Do azithromycin tablets help with pneumonia. Azithromycin in the treatment of community-acquired pneumonia

Sarygina O.D.

Community-acquired pneumonia(synonyms: home, outpatient) - this is acute illness, which arose in out-of-hospital conditions accompanied by symptoms of infection of the lower respiratory tract(fever, cough, chest pain, shortness of breath) and “fresh” focally infiltrative changes in the lungs in the absence of an obvious diagnostic alternative.

Community-acquired pneumonia(PFS) can be divided into 3 groups:

1. Pneumonia that do not require hospitalization. This group of patients is the largest, accounting for up to 80% of all patients pneumonia; these patients have mild pneumonia and can receive therapy on an outpatient basis; mortality does not exceed 1-5%.

2. Pneumonia requiring hospitalization of patients in a hospital. This group makes up about 20% of all pneumonia; patients have underlying chronic diseases and severe clinical symptoms, the mortality risk of hospitalized patients reaches 12%.

3. Pneumonia requiring hospitalization of patients in intensive care units. Such patients are defined as patients with severe out-of-hospital pneumonia. The mortality rate for severe pneumonia is about 40%.

The reasons for the development of an inflammatory reaction in the respiratory parts of the lungs can be either a decrease in the effectiveness of the body’s defense mechanisms, or a massive dose of microorganisms and/or their increased virulence. Aspiration of the contents of the oropharynx is the main route of infection of the respiratory parts of the lungs, and therefore the main pathogenetic mechanism for the development of pneumonia. Under normal conditions, a number of microorganisms (for example, Streptococcus pneumoniae) can colonize the oropharynx, but the lower respiratory tract remains sterile. In cases of damage to the “self-cleaning” mechanisms of the tracheobronchial tree, for example, with a viral respiratory infection, favorable conditions are created for the development of pneumonia. In some cases, an independent pathogenetic factor may be the massive dose of microorganisms or the penetration into the respiratory parts of the lungs of even single highly virulent microorganisms that are resistant to the action of the body’s defense mechanisms, which also leads to the development of pneumonia.

The etiology of CAP is directly related to the normal microflora colonizing the upper respiratory tract. Of the numerous microorganisms, only a few that have increased virulence are capable of causing an inflammatory reaction when they enter the lower respiratory tract.

Such typical pathogens out-of-hospital The PBPs are: Streptococcus pneumoniae, Haemophilus influenzae.

Certain significance in etiology out-of-hospital CAPs have atypical microorganisms, although it is difficult to accurately determine their etiological significance: Chlamydophila (Chlamydia) pneumoniae, Mycoplazma pneumoniae, Legionella pneumophila.

Typical but rare pathogens of CAP include: Staphylococcus aureus, Klebsiella pneumoniae, and less commonly, other enterobacteriaceae.

Streptococcus pneumoniae is the most common causative agent of CAP in people of all age groups. Due to the difficulty of identifying the pathogen, initial therapy for CAP in the vast majority of cases is empirical. The choice of drugs is based on data on the frequency of occurrence of certain pathogens in different age groups, the local level of antibiotic resistance, the clinical picture of the disease and epidemiological information.

The initial choice of an antimicrobial drug is made empirically (i.e., before receiving the results of a microbiological study), since:

In at least half of the cases, the responsible microorganism cannot be identified even with the most modern methods research, and existing microbiological methods are rather nonspecific and insensitive;

Any delay in etiotropic treatment of pneumonia is accompanied by increased risk the development of complications and mortality of pneumonia, while timely and correctly selected empirical therapy can improve the outcome of the disease;

Grade clinical picture, radiological changes, concomitant diseases, risk factors and severity of pneumonia in most cases allows you to make the right decision on the choice of adequate therapy.

At the same time, it is necessary to strive to clarify the etiological diagnosis, especially in patients with severe pneumonia, since such an approach may have an impact on the outcome of the disease. In addition, the advantages of “directed” therapy are a reduction in the number of prescribed drugs, a reduction in cost treatment, reducing the number of side effects of therapy and reducing the potential for selection of resistant strains of microorganisms.

The choice of initial therapy depends on the severity of the disease, site of therapy, clinical and epidemiological factors. Since it is often difficult to immediately determine the type of causative agent of CAP, macrolides, which have a wide spectrum of antimicrobial action, are widely used drugs.

As an analysis of foreign data shows, macrolides are effective in 80-90% of patients with CAP. This is determined by their adequate spectrum of activity, including most potential pathogens, incl. mycoplasma, chlamydia and legionella, as well as favorable pharmacokinetic properties that lead to the creation of high concentrations in the lungs. An important factor What determines the empirical choice of macrolides is the low level of resistance of a number of microorganisms to them. For example, mycoplasmas exhibit constant sensitivity to antibiotics of this group; the development of resistance to them has not been described. In Russia, the level of macrolide resistance of the most common causative agent of CAP, S. Pneumoniae, is less than 5%. Moreover, in a number of microorganisms, sensitivity to macrolides was restored after a period of decreased intensity of their use.

The advantages of macrolides also include low toxicity and good tolerability, including low allergenic potential. The frequency of hypersensitivity reactions with their use does not exceed 0.5%, which is significantly lower than that with treatment penicillins (up to 10%) and cephalosporins (up to 4%), and therefore macrolides are considered the drugs of choice in patients with allergies to 3-lactam antibiotics.

In North American manuals treatment PBP macrolides are considered as first choice drugs. Their effectiveness and safety are confirmed by the results of a meta-analysis of clinical studies.

It is suggested that macrolides not only have a therapeutic effect, but also help prevent carriage of atypical pathogens, which can lead to a decrease in the frequency of recurrent cases of PAP and a decrease in morbidity.

The above factors determine the widespread use of macrolides in adults and children for lower respiratory tract infections, starting in 1952, when the first representative of this drug appeared on the international pharmaceutical market. pharmacological group- erythromycin. In subsequent years, new antibiotics from the macrolide group were developed, differing from erythromycin primarily in improved pharmacokinetic properties and better tolerability.

The most widely used among modern macrolides is azithromycin. More than 20 years of experience in clinical practice azithromycin testifies to its truly worldwide recognition. During this time, the drug has proven itself well in treatment various infectious diseases, and above all bronchopulmonary infections. According to the results of a study by the European Society of Antimicrobial Chemotherapy (ESAC), conducted in 2001-2002, in most European countries, macrolides rank second in terms of consumption among antibiotics used in outpatient practice, second only to penicillins. Azithromycin and clarithromycin are among the “top five” most actively sold antimicrobial drugs in the world. Consumption azithromycin reaches colossal volumes and continues to grow steadily. In 1999 azithromycin was the most prescribed macrolide drug in the world (IMS Drug Monitor, 1999), with sales exceeding US$1 billion in 2002.

Features of azithromycin

compared to others

macrolides

Azithromycin (Zitrocin) is a semisynthetic antibiotic from the group of 15-membered macrolides or azalides. This chemical structure determines its improved pharmacokinetics, primarily significantly increased acid resistance (compared to erythromycin 300 times), better absorption from gastrointestinal tract and more reliable bioavailability. The features of azithromycin that distinguish it from other macrolides are its very long half-life (up to 79 hours) and the ability to create higher concentrations in tissues. Azithromycin is superior to other macrolides in its ability to accumulate intracellularly. It is actively captured by phagocytes and delivered to foci of infectious inflammation, where its concentrations are 24-36% higher than those in healthy tissues. The ability of azithromycin to penetrate phagocytes is 10 times higher than that of erythromycin.

Due to its high lipophilicity, azithromycin (Zitrocin) is well distributed throughout the body, reaching various organs and tissues at a level that far exceeds the minimum inhibitory concentrations (MICs) for the main pathogens of infections in the corresponding localization. Intracellular concentrations of the drug are 10-100 times higher than those in blood plasma. The highest concentrations are created in the tonsils, adenoids, middle ear exudate, bronchial mucosa and bronchial secretions, as well as in the epithelium of the alveoli. High level the drug in the bronchi and lungs is maintained for several days after its discontinuation. The spectrum of action of azithromycin is wider than that of erythromycin, due to microorganisms such as Borrelia burg-dorferi, Helicobacter pylori, the intracellular complex of Mycobacterium avium, Crypto-spori-dium spp. and Toxoplasma gondii. The activity of azithromycin against gram-positive microorganisms is comparable to that of erythromycin, but it is superior to erythromycin in its activity against gram-negative microorganisms in vitro. In particular, azithromycin is 2-8 times more active than erythromycin against H. influenza, including 3-lactamase-producing strains, which occur in approximately 20-40% of cases. Azithromycin is superior to erythromycin in activity against Legionella spp., H. ducreyi, Campylobacter spp. and some other microorganisms. The drug acts on all major pathogens of lower respiratory tract infections, including S. pneumoniae, H. influenzae, M. catarrhalis, M. pneumoniae and C. pneumoniae. According to Japanese authors, azithromycin remains active against pneumococci resistant to other macrolides.

Azithromycin (Zitrocin) has a post-antibiotic effect, incl. against such pathogens community-acquired pneumonia, like S. pneumoniae and N. influenzae.

The advantage of azithromycin over other macrolides, as well as most antibiotics of other groups, is a once daily dose and a short course treatment, which is convenient for both children and their parents. A convenient regimen of administration, in turn, increases the accuracy of following therapeutic recommendations.

The advantages of azithromycin include high safety and good tolerability, due to both a favorable adverse reaction profile and a low potential for clinically significant drug interactions. According to the results of meta-analyses, the rate of discontinuation of azithromycin due to adverse reactions is 0.7% for lower respiratory tract infections and 0.8% for upper respiratory tract infections. The discontinuation rate of comparison antibiotics according to the results of these meta-analyses was for amoxicillin/clavulanate - 2.3-4%, cefaclor - 1.3-2.8%, erythromycin -1.9-2.2%, clarithromycin - 0.9 -1%. In clinical studies, azithromycin rarely caused serious adverse reactions, the cause-and-effect relationship of which with the drug has not been fully established.

The ability of macrolides to enter into drug interactions is primarily determined by their effect on enzymes of the cytochrome P450 system in the liver. According to the degree of inhibition of cytochrome P450, they are arranged in the following order: clarithromycin > erythromycin > roxithromycin > azithromycin > spiramycin. Thus, with regard to drug interactions, azithromycin (Zitrocin) is safer than most other macrolides. Unlike erythromycin and clarithromycin, it does not interact clinically with cyclosporine, cisapride, pimozide, disopyramide, astemizole, carbamazepine, midazolam, digoxin, statins and warfarin.

Azithromycin (Zitrocin) is recommended to be taken before meals, since under the influence of food its bioavailability, according to some data, may decrease. However, 3 studies showed that food does not affect the bioavailability of azithromycin in such dosage forms, as tablets of 250 mg, powders of 1000 mg and children's suspension of 500 mg. The results of these studies indicate that taking azithromycin (Zitrocin) does not need to be tied to meals, which makes the use of the drug even easier.

Thus, the main properties of azithromycin, which allow it to maintain a strong position in the treatment of not only community-acquired pneumonia, but also other respiratory tract infections, come down to the following:

High activity against the main pathogens of lower respiratory tract infections (S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, Enterobactericae);

Activity against intracellular atypical pathogens;

Low resistance of S. pneumoniae and H. influenzae to azithromycin;

High concentration in various bronchopulmonary structures;

Presence of post-antibiotic effect;

No clinically significant interactions with other drugs;

Convenient dosing regimen;

Availability of the drug in various dosage forms.

In the modern extensive arsenal of antibacterial drugs intended for the treatment of bronchopulmonary infections, azithromycin continues to occupy an important place.

Azithromycin belongs to the group antibacterial agents, which is taken for acute and chronic bronchitis. The peculiarity of this drug is that the components are actively concentrated in the alveoli a couple of hours after consuming the initial dosage cycle of the antibacterial drug. A long period of removal of the drug from the body allows it to acquire greater antibacterial effectiveness, as well as reduce the period of the therapeutic course of curing bronchitis with an antibacterial drug.

Acute respiratory illnesses that are caused by a viral infection or microbes do not stop with curing rhinitis. The infectious bacillus leads to inflammation of the bronchial tract, and bronchitis develops. As a rule, the onset of bronchitis is accompanied by a dry cough, a rise in temperature, fatigue, and dizziness. After some time, the cough turns into a wet one, and mucus begins to be discharged. If bronchitis occurs without signs of complications, then it can be cured in 2 weeks. Chronic bronchitis occurs with coughing attacks during a three-month cycle throughout the year, but not less than a two-year period.

Bronchitis cannot be left untreated, because the disease can develop into an obstructive pulmonary form, which can result in complicated processes: respiratory failure, as well as other respiratory ailments.

General information about azithromycin

Azithromycin for bronchitis is used for children and adults as an antibacterial agent. This antibiotic is used to cure many diseases. It is not recommended to use it without permission without a doctor’s prescription, since to do this you need to have all the information about this medicine in order not to make erroneous dosage options when you start using it for treatment.

Azithromycin belongs to the macrolide and azalide group of antibiotics. This medicine is used to cure the pathological process of ailments caused by microbes. Many patients self-medicate with antibacterial agents, for example, use Azithromycin. All this leads to the development of drug resistance of the microbe, which reduces the effectiveness of antibiotics from different group types.

Spectrum of indications for the use of Azithromycin

Azithromycin is taken orally. How long can you take Azithromycin? The number of doses is determined by the doctor for each patient individually, depending on the form of bronchitis. Do not use without permission without a doctor's prescription. This medicine has a wide range of uses. Here is a list of diseases for which it is used:

• Infectious inflammation of the airways, with pharyngitis, tonsillitis, bronchitis, pneumonia;
• Ailments of the ear, nose and throat, used for otitis media, sinusitis, laryngitis, rhinitis;
• Treatment of the genitourinary system, for ailments such as urethritis, cervicitis;
• Inflammation of the skin, from diseases of streptococcal dermatosis, erysipelas;
• Cures tick-borne borreliosis;
• Diseases of the gastrointestinal tract.

In some situations, doctors prescribe this type of medication intravenously, the information for use is the same, but it is prescribed for serious types diseases.

Range of contraindications

Limitations for the use of Azithromycin must be determined for the patient prior to its prescription. The doctor himself determines many restrictions; the patient must inform him personally about unknown ones. Here is a list of contraindications for use:

1. Increased sensitivity to this antibiotic, as well as to the auxiliary elements of the medication.
2. Functional renal disorder, as well as liver disease.
3. Intolerance to fruit sugar, sugar isomaltase deficiency, deviations in the absorption of grape sugar and monosaccharides from the hexose group.
4. For children and young people up to the age of sixteen, intravenous use.
5. For children under twelve years of age weighing 40 kg when using capsules or tablets.
6. Babies under six months of age cannot include the suspension in therapy.
7. Combined use of an antibiotic with an ergot alkaloid.

When a patient has a pulse deviation or a tendency to chaotic heartbeat, Azithromycin should not be used. Not recommended for pregnant women.

Admission rules

The antibiotic Azithromycin is good to use for bronchitis in adults. The order of use is determined by the doctor, this depends on the severity of the infectious infection and the limited structure of the bacterial course. If the infection is severe, the antibiotic is injected intravenously. The medication in tablets is prescribed to be taken orally. It is best to use it 60 minutes before a meal or 120 minutes after eating. The tablet, capsule, or suspension should be washed down with water. The powder is diluted with water. Before using the suspension, it is recommended to stir it.

Azithromycin for pneumonia is prescribed to increase the effectiveness of the therapeutic course. For this purpose, an individual technique is prescribed. First, an antibacterial agent for adults is injected into the buttock, and then administered intravenously. At the second stage of therapy, the antibiotic is used in tablet form. It is strictly forbidden to cure pneumonia on your own, as it can lead to either serious complications or death. The doctor will expertly determine the cause of the infection and personally select the medication, as he has information about antibiotics that help cure pulmonary inflammatory process in mature people and children.

How many days should I take Azithromycin? Therapy should be combined, and it is advisable to use Azithromycin three times at a dosage rate of 1 gram over a 3-day cycle. Children under 12 years of age and weighing more than 40 kg with infectious lesions respiratory canal, 3 pills of 500 mg are prescribed over a 3-day cycle.

Use in pediatrics

Respiratory tract diseases are currently in first place among diseases and deaths in children. The development of medicine among acute and chronic bronchial and pulmonary diseases is considered a major and unresolved problem. Therapy with antibacterial agents is one of the main elements of the overall treatment of respiratory tract diseases for adults and children.

Azithromycin for bronchitis is effective antibiotic. It is widely used for children, as it is available in the form of suspension, syrup, pills with a suitable dose. It can be used as injections, inhalations, and also by mouth.

Azithromycin is prescribed for pneumonia in simple and moderate cases, which are established after examination, as well as for atypical pneumonia caused by atypical pathogens (chlamydia, mycoplasma).

Azithromycin for bronchitis in children is prescribed when it occurs in acute, recurrent or chronic form, the course of the disease is mild or moderate.

Important elements when prescribing an antibiotic for respiratory diseases are:

• Intolerance to drugs from the penicillin group;
• The existence of allergies in adults and children;
• The need for an antibacterial session for people with bronchial asthma.

High accuracy Azithromycin for pneumotropic, atypical irritant. Azithromycin has advantages: it is convenient for use by children, the dose can be reduced to a single dose per day, the drug has a greater impact on many diseases of any severity of the respiratory system.

Side effects

In case of bronchial disease, treatment with an antibiotic for adults and children is dangerous if the patient has increased irritability to the constituent elements of the medication, or is intolerant to antibacterial agents from the macrolide group.

Responses to the drug Azithromycin do not have any side effects, but sometimes they occur:

• Dizziness, heart rhythm disturbances, nettle fever;
• Inflammation of the vaginal mucosa, lack of taste buds, excessive accumulation of gases in the intestines;
• Inflammation of the internal walls of the stomach, delayed bowel movement, indigestion;
• Skin irritation, skin rash, painful sensations in the chest area;
• Asthenic syndrome, decreased number of leukocytes, liver dysfunction and impaired bile outflow;
• Attacks of headaches, vomiting, attacks of nausea, pain in the abdomen, diarrhea.

Side effects can be found in older people, as their bodies are weakened. The therapeutic course using an antibiotic for the elderly should be supervised by a doctor.

special instructions

Azithromycin 500, how many days can you take? The doctor prescribes 3 tablets of 500 mg per day, taken three times for 3 days. The effect of the medicine begins after 7 days. If the patient chronic illness liver or kidneys, then take the medicine with caution. If the patient has symptoms:

• Gospel disease, icteric discoloration of the skin;
• Urine is dark in color;
• Brain damage;
• Disease of the genitourinary system.

If you experience these symptoms, you should stop taking Azithromycin and visit a doctor. It is recommended to focus on patients suffering from arrhythmia; it appears due to the use of medications for other purposes. The instructions indicate that the following may develop:

• Eaton Lambert syndrome – muscle weakness;
• Autoimmune neuromuscular disease.

Overdose

If the patient took the medicine more than the prescribed dose, then side effects:

• The patient may become temporarily deaf;
• Diarrhea;
• Nauseous attacks;
• Vomit.

In such situations, it is necessary to rinse the stomach and carry out a symptomatic course of treatment. Under no circumstances should you take more than the prescribed dose of medication to avoid side effects.

Azithromycin belongs to the group of macrolides and is used for many diseases. Helps very well with bronchitis. The medicine is well tolerated by children, which is why it is used in hospitals to treat pneumonia and tonsillitis. A drug high efficiency. You cannot use an antibiotic without permission without a doctor's prescription.

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

Azithromycin- broad-spectrum antibiotic. Is a subgroup representative macrolide antibiotics- azalides, act bacteriostatically. When high concentrations are created at the site 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.

Pharmacokinetics

Azithromycin is rapidly absorbed from the gastrointestinal tract due to its stability in 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 fabrics. 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 sites of infection, where it is released during the process of phagocytosis. The concentration of azithromycin in foci of infection is significantly higher than in healthy tissues (on average by 24-34%) and correlates with the degree inflammatory edema. Despite its high concentration in phagocytes, azithromycin does not have a significant effect on their function. Azithromycin remains in bactericidal concentrations for 5-7 days after the last dose, which has made it possible to develop short (3-day and 5-day) courses of treatment. It is demethylated in the liver, the resulting metabolites are not active. 50% is excreted unchanged with bile, 6% by the kidneys.

Indications

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, secondary infected dermatoses);
• infections of the urogenital tract (uncomplicated urethritis and/or cervicitis);
• Lyme disease (borreliosis), for treatment initial stage(erythema migrans);
• stomach diseases and duodenum associated with Heliobacter pylori (as part of combination therapy).

Release forms

Film-coated tablets 250 mg and 500 mg.

Capsules 250 mg and 500 mg.

Instructions for use and dosage

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

For adults with infections of the upper and lower respiratory tract - 500 mg per day in one dose for 3 days (course dose - 1.5 g).

For infections of the skin and soft tissues - 1000 mg per day on the first day for 1 dose, then 500 mg per day daily from days 2 to 5 (course dose - 3 g).

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

For Lyme disease (borreliosis) for the treatment of stage 1 (erythema migrans) - 1000 mg on the first day and 500 mg daily from days 2 to 5 (course dose - 3 g).

At peptic ulcer stomach and duodenum associated with Helicobacter pylori - 1 g per day for 3 days as part of combination anti-Helicobacter pylori therapy. Children over 12 years of age (with a body weight of 50 kg or more) for infections of the upper and lower respiratory tract, skin and soft tissues - 500 mg 1 time per day for 3 days.

When treating erythema migrans in children, the dose is 1000 mg on the first day and 500 mg daily from days 2 to 5.

Side effect

• diarrhea;
• nausea;
• abdominal pain;
• dyspepsia (flatulence, vomiting);
• constipation;
• anorexia;
• change in taste;
• candidiasis of the oral mucosa;
• heartbeat;
• chest pain;
• dizziness;
• headache;
• drowsiness;
• neurosis;
• sleep disturbance;
• vaginal candidiasis;
• rash;
• Quincke's edema;
• itchy skin;
• hives;
• conjunctivitis;
• increased fatigue;
• photosensitivity.

Contraindications

• liver and/or kidney failure;
• lactation period;
• children under 12 years of age;
• hypersensitivity (including to other macrolides).

Use during pregnancy and breastfeeding

Can be used during pregnancy when the benefits of its use significantly outweigh the risks that always exist when using any drug during pregnancy.

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

special instructions

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 while using antacids. After discontinuation of treatment, hypersensitivity reactions may persist in some patients, which requires specific therapy under medical supervision.

Drug interactions

Antacids (aluminum and magnesium containing), ethanol (alcohol) and food slow down and reduce absorption. When warfarin and azithromycin were co-administered (in usual doses), no changes in prothrombin time were detected, however, given that the interaction of macrolides and warfarin may enhance the anticoagulation effect, patients need careful monitoring of prothrombin time.

Digoxin: increased digoxin concentrations.

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

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

Lincosamines weaken the effectiveness, tetracycline and chloramphenicol enhance it.

Analogues of the drug Azithromycin

Structural analogues according to active substance:

• Azivok;
• Azimicin;
• Azitral;
• Azitrox;
• Azithromycin Forte;
• Azithromycin-OBL;
• Azithromycin-McLeodz;
• Azithromycin dihydrate;
• AzitRus;
• AzitRus forte;
• Azicide;
• Vero-Azithromycin;
• Zetamax retard;
• ZI-Factor;
• Zitnob;
• Zitrolide;
• Zitrolide forte;
• Zithrocin;
• Sumasid;
• Sumaclid;
• Sumamed;
• Sumamed forte;
• Sumamecin;
• Sumamecin forte;
• Sumamox;
• Sumatrolide solutab;
• Tremak-Sanovel;
• Chemomycin;
• Ecomed.

If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and look at the available analogues for the therapeutic effect.

It has a bacteriostatic and, in high doses, a bactericidal effect against the main pathogens of lower respiratory tract infections: pneumococcus, Staphylococcus aureus, Haemophilus influenzae and others, and is also active against intracellular atypical pathogens such as chlamydia, mycoplasma and legionella.

For what form of disease is it prescribed?

The drug has proven itself in the treatment of mild community-acquired pneumonia, including as empirical antimicrobial therapy (therapy started before knowledge of the pathogen and its sensitivity to antibiotics was obtained), as well as in the treatment of pneumonia caused by so-called atypical pathogens (intracellular), on which, according to some data, accounts for up to 40 percent of all cases of community-acquired pneumonia.

In severe forms of the disease with a high probability of bacteremia, azithromycin is used intravenously (in adult patients) or oral azithromycin is combined with cephalosporins or inhibitor-protected penicillins.

Advantages and disadvantages of azithromycin in treatment

The widespread use of azithromycin in the treatment of community-acquired pneumonia is due not only to the sensitivity of most pathogens of lower respiratory tract infections to this drug, but also to its unique features that distinguish macrolides from other groups of antibiotics.

Azithromycin is quickly absorbed into the blood, but remains in the body longer than other antibiotics. This allows you to take it once a day in a short course.

Today, azithromycin is the only one in the world antibacterial drug, the course of which is only three for non-severe respiratory tract infections. In this case, the effect of the drug continues for 5-7 days after the end of the course of treatment.

Another undoubted advantage of azithromycin is its ability to accumulate in high concentrations at the site of infection, in this case in the bronchopulmonary structures. Thus, when taking 500 mg of azithromycin, its concentration in the bronchial mucosa is 200 times, and in bronchoalveolar secretions 80 times higher than the serum concentration.

The disadvantages of the drug include the fact that it is not recommended for use intravenously in children under 16 years of age, and in tablet form in children under 12 years of age, as well as, although not too frequent, but still possible undesirable side effects, including the likelihood of hearing loss with intravenous administration large doses of the drug.

Also, when empirically treating pneumonia, it is important to take into account situations in which infection with pneumococcus resistant to penicillin and macrolides is suspected, which is often found in children and elderly patients.

Directions for use and dosage

The dosage is selected by the doctor individually depending on the pathogen and severity of the disease, tolerability, age and form of release of the drug.

For adults with mild community-acquired pneumonia, 500 mg is usually prescribed once a day. The course of treatment can last from 3 to 7 days.

In case of severe pneumonia requiring hospitalization, azithromycin is administered intravenously at the same dosage for two days, and then switched to oral administration for a total course of 7–10 days.

The dose for children weighing up to 45 kg is calculated based on their weight - 10 mg/kg per day.

Oral forms of drugs should be taken one hour before or two hours after meals. It is also important to maintain equal time intervals between taking the drug, and if missed, strive to take the drug as early as possible.

Contraindications

Azithromycin in tablet form and in the form of intravenous injections is contraindicated in children. Patients in this category (over 6 months) can take it in the form of a suspension.

Also contraindications to the use of azithromycin are severe liver and kidney damage, individual intolerance.

It is used with caution during pregnancy, lactation, arrhythmia, prolonged ventricular complex on the ECG and while taking drugs such as digoxin and warfarin.

Cautions

Antacids and alcohol reduce the absorption of azithromycin. Tetracycline antibiotics, on the contrary, enhance its effect. Azithromycin is incompatible with heparin.

2016-05-02 09:32:21

Katie asks:

Hello! I’m 24 years old, weight 49 kg. I have a 2-year-old child. I had fluography done before pregnancy, everything was fine! And recently I was offered a job, I went for a medical examination! There was a spot on fluorography, they sent me for X-ray. The X-ray says “infiltrative area in the right easy in area s2. Consultation with a phthisiatrician. Sputum analysis "I went to the tubal dispensary. The doctor looked at me, no cough, no temperature! I donated blood, urine, sputum 7 jars, Diaskin test. All tests are good, all sputum is negative (one will be ready in 2 months, I don’t know about BC, I don’t know), the diaskin test was negative. They had an x-ray done, they described “right-sided lobar pneumonia”, they prescribed ceftriaxone injections for 10 days, then for a control shot. I came back 10 days later, they did another x-ray , then a CT scan. The radiologists wrote there was no improvement. The phthisiatrician said there will be a commission, we will prescribe you treatment for tuberculosis!! Of course, I am in shock, in tears!! She don’t worry about me, you are not contagious, the tests are all normal, the sputum is negative, live as you live etc.! They told me to check my husband and child anyway!! While there was a commission, my husband did a fluorography, everything was fine, the diaskin test was negative, the tests were normal!!! I took the child, and on the same day I had to see a phthisiatrician what did they decide about me!!! It so happened that the child had an X-ray, everything was fine. The pain was normal. We went to the children's TB doctor! She says that I came and was diagnosed with TB disease, she says where is your certificate, I say they didn’t give me anything!!! I can’t live without There’s nothing you can do about it, go get a certificate from your TB doctor with a diagnosis and come back! But I looked at the child so superficially, everything is normal!! I haven’t prescribed Diaskin yet!!!
I went to my phthisiatrician that same day and the commission decided that!! I came to her and said give me a certificate, the child cannot be examined properly without it!! She says that at the commission we finally decided that there were improvements, but insignificant, it was still pneumonia! She looked at me, there was no cough, and she tested sputum again that day. She prescribed Azithromycin to come to her for 10 days, the child does not need to be examined yet!!!
I took the pills and came to see her on the 9th day. I donated blood, macular examination, and had an x-ray done! I’m sitting here waiting for a description! And so I go to her, she says that after all, we are diagnosing you with infiltrative tuberculosis, MBT (-). Trial treatment for 2 months until this macrota comes! It is treated at home, go every day to get pills. What does it have to do with I was surprised to receive pills not from them, but from my own clinic. I was still surprised, I said something like this: Why is it in your dispensary? And where? healthy people!! She says that no one will let you into the tuberculosis dispensary!! There are sick people there! And it’s like you’re just starting, and you’re not contagious!!! I’ll take the child to the nursery soon! I don’t have any certificates on hand, I just wrote on a piece of paper that pass it on to the children’s! They didn’t register it, they said that it’s a trial treatment, it all depends on the sputum, which will come in 2 months!
I have a lot of questions: Please tell me something. Help with a word. I’m crying, I feel bad. I’m all at a loss

P.S. This has all been going on for a month now, I feel just as good. There is no cough! I take the temperature in the morning and at night everything is fine. There is no fatigue, because we live alone as a child and no one helps. I do everything at home as I do (And sometimes it seems that I do more out of fear). I eat normally, we have a normal, ordinary family, I’m skinny, so I have no one to be fat, I’ve always been like that.
Questions:
1) Can a diagnosis be made only on the basis of an x-ray? If all tests are normal, there is no cough, the Diaskin test is negative, the sputum is negative!

2) And what does trial treatment mean? (I asked them what would happen in 2 months, how would I take the medicine, they said, if you go through an X-ray, sputum will come to the BC. If it’s negative, then it’s not TBR, but something else. And if the x-ray is normal, then we will let you go and won’t even register you) Is it possible to carry out a trial treatment like this without anything?

3) I read on the Internet that both my husband and child now need to take pills.? (But she didn’t say anything about her husband, she asked that everything was fine with her husband. I said yes. And that was the end of it. She said I’ll see you in 2 months)

4) I’ll take the child soon, I’m absolutely terribly afraid!!! I don’t want to stuff her with pills. Do I have the right to refuse to give her pills now (naturally after the Diaskin test) until my sputum comes, i.e. in 2 months? And can I Should I take her to kindergarten? (My doctor, a phthisiatrician, said that of course you can, who told you that you can’t. Anything is possible) But I’m afraid to go to the nursery right now, I’m shaking all over!!

5) Can I judge by their simple attitude towards me that this is not TB disease, but pneumonia (let’s say)? It’s just not being treated well!! (I asked the nurse at the tuberculosis dispensary. What and why. She says that they decided to kill two birds with one stone with these drugs, that if it’s TBR, then we’ll treat it already, and if it’s pneumonia, then it will go away, because the pills are strong)

6) And is it normal that they made a diagnosis, but didn’t register it? Or are they just not sure?

7) And for some reason they didn’t schedule me for a bronchoscopy?! Should I insist that they send it? Or is it not obligatory for me?

I haven’t refused treatment, I’ll take the pills. Because I’m worried. They say it’s at a very early stage, so it’s better to start sooner than later!!
I’m just really worried!!! Can I just make a diagnosis based on X-rays?! And even get the pills in my clinic!! There are a lot of contradictions with such a disease!

Answers Agababov Ernest Danielovich:

Hello, I will answer you in the same order. 1) They can. 2) The effectiveness of initial therapy cannot be assessed immediately; after 2 months, in the absence of proper dynamics, 2nd line drugs are prescribed. 3) In your case, you can do without it. 4) Of course you have the right, but if a pediatric TB specialist assesses the situation as necessary to prescribe therapy or chemoprophylaxis, I assure you that this is a lesser evil than leaving everything at chance, it’s difficult for me to judge without seeing you, trust your doctor. 5) You can’t, people like your case are not alone and the choice of such tactics is the most acceptable. 6) It’s difficult to judge without delving into your situation, because I don’t see any documentation or examination results; no one except the attending physician will answer this question. 7) This examination method is not always prescribed, since there are parts of the lungs where bronchoscopy cannot objectively visualize the picture. If you have any more questions, you can write to me by email. [email protected]

2016-04-11 13:59:17

Elena asks:

I have a son, 19 years old.
1. First rise in temp. up to 39 C was at the beginning of January 2016, they shot down the special ones. help, 2nd day 38.4, 3rd and 4th - dropped to normal.

2. The second increase in temperature to 39.9 from 02/08/2016. Hospitalization to the infectious diseases department with DS: ARVI, Influenza, hilar pneumonia was not confirmed by CT tomogram. Prescribed: Relenza, ceftriaxone, levomak, azithromycin, rheosorbilact and drugs that reduce the rate. Organs abdominal cavity and kidneys - without structural changes. Discharged on February 19, 2016 with normal temp.
3. In the next two weeks after discharge, I froze.
4. Third rise in temperature: 03/02/2016 to 39 and even to 40.5 (single). Done laboratory research: Chlamydia - negative, Toxoplasma - negative, Hepatitis A, B, C- negative, ECHO of the heart - no additional structures were found on the valves, deflection of the anterior wall by 4 mm, ultrasound of the abdominal organs - enlarged liver and spleen (splenomegaly), which is observed throughout the entire treatment period, Antinuclear bodies (ANA-9) - all negative, MRI goal. brain - no pathology detected, ultrasound thyroid gland- no pathology was detected, analysis of bone marrow punctunate - leukemoid reaction of the neutrophilic type, HIV - negative, increased Aspartaminotransphenase 46.6, Alanine aminotransphenase - 97.9, Gammaglutamyltransphenase - 215, Total cholesterol - 6.91 (there are laboratory tests from Eurolab), Anti-CCP - 28, 31 (by March 29 - already 42, 69), Herpes type 6 was detected (5 copies of DNA), treated for 10 days with cymevene - twice 500 ml/day, not detected in subsequent analysis. S-RB - 102, Antistreptolysin 03/09/16 - 315, and 03/29/2016 - 244. MRI done knee joints- initial degenerative changes. Due to hypotremia, Solumedrol was introduced for 7 days at a dose of 165 mg/day, stopped for a day, and therefore an acute knee pain and a rise in temperature, administered at a dose of 80 mg/day, now taking Metypred 32 mg per day. When trying to reduce it to 24 mg/day, the temperature rose to 38.2, but returned to 32 mg/day. MRI of the knees. sust. - initial degenerative-dystrophic changes. Rheumat. factor - 2.57 on March 13, 2016 and 2.50 on March 29, 2016. AT to double-stranded DNA - 1.00. Analysis for Ferritin from March 29, 2016 - 195, for C-reactive protein - 9.3, Procalcitonin

Answers Vasquez Estuardo Eduardovich:

good day, Elena! Based on your description, it is clear that there is a violation of the immune status, which makes it difficult to make a specific diagnosis. Still's syndrome currently looks like the most likely and leading diagnosis; its clarification will depend on further observation.

2016-02-16 20:06:26

Anna asks:

Hello. For 5 days the temperature was 37.5-37.7. One night it was over 38.5. After examination by a doctor, a diagnosis was made: bronchopneumonia. On the same day, I did a fluorography and was diagnosed with left-sided lower lobe pneumonia. Treatment was prescribed: cefuroxime 2 times a day (after the 4th injection I lost consciousness, but after that it didn’t happen again), Langes, Linex, loratadine, and a drip was put on. Eight days - cefuroxime, three days - azithromycin. On the 5th-6th day of treatment, sharp pain in the left side under the ribs. They prescribed rectodelt 1 suppository, plasmol, declofenac suppositories. The pain changed from acute to muted and only during coughing. Plus I also did inhalations with Borjomi and Ventolin. 4 sessions of drainage massage. 10 injections of plasmol. After antibiotic injections, she took cardonate and moltafer.
My general condition has become much better. The sick leave was closed and I went back to work. Two days later the pain in my side returned and became much worse. Terrible acute pain when coughing, with any movement, just when inhaling and exhaling.
Tell me, what could be the cause of the pain? Which specialist should I contact?

Answers:

Hello Anna! The most likely causes of pain are pleurisy (as an exacerbation of pneumonia), myositis (inflammation of the muscles chest as a result of hypothermia), intercostal neuralgia and osteochondrosis thoracic spine. Go to an appointment with a therapist - to determine the actual cause of the pain, an examination is necessary (examination, general clinical blood test, x-ray of the chest and spine). Take care of your health!

2016-01-12 14:17:16

Elena asks:

Good afternoon Back in September, my child and I fell ill with a cold, then a cough began - dry and infrequent, and I was bothered by congestion in the chest. The doctors heard nothing when listening, they said it was a residual cough. Then, somewhere at the end of October, the doctor listened and prescribed the antibiotic azithromycin. After the antibiotic, the cough became less, but did not go away completely. I drank licorice syrup, breast milk, put on mustard plasters, but the cough remained. At the end of December, I had an appointment with another therapist, she heard wheezing and said that it was an allergic cough with obstruction. She prescribed salbroxol and neophylline. After the neophylline tablet it was very bad feeling, the temperature rose to about 37, which remains until today. Before this there was no temperature. December 21, flu without pathology. In January, another therapist listened to hard breathing and prescribed Augmentin. I took it for 7 days, the temperature remained. There was practically no cough, there was chest pain, headache and a temperature of 36.8-37.1. Today, based on the results of a repeated flu, a diagnosis of left-sided pneumonia was made (in the lower part, a site of peribronchial infiltration is identified medially). The radiologist reviewed the previous image and said that this area was also visible on it, it was just not noticed and that in the new image it is clearer. What does this mean, and in general, was the diagnosis made correctly if there is no effect at all from Augmentin? They are very worried that there will be no oncology, because... the symptoms are alarming. Thank you for listening.

Answers Medical consultant of the website portal:

Hello, Elena! It's time to get an X-ray or CT scan of the chest. Fluorography is a screening method and changes in the fluorogram are a reason for further thorough examination. In addition to radiography/CT, indicated general analysis blood with a leukocyte formula, you may need an in-person consultation with a phthisiatrician and other tests/research/consultations, the need for which will be determined by the examination. Discuss your screening plan with your GP. Take care of your health!

2015-02-17 18:08:46

Zhanara asks:

Hello! For my husband, it all started with the flu, then he suddenly began coughing, chest pain when coughing, phlegm, and a temperature of 38.5 lasted for about 5 days. They knocked her down, then she got up again. We live in the States, and here they did not give him an X-ray or any additional tests. Based on the symptoms and listening to the chest, a diagnosis of pneumonia was made. I took Azithromycin for 5 days. Expectorant syrup made from honey and turnip juice. A week after starting antibiotics, she feels much better, her temperature is normal, her cough is drier and less frequent. There is no particular weakness. But at night he sweats a lot 1-2 times, and during the day under some kind of stress (doing some work, reading, etc.). Please tell me, is this normal? And how long will this last? When can I return to normal activities (he is a student)? Doing sports? How to strengthen your immune system? And what preventive measures do you recommend? We are planning to start taking probiotics. Thank you very much in advance for your answer.

Answers Shidlovsky Igor Valerievich:

Zhanara, good evening! X-ray is required. Why not ask your doctor these same questions? It's hard to say something in absentia. Probiotics are possible. Multivitamins are okay. Light sports are possible. Herbal immunostimulants and adaptogens (ginseng, echinacea, etc.).

2014-08-15 20:36:30

svitlana asks:

Good evening! 12 days ago, the illness began with a sore throat, aches throughout the body and a headache.

At the same time, I went to work (air conditioning), drank Theraflu, MA to improve my condition at work. I drank raspberry tea at home. At the same time I was very weak, and with the last effort I carried myself to work.
On the 5th day, the voice disappeared, it was not the throat that hurt, but the larynx with a feeling of a lump in the throat, a strong painful cough appeared. The temperature rose, yellow sputum was coughed up, I drank milk with honey - it became easier to breathe with soda.
I called a doctor I know from another city, described the symptoms, prescribed azithromycin (I took it for 6 days) and Erespal, but it’s better to go to the doctor, of course, he said. On the 4th day after taking the antibiotic, the temperature dropped, even very much (36 in the morning)
The cough continued, at night I even felt a gurgle in my lungs, in the morning I was sweating and now too.
I went to the doctor, listened, said bronchitis, prescribed me to continue taking azithromycin, erespal, bronchophyte tea, and do a fluorography, which was done only a day later.
In the picture, the doctor saw right-sided pneumonia (I don’t remember the exact name), and they admitted me to the hospital.
And in the hospital, the doctor, looking at the picture and the nature of the pneumonia, diagnosed tuberculosis and sent me to the tuberculosis clinic.

At the tuberculosis dispensary they said that you first need to undergo treatment, take a sputum test, take another picture and only then send it to them.
I returned to the hospital, and the attending physician told me that she would treat me, but would still end up in a tuberculosis dispensary (taking into account her many years of experience).
For two days I have already been injected with levoflxacin (100), dexamethasone, asparkam, riboxin, lazolvan, vitamin C, loraxone, lidocaine.
I feel better, the cough is slight, they gave me a jar to collect sputum, but now I don’t even have one, what I cough up a little is immediately swallowed.
1) I’m very scared, please tell me, is it possible to diagnose tuberculosis based on the image?
2) Can tuberculosis develop so quickly? Before this I didn’t have a cough, I didn’t even get sick with ARVI for more than six months?
3) I was admitted in the evening, the doctor on duty saw me, prescribed me medicine, after looking at the picture, he just asked if I had suffered from tuberculosis before, they immediately gave me a puncture.
In the morning, the head of the department, seeing the picture, immediately sent me, sick on my own legs, to the tuberculosis dispensary.
Did the doctor - the head of the department - behave correctly?
Thanks for the answer.

Answers Veremeenko Ruslan Anatolievich:

Hello! It could be viral infection. Consult your local physician for advice.

X-rays can be used to diagnose pulmonary tuberculosis.
But!!! You should be treated in a hospital for 2 weeks for pneumonia, during this period your sputum should be examined for the presence or absence of Mycobacterium tuberculosis, if it is found, send it to tuberculosis dispensary. If it is not there, after 2 weeks of antibiotic therapy, take an X-ray of the chest organs and undergo general tests.

2013-11-07 22:30:13

Julia asks:

Hello.
For several years now I have been trying to recover from white discharge. From time to time I have itching during sexual intercourse in the vagina and after sexual intercourse there is pain when urinating.
She took tests for vaginal flora and urine culture.
Results:
urine:
E. Coli Moderate growth 10^4
Enterococcus faecalis Moderate growth 10^4
Klebsiella Moderate growth 10^4

Antibioticogram for Escherichia coli
Amoxiclav is sensitive
Sulfafurazole is sensitive
Furagin is sensitive
Furadonin is sensitive
Pipemidic acid is slightly sensitive
Ciprofloxacin is sensitive
Ofloxacin is sensitive
Co-trimoxazole is sensitive
Fosfomycin is sensitive

Nitroxoline is sensitive
Azithromycin is sensitive
Cefixime is sensitive

Antibioticogram for Enterococcus faecalis
Amoxiclav is sensitive
Sulfafurazole is stable
Furagin is sensitive
Furadonin is sensitive
Pipemidic acid is stable
Ciprofloxacin is sensitive
Ofloxacin is sensitive
Co-trimoxazole is sensitive
Fosfomycin is sensitive
Nitroxoline is stable
Nalidixic acid is stable
Azithromycin is slightly sensitive
Cefixime is sensitive

Antibioticogram for Klebsiella pneumonia Amoxiclav is resistant
Sulfafurazole is stable
Furagin is slightly sensitive
Furadonin is slightly sensitive
Pipemidic acid is sensitive
Ciprofloxacin is sensitive
Ofloxacin is sensitive
Co-trimoxazole is sensitive
Fosfomycin is sensitive
Nitroxoline is slightly sensitive
Nalidixic acid is sensitive
Azithromycin is sensitive
Cefixime is sensitive

from the vagina:
Isolated: Lactobacillus 10^5 CFU and Enterobacter aerogenes Antibioticogram for Enterobacter aerogenes Amoxicillin is slightly sensitive
Azithromycin is slightly sensitive
Doxycycline is sensitive
Ofloxacin is sensitive
Roxithromycin is slightly sensitive
Ceftriaxone is sensitive
Ciprofloxacin is sensitive
Cefixime is sensitive
Ceftibuten is sensitive
Clarithromycin is slightly sensitive
Levomycetin is sensitive
Klebsiella pneumoniae bacteriophage purified (Perm) resistant
Klebsiella bacteriophage polyvalent purified (Ufa) resistant
Bacteriophage coli-proteus (Nizhny Novgorod) is resistant
Intesti-Bacteriophage (Perm) is resistant
Piobacteriophage complex (Nizhny Novgorod) is sensitive

Chlorhexidine is sensitive
Miramistin is stable
Dioxidin is sensitive
Eleflox is sensitive
Clotrimazole is resistant
Chlorophyllipt stable
Metronidazole is stable

Tsiprobay was prescribed for 10 days, after Canephron for 14 days, and Terzhinan in the vagina.
the symptoms remained.

What kind of diseases are these, what else needs to be tested, why did the treatment not help me?