Antibacterial tablets. Antimicrobial drugs. VI generation drugs

According to the spectrum of activity antimicrobial drugs are divided into: antibacterial, antifungal and antiprotozoal. In addition, all antimicrobial agents are divided into drugs with a narrow and broad spectrum of action.

Narrow-spectrum drugs primarily targeting gram-positive microorganisms include, for example, natural penicillins, macrolides, lincomycin, fusidine, oxacillin, vancomycin, and first-generation cephalosporins. Narrow-spectrum drugs primarily targeting gram-negative bacilli include polymyxins and monobactams. Broad-spectrum drugs include tetracyclines, chloramphenicol, aminoglycosides, most semisynthetic penicillins, cephalosporins starting from the 2nd generation, carbopenems, fluoroquinolones. The antifungal drugs nystatin and levorin (only against candida) have a narrow spectrum, and clotrimazole, miconazole, amphotericin B have a wide spectrum.

By type of interaction with a microbial cell antimicrobial drugs are divided into:

· bactericidal - irreversibly disrupt the functions of the microbial cell or its integrity, causing immediate death of the microorganism, used for severe infections and in weakened patients,

· bacteriostatic - reversibly block cell replication or division, used for mild infections in non-weakened patients.

According to acid resistance antimicrobial drugs are classified into:

acid-resistant - can be used orally, for example, phenoxymethylpenicillin,

· acid-labile - intended only for parenteral use, for example, benzylpenicillin.

Currently, the following main groups of antimicrobial drugs are used for systemic use.

¨ Lactam antibiotics

Lactam antibiotics ( table 9.2) Of all antimicrobial drugs, they are the least toxic, since, by disrupting the synthesis of the bacterial cell wall, they have no target in the human body. Their use in cases where pathogens are sensitive to them is preferable. Carbapenems have the widest spectrum of action among lactam antibiotics; they are used as reserve drugs - only for infections resistant to penicillins and cephalosporins, as well as for hospital-acquired and polymicrobial infections.

¨ Antibiotics of other groups

Antibiotics of other groups ( table 9.3) have different mechanisms of action. Bacteriostatic drugs disrupt the stages of protein synthesis on ribosomes, while bactericidal drugs disrupt either the integrity of the cytoplasmic membrane or the process of DNA and RNA synthesis. In any case, they have a target in the human body, therefore, compared to lactam drugs, they are more toxic, and should be used only when it is impossible to use the latter.

¨ Synthetic antibacterial drugs

Synthetic antibacterial drugs ( table 9.4) also have different mechanisms of action: inhibition of DNA gyrase, disruption of the incorporation of PABA into DHPA, etc. Also recommended for use when it is impossible to use lactam antibiotics.

¨ Side effects of antimicrobial drugs,

their prevention and treatment

Antimicrobial drugs have a wide variety of side effects, some of which can lead to serious complications and even death.

Allergic reactions

Allergic reactions can occur when using any antimicrobial drug. Allergic dermatitis, bronchospasm, rhinitis, arthritis, Quincke's edema, anaphylactic shock, vasculitis, nephritis, lupus-like syndrome may develop. Most often they are observed with the use of penicillins and sulfonamides. Some patients develop cross-allergy to penicillins and cephalosporins. Allergies to vancomycin and sulfonamides are often observed. Very rarely, aminoglycosides and chloramphenicol cause allergic reactions.

Prevention is facilitated by a thorough collection of allergy history. If the patient cannot indicate which antibacterial drugs he had allergic reactions to, tests must be performed before administering antibiotics. The development of an allergy, regardless of the severity of the reaction, requires immediate discontinuation of the drug that caused it. Subsequently, the introduction of even antibiotics with a similar chemical structure (for example, cephalosporins for allergies to penicillin) is allowed only in cases of extreme necessity. Treatment of infection should be continued with drugs from other groups. In case of severe allergic reactions, intravenous administration of prednisolone and sympathomimetics and infusion therapy are required. In mild cases, antihistamines are prescribed.

Irritant effect on routes of administration

When administered orally, the irritant effect can be expressed in dyspepsia, and when administered intravenously, it can result in the development of phlebitis. Thrombophlebitis is most often caused by cephalosporins and glycopeptides.

Superinfection, including dysbacteriosis

The likelihood of dysbacteriosis depends on the breadth of the spectrum of action of the drug. The most common candidomycosis develops when using narrow-spectrum drugs after a week, when using broad-spectrum drugs - already from one tablet. However, cephalosporins cause fungal superinfection relatively rarely. Lincomycin ranks first in the frequency and severity of dysbiosis caused. Disorders of the flora when using it can take the form of pseudomembranous colitis - a severe intestinal disease caused by clostridia, accompanied by diarrhea, dehydration, electrolyte disturbances, and in some cases complicated by perforation of the colon. Glycopeptides can also cause pseudomembranous colitis. Tetracyclines, fluoroquinolones, and chloramphenicol often cause dysbacteriosis.

Dysbacteriosis requires discontinuation of the drug used and long-term treatment with eubiotics after preliminary antimicrobial therapy, which is carried out based on the sensitivity of the microorganism that caused the inflammatory process in the intestine. Antibiotics used to treat dysbiosis should not affect the normal intestinal autoflora - bifidobacteria and lactobacilli. However, the treatment of pseudomembranous colitis uses metronidazole or, alternatively, vancomycin. Correction of water and electrolyte imbalances is also necessary.

Impaired alcohol tolerance- common to all lactam antibiotics, metronidazole, chloramphenicol. It is manifested by the appearance of nausea, vomiting, dizziness, tremor, sweating and a drop in blood pressure when drinking alcohol simultaneously. Patients should be warned not to drink alcohol during the entire period of treatment with an antimicrobial drug.

Organ-specific side effects for various groups of drugs:

· Damage to the blood system and hematopoiesis - inherent in chloramphenicol, less commonly lincosomides, 1st generation cephalosporins, sulfonamides, nitrofuran derivatives, fluoroquinolones, glycopeptides. Manifested by aplastic anemia, leukopenia, thrombytopenia. It is necessary to discontinue the drug, in severe cases, replacement therapy. Hemorrhagic syndrome can develop with the use of 2-3 generation cephalosporins, which impair the absorption of vitamin K in the intestine, antipseudomonal penicillins, which impair platelet function, and metronidazole, which displaces coumarin anticoagulants from bonds with albumin. Vitamin K preparations are used for treatment and prevention.

· Liver damage - inherent in tetracyclines, which block the enzyme system of hepatocytes, as well as oxacillin, aztreonam, lincosamines and sulfonamides. Macrolides and ceftriaxone can cause cholestasis and cholestatic hepatitis. Clinical manifestations are an increase in liver enzymes and bilirubin in the blood serum. If it is necessary to use hepatotoxic antimicrobial agents for more than a week, laboratory monitoring of the listed indicators is necessary. In case of an increase in AST, ALT, bilirubin, alkaline phosphatase or glutamyl transpeptidase, treatment should be continued with drugs of other groups.

· Damage to bones and teeth is typical for tetracyclines, growing cartilage - for fluoroquinolones.

· Kidney damage is inherent in aminoglycosides and polymyxins that disrupt tubular function, sulfonamides that cause crystalluria, generation cephalosporins that cause albuminuria, and vancomycin. Predisposing factors are old age, kidney disease, hypovolemia and hypotension. Therefore, when treating with these drugs, preliminary correction of hypovolemia, control of diuresis, and selection of doses taking into account renal function and body mass are necessary. The course of treatment should be short.

· Myocarditis is a side effect of chloramphenicol.

· Dyspepsia, which is not a consequence of dysbacteriosis, is typical when using macrolides that have prokinetic properties.

· Various lesions of the central nervous system develop from many antimicrobial drugs. Observed:

Psychoses during treatment with chloramphenicol,

Paresis and peripheral paralysis when using aminoglycosides and polymyxins due to their curare-like action (therefore they cannot be used simultaneously with muscle relaxants),

Headache and central vomiting when using sulfonamides and nitrofurans,

Convulsions and hallucinations when using aminopenicillins and cephalosporins in high doses, resulting from the antagonism of these drugs with GABA,

Convulsions when using imipenem,

Excitement when using fluoroquinolones,

Meningism when treated with tetracyclines due to their increase in cerebrospinal fluid production,

Visual impairment during treatment with aztreonam and chloramphenicol,

Peripheral neuropathy when using isoniazid, metronidazole, chloramphenicol.

· Hearing damage and vestibular disorders are a side effect of aminoglycosides, more characteristic of the 1st generation. Since this effect is associated with the accumulation of drugs, the duration of their use should not exceed 7 days. Additional risk factors include old age, renal failure and concomitant use of loop diuretics. Vancomycin causes reversible changes in hearing. If there are complaints of hearing loss, dizziness, nausea, or unsteadiness when walking, it is necessary to replace the antibiotic with drugs from other groups.

· Skin lesions in the form of dermatitis are characteristic of chloramphenicol. Tetracyclines and fluoroquinolones cause photosensitivity. Physiotherapeutic procedures are not prescribed during treatment with these drugs, and exposure to the sun should be avoided.

· Hypofunction of the thyroid gland is caused by sulfonamides.

· Teratogenicity is inherent in tetracyclines, fluoroquinolones, and sulfonamides.

· Paralysis of the respiratory muscles is possible with rapid intravenous administration of lincomycin and cardiodepression with rapid intravenous administration of tetracyclines.

· Electrolyte disturbances are caused by antipseudomonas penicillins. The development of hypokalemia is especially dangerous in the presence of diseases of the cardiovascular system. When prescribing these drugs, monitoring of ECG and blood electrolytes is necessary. In treatment, infusion-corrective therapy and diuretics are used.

Microbiological diagnostics

The effectiveness of microbiological diagnostics, which is absolutely necessary for the rational selection of antimicrobial therapy, depends on compliance with the rules for collection, transportation and storage of the test material. Rules for collecting biological material include:

Taking material from the area as close as possible to the source of infection,

Prevention of contamination by other microflora.

Transportation of the material must, on the one hand, ensure the viability of bacteria, and on the other hand, prevent their reproduction. It is advisable that the material be stored at room temperature before the start of the study and for no more than 2 hours. Currently, special tightly closed sterile containers and transport media are used for collecting and transporting material.

To no less an extent, the effectiveness of microbiological diagnostics depends on the competent interpretation of the results. It is believed that the isolation of pathogenic microorganisms, even in small quantities, always allows them to be classified as the true causative agents of the disease. A conditionally pathogenic microorganism is considered a pathogen if it is isolated from normally sterile environments of the body or in large quantities from environments not typical for its habitat. Otherwise, it is a representative of normal autoflora or contaminates the test material during collection or research. Isolation of low-pathogenic bacteria from areas uncharacteristic of their habitat in moderate quantities indicates the translocation of microorganisms, but does not allow them to be classified as the true causative agents of the disease.

It can be much more difficult to interpret the results of a microbiological study when culturing several types of microorganisms. In such cases, they focus on the quantitative ratio of potential pathogens. More often, 1-2 of them are significant in the etiology of this disease. It should be borne in mind that the likelihood of equal etiological significance of more than 3 different types of microorganisms is negligible.

Laboratory tests for the production of ESBLs by Gram-negative microorganisms are based on the sensitivity of ESBLs to beta-lactamase inhibitors such as clavulanic acid, sulbactam and tazobactam. Moreover, if a microorganism of the Enterobacteriaceae family is resistant to 3rd generation cephalosporins, and when beta-lactamase inhibitors are added to these drugs, it demonstrates sensitivity, then this strain is identified as ESBL-producing.

Antibiotic therapy should be aimed only at the true causative agent of the infection! However, in most hospitals, microbiological laboratories cannot establish the etiology of infection and the sensitivity of pathogens to antimicrobial drugs on the day of admission of the patient, so the initial empirical prescription of antibiotics is inevitable. At the same time, the peculiarities of the etiology of infections of various localizations characteristic of a given medical institution are taken into account. In this connection, regular microbiological studies of the structure of infectious diseases and the sensitivity of their pathogens to antibacterial drugs are necessary in each hospital. Analysis of the results of such microbiological monitoring must be carried out monthly.

Table 9.2.

Lactam antibiotics.

Group of drugs		Name	Characteristics of the drug
Penicillins	Natural penicillins	sodium and potassium salts of benzylpenicillin	administered only parenterally, effective for 3-4 hours			highly effective in their spectrum of action, but this spectrum is narrow, in addition, the drugs are lactamase unstable
		bicillin 1,3,5	administered only par-enterally, lasts from 7 to 30 days
		phenoxymethylpenicillin	drug for oral administration
	Antistaphylococcal	oxacillin, methicillin, cloxacillin, dicloxacillin	have less antimicrobial activity than natural penicillins, but are resistant to staphylococcal lactamases, can be used orally
	Amino penicillins	ampicillin, amoxicillin, bacampicillin	broad-spectrum drugs that can be used orally, but not resistant to beta-lactamases
	Combined bathrooms	Ampiox - ampicillin+ Oxacillin	a broad-spectrum drug resistant to beta-lactamases, can be used orally
	Antisinopurulent	carbenicillin, ticarcillin, azlocillin, piperacillin, mezlocillin	have a wide spectrum of action, act on strains of Pseudomonas aeruginosa that do not produce beta-lactamases; during treatment, bacterial resistance to them can quickly develop
	Lactamase protected - preparations with clavulanic acid, tazobactam, sulbactam	amoxiclav, tazocin, timentin, cyazine,	the drugs are a combination of broad-spectrum penicillins and beta-lactamase inhibitors, therefore they act on bacterial strains that produce beta-lactamases
Cephalosporins	1st generation	cefazolin	antistaphylococcal drug for parenteral approx.		you are not resistant to lactactases, they have a narrow spectrum of action		With each generation of cephalosporins, their spectrum expands and toxicity decreases; cephalosporins are well tolerated and occupy first place in frequency of use in hospitals
		cephalexin and cefaclor	applied per os
	2 generations	cefaclor, cefuraxime	applied per os		resistant to lactams, spectrum includes both gram-positive and gram-negative bacteria
		cefamandole, cefoxitin, cefuroxime, cefotetan, cefmetazole	used only parenterally
	3 generations	ceftizoxime, cefotaxime, ceftriaxone, ceftazidime, cefoperazone, cefmenoxime	only for parenteral use, have anti-blue purulent activity		resistant to lactamases of gram-negative bactheniums, not effective against staphylococcal infections
		cefixime, ceftibuten, cefpodoxime, cefetamet	used per os, have anti-anaerobic activity
	4 generations	cefipime, cefpirone	the widest spectrum of action, used parenterally
Cephalosporins with beta-lactamase inhibitors		sulperazone	Has the spectrum of action of cefoperazone, but also acts on lactamase-producing strains
Carbapenems	imipenem and its combination with cilostatin, which protects against destruction in the kidneys - tienam	More active against gram-positive microorganisms		have the widest spectrum of action among lactam antibiotics, including anaerobes and Pseudomonas aeruginosa, and are resistant to all lactamases, resistance to them is practically not developed, they can be used for almost any pathogen, excluding methicillin-resistant strains of staphylococcus, and as monotherapy even for severe infections, have an aftereffect
	meropenem	More active against gram-negative microorganisms
	ertapenem
Mono-bactams	Aztreons	a narrow-spectrum drug, acts only on gram-negative bacilli, but is very effective and resistant to all lactamases

Table 9.3.

Antibiotics of other groups.

Group of drugs	Name	Characteristics of the drug
Glyco-peptides	vancomycin, teicoplamin	have a narrow gram-positive spectrum, but are very effective in it, in particular they act on methicillin-resistant staphylococci and L-forms of microorganisms
Polymyxins		These are the most toxic antibiotics; they are used only for topical use, in particular per os, since they are not absorbed into the gastrointestinal tract
Fuzidin		low toxic but also low effective antibiotic
Levomycetin		highly toxic, currently used mainly for meningococcal, eye and especially dangerous infections
Lincos-amines	lincomycin, clindamycin	less toxic, act on staphylococcus and anaerobic cocci, penetrate well into bones
Tetra-cyclins	natural - tetracycline, semi-synthetic - metacycline, synthetic - doxycycline, minocycline	broad-spectrum antibiotics, including anaerobes and intracellular pathogens, are toxic
Amino-glycosides	1st generation: streptomycinkanamycin monomycin	highly toxic, used only locally for decontamination of the gastrointestinal tract, for tuberculosis	toxic antibiotics with a fairly broad spectrum of action, have a poor effect on gram-positive and anaerobic microorganisms, but enhance the effect of lactam antibiotics on them, and their toxicity decreases in each subsequent generation
	2nd generation: gentamicin	widely used for surgical infections
	3 generations: amikacin, sisomycin, netilmicin, tobramycin	act on some microorganisms resistant to gentamicin; against Pseudomonas aeruginosa, tobramycin is the most effective
Macro leads	natural: erythromycin, oleandomycin	low toxic, but also low effective, narrow-spectrum antibiotics, act only on gram-positive cocci and intracellular pathogens, can be used per os
	semi-synthetic: rock-sithromycin, clarithromycin, flurithromycin	also act on intracellular pathogens, the spectrum is somewhat wider, in particular includes Helicobacter and Moraxella, they pass through all barriers in the body well, penetrate various tissues, and have an aftereffect of up to 7 days
	azolides: azithromycin (sumamed)	have the same properties as semisynthetic macrolides
Rifampicin		used mainly for tuberculosis
Antifungal antibiotics	fluconazole, amphotericin B	amphotericin B is highly toxic and is used when pathogens are not sensitive to fluconazole

Table 9.4.

Synthetic antibacterial drugs.

Group of drugs		Name	Characteristics of the drug
Sulfonamides	Resorptive action	norsulfazole, streptocide, etazol	short-acting drugs	broad-spectrum drugs; pathogens often develop cross-resistance to all drugs in this series
		sulfadimethoxine, sulfapyridazine, sulfalene	long-acting drugs
	Acting in the intestinal lumen	phthalazole, sulgin, salazopyridazine	salazopyridazine - used for Crohn's disease, ulcerative colitis
	Local application	sulfacyl sodium	mainly used in ophthalmology
Nitrofuran derivatives		furagin, furazolidone, nitrofurantoin	have a wide spectrum of action, including clostridia and protozoa; unlike most antibiotics, they do not inhibit, but stimulate the immune system; they are used topically and per os
Quinoxaline derivatives		quinoxidine, dioxidine	have a wide spectrum of action, including anaerobes, dioxidin is used topically or parenterally
Quinolone derivatives		nevigramon, oxolinic and pipemidic acid	act on a group of intestinal gram-negative microorganisms, are used mainly for urological infections, resistance to them quickly develops
Fluoroquinolones		ofloxacin, ciprofloxacin, pefloxacin, lomefloxacin, sparfloxacin, levofloxacin, gatifloxacin, moxifloxacin, gemifloxacin	highly effective broad-spectrum drugs that act on Pseudomonas aeruginosa and intracellular pathogens, are well tolerated against many lactamase-producing strains, are widely used in surgery, ciprofloxacin has the greatest antipseudomonas activity, and moxifloxacin has the greatest antianaerobic activity
8-hydroxyquinoline derivatives		nitroxoline, enteroseptol	act on many microorganisms, fungi, protozoa, are used in urology and intestinal infections
Nitroimide-ash		metronidazole, tinidazole	act on anaerobic microorganisms, protozoa
Specific antituberculosis, antisyphilitic, antiviral, antitumor drugs			used mainly in specialized institutions

Antibiotics or antibacterial drugs are the name of a group of drugs that are used in the treatment of diseases caused by microorganisms. Their discovery occurred in the 20th century and became a real sensation. Antimicrobial agents were considered a panacea for all known infections, a miracle cure for terrible diseases that have plagued humanity for thousands of years. Due to their high effectiveness, antibacterial agents are still actively used in medicine to treat infectious diseases. Their use has become so commonplace that many people buy over-the-counter antibiotics at the pharmacy on their own, without waiting for a doctor’s recommendation. But we must not forget that their use is accompanied by a number of features that affect the outcome of treatment and human health. We will consider in more detail what you should know before using antibiotics, as well as the features of treatment with this group of medications.

This is interesting! Depending on their origin, all antibacterial drugs are divided into synthetic, semi-synthetic, chemotherapeutic drugs and antibiotics. Chemotherapy or synthetic medications are obtained in laboratory conditions. In contrast, antibiotics are waste products of microorganisms. But, despite this, the term “antibiotic” in medical practice has long been considered a full synonym for “antibacterial agent” and has been widely used.

Antibiotics - what are they?

Antibiotics are special substances that selectively act on certain microorganisms, inhibiting their vital functions. Their main task is to stop the proliferation of bacteria and gradually destroy them. It is implemented by disrupting the synthesis of harmful DNA.

There are several types of effects that antibacterial agents can have: bacteriostatic and bactericidal.

Bactericidal action. It indicates the ability of drugs to damage the cell membrane of bacteria and cause their death. The bactericidal mechanism of action is characteristic of Klabax, Sumamed, Isofra, Tsifran and other similar antibiotics.
Bacteriostatic effect. It is based on inhibition of protein synthesis, suppression of the proliferation of microorganisms and is used in the treatment and prevention of infectious complications. Unidox Solutab, Doxycycline, Tetracycline hydrochloride, Biseptol, etc. have a bacteriostatic effect.

Ideally, antibiotics block the vital functions of harmful cells without negatively affecting the host cells. This is facilitated by the unique property of this group of drugs – selective toxicity. Due to the vulnerability of the bacterial cell wall, substances that interfere with its synthesis or integrity are toxic to microorganisms but harmless to host cells. The exception is strong antibiotics, the use of which is accompanied by adverse reactions.

In order to obtain only a positive effect from treatment, antibacterial therapy should be based on the following principles:

The principle of rationality. Correct identification of the microorganism plays a key role in the treatment of an infectious disease, so in no case should you choose an antibacterial drug on your own. See your doctor. Based on the tests and personal examination, a medical specialist will determine the type of bacteria and prescribe you the appropriate highly specialized medicine.
The "umbrella" principle. It is used when it is not possible to identify the microorganism. The patient is prescribed broad-spectrum antibacterial drugs that are effective against most of the most likely pathogens. In this case, combination therapy is considered the most optimal, reducing the risk of the microorganism developing resistance to the antibacterial agent.
The principle of individualization. When prescribing antibacterial therapy, it is necessary to take into account all factors associated with the patient: his age, gender, localization of infection, pregnancy, as well as other concomitant diseases. It is equally important to choose the optimal route of drug administration for timely and effective results. It is believed that oral administration of the drug is acceptable for moderate infections, and parenteral administration is optimal in extreme cases and acute infectious diseases.

General rules for taking antibacterial drugs

There are general rules for antibiotic treatment that should not be neglected to achieve the maximum positive effect.

Rule #1. The most important rule in antibacterial therapy is that all medications must be prescribed by a medical specialist.
Rule #2. It is forbidden to take antibiotics for viral infections, as there is a possibility of the opposite effect occurring - aggravation of the course of the viral disease.
Rule #3. You should follow the prescribed course of treatment as carefully as possible. It is recommended to take medications at approximately the same time of day. Under no circumstances should you stop taking them on your own, even if you begin to feel much better, as the disease may return.
Rule #4. The dosage cannot be adjusted during treatment. Reducing the dose can cause the bacteria to develop resistance to this group of drugs, and increasing it can lead to an overdose.
Rule #5. If the medicine is presented in the form of a tablet, then it should be washed down with 0.5 - 1 glass of water. Do not take antibiotics with other drinks: milk, tea, etc., as they reduce the effectiveness of the medications. Remember well that you should not drink milk at elevated temperatures, as it will not be completely digested and may cause vomiting.
Rule #6. Develop your own system and order of taking the medications prescribed to you so that there is approximately the same period of time between their use.
Rule #7. It is not recommended to exercise during antibiotic therapy, so during treatment, reduce physical activity or eliminate it completely.
Rule #8. Alcoholic drinks and antibiotics do not mix, so avoid alcohol until you have fully recovered.

Should children be treated with antibiotics?

According to the latest statistics in Russia, 70–85% of children suffering from viral diseases receive antibiotics due to unprofessional treatment. Despite the fact that taking antibacterial drugs contributes to the development of bronchial asthma, these medications are the most “popular” method of treatment. Therefore, parents should be careful when visiting a doctor and ask the specialist questions if you have any doubts about prescribing antibacterial drugs to your child. You yourself must understand that the pediatrician, by prescribing a long list of medications for the baby, protects only himself, insures himself in case of complications, etc. After all, if the child gets worse, then the responsibility for “not curing” or “treating poorly” falls on the doctor.

Unfortunately, this model of behavior is increasingly common among domestic doctors who strive not to cure the child, but to “heal” him. Be careful and remember that antibiotics are only prescribed to treat bacterial, not viral, diseases. You should know that only you care about the health of your child. A week or a month later, when you come back for an appointment with another disease that arose against the background of a weakened immune system by the previous “treatment,” the doctors will only greet you with indifference and again prescribe a long list of medications.

Antibiotics: benefit or harm?

The belief that antibiotics are extremely harmful to human health is not without merit. But it is valid only in case of improper treatment, when there is no need to prescribe antibacterial drugs. Despite the fact that this group of drugs is now freely available and sold over-the-counter through pharmacies, you should under no circumstances take antibiotics on your own or at your own discretion. They can only be prescribed by a doctor in case of a serious bacterial infection.

If there is a serious illness that is accompanied by high fever and other symptoms confirming the severity of the disease, you cannot hesitate or refuse antibiotics, citing the fact that they are harmful. In many cases, antibacterial agents save a person’s life and prevent the development of serious complications. The main thing is to approach antibiotic treatment wisely.

Below is a list of popular antibacterial agents, instructions for which are presented on our website. Simply follow the link in the list to receive instructions and recommendations for the use of this drug.

In the medical literature and among doctors you can hear the term “broad-spectrum antibacterial drugs.” What does it mean?

Any antibacterial drug (ABP) has a spectrum of action. These are the microorganisms on which it acts. The more bacteria are sensitive to a drug, the wider its spectrum.

Typically, such antibiotics are drugs that destroy or inhibit the growth of gram-negative and gram-positive bacteria. These pathogens cause most of the inflammatory diseases in the body.

Most often, ABPs are prescribed for the following diseases:

pneumonia and bronchitis;
sinusitis and frontal sinusitis;
streptococcal sore throat;
otitis;
pyelonephritis.

Broad-spectrum antimicrobials are indicated in situations where the exact pathogen is unknown and there is no time to carry out culture tests to determine drug sensitivity.

For example, pneumonia requires treatment on the day of diagnosis, and the only solution is the use of broad-spectrum antibiotics.

With this approach, there is always the possibility of choosing an ineffective drug to which a specific pathogen is resistant. But this does not happen so often and in any case is preferable to waiting for the results of bacterial culture.

The following groups of such antibiotics are distinguished:

penicillins;
cephalosporins;
macrolides;
fluoroquinolones.

Penicillins

Penicillin is the first antibiotic to be used in the fight against purulent infection. Thanks to its action, the survival rate of patients in the postoperative period has increased dramatically. The mortality rate of patients from pneumonia, which was common at all times, has also decreased.

The group of penicillins includes the following representatives:

benzylpenicillin;
bicillin;
oxacillin;
ampicillin;
amoxicillin.

One, due to the widespread and often unjustified use of these antibiotics, most microbes have developed resistance to them, and penicillins have practically ceased to be used. Also, a significant drawback of this group was the inability to resist the destructive effects of beta-lactamases - bacterial enzymes.

However, modern penicillins are protected from microbial influence due to their combination with clavulanic acid.

The most popular drug amoxiclav (Augmentin, Amoxiclav Quiktab) is widely used by doctors of all specialties and is the gold standard in the treatment of infectious and purulent diseases.

Cephalosporins

In terms of their spectrum of action, cephalosporins are not much different from penicillins. Moreover, these groups are characterized by cross-sensitivity.

Allergies to these medications occur quite often. And if the patient has hypersensitivity to penicillin antibiotics, the prescription of drugs of the second group should be approached with caution. The likelihood of allergies in such a patient will be increased.

There are four generations of cephalosporins, the first does not have a wide spectrum of action. In routine practice, the third generation drugs most often prescribed are ceftriaxone (Medaxon) and cefixime (Cefix).

Cephalosporins are available in tablets and ampoules. Parenteral forms are widely used in surgical, therapeutic and pulmonology (pneumonia, COPD, pleurisy) hospitals.

Macrolides

Considering that the proportion of these pathogens in the development of diseases of the respiratory system has increased significantly, the relevance of macrolides is increasing every year.

Representatives of this group are:

azithromycin;
clarithromycin;
erythromycin.

The latter drug is currently practically not used. Doctors can prescribe it only for strict indications - for example, with confirmed sensitivity of microbes to this antibiotic.

Fluoroquinolones

Fluoroquinolones are reserve antibiotics due to the large number of side effects. They affect the liver and kidneys, the blood system, and the central nervous system.

However, the effectiveness of these drugs is quite high, and there are still not many bacteria resistant to them.

Currently, fluoroquinolones are beginning to displace even penicillins and cephalosporins from practice. If at first these drugs were prescribed only for diseases of the urinary system, now a group of respiratory fluoroquinolones has been identified. They are widely used for the following pathologies:

bronchitis;
pneumonia;
COPD;
pleurisy;
exacerbation of bronchiectasis.

However, when prescribing fluoroquinolones, their various side effects should be kept in mind and patients should be warned about this.

Antimicrobial drugs in children

Which antimicrobial agent can be freely used in pediatrics? Most often, pediatricians recommend antibiotics from the group of penicillins, cephalosporins or macrolides for children. The latter are used most often due to their high efficiency and ease of use.

Fluoroquinolones, according to the manufacturer's instructions, are not used in children under 14 years of age. This is due to their negative effect on the child’s cartilage tissue.

However, in recent years, pediatricians have begun to use these antibiotics in children with cystic fibrosis. The disease is extremely difficult to treat and is characterized by frequent exacerbations, while the pathogens are resistant to most drugs.

Modern medicine cannot do without broad-spectrum antibiotics. However, they should not be abused to avoid developing drug resistance in microbes. These drugs are prescribed only by a doctor.

Despite the undoubted successes and achievements of modern medicine in the fight against infections caused by pathogenic fungi, the number of people suffering from such diseases is not decreasing.

In addition to superficial and urogenital mycoses, deep lesions associated with HIV, organ donation, hemato-oncology, and nursing newborns are quite often recorded today.

Antimycotic drugs, used in various regimens for the treatment and prevention of fungal infections, must exhibit high activity against the pathogen, have a prolonged effect, have a minimal frequency of formation of resistance of the pathogenic organism, have good compatibility with pharmaceuticals of other groups, be effective, safe, and easy to use.

These requirements are met, in particular, by an antimycotic from the azole group - fluconazole, which acts as the active substance of broad-spectrum antifungal drugs. One of them is a drug Diflucan.

Mikosist It is considered one of the most effective drugs for the treatment of fungal diseases.