What are cephalosporins, generations of drugs, use in children and adults. III generation cephalosporins Oral cephalosporins 3

From a microbiological point of view, 3rd generation cephalosporins are characterized by the following features.

A. Pronounced antibacterial activity against enterobacteria, including multi-resistant problematic microorganisms (Serratia marcescens, Proteus vulgaris). However, the recent unjustified widespread use of “modern” cephalosporins, i.e. 3rd generation cephalosporins led to the dramatic spread of gram-negative microorganisms producing chromosomal beta-lactamases and their “contribution” to infectious morbidity.

B. Extended spectrum of action against gram-negative microorganisms, including P.aeruginosa and Citrobacter freundii. However, the variable sensitivity of clinical isolates to these antibiotics should be taken into account.

B. The stronger antibacterial effect on gram-negative microorganisms of all 3rd generation cephalosporins without exception compared to 1st and 2nd generation cephalosporins “coexists” with noticeably weaker activity against gram-positive cocci (staphylococci) (Table 6) .

Table 6. Antimicrobial activity of 3rd generation cephalosporins

Cefotaxime (claforan) is active against S.pneumoniae, S.pyogenes, H.influenzae, Neisseria spp., moderately active against S.aureus. The drug is highly effective against E.coli, Proteus mirabilis, Klebsiella spp. and other members of the Enterobacteriaceae family that do not produce beta-lactamases (Bush 1). Cefotaxime does not exhibit clinically significant anti-pseudomonal activity (P. aeruginosa, non-pseudomonal pseudomonas).

Ceftriaxone (Rocephin) is characterized as the most active 3rd generation cephalosporin against certain microorganisms - N.gonorrhoeae, N.meningitidis, H.influenzae. The drug has unique pharmacokinetic characteristics. In comparison with most cephalosporins, the half-life of which, which determines the frequency of administration, is 0.5-2 hours, for ceftriaxone this figure is 8 hours. In this regard, the drug can be administered once a day.

One of the main requirements for antibiotics used in the treatment of meningitis is the ability to penetrate the blood-brain barrier. If the pia mater is intact, the concentration of ceftriaxone in the cerebrospinal fluid is relatively low, but with the development of meningitis it increases significantly. The content of the drug in the cerebrospinal fluid reaches 7-11% of its concentration in the blood serum, which is 5-10 times higher than the minimum inhibitory concentration for current pathogens of purulent meningitis.

Cefoperazone (cephobid): About 50% of clinical isolates of Pseudomonas aeruginosa are sensitive to the drug. Cefoperazone exhibits less activity against gram-positive cocci and gram-negative bacilli compared to cefotaxime. The drug actively binds to plasma proteins, is characterized by a relatively small volume of distribution and, despite achieving high concentrations in the blood serum, does not penetrate into the cerebrospinal fluid.

Ceftazidime (Fortum) is characterized by low sensitivity to most inducible beta-lactamases and has pronounced activity against gram-negative bacteria, including Pseudomonas aeruginosa. In comparison with other representatives of 3rd generation cephalosporins, it has the least pronounced bactericidal effect on B.fragilis and staphylococci (15-25%).

Clinical use of 3rd generation cephalosporins. Currently, 3rd generation cephalosporins rightly occupy one of the key positions in the chemotherapy of infectious diseases. Of particular importance in clinical practice is the high activity of these antibiotics against gram-negative microorganisms, which are often resistant to most other beta-lactams. Since these microorganisms, primarily aerobic gram-negative bacilli, in extremely rare cases are causative agents of community-acquired infections, it is obvious that 3rd generation cephalosporins are not advisable to prescribe in these clinical situations. These drugs can only be used in cases of severe community-acquired infection (most likely associated with E.coli, Proteus mirabilis, K.pneumoniae, etc.).

Ceftriaxone and cefotaxime have established themselves as highly effective drugs in the treatment of nosocomial infections caused by microorganisms sensitive to them (pneumonia, wound infection, complicated urinary tract infection). However, if treatment for nosocomial infection is started empirically, i.e. in the absence of a microbiological diagnosis, one should remember about the possible participation in the development of the infectious process of microflora resistant to 3rd generation cephalosporins (Pseudomonas aeruginosa, methicillin-resistant staphylococci - MRSA, enterococci). In this regard, when carrying out initial empirical treatment of severe nosocomial infection, the combined administration of cephalosporins and aminoglycosides is usually assumed.

The widespread and not always justified (especially in community-acquired infections) use of 3rd generation cephalosporins is associated with an ever-increasing frequency of detection of clinical isolates of Enterobacter spp. (especially E. cloacae), Citrobacter freundii, Serratia marcescens and other microorganisms resistant to their action. This circumstance is an additional argument confirming the need to use a combination of antibiotics in the treatment of severe nosocomial infections.

Ceftriaxone and cefotaxime have established themselves as the most effective antimicrobial agents for the treatment of meningitis caused by H. influenzae, S. pneumoniae, N. meningitidis. When treating meningitis in pediatric practice, ceftriaxone is significantly more effective than previously traditionally used combinations of antibiotics (ampicillin + chloramphenicol or ampicillin + gentamicin). Currently, Ceftriaxone and cefotaxime are considered as empirical treatments for meningitis in children and the elderly, and in the case of H. influenzae isolated from the cerebrospinal fluid, these drugs become the drugs of choice. These antibiotics are also highly effective against meningitis caused by other gram-negative bacilli, with the exception of P. aeruginosa (the drug of choice is ceftazidime) and Enterobacter spp. (drug of choice is trimethoprim/sulfamethoxazole). Ceftriaxone is also successfully used in the treatment of pneumococcal meningitis (in the case of S.pneumoniae resistance to penicillin).

Taking into account the high bactericidal potential of ceftazidime against Pseudomonas aeruginosa, it has been assigned the status of a reserve drug (prescription is justified in cases of proven infection caused by P. aeruginosa or suspected infection).

Third-generation cephalosporins are often prescribed as part of empirical therapy in febrile patients with neutropenia (usually a combination of ceftazidime and aminoglycosides).

Due to their wide spectrum of antibacterial activity, 3rd generation cephalosporins are also used in the treatment of a number of specific infectious diseases. For example, in the USA, due to the increased resistance of N.gonorrhoeae to most antibiotics, ceftriaxone has become the most popular drug prescribed to patients with gonococcal infection. A single dose of ceftriaxone is a highly effective treatment for chancroid. The drug has also proven itself in the treatment of Lyme disease (carditis, arthritis, neurological disorders).

The high bactericidal activity of ceftriaxone against representatives of the Streptococcus family (excluding enterococci) allows us to consider it as an alternative to traditional antibacterial treatment regimens for streptococcal endocarditis.

3rd generation cephalosporins are often prescribed to patients with acute uncomplicated cystitis or pyelonephritis if previous therapy with trimethoprim/sulfamethoxazole or fluoroquinolones was ineffective.

Antibiotic therapy has changed the essence of the fight against dangerous infectious diseases. Previously, doctors did not have methods of influencing pathogenic pathogens, and all efforts were aimed at maintaining the general condition of the patient.

After the discovery of penicillin by Alexander Fleming, it became possible to destroy microorganisms that previously provoked the development of epidemics that took the lives of thousands and millions of people. And cephalosporins in tablets play a very important role in this successful fight.

The group of cephalosporins are drugs that have a very important practical role in the inpatient and outpatient treatment of bacterial pathologies. Statistics show that this group of antibiotics is most often prescribed in domestic hospitals. This is due to the large list of pathologies for which it is used, low overall toxicity, and a wide spectrum of action.

Also, over decades of use, cephalosporins have received a good evidence base and good experience in prescription. New studies are regularly conducted that confirm the effectiveness of these medications.

Pharmacological features of the drug

Cephalosporins are beta-lactam antibacterial drugs. They have a common chemical structure, which determines their general pharmacological properties. Cephalosporins have a bactericidal effect.

The mechanism of action of the drugs is as follows - antibiotic compounds act on the components of the cell wall, and in this way violate their integrity.

As a result, there is a massive death of pathogenic pathogens.

The pharmacological characteristics of drugs determine the features of their use. Most cephalosporins are poorly absorbed from the digestive tract, so most are available in the form of ampoules for intravenous or intramuscular use. They also pass well through the blood-brain barrier, especially with inflammation of the meningeal membranes.

Cephalosporin antibiotics are distributed fairly evenly in the patient's body. The highest concentrations of drugs are observed in bile, urine, respiratory epithelium and digestive tract. The therapeutic concentration is maintained for 5-6 hours after taking the medication.

When administered orally, cephalosporin antibiotics pass through hepatic metabolism. These bacterial preparations are excreted from the body mainly unchanged by the kidneys. Therefore, if the function of this organ is impaired, the accumulation of antibiotics in the patient’s body is observed. The spectrum of action of cephalosporins is quite wide, especially in recent generations. Most drugs act on:

• streptococci;
• staphylococci;
• hemophilus influenzae;
• Neisseria;
• enterobacterial infection;
• Klebsiella;
• Moraxella;
• E. coli;
• shigella;
• salmonella.

Classification of cephalosporins

Currently, there are five generations of cephalosporins. They differ in some characteristics. The first representatives of this group of medications have a more effective effect on gram-positive bacteria.

Also, the latest cephalosporin drugs act on a large number of microbes and penetrate the blood-brain barrier better.

An important problem is the development of antibiotic resistance to the first generations, which have already been used for many decades. This situation leads to a decrease in the effectiveness of the drugs used.

Cephalosporins are divided into the following generations:

Rules for the use of antibacterial drugs

Antibiotics are potent drugs that have a systemic effect on the body. Therefore, antibacterial drugs should not be used independently without consulting a doctor. It is very difficult for a patient to choose the optimal treatment option for the disease for himself and his relatives. Uncontrolled use of antibiotics also more often leads to the development of side effects and a decrease in the effect of the drug.

During therapy, you must follow a few simple rules of administration. The course of treatment usually lasts at least 3 days.

It is not recommended for the patient to independently cancel or refuse therapy after the first signs of improvement in general condition.

This very often leads to relapse of the pathology.

Antibiotics must be used at the same time of day. This allows you to maintain a good concentration of the drug in the peripheral blood, which gives an optimal therapeutic effect.

If you miss a dose of an antibiotic, you should not panic, but take the missed dose of cephalosporin as quickly as possible. In the future, therapy should be continued as usual.

When using antibiotics, it is important to monitor the development of side effects, which should be reported to your doctor as soon as possible. Only he is able to competently assess their severity and make a decision on suspending or continuing cephalosporin therapy.

How to correctly prescribe cephalosporins in tablets

Before prescribing cephalosporins, the doctor must make sure of the bacterial etiology of the patient's disease. This is very important, since antibacterial drugs do not act on viral or fungal flora, and in such cases they can even harm the patient. To this end, the doctor must conduct a complete examination of the patient, which usually begins with a complete medical history. The patient or his relatives (if his condition is serious) must talk about how, when and after what the first symptoms of the pathology appeared.

Information is also usually collected about the presence of a similar disease in close relatives and friends, about possible contact with patients, as well as about concomitant disorders of other organs and systems. The next step is a thorough examination of the affected areas, skin or mucous membranes, palpation, percussion and auscultation of the heart, lungs and abdomen. Do not be surprised by questions about urination frequency, changes in stool and appetite.

After this, a series of laboratory and instrumental studies are usually carried out. A number of changes in them with a high degree of probability may indicate the bacterial etiology of the pathological process.

First of all, we are talking about changes in the general blood test - leukocytosis, a shift in the leukocyte formula to the left, an increase in the number of neutrophils (as well as their immature forms) and an increase in ESR (erythrocyte sedimentation rate).

With an infection in the genitourinary system, leukocytes and various bacteria are often found in a general urine test.

The most accurate research method is considered to be bacteriological. It allows not only to accurately isolate the causative agent of the pathology, but also to study its sensitivity to certain antibiotics. This makes this test the reference test for all diseases of infectious origin.

In this case, blood, a smear from the back of the throat, urine, sputum, biopsy or any other biological media in which a microorganism may be located can be used as research material.

The most significant drawback of the bacteriological research method is the long time it takes to perform it in conditions where the doctor needs to make a decision on the choice of treatment tactics immediately. Therefore, this test has the greatest practical value in situations where the initial treatment was not effective enough. It allows you to change the drug used in treatment.

Modern international and national recommendations play a very important role in determining the indications for prescribing cephalosporins, which clearly regulate the situations in which they need to be used.

The effectiveness of prescribed antibiotic therapy is assessed 48-72 hours after the first dose of the drug.

For this purpose, laboratory tests are repeated and the dynamics of the patient’s clinical symptoms are also looked at. If it is positive, the doctor continues treatment with the original drug. If there is no improvement, there is a need to switch to second-line or reserve antibacterial agents.

The role of cephalosporins in tablets in treatment

Cephalosporins in clinical practice are used mainly in injection form. However, this significantly reduces their ability to prescribe in outpatient practice, since not all patients can correctly dilute and administer the antibacterial drug.

This also determines the role of tablet forms of cephalosporins. They are often used as initial antibiotic therapy for pathologies that do not require hospitalization, if the patient’s condition is satisfactory and there are no decompensated diseases of other organs.

They also play an important role in step therapy. It consists of two stages. In the first stage, cephalosporin is used in injection form in order to eliminate the pathological process as quickly and effectively as possible. To consolidate the result of treatment and complete the course of therapy, the same drug is prescribed to the patient in tablet form for several days after discharge from the hospital.

This strategy allows you to reduce the number of days the patient spends in the hospital.

Today in pharmacies it is possible to find only drugs of the first three generations of cephalosporins in tablets or suspensions:

• the first - cephalexin;
• the second - cefuroxime;
• third - cefixime.

Indications for the use of cephalosporins in tablets

Cephalosporins are used to treat bacterial pathologies in systems where they accumulate during their metabolism and create a therapeutic concentration sufficient to kill microbes. First of all, we are talking about diseases of the respiratory, genitourinary systems and ENT organs. They are also used for inflammation of the biliary tract and some pathologies of the digestive system.

According to the instructions for use, there is a list of pathologies for which the prescription of cephalosporins is justified. They are used for:

• pneumonia;
• bronchitis;
• tracheitis;
• laryngitis;
• tonsillitis;
• pharyngitis;
• sinusitis;
• otitis media;
• cystitis;
• urethritis;
• prostatitis;
• bacterial inflammation of the uterus and its appendages;
• prevention of complications during surgical procedures or interventions.

How to take cephalosporins tablets

The duration of treatment with cephalosporins is at least 5 days. Usually the tablets are taken 2 times a day to ensure the required concentration of the drug. The tablet should be taken with a sufficient amount of water.

It is not recommended to use other drinks (soda, dairy products, tea, coffee) for this purpose, since they can change the pharmacological properties of the drug.

Drinking alcohol during the course of treatment is strictly prohibited, as this can lead to the development of acute hepatosis and impaired liver function.

Side effects when using cephalosporins

Cephalosporins are classic drugs of the beta-lactam group, so they are characterized by the presence of fairly frequent allergic reactions of varying severity. The development of urticaria, dermatoses, angioedema and even anaphylactic shock in patients has been described.

Allergy to all beta-lactams is cross-linked, therefore, if there are hypersensitivity reactions to any of the drugs from a number of penicillins, carbapenems, monobactams, prescribing cephalosporins is strictly contraindicated.

Another dangerous condition is pseudomembranous colitis, which sometimes develops due to the uncontrolled proliferation of clostridial infection. In most cases, it has a mild course, manifests itself only in stool disorders, and is not even diagnosed. But in some cases, the pathological process follows an unfavorable scenario and is complicated by perforations, intestinal bleeding and sepsis.

The most common side effect of cephalosporins is transient digestive disorders.

They are manifested by nausea, vomiting, diarrhea, abdominal pain or flatulence. These symptoms disappear quickly after discontinuation of the drug.

Sometimes there are increases in liver enzymes or toxic effects on the renal tubules. Additionally, the addition of superinfection or fungal pathology (mainly candidiasis) against the background of antibiotic therapy is described. There have been isolated cases of negative effects on the central nervous system, which were manifested by epileptic seizures, convulsions and emotional lability.

Contraindications for use

The main contraindication to taking oral cephalosporins is the presence of an allergy to any of the beta-lactam antibiotics. Before the first use of the drug, a test for the presence of hypersensitivity must be carried out.

Caution should be exercised when prescribing these antibacterial drugs in patients with impaired renal function, since this condition can lead to the accumulation of the antibiotic in the patient's body. In such cases, the doctor must individually calculate the dose based on the glomerular filtration rate.

Cephalosporins are classified as low-toxic drugs that are approved for use in young children, as well as during pregnancy and lactation.

Oral use of these drugs can lead to the development of exacerbations of chronic inflammatory processes of the digestive system (colitis, enteritis). Therefore, for these pathologies, it is recommended to give preference to parenteral forms of antibiotics.

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Antibacterial drugs are divided into several groups based on their mechanism of action and active substance. One of them is cephalosporins, which are classified according to generations: from the first to the fifth. The third is more effective against gram-negative bacteria, including streptococci, gonococci, Pseudomonas aeruginosa, etc. This generation includes cephalosporins for both internal and parenteral use. They are chemically similar to penicillins and can replace them if you are allergic to such antibiotics.

Classification of cephalosporins

This concept describes a group of semi-synthetic beta-lactam antibiotics that are produced from “cephalosporin C”. It is produced by the fungi Cephalosporium Acremonium. They secrete a special substance that inhibits the growth and reproduction of various gram-negative and gram-positive bacteria. Inside the cephalosporin molecule there is a common core consisting of bicyclic compounds in the form of dihydrothiazine and beta-lactam rings. All cephalosporins for children and adults are divided into 5 generations depending on the date of discovery and the spectrum of antimicrobial activity:

• First. The most common parenteral cephalosporin in this group is Cefazolin, and the most common oral cephalosporin is Cephalexin. They are used for inflammatory processes of the skin and soft tissues, often for the prevention of postoperative complications.
• Second. These include the drugs Cefuroxime, Cefamandole, Cefaclor, Ceforanide. They have increased activity against gram-positive bacteria compared to 1st generation cephalosporins. Effective for pneumonia, combined with macrolides.
• Third. This generation includes antibiotics Cefixime, Cefotaxime, Ceftriaxone, Ceftizoxime, Ceftibuten. They are highly effective against diseases caused by gram-negative bacteria. Used for infections of the lower respiratory tract, intestines, inflammation of the biliary tract, bacterial meningitis, gonorrhea.
• Fourth. Representatives of this generation are the antibiotics Cefepime and Cefpirom. Can affect enterobacteria that are resistant to 1st generation cephalosporins.
• Fifth. They have the spectrum of activity of 4th generation cephalosporin antibiotics. They act on flora resistant to penicillins and aminoglycosides. Effective antibiotics in this group are Ceftobiprole and Zefter.

The bactericidal effect of such antibiotics is due to inhibition (inhibition) of the synthesis of peptidoglycan, which is the structural main wall of bacteria. Among the common features of cephalosporins, the following can be noted:

• good tolerability due to minimal side effects compared to other antibiotics;
• high synergy with aminoglycosides (in combination with them they have a greater effect than individually);
• manifestation of a cross-allergic reaction with other beta-lactam drugs;
• minimal impact on intestinal microflora (bifidobacteria and lactobacilli).

3rd generation cephalosporins

This group of cephalosporins, unlike the previous two generations, has a wider spectrum of action. Another feature is a longer half-life, due to which the medicine can be taken only once a day. The advantages include the ability of third-generation cephalosporins to cross the blood-brain barrier. Thanks to this, they are effective against bacterial and inflammatory lesions of the nervous system. The list of indications for the use of third generation cephalosporins includes the following diseases:

• meningitis of bacterial nature;
• intestinal infections;
• gonorrhea;
• cystitis, pyelonephritis, pyelitis;
• bronchitis, pneumonia and other lower respiratory tract infections;
• inflammation of the biliary tract;
• shigillosis;
• typhoid fever;
• cholera;
• otitis.

3rd generation cephalosporins in tablets

Oral forms of antibiotics are convenient to use and can be used for complex treatment at home for infections of bacterial etiology. Oral cephalosporins are often prescribed in a stepped therapy regimen. In this case, antibiotics are first administered parenterally and then switched to forms that are taken orally. Thus, oral cephalosporins in tablets are represented by the following drugs:

• Cefodox;
• Pantsef;
• Tsedex;
• Suprax.

The active ingredient in this drug is cefixime trihydrate. The antibiotic is presented in the form of capsules with a dosage of 200 mg and 400 mg, suspensions with a dosage of 100 mg. The price of the first is 350 rubles, the second is 100-200 rubles. Cefixime is used for diseases of an infectious-inflammatory nature caused by pneumococci and streptococci pyrrolidonyl peptidase:

• acute bronchitis;
• acute intestinal infections;
• acute pneumonia;
• otitis media;
• relapses of chronic bronchitis;
• pharyngitis, sinusitis, tonsillitis;
• urinary tract infections that occur without complications.

Cefixime capsules are taken with meals. They are allowed for patients over 12 years of age. They are prescribed a dosage of 400 mg of Cefixime daily. Treatment depends on the infection and its severity. Children from six months to 12 years are prescribed Cefixime in the form of a suspension: 8 mg/kg body weight 1 time or 4 mg/kg 2 times a day. Regardless of the form of release, Cefix is ​​prohibited if you are allergic to cephalosporin antibiotics. After taking the drug, the following adverse reactions may develop:

• diarrhea;
• flatulence;
• dyspepsia;
• nausea;
• stomach ache;
• rash;
• hives;
• itching;
• headache;
• dizziness;
• leukopenia;
• thrombocytopenia.

Cefodox

The bactericidal effect of this antibiotic is due to the cefpodoxime in its composition. The release forms of this drug are tablets and powder. Suspensions are prepared from the latter. Regardless of the form of release, Cefodox is used to treat:

• pyelonephritis, mild or moderate cystitis;
• tonsillitis, pharyngitis, laryngitis, sinusitis, otitis;
• pneumonia, bronchitis;
• urethritis, proctitis, cervicitis of gonococcal origin;
• infectious lesions of the skin, joints, bone and soft tissues.

The use of Cefodox is not practiced in people who are hypersensitive to the composition of the drug. In tablet form, the antibiotic is not prescribed to children under 12 years of age, in the form of a suspension - under the age of 5 months, with galactose intolerance, malabsorption syndrome, lactase deficiency. The dosage of Cefodox is determined as follows:

• 200-400 mg per day – for patients over 12 years of age (average dose);
• 200 mg – for infectious diseases of the respiratory and genitourinary systems;
• 400 mg – for bronchitis or pneumonia.

The course of therapy continues as prescribed by the doctor. Its average duration depends on the course of the disease and is determined by a specialist. The price of the drug is about 350-400 rubles. The list of side effects of Cefodox includes the following symptoms:

• rash;
• skin itching;
• headache;
• diarrhea;
• vomiting, nausea;
• eosinophilia;
• an increase in plasma levels of creatinine and urea;
• violation of thrombocytopoiesis and leukocytopoiesis.

Pantsef

This representative of the 3rd generation cephalosporins is based on cefexime. You can buy Pancef in the form of tablets and granules. They are indicated for the treatment of infectious diseases of various body systems:

• Urinary. Pancef is effective for gonococcal urethritis and cervicitis.
• Respiratory. This antibiotic is indicated for acute and chronic bronchitis, tracheitis, and pneumonia.
• ENT organs. Panzef is prescribed for otitis, pharyngitis, infectious sinusitis, tonsillitis.

Contraindications for this drug include sensitivity to penicillins and cephalosporins, the elderly and age under six months. The dosage is determined taking into account the following principles:

• 8 mg/kg 1 time or 4 mg/kg 2 times a day – for patients over 12 years of age;
• 400 mg – maximum of the drug per day;
• 400 mg for 7-10 days, 1 time per day - for gonorrhea that occurs without complications.

• 8 mg/kg 1 time or 4 mg/kg 2 times a day (6-12 ml suspension) – for children 5–15 years old;
• 5 ml of suspension – children 2–4 years old;
• 2.5-4 ml of suspension – for babies from 6 months to one year.

The cost of 6 tablets of Pancef 400 mg is 350 rubles, 5 ml of suspension is 550 rubles. Side effects of the drug occur most often in the digestive tract, but there are other reactions:

• anorexia;
• dysbacteriosis;
• dizziness;
• fever;
• flatulence;
• nausea;
• dysbacteriosis;
• vomit;
• jaundice;
• dry mouth;
• hyperbilirubinemia;
• glossitis;
• stomatitis;
• nephritis;
• skin hyperemia;
• eosinophilia;
• hives.

3rd generation cephalosporin Spectracef exists only in tablet form. Its active component is cefditoren in a dosage of 200 mg or 400 mg. Microorganisms that cause the following pathologies are sensitive to this substance:

• Diseases of the upper respiratory tract, including acute sinusitis and tonsillopharyngitis.
• Uncomplicated infections of subcutaneous fat and skin, including impetigo, abscess, folliculitis, infected wounds, furunculosis.
• Infections of the lower respiratory tract, such as community-acquired pneumonia. This also includes periods of relapse of chronic bronchitis.

Spectracef should be taken with liquid, preferably after a meal. The recommended dose is determined by the type of infection and its severity:

• 200 mg every 12 hours for 5 days - with exacerbation of bronchitis;
• 200 mg every 12 hours for 10 days – for skin infections, sinusitis, pharyngotonsillitis;
• 200 mg every 12 hours for 4–5 days – for community-acquired pneumonia.

Compared to other cephalosporins, Spectracef has a higher cost - 1300–1500 rubles. It is better to clarify the list of side effects in the detailed instructions for the drug, since they are numerous. Spectracef contraindications include:

• allergy to drug components and penicillins;
• children under 12 years of age;
• hypersensitivity to casein protein;
• liver failure;
• breast-feeding;
• pregnancy;
• being in a hospital for hemodialysis.

Tsedex

One capsule of Cedex contains 400 mg of ceftibuten dihydrate, 1 g of this drug in powder form contains 144 mg of this active component. Their price varies from 500 to 650 rubles. The list of indications for both forms of drug release includes the following diseases:

• enteritis and gastroenteritis in children caused by Escherichia coli or strains of the genus Shigella and Salmonella;
• otitis media;
• pneumonia, bronchitis, scarlet fever, pharyngitis, acute sinusitis, tonsillitis;
• urinary tract infections.

Cedex is contraindicated in patients with allergies to penicillins, intolerance to cephalosporins, severe renal failure and patients on hemodialysis. Age restrictions: suspension is allowed from 6 months, capsules - from 10 years. The dosage is determined as follows:

• 400 mg every day – for acute sinusitis and bronchitis;
• 200 mg every 12 hours for 10 days – for community-acquired pneumonia;
• 9 mg/kg suspension – for children from six months to 10 years.

Treatment lasts on average 5–10 days. If Streptococcus pyogenes is affected, therapy should last for at least 10 days. List of possible adverse reactions:

• drowsiness;
• dyspepsia;
• anemia;
• eosinophilia;
• gastritis;
• headache;
• dizziness;
• convulsions;
• hives;
• nausea, vomiting;
• thrombocytosis;
• ketonuria;
• taste changes;
• abdominal pain.

Suprax

Suprax is available in the form of dispersible tablets, i.e., soluble in water. Each contains 400 mg of cefixime. The cost of 7 tablets is about 800 rubles. List of indications for use of Suprax:

• uncomplicated gonorrhea of ​​the urethra or cervix;
• shigellosis;
• agranulocytic tonsillitis;
• acute bronchitis;
• urinary tract infections;
• acute pharyngitis;
• Otitis media, sinusitis, tonsillitis.

Suprax should not be used for colitis, kidney failure, pregnancy, colitis and old age. You can take the drug regardless of food. The daily dose is calculated as follows:

• 400 mg in 1–2 doses – for body weight more than 50 kg;
• 200 mg at a time – with a weight of 25 to 50 kg.

For gonorrhea, treatment lasts 1 day, for mild infections of the genitourinary system - 3-7 days, for sore throat - 1-2 weeks. To prepare the suspension, crush one tablet and add a small amount of water, then shake well. List of side effects of Supraxa:

• nephritis;
• rash;
• hives;
• headache;
• constipation;
• vomit;
• skin itching;
• nausea;
• pain in the epigastric region;
• bleeding;
• kidney dysfunction.

In powder form

To prepare a solution for injection, third generation cephalosporins are used in powder form. When administered intramuscularly, drugs have a faster effect and rarely cause adverse reactions, since they enter the body bypassing the digestive tract. Also, cephalosporin antibiotics in powder form are used for those who, due to physiological characteristics, cannot take pills. From this form of medicine you can prepare a suspension that is easier to give to children.

Fortum

The active component of Fortum is ceftazidime in a dosage of 250, 500, 1000 or 200 mg. The drug is presented as a white powdery mass for the preparation of solutions for injections. The cost of 1 g is 450 rubles, 0.5 g – 180 rubles. The list of indications for use of Fortum includes infections:

• respiratory tract, including lesions due to cystic fibrosis;
• ENT organs;
• organs of the musculoskeletal system;
• subcutaneous tissue and skin;
• genitourinary tract;
• infections caused by dialysis;
• in patients with suppressed immunity;
• meningitis, bacteremia, peritonitis, septicemia, infected burns.

Fortum is contraindicated in case of sensitization to ceftazidime, penicillins and antibiotics from the group of 3rd generation cephalosporins. The drug is prescribed with caution to pregnant and lactating women, with renal failure and in combination with aminoglycosides. The daily dose is selected as follows:

• the dosage per day should not be more than 6 g;
• adults are administered 1–6 g, divided into 2–3 doses;
• with reduced immunity and severe forms of infections, administer 2 g 2–3 times or 3 g 2 times;
• in case of damage to the urinary tract, 0.5-1 g is administered 2 times.
• sepsis;
• cholangitis;
• peritonitis;
• infections of bones, skin, joints, soft tissues;
• pyelonephritis;
• infected burns and wounds;
• infections caused by hemodialysis and peritoneal dialysis.

The dosage is set for each patient individually, taking into account the location and severity of the disease. The drug is administered intramuscularly or intravenously in the following dosages:

• 0.52 g every 8–12 hours – for adults;
• 30–50 mg per 1 kg of body weight 2–3 times a day – for children from 1 month to 12 years;
• 30 mg/kg/day. With an interval of 12 hours - for children up to 1 month.

A maximum of 6 g of Tizim per day is allowed. A contraindication to the use of this drug is high sensitivity to ceftazidime. The list of possible side effects includes:

• nausea, vomiting;
• hepatitis;
• cholestatic jaundice;
• eosinophilia;
• diarrhea;
• hypoprothrombinemia;
• interstitial nephritis;
• candidiasis;
• phlebitis;
• pain at the injection site.

Drug interactions

When using 3rd generation cephalosporins while drinking alcohol, there is a high risk of developing a disulfiram-like effect. This deviation is similar to the state of the body during ethyl alcohol poisoning. Against this background, the patient develops an aversion to alcohol. The effect persists for several days after discontinuation of cephalosporins. The danger is the possible development of hypoprothrombinemia - an increased tendency to bleed. Interaction of cephalosporins with drugs:

• simultaneous use of antacids reduces the effectiveness of antibiotic therapy;
• combination with loop diuretics is not allowed due to the risk of nephrotoxic effect;
• combination with thrombolytics, anticoagulants and antiplatelet agents is also not recommended due to the increased likelihood of intestinal bleeding.

Video

This is one of the most popular drugs representing 3rd generation cephalosporins. In this case, 4th generation cephalosporins are administered only parenterally.

Cephalosporins have a fairly wide spectrum of action, due to which they are actively used to treat infections (bacterial) of the upper respiratory tract, genitourinary, and digestive systems.

In addition, 3rd generation cephalosporins produce a less inhibitory effect on the immune system, the reaction of the defense system is practically not reduced, interferon is released in normal quantities.

But in the fight against staphylococci, cephalosporins are practically not used. The tablets have a fairly broad spectrum of action. Thanks to this, there are practically no side effects from the use of tablets.

In addition, cephalosporins have virtually no effect on intestinal function.

The drug is presented in the form of film-coated tablets. Most often, tablets are used for inflammatory processes of the respiratory system. If we consider 3rd generation cephalosporins for children, then the drug “Pancef” is worth remembering first.

Some 3rd generation cephalosporins are used prophylactically after surgery. Zedex tablets have an excellent effect on microorganisms that have developed resistance to penicillins.

Cedex tablets are prescribed to children over 12 years of age to treat bacterial infections of the respiratory system. But for patients who are allergic to penicillins, tablets are contraindicated.

Third generation cephalosporin antibiotics are used to treat infections of the respiratory system, as well as simple infections of the skin and subcutaneous tissue. Spectracef tablets do an excellent job of treating furunculosis and folliculitis.

3rd generation cephalosporins

Tablets can be prescribed to older people, as well as women during lactation. Many patients, due to their physiological characteristics, cannot take pills.

For older people, cephalosporins can be prescribed in the form of an injection solution.

Third generation cephalosporins - ATC classification of drugs

Another broad-spectrum cephalosporin antibiotic, which is offered in pharmacies in powder form. Cephalosporins in tablets are often used to treat diseases of bacterial etiology. The first drug from this group was obtained in 1964 (cephalothin).

Since then, a large number of cephalosporins have been successfully synthesized. Cephalosporin antibiotics are currently divided into several generations. There are 4 generations of these drugs.

Antibiotics of the cephalosporin group, use

It follows that tablet forms are represented by only three generations.

The second generation includes Cefuroxime axetil and Cefaclor tablets. As for the 3rd generation, this group includes Cefixime and Ceftibuten. Each generation has its own characteristics.

1st generation cephalosporin tablets kill staphylococci, streptococci, Neisseria, E. coli, Shigella and Salmonella. Most often, 3rd generation drugs are used to treat patients. Unlike parenteral cephalosporins (Cefotaxime and Ceftriaxone), tablets are less effective.

Group drugs: Third generation cephalosporins

This remedy is taken orally in tablet form. The drug is not prescribed to children under 3 years of age or if the drug is intolerant. Like most other cephalosporins, Cephalexin tablets can cause various unwanted reactions.

3rd generation cephalosporin preparations in injection ampoules

Of the 2nd generation tablet drugs, Zinnat and its analogues can be taken.

Pharmacological group - Cephalosporins

Of the third generation tablet forms, patients are often prescribed Suprax or Tsemidexor. Suprax tablets are pale orange in color and have a strawberry scent.

It is worth noting that the improved molecular structure of these synthetic antibiotics allows for a minimum number of side effects on the body.

Against streptococci and pneumococci, it is 3rd generation cephalosporins (in tablets or other dosage form) that have the highest activity.

3rd generation cephalosporins are a group of antibiotics that are in many ways superior to the cephalosporins of the two previous generations. 3rd generation cephalosporins are characterized by increased activity against gram-negative bacteria belonging to the Enterobacteriaceae family. Also, 3rd generation antibiotics have an active effect on Pseudomonas aeruginosa. 3rd generation parenteral cephalosporins were initially used as a treatment for severe infectious diseases in hospital settings.

The main antimicrobial drugs of third generation cephalosporins are Ceftriaxone and Cefotaxime. These antibiotics have a high degree of activity against streptococci, meningococci, gonococci, Haemophilus influenzae, etc.

The antibiotic "Ceftriaxone" is used in combination to treat many diseases, both in adults and children.

3rd generation cephalosporins in tablets are used to treat a wide variety of infections caused by bacteria. Oral cephalosporins are convenient to use, as they are suitable for complex treatment of diseases at home, and prescribing them to children will help avoid negative emotions that often arise during the use of injectable drugs.

Often, in the treatment of diseases, a step-by-step scheme is used, in which parenteral antibiotics are first used, and then oral antibiotics are prescribed, which are convenient for use at home, when treatment can be carried out on an outpatient basis. This scheme is convenient both for the patient and for the hospital itself - the person saves money on syringes, alcohol, etc., and the hospital has the opportunity to save space in the hospital for more severely ill patients.

3rd generation cephalosporins have little effect on bifidobacteria and lactobacilli that live in the intestines, so the risk of developing various disorders typical of antibiotic therapy is minimal. And yet, in order not to develop dysbacteriosis, it is recommended to use drugs with lacto- and bifidobacteria along with antibiotics.

3rd generation antibiotics do not have a negative effect on the body’s immune system, as a result of which interferon is released in normal quantities and protective functions are not reduced. 3rd generation cephalosporins are safe and effective drugs, so they are approved for use in the treatment of endocrine diseases, pancreas, etc.

Oral group three cephalosporins in tablets:

• Cefsulodin;
• Cefpodocashproxetil;
• Ceftazidime;
• Spectracef;
• Pancef et al.

In rare cases, 3rd generation cephalosporins can cause side effects such as an allergic reaction in the form of a rash or hives, chills, bleeding, etc. You cannot use antibiotics yourself, as this can cause serious harm to the body.

Pregnant women can use antibiotics of this group if there is a risk to the life of the mother or child that exceeds the risk of developing possible side effects.

When breastfeeding while taking antibiotics, undesirable consequences may develop, such as dysbiosis in children, thrush, since part of the drug passes into breast milk. Children and older people should take the drug in a lower dosage, due to the insufficient functionality of internal organs, especially the kidneys.

For various disorders of the functioning of the kidneys or liver, the use of the drug, dosage and its effects must be strictly controlled, as there is a risk of developing serious disorders, such as bleeding or nephrotoxic effect.

Stomatitis may develop in the oral cavity as a result of long-term use of antibiotics. If any side effect occurs, you must inform your doctor immediately.

Antibiotic tablets should be taken with meals with plenty of liquid. The drug must be taken strictly at the same time, in compliance with the correct dosage. You should not skip taking antibiotics, but you should not take a double dose if you missed a previous dose. During antibiotic treatment and after three days, you must completely stop drinking alcohol.

Use of third generation cephalosporins

The use of antibiotics depends on the characteristics of their effect on various bacteria. Most often they are prescribed to patients with bacterial infections, such as:

1. Tonsillitis caused by streptococcal bacteria (antibiotics are used to treat tonsillitis or sore throat not only in adults, but also in children). The most commonly prescribed drugs are Ceftriaxone or Cephalexin.
2. Pneumonia.
3. Acute bronchitis or otitis media.
4. Pyelonephritis.
5. Bacteriuria, asymptomatic.
6. Sinusitis.
7. Diarrhea.
8. Typhoid fever.
9. Acute cystitis.
10. Staphylococcal infections, etc.

Antibiotics act on gram-negative bacteria at the cellular level, which helps them cope with pathogenic microflora in the human body in a relatively short time.

Ceftriaxone: instructions

Ceftriaxone belongs to the cephalosporin group of antibiotics. This drug is successfully prescribed to both young children and adults due to its effectiveness, safety and inexpensive pricing. Ceftriaxone is available in powder form for the preparation of a solution used for intramuscular injection. Since the drug has a long-lasting effect on bacteria, it is prescribed once a day.

The instructions for the drug indicate that, depending on the severity of the disease and improvement of the condition during antibiotic therapy, the drug is prescribed for 4 to 12 days of use. If symptoms improve after one or two days, the antibiotic should not be stopped for at least 4 days from the start of use. This is necessary to ensure that bacteria in the body are completely destroyed. There are cases when patients stopped taking antibiotics without completing the full course, as a result of which a certain group of bacteria developed immunity to the drug, and the next time it had no effect on them.

The drug "Ceftriaxone" is used for prophylactic purposes once before surgery to prevent possible infection during surgery or during the rehabilitation period.

For intramuscular administration, the drug "Ceftriaxone" is pre-diluted with lidocaine, and for intravenous administration, it is diluted with distilled sterile water, which is sold at the pharmacy in special ampoules.

To properly open an antibiotic ampoule, you need to rub along the intended line or in the narrowest part of the ampoule with a special file or nail file, then tap your fingernail on the top of the ampoule and carefully break it off.

Antibiotic Cefotaxime

"Cefotaxime" is an antibiotic, belongs to the 3rd generation cephalosporins. It is considered one of the most effective drugs used against gram-negative bacteria, including E. coli. Used to treat meningitis, tonsillitis, and various diseases of the urinary system. It is also prescribed for various skin infections, peritonitis, sepsis, gonorrhea, etc. The drug is often used to eliminate negative inflammatory processes after operations on the gastrointestinal tract and after childbirth.

Available in powder form in ampoules for preparing a solution. The drug is administered intramuscularly or intravenously (dropper).

Possible side effects: headaches, weakness, gastrointestinal disorders, arrhythmia, phlebitis, chills, bronchospasm, allergic reactions, etc. The drug should not be used during pregnancy, young children, or with individual intolerance to the components.

Any antibiotics, in addition to having a negative effect on bacteria, also have a negative effect on beneficial microorganisms. To avoid the appearance of diarrhea, which often occurs in the first days of taking the drug, you need to start taking Yogurt, Lactobacterin, Bifidumbacterin, etc.

If during a course of treatment with an antibiotic you need to test your urine for sugar, you must report the use of the drug, since while taking it, the level of glucose in urine may not correspond to reality. You should not drink alcohol together with an antibiotic, as there is a risk of developing various disorders, such as nausea, vomiting, a decrease in blood pressure, severe headache, shortness of breath, etc.

Analogs of the drug: “Kefotex”, “Spirozin”, “Talcef”, “Cephabol”, “Cefotoxime Sandoz”, etc.

"Cefotoxime" differs from the antibiotic "Ceftriaxone" mainly in that it is less painful when administered, which is an important factor, given the long course of taking antibiotics.

After the first administration of the drug "Cefotoxime", a slight increase in body temperature may be observed. You should not be afraid of this, since this symptom occurs as a reaction of the body to the death of bacteria, the waste products and particles of which enter the blood, causing a rise in temperature. After 5 days, the unpleasant symptoms will go away.

If the drug is prescribed during breastfeeding, then it is better to switch the child to formula during the administration of antibiotics and express the milk so as not to provoke various disorders in the baby. After the last injection, after 2 hours, breastfeeding can be resumed, since the drug is eliminated from the body very quickly.

Treatment with antibiotics is the best remedy in the fight against many bacteria, but the result is achieved only if all the rules and dosage of the drug are followed.