflammatory drugs slow down the excretion of aminoglycosides due to a slowdown in renal blood flow.

Quinolones (fluoroquinolones) group

Simultaneous use with antacids reduces the degree of absorption and bioavailability of the antibiotic.

They are not prescribed simultaneously with NSAIDs and nitroimidazole derivatives due to high toxicity to the nervous system and the possible occurrence of seizures.

They are antagonists and derivatives of nitrofuran, so this combination is not prescribed.

Ciprofloxacin ® , Norfloxacin ® , Pefloxacin ® is not used in conjunction with sodium bicarbonate, citrates and carbonic anhydrase inhibitors, due to the risk of crystalluria and kidney damage. Also disrupt the metabolism of indirect anticoagulants, can cause bleeding.
Appointment to patients receiving glucocorticosteroid therapy significantly increases the possibility of tendon rupture.

Violate the action of insulin and sugar-lowering tablets, are not prescribed to diabetics.

macrolides

Do not use in conjunction with antacids, due to reduced effectiveness. Appointment with rifampicin ® reduces the concentration of macrolides in the blood. Also not compatible with amfinekol ® and lincosamides. Not recommended for use in patients receiving statins.

Sulfonamides

They have a pronounced toxic effect in combination with anticoagulants, antidiabetic and anticonvulsants.

Not prescribed with estrogen-containing contraceptives due to the risk of uterine bleeding.

Not allowed to be combined with medicines depressing bone marrow function.

Sulfamethoxazoline/trimethoprim ® (Biseptol ®) and other sulfonamide antibiotics are compatible with polymyxin B ® , gentamicin ® and sisomycin ® , penicillins.

Tetracyclines

Not prescribed in conjunction with iron preparations. This is due to impaired absorption and digestibility of both drugs.

The combination with vitamin A can cause brain pseudotumor syndrome.
Not combined with indirect anticoagulants and anticonvulsants, tranquilizers.

Interactions of antibiotics with food, alcohol and herbs

Taking products that increase the secretion of hydrochloric acid in the stomach (juices, tomatoes, tea, coffee) leads to a decrease in the absorption of semi-synthetic penicillins and erythromycin ® .

Dairy products, with high content calcium: milk, cheese, cottage cheese, yoghurts, significantly inhibit the absorption of tetracyclines and ciprofloxacin ® .

When using chloramphenicol ® , metronidazole ® , cephalosporins, sulfonamides with alcohol, Antabuse-like syndrome may develop (tachycardia, heart pain, hyperemia skin, vomiting, nausea, severe headache, tinnitus). This complication is a life-threatening condition and can lead to death.

These drugs should not be combined even with alcoholic tinctures of medicinal herbs.

The combination of sulfonamides and tetracyclines with St. John's wort can cause a sharp increase in skin sensitivity to ultraviolet rays (drug photosensitivity).

Ciprofloxacin is a well-known antibiotic of the fluoroquinolone group, actively used in diagnosing a number of acute and chronic pathologies.

Not always diseases can be cured with only one antibiotic.

Doctors often prescribe combination antibacterial drugs or other drugs are added for treatment in order to enhance the bactericidal and bacteriostatic effect, as well as to avoid bacterial resistance or side effects.

Ciprofloxacin may easily be combined with other drugs, but patients are most often interested in the specifics of such a combination, because enhanced antibiotic therapy does not benefit the body.

What drugs are prescribed Ciprofloxacin

Ciprofloxacin is a fluoroquinolone antibiotic produced for the purpose of extended exposure to pathogenic bacteria. The drug is suitable for the treatment of many diseases, and its action is diverse. Antibiotics are most often not prescribed alone, because the treatment of many pathologies requires an individual and combined approach.

Photo 1. Ciprofloxacin, 20 tablets, 500 mg, Aliud Pharma.

Bacteria in the aggressive course of the disease acquire stability to the active components of the drug, which leads to incomplete recovery and increased frequency of relapses. Ciprofloxacin, like a fluoroquinolone, is not a highly effective antibiotic, which justifies prescribing additional drugs.

Most often it is combined with the following antibiotics and antimicrobials:

• doxycycline;
• Levofloxacin;
• Metronidazole;
• Azithromycin;
• Ciftriaxone;
• Cephalosporin;
• fluconabose;
• Ibuprofen.

It has been proven that the effectiveness of Ciprofloxacin increases and intensifies with a combination of other antibacterial medicines, but in some cases additional treatment is prescribed as a relief of pain symptoms, as well as the elimination of side effects.

Compatibility of Ciprofloxacin and Doxycycline

Both drugs are antibiotics, but Doxycycline belongs to the group tetracyclines, that is, he has a completely different chemical composition. These groups of antibacterial drugs have no contraindications for combination.

Due to the combination of doxycycline and ciprofloxacin, there is amplifying effect of antibacterial action, resistance to other antibiotics decreases.

Ciprofloxacin is a drug with a unique chemical formula, which means the absence of cross-resistance with drugs of another antibacterial series. It goes well with doxycycline.

The components of both drugs do not block or reduce pharmacological actions each other, but only complement (synergy).

Doxycycline itself is a very strong and toxic drug, so its simultaneous administration with Ciprofloxacin is a case exceptions, not the rules. This combination is prescribed for the following pathologies:

• acute inflammatory pelvic disease among women;
• specific urethritis caused by STIs;
• infectious complications after operations, abortions;
• pneumonia;
• tuberculosis;
• sepsis;
• sinusitis, sinusitis, sinusitis in acute form.

Most often Ciprofloxacin + Doxycycline are used in obstetrics and gynecology but the cases are different. Doxycycline has many dangerous side effects, and the additional use of other antibiotics will only increase their manifestation. The doctor must be sure to monitor the patient's condition.

Important! Ciprofloxacin + Doxycycline can be taken together only for acute or complicated infections.

Sluggish and chronic pathologies do not imply the combined use of drugs, but a similar option is possible if other treatment is ineffective.

The dosage, as well as the combination of drugs, depends on the recommendations of the doctor and the clinical diagnosis.

In acute, severe infections or severe foci of inflammation, ciprofloxacin and doxycycline are taken together or combined a week later to block resistance.

In cases of ineffectiveness of Ciprofloxacin, Doxycycline is prescribed, which is taken strictly as prescribed doctor.

Ciprofloxacin and Levofloxacin: can I take it at the same time

Levofloxacin is a 3rd generation fluoroquinolone antibiotic that belongs to the same drug group as Cifprofloxacin. In clinical practice, such combinations of drugs can cause cross resistance, that is, the usual resistance of bacteria to the active components of all fluoroquinolones. Them joint appointment doesn't make sense and carries certain risks, but at the same time they are compatible and do not cause any negative manifestations on the part of the body.

The side effects of every antibiotic are dangerous anyway. Levofloxacin is often prescribed after failure or intolerance to ciprofloxacin. They are not taken together, but Cifprofloxacin can be combined with another fluoroquinolone after 7-10 days to reduce resistance.

Photo 2. Levofloxacin, 10 tablets, 250 and 500 mg, manufacturer - Vertex.

Ciprofloxacin + Levofloxacin is theoretically used for any infectious diseases, as they have a wide spectrum of action, but the joint use of drugs leads to the risk of sustainability bacteria.

Ciprofloxacin and Metronidazole: their interaction

Metronidazole is not an antibiotic, according to its pharmacological group it is antimicrobial a drug that is intended for auxiliary treatment during antibiotic therapy. Ciprofloxacin and Metronidazole can be taken both together and separately, but in the latter case, Metronidazole is prescribed after the end of the intake Ciprofloxacin to maintain the therapeutic effect.

Ciprofloxacin + Metronidazole are effective against the following pathologies:

• protozoal diseases: amoebiasis, giardiasis, trichomonas urethritis / colpitis / vaginitis;
• cystitis, caused STD;
• endocarditis bacterial nature;
• meningitis;
• pneumonia;
• sepsis;
• infections caused Bacteroides spp, Peptostreptococcus spp, Clostridium spp, Peptococcus spp;
• organ diseases small pelvis;
• skin diseases;
• postoperative complications in gynecology/urology.

Reference! Metronidazole is also available under a different brand name. Trichopolum, which contains a similar pharmacological composition.

Metronidazole is ineffective when taken alone, so it is always prescribed with other drugs or antibiotics. Simultaneous administration of drugs is not dangerous, but Metronidazole has many side effects, which usually occur when interacting with other antibiotics. Doctors either reduce the dose of Metronidazole or prescribe it after antibiotic therapy.

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How to combine Ciprofloxacin and Azithromycin

Azithromycin is a drug antibacterial group, which traditionally refers to azalide macrolides. There are no contraindications for the combination of Azithromycin with fluoroquinolones, as they are successfully combined in the treatment of a number of specific diseases.

First of all, these pathologies include:

• pneumonia;
• pleurisy;
• COPD;
• tuberculosis;
• ENT pathology(sinusitis, frontal sinusitis, otitis, sinusitis).

Ciprofloxacin + Azithromycin is taken together for the treatment pulmonary diseases. Their separate use in the above acute pathologies is inappropriate and ineffective. They are perfectly combined and safe to use, but side effects and individual intolerance may occur.

Ciprofloxacin and Ceftriaxone

Ceftriaxone is an antibiotic belonging to the cephalosporin group, which can be combined with fluoroquinolones, enhancing the bactericidal and bacteriostatic effect. Both antibiotics have a wide spectrum of activity, which indicates the fact that any bacterial infection can be treated.

In clinical practice, they are combined for the treatment of various pathologies of a bacterial nature, and especially in the case when the patient has resistance to groups of other antibiotics.

They are safe to use and can be consumed at the same time.

Most often, this combination is used for therapy ENT pathology, as well as infections of the gastrointestinal tract, urogenital tract, skin ailments.

Ciprofloxacin and Cephalosporin: are they taken together?

Cephalosporin is a β-lactam antibiotic known for its versatility. pharmacological properties. Ciprofloxacin goes well with Cephalosporin, which complements and maintains the bactericidal effect.

In practice, doctors use this combination to treat a wide range of bacterial infections. First of all, this Gastrointestinal diseases, as well as urogenital diseases. Both drugs destroy opportunistic bacteria at the cellular level, which is extremely effective when taken twice. This combination of drugs allows you to quickly stop the foci of infection.

Most often, drugs are used simultaneously, as this helps to prevent the reproduction of bacteria and block resistance. Cephalosporin completely destroys the DNA of bacteria, stopping their division, and Ciprofloxacin reinforces the therapeutic effect.

ciprofloxacin and fluconazole

Most antibacterial agents cause side effects, among which the most common is candidiasis(thrush) caused by pathogenic fungi Candida spp.

Fluconazole is a proven antifungal agent, the pharmacokinetics of which inhibit the reproduction of Candida spp, as well as other representatives of fungal organisms.

Fluconazole can be taken simultaneously with any antibiotic in order to eliminate fungal manifestations.

But most often Fluconazole is used after antibiotic therapy or in last days taking ciprofloxacin to avoid hepatotoxicity and blocking the active components of the antifungal agent.

Important! Simultaneous reception of Ciprofloxacin and Fluconazole obligatory with a significant weakening of immunity after severe conditions (AIDS, radiation therapy).

Ciprofloxacin and Ibuprofen

Ibuprofen is a non-steroidal anti-inflammatory drugs that are designed to stop pain syndrome and lowering the temperature. Often pathological conditions accompanied by extremely unpleasant and painful symptoms, which requires action.

Ciprofloxacin + Ibuprofen - ideal for both treatment antibacterial infections, and to eliminate concomitant symptoms.

By itself, Ibuprofen has no effect on bacteria, and its pharmacokinetics have no effect on the components of any antibiotic that fights the cause, not the effect.

This combination of drugs is often prescribed for arthritis, myositis and other musculoskeletal diseases. In terms of side effects and compatibility, these are safe drugs.

What combination of drugs is most suitable for the treatment of tuberculosis

Each combination of drugs has varying degrees of effectiveness and is intended for the treatment of certain diseases. Tuberculosis cannot be stopped with one antibiotic, which provides for combination therapy.

Ciprofloxacin, like a fluoroquinolone, is a "reserve" drug in the treatment tuberculosis of the lungs. It has a relatively moderate efficacy, which in practice means the use of ciprofloxacin only in case of resistance to the most powerful drugs.

The ideal option is the combination of Ciprofloxacin and Doxycycline, as well as Azithromycin. Other combinations of antibiotics will have little effect.

Important! The ideal combination of antibiotics is their simultaneous use in tableted and injection form (injections).

Ciprofloxacin is perfectly combined with other antibiotics and antimicrobials. Their double effect enhances the bactericidal property and speed up overall recovery. But Ciprofloxacin does not mix well with other fluoroquinolones, as well as with some other groups of antibiotics. In other cases, a combination of drugs is an excellent treatment option, but there is a high probability of side effects.

Useful video

Check out the video that talks about Ciprofloxacin, indications for its use and how it works.

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