home Calculators Azithromycin for the treatment of pneumonia. Azithromycin in the treatment of lower respiratory tract infections. Interaction with alcohol

Azithromycin for the treatment of pneumonia. Azithromycin in the treatment of lower respiratory tract infections. Interaction with alcohol

Improper treatment of this disease can lead to serious consequences and even death.

Treatment

Treatment of pneumonia is, first of all, antibacterial drugs. Without them, it is almost impossible to cope with the infection. Previously, before the advent of antibiotics in the doctor's arsenal, pneumonia often led to death, especially in debilitated patients.

To date, pneumonia can be caused by various microorganisms:

viruses;
bacteria, chlamydia and mycoplasma;
fungi, including pneumocystis.

Depending on the pathogen, the doctor prescribes the appropriate etiotropic treatment - antiviral, antibacterial or antifungal.

Among pneumonias, hospital and out-of-hospital forms are distinguished. The first is caused by a nosocomial infection that is resistant to most antimicrobials, so its treatment is quite complicated. However, it does not occur so often, usually in surgical and trauma, burn departments, in bedridden patients.

All other cases of pneumonia are considered out-of-hospital. Most often they are the result of a cold, SARS or bronchitis.

The most common bacterial pathogens of pneumonia are:

If the disease is uncomplicated, then treatment usually begins with the antibacterial drug azithromycin. In pharmacies, he is known as Sumamed.

Sumamed

The active substance of Sumamed - azithromycin - belongs to the antibiotics from the group of macrolides. This is a broad spectrum drug. The following microorganisms are sensitive to azithromycin:

Azithromycin inhibits the synthesis of bacterial protein, due to this, its antibacterial action is carried out. Fecal enterococcus and methyl-resistant staphylococcus are resistant to the drug.

A significant list of sensitive microflora determines the choice of azithromycin as a first-line drug in the treatment of pneumonia. When prescribing, doctors also take into account the tolerability of this medication.

Tolerance of Sumamed

Sumamed refers to drugs that are fairly well tolerated by patients. As with any antibacterial drug, the list of its possible side effects is significant, but most of them are rare.

Most often, during the treatment with Sumamed, such unpleasant effects are observed:

Headache.
Violation of vision.
Nausea.
Vomit.
Stomach ache.
Disorder of the stool by the type of diarrhea.

Rare complications include the following:

fungal infection.
Blood changes - leukopenia, eosinophilia, neutropenia, anemia, thrombocytopenia.
Various allergic reactions.
Eating disorder - anorexia.
Drowsiness or insomnia.
Irritability.
Hearing impairment.
Nose bleed.
Liver damage.
Pain in the back, neck, muscles.

In most cases, when treating pneumonia with Sumamed, patients do not present any complaints related to the medication. In addition, the advantage of azithromycin is a short course of administration.

Admission course

Sumamed is available in the form of capsules divided into tablets. There are various dosage regimens.

Often azithromycin as an etiotropic therapy is prescribed for three days. The drug is taken regardless of food. If the next tablet was missed, the next one should be taken as soon as possible.

There is also another scheme for prescribing an antibiotic. In this case, Sumamed must be taken for five days, and the dosage will change in accordance with the recommendations of the attending physician.

Instead of tablets, adult patients may be prescribed capsules.

In the absence of the required dosage in the pharmacy, Sumamed can be taken 2 capsules instead of tablets. The frequency and duration of therapy is determined by the doctor.

In childhood, treatment with azithromycin is also allowed. In this case, it is used in the form of a suspension or tablets.

Performance criteria

With pneumonia, it is not enough just to prescribe an antibiotic. Since in most cases it is not possible to perform sputum culture due to the duration of the analysis, treatment is selected empirically. This means that therapy begins with the strongest drug or combination.

In such a situation, it is very important to correctly evaluate its effectiveness, because further treatment depends on it. If the antibiotic does not have a therapeutic effect in a particular patient, the drug must be replaced with a drug of another group.

Evaluation of the effectiveness of Sumamed in pneumonia is carried out after 72 hours. The following indicators are taken into account:

Fever. Body temperature by the end of the third day should normalize or remain within moderate subfebrile condition.
Well-being. Against the background of effective treatment, the patient notes the disappearance of signs of intoxication and an improvement in the general condition as early as 2-3 days.
Disease symptoms. Cough, chest pain, shortness of breath should decrease.
Laboratory indicators. A repeated general blood test by the end of the third day shows a positive trend.

If after 72 hours the patient has severe fever, the severity of the condition increases, the dynamics of laboratory parameters worsens, this indicates the ineffectiveness of Sumamed in a particular clinical case. Almost always this is due to the causative agent of pneumonia, insensitive to azithromycin.

Sumamed in pediatrics

In children, azithromycin can be prescribed almost from birth. For babies under three years of age, the use of Sumamed suspension is recommended, as there is a risk of choking on the tablet.

The dose of the suspension is calculated based on the body weight of the child.

Therapy of pneumonia in pregnant women

There is no clinically proven negative effect of azithromycin on the body of a woman and fetus during pregnancy. So far, no teratogenic effect has been reported with this drug.

However, full-scale studies of the safety of Sumamed in relation to pregnant women have not been conducted for ethical reasons. That is why such an antibiotic can be prescribed for pneumonia to women who are expecting a baby, but only when it is really necessary.

Indications for azithromycin therapy during pregnancy are determined only by the attending physician.

This statement is also true for the lactation period. An antibacterial drug in certain concentrations is able to penetrate into breast milk. There are no specific contraindications for treatment with Sumamed during breastfeeding. However, the doctor must consider the possible harm to the child and carefully evaluate the risks and benefits.

Contraindications

The list of contraindications for the appointment of Sumamed for pneumonia is small. These include:

Allergic reactions to azithromycin.
Severe side effects during previous treatment with Sumamed.
Proven insensitivity of the pathogen to this antibiotic.
Severe disorders of the liver. Since Sumamed is excreted by this organ, it can sometimes cause liver damage with the development of fulminant hepatitis.

Combination with other drugs

It is not always possible to cure pneumonia with Sumamed alone. Despite the wide spectrum of action of this drug, there are pathogens against which its effectiveness is not high enough.

In such situations, the simultaneous appointment of two antibiotics is justified - azithromycin and, for example, amoxicillin with clavulanic acid.

Two drugs that act on different pathogens increase the likelihood of a patient being successfully cured of pneumonia.

Analogues

If the doctor prescribed Sumamed for the treatment of pneumonia, but it is not possible to find the original drug in the pharmacy, you can use its synonyms or analogues.

Azithromycin is the active ingredient in many drugs. The most popular are:

If desired, you can replace Sumamed with a similar medicine based on azithromycin. But do not forget that sometimes the low price of the drug affects its quality. This is especially important for antibacterial agents.

Azithromycin in the fight against pneumonia

Azithromycin is an antibiotic drug endowed with a fairly powerful bactericidal property. It copes well with both gram-positive bacteria and streptococci, as well as anaerobic microorganisms. Azithromycin is available in capsules. It should also be noted that this drug is quickly and easily absorbed from the gastrointestinal tract.

cervicitis, bronchitis, erysipelas, dermatoses, gonorrhea, infectious diseases of the urinary system- all this is also subject to azithromycin.

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Treatment of pneumonia with azithromycin

Inflammation of the lungs is the most common cause of death from infections worldwide. Every year, millions of people suffer from this dangerous disease, so the correct selection of antibacterial drugs is still relevant. The choice of medicine for the treatment of pneumonia is carried out based on many factors. It is necessary to take into account the sensitivity of the pathogen, the pharmacokinetics of the drug, contraindications and possible side effects. An important role in the choice of medication is played by the method of application and the frequency of treatment. Azithromycin in pneumonia often becomes the drug of choice No. 1, since this antibiotic has a detrimental effect on many pathogenic microorganisms, and you only need to take it once a day.

The principle of choosing an antibiotic for lung pathologies

Specialists select antibiotics for the treatment of lower respiratory tract infections, based on data on the most common pathogens of these pathologies. This approach is due to the fact that not all clinics have the ability to quickly do a sputum culture and determine which microorganism provoked the disease. In some cases of pneumonia, there is an unproductive cough, so it is very difficult to take sputum samples.

The choice of an antibiotic is often hampered by the fact that the doctor is not able to constantly monitor the course of the disease and, if necessary, promptly adjust the treatment. Different antibiotics have different pharmacological effects, they penetrate different tissues and fluids in the body in different ways. So only a few types of antibiotics penetrate well into cells - macrolides, tetracyclines and sulfonamides.

In the event that the pathogen is sensitive to the antibacterial drug, but the drug reaches the focus of inflammation in insufficient concentration, then there will be no effect from such treatment. But you need to understand that with this method, there is no improvement in the patient's condition, and microbial resistance to the antibiotic appears.

A very important aspect when choosing antibiotics is the safety of the drug. In home treatment settings, the choice is most often given to oral medications. Doctors try to select such medicines, the frequency of which is minimal, and the effectiveness is high.

In pediatric practice, when choosing antibacterial drugs, syrups and suspensions with a broad-spectrum active substance are preferred.

What pathogens cause pneumonia

Colds in children and adults often turn into obstructive bronchitis, and in the absence of proper treatment and the addition of bacterial microflora, they can turn into pneumonia.

The most common causative agent of pneumonia remains pneumococcus, less often the disease is provoked by mycoplasmas, chlamydia and Haemophilus influenzae. In young people, the disease is most often caused by a single pathogen. In the elderly, in the presence of concomitant diseases, the disease is provoked by a mixed microflora, where both gram-positive and gram-negative bacteria are present.

Lobar pneumonia in all cases is caused by streptococcus. Staphylococcal pneumonia is less common, mainly in the elderly, in people with bad habits, as well as in patients who are on hemodialysis for a long time or have had the flu.

Quite often, it is not possible to determine the pathogen. In this case, antibacterial drugs are prescribed by trial. Recently, the number of pneumonias caused by atypical pathogens has increased.

Azithromycin for pneumonia in adults and children gives good results. It is generally well tolerated by patients of all age groups and rarely causes side effects.

Azithromycin belongs to the group of macrolides. This antibacterial drug is often prescribed for intolerance to antibiotics from the penicillin group.

General Description of Azithromycin

Azithromycin is available in capsules with different dosages of the active substance. The drug belongs to the group of macrolides. It has a pronounced activity against gram-positive, gram-negative, anaerobic and intracellular pathogens.

The shelf life of the drug is 2 years. It must be stored in a cool place, at a temperature not exceeding 25 degrees.

Application for pneumonia

The instructions for use of Azithromycin for pneumonia indicate that it is necessary to take the drug in such dosages:

Children over 12 years old and adults drink 1 capsule, which contains 500 mg of the active substance, 1 time per day. The duration of treatment is most often 3 days.
Children from 6 to 12 years old take 1 capsule, which contains 250 mg of the active substance, just once a day.
For children under 6 years of age, it is advisable to prescribe a suspension. The dosage is calculated by the attending physician individually, depending on the age of the small patient.

The manual for the drug says that the interval between taking the antibiotic should be about a day. In this case, a constantly high concentration of the drug is maintained in the blood.

Features of treatment with Azithromycin

Azithromycin for pneumonia is used with great caution in patients with chronic liver disease, as hepatitis and severe liver failure may develop. If there are signs of a violation of the liver, which are manifested by jaundice, darkening of the urine and a tendency to bleeding, then the therapy with an antibacterial drug is stopped and the patient is examined.

If the patient has a moderate impairment of kidney function, then the treatment of pneumonia with Azithromycin should be carried out under the supervision of a physician.

If an antibacterial drug is used for treatment for more than 3 days, pseudomembranous colitis may develop. This condition may be accompanied by dyspeptic disorders, including severe diarrhea.

When treated with antibiotics from the macrolide group, the risk of developing cardiac arrhythmia increases. This must be taken into account when treating people with heart pathologies.

Features of the treatment of pneumonia in children

In the treatment of pneumonia in children, it is necessary to correctly select the dosage form of the drug. For the treatment of children under 6 years old, a suspension should be taken, since it is very problematic for a child to swallow a whole capsule, and if you pour out the powder from the capsule, the baby will not want to swallow it because of the too bitter taste.

In severe infections of the lower respiratory tract, the attending physician calculates the dosage, and he also determines the duration of therapy. In most cases, the course of treatment lasts three days, but in severe cases of pneumonia, a weekly course may be recommended. The child must take the medicine at the same time. This provides a constantly high concentration of antimicrobial agent in the blood.

It is impossible to interrupt treatment when the patient's condition improves. If you do not drink a full course of antibiotics, a superinfection may develop, which is difficult to treat.

Azithromycin is a broad-spectrum, long-acting antibiotic. After taking the last capsule, the therapeutic concentration of the active substance in the blood is maintained for three days. Due to this property, this macrolide becomes the drug of choice # 1 in the treatment of pneumonia.

Azithromycin in the treatment of community-acquired pneumonia

Department of Therapy and Occupational Diseases, MMA named after I.M. Sechenov, Moscow State University. M.V. Lomonosov

In recent years, it would seem that everything that can be said about community-acquired pneumonia has already been said, but attention to this problem has not been weakened, which is reflected in the constant stream of publications and recommendations for the diagnosis and treatment of pneumonia. This interest is understandable. On the one hand, community-acquired pneumonia remains one of the most common infectious diseases, and on the other hand, the changing epidemiological situation makes it necessary to revise existing approaches to treatment and re-evaluate the role of certain antibacterial drugs. Currently, a list of antibiotics is clearly defined, which are considered possible worldwide for the empirical treatment of community-acquired pneumonia. One of them is azithromycin (Sumamed), which appears in all recommendations on this disease. The choice of this azalide antibiotic is determined by the spectrum of action, which includes the main pathogens of community-acquired pneumonia, the features of pharmacokinetics / pharmacodynamics that make short courses of treatment possible, and the variety of formulations that allow prescribing the drug in any situation. What is the place of azithromycin in modern therapy of community-acquired pneumonia?

Results of controlled clinical trials

The effectiveness of azithromycin in the treatment of community-acquired pneumonia has been proven in numerous controlled studies. For 10 years) 29 such studies were published in total in 5901 patients, including 762 children. 12 studies included patients with various infections, 8 - with exacerbation of chronic bronchitis and 9 - with pneumonia. Macrolides (erythromycin, clarithromycin, roxithromycin, dirithromycin) were used as reference drugs in 8 studies, penicillins (co-amoxiclav, amoxicillin, benzylpenicillin) in 13, cephalosporins (cefaclor, cefuroxime axetil, ceftibuten) in 4 and fluoroquinolones (moxifloxacin) in 1 Most often (in 9 studies), azithromycin was compared with co-amoxiclav. The effectiveness of both 3-day and 5-day courses of azithromycin therapy was high and in most studies was comparable to that of 10-day courses of treatment with comparator drugs. In 5 studies, azithromycin outperformed comparators (co-amoxiclav, erythromycin, benzylpenicillin, and ceftibuten). It should be noted that a small but statistically significant superiority of azithromycin over co-amoxiclav was noted in two large studies in 759 patients with exacerbation of chronic bronchitis (clinical efficacy 89.7 and 80.2%, respectively, p = 0.0003) and 481 patients with infections of the lower respiratory tract (95.0 and 87.1%, p=0.0025). The tolerability of therapy in the main and control groups was generally comparable, although in 4 studies azithromycin caused adverse reactions less frequently than co-amoxiclav or cefuroxime. The difference was mainly due to the lower incidence of gastrointestinal disturbances.

Empiric Outpatient Therapy for Pneumonia

The etiology of community-acquired pneumonia depends on many factors and can vary significantly from study to study. Its main causative agent is Streptococcus pneumoniae. In modern conditions, the role of atypical microorganisms, including M. pneumoniae, C. pneumoniae, L. pneumophila, is growing in the etiology of community-acquired pneumonia. Much less often, pneumonia is caused by H. influenzae, as well as S. aureus, Klebsiella and other enterobacteria. Quite often at patients find the mixed or co-infection. In recent years, the main concern among specialists has been the spread of penicillin-resistant strains of pneumococcus, which often show resistance to several classes of antibacterial drugs, i.e. are multiresistant. In some countries, the share of such strains reaches 40-60%. However, for Russia this problem is apparently not relevant yet. According to the monitoring of resistance of clinical strains of S. pneumoniae in the multicenter Russian study PeGAS, the proportion of resistant strains remains low. Only 6-9% of pneumococcal strains were resistant to macrolides, including azithromycin.

When should azithromycin be given? Any antibiotic intended for the empirical treatment of community-acquired pneumonia must be active against S. pneumoniae. It is also desirable that it act on atypical pathogens. Macrolide antibiotics meet these requirements, therefore, in all recommendations, they are referred to as the means of choice in the treatment of community-acquired pneumonia of mild to moderate severity that does not require hospitalization. The advantage of azithromycin over most other macrolides is the activity against H. influenzae, which further expands the indications for its use. The range of drugs with activity against pneumococcus and atypical pathogens is not so wide. In addition to macrolides, these include respiratory fluoroquinolones (levofloxacin, moxifloxacin) and tetracyclines. There are no grounds yet for wider use of the former in routine clinical practice (including due to high cost), while the use of tetracyclines is constrained by the spread of resistant strains of pneumococcus. The advantages of azithromycin over amoxicillin and other beta-lactams are especially obvious if there is a high probability of having SARS (gradual onset, upper respiratory symptoms, non-productive cough, headache, etc.). Mycoplasma pneumoniae is the main causative agent of pneumonia in schoolchildren, therefore, in such cases, macrolides should always be preferred, especially if they are available in the form of a suspension. In pediatric practice, macrolides essentially have no competitors, since fluoroquinolones cannot be prescribed to children. In the treatment of pneumonia in young children, the possibility of prescribing azithromycin once a day and a short course of therapy (3-5 days) are of particular importance.

All recommendations highlight situations when the usual spectrum of pneumonia pathogens changes and, accordingly, there is a need to modify approaches to empirical therapy. In the draft national recommendations for the diagnosis and treatment of community-acquired pneumonia (2005), adult patients are proposed to be divided into two groups depending on age (younger or older than 60 years) and the presence of a number of unfavorable prognostic factors:

chronic obstructive pulmonary disease (COPD);
diabetes;
congestive heart failure;
chronic renal failure;
cirrhosis of the liver;
alcoholism, drug addiction;
body weight deficiency.

In elderly patients with these risk factors, the etiological role of H. influenzae and other gram-negative bacteria increases. Accordingly, in this case, it is better to use amoxicillin/clavulanate or respiratory fluoroquinolones. However, it should be noted that the question of the etiology of community-acquired pneumonia in the elderly is complex. For example, in a Finnish study, 48% of 345 patients over the age of 60 had pneumonia due to S. pneumoniae, 12% to C. pneumoniae, 10% to M. pneumoniae, and only 4% to H. influenzae. Such a spectrum of pathogens "perfectly" corresponds to the spectrum of activity of azithromycin. The results of controlled studies have not confirmed the benefits of co-amoxiclav over azithromycin in patients with COPD exacerbation (see above). R. Panpanich et al. conducted a meta-analysis of comparative studies of azithromycin and amoxicillin (amoxicillin / clavulanate) in more than 2500 patients with acute bronchitis, pneumonia and exacerbation of chronic bronchitis. In general, there were no significant differences between these drugs in terms of clinical and microbiological efficacy, although in some studies azithromycin had certain advantages. In addition, its use was associated with a lower frequency of adverse effects (relative risk 0.75).

The American guidelines list azithromycin as the drug of choice for the treatment of community-acquired pneumonia in patients with comorbidities (COPD, diabetes mellitus, renal or heart failure, or malignancy) who have not received antibiotics. If patients have recently received antibiotic therapy, macrolides should be combined with beta-lactams. The possibility of combination therapy is also indicated in domestic recommendations.

Empiric therapy for pneumonia in hospitalized patients

In accordance with modern concepts, a significant number of patients with community-acquired pneumonia can receive antibacterial drugs orally and, accordingly, do not need inpatient treatment. In this regard, it is very important to correctly identify patients subject to hospitalization. Signs of severity of pneumonia, for example, high fever (> 40 ° C), tachypnea, arterial hypotension, severe tachycardia, impaired consciousness, damage to more than one lobe of the lung, the presence of decay cavities, pleural effusion, etc., are of the greatest importance for resolving this issue. Reasons for hospitalization can be advanced age, serious comorbidities, the impossibility of organizing home treatment, the ineffectiveness of previous antibiotic therapy, the desire of the patient or his relatives. Patients deserve special attention, the severity of whose condition dictates the need for urgent hospitalization in the intensive care unit (rapid progression of infiltrative changes in the lungs, septic shock, acute renal failure, etc.). For an objective assessment of the condition of patients and prognosis, it is proposed to use various scales (for example, Pneumonia Outcomes Research Team - PORT), but in normal practice they are rarely used.

The group of hospitalized patients with community-acquired pneumonia is heterogeneous. Among them, there may be a fairly significant proportion of patients with non-severe pneumonia (this can be facilitated by simplified hospitalization in departmental medical institutions). Consequently, in many cases, the approaches to the treatment of pneumonia in outpatients and hospitalized patients overlap and involve oral antibiotics, including azithromycin, although doctors still usually prefer parenteral administration. When choosing parenteral antibiotics for the treatment of more severe pneumonia, one should take into account the possible etiological role of gram-negative pathogens (H. influenzae, Enterobacteriaceae), therefore, inhibitor-protected penicillins and II-III generation cephalosporins (ceftriaxone, cefotaxime, etc.) are usually considered the drugs of choice. However, atypical pathogens can also be causes of pneumonia in hospitalized patients. For example, the role of Legionella pneumophila in the development of severe pneumonia requiring ICU hospitalization is well known. In order to completely cover the spectrum of the most likely causative agents of pneumonia, macrolides should always be included in combination therapy. This point of view is reflected both in the draft domestic recommendations (Table 1) and in the American recommendations for the treatment of pneumonia. The choice of the way to use a macrolide antibiotic depends on the severity of the patient's condition. In more severe cases, intravenous azithromycin is preferred.

Ampicillin IV, IM ± macrolide orally 1;

Co-amoxiclav IV ± macrolide inside 1;

Cefuroxime IV, IM ± macrolide orally 1;

Cefotaxime IV, IM ± macrolide orally 1;

Ceftriaxone IV, IM ± macrolide orally 1

Azithromycin IV 3

Cefotaxime IV + Macrolide IV

IV ceftriaxone + IV macrolide

2 If P. aeruginosa infection is suspected, the drugs of choice are ceftazidime, cefepime, cefoperazone/sulbactam, ticarcillin/clavulanate, piperacillin/tazobactam, carbapenems (meropenem, imipenem), ciprofloxacin. If aspiration is suspected, amoxicillin/clavulanate, cefoperazone/sulbactam, ticarcillin/clavulanate, piperacillin/tazobactam, carbapenems (meropenem, imipenem).

3 In the absence of risk factors for antibiotic-resistant S. pneumoniae, gram-negative enterobacteria, or Pseudomonas aeruginosa

The argument in favor of combination therapy are reports that it is associated with an improved prognosis and a reduction in the length of stay of patients in the hospital. R.Brown et al. retrospectively analyzed the effect of initial therapy on 30-day mortality, hospital costs, and duration of hospital stay in near-patients hospitalized for pneumonia. Depending on the therapy, they were divided into the following groups: monotherapy with ceftriaxone, other cephalosporins, fluoroquinolones, macrolides or penicillins, or combination therapy with the listed drugs and macrolides. The addition of macrolides in all groups led to a decrease in mortality compared with that in monotherapy with antibiotics of the same groups from 5-8 to<3% (р>0.05). Treatment with ceftriaxone in combination with a macrolide was also associated with a reduction in hospital stay and overall costs (p<0,0001). У пациентов молодого и пожилого возраста результаты исследования оказались в целом сходными, хотя у молодых людей летальность была ниже.

It cannot be ruled out that the choice of macrolide antibiotic may influence the results of combination therapy. F.Sanchez et al. compared the effectiveness of treatment with ceftriaxone in combination with azithromycin (3 days) or clarithromycin (10 days) in 896 elderly patients with community-acquired pneumonia. According to the severity of pneumonia and the frequency of bacteremia, the two groups of patients were comparable. The azithromycin group showed a reduction in hospital stay (7.4 vs. 9.4 days in the clarithromycin group; p<0,01) и летальности (3,6 и 7,2%; р<0,05). По мнению авторов, полученные данные необходимо подтвердить в дополнительных исследованиях.

Possible mechanisms of the beneficial effect of combination therapy on the prognosis of the disease: 1) expansion of the spectrum of action against pneumonia pathogens; 2) anti-inflammatory activity of macrolides; 3) the possible advantages of using two agents that act on the same pathogen; 4) coinfection caused by atypical pathogens. The results of the use of beta-lactams in combination with macrolides in a 10-year study in 409 patients with pneumococcal pneumonia accompanied by bacteremia can serve as confirmation of the third mechanism. In a multivariate regression analysis, the authors identified 4 independent factors that were associated with a lethal outcome: shock (p<0,0001), возраст 65 лет и старше (р=0,02), устойчивость к пенициллину и эритромицину (р=0,04) и отсутствие макролида в составе стартовой антибиотикотерапии (р=0,03). Привлекательной выглядит и гипотеза о противовоспалительных и иммуномодулирующих свойствах макролидных антибиотиков, которые подтверждены в многочисленных исследованиях in vitro и in vivo . Установлено, что азитромицин оказывает двухфазное действие при инфекционных заболеваниях. В острую фазу он усиливает защитные механизмы организма и подавляет рост возбудителей, а в более поздние сроки индуцирует апоптоз нейтрофилов и других воспалительных клеток, ограничивая воспаление.

In a hospital, the treatment of pneumonia (regardless of severity) almost always begins with parenteral antibiotics. A rational approach to reduce the cost and duration of the patient's stay in the hospital is a stepwise therapy, which involves the transition to oral administration of an antibacterial drug after normalization of body temperature and the disappearance of other symptoms of pneumonia. Ideally, for stepwise therapy, the same antibiotic is used, which is available in various forms. Although combination antibiotic therapy is recommended for most hospitalized patients with community-acquired pneumonia, nevertheless, stepwise azithromycin monotherapy (500 mg once a day intravenously for 2-5 days, and then 500 mg once a day by mouth; total course duration 7 -10 days). Domestic experts consider it justified in patients with non-severe pneumonia who do not have risk factors for infection with antibiotic-resistant S. pneumoniae (age over 65 years, beta-lactam therapy for the last 3 months, chronic alcoholism, immunodeficiency states, including therapy with systemic glucocorticoids), enterobacteria (associated cardiovascular and bronchopulmonary diseases) and P. aeruginosa ("structural" lung diseases, eg bronchiectasis, systemic glucocorticoid therapy, broad-spectrum antibiotics for more than 7 days in the last month, exhaustion). The American Thoracic Society guidelines (2001) indicate that azithromycin monotherapy is possible in young and middle-aged hospitalized patients with non-severe community-acquired pneumonia in the absence of serious cardiovascular and bronchopulmonary diseases, renal or hepatic insufficiency, impaired immune system and risk factors for the detection of resistant pathogens (previous antibiotic therapy for 3 months, hospital stay for the next 14 days, etc.).

The effectiveness of azithromycin monotherapy in hospitalized patients with community-acquired pneumonia has been confirmed in a number of clinical studies. R. Feldman et al. compared the results of the use of azithromycin (n=221) and antibiotics recommended (n=129) and not recommended (n=92) by the American Thoracic Society in patients with mild to moderate pneumonia who did not suffer from immunosuppression or metastatic cancer. Clinical outcomes did not differ significantly in the three groups, however, the average duration of hospitalization in the azithromycin group was significantly lower (4.35 days) than in the other two groups (5.73 and 6.21 days, respectively; p = 0.002 and p<0,001). Сходные результаты были получены в другом исследовании у 92 госпитализированных больных внебольничной пневмонией, у которых сравнивали эффективность монотерапии азитромицином и другими парентеральными антибиотиками . У больных, получавших азитромицин, средняя длительность пребывания в стационаре была в два раза короче, чем в группе сравнения (4,6 и 9,7 дня соответственно; р=0,0001). В открытом рандомизированном исследовании у 202 госпитализированных больных внебольничной пневмонией сравнивали эффективность ступенчатой монотерапии азитромицином и цефуроксимом/эритромицином . По клинической эффективности две схемы не отличались (выздоровление или улучшение у 77 и 74% больных соответственно), хотя средняя длительность терапии в группе азитромицина была достоверно короче (р<0,05).

Based on the analysis of pneumococcal antibiotic resistance, the results of clinical studies and existing recommendations, the following conclusions can be drawn about the role of azithromycin in the treatment of community-acquired pneumonia:

given the high activity of Sumamed against the main pathogens of respiratory tract infections, especially pneumococcus and Haemophilus influenzae, and the growing role of atypical pathogens in the etiology of community-acquired pneumonia, azithromycin remains the drug of choice in patients with mild to moderate pneumonia that does not require hospitalization (3-5-day course );
in patients with severe community-acquired pneumonia, the drug is the drug of choice in combination with beta-lactam antibiotics;
the appearance of the intravenous form of Sumamed expands the therapeutic possibilities of the doctor through the use of modern treatment technology - stepwise therapy;
Sumamed's unique biphasic immunomodulatory/anti-inflammatory properties modify the immune response, increasing the body's innate ability to protect against infection and help resolve inflammation, including chronic and long-term inflammation.

Azithromycin (Sumamed) main properties and features of use in the treatment of community-acquired pneumonia

Budanov S.V.

Scientific Center for Expertise and State Control of Medicinal Products, Moscow

(Continuation)

Clinical use of azithromycin (indications for use and treatment regimens)

The main indications for the use of azithromycin and the scheme of its use are presented in Table. 4 . Among the macrolides, azithromycin is the most commonly prescribed antibiotic for the treatment of upper and lower respiratory tract infections, infections of the skin and skin structures, sexually transmitted diseases, and diseases of the gastrointestinal tract.

Table 4. The main indications for the appointment of azithromycin
Disease	pathogens	Treatment regimens (dose and course duration)
Acute and exacerbations of chronic obstructive pulmonary disease	S. pneumoniae M. catarrhalis H. influenzae	500 mg on the first day, 250 mg from the 2nd to the 5th day (course dose 1.5 g) or 500 mg for 3 days once orally per day (course dose 1.5 g)
community-acquired pneumonia	S. pneumoniae H. influenzae S. pyogenes Atypical pathogens	500 mg on day 1, 250 mg from days 2 to 5 (course dose 1.5 g) or 500 mg for 3 days once a day (course dose 1.5 g)
Pharyngitis, tonsillitis, sinusitis	S. pyogenes S. pneumoniae H. influenzae	500 mg on the first day, 250 mg on subsequent days (adults); 12 mg/kg per day for 5 days (children)
Acute otitis media	S. pneumoniae H. influenzae M. catarrhalis	10 mg/kg per day, 5 mg/kg for the next 4 days or 10 mg/kg per day for 3 days
Nongonococcal urethritis and cervicitis	C. trachomatis	1 g x 1 day
Uncomplicated diseases of the skin and skin structures	S. aureus S. pyogenes S. agalactiae	500 mg on day 1, 250 mg on days 2-5

Its role is especially great in community-acquired pneumonia, otitis media, sinusitis, the leading pathogens of which (Streptococcus spp., H.influenzae, M.catarrhalis, as well as atypical pathogens - Chlamydia, Legionella spp.) are highly sensitive to this antibiotic.

The problem of choosing optimal antibiotics and treatment regimens for community-acquired pneumonia remains relevant, despite the introduction into clinical practice of new generations of cephalosporins, new dosage forms of broad-spectrum penicillins, the latest fluoroquinolones, etc. Its severity is due to the highest frequency of referrals of the population for pneumonia among outpatients. patients with a high mortality rate (from 10 to 40%) with late access to a doctor; difficulties of diagnosis in the conditions of treatment at home; changes in the structure and properties of pathogens, damage to immune defense systems.

The initial therapy of community-acquired pneumonia is almost always empirical due to the need for immediate treatment, especially in severe disease in the absence of data on its causative agent.

According to the recommendations of the American Thoracic Society, the Infectious Diseases Society of the United States, the Consensus Group of Canada on community-acquired infection, the most appropriate is the use of azithromycin for community-acquired pneumonia, including in the form for intravenous administration (in severe cases). For the initial therapy of hospitalized patients, it is recommended to prescribe beta-lactam antibiotics in combination with macrolides, taking into account in vitro data. The basis of the recommendation of azithromycin is the spectrum of action of the drug, which overlaps the expected typical and atypical pathogens of pneumonia. This is especially important from the point of view of varying data on the composition of its pathogens. Thus, when analyzing the results of 16 studies, the frequency of isolation of S.pneumoniae as the causative agent of pneumonia ranged from 1 to 76%. H.influenzae among the etiological agents ranked second in frequency of isolation (5-22%). The share of intracellular pathogens accounted for about 25%, and it was noted that hospitalization was required only for 5% of patients. Severe pneumonia was noted in the presence of such risk factors as advanced age, the presence of concomitant diseases, the development septic shock. Given these data, the choice and prescription of azithromycin for community-acquired pneumonia is the most appropriate, due to its greatest activity against H.influenzae and M.catarrhalis among the compared drugs (Table 5).

At present, a huge experimental and clinical material has been accumulated that characterizes the current value of azithromycin in the treatment of infections of the lower respiratory tract (pneumonia, acute and exacerbation of chronic bronchitis, diffuse panbronchiolitis, etc.). Many aspects of this problem are discussed in the review, especially in terms of the effectiveness of azithromycin in comparison with other modern antibiotics, optimization of azithromycin treatment regimens, pharmacoeconomics of the drug in comparison with other antibiotic therapy regimens for pneumonia, etc.

Azithromycin is not recommended for oral use in nosocomial pneumonia, due to the absence in its spectrum of the most severe pathogens of nosocomial pneumonia, such as Klebsiella spp. , Pseudomonas aeruginosa and other types of microbes of the Citro-Enterobacter-Serratia group, etc. At the same time, the main causative agents of community-acquired pneumonia are S. pneumoniae, H. influenzae, M. catarrhalis, as well as nosocomial pathogens such as C. pneumoniae, M. pneumoniae, L.pneumophila, are characterized by high sensitivity to azithromycin.

Treatment regimens with azithromycin for pneumonia have been well established in recent years. As a result of multicenter clinical trials in large treatment centers on a large number of patients, a higher or close efficacy of short courses of azithromycin therapy (3-5 days) was convincingly shown in comparison with the results of treatment with erythromycin for 7-10 days or 10-12 days of treatment other antibiotics - amoxicillin, amoxicillin / clavulanic acid, cefuroxime, cefaclor, etc. .

With the treatment regimen with azithromycin orally 500 mg on the 1st day once and 250 mg once a day from the 2nd to the 5th day, the treatment effect was 30% in clinical indicators and 70-80% in bacteriological in pneumonia, caused by susceptible strains of pneumococci, moraxella, Haemophilus influenzae.

The effectiveness of azithromycin (3-day course of treatment, 500 mg once a day orally) was evaluated in community-acquired pneumonia in an open, non-comparative study in 66 patients. Microbiologically, 40 patients were examined, in which Legionella pneumophila, S.pneumoniae were isolated; the patient with re-isolation of H.influenzae was excluded from the study. Based on the results of the study, it was concluded that the prescribed course of therapy was highly effective (clinical effect in 97% of cases, including cases of pneumococcal bacteremia in 6 patients). In patients with bacteremia, eradication of the pathogen from the blood was achieved within 48 hours, complete cure on the 14th day, adverse reactions in 6% of cases. There is also evidence of excellent results in the treatment of acute bronchitis, community-acquired pneumonia caused by azithromycin-sensitive strains of traditional bacterial pathogens, as well as chlamydial and legionella pneumonia. The drug was used according to the usual schemes: adults 500 mg on the first day and 250 mg on the next 4 days or a 3-day course of 500 mg 1 time per day once and at a daily dose of 5-10 mg/kg for children.

In comparative studies of azithromycin with erythromycin, roxithromycin, cefaclor and cefuroxime (all drugs were used according to typical treatment regimens for infections of the upper respiratory tract), obvious advantages of azithromycin (5-day course of treatment) over other drugs were shown: effectiveness in more than 90% of cases according to clinical and more than 70% - by bacteriological indicators, as well as by tolerability and compliance. However, it is noted that these data relate to the use of azithromycin orally for community-acquired infections; systematic data on the possibilities and effectiveness of the treatment of severe forms of pneumonia in conditions of bacteremia and generalization of infection are absent.

In connection with the emergence of the problem of resistance to benzylpenicillin S.pneumoniae in the last decade, the question arises of clarifying approaches to the choice of antibiotics for the treatment of community-acquired pneumonia caused by resistant strains. Pneumococcus resistant to benzylpenicillin(BP-R S.pneumoniae) is their cross-resistance to antibiotics of other groups, including macrolides (erythromycin and new semi-synthetic ones - azithromycin, clarithromycin, etc.). The frequency of isolation of BP-R pneumococci varies by country, region, and hospital and correlates with the frequency of isolation of strains resistant to macrolides. Thus, data are given on the isolation of 17% of erythromycin-resistant pneumococci among PD-sensitive strains, 22% among strains with intermediate PD-R, and 33% among PD-R strains. Given this fact, it is obvious that it is necessary to constantly monitor the sensitivity of pneumococci not only to benzylpenicillin and macrolides, but also to antibiotics of other groups, since this resistance is multiple in nature, and control over its spread can serve as a certain guarantee of the effectiveness of antibacterial therapy for pneumococcal pneumonia.

In countries with a low incidence of PD-R pneumococci, azithromycin and beta-lactams may retain their value as first-line antibiotics for community-acquired pneumonia. In severe cases, combinations of beta-lactam antibiotics are prescribed parenterally in combination with erythromycin. Azithromycin or other macrolides are prescribed for suspected "atypical" pneumonia with simultaneous differential diagnosis between "typical" and "atypical" pneumonia, including its subsequent laboratory confirmation.

In countries with a high rate of isolation of resistant pneumococci, azithromycin, like other macrolides, cannot be prescribed as a first-line drug of choice. They are also not prescribed in patients with a high risk of developing infections caused by gram-negative microorganisms, debilitated patients, with severe concomitant diseases, alcoholism, drug addiction, etc.

Evaluation of the effectiveness of azithromycin with an analysis of the causes of failures based on determining the etiology of the disease, antibiotic sensitivity, doses of the drug, duration of treatment courses, the presence of risk factors in the patient will clarify the therapeutic possibilities of azithromycin in various forms of pneumonia and the appropriateness of its appointment in certain clinical situations.

Significant difficulties arise in the antibiotic therapy of respiratory tract infections caused by "atypical" pathogens, due to the difficulties of laboratory diagnosis, making a clinical diagnosis with an erased picture of the disease. The most common causative agents of "atypical" pneumonia include: M.pneumoniae, C.pneumoniae; Legionella pneumophila (the latter during epidemiological outbreaks).

Among the "atypical" infectious agents, M.pneumoniae accounts for 30-50% in children and adults. M.pneumoniae is found with sufficient frequency in pharyngitis, sinusitis and bronchitis. The microorganism in rare cases can also be detected with "non-respiratory" localization of infection (myocarditis, encephalitis, etc.). Azithromycin is effective in the treatment of mycoplasmal pneumonia, however, with a late start of treatment, eradication of the pathogen is not always observed, despite a positive clinical diagnosis.

The frequency of isolation of C.pneumoniae in community-acquired pneumonia ranges from 10-20% in adults. In debilitated patients, an asymptomatic course with prolonged persistence of the pathogen is often observed. Azithromycin treatment regimens for atypical pneumonia cannot be considered finally tested, despite the high sensitivity of both pathogens to the drug (Table 6), good tissue penetration, accumulation in high concentrations in polynuclear cells, monocytes, and alveolar macrophages. In some patients, the clinical symptoms of the disease persist, and the pathogen continues to be isolated even with prolonged treatment - more than 11 months.

S.V. Moiseev
Department of Therapy and Occupational Diseases, MMA named after I.M. Sechenov, Moscow State University. M.V. Lomonosov

Results of controlled clinical trials

The effectiveness of azithromycin in the treatment of community-acquired pneumonia has been proven in numerous controlled studies. For 10 years (1991-2001) 29 such studies were published in total in 5901 patients, including 762 children. 12 studies included patients with various infections, 8 - with exacerbation of chronic bronchitis and 9 - with pneumonia. Macrolides (erythromycin, clarithromycin, roxithromycin, dirithromycin) were used as reference drugs in 8 studies, penicillins (co-amoxiclav, amoxicillin, benzylpenicillin) in 13, cephalosporins (cefaclor, cefuroxime axetil, ceftibuten) in 4 and fluoroquinolones (moxifloxacin) in 1 Most often (in 9 studies), azithromycin was compared with co-amoxiclav. The effectiveness of both 3-day and 5-day courses of azithromycin therapy was high and in most studies was comparable to that of 10-day courses of treatment with comparator drugs. In 5 studies, azithromycin outperformed comparators (co-amoxiclav, erythromycin, benzylpenicillin, and ceftibuten). It should be noted that a small but statistically significant superiority of azithromycin over co-amoxiclav was noted in two large studies in 759 patients with exacerbation of chronic bronchitis (clinical efficacy 89.7 and 80.2%, respectively, p = 0.0003) and 481 patients with infections of the lower respiratory tract (95.0 and 87.1%, p=0.0025). The tolerability of therapy in the main and control groups was generally comparable, although in 4 studies azithromycin caused adverse reactions less frequently than co-amoxiclav or cefuroxime. The difference was mainly due to the lower incidence of gastrointestinal disturbances.

Empiric Outpatient Therapy for Pneumonia

The etiology of community-acquired pneumonia depends on many factors and can vary significantly from study to study. The main causative agent remains Streptococcus pneumoniae. In modern conditions, the role of atypical microorganisms in the etiology of community-acquired pneumonia is growing, including M. pneumoniae, C. pneumoniae, L. pneumophila. Much less likely to cause pneumonia H. influenzae, and S. aureus Klebsiella and other enterobacteria. Quite often at patients find the mixed or co-infection. In recent years, the main concern among specialists has been the spread of penicillin-resistant strains of pneumococcus, which often show resistance to several classes of antibacterial drugs, i.e. are multiresistant. In some countries, the share of such strains reaches 40-60%. However, for Russia this problem is apparently not relevant yet. According to monitoring of resistance of clinical strains S. pneumoniae in the multicenter Russian PeGAS study, the proportion of resistant strains remains low. Only 6-9% of pneumococcal strains were resistant to macrolides, including azithromycin.

When should azithromycin be given? Any antibiotic intended for the empiric treatment of community-acquired pneumonia must be active against S. pneumoniae. It is also desirable that it act on atypical pathogens. Macrolide antibiotics meet these requirements, therefore, in all recommendations, they are referred to as the means of choice in the treatment of community-acquired pneumonia of mild to moderate severity that does not require hospitalization. The advantage of azithromycin over most other macrolides is its activity against H. influenzae, which further expands the indications for its use. The range of drugs with activity against pneumococcus and atypical pathogens is not so wide. In addition to macrolides, these include respiratory fluoroquinolones (levofloxacin, moxifloxacin) and tetracyclines. There are no grounds yet for wider use of the former in routine clinical practice (including due to high cost), while the use of tetracyclines is constrained by the spread of resistant strains of pneumococcus. The advantages of azithromycin over amoxicillin and other beta-lactams are especially obvious if there is a high probability of having SARS (gradual onset, upper respiratory symptoms, non-productive cough, headache, etc.). Mycoplasma pneumoniae is the main causative agent of pneumonia in schoolchildren, therefore, in such cases, macrolides should always be preferred, especially if they are available in the form of a suspension. In pediatric practice, macrolides essentially have no competitors, since fluoroquinolones cannot be prescribed to children. In the treatment of pneumonia in young children, the possibility of prescribing azithromycin once a day and a short course of therapy (3-5 days) are of particular importance.

chronic obstructive pulmonary disease (COPD);
diabetes;
congestive heart failure;
chronic renal failure;
cirrhosis of the liver;
alcoholism, drug addiction;
body weight deficiency.

In elderly patients with these risk factors, the etiological role increases H. influenzae and other Gram-negative bacteria. Accordingly, in this case, it is better to use amoxicillin/clavulanate or respiratory fluoroquinolones. However, it should be noted that the question of the etiology of community-acquired pneumonia in the elderly is complex. For example, in a Finnish study, 48% of 345 patients over the age of 60 had pneumonia due to S. pneumoniae, 12% - C. pneumoniae, 10% - M. pneumoniae and only 4% H. influenzae. Such a spectrum of pathogens "perfectly" corresponds to the spectrum of activity of azithromycin. The results of controlled studies have not confirmed the benefits of co-amoxiclav over azithromycin in patients with COPD exacerbation (see above). R. Panpanich et al. conducted a meta-analysis of comparative studies of azithromycin and amoxicillin (amoxicillin / clavulanate) in more than 2500 patients with acute bronchitis, pneumonia and exacerbation of chronic bronchitis. In general, there were no significant differences between these drugs in terms of clinical and microbiological efficacy, although in some studies azithromycin had certain advantages. In addition, its use was associated with a lower frequency of adverse effects (relative risk 0.75).

Empiric therapy for pneumonia in hospitalized patients

The group of hospitalized patients with community-acquired pneumonia is heterogeneous. Among them, there may be a fairly significant proportion of patients with non-severe pneumonia (this can be facilitated by simplified hospitalization in departmental medical institutions). Consequently, in many cases, the approaches to the treatment of pneumonia in outpatients and hospitalized patients overlap and involve oral antibiotics, including azithromycin, although doctors still usually prefer parenteral administration. When choosing parenteral antibiotics for the treatment of more severe pneumonia, the possible etiological role of gram-negative pathogens should be considered. (H. influenzae, Enterobacteriaceae), therefore, inhibitor-protected penicillins and II-III generation cephalosporins (ceftriaxone, cefotaxime, etc.) are usually considered the drugs of choice. However, atypical pathogens can also be causes of pneumonia in hospitalized patients. For example, the well-known role Legionella pneumophila in the development of severe pneumonia requiring hospitalization in the ICU. In order to completely cover the spectrum of the most likely causative agents of pneumonia, macrolides should always be included in combination therapy. This point of view is reflected both in the draft domestic recommendations (Table 1) and in the American recommendations for the treatment of pneumonia. The choice of the way to use a macrolide antibiotic depends on the severity of the patient's condition. In more severe cases, intravenous azithromycin is preferred.

The use of Azithromycin for pneumonia and colds

With the advent of cold weather, the body begins to freeze strongly. So I got sick! I was standing at the bus stop, waiting for a minibus for a long time, I was very cold, and now! Temperature 39, weakness, severe cough, after which the throat and lungs are very sore. Called an ambulance. The doctor prescribed Azithromycin for pneumonia (yes, it was he who was found in me)

Indications for use

Azithromycin is prescribed in the presence of infection in the respiratory tract, as well as in the nasopharynx. This drug is also used in inflammatory infectious processes of the skin, as well as in diseases of the urinary and reproductive system with the Chlamydia virus.

It should be noted that today Azithromycin occupies the first position among effective and popular antimicrobial drugs. It has a positive effect on the bronchial system and very quickly leads the body to recovery.

Azithromycin is a novelty in the pharmacological world, which is sold at the most affordable prices. Azithromycin is your assistant in the fight against a hated cough.

Experts prescribe Azithromycin to people with pneumonia, as an excellent antimicrobial agent that will quickly bring the body out of such a critical state.

Everyone knows that pneumonia is a serious disease that requires treatment only with antibiotics. In this case, it is azithromycin that will help, since it is considered the most powerful broad-spectrum antibiotic. It eliminates gram-positive bacteria and anaerobic microorganisms.

It is available only in capsules. It is very rapidly absorbed into the gastrointestinal tract, and from there it enters the bloodstream and spreads throughout the body.

Contraindications

There are also some contraindications to the use of this drug. It should not be prescribed to children under 12 years of age, as well as to people with renal and hepatic insufficiency.

It is also forbidden to prescribe this drug to pregnant and lactating women, as well as to those who may have allergic reactions to the components of this medication.

Side effects

Experts warn that Azithromycin should be taken strictly as directed by a specialist doctor, as it has a lot of side effects.

They are observed from the side of the central nervous, circulatory systems, sensory organs, as well as the gastrointestinal tract. If symptoms of an overdose of the drug appear, it is imperative to clean the stomach by washing and call an ambulance!

You also need to be very careful when using it with other drugs, as it is not compatible with anything.

How to drink Azithromycin

The usual dose of the drug, which is prescribed by doctors, is 1 mg. It should be taken once a day and preferably an hour or two after a meal.

The dosage depends on the disease, weight and age of the patient. It should be noted that you need to take the drug very seriously and if you forgot to take the next dose on time, you do not need to wait for the next dose, but drink it as soon as you remember. The following medications should be taken in the usual schedule, as prescribed by a specialist doctor.

Since Azithromycin is a drug of the antibiotic group, it is necessary to take antifungal therapy along with it. During treatment with this drug, you should stop driving a car, and also not engage in activities that require maximum concentration.

My results and results

This drug helped me get back on my feet very quickly. Azithromycin eliminated all coughing and thereby helped me get rid of pain in the chest area. After the first application, the body temperature stabilized, weakness disappeared.

I am very grateful to Azithromycin that I got back on my feet so quickly. I recommend to all!

Treatment of pneumonia with azithromycin

Inflammation of the lungs is the most common cause of death from infections in the world. Every year, millions of people suffer from this dangerous disease, so the correct selection of antibacterial drugs is still relevant. The choice of medicine for the treatment of pneumonia is carried out based on many factors. It is necessary to take into account the sensitivity of the pathogen, the pharmacokinetics of the drug, contraindications and possible side effects. An important role in the choice of medication is played by the method of application and the frequency of treatment. Azithromycin in pneumonia often becomes the drug of choice No. 1, since this antibiotic has a detrimental effect on many pathogenic microorganisms, and you only need to take it once a day.

The principle of choosing an antibiotic for lung pathologies

Specialists select antibiotics for the treatment of lower respiratory tract infections, based on data on the most common pathogens of these pathologies.. This approach is due to the fact that not all clinics have the ability to quickly do a sputum culture and determine which microorganism provoked the disease. In some cases of pneumonia, there is an unproductive cough, so it is very difficult to take sputum samples.

A very important aspect when choosing antibiotics is the safety of the drug. In home treatment settings, the choice is most often given to oral medications.. Doctors try to select such medicines, the frequency of which is minimal, and the effectiveness is high.

In pediatric practice, when choosing antibacterial drugs, syrups and suspensions with a broad-spectrum active substance are preferred.

What pathogens cause pneumonia

Colds in children and adults often turn into obstructive bronchitis, and in the absence of proper treatment and the addition of bacterial microflora, they can turn into pneumonia.

Quite often, it is not possible to determine the pathogen. In this case, antibacterial drugs are prescribed by trial. Recently, the number of pneumonias caused by atypical pathogens has increased.

Azithromycin for pneumonia in adults and children gives good results. It is generally well tolerated by patients of all age groups and rarely causes side effects.

Azithromycin belongs to the group of macrolides. This antibacterial drug is often prescribed for intolerance to antibiotics from the penicillin group.

General Description of Azithromycin

The shelf life of the drug is 2 years. It must be stored in a cool place, at a temperature not exceeding 25 degrees.

Application for pneumonia

The instructions for use of Azithromycin for pneumonia indicate that it is necessary to take the drug in such dosages:

Children over 12 years old and adults drink 1 capsule, which contains 500 mg of the active substance, 1 time per day. The duration of treatment is most often 3 days.
Children from 6 to 12 years old take 1 capsule, which contains 250 mg of the active substance, just once a day.
For children under 6 years of age, it is advisable to prescribe a suspension. The dosage is calculated by the attending physician individually, depending on the age of the small patient.

The manual for the drug says that the interval between taking the antibiotic should be about a day. In this case, a constantly high concentration of the drug is maintained in the blood.

Features of treatment with Azithromycin

Azithromycin for pneumonia is used with great caution in patients with chronic liver disease, as hepatitis and severe liver failure may develop.. If there are signs of a violation of the liver, which are manifested by jaundice, darkening of the urine and a tendency to bleeding, then the therapy with an antibacterial drug is stopped and the patient is examined.

If the patient has a moderate impairment of kidney function, then the treatment of pneumonia with Azithromycin should be carried out under the supervision of a physician.

If an antibacterial drug is used for treatment for more than 3 days, pseudomembranous colitis may develop. This condition may be accompanied by dyspeptic disorders, including severe diarrhea.

When treated with antibiotics from the macrolide group, the risk of developing cardiac arrhythmia increases. This must be taken into account when treating people with heart pathologies.

Features of the treatment of pneumonia in children

For severe infections of the lower respiratory tract, the attending physician calculates the dosage, and he also determines the duration of therapy. In most cases, the course of treatment lasts three days, but in severe cases of pneumonia, a weekly course may be recommended. The child must take the medicine at the same time. This provides a constantly high concentration of antimicrobial agent in the blood.

It is impossible to interrupt treatment when the patient's condition improves. If you do not drink a full course of antibiotics, a superinfection may develop, which is difficult to treat.

How many days to take Azithromycin for pneumonia?

The drug Azithromycin for pneumonia in adults often becomes the main drug in therapy. The choice of medicine for pneumonia depends on many factors.

Azithromycin is detrimental to most harmful bacteria, so it is often prescribed for pneumonia. The specialist selects an antibiotic to eliminate the infection, based on the results of the tests, medical knowledge about the most common types of pathogens and the effectiveness of a modern medication. It is not always possible to pass a bakposev of secretions and determine the type of pathogen. And the use of the drug Azithromycin helps to overcome community-acquired pneumonia.

The action of the drug

The positive effect of Azithromycin in pneumonia has been repeatedly proven over many years by clinical studies. In the course of various tests, drugs from the macrolide group were used to eliminate the infectious process. The drug Azithromycin has been compared with the effects of many drugs. In most studies on the treatment of pneumonia, it was Azithromycin that showed the best therapeutic results.

The superiority of Azithromycin over other drugs is due to its pharmacological properties.

In the human body, Azithromycin:

suppresses causative agents of pneumonia;
has a pronounced anti-inflammatory effect;
affects anaerobic bacteria;
eliminates chills and normalizes temperature;
reduces cough;
enhances the functioning of the immune system.

Pneumonia is often an exacerbation of obstructive bronchitis. In the process of the inflammatory process, the bacterial flora is attached, and the pathology affects the lung tissues. The main causative agent of pneumonia is pneumococcal bacteria. They penetrate into the blood of the body and cause the destruction of lung cells. Also, the disease can be provoked by chlamydia, mycoplasmas, Haemophilus influenzae.

In the absence of competent therapy, the infection develops further and can even lead to death. It is advisable to treat pneumonia with Azithromycin in various forms of the disease under medical supervision. The drug copes well with infectious agents with mixed microflora in the lower lung tissues. Therapy with the antibiotic Azithromycin is carried out according to the instructions that the manufacturer attaches to the package.

If it is impossible to determine the exact causative agent of the disease, the selection of a medicine for pneumonia is carried out by sampling. The antibacterial drug Azithromycin has proven itself in the treatment of pneumonia. It is well tolerated by patients of all ages and less likely than other medicines to cause side effects.

Azithromycin in pneumonia has a pronounced effect on the production of polynucleotides and inhibits the inflammatory process in the body. It actively fights pneumonia and eliminates its symptoms. The action of the drug in pneumonia is aimed at improving well-being, reducing the symptoms of the disease. The drug reduces the active compounds that affect the cellular links of the immune system. It reduces the action of nitric oxide, which prevents damage to organic cells. The drug also increases the synthesis of cytokines, which actively fight the inflammatory process in the lung tissues.

Application

The dosage of Azithromycin for pneumonia is 500 mg per day. Take the medicine one tablet once a day. The tablet is swallowed whole, it is not recommended to chew it. Wash down with 1 glass of clean water. Take the medicine 1 hour before meals or 2 hours after.

The drug is intended for systemic use and is a powerful antimicrobial agent. With pneumonia, Azithromycin is drunk for 3-5 days, the duration of the course is regulated by the doctor. If necessary, the dose may be reduced to 250 mg per day.

Adverse reactions

In some cases, when taking Azithromycin in the elimination of pneumonia, some side effects may develop.

May be observed:

If any adverse reactions occur, the doctor should be informed. It is possible that the doctor will reduce the recommended dose of the drug for an adult or include another drug in the treatment.

Treatment of pediatric pneumonia

With pneumonia in children, Azithromycin has a pronounced anti-inflammatory effect and helps the child cope with the disease faster. The child's body can react quite violently to the medicine. However, with a well-chosen dosage, pneumonia therapy passes without complications.

Azithromycin:

promotes liquefaction of sputum accumulated in the lungs;
exhibits optimal activity against pathogenic agents;
improves the condition of the epithelium of the alveoli;
maintains fluid balance in the lung tissues;
reduces the amount of bronchial secretion;
restores the mucous membrane of the respiratory tract.

In terms of its effectiveness, treatment with Azithromycin pneumonia is not inferior to therapy with other antibacterial drugs. Medical studies have shown that the elimination of pneumonia with Azithromycin within 5 days in patients aged 7-16 years has a very powerful therapeutic result and does not differ from treatment with drugs such as Amoxicillin, Erythromycin, Sumamed. In preschool children, the course of treatment with Azithromycin for pneumonia passes, basically, without adverse reactions.

Azithromycin has a high degree of safety and is a fairly effective macrolide. It is metabolized in the liver structures, does not contribute to organ damage and interacts well with other drugs. Drug components in unchanged form are excreted from the body by bile and kidneys.

The overall incidence of adverse events with the use of macrolide in pediatric patients is approximately 10%. Whereas other drugs show a significantly higher percentage. The possible cancellation of this drug due to the development of adverse events did not exceed 0.6% in pneumonia. These research results are included in the relevant protocols.

Given the low level of resistance of pathogenic microbes to Azithromycin, this remedy is treated by physicians as a first-line drug for pneumonia in children. It is clinically recommended to treat community-acquired pneumonia with Azithromycin in weak and premature babies. According to medical observations, atypical pneumonia of mixed type prevails in children older than 5 years. Azithromycin is an effective drug in its treatment.

Indications for use

Azithromycin is a novelty in the pharmacological world, which is sold at the most affordable prices. Azithromycin is your assistant in the fight against a hated cough.

Experts prescribe Azithromycin to people with pneumonia, as an excellent antimicrobial agent that will quickly bring the body out of such a critical state.

It is available only in capsules. It is very rapidly absorbed into the gastrointestinal tract, and from there it enters the bloodstream and spreads throughout the body.

Contraindications

There are also some contraindications to the use of this drug. It should not be prescribed to children under 12 years of age, as well as to people with renal and hepatic insufficiency.

It is also forbidden to prescribe this drug to pregnant and lactating women, as well as to those who may have allergic reactions to the components of this medication.

Side effects

Experts warn that Azithromycin should be taken strictly as directed by a specialist doctor, as it has a lot of side effects.

You also need to be very careful when using it with other drugs, as it is not compatible with anything.

How to drink Azithromycin

The usual dose of the drug, which is prescribed by doctors, is 1 mg. It should be taken once a day and preferably an hour or two after a meal.

My results and results

I am very grateful to Azithromycin that I got back on my feet so quickly. I recommend to all!

Reviews of site visitors - consumers of this medicine, as well as opinions of doctors of specialists on the use of Azithromycin in their practice are presented. We kindly ask you to actively add your reviews about the drug: the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not declared by the manufacturer in the annotation. Azithromycin analogues in the presence of existing structural analogues. Use for the treatment of tonsillitis, pneumonia and other infections in adults, children, as well as during pregnancy and lactation.

Azithromycin is a broad-spectrum antibiotic. It is a representative of a subgroup of macrolide antibiotics - azalides, acts bacteriostatically. When creating high concentrations in the focus of inflammation, it has a bactericidal effect.

Acts on extra- and intracellular pathogens. Gram-positive and gram-negative microorganisms are sensitive to azithromycin; some anaerobic microorganisms: Bacteroides bivius, Clostridium perfringens, Peptostreptococcus spp; as well as Chlamydia trachomatis, Mycoplasma pneumoniae, Ureaplasma urealyticum, Treponema pallidum, Borrelia burgdorferi. Azithromycin is not active against Gram-positive bacteria resistant to erythromycin.

Also active against Toxoplasma gondii.

Azithromycin is rapidly absorbed from the gastrointestinal tract, due to its stability in an acidic environment and lipophilicity. Azithromycin penetrates well into the respiratory tract, organs and tissues of the urogenital tract (in particular, into the prostate gland), into the skin and soft tissues. The ability of azithromycin to accumulate predominantly in lysosomes is especially important for the elimination of intracellular pathogens. It has been proven that phagocytes deliver azithromycin to the sites of infection, where it is released during phagocytosis. The concentration of azithromycin in the foci of infection is significantly higher than in healthy tissues (on average by 24-34%) and correlates with the degree of inflammatory edema. Despite the high concentration in phagocytes, azithromycin does not significantly affect their function. Azithromycin persists at bactericidal concentrations for 5-7 days after the last dose, which has allowed the development of short (3-day and 5-day) courses of treatment. Demethylated in the liver, the resulting metabolites are not active. 50% is excreted unchanged in the bile, 6% - by the kidneys.

Infectious and inflammatory diseases caused by microorganisms sensitive to the drug:

infections of the upper respiratory tract and ENT organs (tonsillitis, sinusitis, tonsillitis, pharyngitis, otitis media);
scarlet fever;
infections of the lower respiratory tract (including those caused by atypical pathogens);
infections of the skin and soft tissues (erysipelas, impetigo, secondarily infected dermatoses);
infections of the urogenital tract (uncomplicated urethritis and / or cervicitis);
Lyme disease (borreliosis), for the treatment of the initial stage (erythema migrans);
diseases of the stomach and duodenum associated with Heliobactcr pylori (as part of combination therapy).

Film-coated tablets 250 mg and 500 mg.

Capsules 250 mg and 500 mg.

Instructions for use and dosage

Inside, 1 hour before or 2 hours after meals 1 time per day.

Adults with infections of the upper and lower respiratory tract mg per day for 1 dose for 3 days (course dose - 1.5 g).

For infections of the skin and soft tissues, mg per day on the first day for 1 dose, then 500 mg per day daily from 2 to 5 days (course dose - 3 g).

In acute infections of the genitourinary organs (uncomplicated urethritis or cervicitis) - once 1000 mg.

In Lyme disease (borreliosis) for the treatment of stage 1 (erythema migrans) mg on the first day and 500 mg daily from 2 to 5 days (course dose - 3 g).

For peptic ulcer of the stomach and duodenum associated with Helicobacter pylori - 1 g per day for 3 days as part of a combined anti-Helicobacter therapy. Children over 12 years of age (weighing 50 kg or more) with infections of the upper and lower respiratory tract, skin and soft tissues mg 1 time per day for 3 days.

In the treatment of erythema migrans in children, doses of mg on the first day and 500 mg daily from days 2 to 5.

hepatic and / or renal failure;
lactation period;
children's age up to 12 years;
hypersensitivity (including to other macrolides).

Use during pregnancy and lactation

May be used during pregnancy when the benefits far outweigh the risks associated with the use of any drug during pregnancy.

If it is necessary to prescribe the drug during lactation, it is necessary to resolve the issue of stopping breastfeeding.

If a dose is missed, the missed dose should be taken as soon as possible and subsequent doses should be taken 24 hours apart.

It is necessary to observe a break of 2 hours with the simultaneous use of antacids. After discontinuation of treatment, hypersensitivity reactions may persist in some patients, which requires specific therapy under medical supervision.

Antacids (aluminum and magnesium containing), ethanol (alcohol) and food slow down and reduce absorption. With the joint appointment of warfarin and azithromycin (at usual doses), no change in prothrombin time was detected, however, given that the interaction of macrolides and warfarin may increase the anticoagulant effect, patients need careful monitoring of prothrombin time.

Digoxin: increased concentration of digoxin.

Ergotamine and dihydroergotamine: increased toxic effect (vasospasm, dysesthesia).

Triazolam: decreased clearance and increased pharmacological action of triazolam. Slows down the excretion and increases the plasma concentration and toxicity of cycloserine, indirect anticoagulants, methylprednisolone, felodipine, as well as drugs undergoing microsomal oxidation (carbamazepine, terfenadine, cyclosporine, hexo-barbital, ergot alkaloids, valproic acid, disopyramide, bromocriptine, phenytoin, oral hypoglycemic agents, theophylline and other xanthine derivatives) - due to the inhibition of microsomal oxidation in hepatocytes by azithromycin.

Lincosamines weaken the effectiveness, tetracycline and chloramphenicol - increase.

Analogues of the drug Azithromycin

Structural analogues for the active substance:

The use of Azithromycin for pneumonia and colds

Indications for use

It should be noted that today Azithromycin occupies the first position among effective and popular antimicrobial drugs. It has a positive effect on the bronchial system and very quickly leads the body to recovery.

Azithromycin is a novelty in the pharmacological world, which is sold at the most affordable prices. Azithromycin is your assistant in the fight against a hated cough.

Experts prescribe Azithromycin to people with pneumonia, as an excellent antimicrobial agent that will quickly bring the body out of such a critical state.

It is available only in capsules. It is very rapidly absorbed into the gastrointestinal tract, and from there it enters the bloodstream and spreads throughout the body.

Contraindications

There are also some contraindications to the use of this drug. It should not be prescribed to children under 12 years of age, as well as to people with renal and hepatic insufficiency.

It is also forbidden to prescribe this drug to pregnant and lactating women, as well as to those who may have allergic reactions to the components of this medication.

Side effects

Experts warn that Azithromycin should be taken strictly as directed by a specialist doctor, as it has a lot of side effects.

You also need to be very careful when using it with other drugs, as it is not compatible with anything.

How to drink Azithromycin

The usual dose of the drug, which is prescribed by doctors, is 1 mg. It should be taken once a day and preferably an hour or two after a meal.

The dosage depends on the disease, weight and age of the patient. It should be noted that you need to take the drug very seriously and if you forgot to take the next dose on time, you do not need to wait for the next dose, but drink it as soon as you remember. The following medications should be taken in the usual schedule, as prescribed by a specialist doctor.

My results and results

I am very grateful to Azithromycin that I got back on my feet so quickly. I recommend to all!

Azithromycin: instructions for use 500, 250 for children and adults

The article provides detailed instructions for the use of Azithromycin 500, 250 dl for children and adults. The drug is in capsules, tablets, suspension. Reviews. Analogues. Price.

Azithromycin is a macrolide that protects the body from the harm caused by many types of bacteria. At a high level of the active substance in the body, the bactericidal effect of the drug is noted.

Dosage forms

The drug can be purchased in different forms - in powder form, in tablets, capsules. Tablets and capsules are sold in pharmacies in 6 pieces. The tablets are also available in packs of 3. The drug in powder is available in 20 g vials. The composition of capsules and tablets includes 250 and 500 mg of the active ingredient. 1 g of powder contains 15, 30 and 75 mg of azithromycin.

Description of the drug

The drug is a semi-synthetic antibiotic, prevents the growth of microbes, disrupts the processes necessary for their life.

The properties of the drug are preserved in an acidic environment. The components are quickly absorbed from the digestive tract, their maximum content in the blood is reached in an average of 2.5 hours. The drug is partially removed from the body for three days. It takes five to seven days for the drug to reach a stable blood level. In tissues affected by the disease, the concentration of the drug is 24-34% higher than in healthy tissues. Most of the accepted dose of Azithromycin is excreted in the bile, about 6% in the urine.

Indications

The drug is used to treat:

scarlet fever;
infections of the respiratory system;
diseases accompanied by lesions of the duodenum and stomach;
uncomplicated infectious processes in which the urogenital tract is affected;
beginning borreliosis;
infectious processes affecting the skin and soft tissues.

Contraindications

The drug is not used for severe liver and kidney damage, it is not prescribed for a negative reaction to macrolide antibiotics. Azithromycin in the form of a suspension is not treated for children weighing less than 5 kg. For the treatment of children weighing less than 45 kg, only powder is used.

Side effects

Most often, the body undergoes such negative reactions:

lymphocytopenia;
nausea with vomiting;
diarrhea
visual impairment;
the appearance of discomfort in the abdomen;
decrease in the level of bicarbonates in the blood.

The following side effects are rarely recorded:

skin itching, rashes;
convulsions;
oral candidiasis;
vaginitis;
violation of the process of processing and assimilation of food;
leukopenia;
drowsiness;
fast fatiguability;
dizziness;
headache;
vaginal infections;
gastritis;
syncope;
flatulence;
arthralgia;
ephosinophilia;
decreased frequency of bowel movements;
hypoesthesia;
anorexia;
increase in the concentration of k, AlAt, AsAt, urea, creatinine, bilirubin in the blood;
distorted sense of smells and tastes.

Very rarely there are such violations:

Some patients develop during treatment:

The frequency of the following disorders has not been established:

necrotizing hepatitis;
myasthenia gravis;
liver failure;
fulminant hepatitis;
agitation.

In some patients, as a result of taking the drug, hearing deteriorated, deafness developed, ringing in the ears appeared. Most of the disturbances were found during studies with high doses of the drug and disappeared over time.

Azithromycin capsules and tablets 500: instructions for use

The antibiotic is taken 60 minutes before eating or 120 minutes after eating. The drug is used once a day. If the medication was missed, the necessary dose of the drug is taken in the near future, the next one - in a day.

According to the instructions for use, the optimal dose of azithromycin 500 for patients weighing 45 kg or more with skin lesions, diseases of the respiratory system is 500 mg per day. The therapy is carried out for three days.

With urethritis, cervicitis, which occur without complications, use 1 g of the drug. Patients with migrating erythema are prescribed 2 tablets or capsules of 500 mg. On other days, it is recommended to use one tablet (capsule). Treatment is carried out for five days.

Azithromycin Forte: how to use

In cases where the skin, organs of the respiratory system, soft tissues are affected, use 1.5 g of the drug in three divided doses. A single dose is 500 mg. The medicine must be taken at intervals of one day.

When acne appears within three days, use 500 mg of the drug per day. After 4 days, the treatment is extended for nine weeks, but the dose is reduced to 500 mg per week, the drug is taken once. Between taking the following doses, an interval of one week is maintained.

With uncomplicated urethritis and cervicitis, 1 g of the drug is taken once. In Lyme disease, 1 g of the drug is used on the first day, in the following days until the last fifth day of therapy, inclusive, 500 mg each. One course of treatment requires 3 g of the drug. When prescribing Azithromycin to children, the dose is selected taking into account weight. Usually the daily dosage is determined at the rate of 10 mg / kg. One of two treatment regimens is used:

on the first day - 10 mg / kg once, on the next four days - 5-10 mg / kg;
10 mg / kg every 24 hours - the drug is taken in three doses.

In cases where a developing Lyme disease is detected in a child, 20 mg of the drug per 1 kg of body weight is used on the first day. Further, the dose is reduced to 10 mg / kg and the drug is taken for another four days.

Azithromycin for pneumonia

In the inflammatory process in the lungs, the drug is administered intravenously.

At least two days, 500 mg of the drug is administered per day. Later, the transition to capsules is performed. The duration of the course is 1-1.5 weeks. To achieve a stable positive effect in pneumonia, 500 mg of azithromycin per day is required.

Treatment of diseases of the small pelvis

In diseases developing in the small pelvis, infusion therapy is first performed. Later treatment is carried out by taking capsules. The recommended daily dosage corresponds to 500 mg of the drug in the form of capsules (250 mg capsules). The duration of treatment is 7 days. The transition to capsules and tablets is carried out depending on the results of treatment.

As indicated in the instructions for use of Azithromycin 500, when using a powdered substance, 60 ml of water is required per 2 g of the product. An injection solution is obtained by adding 0.5 g of the drug to 4.8 ml of water. When performing infusion therapy, a solution of dextrose (5%) or Ringer's (0.9%) is used. Depending on the solution used, the duration of the infusion is 1 or 3 hours.

Treatment regimen for ureaplasma

Treatment must be comprehensive. Before the use of the drug, immunomodulators are used. After a few days, Azithromycin is injected into the muscle. The drug is used every other day. The use of Azithromycin in the form of injections is carried out during the entire period of treatment.

In combination with an immunomodulator (second dose), they take an antibiotic that has a bactericidal effect, later they switch to Azithromycin - they use it for 5 days in an amount of 1 g. The remedy is taken in the morning 1.5 hours before eating. After a break for 5 days, take 1 g of Azithromycin. After 5 days, the drug is taken again at the same dose. During therapy (during the day) 2-3 times a day, it is recommended to take:

polyene antimycotics;
substances that stimulate the synthesis of interferons.

After a course of treatment based on the use of antibiotics, it is required to take drugs that restore the functions of the digestive tract and microflora. To obtain positive results, maintenance therapy for a period of at least two weeks is necessary.

Azithromycin treatment regimen for chlamydia

Since the drug is well tolerated by the body, it is used to treat chlamydia during childbearing and in adolescence in cases where the lower parts of the genitourinary system are affected.

Reception of 1 g of medicine is carried out once a day.

In the infectious process in the upper sections, short courses of treatment with long intervals are recommended. It is necessary to take 1 g of funds on the first, seventh and fourteenth days.

Therapy for angina in adults and children

Angina is treated with an antibiotic for 3-5 days. Azithromycin is much more easily tolerated by the patient's body than drugs belonging to the penicillin series.

With a body weight of more than 45 kg per day, 500 mg of the drug is used. Children aged 6 months to 12 years are prescribed a powdered drug to be taken once a day. Therapy is carried out for three days or longer using an individually prescribed dose of the drug. As the reviews show, in patients with purulent tonsillitis, the state of health improves significantly after 6 hours after using the medicine.

Treatment of sinusitis with Azithromycin

The drug is prescribed for daily use for four days (dosage 500 mg). Another option is possible - taking the indicated dose of the drug, followed by a decrease to 250 mg / day in the next four days.

Children under 12 years of age are treated with a suspension. For 1 kg of body weight, 10 mg of the drug is required. The drug is used for three days, taken once a day.

Sometimes 10 mg / kg of weight is used only on the first day, on the remaining 4 days - 5 mg / kg of weight. The maximum dose is 30 mg/kg. With sinusitis, the components of the medication accumulate in the affected area, destroy bacteria and eliminate the inflammatory process in the sinuses.

How to use for cystitis in women

According to the instructions for use, for the treatment of cystitis in women, Azithromycin requires 1 g per day. The most convenient form of the drug is capsules and tablets of 500 mg. In most cases, it is enough to take the drug for 3-5 days.

Carrying and feeding a child

It is permissible to use Azithromycin during the period of bearing a child and breastfeeding. Treatment with the drug is carried out on the recommendation of a doctor in cases where the benefit significantly outweighs the possible harm to the mother and fetus / child. During therapy, breastfeeding is recommended to be interrupted.

Alcohol compatibility

As a result of drinking alcohol, the absorption of the drug decreases, which leads to a slowdown in metabolism, a serious burden on the liver and the destruction of hepatocytes. Alcohol can be taken once in a small amount a few days after completion of therapy.

Azithromycin for children

With a body weight of more than 45 kg, tablets and capsules are used. The required dosage is determined by the doctor, taking into account the indications.

Small patients are prescribed a suspension.

Negative reviews are rare. Usually, treatment is required for 3-5 days to improve the condition (other antibiotics need to be applied for 10 days). The action of the drug is continued for 7 days after completion of therapy.

Attention

In 2013, a very rare but terrible side effect of the drug was revealed in the United States, namely, sudden cardiac arrest. This is explained by the fact that azithromycin changes the electrical conductivity of the heart muscle, which is fraught with cardiac arrest. One infant died from an overdose in 2011.

Reviews

Despite the foregoing, patients and doctors generally respond positively to the drug. The drug has a powerful effect on the body, designed to eliminate infections caused by bacteria. The medicine is normally perceived by the body, but sometimes leads to the appearance of temporary negative reactions.

The main advantages of the drug experts consider:

the presence of immunomodulatory and anti-inflammatory action;
maintaining a high level of the main substance in the tissues;
possibility of use during pregnancy;
preparation of the drug in a form intended for children;
high efficiency of the agent in the treatment of infections of the respiratory system and diseases caused by atypical intracellular pathogens.
the action that persists after the drug is discontinued is a significant advantage, due to the presence of which it is possible to treat with short courses;
increased sensitivity of pathogens to the effects of immunity;
The components of Azithromycin have a lesser effect on the motility of the digestive tract than Erythromycin, it does not decompose in the stomach under acidic conditions.

The approximate price of Azithromycin is 44 rubles. for 6 tablets with a dose of the active substance 250 mg and 90 rubles. for 3 tablets with a dose of the active substance 500 mg.

Analogues

Azithromycin or Sumamed: what is the difference and which is better?

According to many specialists and patients, the drugs work in the same way, and are effective in the treatment of diseases caused by bacteria of many species. Both drugs are produced in different dosage forms, which is very convenient for the patient. Since the medicines contain the same active substance, both the dosage and the possible negative reactions of the body are the same.

It is impossible to determine exactly which medicine is better. The price for Sumamed is higher, but the drug has been tested in the laboratory. In any case, the choice of medicine should be carried out by a doctor.

Which is better: Azithromycin or Amoxicillin?

Amoxicillin is prescribed mainly for the treatment of pharyngitis, frontal sinusitis, tonsillitis, Azithromycin - for the treatment of sinusitis, pharyngitis, otitis media. Both antibiotics are effective, which one to choose in a particular case, the doctor decides.

Azitrox

Means differ in price, but have the same active ingredient in their composition. The choice of drug depends on the patient's condition and disease.

Tsiprolet

Unlike Tsiprolet, Azithromycin has a wider spectrum of action, it can be used to treat children.

macrofoam

Both drugs are good antibiotics, they are selected by the doctor in accordance with the indications and the body's sensitivity to the composition of the funds.

Azithromycin is an effective antibiotic, the action of which persists for some time after the completion of the course of treatment. Despite the large list of possible negative reactions, side effects rarely develop and disappear after the end of therapy. If you need to choose an analogue, you must consult a doctor.

Detailed description of the instructions for use of Azithromycin 500, 250 dl for children and adults. The drug is in capsules, tablets, suspension. Reviews. Analogues. Price.

Comments 3

Good antibiotic. I drank from prostatitis while being treated with smartprost, it helped a lot. Just a week of treatment. And usually antibiotics for several weeks, such a misfortune is treated.

Irina, from prostatitis? 🙂

My father drank for prostatitis, he felt better after a couple of days, and after five days he was told to continue to be treated with candles, the inflammation had already passed. He took other antibiotics longer.

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Antibiotic Azithromycin for children and adults - indications, active substance, side effects and analogues

An effective antibiotic is widely used in the treatment of bacterial infections. The summary "Azithromycin - instructions for use" contains the necessary information about the drug, which, thanks to the active substance, is often prescribed for pain in the abdomen and intestines, stomach diseases caused by bacteria. Many doctors prescribe Azithromycin for pneumonia. A quick effect on the focus of inflammation, a short course of administration and an inexpensive price are 3 factors that distinguish the remedy from other antibiotics.

Antibiotic Azithromycin

The drug belongs to a new subgroup of macrolide antibiotics. An agent from the azalide group has an antimicrobial effect and is used to treat bacterial infections. Reception of macrolides reduces the growth of bacterial cells, destroys the site of infection. The use of the drug is allowed in accordance with the instructions, according to the recommendations of the doctor. Consideration should be given to the interaction of macrolides and other drugs.

Compound

One of the forms of release of the antibiotic are round tablets, covered with a blue shell, with a risk and a biconvex surface. The drug contains the main substance and auxiliary ingredients for better absorption into the body. The active component of the antibiotic is 500 mg of azithromycin. Among the additional substances are:

hypromellose;
E132 - aluminum varnish based on indigo carmine;
calcium hydrophosphate dihydrate;
E172 - iron oxide yellow;
corn starch;
E171 - titanium dioxide;
starch 1500;
soy lecithin;
partially pregelatinized corn starch;
macrogol 3350;
sodium lauryl sulfate;
talc;
magnesium stearate;
polyvinyl alcohol;
microcrystalline cellulose.

Release form

The drug is available in the form of capsules, tablets, powder. Children under 12 years of age should not take Azithromycin capsules, they can be replaced with a suspension. The powder is bought in a 20 ml bottle, where you need to add water. Along with the packaging there is a dosing spoon and a syringe. The suspension form is available in two versions: 5 ml - 100 mg, 5 ml - 200 mg. Tablets are supplied in packs of 3 (0.5 g of azithromycin dihydrate) and 6 pieces (0.125 g). In pharmacies, you can find capsules in packs of 6 pieces (0.5 g).

Pharmacodynamics and pharmacokinetics

Semi-synthetic representative of the group of macrolides, which are among the least toxic antibiotics. The drug has a wide spectrum of action and has a bactericidal effect. Many pathogens are sensitive to antibiotics: gram-positive cocci, gram-negative bacteria, anaerobic microorganisms, intracellular pathogens (chlamydia, mycoplasmas). The bioavailability of azithromycin is 37%.

The drug is inactive against gram-positive bacteria that are resistant to erythromycin. Absorption of the drug occurs quickly, and the maximum concentration of azithromycin in plasma after 500 mg is reached after 2.96 hours (0.4 mg / l). Special cells (phagocytes) located in the tissues of the body supply azithromycin to the focus of infection, where pathogens are located. The active ingredient remains in bactericidal concentrations for 5-7 days after the last dose. Azithromycin is excreted for 76 hours.

Azithromycin - indications for use

A course of a bacteriostatic antibiotic is indicated after determining the sensitivity of pathogens to the drug. The agent is prescribed for infectious diseases of the ENT organs and upper respiratory tract - inflammation of the paranasal sinuses (sinusitis), tonsils (chronic tonsillitis), middle ear cavity (otitis media), tonsillitis, scarlet fever. The drug is used in the treatment of infectious diseases of the lower respiratory system - inflammation of the bronchi (bronchitis), lungs (atypical and bacterial pneumonia). Other indications for the use of the drug:

borreliosis caused by the causative agent of the disease - Borrelia spirochete;
skin infections (skin diseases, impetigo (pustular skin lesions), erysipelas, secondarily infected dermatoses);
diseases of the stomach and duodenum;
infections of the genitourinary systems (inflammation of the cervix (cervicitis), urethra (non-gonococcal and gonorrheal urethritis)).

Contraindications

It is forbidden to use an antibiotic with a bactericidal effect together with dihydroergotamine, ergotamine. Contraindications are also severe dysfunction of the liver, kidneys, hypersensitivity to macrolide antibiotics, heart failure, a history (medical history) of indications of allergic reactions. Do not prescribe antibiotic therapy during pregnancy if the potential harm to the fetus is greater than the benefit to the mother. Breastfeeding while taking medication is contraindicated.

Method of application and dosage

Oral administration is indicated 60 minutes before meals or 120 minutes after. The dosage of Azithromycin according to the instructions is taken once a day. For the treatment of the first stage of Lyme disease, 1 g is prescribed on the first day, from days 2 to 5 - 0.5 g each. How to take Azithromycin for acute infections of the urogenital tract: oral administration of 2 tablets of 0.5 g is indicated. For the treatment of respiratory infections ways, soft tissues and skin, Azithromycin for adults is prescribed according to the instructions in a dosage of 0.5 g, then 0.25 g - with a 5-day course. Pneumonia is treated with injections for no more than 10 days.

special instructions

According to the instructions, the missed dose of the drug should be taken in the near future, and subsequent doses should be taken at intervals of 24 hours. If it is necessary to drive road vehicles, extreme caution must be exercised, as in case of kidney and liver disorders, cardiac arrhythmias (ventricular arrhythmias are possible). In some patients, hypersensitivity reactions may persist even after discontinuation of the drug. In such situations, the patient will need specific therapy under the supervision of a physician.

During pregnancy and lactation

The instructions indicate that if the intended benefit for a pregnant woman is higher than the potential risk to the fetus, then in this case the use of the drug is justified. In all other situations, it is better not to risk the health of the unborn baby. If necessary, the use of the drug during lactation, breastfeeding should be abandoned. The components contained in the composition of the drug are transported to the child with mother's milk.

Azithromycin for children

The doctor prescribes medication to children in cases where other antibiotics have been ineffective. Before starting the treatment course, it is necessary to identify the causative agent of the infection and its sensitivity to the drug. For this, an analysis of the pathogenic microflora is made, and if the bacterial form of the infection is confirmed, then the drug is prescribed. Dosage for children according to the instructions: the initial dose with a weight of more than 10 kg is 10 mg / kg, the next - 5 mg / kg with a course of treatment of 5 days. If taken for 3 days, then 10 mg / kg.

Interaction with drugs

After taking antacids - drugs that protect the gastric mucosa from bile and hydrochloric acid, the medicine is taken after 2 hours. A strong antibiotic is incompatible with heparin contained in anti-thrombotic drugs. Increases the absorption and effect of ergot alkaloids, dihydroergotamine (a substance with a vasodilating effect). Macrolides affect the metabolism of cyclosporine, increase the concentration of digoxin, which should be considered when taking digoxin and Azithromycin. After the use of coumarin anticoagulants, the anticoagulant effect is enhanced.

Interaction with alcohol

It is forbidden to use an antibacterial drug along with alcoholic beverages. The strict ban is due to the property of alcohol to increase both the effect of the drug on the body and increase the likelihood of adverse reactions. With the simultaneous use of Azithromycin with alcohol, the kidneys and liver have a double burden, because. through them, the body gets rid of ethanol and drug components. The situation threatens the development of renal failure and the death of liver cells.

Side effects

The drug belongs to potent antibacterial agents, so unpleasant side effects can be observed during administration. The instructions indicate that an allergic reaction is manifested by dermatological problems (rash, itching), bronchospasm, Quincke's edema and photosensitivity - a state of increased sensitivity of the body to the action of visible or ultraviolet radiation. The consequences of taking the drug can adversely affect the functioning of various body systems:

gastrointestinal tract (constipation, severe nausea, diarrhea, vomiting, gastritis, loss of appetite, cholestatic jaundice, pseudomembranous colitis);
reproductive system (vaginal candidiasis);
urinary (nephritis);
cardiovascular (chest pain, palpitations - tachycardia, headache);
nervous (drowsiness, neurosis, hyperkinesia);
visual (conjunctivitis).

Analogues

The active substance of the drug azithromycin is an international non-proprietary name (INN), indicated on the package. Synonyms or generic drugs of Azithromycin are products with the same active ingredient: EcoMed, Azivok, Hemomycin, Azitral, Sumametsin, Zi-factor, Sumamed Forte and Sumazid. An analogue of Azithromycin is a drug with a different composition, but having a bactericidal effect and used to treat the same diseases. Analogues of the drug include:

The price of Azithromycin

You can buy a medicine at any pharmacy in Moscow if you have a prescription that your doctor will give you if you have the appropriate indications. When purchasing a drug online, you order delivery by mail to a convenient distribution point and show your prescription there. Judging by the reviews of patients, the drug is effective and cheap - Azithromycin in capsules costs from 30 rubles.

Ozone OOO Russia

Replek Pharm OOO Skopje/Berezovsk

tablets 500 mg

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Azithromycin for the treatment of pneumonia. Azithromycin in the treatment of lower respiratory tract infections. Interaction with alcohol

Treatment

Sumamed

Tolerance of Sumamed

Admission course

Performance criteria

Sumamed in pediatrics

Therapy of pneumonia in pregnant women

Contraindications

Combination with other drugs

Analogues

Azithromycin in the fight against pneumonia

Read more:

Reviews

Leave feedback

Treatment of pneumonia with azithromycin

The principle of choosing an antibiotic for lung pathologies

What pathogens cause pneumonia

General Description of Azithromycin

Application for pneumonia

Features of treatment with Azithromycin

Features of the treatment of pneumonia in children

Azithromycin in the treatment of community-acquired pneumonia

Azithromycin (Sumamed) main properties and features of use in the treatment of community-acquired pneumonia

The use of Azithromycin for pneumonia and colds

Indications for use

Contraindications

Side effects

How to drink Azithromycin

My results and results

Treatment of pneumonia with azithromycin

The principle of choosing an antibiotic for lung pathologies

What pathogens cause pneumonia

General Description of Azithromycin

Application for pneumonia

Features of treatment with Azithromycin

Features of the treatment of pneumonia in children

How many days to take Azithromycin for pneumonia?

The action of the drug

In the human body, Azithromycin:

Application

Adverse reactions

Treatment of pediatric pneumonia

Azithromycin:

Indications for use

Contraindications

Side effects

How to drink Azithromycin

My results and results

The use of Azithromycin for pneumonia and colds

Indications for use

Contraindications

Side effects

How to drink Azithromycin

My results and results

Azithromycin: instructions for use 500, 250 for children and adults

Dosage forms

Description of the drug

Indications

Contraindications

Side effects

Azithromycin capsules and tablets 500: instructions for use

Azithromycin Forte: how to use

Azithromycin for pneumonia

Treatment of diseases of the small pelvis

Treatment regimen for ureaplasma

Azithromycin treatment regimen for chlamydia

Therapy for angina in adults and children

Treatment of sinusitis with Azithromycin

How to use for cystitis in women

Carrying and feeding a child

Alcohol compatibility

Azithromycin for children

Attention

Reviews

Analogues

Azithromycin or Sumamed: what is the difference and which is better?

Which is better: Azithromycin or Amoxicillin?

Azitrox

Tsiprolet