Antibiotic with minimal side effects. Tableted broad-spectrum antibiotic drugs: application features

Antibiotics are metabolic products of microorganisms that suppress the activity of other microbes. Natural antibiotics, as well as their semi-synthetic derivatives and synthetic analogs, are used as medicines, which have the ability to suppress pathogens of various diseases in the human body.

Based on their chemical structure, antibiotics are divided into several groups:

A. Beta-lactam antibiotics.

1. Penicillins.

a) Natural penicillins: benzylpenicillin and its salts, phenoxymethyl penicillin.

b) Semisynthetic penicillins:

Penicillinase-resistant with primary activity against staphylococci: oxacillin, cloxacillin, flucloxacillin;

With preferential activity against gram-negative bacteria (amidinopenicillins); amdinocillin (mecillinam), acidocillin;

Broad-spectrum (aminopenicillins): ampicillin, amoxicillin, pivampicillin;

Broad spectrum of action, especially highly active against Pseudomonas aeruginosa and other gram-negative bacteria (carboxy- and urea-dopenicillins): carbenicillin, tikarishin, azlocillin, mezlocillin, piperacillin.

2. Cephalosporins:

a) first generation: cephaloridine, cefazolin, etc.;

b) second generation: cefamandole, cefuroxime, etc.;

c) third generation: cefotaxime, ceftazidime, etc.;

d) fourth generation: cefpirome, cefepime, etc.

3. Monobactams: aztreonam.

4. Carbapenems: imipenem, meronem, tienam, primaxin. B. Fosfomycin.

B. Macrolides:

a) first generation: erythromycin, oleandomycin;

b) second generation: spiramycin (Rovamycin), roxithromycin (Rulid), clarithromycin (Klacid), etc.;

c) third generation: azithromycin (sumamed). G. Lincosamides: lincomycin, clindamycin. D. Fuzidin.

E. Aminoglycosides:

a) first generation: streptomycin, monomycin, kanamycin;

b) second generation: gentamicin;

c) third generation: tobramycin, sisomycin, amikacin, netilmicin;

d) fourth generation: isepamycin. J. Levomycetin.

3. Tetracyclines: a) natural: tetracycline, oxytetracycline, chlortetracycline; b) semi-synthetic: metacycline, doxycycline, minocycline, morphocycline.

AND. Rifamycins: rifocin, rifamide, rifampicin.

TO. Glycopeptide antibiotics: vancomycin, teicoplanin.

L. Ristomycin.

M. Polymyxins: polymyxin B, polymyxin E, polymyxin M.

H. Gramicidin.

ABOUT. Polyene antibiotics: nystatin, levorin, amphotericin B.

Based on the nature of their antimicrobial action, antibiotics are divided into bactericidal and bacteriostatic. Bactericidal drugs that cause the death of microorganisms include penicillins, cephalosporins, aminoglycosides, polymyxins, etc. Such drugs can give a quick therapeutic effect in severe infections, which is especially important in young children. Their use is less often accompanied by relapses of diseases and cases of carriage. Bacteriostatic antibiotics include tetracyclines, chloramphenicol, macrolides, etc. These drugs, by disrupting protein synthesis, inhibit the division of microorganisms. They are usually quite effective for moderately severe diseases.

Antibiotics are capable of inhibiting biochemical processes occurring in microorganisms. According to their mechanism of action, they are divided into the following groups:

1. Inhibitors of the synthesis of the microbial wall or its components during mitosis: penicillins, cephalosporins, carbapenems, monobactams, glycopeptide antibiotics, ristomycin, fosfomycin, cycloserine.

2. Antibiotics that disrupt the structure and function of cytoplasmic membranes: polymyxins, aminoglycosides, polyene antibiotics, gramicidin, glycopeptide antibiotics.

3. Inhibitors of RNA synthesis at the level of RNA polymerase: rifamycins.

4. Inhibitors of RNA synthesis at the ribosome level: chloramphenicol, macrolides (erythromycin, oleandomycin, etc.), lincomycin, clindamycin, fusidine, tetracyclines, aminoglycosides (kanamycin, gentamicin, etc.), glycopeptide antibiotics.

In addition, important in the mechanism of action of individual antibiotics, especially penicillins, is their inhibitory effect on the adhesion of microorganisms to cell membranes.

The mechanism of action of antibiotics largely determines the type of effects they cause. Thus, antibiotics that disrupt the synthesis of the microbial wall or the function of cytoplasmic membranes are bactericidal drugs; antibiotics that inhibit the synthesis of nucleic acids and proteins usually act bacteriostatically. Knowledge of the mechanism of action of antibiotics is necessary for their correct selection, determining the duration of treatment, selecting effective combinations of drugs, etc.

To provide etiotropic therapy, it is necessary to take into account the sensitivity of pathogens to antibiotics. Natural sensitivity to them is due to the biological properties of microorganisms, the mechanism of action of antibiotics and other factors. There are narrow- and broad-spectrum antibiotics. Narrow-spectrum antibiotics include drugs that suppress predominantly gram-positive or gram-negative bacteria: some penicillins (benzylpenicillin, oxacillin, acido-cillin, aztreonam, ristomycin, fusidin, novobiocin, bacitracin, vancomycin, monobactams (aztreonam). Polymyxins B also have a narrow spectrum. E, M, inhibitory gram-negative bacteria, as well as antifungal antibiotics nystatin, levorin, amphotericin B, amphoglucamine, mycoheptin, griseofulvin.

Broad-spectrum antibiotics include drugs that affect both gram-positive and gram-negative bacteria: a number of semisynthetic penicillins (ampicillin, amoxicillin, carbenicillin); cephalosporins, especially third and fourth generations; carbapenems (imipenem, meronem, tienam); chloramphenicol; tetracyclines; aminoglycosides; rifamycins. Some of these antibiotics also act on rickettsia, chlamydia, mycobacteria, etc.

When identifying the causative agent of an infectious disease and its sensitivity to antibiotics, it is preferable to use drugs with a narrow spectrum of action. Broad-spectrum antibiotics are prescribed for severe disease and mixed infection.

Antibiotics include drugs that accumulate inside cells (the ratio of intra- and extracellular concentrations is more than 10). These include macrolides, especially new ones (azithromycin, roxithromycin, spiramycin), carbapenems, and clindamycin. Rifampicin, chloramphenicol, tetracyclines, lincomycin, vancomycin, teicoplanin, fosfomycin penetrate well into cells (the ratio of intra- and extracellular concentrations is from 1 to 10). Penicillins, cephalosporins, aminoglycosides penetrate into cells poorly (the ratio of intra- and extracellular concentrations is less than 1). Polymyxins also do not penetrate into cells.

In the process of using antibiotics, microorganisms may develop resistance to them. To penicillins, cefa osporins, monobactams, carba-penems, chloramphenicol, tetracyclines, glycopeptides, ristomycin, fosfomycin, lincosamides, resistance develops slowly and in parallel the therapeutic effect of the drugs decreases. Resistance to aminoglycosides, macrolides, rifamycins, polymyxins, and fusidine develops very quickly, sometimes during the treatment of one patient.

CHARACTERISTICS OF SEPARATE GROUPS OF ANTIBIOTICS

Penicillins. According to their chemical structure, these antibiotics are derivatives of 6-aminopenicillanic acid (6-APA) containing various substituents (R) in the amino group.

The mechanism of the antimicrobial action of penicillins is to disrupt the formation of the cell wall from pre-synthesized murein fragments. There are natural penicillins: benzylpenicillin (in the form of sodium, potassium, novocaine salts), bicillins, phenoxymethylpenicillin; semisynthetic penicillins: oxacillin, cloxacillin, ampicillin (pentrexil), amoxicillin, carbenicillin, carfecillin, piperacillin, mezlocillin, azlocillin, etc.

Benzylpenicillin gives a clear therapeutic effect in the treatment of diseases caused by pneumococci, staphylococci, hemolytic group A streptococci, meningococci, gonococci, spirochete pallidum, corynobacteria, anthrax bacillus and some other microorganisms. Many strains of microbes, especially staphylococci, are resistant to benzylpenicillin, as they produce an enzyme (3-lactamase, which inactivates the antibiotic.

Benzylpenicillin is usually administered intramuscularly, in critical situations intravenously (sodium salt only). Doses vary widely from 30,000-50,000 EDUkg/day) to 1,000,000 EDU/kg/day) depending on the pathogen, severity and localization of the infectious process.

Therapeutic concentration in the blood plasma occurs within 15 minutes after intramuscular administration and remains there for 3-4 hours. Benzylpenicillin penetrates well into the mucous membranes and lungs. It enters little into the cerebrospinal fluid, myocardium, bones, pleural, synovial fluid, into the lumen of the bronchi and into the uterus. For meningitis, endolumbar administration of benzylpenicillin sodium salt is possible. The drug can be administered into the cavities, endobronchially, endolymphatically. It is found in high concentrations in bile and urine. In children under one month of age, benzylpenicillin elimination occurs more slowly than in adults. This determines the frequency of administration of the drug: in the first week of life 2 times a day, then 3-4 times, and after a month, as in adults, 5-6 times a day.

When treating infections that require long-term antibiotic therapy and do not have an acute course (focal streptococcal infection, syphilis), long-acting benzylpenicillin preparations are used to prevent exacerbations of rheumatism: novocaine salt, ? bicillins 1, 3, 5. These drugs do not differ in the spectrum of antimicrobial action from the sodium and potassium salts of benzylpenicillin; they can be used in children over 1 year of age. All long-acting penicillins are administered only intramuscularly in the form of a suspension. After a single injection of novocaine salt, the therapeutic concentration of benzylpenicillin in the blood remains for up to 12 hours. Bicillin-5 is administered once every 2 weeks. Injections of bicillin-1 and bicillin-3 are performed once a week. Bicillins are mainly used to prevent relapses of rheumatism.

Phenoxymethylpenicillin- an acid-resistant form of penicillin, used orally on an empty stomach 4-6 times a day for the treatment of mild infectious diseases. Its spectrum of action is almost the same as that of benzylpenicillin.

Ospen (bimepen) benzathine phenoxymethylpenicillin is slowly absorbed from the gastrointestinal tract and maintains therapeutic concentrations in the blood for a long time. Prescribed in the form of syrup 3 times a day.

Oxacillin, cloceacillin, flucloxacillin- semisynthetic penicillins, used mainly in the treatment of diseases caused by staphylococci, including those resistant to benzylpenicillin. Oxacillin is able to inhibit (3-lactamase of staphylococci and enhance the effect of other penicillins, for example ampicillin (a combined drug of oxacillin with ampicillin - ampiox). For diseases caused by other microorganisms sensitive to benzylpenicillin (meningococci, gonococci, pneumococci, streptococci, spirochetes, etc.) , these antibiotics are practically rarely used due to the lack of a positive effect.

Oxacillin, cloxacillin, flucloxacillin are well absorbed from the gastrointestinal tract. In blood plasma, these drugs are bound to proteins and do not penetrate tissues well. These antibiotics can be administered intramuscularly (every 4-6 hours) and intravenously by stream or drip.

Amidinopenicillins - amdinocillin (mecillinam) is a narrow-spectrum antibiotic, inactive against gram-positive bacteria, but effectively suppresses gram-negative bacteria (Escherichia coli, Shigella, Salmonella, Klebsiella). Pseudomonas aeruginosa, Proteus and non-fermenting gram-negative bacteria are usually resistant to amdinocillin. The peculiarity of this antibiotic is that it actively interacts with PSB-2 (penicillin-binding protein), while most other (3-lactam antibiotics) interact with PSB-1 ​​and PSB-3. Therefore, it can be a synergist with other penicillins, as well as cephalosporins. The drug is administered parenterally, and it penetrates into cells many times better than ampicillin and carbenicillin. The antibiotic is especially effective against urinary tract infections. An ether derivative of the drug pivamdinocillin has been synthesized for enteral use.

Broad-spectrum semi-synthetic penicillins - ampicillin, amoxicillin - are of greatest importance in the treatment of diseases caused by Haemophilus influenzae, gonococci, meningococci, some types of Proteus, salmonella, and, in addition, pathogens of listeriosis and enterococci. These antibiotics are also effective for the treatment of infectious processes caused by mixed (gram-positive and gram-negative) microflora. Ampicillin and amoxicillin can be administered orally, for example, in the treatment of infections of the gastrointestinal tract, urinary tract, and otitis media. Ampicillin that is not absorbed from the gastrointestinal tract causes irritation of the mucous membranes, leading to vomiting, diarrhea, and irritation of the skin around the anus in a significant percentage of children. Amoxicillin differs from ampicillin in better absorption, so it can be prescribed orally not only for mild but also for moderate infections. Amoxicillin is less irritating to the mucous membranes of the gastrointestinal tract and less likely to cause vomiting and diarrhea. For severe diseases that require the creation of a high concentration of antibiotic in the blood, these drugs are administered parenterally.

Carboxypenicillins- carbenicillin, ticarcillin have an even wider spectrum of antimicrobial action than ampicillin, and differ from it in the additional ability to suppress Pseudomonas aeruginosa, indole-positive strains of Proteus and bacteroides. Their main use is diseases caused by these pathogens. Carbenicillin and ticarcillin are absorbed very poorly from the gastrointestinal tract, so they are used only parenterally (carbenicillin intramuscularly and intravenously, ticarcillin intravenously). Carfecillin is a phenyl ester of carbenicillin. It is well absorbed from the gastrointestinal tract, after which carbenicillin is released from it. Carboxypenicillins, compared to ampicillin, penetrate worse into tissues, serous cavities, and cerebrospinal fluid. Carbenicillin is found in active form and in high concentrations in bile and urine. It is produced in the form of disodium salt, so if kidney function is impaired, water retention in the body and edema may occur.

The use of drugs may be accompanied by the appearance of allergic reactions, symptoms of neurotoxicity, acute interstitial nephritis, leukopenia, hypokalemia, hypernatremia, etc.

Ureidopenicillins (acylaminopenicillins)- piperacillin, mezlocillin, azlocillin - broad-spectrum antibiotics that suppress gram-positive and gram-negative microorganisms. These antibiotics are mainly used for severe gram-negative infections, especially for diseases caused by Pseudomonas aeruginosa (necessarily in combination with aminoglycosides), Klebsiella. Ureidopenicillins penetrate well into cells. They are little metabolized in the body and are excreted by the kidneys through filtration and secretion. The drugs are poorly resistant to B-lactamase, so they are recommended to be prescribed with inhibitors of this enzyme. Piperacillin is prescribed for chronic inflammatory diseases of the bronchi, including cystic fibrosis and chronic bronchitis. The drugs can cause leukopenia, thrombocytopenia, neutropenia, eosinophilia, allergic reactions, gastrointestinal dysfunction, interstitial nephritis, etc.

Upon appointment broad-spectrum semisynthetic penicillins: aminopenicillins (ampicillin, amoxicillin), carboxypenicillins (carbenicillin, ticarcillin), ureidopenicillins (piperacillin, mezlocillin, azlocillin), it must be remembered that all of these antibiotics are destroyed by staphylococcal B-lactamases, and therefore penicillinase-producing strains of these microbes are resistant to their action.

Combination drugs with B-lactamase inhibitors- clavulanic acid and sulbactam. Clavulanic acid and sulbactam (penicillanic acid sulfone) are classified as B-lactamines, which have a very weak antimicrobial effect, but at the same time they suppress the activity of B-lactamases of staphylococci and other microorganisms: Haemophilus influenzae, Escherichia coli, Klebsiella, some bacteroides, gonococci, le -gionella; do not suppress or suppress very weakly B-lactamases of Pseudomonas aeruginosa, Enterobacteriaceae, and Citrobacter. Preparations containing clavulanic acid and sulbactam are intended for parenteral use - augmentin (amoxicillin + potassium clavulanate), timentin (ticarcillin + potassium clavulanate), unasin (ampicillin + sulbactam). They are used in the treatment of otitis media, sinusitis, infections of the lower respiratory tract, skin, soft tissues, urinary tract and other diseases. Unazine is highly effective for the treatment of peritonitis and meningitis caused by microorganisms that intensively produce B-lactamase. Analogues of the drug unasin intended for oral administration are sultamicillin and sulacillin.

Natural and semi-synthetic penicillins(except for carboxy- and ureidopenicillins) - low-toxic antibiotics. However, benzylpenicillin and, to a lesser extent, semisynthetic penicillins can cause allergic reactions, and therefore their use in children with diathesis and allergic diseases is limited. The administration of high doses of benzylpenicillin, ampicillin, amoxicillin can lead to increased excitability of the central nervous system and convulsions, which is associated with the antagonism of antibiotics towards the GABA inhibitory transmitter in the central nervous system.

Long-acting penicillin preparations should be injected very carefully under slight pressure through a large-diameter needle. If the suspension enters a vessel, it can cause thrombus formation. Semi-synthetic penicillins used orally cause irritation of the gastric mucosa, a feeling of heaviness in the abdomen, burning, and nausea, especially when administered on an empty stomach. Broad-spectrum antibiotics can lead to dysbiocenosis in the intestines and provoke the appearance of a secondary infection caused by Pseudomonas aeruginosa, Klebsiella, yeast, etc. For other complications caused by penicillins, see above.

Cephalosporins- a group of natural and semi-synthetic antibiotics based on 7-aminocephalosporanic acid.

Currently, the most common division of cephalosporins is by generation.

Some drugs in this group can be used for oral administration: of the first generation cephalosporins - cefadroxil, cephalexin, cefradine; II generation - cefuroxime (zinnate), III generation - cefspan (cefoxime), cefpodoxime (orelax), ceftibuten (cedex). Oral cephalosporins are usually used for moderate diseases, since they are less active compared to drugs for parenteral administration.

Cephalosporins have a wide spectrum of action.

I generation cephalosporins inhibit the activity of cocci, especially staphylococci and streptococci (with the exception of enterococci and methicillin-resistant strains of staphylococci), as well as diphtheria bacilli, anthrax bacilli, spirochetes, Escherichia, Shigella, Salmonella, Moraxella, Klebsiella, Yersinia, Bordetella, Protea and hemophilus influenzae. Second generation cephalosporins have the same spectrum of action, but they create higher concentrations in the blood and penetrate tissue better than first generation drugs. They have a more active effect on some strains of gram-negative bacteria that are resistant to the first generation of cephalosporins, including most strains of Escherichia coli, Klebsiella, Proteus, Haemophilus influenzae, Moraxella, whooping cough pathogens, and gonococci. At the same time, second generation cephalosporins do not affect Pseudomonas aeruginosa, “hospital strains” of gram-negative bacteria and have a slightly less inhibitory effect compared to first generation cephalosporins on staphylococci and streptococci. III generation cephalosporins are characterized by an even greater breadth of the antimicrobial spectrum, good penetrating ability, and high activity against gram-negative bacteria, including nosocomial strains resistant to other antibiotics. They affect, in addition to the above-mentioned microbes, pseudomonads, morganella, serrations, clostridia (except CY. difficile) and bacteroides. At the same time, they are characterized by relatively low activity against staphylococci, pneumococci, meningococci, gonococci and streptococci. IV generation cephalosporins are more active than III generation drugs in suppressing most gram-negative and gram-positive bacteria. IV generation cephalosporins affect some multi-resistant microorganisms that are resistant to most antibiotics: Cytobacter, Enterobacter, Acinetobacter.

IV generation cephalosporins are resistant to B-lactamases and do not induce their formation. But they do not affect SY. difficile, bacteroides, enterococci, listeria, legionella and some other microorganisms.

They are used to treat severe diseases, as well as in patients with neutropenia and suppressed immunity.

The highest concentrations of cephalosporins are found in the kidneys and muscle tissue, lower concentrations are found in the lungs, liver, pleural, and peritoneal fluids. All cephalosporins easily pass through the placenta. Cephaloridin (Zeporin), cefotaxime (Claforan), moxalactam (Latamoxef), ceftriaxone (Longacef), ceftizoxime (Epocelin), etc. penetrate into the cerebrospinal fluid. Most cephalosporins are excreted unchanged by the kidneys through active secretion by tubular cells and partly glomerular filtration.

Cephalosporins are used in the treatment of diseases caused by penicillin-resistant microorganisms, sometimes in the presence of allergic reactions to penicillins. They are prescribed for sepsis, diseases of the respiratory system, urinary tract, gastrointestinal tract, soft tissues, and bones. For meningitis in premature newborns, high activity of cefotaxime, moxalactam, ceftizoxime, and ceftriaxone was detected.

The use of cephalosporins may be accompanied by pain at the site of intramuscular injection; phlebitis after intravenous use; nausea, vomiting, diarrhea when taking drugs orally. With repeated use, children with high sensitivity to the drug may experience skin rash, fever, and eosinophilia. Cephalosporins are not recommended for children with an anaphylactic reaction to penicillins, but their use is acceptable in the presence of other manifestations of allergies - fever, rash, etc. Cross allergic reactions between cephalosporins and penicillins are observed in 5-10% of cases. Some cephalosporins, especially cephaloridine and cephalothin, are nephrotoxic. This effect is associated with their slow excretion by the kidneys and the accumulation of lipid peroxidation products in them. The nephrotoxicity of the antibiotic increases with a deficiency of vitamin E and selenium. Drugs can inhibit the microflora of the gastrointestinal tract and lead to dysbiocenosis, cross-infection caused by hospital strains of microbes, candidiasis and vitamin E deficiency in the body.

Aztreons- highly effective synthetic (3-lactam antibiotic from the monobactam group. Used for the treatment of respiratory tract infections, meningitis, septic diseases caused by gram-negative, including multidrug-resistant microorganisms (pseudomonas, moraxella, klebsiella, hemophilus influenzae, E. coli, yersinia, serracia , enterobacter, meningococcus, gonococcus, salmonella, morganella).Aztreonam does not affect gram-positive aerobic and anaerobic bacteria.

Imipenem- (3-lactam antibiotic from the carbapenem group with an ultra-broad spectrum of action, including most aerobic and anaerobic gram-positive and gram-negative bacteria, including microorganisms resistant to penicillins, cephalosporins, aminoglycosides and other antibiotics. The high bactericidal activity of imipenem is due to easy penetration through the walls bacteria, with a high degree of affinity for enzymes involved in the synthesis of the bacterial wall of microorganisms. Currently, from the mentioned group of antibiotics, imipenem is used in the clinic in combination with cilastatin (this combination is called tienam). Cilastatin inhibits renal peptidase, thereby inhibiting the formation of nephrotoxic metabolites of imipenem. Thienam has strong antimicrobial activity, a wide spectrum of action. The sodium salt of imipenem-cilastatin is produced under the name Primaxin. Imipenem is stable to (3-lactamase, but has a weak effect on microorganisms located inside cells. When prescribing imipenem, there may be thrombophlebitis, diarrhea, and in rare cases, convulsions (especially with impaired renal function and diseases of the central nervous system).

Meronem (meropenem) does not undergo biotransformation in the kidneys and does not produce nephrotoxic metabolites. Therefore, it is used without cilastatin. It has less effect than tienam on staphylococci, but is more effective against gram-negative enterobacteria and pseudomonads.

Meronem creates an active bactericidal concentration in the cerebrospinal fluid (CSF) and is successfully used for meningitis without fear of undesirable effects. This compares favorably with tienam, which causes neurotoxic effects and is therefore contraindicated for meningitis.

Aztreonam and carbapenem are practically not absorbed into the gastrointestinal tract and are administered parenterally. They penetrate well into most body fluids and tissues and are excreted primarily in the urine in an active form. The drugs have been noted to be highly effective in treating patients with infections of the urinary tract, osteoarticular system, skin, soft tissues, gynecological infections, and gonorrhea. The use of aztreonam in pediatric practice as an alternative to aminoglycoside antibiotics is especially indicated.

Fosfomycin (fosfonomycin)- a broad-spectrum bactericidal antibiotic that disrupts the formation of the microbial wall by suppressing the synthesis of UDP-acetylmuramic acid, that is, its mechanism of action differs from that of penicillins and cephalosporins. It has a wide spectrum of action. It is able to suppress gram-negative and gram-positive bacteria, but does not affect Klebsiella, indole-positive Proteus.

Fosfomycin penetrates well into tissues, including bone and cerebrospinal fluid; is found in sufficient quantities in bile. The named antibiotic is excreted mainly by the kidneys. It is prescribed mainly for severe infections caused by microorganisms resistant to other antibiotics. It combines well with penicillins, cephalosporins, and when used together with aminoglycoside antibiotics, not only an increase in antimicrobial action is observed, but also a decrease in the nephrotoxicity of the latter. Fosfomycin is effective in the treatment of meningitis, sepsis, osteomyelitis, urinary and biliary tract infections. For oral and intestinal infections, it is prescribed enterally. Fosfomycin is a low-toxic drug. When using it, some patients may experience nausea and diarrhea; no other undesirable effects have been identified to date.

Glycopeptide antibiotics. Vancomycin, teicoplanin are antibiotics that act on gram-positive cocci (including methicillin-resistant staphylococci, strains of staphylococci that form B-lactamase, streptococci, penicillin-resistant pneumococci, enterococci) and bacteria (corynebacteria, etc.). Their effect on clostridia, especially difficile, is very important. Vancomycin also affects actinomycetes.

Vancomycin penetrates well into all tissues and fluids of the body, except the cerebrospinal fluid. It is used for severe staph infections caused by strains resistant to other antibiotics. The main indications for vancomycin are: sepsis, soft tissue infections, osteomyelitis, endocarditis, pneumonia, necrotizing enterocolitis (caused by toxigenic clostridia). Vancomycin is administered intravenously 3-4 times a day, for newborns 2 times a day. In the treatment of very severe staphylococcal meningitis, given the relatively weak penetration of vancomycin into the cerebrospinal fluid, its intrathecal administration is advisable. Teicoplanin differs from vancomycin in its slow elimination; it is administered intravenously once a day. For pseudomembranous colitis and staphylococcal enterocolitis, vancomycin is prescribed orally.

The most common complication of vancomycin use is massive - the release of histamine from mast cells, leading to arterial hypotension, the appearance of a red rash on the neck (red neck syndrome), head, and limbs. This complication can usually be avoided if the required dose of vancomycin is administered over at least an hour and pre-administered antihistamines. Thrombophlebitis and hardening of the veins are possible during the infusion of the drug. Vancomycin is a nephrotoxic antibiotic; its combined use with aminoglycosides and other nephrotoxic drugs should be avoided. Vancomycin may cause seizures when administered intrathecally.

Ristomycin (ristocetin)- an antibiotic that suppresses gram-positive microorganisms. Staphylococci, streptococci, enterococci, pneumococci, spore-forming gram-positive bacilli, as well as corynebacteria, listeria, acid-fast bacteria and some anaerobes are sensitive to it. Does not affect gram-negative bacteria and cocci. Ristomycin is administered only intravenously; it is not absorbed from the gastrointestinal tract. The antibiotic penetrates well into tissues; especially high concentrations are found in the lungs, kidneys and spleen. Ristomycin is used mainly for severe septic diseases caused by staphylococci and enterococci in cases where previous treatment with other antibiotics was ineffective.

When using ristomycin, thrombocytopenia, leukopenia, neutropenia (up to agranulocytosis) are sometimes observed, and eosinophilia is sometimes noted. In the first days of treatment, exacerbation reactions (chills, rash) are possible, allergic reactions are quite often observed. Long-term intravenous administration of ristomycin is accompanied by hardening of the vein walls and thrombophlebitis. Oto- and nephrotoxic reactions have been described.

Polymyxins- a group of polypeptide bactericidal antibiotics that suppress the activity of predominantly gram-negative microorganisms, including Shigella, Salmonella, enteropathogenic strains of Escherichia coli, Yersinia, Vibrio cholerae, Enterobacter, Klebsiella. Of great importance for pediatrics is the ability of polymyxins to suppress the activity of Haemophilus influenzae and most strains of Pseudomonas aeruginosa. Polymyxins act on both dividing and dormant microorganisms. The disadvantage of polymyxins is their low penetration into cells and therefore low effectiveness in diseases caused by intracellular pathogens (brucellosis, typhoid fever). Polymyxins are characterized by poor penetration through tissue barriers. When taken orally, they are practically not absorbed. Polymyxins B and E are used intramuscularly, intravenously, for meningitis they are administered endolumbarally, for gastrointestinal infections they are prescribed orally. Polymyxin M is used only internally and topically. Oral polymyxins are prescribed for dysentery, cholera, colienteritis, enterocolitis, gastroenterocolitis, salmonellosis and other intestinal infections.

When polymyxins are prescribed orally, as well as when they are applied topically, adverse reactions are rarely observed. When administered parenterally, they can cause nephro- and neurotoxic effects (peripheral neuropathies, impaired vision and speech, muscle weakness). These complications are most common in people with impaired renal excretory function. Fever, eosinophilia, and urticaria are sometimes observed when using polymyxins. In children, parenteral administration of polymyxins is permissible only for health reasons, in the case of infectious processes caused by gram-negative microflora that are resistant to the action of other, less toxic antimicrobial drugs.

Gramicidin (Gramicidin C) active mainly against gram-positive microflora, including streptococci, staphylococci, pneumococci and some other microorganisms. Gramicidin is used only topically in the form of paste, solutions and buccal tablets. Solutions of gramicidin are used for treating the skin and mucous membranes, for washing, irrigating bandages in the treatment of bedsores, purulent wounds, boils, etc. Gramicidin tablets are intended for resorption in infectious processes in the oral cavity and pharynx (sore throat, pharyngitis, stomatitis, etc. .). Gramicidin tablets should not be swallowed: if they enter the bloodstream, they can cause hemolysis of erythromytes.

Macrolides. There are three generations of macrolides. I generation - erythromycin, oleandomycin. II generation - spiramycin (Rovamycin), roxithromycin (Rulid), josamycin (Vilprafen), clarithromycin (Cladid), midecamycin (Macropen). III generation - azithromycin (sumamed).

Macrolides are broad-spectrum antibiotics. They have a bactericidal effect on microorganisms that are very sensitive to them: staphylococci, streptococci, pneumococci, corynebacteria, bordetella, moraxella, chlamydia and mycoplasma. They affect other microorganisms - Neisseria, Legionella, Haemophilus influenzae, Brucella, Treponema, Clostridia and Rickettsia - bacteriostatically. Macrolides of the II and III generations have a wider spectrum of action. Thus, josamycin and clarithromycin suppress Helicobacter pylori (and are used in the treatment of gastric ulcers), spiramycin affects toxoplasma. Preparations of the II and III generations also inhibit gram-negative bacteria: Campylobacter, Listeria, Gardnerella and some mycobacteria.

All macrolides can be administered orally, some drugs (erythromycin phosphate, spiramycin) can be administered intravenously.

Macrolides penetrate well into adenoids, tonsils, tissues and fluids of the middle and inner ear, lung tissue, bronchi, bronchial secretions and sputum, skin, pleural, peritoneal and synovial fluids, and are found in high concentrations in neutriphils and alveolar macrophages. Macrolides penetrate poorly into the cerebrospinal fluid and central nervous system. Of great importance is their ability to penetrate cells, accumulate in them and suppress intracellular infection.

The drugs are eliminated primarily by the liver and create high concentrations in the bile.

New macrolides differ from old ones by greater stability in an acidic environment and better bio-absorption from the gastrointestinal tract, regardless of food intake, and prolonged action.

Macrolides are mainly prescribed for mild forms of acute diseases caused by microorganisms sensitive to them. The main indications for the use of macrolides are tonsillitis, pneumonia (including those caused by Legionella), bronchitis, diphtheria, whooping cough, purulent otitis, diseases of the liver and biliary tract, pneumopathy and conjunctivitis caused by chlamydia. They are very effective against chlamydial pneumonia in newborns. Macrolides are also used for diseases of the urinary tract, but to obtain a good therapeutic effect, especially when using “old” macrolides, the urine must be alkalized, since they are inactive in an acidic environment. They are prescribed for primary syphilis and gonorrhea.

Synergism is observed when macrolides are used together with sulfonamide drugs and tetracycline antibiotics. Combined preparations containing oleandromycin and tetracyclines are marketed under the names oletetr i n, tetraolean, and sigmamycin. Macrolides cannot be combined with chloramphenicol, penicillins or cephalosporins.

Macrolides are low-toxic antibiotics, but they irritate the mucous membrane of the gastrointestinal tract and can cause nausea, vomiting, and diarrhea. Intramuscular injections are painful, and phlebitis may develop with intravenous injection. Sometimes when they are used, cholestasis develops. Erythromycin and some other macrolides inhibit the monooxygenase system in the liver, as a result of which the biotransformation of a number of drugs, in particular theophylline, is disrupted, thereby increasing its concentration in the blood and toxicity. They also inhibit the biotransformation of bromocriptine, dihydroergotamine (included in a number of antihypertensive drugs), carbamazepine, cimetidine, etc.

Microlides cannot be prescribed together with new antihistamines - terfenadine and astemizole due to the danger of their hepatoxic action and the danger of heart arrhythmia.

Lincosamides: lincomycin and clindamycin. These antibiotics suppress predominantly gram-positive microorganisms, including staphylococci, streptococci, pneumococci, as well as mycoplasmas, various bacteroides, fusobacteria, anaerobic cocci, and some strains of Haemophilus influenzae. Clindamycin, in addition, has an effect, although weakly, on toxoplasma, the causative agents of malaria, and gas gangrene. Most gram-negative bacteria are resistant to lincosamides.

Lincosamides are well absorbed from the gastrointestinal tract, regardless of food intake, penetrate into almost all fluids and tissues, including bone, but poorly penetrate into the central nervous system and cerebrospinal fluid. For newborns, the drugs are administered 2 times a day, for older children - 3-4 times a day.

Clindamycin differs from lincomycin in its greater activity against certain types of microorganisms and better absorption from the gastrointestinal tract, but at the same time it more often causes undesirable effects.

Lincosamides are used in the treatment of infections caused by gram-positive microorganisms resistant to other antibiotics, especially in cases of allergies to penicillin drugs and cephalosporins. They are prescribed for infectious gynecological diseases and gastrointestinal infections. Due to good penetration into bone tissue, lincosamides are the drugs of choice in the treatment of osteomyelitis. Without special indications, they should not be prescribed to children when other, less toxic antibiotics are effective.

When using lincosamides, children may experience nausea and diarrhea. Sometimes pseudomembranous colitis develops - a severe complication caused by dysbiocenosis and reproduction in the Intestine of Cy. difficile, which secretes a toxin. These antibiotics can cause liver dysfunction, jaundice, leukoneutropenia and thrombocytopenia. Allergic reactions, mainly in the form of skin rashes, are quite rare. With rapid intravenous administration, lincosamides can cause neuromuscular block with respiratory depression and collapse.

Fuzidin. The activity of fusidine against staphylococci, including those resistant to other antibiotics, is of greatest importance. It also acts on other gram-positive and gram-negative cocci (gonococci, meningococci). Fuzidin is somewhat less active against corynebacteria, listeria, and clostridia. The antibiotic is not active against all gram-negative bacteria and protozoa.

Fusidine is well absorbed from the gastrointestinal tract and penetrates into all tissues and fluids, except the cerebrospinal fluid. The antibiotic penetrates especially well into the source of inflammation, liver, kidneys, skin, cartilage, bones, and bronchial secretions. Fusidine preparations are prescribed orally, intravenously, and also locally in the form of an ointment.

Fusidine is especially indicated for diseases caused by penicillin-resistant strains of staphylococci. The drug is highly effective for osteomyelitis, diseases of the respiratory system, liver, biliary tract, and skin. In recent years, it has been used in the treatment of patients with nocardiosis and colitis caused by clostridia (except CY. difficile). Fusidine is excreted primarily in bile and can be used in patients with impaired renal excretory function.

A pronounced increase in antimicrobial activity is observed when fusidine is combined with other antibiotics; the combination with tetracyclines, rifampicin and aminoglycosides is especially effective.

Fuzidin is a low-toxic antibiotic, but can cause dyspeptic disorders that disappear after discontinuation of the drug. When an antibiotic is administered intramuscularly, tissue necrosis is observed (!), and when administered intravenously, thrombophlebitis may occur.

Aminoglycoside antibiotics. There are four generations of aminoglycosides. First generation antibiotics include streptomycin, monomycin, neomycin, kanamycin; II generation - gentamicin (garamycin); III generation - tobramycin, sisomycin, amikacin, netilmicin; IV generation - isepamycin.

Aminoglycoside antibiotics are bactericidal, have a wide spectrum of action, and inhibit gram-positive and especially gram-negative microorganisms. Aminoglycosides of the II, III and IV generations are able to suppress Pseudomonas aeruginosa. Of main practical importance is the ability of drugs to inhibit the activity of pathogenic Escherichia coli, Haemophilus influenzae, Klebsiella, gonococci, Salmonella, Shigella, and staphylococci. In addition, streptomycin and kanamycin are used as anti-tuberculosis drugs, monomycin to act on dysenteric amoeba, leishmania, trichomonas, gentamicin - on the causative agent of tularemia.

All aminoglycoside antibiotics are poorly absorbed from the gastrointestinal tract and from the bronchial lumen. To obtain a resorptive effect, they are administered intramuscularly or intravenously. After a single intramuscular injection, the effective concentration of the drug in the blood plasma remains in newborns and young children for 12 hours or more, in older children and adults for 8 hours. The drugs penetrate satisfactorily into tissues and body fluids, with the exception of cerebrospinal fluid, they penetrate poorly into cells. When treating meningitis caused by gram-negative bacteria, aminoglycoside antibiotics are preferably administered endolumbarally. In the presence of a severe inflammatory process in the lungs, abdominal organs, pelvis, osteomyelitis and sepsis, endolymphatic administration of drugs is indicated, which ensures a sufficient concentration of the antibiotic in the organs without causing its accumulation in the kidneys. For purulent bronchitis, they are administered in the form of an aerosol or by installing a solution directly into the lumen of the bronchi. Antibiotics of this group pass well through the placenta and are excreted in milk (in an infant, aminoglycosides are practically not absorbed from the gastrointestinal tract), but there is a high risk of dysbacteriosis.

With repeated administration, accumulation of aminoglycosides is observed in the tubes, in the inner ear and some other organs.

The drugs are not. undergo biotransformation and are excreted by the kidneys in an active form. Elimination of aminoglycoside antibiotics is slowed down in newborns, especially premature infants, as well as in patients with impaired renal excretory function.

Aminoglycoside antibiotics are used for complicated infectious diseases of the respiratory and urinary tract, for septicemia, endocarditis, and less often for gastrointestinal tract infections, for the prevention and treatment of infectious complications in surgical patients.

Aminoglycoside antibiotics administered parenterally are toxic. They can cause ototoxic, nephrotoxic effects, disrupt neuromuscular transmission of impulses and the processes of active absorption from the gastrointestinal tract.

The ototoxic effect of antibiotics is a consequence of irreversible degenerative changes in the hair cells of the organ of Corti (inner ear). The danger of this effect occurring is greatest in newborns, especially premature infants, as well as in cases of birth trauma, hypoxia during childbirth, meningitis, and impaired renal excretory function. An ototoxic effect can develop when antibiotics reach the fetus through the placenta; when combined with other ototoxic drugs (furosemide, ethacrynic acid, ristomycin, glycopeptide antibiotics).

The nephrotoxic effect of aminoglycoside antibiotics is associated with dysfunction of many enzymes in the epithelial cells of the kidney tubules and destruction of lysosomes. Clinically, this is manifested by an increase in urine volume, a decrease in its concentration and proteinuria, that is, the occurrence of non-oliguric renal failure.

Antibiotics of this group cannot be combined with other oto- and nephrotoxic drugs. In young children, especially malnourished and weakened children, aminoglycoside antibiotics can inhibit neuromuscular transmission due to a decrease in the sensitivity of skeletal muscle H-cholinergic receptors to acetylcholine and suppression of the release of the transmitter; As a result, respiratory muscle function may be impaired. To eliminate this complication, calcium preparations are prescribed together with proserin after preliminary administration of atropine. Accumulating in the intestinal wall, aminoglycosides disrupt the process of active absorption of amino acids, vitamins, and sugars. This can lead to malabsorption, which worsens the child's condition. When aminoglycoside antibiotics are prescribed, the concentration of magnesium and calcium in the blood plasma decreases.

Due to their high toxicity, aminoglycoside antibiotics should be prescribed only for severe infections, in short courses (no more than 5-7 days).

Levomycetin- a bacteriostatic antibiotic, but it has a bactericidal effect on Haemophilus influenzae type “B”, some strains of meningococci and pneumococci. It inhibits the division of many gram-negative bacteria: Salmonella, Shigella, Escherichia coli, Brucella, whooping cough pathogen; gram-positive aerobic cocci: pyogenic streptococci and group B streptococci; most anaerobic microorganisms (clostridia, bacteroides); Vibrio cholerae, rickettsia, chlamydia, mycoplasma.

Mycobacteria are resistant to chloramphenicol, CI. difficile, Cytobacter, Enterobacter, Acinetobacter, Proteus, Pseudomonas aeruginosa, Staphylococcus, Enterococcus, Corynebacterium, Serration, protozoa and fungi.

Levomycetin base is well absorbed from the gastrointestinal tract, quickly creating active concentrations in the blood plasma. The antibiotic penetrates well from the blood plasma into all tissues and fluids, including the cerebrospinal fluid.

Unfortunately, chloramphenicol itself has a bitter taste and can cause vomiting in children, so at a younger age they prefer to prescribe chloramphenicol esters - stearate or palmitate. In children in the first months of life, the absorption of chloramphenicol prescribed in the form of esters occurs slowly due to the low activity of lipases that hydrolyze ester bonds and release chloramphenicol base, which is capable of absorption. Intravenously administered chloramphenicol succinate also undergoes hydrolysis (in the liver or kidneys) with the release of the active chloramphenicol base. Non-hydrolyzed ester is excreted by the kidneys, in newborns about 80% of the administered dose, in adults 30%. The activity of hydrolases in children is low and has individual differences, therefore, from the same dose of chloramphenicol, unequal concentrations in the blood plasma and cerebrospinal fluid may occur, especially at an early age. It is necessary to control the concentration of chloramphenicol in the child’s blood, since without this you may either not get a therapeutic effect or cause intoxication. The content of free (active) chloramphenicol in the blood plasma and cerebrospinal fluid after intravenous administration is usually lower than after oral administration.

Levomycetin is especially important in the treatment of meningitis caused by Haemophilus influenzae, meningococci and pneumococci, on which it has a bactericidal effect. To treat these meningitis, chloramphenicol is often combined with B-lactam antibiotics (especially ampicillin or amoxicillin). For meningitis caused by other pathogens, the combined use of chloramphenicol with penicillins is inappropriate, since in such cases they are antagonists. Levomycetin is successfully used in the treatment of typhoid fever, paratyphoid fever, dysentery, brucellosis, tularemia, whooping cough, eye infections (including trachoma), middle ear, skin and many other diseases.

Levomycetin is neutralized in the liver and excreted by the kidneys. In case of liver diseases, due to disruption of the normal biotransformation of chloramphenicol, intoxication with it may occur. In children in the first months of life, the neutralization of this antibiotic occurs slowly, and therefore there is a high risk of accumulation of free chloramphenicol in the body, which leads to a number of undesirable effects. Levomycetin, in addition, inhibits liver function and inhibits the biotransformation of theophylline, phenobarbital, diphenin, benzodiazepines and a number of other drugs, increasing their concentration in the blood plasma. The simultaneous administration of phenobarbital stimulates the neutralization of chloramphenicol in the liver and reduces its effectiveness.

Levomycetin is a toxic antibiotic. With an overdose of chloramphenicol in newborns, especially premature infants, and children in the first 2-3 months of life, “gray collapse” may occur: vomiting, diarrhea, respiratory failure, cyanosis, cardiovascular collapse, cardiac and respiratory arrest. Collapse is a consequence of impaired cardiac activity due to inhibition of oxidative phosphorylation in mitochondria. Without help, the mortality rate of newborns from “gray collapse” is very high (40% or more).

The most common complication when prescribing chloramphenicol is a disorder of hematopoiesis. There may be dose-dependent reversible disorders in the form of hypochromic anemia (due to impaired iron utilization and heme synthesis), thrombocytopenia and leukopenia. After discontinuation of chloramphenicol, the blood picture is restored, but slowly. Irreversible dose-independent changes in hematopoiesis in the form of aplastic anemia occur with a frequency of 1 in 20,000-1 in 40,000 people taking chloramphenicol, and usually develop 2-3 weeks (but can be 2-4 months) after using the antibiotic. They do not depend on the dose of the antibiotic and the duration of treatment, but are associated with the genetic characteristics of the biotransformation of chloramphenicol. In addition, chloramphenicol inhibits the function of the liver, adrenal cortex, pancreas, and can cause neuritis and malnutrition. Allergic reactions when using chloramphenicol are rare. Biological complications can manifest themselves in the form of superinfections caused by antibiotic-resistant microorganisms, dysbiocenosis, etc. For children under 3 years of age, chloramphenicol is prescribed only for special indications and only in very severe cases.

Contents [Show]

Among medications, an important place is occupied by the latest generation of antibiotics, which are active against many microbes. They are used to treat infectious pathologies, which has significantly reduced the mortality rate of patients from pneumonia and pyelonephritis, which are now commonplace. Thanks to antibiotics, the course of bronchitis and sinusitis is alleviated and recovery is accelerated, and it has also become possible to perform complex surgical operations. Even wound infections can be successfully treated with antibiotics.

This category of antimicrobial drugs includes substances active against gram-negative and gram-positive organisms. The former are causative agents of intestinal diseases, inflammatory pathologies of the genitourinary and respiratory systems. Gram-positive organisms often cause wound infections and mediate postoperative complications in surgery.

Some broad-spectrum antibiotics of the latest generation are also active against protozoal infections. An example is the nitroimidazole derivatives - tinidazole, ornidazole and metronidazole. Metronidazole is most widely used due to its affordability. Its class analogue, tinidazole, is similar in its spectrum of antimicrobial activity, but is not used parenterally. In general, all groups of broad-spectrum antibiotics are presented as follows:

• natural penicillins;
• inhibitor-protected aminopenicillins;
• antipseudomonas penicillins, including inhibitor-protected ones;
• III generation cephalosporins, IV generation cephalosporins;
• aminoglycoside group;
• tetracycline antibiotics;
• macrolide antibiotics;
• antibiotics of a number of carbapenems;
• chloramphenicol;
• fosfomycin;
• rifampicin;
• dioxidine;
• sulfonamides;
• quinolones, fluoroquinolones;
• nitrofuran group;
• antibiotics of the nitroimidazole series.

This list does not contain the names of groups of narrow-spectrum antibiotics. They are specific for a small number of microbes and are effective against them. Narrow-spectrum drugs cannot be used to treat superinfections and are not used empirically. They are used as first-line antibiotics when the type of pathogen is identified.

The above antimicrobial agents are broad-spectrum drugs. This is a complete list of groups of substances that are active against gram-positive and gram-negative microbes. However, the list contains both the latest generation of antibiotics and earlier representatives of the group. Of the above, representatives of the latest generations are the following groups of drugs:

• aminopenicillins resistant to beta-lactamase (Sulbactam, Ampicillin, Clavulanate, Amoxicillin);
• cephalosporins of the III and IV generations (“Cefotaxime”, “Cefoperazone”, “Ceftazidime”, “Ceftriaxone”, “Cefpirome”, “Cefepime”);
• aminoglycoside antibiotics of the third generation (“Amikacin”, “Netilmitsin”);
• 14- and 15-membered semisynthetic macrolides (“Roxithromycin”, “Clarithromycin”, “Azithromycin”);
• 16-membered natural macrolide antibiotics (“Midecamycin”);
• fluoroquinolones of the third and fourth generations (“Levofloxacin”, “Sparfloxacin”, “Gatifloxacin”, “Trovafloxacin”, “Moxifloxacin”);
• carbapenems (“Meropenem”, “Imipinem-cilastatin”, “Ertapenem”);
• nitrofurans (“Nitrofurantoin”, “Furazidin”, “Ersefuril”).

The previously mentioned protected anti-pseudomonas penicillins have a wide spectrum of activity, but are used only against Pseudomonas aeruginosa due to the need to reduce the probable contact of the latter with a modern and powerful antibiotic. This prevents the risk of the bacteria developing drug resistance. Tazobactam is most effective against Pseudomonas aeruginosa infection. Occasionally, Piperacillin or Clavulanate are used as the latest generation antibiotics for pneumonia caused by a hospital strain of the pathogen.

Also, this list does not include the latest generation of antibiotics from the group of natural and antistaphylococcal penicillins. The former cannot be used in outpatient treatment due to the need for frequent intravenous or intramuscular administration. There are no forms that allow you to take them orally. A similar situation has developed with cephalosporins. Having the same spectrum of activity as penicillins, they cannot be used orally due to destruction in the stomach.

Parenteral cephalosporins and penicillins are effective latest-generation antibiotics for pneumonia. Scientists of the National Academy of Sciences of the Republic of Belarus have achieved success in developing a dosage form for their enteral use. However, the research results have not yet been applied in practice, and drugs of this series can so far only be used in the work of inpatient healthcare institutions.

Studying the latest generation of antibiotics, the list of drugs recommended for children is significantly narrowed. In childhood, only representatives of a number of aminopenicillins (Amoxicillin, Clavulanate), cephalosporins (Ceftriaxone, Cefepime), and macrolides (Azithromycin, Midekamicin, Roxithromycin, Clarithromycin) can be used. Fluoroquinolone antibiotics, carbapenems and nitrofurans cannot be used due to inhibition of bone growth, liver and kidney toxicity.

Systemic nitrofurans are not used due to the lack of scientific data confirming the safety of treatment. The only exception is Furacillin, which is suitable for local treatment of wounds. Modern and highly effective antibiotics for children of the latest generation are the following: macrolides, penicillins, cephalosporins (the names of the drugs are presented above). The use of other groups of antimicrobial drugs is not recommended due to the toxic effect and disruption of skeletal development.

According to the FDA (USA) classification, only certain antibiotics of the latest generation can be used in the treatment of pregnant women, the list of which is extremely small. They belong to categories A and B, that is, their danger has not been confirmed or there is no teratogenic effect in animal studies.

Substances with unproven effects on the fetus, as well as with a toxic effect, can only be used if the therapeutic effect predominates over the side effect (category C and D). Category X drugs have a proven teratogenic effect on the fetus, therefore, if their use is necessary, termination of pregnancy is mandatory.

During pregnancy, the following broad-spectrum antibiotics in tablets are used: protected aminopenicillins (Amoclave, Amoxiclav), cephalosporins (Cefazolin, Ceftriaxone, Cefepime). Macrolides (“Azithromycin”, “Clarithromycin”, “Midecamycin”, “Roxithromycin”) are allowed to be used in the third trimester of pregnancy due to the fact that their teratogenic effect has not yet been fully studied, and its absence cannot be stated unambiguously. It is also safe to use penicillin antibiotics in pregnant women in the absence of allergies.

All broad-spectrum antibiotics of the latest generation, theoretically, can be used for bronchitis and pneumonia if their pharmacodynamic characteristics are optimal for this. However, there are optimal schemes for the rational treatment of such diseases. They consider options for successful combinations of antimicrobial drugs with the goal of broad coverage of microbial strains.

Nitrofurans, nitroimidazole derivatives and sulfonamides are irrationally used for inflammatory diseases of the respiratory system. The most successful combination for bronchitis or mild pneumonia is protected aminopenicillin with a macrolide (“Amoclav” + “Azithromycin”). Protracted bronchitis requires the prescription of a cephalosporin instead of aminopenicillin (Ceftriaxone + Azithromycin). In this scheme, the macrolide can be replaced with another class analogue: Midecamycin, Clarithromycin or Roxithromycin.

All of these latest generation antibiotics for bronchitis have a pronounced effect, although clinical signs of the disease may continue to be present. The criterion for the effectiveness of treatment is the appearance of a cough with gradually cleared sputum and relief of fever. With COPD, shortness of breath also weakens, appetite improves, and the frequency of coughing decreases.

Mild pneumonia is treated according to the principle of bronchitis, but with the use of cephalosporin and macrolide. For moderate or severe pneumonia of community-acquired origin, a cephalosporin (Ceftriaxone or Cefepime) with a representative of a number of fluoroquinolones (Ciprofloxacin or Levofloxacin) is prescribed. These latest generation broad-spectrum antibiotics suppress community-acquired microflora well, and the effect of their use is noticeable on the second day of treatment.

Modern antibiotics of the latest generation for pneumonia (the names are presented above) act on the pathogen, suppressing its vital activity or killing it. The first substances are called bacteriostatics, and the second bactericidal drugs. Cephalosporins, aminopenicillins and fluoroquinolones are bactericidal substances, and macrolides are bacteriostatic. Moreover, combining antibiotics aims not only to expand the spectrum of activity, but also to comply with the rules of combination: one bactericidal drug with one bacteriostatic one.

In intensive care, where there may be patients with severe pneumonia and distress syndrome due to intoxication. The main contribution to the severity of the condition of such patients is made by pathogenic microflora that are resistant to most antimicrobial drugs. In such situations, carbapenems (Imipinem-cilastatin, Tienam, Meropenem) are used, which are unacceptable for use in outpatient settings.

Modern antibiotics of the latest generation for sinusitis or sinusitis are used to destroy microbes. In such cases, a single bactericidal antibiotic may be used. However, with sinusitis, the main difficulty is access of the antimicrobial drug to the site of inflammation. Therefore, the cephalosporin drug is most often used. An example is Ceftriaxone or Cefepime. A third generation fluoroquinolone, Levofloxacin, can also be prescribed.

Antibiotics of the latest generation for angina are prescribed for the same purpose. Moreover, both for sinusitis and tonsillitis the same antimicrobial agents can be used. The only difference is that in the case of inflammation of the tonsils, antiseptics can also be used, for example, Furacillin, a preparation of a number of nitrofurans. Although aminopenicillins protected with sulbactam or clavulanic acid (Amoclav, Amoxiclav, Ospamox) can also be successfully used for angina. Moreover, the drugs should be prescribed for 10-14 days.

Due to the contamination of the urinary tract with microbes, the latest generation of antibiotics for pyelonephritis are necessary for their treatment. The greatest therapeutic value here is cephalosporins, fluoroquinolones and nitrofurans. Cephalosporins are used for relatively mild pyelonephritis, and fluoroquinolones (“Ciprofloxacin”, “Levofloxacin”, “Ofloxacin”, “Moxifloxacin”) - when the condition worsens due to already ongoing therapy.

The most successful drug, suitable both for monotherapy and for combination with Ceftriaxone, is any representative of the nitrofuran series - Furamag). A quinolone, Nalidixic acid, can also be used. The latter create high concentrations in the urine and act actively against pathogens of genitourinary infections. Metronidazole is also occasionally used for gardnellosis and vaginal dysbiosis.

Due to the constant change in the genetic material of microorganisms, mainly bacteria, the effectiveness of many antimicrobials is significantly reduced. By acquiring resistance to drugs, bacteria gain the ability to survive in the human body, mediating the deterioration of infectious diseases. This forces researchers to search for and introduce into practice new antibiotics of the latest generation.

In total, over the period of existence of antimicrobial agents, about 7,000 substances have been developed that are used in medicine in a certain way. Some of them have fallen out of use due to clinically important side effects or because microbes have acquired resistance to them. Therefore, today about 160 drugs are used in medicine. About 20 of them are the latest generation of antibiotics, the names of which often appear in medical guidelines on antimicrobial therapy of infectious diseases.

Antibiotics help cope with most diseases. Many people do not like them, considering the drugs to be dangerous to health (“they treat one, the other cripple”). But it’s hard to argue with the fact that these drugs stopped more than one epidemic. Moreover, due to their wide range of uses, people are less likely to die from infectious diseases. As a result, people's life expectancy has increased significantly.

There is just one problem: viruses and bacteria can mutate and adapt to antibiotics (this property is called antibiotic resistance - the developed immunity of microorganisms to the action of a drug). This is why antibiotics, invented decades ago and considered almost a panacea for all infections, are now poorly effective in treating most diseases.

Scientists are forced to improve medicines, that is, to produce a new generation of drugs. Currently, there are four generations of widely used antibiotics. In this article we will compile a list of the most popular modern drugs of the new generation, analyze their main characteristics, indications, contraindications and prices.

Broad-spectrum antibiotics are drugs with universal action, prescribed to combat a large number of pathogens (including those with an unknown source of infection). Unfortunately, such versatility is a weakness: there is a possibility that antibiotics will begin to fight against beneficial microflora (for example, if the symbiotic intestinal flora is destroyed, dysbiosis occurs). This is why after treatment with broad-spectrum antibiotics, it is necessary to restore normal levels of beneficial bacteria.

New generation drugs are universal and can act on a large number of pathogenic microbes.

The new generation of antibiotics are more effective than their predecessors because bacteria have not yet had time to adapt to them. Besides:

• new generation antibiotics are considered safer (they have fewer side effects and are not so severe);
• New generation antibiotics are easy to use - first generation drugs had to be taken 3-4 times a day, while modern antibiotics are enough to be taken 1-2 times;
• New generation antibiotics are available in different forms. There are even medications in the form of syrups and patches.

Having studied the reviews of doctors and patients, we can identify the most common broad-spectrum antibiotics from the latest generation. We get this list:

1. Sumamed.
2. Cefamandole.
3. Unidox Solutab.
4. Rulid.
5. Amoxiclav.
6. Lincomycin.
7. Cefoperazone.
8. Cefotaxime.
9. Cefixime.
10. Avelox.

Now let's look at each medicine on this list in a little more detail.

• Sumamed

Broad-spectrum antibiotics from the list of new generation macrolides. They act due to azithromycin (in one capsule - 250 ml of the substance).

Sumamed is especially effective in combating infections affecting the respiratory tract (angina, sinusitis, bronchitis, pneumonia), skin and soft tissues, the genitourinary system (for example, prostatitis) and the gastrointestinal tract (including intestinal infections). Contraindicated in case of hypersensitivity to macrolides, as well as liver and kidney diseases. It has mild side effects, which distinguishes Sumamed from other broad-spectrum antibiotics. Take one tablet per day for 3 days (the course can then be extended by a doctor).

The price of Sumemd depends on the form of release and packaging: 250 mg capsules, 6 pieces - from 320 rubles; 6 tablets 125 mg - from 290 rubles; 6 tablets 500 mg - from 377 rub.

• Cefamandole

Packaging of the drug.

A drug from the group of cephalosporins of the latest generation. Rarely causes an adaptive reaction in microorganisms, therefore it effectively fights gram-positive and gram-negative bacteria, mycoplasmas, legionella, salmonella, and sexually transmitted pathogens. Often prescribed for colds and intestinal infections. Can be used as an alternative to cephalosporin if resistance to the latter is observed. Effective for the prevention of postoperative infectious complications. One of the disadvantages of the drug is its high price.

• Unidox Solutab

Broad-spectrum antibiotic from the list of new generation tetracyclines. The active substance in the composition is doxycycline. Available in the form of 100 mg tablets (10 tablets per package).

Effective in the fight against gram-positive and gram-negative microorganisms, protozoa, anaerobes, and atypical pathogens. Most often prescribed for the treatment of colds, intestinal infections, and prostatitis. Almost does not cause dysbacteriosis. Dosage for adults: 200 mg (2 tablets) once or twice a day. The price of the drug is approximately 280 rubles. per package.

• Rulid

Fourth generation antibiotic from the list of macrolides. The basic substance is roxithromycin. Available in the form of tablets with a dosage of 150 mg. A single daily dose of the drug is sufficient. Most often prescribed for upper respiratory tract infections, urogenital diseases (for example, prostatitis), intestinal, and ondotological infections. Not recommended for use in case of renal failure. It is quite expensive - from 800 rubles. for 10 pieces.

• Amoksiklav

Fourth generation antibiotic packaging.

A new generation antibiotic from the list of pharmacological group of aminopenicillins. It has a wide spectrum of action, resistance to the action of beta-lactamase strains. It has a mild effect, so it is used for both treatment and prevention. Unlike many fourth-generation antibiotics, it can be prescribed to pregnant and lactating women. Manufactured by Lek Pharma and Lek D.D. Available in the form of powder for intravenous administration, powder for oral administration, and tablets. The price of powders for injections is from 200 rubles, powders taken orally are from 60 rubles, tablets 375 mg are from 224 rubles.

• Lincomycin

Widely used in dentistry.

One of the most affordable broad-spectrum antibiotics. Sold in the form of ampoules for intravenous and intramuscular administration and in the form of capsules. The selective bacteriostatic effect allows its use in cases where other drugs are ineffective due to developed resistance. True, this same quality does not allow Lincomycin to be prescribed as a first-line drug. It is quite toxic and has a list of a large number of side effects and contraindications that you should familiarize yourself with before taking the medicine. The cost of ampoules with solution is from 68 rubles. for 10 pieces; cost of capsules - from 73 rubles.

• Cefoperazone

Prices for antibiotics in pharmacies for different forms and dosages range from 110 to 370 rubles. It has a wide range of uses: respiratory and urinary tract infections, skin and intestinal infections, pelvic inflammation, prostatitis, prevention after abdominal, gynecological and orthopedic surgeries. Belongs to the group of cephalosporins. Twice daily administration is sufficient. As a rule, it is well tolerated, side effects are rare. Unfortunately, it is available only in the form of an injection solution. Price - from 115 rub.

• Cefotaxime

Antibiotic of the new generation cephalosporin group. It is considered one of the most frequently prescribed drugs for most infectious and inflammatory diseases (colds, intestinal, urological, gynecological, prostatitis, etc.). This prevalence is due to the broad spectrum of action of the antibiotic, affordable price, low toxicity, and minimal effect on beneficial bacteria. Can be used for treatment and prevention (for example, in the postoperative period). Available only in the form of a solution for injection.

• Cefixime

Another name for the antibiotic is Pancef. Available only in the form of capsules and tablets taken orally. Acts bactericidal (prevents the synthesis of cell walls of pathogens). It has a wide spectrum of action (kills intestinal infections, treats colds, prostatitis, and is used after operations). Unfortunately, this new generation antibiotic has a fairly strong toxic effect on the kidneys and liver, so it is not recommended for use in diseases of these organs. Price - from 397 rub.

• Avelox

A very strong antibiotic of the latest generation from the group of fluoroquinolones. It is a modern analogue of Moxifloxcin. Effective against many known bacterial and atypical pathogens. It has virtually no negative effect on the kidneys and stomach. Such antibiotics can be used as children's medicines, so they are not prescribed in pediatrics. They are quite expensive - from 750 rubles. for 5 pcs.

Naturally, it is not enough to familiarize yourself with the list of new generation antibiotics. I would like to say which broad-spectrum antibiotics are the safest and most effective. Unfortunately, it is impossible to single out a specific drug, since each antibiotic has its own characteristics and in each specific case different drugs will be more effective. This is why you should not prescribe drugs for treatment and prevention on your own if you do not have a medical education. For intestinal infections, prostatitis, sore throat or otitis, various antibiotics will be prescribed. It is better to trust a specialist who prescribes medicine based on the diagnosis, stage of the disease, concomitant diseases, as well as the individual characteristics of the patient.

Numerous diseases of the human body can be eliminated after using different groups of drugs, but antibiotics are considered the most effective and fastest-acting. But only the attending physician can prescribe such medications, since they involve a list of contraindications and risks of side effects. In addition, irrational use can lead to a number of other disorders in the body.

The most popular today are broad-spectrum antibiotics of the new generation, since these drugs have been improved and are less toxic due to their modifications. But their most important advantage is that a large number of pathogens show resistance to them. You need to take antibiotics strictly as prescribed by your doctor and as prescribed by him.

New antibiotics have an improved formula and principle of action, due to which their active components affect the pathogenic agent exclusively at the cellular level, without disturbing the beneficial microflora of the human body. And if previously such agents were used in the fight against a limited number of pathogenic agents, today they will be effective against a whole group of pathogens at once.

For reference! The latest broad-spectrum antibiotics (ABSA) have one advantageous difference from previous antibiotics - minimal risks of causing damage to the patient's body.

Some of these drugs have a depressing effect on the synthesis of the outer cell membrane, but no negative effect on it is expected (penicillins or cephalosporins). Others disrupt protein synthesis at the cellular level in bacteria, such as tetracyclines or macrolides.

Modern broad-spectrum antibiotics can be prescribed in several cases:

• the pathogen is not susceptible to the active substance of the narrow-profile antibiotic;
• in case of superinfection provoked by several infectious or bacterial agents;
• if you need to prevent infection after surgery;
• in the presence of certain clinical symptoms, but without the ability to determine the type of pathogen.

Antibiotics of this type are strong drugs, so they can be used by doctors in the complex treatment of otitis, lymphadenitis, colds and other ailments caused by pathogenic microbes and microorganisms.

Before choosing the right ABSS in a particular case, you need to know the classification of such drugs according to groups according to the active substance. All of them can be produced in different forms - tablets or capsules, injection solutions or topical agents.

So, there are several groups of ABHS:

• tetracycline group - Tetracycline;
• group of aminoglycosides - Streptomycin;
• amphenicol antibiotics - Chloramphenicol;
• penicillin series of drugs - Amoxicillin, Ampicillin, Bilmicin or Ticarcycline;
• antibiotics of the carbapenem group - Imipenem, Meropenem or Ertapenem.

Each of these drugs can be used only after determining the type of pathogenic agent that caused the disease in humans. Therefore, the patient undergoes a comprehensive diagnosis, after which the attending physician chooses a new generation antibiotic based on the data obtained. ABSS are less toxic; they act deeply and only on opportunistic flora, without suppressing the immune system and beneficial microflora of the human body.

The names of bactericidal agents for the disease bronchitis are varied, but most often experts give preference to the new generation ABSS, but always after examining the patient’s sputum in the laboratory. If there is not enough time to study the bronchitis bacteria, doctors may prescribe the following ABSS:

• in case of intolerance to penicillins, macrolides are prescribed - Erythromycin or Clarithromycin;
• penicillin drugs - Amoxiclav, Augmentin, and Panclave;
• chronic bronchitis at the acute stage is treated with fluoroquinolone drugs - Levofloxacin, Ciprofloxacin or Moxifloxacin;
• Cephalosporins are also effective (if bronchitis is obstructive) - Ceftriaxone and Cefuroxime.

The above drugs penetrate deep into the human body, identifying the pathogenic agent. As practice has shown, most of them do not cause side effects if used strictly according to the doctor’s instructions.

In medical practice, the most effective antibiotics for this type of infection are two groups of antibiotics - macrolides or cephalosporins. And if penicillin drugs were used in the past, today numerous pathogenic microorganisms have developed immunity to them.

It's just elementary! To restore and enhance potency, you need every evening...

Treatment of sinusitis is appropriate when using the following ABSS:

• Cefuroxine;
• Cefexime;
• Cecefoxitin;
• Cefotaxime;
• Cefachlor;
• Azithromycin;
• Macropen.

Moreover, macrolides are prescribed even in the most advanced cases, since they demonstrate the highest percentage of effectiveness against such a disease. It is only important to follow the treatment regimen prescribed by the doctor.

If earlier in medical practice a sore throat was treated with penicillins, over the years the causative agent of the disease has developed immunity to them. In addition, recent studies have confirmed that cephalosporins and macrolides are most effective against such a pathogen. Today they are most often used in the treatment of bacterial infections of the nasopharynx.

The most popular drugs for angina are as follows:

• Cephalexin;
• Spiramycin;
• Erythromycin;
• Leucomycin;
• Aziromycin;
• Azitral;
• Clarithromycin;
• Dirithromycin.

Macrolides are often prescribed to patients for the treatment of tonsillar pathologies; moreover, they do not affect the digestive organs and do not cause reactions from the nervous system due to minimal toxicity.

Such common diseases as colds and flu occupy a leading position in their prevalence and frequency of cases. The following new generation ABSS are used in treatment:

• Sumamed- a drug from the macrolide group, despite its broad antibacterial effect, it does not affect the gastrointestinal tract, and after the end of treatment it lasts for another week. It is not allowed in the treatment of children.
• Cefaclor– a second-generation drug that demonstrates high effectiveness against numerous human respiratory diseases.
• Cefamandole- a group of second generation cephalosporins, the release form is presented in the form of solutions for injection. The best antibiotic with a bactericidal effect for intramuscular administration.
• Rulid- a medicine from the group of macrolides with a narrow focus only against agents of respiratory diseases or inflammation of the ENT organs.
• Avelox- a strong drug in tablet form, belonging to the latest generation of fluoroquinolone antibiotics, which exhibits a pronounced bactericidal effect.
• Clarithromycin- macrolide of semi-synthetic composition, which is produced in the form of capsules. Its antibacterial effect affects numerous pathogenic microorganisms.

For reference! All of these drugs have been tested by time, research by pharmacologists and scientific experts. Under no circumstances should you prescribe such drugs on your own without consulting a doctor. Despite the wide range of influences, only a medical specialist can select the right group of drugs for a specific pathogen.

Selecting a new generation of ABSS is more difficult, since there are many more varieties of such diseases, many of them involve different pathogens and etiologies.

1. For cystitis- Monural, Palin, Nocilin or Levomecitin, Ecomural.
2. For urethritis- cephalosporins Suprax or Ceftriaxone in case of gonococcal origin, but if the disease is provoked by trichomoniasis, Metronidazole is used together with Azithromycin.
3. For pyelonephritis- combined antibiotics Amoxicillin or Amoxil, if acute kidney infiltration is observed - Cefaclor, Cephalexin or Ofloxacin.
4. For prostatitis- Amoxiclav, Ofloxacin, Ciprofloxacin, Ceftriaxone, Amoxicillin.

Most of the listed remedies help cope with the unpleasant symptoms of inflammation of the genitourinary system already on the first day of use.

These diseases require careful comprehensive diagnosis; only after accurately identifying the pathogenic microorganism can the right drug be selected. Doctors identify the following latest generation ABSS against fungi:

• AB polyene first generation for candidiasis or dermatomycosis - Amphotericin B, Levorin, Nystatin;
• second generation from fungi of the genitourinary system - Clotrimazole, Ketoconazole, Miconazole;
• Third generation AB - Fluconazole, Terbinafine, Naftifine or Anthraconazole for fungi;
• fourth generation drugs for different strains of fungi - Caspofungin, Posaconazole, Voriconazole or Ravuconazole.

Self-medication with such medications is unacceptable, since fungal infections tend to quickly spread throughout the body, multiplying en masse.

In recent years, ophthalmology has introduced into practice the use of numerous latest-generation ABSSs for local therapy of a wide variety of diseases. The latest medication and the most effective is Maxaquin, effective in the fight against bacterial keratitis or conjunctivitis of chlamydial etiology. Also no less popular are such products as Okacin, Torbex, Eubetal, Vitabact or Colbiocin.

Antibiotics are a huge group of bactericidal drugs, each of which is characterized by its own spectrum of action, indications for use and the presence of certain consequences

Antibiotics are substances that can inhibit the growth of microorganisms or destroy them. According to the GOST definition, antibiotics include substances of plant, animal or microbial origin. Currently, this definition is somewhat outdated, since a huge number of synthetic drugs have been created, but natural antibiotics served as the prototype for their creation.

The history of antimicrobial drugs begins in 1928, when A. Fleming first discovered penicillin. This substance was discovered, and not created, since it has always existed in nature. In living nature, it is produced by microscopic fungi of the genus Penicillium, protecting themselves from other microorganisms.

In less than 100 years, more than a hundred different antibacterial drugs have been created. Some of them are already outdated and are not used in treatment, and some are just being introduced into clinical practice.

How do antibiotics work?

All antibacterial drugs can be divided into two large groups according to their effect on microorganisms:

• bactericidal– directly cause the death of microbes;
• bacteriostatic– prevent the proliferation of microorganisms. Unable to grow and reproduce, bacteria are destroyed by the immune system of a sick person.

Antibiotics exert their effects in many ways: some of them interfere with the synthesis of microbial nucleic acids; others interfere with the synthesis of bacterial cell walls, others disrupt protein synthesis, and others block the functions of respiratory enzymes.

Antibiotic groups

Despite the diversity of this group of drugs, all of them can be classified into several main types. This classification is based on chemical structure - drugs from the same group have a similar chemical formula, differing from each other in the presence or absence of certain molecular fragments.

The classification of antibiotics implies the presence of groups:

1. Penicillin derivatives. This includes all drugs created on the basis of the very first antibiotic. In this group, the following subgroups or generations of penicillin drugs are distinguished:

• Natural benzylpenicillin, which is synthesized by fungi, and semi-synthetic drugs: methicillin, nafcillin.
• Synthetic drugs: carbpenicillin and ticarcillin, which have a wider spectrum of action.
• Mecillam and azlocillin, which have an even wider spectrum of action.

1. Cephalosporins- Closest relatives of penicillins. The very first antibiotic of this group, cefazolin C, is produced by fungi of the genus Cephalosporium. Most drugs in this group have a bactericidal effect, that is, they kill microorganisms. There are several generations of cephalosporins:

• I generation: cefazolin, cephalexin, cefradine, etc.
• II generation: cefsulodin, cefamandole, cefuroxime.
• III generation: cefotaxime, ceftazidime, cefodizime.
• IV generation: cefpirom.
• V generation: ceftolozane, ceftopibrol.

The differences between the different groups are mainly in their effectiveness - later generations have a greater spectrum of action and are more effective. 1st and 2nd generation cephalosporins are now used extremely rarely in clinical practice, most of them are not even produced.

1. – drugs with a complex chemical structure that have a bacteriostatic effect on a wide range of microbes. Representatives: azithromycin, rovamycin, josamycin, leucomycin and a number of others. Macrolides are considered one of the safest antibacterial drugs - they can even be used by pregnant women. Azalides and ketolides are varieties of macorlides that have differences in the structure of the active molecules.

Another advantage of this group of drugs is that they are able to penetrate the cells of the human body, which makes them effective in the treatment of intracellular infections:,.

1. Aminoglycosides. Representatives: gentamicin, amikacin, kanamycin. Effective against a large number of aerobic gram-negative microorganisms. These drugs are considered the most toxic and can lead to quite serious complications. Used to treat genitourinary tract infections.
2. Tetracyclines. These are mainly semi-synthetic and synthetic drugs, which include: tetracycline, doxycycline, minocycline. Effective against many bacteria. The disadvantage of these drugs is cross-resistance, that is, microorganisms that have developed resistance to one drug will be insensitive to others from this group.
3. Fluoroquinolones. These are completely synthetic drugs that do not have their natural counterpart. All drugs in this group are divided into first generation (pefloxacin, ciprofloxacin, norfloxacin) and second generation (levofloxacin, moxifloxacin). They are most often used to treat infections of the ENT organs (,) and respiratory tract (,).
4. Lincosamides. This group includes the natural antibiotic lincomycin and its derivative clindamycin. They have both bacteriostatic and bactericidal effects, the effect depends on the concentration.
5. Carbapenems. These are one of the most modern antibiotics that act on a large number of microorganisms. Drugs in this group belong to reserve antibiotics, that is, they are used in the most difficult cases when other drugs are ineffective. Representatives: imipenem, meropenem, ertapenem.
6. Polymyxins. These are highly specialized drugs used to treat infections caused by. Polymyxins include polymyxin M and B. The disadvantage of these drugs is their toxic effect on the nervous system and kidneys.
7. Antituberculosis drugs. This is a separate group of drugs that have a pronounced effect on. These include rifampicin, isoniazid and PAS. Other antibiotics are also used to treat tuberculosis, but only if resistance to the drugs mentioned has developed.
8. Antifungal agents. This group includes drugs used to treat mycoses - fungal infections: amphothirecin B, nystatin, fluconazole.

Methods of using antibiotics

Antibacterial drugs are available in different forms: tablets, powder from which an injection solution is prepared, ointments, drops, spray, syrup, suppositories. The main uses of antibiotics:

1. Oral- oral administration. You can take the medicine in the form of a tablet, capsule, syrup or powder. The frequency of administration depends on the type of antibiotic, for example, azithromycin is taken once a day, and tetracycline is taken 4 times a day. For each type of antibiotic there are recommendations that indicate when it should be taken - before, during or after meals. The effectiveness of treatment and the severity of side effects depend on this. Antibiotics are sometimes prescribed to young children in syrup form - it is easier for children to drink the liquid than to swallow a tablet or capsule. In addition, the syrup can be sweetened to get rid of the unpleasant or bitter taste of the medicine itself.
2. Injectable– in the form of intramuscular or intravenous injections. With this method, the drug reaches the site of infection faster and is more active. The disadvantage of this method of administration is that the injection is painful. Injections are used for moderate and severe diseases.

Important:Only a nurse should give injections in a clinic or hospital setting! It is strictly not recommended to inject antibiotics at home.

1. Local– applying ointments or creams directly to the site of infection. This method of drug delivery is mainly used for skin infections - erysipelas, as well as in ophthalmology - for infections of the eye, for example, tetracycline ointment for conjunctivitis.

The route of administration is determined only by the doctor. In this case, many factors are taken into account: the absorption of the drug in the gastrointestinal tract, the state of the digestive system as a whole (in some diseases, the absorption rate decreases and the effectiveness of treatment decreases). Some drugs can only be administered one way.

When injecting, you need to know how to dissolve the powder. For example, Abactal can only be diluted with glucose, since when sodium chloride is used it is destroyed, which means the treatment will be ineffective.

Antibiotic sensitivity

Any organism sooner or later gets used to the harshest conditions. This statement is also true in relation to microorganisms - in response to prolonged exposure to antibiotics, microbes develop resistance to them. The concept of sensitivity to antibiotics was introduced into medical practice - the effectiveness with which a particular drug affects the pathogen.

Any prescription of antibiotics should be based on knowledge of the sensitivity of the pathogen. Ideally, before prescribing a drug, the doctor should conduct a sensitivity test and prescribe the most effective drug. But the time required to carry out such an analysis is, in the best case, several days, and during this time the infection can lead to the most disastrous result.

Therefore, in case of infection with an unknown pathogen, doctors prescribe drugs empirically - taking into account the most likely pathogen, with knowledge of the epidemiological situation in a particular region and medical institution. For this purpose, broad-spectrum antibiotics are used.

After performing a sensitivity test, the doctor has the opportunity to change the drug to a more effective one. The drug can be replaced if there is no effect from treatment for 3-5 days.

Etiotropic (targeted) prescription of antibiotics is more effective. At the same time, it becomes clear what caused the disease - using bacteriological research, the type of pathogen is established. Then the doctor selects a specific drug to which the microbe does not have resistance (resistance).

Are antibiotics always effective?

Antibiotics only act on bacteria and fungi! Bacteria are considered single-celled microorganisms. There are several thousand species of bacteria, some of which coexist quite normally with humans—more than 20 species of bacteria live in the large intestine. Some bacteria are opportunistic - they cause disease only under certain conditions, for example, when they enter an atypical habitat. For example, very often prostatitis is caused by E. coli, which enters through the ascending route from the rectum.

Note: Antibiotics are absolutely ineffective for viral diseases. Viruses are many times smaller than bacteria, and antibiotics simply do not have a point of application for their ability. That's why antibiotics have no effect on colds, since colds in 99% of cases are caused by viruses.

Antibiotics for coughs and bronchitis may be effective if they are caused by bacteria. Only a doctor can figure out what causes the disease - for this he prescribes blood tests, and, if necessary, an examination of sputum if it comes out.

Important:Prescribing antibiotics to yourself is unacceptable! This will only lead to the fact that some of the pathogens will develop resistance, and next time the disease will be much more difficult to cure.

Of course, antibiotics are effective for - this disease is exclusively bacterial in nature, caused by streptococci or staphylococci. To treat sore throat, the simplest antibiotics are used - penicillin, erythromycin. The most important thing in the treatment of angina is compliance with the frequency of dosing and the duration of treatment - at least 7 days. You should not stop taking the medicine immediately after the onset of the condition, which is usually noted on the 3-4th day. True tonsillitis should not be confused with tonsillitis, which can be of viral origin.

Note: untreated sore throat can cause acute rheumatic fever or!

Pneumonia (pneumonia) can be of both bacterial and viral origin. Bacteria cause pneumonia in 80% of cases, so even when prescribed empirically, antibiotics for pneumonia have a good effect. For viral pneumonia, antibiotics do not have a therapeutic effect, although they prevent the bacterial flora from joining the inflammatory process.

Antibiotics and alcohol

Taking alcohol and antibiotics at the same time in a short period of time does not lead to anything good. Some drugs are broken down in the liver, just like alcohol. The presence of antibiotics and alcohol in the blood puts a strong strain on the liver - it simply does not have time to neutralize ethyl alcohol. As a result, the likelihood of developing unpleasant symptoms increases: nausea, vomiting, and intestinal disorders.

Important: a number of drugs interact with alcohol at the chemical level, as a result of which the therapeutic effect is directly reduced. These drugs include metronidazole, chloramphenicol, cefoperazone and a number of others. Concomitant use of alcohol and these drugs can not only reduce the therapeutic effect, but also lead to shortness of breath, seizures and death.

Of course, some antibiotics can be taken while drinking alcohol, but why risk your health? It is better to abstain from alcoholic beverages for a short time - the course of antibacterial therapy rarely exceeds 1.5-2 weeks.

Antibiotics during pregnancy

Pregnant women suffer from infectious diseases no less often than everyone else. But treating pregnant women with antibiotics is very difficult. In the body of a pregnant woman, the fetus grows and develops - the unborn child, which is very sensitive to many chemicals. The entry of antibiotics into the developing body can provoke the development of fetal malformations and toxic damage to the central nervous system of the fetus.

During the first trimester, it is advisable to avoid the use of antibiotics altogether. In the second and third trimesters, their use is safer, but should also be limited, if possible.

A pregnant woman cannot refuse to prescribe antibiotics for the following diseases:

• Pneumonia;
• angina;
• infected wounds;
• specific infections: brucellosis, borelliosis;
• sexually transmitted infections: , .

What antibiotics can be prescribed to a pregnant woman?

Penicillin, cephalosporin drugs, erythromycin, and josamycin have almost no effect on the fetus. Penicillin, although it passes through the placenta, does not have a negative effect on the fetus. Cephalosporin and other named drugs penetrate the placenta in extremely low concentrations and are not capable of harming the unborn child.

Conditionally safe drugs include metronidazole, gentamicin and azithromycin. They are prescribed only for health reasons, when the benefit to the woman outweighs the risk to the child. Such situations include severe pneumonia, sepsis, and other severe infections, in which, without antibiotics, a woman can simply die.

Which drugs should not be prescribed during pregnancy?

The following drugs should not be used in pregnant women:

• aminoglycosides– can lead to congenital deafness (with the exception of gentamicin);
• clarithromycin, roxithromycin– in experiments they had a toxic effect on animal embryos;
• fluoroquinolones;
• tetracycline– disrupts the formation of the skeletal system and teeth;
• chloramphenicol– dangerous in late pregnancy due to inhibition of bone marrow functions in the child.

For some antibacterial drugs there is no data on negative effects on the fetus. This is explained simply - experiments are not carried out on pregnant women to determine the toxicity of drugs. Experiments on animals do not allow us to exclude all negative effects with 100% certainty, since the metabolism of drugs in humans and animals can differ significantly.

Please note that you should also stop taking antibiotics or change your plans for conception. Some drugs have a cumulative effect - they can accumulate in a woman’s body, and for some time after the end of the course of treatment they are gradually metabolized and eliminated. It is recommended to become pregnant no earlier than 2-3 weeks after finishing taking antibiotics.

Consequences of taking antibiotics

The entry of antibiotics into the human body leads not only to the destruction of pathogenic bacteria. Like all foreign chemicals, antibiotics have a systemic effect - to one degree or another they affect all systems of the body.

There are several groups of side effects of antibiotics:

Allergic reactions

Almost any antibiotic can cause allergies. The severity of the reaction varies: rash on the body, Quincke's edema (angioedema), anaphylactic shock. While an allergic rash is practically harmless, anaphylactic shock can be fatal. The risk of shock is much higher with antibiotic injections, which is why injections should only be done in medical institutions - emergency care can be provided there.

Antibiotics and other antimicrobial drugs that cause cross-allergic reactions:

Toxic reactions

Antibiotics can damage many organs, but the liver is most susceptible to their effects - toxic hepatitis can occur during antibiotic therapy. Certain drugs have a selective toxic effect on other organs: aminoglycosides - on the hearing aid (cause deafness); tetracyclines inhibit bone growth in children.

note: The toxicity of a drug usually depends on its dose, but in case of individual intolerance, sometimes smaller doses are sufficient to produce an effect.

Effects on the gastrointestinal tract

When taking certain antibiotics, patients often complain of stomach pain, nausea, vomiting, and stool disorders (diarrhea). These reactions are most often caused by the locally irritating effect of the drugs. The specific effect of antibiotics on the intestinal flora leads to functional disorders of its activity, which is most often accompanied by diarrhea. This condition is called antibiotic-associated diarrhea, which is popularly known as dysbiosis after antibiotics.

Other side effects

Other side effects include:

• immunosuppression;
• emergence of antibiotic-resistant strains of microorganisms;
• superinfection – a condition in which microbes resistant to a given antibiotic are activated, leading to the emergence of a new disease;
• violation of vitamin metabolism - caused by inhibition of the natural flora of the colon, which synthesizes some B vitamins;
• Jarisch-Herxheimer bacteriolysis is a reaction that occurs when using bactericidal drugs, when, as a result of the simultaneous death of a large number of bacteria, a large number of toxins are released into the blood. The reaction is clinically similar to shock.

Can antibiotics be used prophylactically?

Self-education in the field of treatment has led to the fact that many patients, especially young mothers, try to prescribe themselves (or their child) an antibiotic at the slightest sign of a cold. Antibiotics do not have a prophylactic effect - they treat the cause of the disease, that is, they eliminate microorganisms, and in their absence, only side effects of the drugs appear.

There are a limited number of situations when antibiotics are administered before clinical manifestations of infection, in order to prevent it:

• surgery– in this case, the antibiotic present in the blood and tissues prevents the development of infection. As a rule, a single dose of the drug administered 30-40 minutes before the intervention is sufficient. Sometimes even after an appendectomy, antibiotics are not injected in the postoperative period. After “clean” surgical operations, antibiotics are not prescribed at all.
• major injuries or wounds(open fractures, soil contamination of the wound). In this case, it is absolutely obvious that an infection has entered the wound and it should be “crushed” before it manifests itself;
• emergency prevention of syphilis carried out during unprotected sexual contact with a potentially sick person, as well as among health workers who have had the blood of an infected person or other biological fluid come into contact with the mucous membrane;
• penicillin can be prescribed to children for the prevention of rheumatic fever, which is a complication of tonsillitis.

Antibiotics for children

The use of antibiotics in children is generally no different from their use in other groups of people. For young children, pediatricians most often prescribe antibiotics in syrup. This dosage form is more convenient to take and, unlike injections, is completely painless. Older children may be prescribed antibiotics in tablets and capsules. In severe cases of infection, they switch to the parenteral route of administration - injections.

Important: The main feature in the use of antibiotics in pediatrics is the dosage - children are prescribed smaller doses, since the drug is calculated in terms of per kilogram of body weight.

Antibiotics are very effective drugs, but at the same time they have a large number of side effects. In order to be cured with their help and not harm your body, they should be taken only as prescribed by a doctor.

What types of antibiotics are there? In what cases is taking antibiotics necessary and in what cases is it dangerous? The main rules of antibiotic treatment are explained by pediatrician Dr. Komarovsky:

Gudkov Roman, resuscitator

Antibiotics are a large group of drugs whose action is aimed at eliminating infectious diseases. Recently, new drugs with a wide spectrum of action can be seen. Which drug is the most effective, what is best to take for bronchitis, fever and colds? More about this in more detail.

How antibiotics work

The popularity of antibiotic tablets has increased sharply due to the fact that the vital processes occurring in the cells of the human body differ from similar processes in a bacterial cell. Such strong antibiotics are able to have selective effects, affecting only the cells of the pathogenic microorganism, without affecting healthy ones. The classification is carried out based on the way in which the influence on the vital activity of such microorganisms occurs.

When choosing which antibiotic to take, you need to know that some of them suppress the synthesis of bacterial cell membranes, which are absent in the human body. These are broad-spectrum drugs such as penicillins and cephalosporins. Other broad-spectrum drugs can almost completely suppress protein synthesis in bacterial cells. These include tetracycline antibiotics and macrolides. The list of broad-spectrum agents can be divided according to the principle of antifungal activity. It is very important to read the instructions for use of the drugs.

Broad-spectrum drugs are very effective against a number of bacteria, while others may have a narrow focus and are intended for a specific group of bacteria. Why does this happen? The reason is that bacteria and viruses have different functioning and structure, so what can kill bacteria is not effective against viruses. Broad-spectrum agents are used when:

• The causative agents of the disease are resistant to the effects of drugs of a certain group.
• It was possible to detect a superinfection, the cause of which was several types of bacteria.
• The formation of infections after surgery is prevented.
• Treatment is prescribed based on clinical symptoms, in other words, empirically. In this case, the specific pathogen is not identified. This is appropriate for fast-acting dangerous diseases and common infections.

Features of the drugs

Broad-spectrum medicines belonging to the new generation are very effective for bronchitis, fever, and colds. They cope very well with otitis media, inflammation of the lymph nodes and other diseases.

Whatever pathogen causes the cold, a broad-spectrum remedy will cope with it. Each drug invented later has an improved, more perfect effect on various pathogenic microorganisms. It is generally accepted that new broad-spectrum drugs for bronchitis and fever cause minimal harm to the body.

New generation of antibiotics

The list of drugs available today with a broad effect of the new generation includes a lot of medications, both cheap and with a higher price. The most popular of them in terms of use are: cephalosporins, fluoroquinolones, macrolides, penicillins. They are available in the form of tablets and injections. Drugs belonging to the new generation can be characterized by better pharmacological action in comparison with drugs of the older generation. Their list is as follows:

• Fluoroquinolones: Ciprofloxacin, Levofloxacin, Gatifloxacin, Moxifloxacin.
• Tetracycline category: "Tetracycline".
• Penicillins: Tetracycline, Amoxicillin, Ampicillin, Biomycin.
• Amphenicols: "Chloramphenicol".
• Carbapenems: Ertapenem, Imipenem, Meropenem.
• Aminoglycosides: "Streptomycin".

Strong, highly targeted products

Narrowly targeted drugs of a newer generation can be used in situations where it was possible to accurately determine the causative agent of the infection, for example, during colds and fever. Each of the available drugs can have a direct effect on a specific category of pathogenic microorganisms.

Unlike broad-spectrum medications, which can also be used during colds, they do not suppress the immune system or disrupt the normal intestinal microflora. Due to the presence of a deeper degree of purification of the active components of the drug, they have less toxicity.

Bronchitis and colds

In most cases, for bronchitis and the presence of a cold, drugs with a wide spectrum of action of the new generation are prescribed, but you need to know that the choice of drug should be based on the results of a sputum test in the laboratory.

During colds and bronchitis, the best medicines are those that can have a detrimental effect on the bacteria that can cause the disease. This approach is explained by the fact that the study can take from 3 to 5 days, and treatment for bronchitis must be immediate so that there are no complications. For bronchitis and colds, the following medications are often prescribed:

• Macrolides - used in the presence of individual intolerance to penicillin. Erythromycin and Clarithromycin are very effective.
• Penicillin has long been used for bronchitis and other diseases, as a result of which some microorganisms have been able to develop high resistance to the active substance. The medicine was strengthened with a number of additives that could block the action of enzymes produced by microorganisms in order to reduce the activity of penicillin. The most effective for treating colds are Augmentin, Panklav, and Amoxiclav.
• Fluoroquinolones - used for chronic bronchitis during exacerbation. Ciprofloxacin, Moxifloxacin, and Levofloxacin are highly effective.
• Cephalosporins are prescribed for the obstructive form of the disease. Ceftriaxone and Cefuroxime are considered effective drugs.

Sinusitis

In the presence of sinusitis, it is recommended to use new generation drugs such as macrolides and cephalosporins. They are considered the most effective means in the treatment of sinusitis, which can be used when, after taking penicillin, no positive dynamics of treatment are observed. Modern antibiotics include Cefexime, Cefuroxime, Cefaclor, Cefoxitin, Cefuroxime. They resemble penicillin drugs in their structure, but can inhibit the development and completely destroy bacteria. Macrolides such as Azithromycin and Macropen were able to show high effectiveness in serious stages of the disease.

Cystitis

Until recently, drugs such as 5-Nok, Biseptol and Furadonin were traditionally used to treat cystitis. But today they have been replaced by antibiotics belonging to a new generation, more effective and stronger. Modern medications make it possible to get relief from the condition already on the first day of treatment and quickly get rid of the disease:

• Unidox Solutab. The remedy, which quickly copes with cystitis, has a prolonged action. Taken once a day.
• "Monural". A long-term drug that accumulates in the urine and can quickly kill bacteria. Due to the ability to maintain therapeutic concentration for a long time, it allows for a short course of treatment.
• "Norbaktin". It is prescribed less frequently than the previous two drugs, since it is recommended to take it twice a day and drink large amounts of liquid, which is not always comfortable for patients.

If you told your doctor about your health problems and he prescribed the use of antibiotics, you need to follow a number of rules. First of all, it is forbidden to independently change the dosage and timing of taking the drug. You should definitely visit a doctor if there are changes in your health or if you experience discomfort, as this can be fraught with serious health problems.