Catad_tema Respiratory diseases - articles

Errors in antibiotic therapy for respiratory tract infections in outpatient practice

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

The problem of rational antibiotic therapy for 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 the numerous antibiotics and their properties (spectrum of action, pharmacokinetics, side effects, etc.), the ability to navigate issues of microbiology, clinical pharmacology and other related disciplines.

According to IV Davydovsky, "medical errors are a kind of conscientious delusions of a doctor in his judgments and actions during the performance of certain special medical duties." Errors in antibacterial therapy of respiratory tract infections have the largest share in the structure of all treatment and tactical errors made in pulmonary practice, and have a significant impact on the outcome of the disease. In addition, improper prescription of antibacterial 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 a rational choice of an antibacterial drug that has the greatest therapeutic and least toxic effect.

The strategic objective 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 highlighted in the antibiotic therapy of respiratory tract infections in outpatient practice (see Table 1).

Table 1. Errors of antibiotic therapy in outpatient practice.

Tactical errors of antibiotic therapy

1. Unjustified appointment of 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 takes place in both therapeutic and pediatric practice. At the same time, errors can be caused both by an incorrect interpretation of 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 for ARVI is not justified (see table 2). At the same time, the alleged possibility of preventing bacterial complications of viral infections by prescribing antibacterial drugs has not been confirmed 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 the antibiotic in order to prevent fungal complications and dysbiosis. It should be emphasized that with the use of modern antibacterial agents in immunocompetent patients, the risk of developing fungal superinfection is minimal, therefore, 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 antineoplastic therapy or in HIV-infected patients. In these cases, 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 appointment of nystatin for the prevention of intestinal dysbiosis does not find a logical explanation at all.

Often, the doctor prescribes nystatin or another antimycotic if fungi of the genus are found in the mouth or urine Candida.At the same time, he focuses only on the data of microbiological research 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 Candidafrom the oral cavity or urinary tract of patients in most cases serves as evidence of asymptomatic colonization that does not require corrective antifungal therapy.

II. Mistakes in choosing an antibacterial drug

Perhaps the largest number of errors that arise in outpatient practice are associated with the choice of antibacterial agent. The choice of antibiotic should be based on the following basic criteria:

spectrum of antimicrobial activity of the drug in vitro;

regional level of pathogen resistance to antibiotics;

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 pathogens 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 recent years are reflected in Table 4. Table 4. Current problems of resistance of the most common pathogens 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 are 10-20%. b-lactams (amoxicillin, ampicillin, III-IV generation cephalosporins, carbapenems) retain full clinical efficacy against penicillin-resistant pneumococci, while the efficacy of generation I-II cephalosporins may be reduced. Low natural activity of oral cephalosporins of the third generation, primarily ceftibuten. Growth of resistance to macrolides: in Europe from 8 to 35%, in Russia - about 12%; resistance is associated with clinical therapy failure. High frequency of resistance to co-trimoxazole and tetracyclines in Russia (\u003e 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: in Europe up to 50%, in Russia 10-20%. The increase in resistance is directly related to an increase in the frequency of consumption of macrolides, mainly prolonged-release drugs (azithromycin, clarithromycin). High resistance to tetracyclines (\u003e 50%). Low natural activity of early fluoroquinolones in. Resistance to penicillin and other b-lactams has not been reported.
Haemophilus influenzae	Production of b-lactamases 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, cephalosporins of II-IV generations, fluoroquinolones. Generation I cephalosporins are inactive. 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;

a low level of resistance in Central Russia (however, the trend towards its increase is alarming);

reliable clinical and bacteriological efficacy. Macrolides:

increase in resistance S. pneumoniaeand S. pyogenes;resistance may be accompanied by a decrease in clinical effectiveness;

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

low natural activity against S. pneumoniaeand S. pyogenes;

increase in resistance 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 stability S. pneumoniae. In view of the above, b-lactam antibiotics and new fluoroquinolones can now be recognized as 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. The value of antibacterial agents for 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. pneumoniaeand potentially high toxicity;

co-trimoxazole - high level of resistance S. pneumoniaeand H. Influenzae;

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

3rd generation oral cephalosporins (ceftibuten) - low activity against S. pneumoniae;

ampiox is an irrational combination, doses of ampicillin and oxacillin (0.125 mg each) are significantly lower than therapeutic. Table 6 shows the current recommendations for antibiotic therapy of community-acquired respiratory infections, taking into account all the required criteria and proven efficacy in controlled clinical trials. Table 6. Antibacterial drugs recommended for the treatment of community-acquired respiratory infections. 1 Mainly with recurrent course
2 For atypical etiology (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumopriila) The recommendations presented are of the most general nature. At the same time, from a practical standpoint, the choice of the optimal antibacterial drug should also be carried out taking into account the characteristics of the patient and the disease. 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, it becomes more important S. aureusand 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 action, is limited - tetracyclines, chloramphenicol, sulfonamides, co-trimoxazole, fluoroquinolones, aminoglycosides. Other antibiotics, in particular b-lactams, macrolides, can 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 lower respiratory tract infections. There are frequent mistakes when choosing an antibacterial drug if the initial one is ineffective. Here it is also necessary to dwell on the errors of antibiotic therapy, which relate to the untimely assessment of the ineffectiveness of the original antibiotic. The generally accepted critical period for assessing the effectiveness (or ineffectiveness) of antibiotic therapy is 48-72 hours from the moment of its appointment. Unfortunately, we often have to deal with 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 on the absence of disease progression during the period of treatment. The continuation of antibiotic therapy, despite its ineffectiveness, 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 duration of treatment. In addition, the risk of side (toxic) effects of drugs increases, as well as the development and enhancement of antibiotic resistance. Continuation of treatment, despite the ineffectiveness of the therapy, undermines the confidence of the patient and his relatives in the attending physician. The inefficiency of such erroneous tactics of antibacterial therapy is also obvious (waste of ineffective AP, additional costs for the treatment of toxic effects, etc.). In addition, errors are encountered when replacing an ineffective antibiotic with another, i.e. when changing a 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 original drug and a number of other additional signs. The lack of effect from the originally prescribed antibiotic should, to a certain extent, 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 (mycoplasma, chlamydial or legionella), taking into account, of course, other clinical signs. Clinical signs of atypical pneumonia caused by Mycoplasma pneumoniaeor Chlamydia pneumonias:

gradual onset (over three to seven days);

often low-grade fever;

unproductive cough;

lack of purulent sputum;

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

interstitial infiltrates;

bilateral defeat. The presence of clinical signs of atypical pneumonia makes the prescription of antibacterial drugs from the group of macrolides, doxycycline or fluoroquinolones (levofloxacin, moxifloxacin, ofloxacin) justified. III. Errors in choosing a dosage regimen of an antibacterial drugErrors in choosing the optimal dose of an antibacterial agent may consist 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 the minimum dose to suppress the main pathogens, which is a condition for the eradication of the corresponding pathogen, then this not only can serve as one of the reasons for the ineffectiveness of therapy, but also creates real prerequisites for the formation resistance of microorganisms. Errors in choosing the optimal dose can be associated both with the appointment of an insufficient single dose, and with an incorrect dosing regimen (insufficient frequency of administration). As an example of an inadequate dosing regimen of antibiotics for community-acquired pneumonia, one can cite amoxicillin, which was previously recommended in a daily dose of up to 1 g. However, current recommendations suggest the appointment of amoxicillin in a daily dose of 1.5 and even 3 g to overcome possible resistance S. pneumoniae. Examples of inadequate dosing regimens of antibiotics in outpatient practice for respiratory infections are shown in Table 8. Table 8. Inadequate dosing regimens for oral antibiotics in outpatient practice for respiratory infections in adults.

Examples of	Expedient
Amoxicillin inside 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 inside 0.5 g per day	0.5 g twice a day
Erythromycin inside 1 g per day	0.5 g four times a day
Clarithromycin inside 0.5 g per day	0.5 g twice a day
Ciprofloxacin inside 0.5 g per day	0.5-0.75 g twice a day
Oxacillin inside 1-1.5 g per day	Not recommended
Ampiox inside 0.25-0.5 g three times a day	Not recommended

The wrong choice of intervals between injections of antibacterial drugs is usually caused not so much by the difficulties of parenteral administration of drugs on an outpatient basis or by the negative attitude of patients, as by the lack of awareness of practitioners about some of the pharmacodynamic and pharmacokinetic features of drugs that should determine their dosage regimen. A typical mistake is the appointment in outpatient pediatric practice for pneumonia of benzylpenicillin with a frequency of administration twice a day, since its more frequent administration is inconvenient for the patient. It should be noted that with a mild course of pneumonia, the desire of some doctors to prescribe parenteral antibiotics is hardly justified. Modern antibacterial drugs are characterized by good oral bioavailability, as well as the same clinical efficacy as parenteral drugs, therefore, in the overwhelming majority of cases, treatment with oral drugs is justified. If the appointment of parenteral antibiotics is really necessary, a drug with a long half-life (eg, ceftriaxone) should be chosen, which allows it to be prescribed once a day. IV. Errors in the combined administration of antibiotics One of the mistakes of antibiotic therapy of 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 in the treatment of pneumonia it was considered mandatory to prescribe penicillin and streptomycin, as evidenced by many textbooks and manuals. It was a kind of standard of treatment for pneumonia at the time. A little later, simultaneously with antibiotics, it was recommended to prescribe sulfonamides, taking into account the data obtained in due time by Z.V. Ermolyeva on the chemotherapeutic synergism of sulfonamides and penicillin. In the modern situation, in the presence of a large arsenal of highly effective antibacterial drugs of a wide spectrum, indications for combined antibiotic therapy are significantly narrowed, and the priority in the treatment of respiratory infections remains with monotherapy. Numerous controlled studies have shown high clinical and bacteriological efficacy of adequate antibacterial agents in the treatment of respiratory infections in monotherapy mode (amoxicillin, amoxicillin / clavulanate, cephalosporins of II - III generations, new fluoroquinolones). Combined antibiotic therapy has no real advantages either in the severity of the effect or in preventing the development of resistant strains. The main indications for combination antibiotic therapy are severe pneumonia - in this case, the generally accepted standard of treatment is the combined administration of a third generation parenteral cephalosporin (cefotaxime or ceftriaxone) and a parenteral macrolide antibiotic (erythromycin, or clarithromycin, or spiramycin); the latter are included in the combination to target 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 in monotherapy even in severe pneumonia. Another clinical situation justifying 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 rationale for this tactic of treatment, while possible antagonism of drugs, 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, ampiox, olettrin. 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 erroneous tactics are due, first of all, to insufficient understanding of the purpose of antibacterial therapy itself, which boils down primarily to eradication of the pathogen or suppression of its further growth, that is, it 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 radiographic infiltration, accelerated ESR), regresses more slowly and does not require continuation of antibiotic therapy (see Table 9). In this regard, it should be considered an erroneous tactic, according to which in a patient with persistent radiological signs of pulmonary infiltration, crepitant rales (crepitacio redux), an increase in ESR with normalization of body temperature and the disappearance (or decrease) of signs of intoxication, antibiotic therapy is continued. Table 9. The timing of the disappearance of symptoms with effective antibiotic therapy of community-acquired pneumonia. Even more erroneous is the tactic of replacing one antibiotic with another in such situations, which the doctor considers as 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 low-grade fever may persist for a long time. The latter is regarded by the doctor as a manifestation of incompletely arrested bronchopulmonary infection, which is "confirmed" by X-ray data in the form of changes in the pulmonary pattern or "residual 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 pulmonary infection (postinfectious asthenia) and does not require antibiotic therapy, although, of course, in each specific case, a thorough examination of the patient and deciphering of all existing symptoms are necessary. The recommended duration of antibacterial therapy for bronchopulmonary infections is shown in Table 10. Table 10. Duration of antibacterial therapy for bacterial respiratory infections in outpatient practice.

*	The efficacy of cefuroxime axetil, telithromycin and azithromycin has been shown for five-day courses; benzathine penicillin is administered once intramuscularly
**	Shown the effectiveness of ceftriaxone (50 mg / kg per day) for three days
***	The effectiveness of new fluoroquinolones (levofloxacin, moxifloxacin) has been shown in a five-day course
****	Usually the recommended treatment time is three to four days after the temperature has returned to normal; the average duration of treatment is five to ten days. With staphylococcal etiology of pneumonia, a longer course of antibiotic therapy is recommended - two to three weeks; with atypical pneumonia (mycoplasma, chlamydial, legionella), the estimated duration of antibiotic therapy is 10-14 days.

In modern medicine, broad-spectrum antibiotics - Ciprofloxacin and Amoxiclav - are very popular. The 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 elimination of microbes from the body without harm to health.

Comparison of drugs

Many patients, for medical reasons, ask the main question, which is better to buy Ciprofloxacin or Amoxiclav, which antibiotic to give their preference to? Both medicines are indicated to be taken for angina, tonsillitis, pharyngitis, laryngitis, and other infectious diseases of the lower respiratory tract.

These antibiotics fell into the category of "good medicine" and are recommended for use in adults and children, according to the prescribed dosages. When prescribing an antibiotic, 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.

The main differences

1. Amoxiclav is a prominent representative of the penicillin series, while the drug Ciprofloxacin belongs to the pharmacological group of broad-profile antibiotics-fluoroquinolones.
2. The active components of Amoxiclav are amoxicillin and clavulanic acid, which support the therapeutic effect of the antibiotic. The active ingredient of Ciprofloxacin is ciprofloxacin, which inhibits the activity of the enzyme responsible for the synthesis of bacterial DNA.
3. Appointment of Amoxiclav is appropriate with increased activity of staphylococci, streptococci, echinococci, proteus, shigella. Taking the medicine Ciprofloxacin is more suitable for infections with gram-positive and gram-negative bacteria.
4. The use of Amoxiclav is appropriate when carrying a fetus when the daily dosage is agreed with the attending physician. The second antibiotic of a wide profile during pregnancy and breastfeeding is contraindicated to use.
5. Oral administration of Amoxiclav is approved for use by patients from 3 months of age, while treatment with Ciprofloxacin is allowed from the age of 18 of the patient.

Reviews about Ciprofloxacin

These tablets help to successfully cure throat infections, and many patients over 18 years of age have turned to his help. Doctors warn about side effects due to the systemic effect 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, the improvements began as early as 3 days after the start of the intake, although before that for almost a week I could not get out of bed, the temperature was very high, I was constantly nauseous, I did not eat anything.

- The 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 by mouth for longer.

Reviews about Amoxiclav

Real notes about a characteristic medication on thematic forums are 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 write:

- In this way, in 5 days I cured a child's angina at 2 years old, acted strictly according to the indications and recommendations of the pediatrician. I am satisfied with the treatment, there were no complications.

- Amoxiclav removes 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 the medical indication, the age of the patient and the individual characteristics of each organism. For example, Amoxiclav or analogs of the drug are allowed to be given to young children, pregnant women with the obvious benefits 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 full 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 the daily dose. Otherwise, symptoms of overdose are observed, represented by increased side effects.

What is more efficient?

Both antibiotics are highly effective, but taking them in the same intensive care regimen is categorically contraindicated. An increase in the concentration of active components of synthetic origin in the blood leads to poisoning of the whole organism. Due to the systemic effect of both medications, side effects can affect the state of the nervous system, digestive tract organs, cardiovascular and respiratory systems.

Each patient independently determines which antibiotic is best. Amoxiclav acts mildly, but the therapeutic effect does not come immediately. The action of Ciprofloxacin is more radical and targeted, but the number of complaints from patients about such an appointment is much greater in extensive medical practice. Otherwise, the last word is with the specialist.

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

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

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

Both drugs are successfully used to treat 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 showing increased activity against staphylococci and chlamydia... As for diseases that develop as a result of pneumococcal infection entering the body, the drug is ineffective against them.

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

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

Indications for use

Absolute indications for the use of Ciprofloxacin are:

• acute bronchitis, and exacerbations of the disease in a chronic form;
• severe tuberculosis;
• pulmonary inflammation;
• infections resulting from cystic fibrosis;
• inflammation of the middle ear - otitis media;
• sinusitis;
• frontal;
• pharyngitis;
• tonsillitis;
• complicated infections and inflammations 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 to treat postoperative infectious complications.

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

Ciprofloxacin has its own contraindications and side effects. In most cases, the drug is easily tolerated, but against the background of his admission may take place:

• allergic reactions;
• swelling of the vocal cords;
• anorexia;
• leukopenia;
• agranulocytosis;
• thrombocytopenia;
• renal failure;
• the occurrence of pain in the abdomen;
• upset stool;
• insomnia;
• violation of taste perception;
• 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... Antibiotic should be used with caution when renal failure.

Levofloxacin

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

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

The drug is used for pulmonary tuberculosis... The spectrum of its action in this respect is completely identical to Ciprofloxacin. When conducting 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 the paranasal sinuses, characterized by a complicated course, for example, sinusitis;
• pulmonary inflammation of any form;
• inflammatory processes of an infectious nature of the ENT organs;
• infections developing against the background of cystic fibrosis;
• inflammation of the genitourinary system: pyelonephritis, inflammation of the prostate, chlamydia;
• abscesses of soft tissues;
• furunculosis.

The active ingredient of the drug is the chemical component of the same name - levofloxacin... The composition of the medicine contains additional components: cellulose, sodium chlorine, 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, 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, sleepy;
• inflammation of the tendons;
• acute liver failure;
• depression;
• rhabdomyolysis;
• neutropenia;
• hemolytic anemia;
• asthenia;
• exacerbation of porphyria;
• exacerbation of epilepsy;
• the development of a secondary infection.

Important! Levofloxacin strongly not recommended to be taken without medical advice.

Contraindications to taking the drug are:

• a tendency to develop an allergic reaction to certain medicinal components, i.e., individual intolerance;
• unhealthy kidneys;
• epilepsy;
• medicinal damage to the tendons associated with treatment with fluoroquinolone antibacterial drugs.

Levofloxacin do not appoint women during pregnancy and while breastfeeding, and children and adolescents... Caution should be exercised by patients with renal pathologies and persons of a geriatric profile.

In case of drug overdose, symptomatic treatment is expected. Dialysis is not very effective.

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

Given the likelihood photosensitivity, it is recommended to stay in direct sunlight as little as possible.

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

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

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

Comparison of drugs: which is more effective

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

The active ingredient of Ciproflaxacin is ciproflaxacin; Levofloxacin contains the main component of Levofloxacin.

Unlike Ciprofloxacin, the antibacterial effect of Levofloxacin in relation to pneumococcal infections and atypical microorganisms are more pronounced. The drug remains active against gram-negative bacteria.

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

The type of bacteria and the degree of its sensitivity is determining factor when choosing a medicine.

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

Both fluoroquinolones well tolerated by the body, have excellent oral absorption and are successfully used as an effective anti-tuberculosis agent. Levofloxacin shows great efficiency in this regard, because it is used in the form intravenous injection.

The concentration of the active substance in the tablets is lower than in the second preparation. Levofloxacin is more often prescribed as the only drug for monotherapy... Food intake does not make any difference during treatment. Both those and other tablets can be drunk both before and after meals.

As for side reactions, they occur rarely and with the same frequency when taking both Levovloxacin and Ciprofloxacin. Undesirable effects are similar in their manifestations. In patients taking these fluoroquinolones, such disorders may be noted:

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

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

For the competent drawing up of such treatment regimens, it is necessary to clearly understand the types of pharmacological interaction of drugs and know which drugs can be used together, and which are categorically contraindicated.

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

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

The result of the pharmacodynamic interaction of drugs can be:

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

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

It is important to understand that such a division according to the type of action on bacteria is not absolute, and different antibiotics can produce different effects depending on the dose prescribed.

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

Also, selective action on certain pathogens is possible. As bactericidal antibiotics, penicillins have a bacteriostatic effect against enterococci.

Antibiotic compatibility table 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: supplementation of penicillins with aminoglycosides or the use of trimethoprim, in combination with sulfamethoxazole.
2. The combined drug of the second generation 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 serrations (often recurrent upper respiratory tract infections). Also combined with cephalosporins to increase efficacy against enterobacteriaceae.

Antibiotic compatibility 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, pronounced nephrotoxic effect.
It is forbidden to mix and inject in the same solution (syringe):
Penicillins are not mixed with ascorbic acid, B vitamins, or aminoglycosides.
Cephalosporins (especially ceftriaxone ®) are not combined with calcium gluconate.
and hydrocortisone.
Carbenicillin ® with kanamycin ®, gentamycin ®.
Tetracyclines with sulfonamides are not combined with hydrocortisone, calcium salts, soda.
All antibacterial drugs are absolutely not compatible with heparin.

Penicillins

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

Additive synergism of antibiotics (summation of the results of action) occurs when administered with macrolides and tetracyclines. Such 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 are using oral contraceptives, since penicillins interfere with their action. In order to prevent unwanted pregnancy, it is recommended to use barrier methods of contraception during antibiotic therapy.

Penicillins are not prescribed with sulfonamides in view of a sharp decrease in their bactericidal action.
It is important to remember that their appointment to patients with long-term use of anticoagulants, antiplatelet agents and non-steroidal anti-inflammatory drugs is undesirable due to the potential for bleeding.

Benzylpenicillin salt is not combined with potassium and potassium-sparing diuretics due to the increased risk of hyperkalemia.

Penicillins and fluoroquinolones are compatible

It is possible both 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, the first generation is not prescribed together with penicillins. It is prescribed with caution to patients with intolerance to beta-lactam antibiotics. in the anamnesis.

The combination with anticoagulants, thrombolytics and antiplatelet agents reduces clotting, can cause bleeding, usually gastrointestinal as a result of hypoprothrombinemia.
The combined appointment with aminoglycosides and fluoroquinolones leads to a pronounced nephrotoxic effect.

The use of antibes. after taking antacids, it reduces the absorption of the drug.

Carbapenems

Ertapenem ® is categorically incompatible with glucose solution. Also, carbapenems are not prescribed concurrently with other beta-lactam agents due to the 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 assigned in conjunction with furosemide.

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

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

Quinolone group (fluoroquinolone)

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 their high toxicity to the nervous system and the possible appearance of seizures.

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

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

They violate the action of insulin and sugar-reducing tablets, are not prescribed for diabetics.

Macrolides

They are not used in conjunction with antacids, due to a decrease in effectiveness. Administration with rifampicin ® reduces the concentration of macrolides in the blood. Also not compatible with amphinecol® 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.

It is forbidden to combine with drugs that inhibit the function of the bone marrow.

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 assimilation of both drugs.

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

Interaction of antibiotics with food, alcohol and herbs

The intake of products that increase the secretion of hydrochloric acid in the stomach (juices, tomatoes, tea, coffee) leads to a decrease in the absorption of semisynthetic penicillins and erythromycin ®.

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

When using chloramphenicol ®, metronidazole ®, cephalosporins, sulfonamides with alcoholic beverages, an antabuse-like syndrome (tachycardia, heart pain, flushing of the skin, vomiting, nausea, sharp headache, tinnitus) may develop. This complication is life-threatening and can be fatal.

These drugs should not be combined even with alcoholic herbal tinctures.

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

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

Diseases cannot always be cured with just one antibiotic.

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

Ciprofloxacin can easycombined 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 medications are prescribed for Ciprofloxacin

Ciprofloxacin is a fluoroquinolone antibiotic produced with the aim of expanding its effect on pathogenic bacteria. The drug is suitable for the treatment of many diseases, and its action is varied. Antibiotics are most often not prescribed alone, because the treatment of many pathologies requires individual and combinedapproach.

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

In an aggressive course of the disease, bacteria acquire sustainabilityto the active components of the drug, which leads to incomplete recovery and increased relapse. Ciprofloxacin, like a fluoroquinolone, is not a highly effective antibiotic, which justifies the prescription of additional drugs.

It is most commonly combined with the following antibiotics and antimicrobials:

• Doxycycline;
• Levofloxacin;
• Metronidazole;
• Azithromycin;
• Ciftriaxone;
• Cephalosporin;
• Fluconabosis;
• Ibuprofen.

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

Compatibility of Ciprofloxacin and Doxycycline

Both drugs are antibiotics, but Doxycycline belongs to the group tetracyclines, that is, it has a completely different chemical composition. These groups of antibacterial drugs do not have any contraindications for combination.

Due to the combination of Doxycycline and Ciprofloxacin, there is amplifyingthe effect of antibacterial action, the resistance to other antibiotics decreases.

Ciprofloxacin is a drug with a unique chemical formula, which means there is no cross-resistance with drugs of a different antibacterial series. It works well with Doxycycline.

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

Doxycycline itself is a very strong and toxic drug, therefore, its simultaneous administration with Ciprofloxacin is a case exceptionsrather than rules. This combination is prescribed for the following pathologies:

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

Most often, Ciprofloxacin + Doxycycline are used in obstetrics and gynecology, but the cases are different. Doxycycline has many dangerous side effects, and taking additional antibiotics will only make them worse. The doctor must be sure to monitor the patient's condition.

Important! Ciprofloxacin + Doxycycline can be taken together only for acuteor 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 doctor's recommendations and the clinical diagnosis.

For acute, severe infections or strong foci of inflammation, Ciprofloxacin and Doxycycline are taken together or combined a week later in order to block resistance.

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

Ciprofloxacin and Levofloxacin: can I take it simultaneously

Levofloxacin is a 3rd generation antibiotic fluoroquinolone, belongs to the same drug group as Cifprofloxacin. In clinical practice, such drug combinations can cause crossresistance, that is, the usual resistance of bacteria to the active components of all fluoroquinolones. Their joint purpose makes no 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 each antibiotic are dangerous in any case. Levofloxacin is often prescribed after ineffectiveness or intolerance to Ciprofloxacin. They are not taken together, but Cifprofloxacin can be combined with another fluoroquinolone in 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, since they have a wide spectrum of action, but joint administration of drugs leads to the risk of sustainabilitybacteria.

Ciprofloxacin and Metronidazole: Their Interaction

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

Ciprofloxacin + Metronidazole are effective against the following pathologies:

• protozoal ailments: amebiasis, giardiasis, trichomonas urethritis / colpitis / vaginitis;
• cystitis,summoned STIs;
• endocarditisbacterial nature;
• meningitis;
• pneumonia;
• sepsis;
• infections caused by Bacteroides spp, Peptostreptococcus spp, Clostridium spp, Peptococcus spp;
• organ diseases small pelvis;
• skin diseases;
• postoperativecomplications in gynecology / urology.

Reference! Metronidazole is also available under another trade name. Trichopolus, which contains a similar pharmacological composition.

Metronidazole is ineffective when taken alone, so it is always prescribed with other medications or antibiotics. The simultaneous use 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 - drug antibacterialgroup, which traditionally refers to macrolides-azalides. There are no contraindications for the combination of Azithromycin with fluoroquinolones, since they are successfully combined in the treatment of a number of specific diseases.

First of all, such pathologies include:

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

Ciprofloxacin + Azithromycin is taken together for treatment pulmonarydiseases. Their separate use for the above acute pathologies is impractical and ineffective. They combine well and are safe to use, but side effects and individual intolerance are possible.

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 broad spectrum of action, indicating that any bacterial infection is being 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 simultaneously.

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

Ciprofloxacin and Cephalosporin: are they taken together

Cephalosporin is an antibacterial agent from the β-lactam group, which is known for the versatility of its pharmacological properties. Ciprofloxacin goes wellwith cephalosporin, which complements and maintains the bactericidal effect.

In practice, doctors use this combination to treat a wide variety of bacterial infections. First of all, it is Gastrointestinal diseases, and urogenitaldiseases. Both drugs destroy conditionally pathogenic bacteria at the cellular level, which, when taken twice, is extremely effective. This combination of drugs allows you to quickly stop the foci of infection.

Most often, drugs are used at the same time, as this allows you to prevent the growth of bacteria and block resistance. Cephalosporin completely destroys the DNA of bacteria, stopping their division, and Ciprofloxacin consolidates the therapeutic effect.

Ciprofloxacin and Fluconazole

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

Fluconazole is a proven antifungal agent whose pharmacokinetics inhibit the multiplication of Candida spp. And other fungal organisms.

Fluconazole can be taken with any antibiotic to treat fungal infections.

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

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

Ciprofloxacin and Ibuprofen

Ibuprofen is a non-steroidal anti-inflammatorydrugs that are designed to relieve pain and lower temperature. Often, pathological conditions are accompanied by extremely unpleasant and painful symptoms, which requires action.

Ciprofloxacin + Ibuprofen is ideal for both treatment antibacterialinfection, 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 against the cause and 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 to treat certain diseases. Tuberculosis cannot be stopped with one antibiotic, which provides for combination therapy.

Ciprofloxacin, like a fluoroquinolone, is a "reserve" drug for the treatment of tuberculous lung disease... It has relatively moderate efficacy, which in practice means that Ciprofloxacin is used only in cases of resistance to the most potent drugs.

The ideal option is to combine Ciprofloxacin and Doxycycline, as well as Azithromycin. Other combinations of antibiotics will have mild effects.

Important! The ideal combination of antibiotics is their simultaneous use in tabletedand injectionform (injections).

Ciprofloxacin works well with other antibiotics and antimicrobials. Their double effect enhances bactericidal property and speeds up overall recovery. But Ciprofloxacin does not combine well with others fluoroquinolonesas well as with some other groups of antibiotics. In other cases, combining drugs is an excellent treatment option, but there is a high likelihood of side effects.

Useful video

Check out the video about Ciprofloxacin, its indications and how it works.

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