New generation antibiotics: pros and cons

Antibiotics are substances of biological or semi-synthetic origin. They are used in medical practice to combat pathogenic microbes and viruses. Before the advent of these medications, typhoid fever, dysentery, pneumonia, and tuberculosis had the status of incurable diseases. Today, treatment of infectious diseases is possible with the use of 1-6 generations of antibiotics.

At this moment, the pharmacological industry produces more than 2000 varieties of drugs of this type. Doctors have described the effects of about 600 positions, and about 120-160 drugs are used in medical practice.

Important! For any disease, it is recommended to take antibiotics after consulting a doctor. Otherwise, antibiotic resistance may develop (decreased sensitivity of pathogenic microorganisms to antibacterial agents).

How to choose an antibiotic

To choose the right antibiotic, you need to consider many factors. Only then will the treatment be effective and safe. So, what should you pay attention to?

• it is necessary to determine which bacteria caused the inflammation;
• choose the most suitable form of antibiotic so that it quickly reaches the site of inflammation;
• take into account the condition of the liver and kidneys;
• remember possible chronic diseases and age to avoid side effects;
• An important factor is the presence of pregnancy or breastfeeding.

If you start taking an antibiotic, also consider the following points:

• look at the dynamics of treatment after 48 hours (is the treatment effective);
• control antibiotic resistance;
• pay attention to side effects (both clinical manifestations and laboratory tests);
• Be sure to follow the course of treatment prescribed by the doctor.

List of the most effective antibiotics

Our rating includes the best antibiotics, since we took into account the recommendations of doctors and reviews of those who took these drugs. We divided antibiotics into groups: broad-spectrum, antibiotics for sore throat, cough and bronchitis, antibiotics for sinusitis and drugs used in gynecology.

The best antibiotics for coughs, bronchitis and sore throats

Most antibiotics have a broad spectrum of action and affect several types of bacteria at once. But for more effective treatment of cough, bronchitis or sore throat, it is better to choose drugs intended for the upper respiratory tract.

Azithromycin

One of the most inexpensive semi-synthetic antibiotics, which is often prescribed for bacterial infections against the background of colds. The active ingredient of the drug is azithromycin dihydrate. Azithromycin is usually taken for laryngitis, bronchitis and pneumonia. This antibiotic has a whole list of side effects and contraindications (like most antibiotics). Azithromycin is contraindicated in children under 16 years of age, as well as adults with liver or kidney failure, or arrhythmia.

Azithromycin

CJSC VERTEX, Russia; Obolenskoye (OBL Pharm), Russia; OZON, Russia; OJSC Pharmstandard-Leksredstva, Russia; Zentiva, Czech Republic; AKRIKHIN, Russia; ProMed, Russia; JSC Dalkhimfarm, Russia

Azithromycin is a broad-spectrum antibiotic.
Azalide antibiotic, a representative of a new subgroup of macrolide antibiotics. When high concentrations are created at the site of inflammation, it has a bactericidal effect. from 38

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Summary

We reviewed Russian and imported broad-spectrum antibiotics and briefly described the classification of drugs. Let's answer the question: which antibacterial agents to choose?

It is important to understand that antimicrobial drugs for extensive use are toxic and therefore negatively affect the microflora. In addition, bacteria mutate, which means the drugs lose their effectiveness. Therefore, antibacterial agents with the latest structure will be a priority over their earlier counterparts.

Self-medication with antibiotics is dangerous to health. In case of an infectious disease, the first step is to consult a doctor. The specialist will determine the cause of the disease and prescribe effective antibacterial agents. Self-medication “at random” leads to the development of antibiotic resistance.

Macropen

Most often, Macropen is prescribed for stomatitis, bronchitis, pneumonia and other infections. In addition, your doctor may recommend this antibiotic to treat diphtheria and whooping cough. The active ingredient of the product is midecamycin. Macropen has a small list of contraindications, it is very effective, and has virtually no side effects. In addition to tablets, you can also buy Macropen in the form of a suspension (for small children). You need to take this antibiotic three times a day, one tablet; there are 16 tablets in a package.

Macropen

KRKA (KRKA), Slovenia

Infectious and inflammatory diseases caused by microorganisms sensitive to the drug: - respiratory tract infections: tonsillopharyngitis, acute otitis media, sinusitis, exacerbation of chronic bronchitis, community-acquired pneumonia (including those caused by atypical pathogens Mycoplasma spp., Chlamydia spp., Legionella spp. and Ureaplasma urealyticum);
— infections of the genitourinary system caused by Mycoplasma spp., Chlamydia spp., Legionella spp. and Ureaplasma urealyticum; - infections of the skin and subcutaneous tissue; — treatment of enteritis caused by Campylobacter spp.; - treatment and prevention of diphtheria and whooping cough. from 213

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Rules for taking antibiotics

New generation antibacterial agents

The difference between the latest generations of antibiotics and their earlier versions is a more advanced formula of the active substance. Active components specifically eliminate only pathological reactions in the cell. For example, new generation intestinal antibiotics do not disrupt the microflora of the gastrointestinal tract. At the same time, they fight an entire “army” of infectious agents.

The newest antibacterial drugs are divided into five groups:

• Tetracycline – tetracycline.
• Aminoglycosides – streptomycin.
• Penicillin series - amoxicillin and others.
• Amphenicols – chloramphenicol.
• Carbapenem group – meropenem, imipenem, invaz.

Let's consider several well-known antimicrobial agents of imported and Russian production.

Amoxicillin is an imported antimicrobial drug from the penicillin group. Used in medical practice to treat bacterial infections. Effective for intestinal infections, sinusitis, sore throat, Lyme disease, dysentery, sepsis.

Avelox is the latest generation of medications from the group of fluoroquinolones. It has a strong effect on bacterial and atypical pathogens. Does not harm the kidneys and gastrointestinal tract. Used for acute and chronic diseases.

Cephalosporins are third generation antibiotics. This group includes Ceftibuten, Ceftriaxone and others. Used to treat pyelonephritis and pneumonia. In general, these are safe products with few side effects. However, they should be taken only after consulting a doctor. There are many medications, but a specialist will recommend which one to choose.

Doriprex is an imported antimicrobial drug of synthetic origin. Showed good results in the treatment of pneumonia, advanced intra-abdominal infections, pyelonephritis.

Invaz is an antibacterial agent from the carbapenem group. Available in ampoules for parenteral administration. Shows a rapid effect in the treatment of bacterial disorders of the skin, soft tissues, urinary tract infections, pneumonia, septicemia.

Augmetin is a third generation semi-synthetic penicillin with the addition of enhancing inhibitors. Pediatricians recognize it as the best comprehensive medication for the treatment of childhood sinusitis, bronchitis, tonsillitis and other respiratory tract infections.

Cefamandole is a Russian-made antibacterial agent. Belongs to the group of third generation cephalosporins. Used to treat intestinal infections, pathogens of genital infections. As an antimicrobial agent with a wide range of effects, it is used for colds.

Sumamed

Broad-spectrum antibiotic with the active substance azithromycin. “Sumamed” is indicated for infections caused by bronchitis, purulent tonsillitis (even in the most difficult cases), and otitis media. “Sumamed” acts as quickly as possible, and the course of treatment lasts three days (one tablet per day). Improvement in the condition of ARVI occurs already on the second day of treatment with this antibiotic. Sumamed does not have such a large list of side effects and contraindications as cheaper antibiotics. Many doctors choose this particular drug for its effectiveness and safety. "Sumamed" can be taken by children from three years of age (available in the form of a suspension).

Sumamed

Pliva Hrvatska, Croatia

Infectious and inflammatory diseases caused by microorganisms sensitive to the drug: - infections of the upper respiratory tract and ENT organs (pharyngitis/tonsillitis, sinusitis, otitis media);
— lower respiratory tract infections (acute bronchitis, exacerbation of chronic bronchitis, pneumonia, including those caused by atypical pathogens); - skin and soft tissue infections (erysipelas, impetigo, secondary infected dermatoses; - initial stage of Lyme disease (borreliosis) - erythema migrans; - genitourinary tract infections (urethritis, cervicitis) caused by Chlamydia trachomatis. from 38

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Read also How to strengthen the immune system: 11 best drugs The best drugs to strengthen the immune system and prevent viral diseases.

The appearance of antibiotics - powerful new class of antibacterial drugs - in the therapeutic arsenal of doctors since the middle of the last century has revolutionized the treatment of infectious diseases, incl. and in dermatovenerological practice. Their use not only had a serious evolutionary impact on the clinical course of infections, but also dramatically transformed the epidemiological process and ecology of the microbial flora.

All antibiotics, despite differences in chemical structure and mechanism of action, share a number of unique qualities. Firstly, the uniqueness of antibiotics lies in the fact that, unlike most drugs, their target receptor is not located in human tissues, but in the cell of a microorganism. Secondly, the activity of antibiotics is not constant, but decreases over time, which is due to the formation of drug resistance (resistance). Antibiotic resistance is an inevitable biological phenomenon, and it is almost impossible to prevent it. Thirdly, antibiotic-resistant microorganisms pose a danger not only to the patient from whom they were isolated, but also to many other people separated by time and space. The widespread frequent use of the same groups of antibiotics inevitably leads to increasing resistance of microorganisms to the drugs used, which necessitates the constant search for new antimicrobial agents. Differences in antibiotic resistance in different regions are partly due to different levels and patterns of antibiotic use [1].

A recent study analyzed robust, representative, comparable data on the use of systemic antimicrobials in countries in the European Region of the World Health Organization that are not members of the European Union. Cumulative antibiotic use (in outpatient and hospital settings) ranged from 15.3 prescribed daily dose/1000 inhabitants (DID) in Armenia to 42.3 DID in Turkey. Among all groups of antibiotics used, those of the β-lactam group predominated. Of the total volume of antibiotics used, the use of amoxiclav in Georgia amounted to 42.9%, in Turkey - 30.7%, ampicillin and amoxicillin in Azerbaijan - 55.9%. Montenegro and Serbia were the largest consumers of macrolides – mainly azithromycin (15.8 and 19.5%, respectively) of the total volume of antibiotics consumed. Parenteral treatment with lactam antibiotics remains common practice: 46.4% of total antibiotic use in Azerbaijan and 31.1% of total antibiotic use in Tajikistan. The level of resistance of Staphylococcus aureus to the lactam antibiotics most commonly used in routine clinical practice can reach 90%. In addition, it has been shown that most antibiotics inhibit representatives of the normal microflora of the skin and mucous membranes and thereby contribute to the activation of pathogenic pathogens [2].

Worldwide sales data indicate a significant increase in the use of antibiotics in the first decade of the 21st century. Differences in antibiotic resistance in different countries are partly due to differences in the volume and patterns of their use. An analysis of trends in the consumption of standard units of antibiotics in 71 countries between 2000 and 2010 showed that antibiotic use in these countries increased by 36% (from 54,083,964,813 to 73,620,748,816 standard units). Brazil, Russia, India, China and South Africa accounted for 76% of this growth. The widespread use of antibiotics is a major cause of the development of antibiotic resistance. To prevent a sharp increase in such resistance, especially in low- and middle-income countries with large populations, and to maintain the effectiveness of antibiotics in the world, it is necessary to establish priority programs to ensure the rational use of antibiotics through concerted efforts of the international community [3].

A group of European scientists conducted a comparative study of the prevalence and level of resistance of Staphylococcus aureus to antibiotics in healthy patients in nine European countries: Austria, Belgium, Croatia, France, Hungary, Spain, Sweden, the Netherlands and the UK. Staphylococcus aureus was isolated from 6,956 (21.6%) of 32,206 patients from whom nasal swabs were collected. The adjusted prevalence of S. aureus among patients over 18 years of age ranged from 12.1 (Hungary) to 29.4% (Sweden). Most often (with the exception of resistance to penicillin), resistance of strains to azithromycin was observed (its level varied from 1.6% in Sweden to 16.9% in France). A total of 91 strains of methicillin-resistant Staphylococcus (MRSA) were isolated, and the highest prevalence of MRSA was recorded in Belgium (2.1%). There were differences between the nine European countries studied in the prevalence of nasal carriage of S. aureus, even after controlling for factors such as age, sex and the patient's family doctor. Overall, prevalence rates of antibiotic-resistant Staphylococcus aureus (including MRSA) were low. Genetic heterogeneity of the isolated MRSA strains was found both within each country and among all nine countries [4]. Reducing antibiotic resistance of microbial agents and increasing the effectiveness of antibacterial therapy can be achieved not only by introducing new antibiotics into medical practice, but also by adhering to the principles of rational antibiotic therapy.

The most common errors in the use of antibiotics include the following:

Prescribing a drug that does not have high activity against a microbial agent, without taking into account the sensitivity of the microorganism to it.

Treatment is carried out either in too short a course, or, conversely, too long.

The daily dose was chosen incorrectly and the frequency of administration was not observed.

The possibility of developing side effects in the presence of concomitant pathology in the patient is not taken into account.

The pharmacokinetics of the drug does not provide sufficient concentration at the site of inflammation to suppress infection [5].

The following groups of antibiotics are used in the treatment of bacterial skin infections and sexually transmitted infections (see table).

As an analysis of modern literature and our own clinical experience shows, today two groups of antibiotics are most often used in dermatovenerological practice: macrolides and fluoroquinolines, and somewhat less frequently - tetracyclines, aminoglycosides and lingosamides. This is due to the mass of strains of microorganisms resistant to these antibiotics, which implies their low therapeutic activity, as well as the presence of severe side effects. It should be remembered that tetracyclines are contraindicated in pregnant women, children and patients with liver failure. β-lactams are used much less frequently than before due to the increased resistance of pyococci to these antibiotics and the high frequency of allergic reactions. The level of resistance of Staphylococcus aureus to the lactam antibiotics most commonly used in routine clinical practice can reach 90%. In the group of patients with drug allergies, penicillin antibiotics have held leading positions in the incidence of allergic reactions over the past decades. However, β-lactam antibiotics remain the main drug for the treatment of syphilis. Fluoroquinolones are prescribed mainly for the treatment of sexually transmitted diseases, due to the high sensitivity of urogenital infections to them, and for pyoderma they are used only when other groups of antibiotics are ineffective. However, in diseases of the central nervous system, in pregnant women, as well as in pediatrics, the range of their use is limited. It is also necessary not to forget about the photosensitizing effect of fluoroquinolones and the associated precautions, especially in spring and summer [6].

Modern medical practice imposes certain requirements on the choice of antibiotic. First of all, the drug must have a wide spectrum of antimicrobial action and minimally expressed antibiotic resistance to microbial agents, have no severe side effects, be convenient to use for the patient (availability of an oral form, convenient dosage regimen) and affordable. In addition, it is very important that the antibiotic does not have clinically significant interactions with other drugs.

Currently, macrolide antibiotics most fully meet these requirements. Macrolides are one of the most well-known antibacterial agents, used in medicine for about 60 years. Due to their high efficiency, wide spectrum of antimicrobial action, exceptional systemic safety and good tolerability, they have not yet lost their practical importance in the treatment of infectious diseases of bacterial etiology of various localizations. According to recent studies, in most European countries, macrolides are the second most consumed antibiotics, second only to penicillins. The antibacterial effect of macrolides is based on disruption of the synthesis of ribosomal proteins of the antibacterial cell and thereby inhibiting the process of pathogen reproduction. They mainly have a bacteriostatic effect, which makes it advisable to prescribe them in the acute phase of the inflammatory process. The drugs belong to “tissue antibiotics”, i.e. when distributed in the body, they accumulate predominantly in those organs and tissues where there is inflammation, thereby creating high concentrations of the drug in the affected area.

In dermatovenerology, macrolides serve as basic therapy for staphylo- and streptococcal lesions of the skin and soft tissues (furuncle, impetigo, cellulitis) and urogenital infections. This is due to the fact that, along with the antimicrobial effect, these antibiotics have moderate anti-inflammatory activity. By activating macrophage cells, they are able to penetrate them and, when phagocytic cells migrate to the site of inflammation, enter there with them. The uniqueness of these drugs also lies in the fact that they have a pronounced post-antibiotic effect, i.e. maintain high concentrations at the site of inflammation for several days after discontinuation. Even with long-term use of macrolides, cases of gastrointestinal dysbiosis, hematopoietic reactions, and cardio/hepatotoxicity are rare. The low toxicity of the drugs allows them to be used by pregnant women and during lactation, and used in pediatric practice, incl. for the treatment of newborns [6–8].

One of the well-studied and highly effective against the main pathogens of bacterial infections of various localizations is the second-generation macrolide drug roxithromycin (Esparoxy; Lindopharm GmbH, Germany). The company's pharmaceutical products are manufactured in strict accordance with GMP (Good Manufacturing Practice) standards.

Roxithromycin is an acid-stable semi-synthetic 14-membered macrolide. It has a bacteriostatic effect by binding to the 50S subunit of ribosomes, suppresses translocation and transpeptidation reactions, carries out the process of formation of peptide bonds between amino acids and the peptide chain, inhibits protein synthesis by ribosomes, as a result of which it inhibits the growth and reproduction of bacteria. Roxithromycin is active against gram-positive cocci (Streptococcus pyogenes, Streptococcus pneumoniae, S. aureus), listeria, spirochetes, chlamydia (Trachomatis, Chlamydia pneumoniae), mycoplasmas, ureaplasmas, anaerobes (except Bacteroides fragilis). In addition, roxithromycin also acts on some protozoa (Toxoplasma gondii, Cryptosporidium spp.). Unlike erythromycin, the spectrum of antibacterial activity of the drug is expanded to include gram-negative flora (Haemophilus influenzae, Neisseria spp.) and some other gram-negative rods [9–10].

The drug is quickly absorbed from the gastrointestinal tract. Having significantly higher bioavailability compared to erythromycin, which is little dependent on food intake, it creates detectable concentrations in the blood within 15 minutes. This is one of the advantages of the antibiotic over other marolides, for example erythromycin, which should be taken on an empty stomach, because. food reduces the degree of its adsorption by half [10–11].

Unlike most other macrolide antibiotics, roxithromycin creates high and stable concentrations not only in tissues and body fluids, but also in blood serum. 1.5–2.0 hours after oral administration, drug concentrations in the blood reach maximum values. For example, 150 mg of roxithromycin provides 4 times higher serum concentrations than 1000 mg of josamycin. The volume of distribution of roxithromycin is 31.2 liters, it penetrates well into most tissues of the body: high concentrations of the drug are found in the secretions of the respiratory tract, lungs, tonsils, paranasal sinuses, skin, prostate tissue, myometrium, endometrium. Compared to erythromycin, the drug is able to create higher concentrations in cells and has a longer half-life (10–12 hours), which allows it to be taken 1–2 times a day [9, 12].

The drug also has a post-antibiotic effect, lasting against gram-positive microorganisms for 6–7 hours. Postantibiotic action is understood as persistent inhibition of bacterial activity after short-term contact with an antibacterial agent.

The effect is based on irreversible changes in the ribosomes of the microorganism, resulting in a persistent block of translocation. Roxithromycin has the strongest post-antibiotic effect on S. pyogenes, S. рneumoniae, H. Influenzae [13–14].

In addition to the antibacterial effect, roxithromycin has anti-inflammatory and immunotropic effects. The drug is able to change the functions of neutrophils. It has been shown to enhance phagocytosis and killing of Staphylococcus aureus and inhibit oxidative stress. The anti-inflammatory effect of roxithromycin is also associated with antioxidant properties and the ability to inhibit the production of pro-inflammatory cytokines (interleukin-3, -4, tumor necrosis factor α). In terms of the severity of the anti-inflammatory effect, roxithromycin is superior to azithromycin and clarithromycin [12, 15–18].

Roxithromycin has significantly less inhibitory effect on cytochrome 450 and is associated with a lower risk of drug interactions. In terms of tolerability, it is superior not only to erythromycin, but also to most other macrolides. The incidence of side effects of roxithromycin, according to most studies, did not exceed 4% [9, 19].

The effectiveness and safety of roxithromycin have been proven in numerous clinical studies in infectious processes of various etiologies and localizations.

There are numerous publications on the high effectiveness of roxithromycin (Esparoxy) in the treatment of bacterial infections of the ENT organs, diseases of the upper and lower respiratory tract, in dentistry, gynecology, urology and dermatology [12, 19–21].

The effectiveness and safety of the drug has also been proven in the treatment of non-gonococcal genital infections. Thus, A. Lassus et al. published the results of five clinical studies: three double-blind comparative and two open. The studies involved 924 patients, 637 of whom received roxithromycin (150 mg twice for 10 days), the remaining patients received doxycycline (200 mg once), lymecycline (300 mg twice), roxithromycin (450 mg once). The effectiveness of roxithromycin treatment in the first group was 90%. The remaining groups demonstrated similar effectiveness. Roxithromycin was most effective against Chlamydia trachomatis (97%) and Ureaplasma urealyticum (88%) [22].

According to the results of a blinded randomized study that included 211 patients (200 men and 11 women) with genital chlamydial infection or nonspecific urethritis, roxithromycin (300 mg once a day) showed equal effectiveness with doxycycline (200 mg on the first day and 100 mg on the second day). -th to 10th), significantly exceeding the latter in tolerability (19 vs. 35%; p=0.0032). Another study conducted on women with genital chlamydia showed higher efficacy of roxithromycin compared with doxycycline, and fewer side effects were also observed with the former [23, 24].

In a double-blind, randomized study of 76 patients of both sexes with skin and soft tissue infections, roxithromycin (150 mg twice) and doxycycline (200 mg once) were demonstrated to be equally effective. Similar results were obtained in a number of other clinical studies. Thus, it was found that for infections of the skin and soft tissues, roxithromycin exhibits high clinical efficacy and is well tolerated when taken either 150 mg 2 times a day or 300 mg 1 time a day. For skin infections caused by S. aureus and accompanied by the formation of a biofilm of this microorganism, roxithromycin can be combined with imipenem, because this combination induces the entry of polymorphonuclear leukocytes into the biofilm [9, 25–27].

The effectiveness and good tolerability of roxithromycin were revealed by P. Bernard, P. Plantin, H. Roger et al. with erysipelas. Clinical recovery was demonstrated by 84% of patients, while in patients taking penicillin this figure was 76%, in addition, two patients developed allergic reactions that required discontinuation of penicillin [28].

Roxithromycin has been shown to be effective in the treatment of acne in a number of studies.

A. Ferahbas et al. noted the effectiveness and safety of roxithromycin in 46 patients with papulopustular forms of acne according to a regimen of 150 mg 2 times a day for a month. Another multicenter randomized controlled trial compared 3 antibiotics: roxithromycin, minocycline, and faropenem in the treatment of inflammatory acne. All antibiotics were prescribed according to standard regimens for a period of 4 weeks followed by 4-week observation; the Skindex-16 questionnaire was used to objectify the data.

As a result of the study, no significant differences were revealed in the therapeutic effect of all three antibiotics on inflammatory acne. The drugs demonstrated equal effectiveness. However, side effects (dizziness, nausea, diarrhea) were observed with minocycline (4.1%) and faropinem (5.9%), while no side effects were observed with roxithromycin [29–30].

Thus, roxithromycin (Esparoxy) meets the criteria of effectiveness, safety, and ease of use required for antibacterial drugs, and significantly expands the possibilities in the treatment of sexually transmitted infections and bacterial skin infections.

In conclusion, I would like to note that any infection develops as a result of the interaction between macro- and microorganisms under certain environmental conditions. The state of the microorganism and the presence of concomitant pathology play a large role in the occurrence of bacterial skin infections. The skin has a natural resistance to pyogenic infections, which is primarily due to the barrier function of the stratum corneum. Under adverse environmental influences, high humidity, leading to maceration of the skin, microtraumatization, dryness and thinning of the stratum corneum, the natural resistance of the skin is weakened and the infectious process develops. Impaired barrier function, clinically manifested by dryness, flaking, microcracks, is a constant symptom of most chronic dermatoses localized to the feet (eczema, psoriasis). A defect in the skin barrier is quite common in various somatic pathologies that lead to impaired innervation and blood circulation in the lower extremities: diabetes mellitus and varicose veins. These changes inevitably lead to increased colonization of pathogenic microorganisms (bacteria, fungi) and their active penetration into the skin with the subsequent development of the infectious process. To correct violations of the barrier properties of the skin in order to prevent a possible risk of infection, it is necessary to constantly use topical agents that help eliminate pathological changes in the epidermis and prevent their development, i.e. having a certain preventive effect.

Relatively recently, a line of topical products developed for the treatment and prevention of xerosis and hyperkeratosis of the skin of the feet in various pathologies was registered. These creams were created by the German company Esparma GmbH and include two products: Balzamed (designed for daytime use, absorbs well) and Balzamed intensive (has a thicker consistency, it is better to use for night care). Balsamed contains panthenol (provitamin B5), an oil solution of vitamin A, tocopherol acetate (vitamin E), urea, avocado oil and jojoba. Balanced components necessary for the skin have anti-inflammatory, regenerating (panthenol), moisturizing, keratolytic (urea), antioxidant (vitamin E), and normalizing keratinization processes (vitamin A) effects. Vegetable oils of avocado and jojoba complement and enhance the anti-inflammatory, regenerating and antioxidant effects, which ensures rapid restoration of the skin barrier function. Balsamed intensive, due to the introduction of essential fatty acid (gamma-linolenic acid), provides active healing, intensive hydration and nutrition of the skin, the drug also has pronounced antiseptic properties. The high therapeutic and preventive effectiveness of Balzamed preparations as part of complex therapy was confirmed in studies on the treatment of patients with diabetic foot syndrome, palmoplantar psoriasis, horny eczema, and palmoplantar keratoderma. At the same time, Balzamed is recommended to be used as a basic treatment and prophylactic agent for dryness and keratinization disorders of the skin of the feet several times a day, while Balzamed intensive is indicated for the active treatment of excessive dry skin, complicated by cracks, hyperkeratosis, using once a day (preferably on night). Studies have shown that Balzamed has a universal therapeutic and prophylactic effect, actively promotes the restoration of the barrier function of the skin, prevents the development of infectious complications, and is well tolerated by patients, causing high adherence to treatment [31].

Fluimucil – IT antibiotic

One of the best antibiotics for coughs, which can be used both as injections and inhalations. The active ingredient is thiamphenicol glycinate acetylcysteinate. “Fluimucil – antibiotic IT” is prescribed in the form of inhalations and rinses for diseases of the upper respiratory tract and ENT organs such as wet cough, bronchitis, exudative otitis media, sinusitis, laryngotracheitis, and sinusitis. The drug successfully combines an antibiotic and a mucolytic, so Fluimucil not only destroys bacteria, but also helps to clear sputum better (for example, with bronchitis). It is important not to confuse this antibiotic with the drug of the same name in the form of soluble tablets and granules that are taken orally.

Fluimucil-Antibiotic IT

Zambon, Italy

Diseases of the upper respiratory tract and ENT organs: exudative otitis media, sinusitis, laryngotracheitis;
diseases of the lower respiratory tract: acute and chronic bronchitis, prolonged pneumonia, lung abscess, emphysema, bronchiectasis, cystic fibrosis, bronchiolitis, whooping cough; prevention and treatment of bronchopulmonary complications after thoracic surgery (bronchopneumonia, atelectasis); prevention and treatment of obstructive and infectious complications of tracheostomy, preparation for bronchoscopy, bronchoaspiration; with concomitant nonspecific forms of respiratory infections to improve drainage, including cavernous lesions, with mycobacterial infections. from 623

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The best antibiotics for sinusitis

In the treatment of sinusitis, antibiotics are usually used, often in combination with other medications. Such drugs come in the form of tablets, solutions, for topical use and injections. We have compiled a list of the most effective antibiotics prescribed by doctors for sinusitis.

Vilprafen Solutab

The active ingredient of this drug is josamycin. "Vilprafen Solutab" is prescribed for many infectious diseases, in particular for otitis, bronchitis, sore throat, pneumonia, dental inflammatory processes, furunculosis and diseases of the genitourinary system. The advantage of this antibiotic is that it can be taken during pregnancy and breastfeeding. "Vilprafen Solutab" is one of the safest antibiotics. Contraindications include only severe liver damage and intolerance to the components of the drug. Vilprafen Solutab has practically no side effects. The only disadvantage of this antibiotic is its high cost.

Vilprafen Solutab

Yamanouchi Europe, Netherlands

Treatment of infectious and inflammatory diseases caused by microorganisms sensitive to josamycin: infections of the upper respiratory tract and ENT organs (including pharyngitis, tonsillitis, paratonsillitis, otitis media, sinusitis, laryngitis);
diphtheria (in addition to treatment with diphtheria antitoxin); scarlet fever (with hypersensitivity to penicillin); lower respiratory tract infections (including acute bronchitis, bronchopneumonia, pneumonia, including atypical form, whooping cough, psittacosis); oral infections (including gingivitis and periodontal disease); infections of the skin and soft tissues (including pyoderma, boils, anthrax, erysipelas / with hypersensitivity to penicillin /, acne, lymphangitis, lymphadenitis); infections of the urinary tract and genital organs (including urethritis, prostatitis, gonorrhea; with increased sensitivity to penicillin - syphilis, lymphogranuloma venereum); chlamydial, mycoplasma (including ureaplasma) and mixed infections of the urinary tract and genital organs. from 45

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The best broad-spectrum antibacterial drugs

New generation antimicrobial agents are usually synthesized from natural raw materials and stabilized in laboratories. This helps enhance the effect of the drug on pathogenic microflora.

What drugs are the most powerful? Doctors classify these as broad-spectrum antibacterial agents. Below is a short list of drugs by name:

• AMOXICLAV - belongs to the group of aminopenicillins. It has a mild effect and is used to treat infectious diseases. The drug can be used with caution and only after consultation with a doctor during pregnancy, as well as during breastfeeding. Available in tablets or in bulk form for oral administration, as well as in powders for injection.
• SUMAMED is a popular antimicrobial drug for the treatment of infections of the gastrointestinal tract, genitourinary system, respiratory tract diseases - sore throat, bronchitis, pneumonia. It affects the liver and kidneys, so it is not prescribed for patients with hypersensitivity to macrolides.
• CEFOPERAZONE – belongs to the group of cephalosporins. Prescribed by doctors for the treatment of urinary tract infections, prostatitis, skin disorders, and respiratory diseases. A good drug for recovery after gynecological, orthopedic and abdominal surgeries. Available in a form for parenteral administration - injection.
• UNIDOX SOLUTAB is the latest generation tetracycline. Used for extensive treatment of gastrointestinal infections, colds, prostatitis. It acts gently, without causing dysbacteriosis.
• LINCOMYCIN is a drug prescribed for the treatment of osteomyelitis, sepsis, and staphylococcal infections. It has a strong effect on pathogenic cells, therefore it has a long series of side effects. Among them are hypotension, weakness, dizziness. Do not use during pregnancy, or in patients with hepatic-renal insufficiency.
• RULID is a fourth generation macrolide. The main substance is roxithromycin. Prescribed for urogenital infections, diseases of the gastrointestinal tract and upper respiratory tract. Available in tablets.
• CEFIXIM – by name, it is a drug from the group of cephalosporins. Has a bactericidal effect on pathogenic cells. Helps with gastrointestinal infections, prostatitis, and also treats colds. It is quite toxic, so it should not be taken if you have kidney or liver problems.
• Cefotaxime is the last group of cephalosporins. The drug is indicated for the treatment of gynecological, urological, and colds. It copes well with inflammatory processes and suppresses pathogenic microflora.

EcoClav

The active ingredients of this drug are amoxicillin and clavulanic acid, which supports the action of the antibiotic, making it even more effective. "EcoClav" is a broad-spectrum antibiotic, but it is often prescribed specifically for bronchitis and sore throat, regardless of the pathogen that caused these diseases. EcoClav is also indicated for skin infections and osteomyelitis. Contraindications include age under 12 years, intolerance to the active substances of the drug, severe liver and kidney damage. EcoClav can be taken during pregnancy and breastfeeding, which indicates its safety compared to other antibiotics.

Ecoclave

ABVA RUS, Russia

Infectious and inflammatory diseases caused by pathogens sensitive to the drug: lower respiratory tract infections (bronchitis, pneumonia);
infections of the ENT organs (sinusitis, tonsillitis, otitis media); infections of the genitourinary system and pelvic organs (pyelonephritis, pyelitis, cystitis, urethritis, bacterial prostatitis, cervicitis, salpingitis, salpingoophoritis, endometritis, bacterial vaginitis, septic abortion, chancroid, gonorrhea); infections of the skin and soft tissues (erysipelas, impetigo, secondary infected dermatoses, abscess, cellulitis, wound infection); infections of bones and joints (osteomyelitis). from 102

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Read also 30 cheap analogues of expensive drugs It often happens that the pharmacy does not have the drug that the doctor prescribed. Or it is too expensive for the patient. But do you need treatment? What to do? You need to pay attention to analogue drugs that have the same effect as the original drugs. There are analogs and generics themselves. What is the difference?

Systemic antibiotics in the treatment of bacterial infections of the skin and soft tissues: focus on macrolides

Bacterial infections of the skin, causing purulent inflammation, were identified as a group of infectious dermatoses by the French scientist H. Leloir in 1891 under the name pyodermatitis (pyon - pus, derma - skin). Abroad, pyoderma is usually classified as a broad group of skin and soft tissue infections (SSTI), which includes, in addition to infections of the skin and its adnexal structures, infections of the subcutaneous fatty tissue and underlying tissues. In economically developed countries, SSTIs account for 1/3 of all infectious diseases. According to domestic studies, pustular skin infections account for 30–40% of all dermatological pathology in people of working age; in military personnel this figure reaches 60%. In pediatric dermatological practice, this pathology is one of the most common and accounts for 30 to 50% of all cases of visits to the doctor [1–3]. Etiology The main source of SSTIs are microorganisms that contaminate and colonize the surface of the skin. Gram-positive cocci S. aureus and S. Pyogenes, capable of penetrating into the thickness of the epidermis in the presence of its damage, undoubtedly play a leading role in the etiology of pustular skin infections. Moreover, S. aureus is the most common pathogen; infections caused by S. pyogenes, as well as a mixed infection involving both microorganisms, are somewhat less common. According to the results of foreign multicenter studies, in addition to S. aureus, S. pyogenes, Corynebacterium diphtheriae, P. aeruginosa, Enterobacteriaceae, Streptococcus spp. may be involved in the development of SSTI. The type of infection is of great importance in determining the etiological role of the suspected pathogen (Table 1). Unlike primary pyodermas, secondary ones, like most necrotizing SSTI infections, have a polymicrobial etiology. The virulence of the microorganism and the degree of bacterial contamination play an important role in the development of infection. It has been shown that the probability of developing an infection is directly proportional to the degree of bacterial contamination and virulence of the microorganism and inversely proportional to the strength of the body's protective reaction. The likelihood of colonization increases in the presence of skin diseases of allergic origin. Thus, in patients with atopic dermatitis, colonization of the affected areas with S. aureus is detected in 90% of cases [3]. Pathogenesis In the occurrence of one or another form of pyoderma, an important role is played by: the type of pathogen, its virulence, the state of the macroorganism, as well as various endogenous and exogenous predisposing factors that reduce the barrier and protective functions of the skin. The virulence of staphylococci and streptococci is determined by a number of pathogenic toxins and enzymes they secrete (coagulase, leukocidin, streptokinase, hyaluronidase streptolysin, hemolysins, etc.), which facilitate the penetration of pathogens into the skin, lead to damage and stratification of all layers of the epidermis, cause hemolysis and necrotization of the dermis and underlying tissues, disrupting their normal metabolism [4,5]. In the occurrence and development of SSTIs, the reactivity of the body and its mechanisms of resistance to microbial aggression are of great importance. The insufficiency of the immunocompetent system in this case is, as a rule, of a secondary (acquired) nature. It can form in the premorbid period as a result of previous or concomitant severe diseases. Diseases of the endocrine system (obesity, diabetes, insufficient activity of the pituitary-adrenal system, thyroid, gonads) contribute to a decrease in the body's anti-infective defense mechanisms. More than half of patients (52%) with chronic pyoderma abuse carbohydrates (usually easily digestible), which creates a constant overload of the insular apparatus of the pancreas and can contribute to carbohydrate metabolism disorders of varying degrees, the accumulation of carbohydrates in tissues, which are a favorable breeding ground for pyococci. A significant role is also assigned to the seborrheic skin condition. Due to an increase in the amount of sebum and changes in its chemical composition, a decrease in the sterilization properties of the skin and activation of pyogenic cocci occurs [6]. Of no small importance in the development of pustular skin diseases are chronic infectious diseases of various organs and tissues: periodontal disease, caries, gingivitis, tonsillitis, pharyngitis, infections of the urogenital tract, dysbacteriosis, intestinal intoxications, which reduce the general and local antibacterial resistance of the body and contribute to the development of subsequent specific sensitization in patients , which aggravates the course of the infectious process. A significant role in the development of chronic pyoderma is played by diseases of the central and autonomic nervous system, mental or physical overstrain, “debilitating diseases” - alcoholism, fasting, malnutrition (lack of proteins, vitamins, mineral salts, hypovitaminosis, especially A and C. Vitamin A is involved in In the process of keratin formation, vitamin C regulates the permeability of the vascular wall and is a synergist of corticosteroids). A major role in the development of pyoderma is played by various immunodeficiency conditions that arise as a result of congenital or acquired immunodeficiency (HIV infection, use of glucocorticosteroids, cytostatics and immunosuppressants). Defects in cellular antibacterial defense in the form of inhibition of the phagocytic activity of neutrophils, impaired chemotaxis, as well as a decrease in opsonic factors of blood serum and immunoglobulins contribute to chronic infection and frequent relapses [7]. Violations of the T-cell immune system are of major importance in the pathogenesis of SSTIs. The basis for disorders of specific mechanisms of immunological reactivity is a decrease in the number of T-lymphocytes in the peripheral blood, a decrease in the number of CD3 and CD4 cells and a change in their relationship with monocytes, which leads to a weakening of the T-cell immune response. Insufficiency of the patient’s immune system (immunological imbalance) and antigenic mimicry of the pathogen often lead to chronic infection and the formation of bacterial carriage, and irrational use of antibiotics leads to pathogen resistance [8]. Unfavorable environmental influences that violate the integrity of the skin and create an “entry gate” for infection are of significant importance in the development of bacterial skin infections. These primarily include the influence of high or low temperature, high humidity, leading to maceration of the skin, increased pollution and microtraumatization by occupational factors (oils, cement, coal dust). The entry point for infection occurs due to household microtraumas (cuts, injections), scratching and itchy dermatoses. Violation of the skin barrier in the form of dryness and thinning of the stratum corneum contributes to the penetration of microorganisms into the deep layers of the skin and underlying tissues, which leads to the development of the pyodermic process. Clinical types of SSTIs SSTIs are a fairly numerous and clinically heterogeneous group of diseases that lead to lesions of varying depth, prevalence and severity. A common symptom characteristic of all is the presence of local purulent inflammation, which in severe cases is accompanied by the development of a systemic inflammatory reaction. Clinical forms depend on the type of etiological factor, anatomical localization, association with skin appendages, depth and area of ​​the lesion, and duration of the process. In domestic dermatology, the classification of primary pyoderma was adopted, proposed by J. Jadasson back in 1934 and built on an etiological principle. It includes: staphyloderma, mainly affecting the skin around the appendages (sebaceous follicles, sweat glands); streptoderma, affecting smooth skin mainly around natural openings and mixed strepto-staphylococcal infections. In each of the three groups, depending on the depth of the lesion, superficial and deep forms are distinguished. In addition, pustular skin diseases are divided into primary, occurring on unchanged skin, and secondary, developing as complications against the background of an existing dermatosis, usually itchy (scabies, eczema, atopic dermatitis). According to the duration of the course, acute and chronic pyoderma are distinguished. Staphylococcal pyoderma is usually associated with skin appendages (hair follicles, apocrine glands). They are characterized by the formation of a deep pustule, in the center of which a cavity is formed, filled with purulent exudate. Along the periphery there is a zone of erythematous-edematous inflammatory skin. The suppurative process ends with the formation of a scar (Fig. 1). Streptococcal pyoderma most often develops on smooth skin, around natural openings (oral cavity, nose) and begins with the formation of phlyctena - a superficially located bubble with a flabby folded tire, inside which contains serous-purulent contents. The thin walls of the phlyctena quickly open, and the contents pour out onto the surface of the skin, drying out into honey-yellow layered crusts. The process tends to spread along the periphery as a result of autoinuculation (Fig. 2). Staphyloderma more often affects men, streptoderma – women and children [3,4]. In foreign literature, from a practical point of view, all SSTIs are divided into three main groups: primary pyoderma, overwhelmingly caused by S. aureus and pyogenic b-hemolytic streptococci (mainly group A), and developing on unchanged skin (folliculitis, impetigo, erysipelas) ; secondary pyoderma developing against the background of skin damage or concomitant somatic pathology (for example, bedsores, diabetic foot ulcers, infections after animal bites, postoperative wound and post-traumatic infections), as well as against the background of dermatoses accompanied by itching and scratching (allergic dermatitis, psoriasis, scabies and etc.); necrotizing infections, representing the most severe form of SSTI (cellulitis of polymicrobial etiology - synergistic cellulitis, necrotizing fasciitis, myonecrosis - gas gangrene) (Fig. 3). With this pathology, determining the depth and extent of the lesion is the priority of the surgeon, because Only with surgical treatment can the true extent of the infection be most accurately determined. The initial management of these patients is the same. It consists of early surgical intervention and the appointment of adequate antimicrobial therapy [9]. Treatment of SSTIs Treatment of patients with bacterial skin infections should be comprehensive (etiotropic and pathogenetic) and carried out after a thorough anamnestic, clinical and laboratory examination of the patient. It is necessary to identify and treat concomitant diseases, examine for foci of focal infection, and in the case of a long-term persistent process, study the immunostatus. The main and only method of etiotropic treatment of patients with SSTIs are antibiotics. In acute superficial non-common processes (impetigo, folliculitis, paronychia), therapy may be limited to the local use of antibiotics and antiseptics. In all other cases, systemic antibiotic therapy is required. Indications for systemic antibiotic therapy are deep forms of pyoderma: boils (especially localized on the face and neck), carbuncle, hidradenitis, erysipelas, cellulite. The listed forms of bacterial skin infections have a long, often chronic, recurrent course, a high prevalence of the process and are often accompanied by symptoms of general intoxication in the form of fever, headache, weakness, as well as the development of regional complications (lymphadenitis, lymphangitis). Antibiotics are used as an etiotropic agent in the treatment of bacterial dermatosis – Lyme disease. They are the drugs of choice for the treatment of acne vulgaris. In dermatovenerological practice, antibiotics are widely used both for the treatment of infectious dermatoses and diseases caused by sexually transmitted infections (STIs) [4]. Before prescribing an antibacterial drug, it is advisable to culture the pus to determine the sensitivity of the isolated microorganism to various antibiotics and, based on the results of the study, prescribe the appropriate drug. However, this is not always feasible, especially if complications of infection threaten or develop. As an analysis of modern literature and our own clinical experience shows, today the following groups of antibiotics are most often used in the treatment of bacterial skin infections: 1. β-lactams: a) natural penicillin, its durant forms and semi-synthetic penicillins; b) cephalosporins (1st–4th generation). 2. Macrolides. 3. Tetracyclines. 4. Fluoroquinolones. In recent years, penicillin and its durant drugs have rarely been used in the treatment of SSTIs, since the overwhelming number of pyococcal strains have acquired the ability to produce the enzyme b-lactamase (penicillinase), which suppresses the antibacterial activity of penicillin. In addition, β-lactams are drugs that have a high incidence of allergic reactions. Tetracyclines and aminoglycosides are currently used much less frequently. This is due to the large number of strains of microorganisms resistant to these antibiotics (which implies their low therapeutic activity), as well as the presence of severe side effects. It should be remembered that tetracyclines are contraindicated in pregnancy, children and patients with liver failure. Fluoroquinolones are prescribed mainly for the treatment of sexually transmitted diseases, due to the high sensitivity of urogenital infections to them, and for pyoderma they are used only when other groups of antibiotics are ineffective. However, in diseases of the central nervous system, in pregnant women, as well as in pediatrics, the range of their use is limited - they are prescribed mainly for health reasons. It is also necessary not to forget about the photosensitizing effect of fluoroquinolones and the associated precautions, especially in spring and summer [10]. Modern medical practice imposes certain requirements on the choice of antibiotic. First of all, the drug must have a wide spectrum of antimicrobial action and minimally expressed antibiotic resistance to microbial agents, have no severe side effects, have a minimal risk of allergic reactions, be convenient to use for the patient (availability of an oral form, a convenient dosage regimen) and affordable. In addition, it is very important that the antibiotic does not have clinically significant interactions with other drugs. Today, antibiotics – macrolides – fully meet these requirements. Classification and mechanisms of pharmacotherapeutic action of macrolides Macrolides have been widely used in clinical practice for more than 50 years. The first natural antibiotic of this group, erythromycin (a metabolite of Streptomyces erythreus), was obtained back in 1952. Macrolides can be classified by chemical structure and origin. The basis of the chemical structure of this class of antibiotics is the macrocyclic lactone ring. Depending on the number of carbon atoms in the ring, macrolides are divided into 14-, 15- and 16-membered (Table 2). Among macrolides, there are 3 generations: a) first generation: erythromycin, oleandomycin; b) second generation: spiramycin, roxithromycin, josamycin, clarithromycin, etc.; c) third generation: azithromycin (Azitral). The antibacterial effect of macrolides is based on disruption of the synthesis of ribosomal proteins of the microbial cell and thereby inhibiting the process of pathogen reproduction. They mainly have a bacteriostatic effect, which makes it advisable to prescribe them in the acute phase of inflammation. Macrolides belong to “tissue antibiotics”, i.e. when distributed in the body, they accumulate predominantly not in the bloodstream, but in those organs and tissues where there is inflammation, thereby creating high concentrations of the drug. Well distributed in the body, macrolides are able to overcome histohematological barriers (with the exception of the blood-brain barrier), significantly superior to β-lactam antibiotics. However, widespread (and often unjustified) use quickly led to the emergence of a high percentage of erythromycin-resistant strains of pathogens, especially staphylococci. This, in turn, has significantly reduced the use of erythromycin in clinical practice [11]. Interest in macrolides arose again in the early 80s of the 20th century, after the emergence of new generations of antibiotics of this group - azalides (in particular, azithromycin). Azithromycin was synthesized in 1983 from erythromycin. The drug in its pharmacokinetic properties surpassed all the indicators of its predecessor and became the first representative of the new group of antibiotics - azalids. The uniqueness of azithromycin is based on its exceptional pharmacokinetics. Azithromycin is stable in an acidic environment, due to which it is well absorbed after oral administration. Simultaneous intake with food reduces the absorption by 50%, so the drug is taken 1 hour before or 2 hours after eating. The lipophilicity of the azithromycin molecule provides, in addition to a high level of absorption in the intestines, also an excellent penetration of the drug into the tissue. The rapid penetration of azithromycin from the blood in the tissue is also ensured by a low level of binding of azithromycin with blood proteins, which makes it possible to achieve a rapid therapeutic effect in infections that affect the cells and tissue. A high concentration of the drug in the area of ​​lesion, 10-100 times higher than the concentration in the bloodstream, allows you to actively affect the pathogenic focus, thereby providing a quick clinical effect and an early recovery. Современные макролиды (в частности, азитромицин) проявляют наибольщую эффективность в отношении таких возбудителей, как S. pyogenus, S. aureus, S. pneumoniae, некоторых грамотрицательных микроорганизмов (гонококи), а также внутриклеточных возбудителей (в частности, Chlamidia trachomatis и Ureaplasma urealyticum) What causes their high demand in dermatovenerological practice [12]. The second -generation macrolides are important for antibacterial activity of the second -generation macrolides. Due to their ability to penetrate neutrophils and create high concentrations in them, many macrolides positively modify the functions of these cells, influencing, in particular, chemotaxis, the activity of phagocytosis and killing. Along with the antimicrobial effect, these antibiotics have moderate anti -inflammatory activity. Activating the cells of the macrophage row, they are able to penetrate them and during the migration of phagocytic cells into the focus of inflammation to go there with them. The uniqueness of these drugs also lies in the fact that they have a pronounced plain effect, that is, they retain high concentrations in the focus of inflammation for 5-7 days after the abolition. This sanogenetic effect made it possible to develop short treatment courses not exceeding 3-5 days, and a convenient dosage regimen (1 time per day). This, in turn, ensures the compliance of treatment and improves the quality of life of the patient. The most pronounced postbiotic effect in azithromycin is, which allows you to create an antibiotic concentration in the foci of infection, which is many times higher than the IPC in relation to active pathogens in the treatment of both acute and chronic infections. Recently, evidence of the immunomodulating action of azithromycin in an experiment on healthy volunteers has been obtained. The first phase of the immunomodulating effect is to degenerate neutrophils and oxidant explosion, which contributed to the activation of protective mechanisms. Upon reaching the eradication of pathogens, it was noted to reduce IL -8 products and the stimulation of neutrophil apoptosis, which minimized the severity of the inflammatory reaction [13]. Macrolides, both natural and semi -synthetic, compared to other antibiotics have a minimal effect on the normal microflora of the human body and do not cause dysbiosis. Therefore, azithromycin is considered not only as a highly effective, but also the safest antibiotic with a minimum number of contraindications to the appointment. Unwanted reactions when taking it as a whole are extremely rare and do not exceed 5%. The most common side effects are symptoms from the gastrointestinal tract (nausea, severity in the epigastric region), which are usually expressed moderately, do not require the cancellation of the drug and quickly pass when taking drugs after eating [11]. The clinical efficiency of azithromycin as comparative studies indicate, with IKMT among antibiotics used in outpatient practice, the most effective macrolides of the new generation, primarily 15- and 16 -member (azithromycin, josamycin, roxyromycin). The 20 -year positive experience in the use of azithromycin in domestic dermatovenerological practice has already been accumulated. In dermatology, it is the basic therapy of staphylococcal and streptococcus lesions of the skin and soft tissues (boil, impetigo, cellulite), and in venereological practice - in the treatment of SPPPs. Unlike most macrolides, azithromycin does not have clinically significant interactions with other drugs. It is not associated with the enzymes of the Cytochrome R450 complex, as a result of which it does not show a reaction of drug interaction with drugs metabolizing along this path. This property is important, since in real clinical practice, most patients who occur IKMT have background or related diseases, about which they receive appropriate treatment. It must also be emphasized that, along with good tolerance and lack of pronounced adverse reactions of macrolides (azithromycin), have another unconditional advantage compared to other groups of antibiotics - this is that it can be prescribed for pregnant women and children [14]. Currently, one of the most commonly used drugs in clinical practice is the Azitral (azithromycin) drug, produced by pharmaceutical. Azitral (azithromycin) is similar to the original azithromycin - the first representative of the Azalids subgroup from the group of macrolide antibiotics used in the treatment of IKMT and urogenital infections. Studies have shown that the clinical effectiveness of the drug prescribed in a single dose of 500 mg for 3 days is comparable to the effectiveness of most widely used antibacterial agents. This allows you to reduce the usual course of antibiotic therapy by 2-3 times, and the unique pharmacokinetic profile of Azitral provides one -time daily intake and high compliance of therapy [15]. Due to the features of pharmacokinetics and a kind of antimicrobial spectrum covering the main pathogens of the genitourinary tract infections, azithromycin is the first choice in the therapy of combined IPPPs, including chronic complicated urogenital chlamydia and in non -understanding women, and an alternative tool for the treatment of this disease during the period of pregnancy. With a single use of 1 g of azithromycin (azitral), its concentration in the tissue of the prostate and uterus exceeds the IPC for C. trachomatis (0.125 μg/ml) by 42.5 times, and in the cervical canal - 12 times, which is the therapeutic concentration for the treatment of this infection. Moreover, even after 2 weeks, the therapeutic concentration of azithromycin in the prostate tissue exceeds the MPC for C. trachomatis by 13.6 times. The authors proved that it was with such a technique in tissues where C. trachomatis is vegetated that a high therapeutic concentration of the drug is supported during 6–8 development cycles. The data obtained indicate the high efficiency of pulse - therapy with Azitral (1 g 1 time per week, a course dose of 3 g). In the complex treatment of chronic chlamydial urethropostatitis and mycouraplasmic and wardenelle infection associated with it. It is important to note that the drug Azitral is well tolerated by patients, is available in price and therefore can be widely used in therapy of complicated urogenital chlamydia and VZ [16,17]. The study of the effectiveness, safety and tolerance of azithromycin in 30 children from 6 months to 3 years with staphylococcal infections of various localization of ENT organs and skin showed that asytromycin (Azitral) is not inferior in effectiveness with anti -staphylococcal penicillins. Along with high efficiency, characterized by quick and persistent reverse dynamics of the main clinical symptoms and local inflammatory changes in 100% of cases, good tolerance of the drug and the lack of side effects in all children were noted. A wide range of antimicrobial activity, features of pharmacokinetics, a low percentage of unwanted phenomena and a number of advantages over other macrolides determine the priority of using the drug for various skin infectious processes (impetigo, furunculosis, folliculitis, cellulite, paronichia) in children. The effectiveness of azithromycin in pediatric practice, proved by clinical trials, allows you to recommend it as an alternative to b -lactam antibiotics, and in children with burdened allergoannesis - as a drug of choice [18,19]. One of the most important pharmacoeconomic indicators that determine the choice of antibiotic is the ratio of cost/efficiency. It is determined how the ratio of the cost of drug treatment (for oral drugs is equal to the cost of a course dose) to the share of successfully treated patients. It should be noted that Azitral among the existing drugs of azithromycin shows the optimal price/quality ratio [20]. It is known that the inefficiency of antibiotic therapy is largely determined by a decrease in sensitivity to the drug used. Currently, there is no clinically significant resistance to azithromycin. According to antibiotic resistance monitoring, resistance to azithromycin and other macrolides of the latest generation among the pathogens of IKMT does not exceed 2-10%. The sensitivity of S. Pyogenes is allocated in Russia to the antibiotic of azithromycin is 92%. As shown in a number of studies, the clinical effectiveness of azithromycin is higher than that of tetracyclines and B - lactam antibiotics. Comparative clinical and microbiological study of effectiveness in deep staphyloderma of the 5 -day course of azithromycin and 10 -day taking cephalexin showed higher therapeutic activity of macrolide. The eradication of the pathogen when using azithromycin was noted in 94%, with cephalexin in 90% of cases, clinical cure - respectively, in 56 and 53% of cases. At the same time, the frequency of adverse reactions, as a rule, does not require the abolition of the drug, does not exceed 5%, which is much lower than erythromycin (up to 14%) or oral forms of B - lactams [21,22]. Thus, azithromycin has a wide spectrum of antimicrobial action, high bacteriostatic activity in relation to sensitive infections for it, high bioavailability with selective effects in the focus of inflammation, it has low toxic, has a minimum of side effects and a convenient regime of administration. Consequently, the drug meets the modern requirements of rational antibiotic therapy and can be recommended for effective use in dermatovenerological practice.

References 1. Jones ME, Karlowsky JA, Draghi DC, Thornsberry C., Sahm DF, Nathwani D. Epidemiology and antibiotic susceptibility of bacteria causing skin and soft tissue infections in the USA and Europe: a guide to appropriate antimicrobial treatment. Int J Antimicrob Agent 2003; 22:406–19. 2. N.N. Murashkin, M.N. Gluzmina, L.S. Galustyan. Pustular skin lesions in the practice of a pediatric dermatologist: a fresh look at an old problem. RZHKVB: Scientific and practical journal, 2008, No. 4, p. 67–71. 3. Belkova Yu.A. Pyoderma in outpatient practice. Diseases and pathogens. Clinical microbiology and antimicrobial chemotherapy: No. 3, volume 7, p. 255–270, 2005. 4. T.A. Belousova, M.V. Goryachkina. Bacterial skin infections: the problem of choosing the optimal antibiotic. RMJ 2005, volume 13, no. 16, p. 1086–1089. 5. Takha T.V., Nazhmutdinova D.K. Rational choice of antibiotic therapy for pyoderma. RMJ 2008, volume 16, no. 8, p. 552–555. 6. Novoselov V.S., Plieva L.R. Pyoderma. RMJ 2004, volume 12, no. 5, p. 327–335. 7. Masyukova S.A., Gladko V.V., Ustinov M.V., Vladimirova E.V., Tarasenko G.N., Sorokina E.V. Bacterial skin infections and their significance in the clinical practice of a dermatologist. Consilium medicum 2004, volume 6, no. 3, p. 180–185. 8. T. File. Diagnosis and antimicrobial therapy of skin and soft tissue infections. Ohio, USA. Clinical microbiology and antimicrobial chemotherapy: No. 2, volume 5, p. 119–125, 2003 9. Shlyapnikov S.A., Fedorova V.V. The use of macrolides for surgical infections of the skin and soft tissues. GRM, 2004.–t.12, no. 4, pp.204–207 10. Guchev I.A., Sidorenko S.V., Frantsuzov V.N. Rational antimicrobial chemotherapy for skin and soft tissue infections. Antibiotics and chemotherapy. 2003, v. 48, 10, pp. 25–31 11. Parsad D., Pandhi R., Dogras S. A guide to selection and appropriate use of macrolides in skin infection Am J Clin Dermatol 2003; 4:389–97 12. Yakovlev S.V., Ukhtin S.A. Azithromycin: basic properties, optimization of application regimens based on pharmacokinetic and parameters. Antibiotics and chemotherapy. 2003 vol. 48, no. 2. - With. 22–27 13. Turovsky A.B., Kolbanova I.G. Macrolides in the treatment of respiratory tract infections from the position of an ENT doctor: pros and cons Consilium medicum, 2010, No. 4, vol. 12, p. 11 -14. 14. Prokhorovich E.A. Azithromycin. From clinical pharmacology to clinical practice. RMJ 2006, volume 14, no. 7, p. 567–572 15. Berdnikova N.G. Current aspects of the use of azithromycin (Azitral) in the treatment of community-acquired pneumonia in adults. RMJ 2006, volume 14, no. 22, p. 1625–1628. 16. Khryanin A.A., Reshetnikov O.V. Macrolides in the treatment of chlamydial infection in pregnant women (efficacy, safety, cost-effectiveness). RMJ 2008, volume 16, no. 1, p. 23–27. 17. Serov V.N., Dubnitskaya L.V., Tyutyunnik V.L. Inflammatory diseases of the pelvic organs: diagnostic criteria and principles of treatment. RMJ 2011, volume 19, no. 1, p. 46–50. 18. Talashova S.V. Some aspects of the use of antibacterial drugs in pediatrics using the example of macrolides. RMJ 2009, volume 17, no. 7, p. 464–466 19. Mazankova L.N., Ilyina N.O. The place of azalides in pediatric practice. RMJ 2008, volume 16, no. 3, p. 121–125. 20. Solovyov A.M., Pozdnyakov O.L., Tereshchenko A.V. Why is azithromycin considered the drug of choice for the treatment of urogenital chlamydial infection. RMJ 2006, volume 14, no. 15, p. 1160–1164. 21. Gurov A.V., Izotova G.N., Yushkina M.A. Possibilities of using the drug Azitral in the treatment of purulent-inflammatory diseases of the ENT organs. RMJ 2011, volume 19, no. 6, p. 405. 22. Klani R. Double-blind, double-dummy comparison of azithromycin and cephalexin in the treatmen of skin and skin structure infection. Eur.J. Clin. Microbiol. Infect.Dis. 1999, Oct. 10 (10) – p.880–84

Isofra

This is perhaps the best antibiotic for treating sinusitis. The active ingredient of the product is framycetin sulfate. You can buy Isofra in the form of a nasal spray for topical use. The drug is often prescribed for long-term rhinitis, sinusitis and nasopharyngitis. Isofra spray is suitable for both adults and children, because it is as safe as possible, it has almost no contraindications, and it can be combined with other medications. Possible side effects include only an allergy to the components of the drug and a slight disruption of the microflora of the nasopharynx (if the spray is used for a long time). Despite its safety, Isofra should be prescribed exclusively by a doctor, because it is an antibiotic. It is prohibited to use the drug for allergic rhinitis.

Isofra

Laboratories Bouchard-Recordati, France

As part of combination therapy for infectious and inflammatory diseases of the upper respiratory tract, including: - rhinitis;
- rhinopharyngitis; - sinusitis (in the absence of damage to the septum). Prevention and treatment of inflammatory processes after surgery. from 220

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Polydexa with phenylephrine

Typically, Polydex spray is prescribed for prolonged runny nose with purulent discharge. Active ingredients of the drug: dexamethasone, neomycin, polymyxin B, phenylephrine (vasoconstrictor). "Polydex with phenylephrine" is indicated for bacterial sinusitis and rhinitis. The spray not only destroys bacteria, but also relieves inflammation, improving nasal breathing. After just three to five days, the positive effect of using Polydex is noticeable. Contraindications include pregnancy, breastfeeding, children under 2.5 years of age, and kidney problems. Because of these contraindications, doctors often prescribe safer analogues of this antibiotic.

Polydexa with phenylephrine

Laboratories Bouchard-Recordati, France

Inflammatory and infectious diseases of the nasal cavity, pharynx, paranasal sinuses: - acute and chronic rhinitis;
- acute and chronic nasopharyngitis; - sinusitis. from 265

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Read also: Top 7 effective remedies for a runny nose The best nasal drops and sprays that quickly and effectively help cure a runny nose.

The best antibiotics for gynecological diseases

Many women face inflammatory diseases that require special treatment. Among such diseases: adnexitis, oophoritis, STDs, salpingoophoritis, cervicitis, bacterial vaginosis, etc. Gynecologists have antibiotics in their arsenal that are prescribed to treat specifically “female” problems.

Etiology of bacterial skin infections

The most common causative agents of skin infections are staphylococci and streptococci:

Cefotaxime

This antibiotic is often prescribed for inflammatory and infectious diseases in gynecology. You can buy Cefotaxime in almost any pharmacy; it is inexpensive and effective. This is a third generation cephalosporin antibiotic whose active ingredient is cefotaxime sodium. This antibiotic is often prescribed to prevent infections after gynecological operations. Cefotaxime should be prescribed exclusively by a doctor; it must be administered intramuscularly or intravenously. It is often indicated in cases where tablets are ineffective. Contraindications include hypersensitivity to active substances, serious liver and kidney diseases.

Cefotaxime

CJSC FF "Lekko", Russia; MJ Biopharm, India; Sintez OJSC, Russia; Belmedpreparaty, Belarus; Deco, Russia; OJSC Borisov Plant of Medical Preparations (Borimed), Belarus; Kraspharma, Russia; PJSC "Biokhimik", Russia; Protek-SVM, Russia

Antibiotic, third generation cephalosporin.
Used for: Severe infectious and inflammatory diseases caused by microorganisms sensitive to cefotaxime, incl. peritonitis, sepsis, abdominal and pelvic infections, infections of the lower respiratory tract, urinary tract, infections of bones and joints, skin and soft tissues, infected wounds and burns, gonorrhea, meningitis, Lyme disease. Prevention of infections after surgery. from 19

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Tsiprolet

This antibiotic is prescribed not only in gynecology, but also in other areas of medicine. The active ingredient is ciprofloxacin hydrochloride monohydrate. “Tsiprolet” is inexpensive, but it is convenient to take, the positive effect is visible fairly quickly, and the drug almost does not disturb the intestinal microflora. The antibiotic is suitable for the treatment of inflammation of the pelvic organs and any “female” inflammatory processes. Contraindications include pregnancy, breastfeeding, allergies to the components of the drug, and the drug is also contraindicated in children and adolescents.

Tsiprolet

Dr. Reddy's Laboratories, India

Tsiprolet eye drops are an aqueous solution of ciprofloxacin for topical use in ophthalmology.
The drug belongs to antimicrobial drugs from the fluoroquinolone group, exhibits a bactericidal effect against most gram-negative and gram-positive bacteria, and is used to treat bacterial eye diseases (conjunctivitis, keratitis), including those caused by microorganisms resistant to other groups of antibiotics. from 45

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By composition

Antibacterial drugs are divided into 6 groups:

• Penicillins are the first antimicrobial drugs, obtained back in 1928 from a biological substance (Penicillium fungi). For a long time they remained the most popular medicine for the treatment of infectious diseases.
• Cephalosporins belong to the group of the most powerful antimicrobial agents with a wide range of applications. They completely destroy pathogenic flora and are well tolerated by humans.
• Macrolides are the name of a group of narrow-range antimicrobial agents. They do not destroy the diseased cell, but only stop its growth. This category includes the following drugs: erythromycin, spiramycin, azithromycin.
• Tetracyclines are good drugs for the treatment of infectious diseases of the respiratory and urinary tract.
• Fluoroquinolones are antimicrobial agents with a wide range of effects. Completely destroy pathogenic microorganisms. You can find 1st-2nd generation medications on sale. Doctors usually prescribe them to combat Pseudomonas aeruginosa.
• Aminoglycosides are antimicrobial drugs with a wide range of applications. Popular drugs in this group - streptomycin (therapy of tuberculosis, plague) and gentamicin - are used as ointments, eye drops, and injections for ophthalmic infections.

Generations of drugs. Advanced antimicrobial drugs already have six generations. For example, penicillin was the first drug of natural origin, while the third or sixth generation is an already improved version, which includes the strongest inhibitors. The relationship is direct: the newer the generation, the more effective the effect of drugs on pathogenic microflora.

By method of administration. Oral – taken by mouth. These are various syrups, tablets, soluble capsules, suspensions. Parenteral - administered intravenously or intramuscularly. They work faster than oral medications. Rectal medications are injected into the rectum.

Important! Taking antibiotics is allowed only after consulting a doctor, otherwise antibiotic resistance will develop.

Tetracycline

Everyone has probably heard about this antibiotic, because it has the widest possible spectrum of action. You can buy Tetracycline in any form. The active substance of the drug is tetracycline hydrochloride. Typically, "Tetracycline" is prescribed in tablets (for bronchitis, pharyngitis, tonsillitis, eczema, prostatitis, infections of the gastrointestinal tract and soft tissues. Thanks to its universal action, this antibiotic quickly defeats the infection. "Tetracycline" ointment is used externally for eye infections. But The drug has a large list of contraindications and side effects, which are important to read in the instructions.

Tetracycline

Belmedpreparaty, Belarus

Infectious and inflammatory diseases caused by microorganisms sensitive to tetracycline, incl.
pneumonia, bronchitis, pleural empyema, tonsillitis, cholecystitis, pyelonephritis, intestinal infections, endocarditis, endometritis, prostatitis, syphilis, gonorrhea, brucellosis, rickettsiosis, purulent soft tissue infections, osteomyelitis; trachoma, conjunctivitis, blepharitis; blackheads Prevention of postoperative infections. from 23

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Amoxicillin

Another popular antibiotic, which is considered universal and at the same time as safe as possible. The active ingredient of the drug is amoxicillin trihydrate. Amoxicillin is inexpensive but effective. The drug is prescribed for many diseases caused by bacteria (from otitis media and tonsillitis to meningitis, Lyme disease and sepsis). You can buy Amoxicillin in any form: tablets, suspension, injections. Due to the fact that this antibiotic has practically no contraindications and side effects, it can be used by children from one month old, pregnant and lactating women.

Amoxicillin

JSC "Biolek", Ukraine

For use as monotherapy and in combination with clavulanic acid: infectious and inflammatory diseases caused by sensitive microorganisms, incl.
bronchitis, pneumonia, tonsillitis, pyelonephritis, urethritis, gastrointestinal infections, gynecological infections, infectious diseases of the skin and soft tissues, listeriosis, leptospirosis, gonorrhea. For use in combination with metronidazole: chronic gastritis in the acute phase, peptic ulcer of the stomach and duodenum in the acute phase, associated with Helicobacter pylori. from 25

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Read also The most effective probiotics for the intestines: top 5 How to choose a probiotic and for what problems it is prescribed.

*This article is for informational purposes only and is not an advertisement or purchase guide. Information is provided for reference purposes. Self-medication is unacceptable. Before purchasing any drug or if there are signs of illness, you must consult a doctor.