A.N. Grazian

Department of Clinical Pharmacology GOU VPO RGMU, Moscow

Infection respiratory tract are the most frequent pathology in the human population, children are sharp respiratory diseases up to 90% of all cases of infectious incidence.
Basically, respiratory infections are common and are common cause of hospitalization, as well as chronic inflammatory diseases with inadequate treatment in outpatient conditions. Bacterial infections of the respiratory tract occupy a leading place among all diagnosed infectious processes, so the main component of treatment for diseases of the respiratory organs is antibiotic therapy.
In the etiologists of non-hospital, that is, the child developed in the usual living conditions, bronchitis and pneumonia, takes part quite a large spectrum of pathogens. Currently, depending on the nature clinical manifestations Complete bronchitis and pneumonia are customary to share on typical and atypical.
For a typical occurrence, a sharp beginning with a pronounced fevering reaction, intoxication, cough and pronounced physical manifestations, which is usually due to the presence of pneumococcus (Streptococcus Pneumoniae), Moraxella (Moraxella Catarrhalis) and hemophilic sticks ( Haemophilus influenzae.).
For an atypical course of the disease, a small-axipty subacute start, with a normal or subfebrile temperature, lack of intoxication, is characterized. The most typical symptom is a dry unproductive obsessive cough. The causes of atypical communities respiratory infections They are chlamydia (chlamydia pneumoniae) and mycoplasma (Mycoplasma pneumoniae). Obviously, the etiological significance of chlamydia (Chlamydia Pneumonia) and mycoplasm (Mycoplasma pneumoniae), which are intracellular causative agents of infections, is much higher than previously supposed. Mycoplasma and chlamydial etiology of bronchitis and pneumonia in children can currently be from 25 to 40%, and it is highest in the first year of life and after 10 years. A peculiarity of intracellular pathogens is their insensitivity to traditional antibacterial therapy, so mycoplasma and chlamydial infections often acquire a protracted or recurrent flow.
The testimony for the purpose of antibiotics in respiratory disease should be considered clinical signs indicating the bacterial nature of the inflammatory process (mucous-purulent and purulent nature of sputum) together with severe intoxication and long-term hyperthermia (more than 3 days). The prolonged course of the disease, especially if the intracellular nature of the pathogen is suspected, is also an indication of antibacterial therapy.
The most widely in the treatment of respiratory infections in pediatric practice Currently, antibiotics belonging to groups of penicillins, cephalosporins and macrolides are used.
Semi-synthetic penicillins wide spectrum actions (amoxicillin, co-amoxiclav) and generation cephalosporins (cefaclor, cefuroxime axetil) are effective against the most likely pathogens of non-hospital bronchitis and pneumonia (S. Pneumoniae, H. Influenzae, M. Catarrhalis) belong to the most secure groups of antibiotics and all have Oral shapes. With a typical picture of the disease (high temperature, intoxication, cough, pronounced physical changes in the lungs) they are considered as selection preparations.
At the same time, as all beta-lactam antibiotics, penicillins and cephalosporins do not affect intracellular causative agents (chlamydia, mycoplasms) and more often than antibiotics of other groups cause allergic reactions Therefore, modern macrolides in the treatment of over-country respiratory tract infections make them serious competition.
With atypical manifestations of the disease (normal or subfebrile temperature, the lack of clear intoxication and shortness of breath, the inexpressiveness of physical data in the presence of a stubborn, dry or unproductive cough cough cough) of the drugs of choice are macrolides.
The first antibiotic group of macrolides - erythromycin was synthesized in 1952 and for the real day is widely used in clinical practice For the treatment of respiratory tract infections, skin and soft tissues. Macrolred antibiotics for several decades were presented in the clinic only erythromycin and synthesized by a slightly later oleandomycin (lost its clinical significance) and spiramycin. The widespread use of erythromycin quickly led to the appearance of erythromycino-resistant stamps of staphylococcus, which, in combination with messages about the poor bioavailability of the drug due to inactivation in the acidic stomach, led to the interest of doctors to it. In the 70s and 1970s, attention to the macrolids sharply increased dramatically, which was due to intensive study of the role of intracellular causative agents of diseases, as well as the opening of Helicobacter ( Helicobacter pylori.) infection. At the same time, an increase in the number of strains of microorganisms producing β-lactamase has led to a decrease in the activity of "traditional" penicillins. All this stimulated the development and introduction into the clinical practice of new macrolidal antibiotics with improved (compared to erythromycin) microbiological and pharmacokinetic parameters, as well as best tolerance. For macrolides, the period of "Renaissance" came - especially in pediatric practice, where they won recognition due to high efficiency, safety and ease of use.
One of the most attractive representatives of the Macrolid Group, in terms of choosing an antibiotic for the treatment of respiratory infections in pediatric practice, is azithromycin (Sumamed).
Azithromycin is a semi-synthetic antibiotic, a representative of the group of "new" macrolides, which was synthesized in 1983 by incorporating the nitrogen atom into a 14-membered lactone ring erythromycin. 15-membered azithromycin according to the structure of the molecule is significantly different from other macrolides - it is even isolated into a separate subgroup of azalides (which is the only one).
Azithromycin is a broad spectrum antimicrobial activity that includes Gram-positive and Gram-negative (Haemophilus influenzae, Moraxella catarrhalis, Bordetella pertussis, Bordetella parapertussis, Campylobacter jejuni, Legionella pneumophila, Neisseria gonorrhoeae, Gardnerella vaginalis) microorganisms anaerobes (Bacteroides bivius, Peptostreptococcus spp., Peptococcus, Clostridium Perfringens), Chlamydia (Chlamydia Trachomatis, Chlamydia Pneumoniae), Mycobacteria (Mycobacteria Avium Complex), Mycoplasma (Mycoplasma Pneumoniae), Ureaplasma, spirochetes (Treponema Pallidum, Borrelia Burgdorferi).
However, azithromycin is in first place among macrolides in activity with respect to H. Influenzae, M. Catarrhalis, N. Gonorrhoeae, B. Melitensis, R. Rickettsii, including their beta-lactomasoproduction strains. In terms of H. influenzae, it is inferior to aminopenicillins and cephalosporins, but surpasses erythromycin in 2-8 times. Azithromycin in vitro is slightly more active than erythromycin against chlamydia, mycoplasmas and ureaplasm, he is somewhat more active in relation to Legionell. However, in vivo, the effectiveness of azithromycin in relation to these intracellular pathogens is many times higher due to its extremely high ability to penetrate the cells.
Forzitromycin, as for other macrolides, is characterized by a post-libeotic effect, that is, the preservation of the antimicrobial effect of the drug after it is removed from the medium.
Azitromycin, like other macrolides, also has a sub-MPK-post-proteotic effect, i.e., under the action of azithromycin at a concentration, even below the IPC, microorganisms, including the antibiotic (for example, a blue chopstick), become more sensitive to immune protection factors. Azithromycin exhibits a post-proteotic and sub-MPK-post-libeotic effect in relation to S. pyogenes, S. Pneumoniae, H. Influenzae, L. Pneumophila.
Azithromycin, like other macrolides, has anti-inflammatory and immunomodulatory action. To the greatest degree of anti-inflammatory action allows you to implement a long reception. Macrolids increase the activity of T-killers and enhance the phagocytic activity and migration of macrophages into the focus of inflammation. The presence of anti-inflammatory effect in azithromycin is successfully used in patients with cystic fibrosis that do not respond to standard therapy.
Macrolids are mainly administered orally and well absorbed from the intestine. The suction of azithromycin occurs quickly, the maximum plasma concentration is achieved in 2-4 hours. Due to the good solubility in lipids, azithromycin easily penetrates into tissues and biological fluids, and its significant part is absorbed by polymorphoid leukocytes and macrophages. Phagocytes, "loaded" azithromycin, during migration transport it to the focus of inflammation, where the antibiotic concentration is created by 24-36% higher than in healthy tissues. By the ability to penetrate the histohematic barriers (except the hematorecephalic) azithromycin exceeds beta lactams and aminoglycosides. Among the macrolides, azithromycin creates the highest tissue concentration (10-100 times greater than whey), therefore it is low in the blood plasma. In the highest concentrations, azithromycin is found in almonds, middle ear, putty sinuses Nose, lungs, bronchial secretion, alveolar fluid, lymph nodes, liver, kidneys, in smaller (however, more than 10 times larger than whey) - in muscle and adipose tissues. After 24-96 hours after accepting azithromycin, its concentration in the mucous membrane of the bronchi is 200 times, and in the bronchial secret - 80 times the serum.
In azithromycin among macrolides, the longest half-life (T1 / 2) period is 35-50 hours, with multiple reception - up to 48-96 hours, which allows you to prescribe an antibiotic 1 time per day. The half-life of the tissue is much larger. The therapeutic concentration of azithromycin in tissues is preserved up to 5-7 days after cancellation (erythromycin - within 1-3 days). Macrolids are subjected to biotransformation in the liver with the participation of cytochrome P-450 and are outlined with bile in the form of active or inactive metabolites and unchanged. Azithromycin is metabolized to a small extent (in connection with which it does not affect the metabolism of other drugs). 50% of the drug is distinguished with bile in a unchanging form and about 6% is allocated with urine.
Despite the extraordinary tissue and intracellide accumulation inherent extraordinary tissue and intracellide accumulation, the whole group is non-toxic and safe antibiotics, which is explained by their unidirectional action with protective mechanisms of macrodganism. The total frequency of development of side effects of azithromycin in children is about 9% (when using erythromycin - 30-40%). The frequency of side effects requiring the abolition of the drug is 0.8%. In the double-blind study of the tolerance of azithromycin, conducted in 2598 children, side effects 8.4% of patients were observed. They met significantly more often in children who received comparison drugs (12.9%) - co-amoxiclav, ampicillin, phenoxymethylpenicillin, cephalexin, cefaclor, doxycycline, dyloxacillin, fluxacoccillin, josamamicin and erythromycin.
In 5% of children during the treatment with azithromycin, light or moderate abdominal pains, nausea, vomiting or diarrhea (with erythromycin reception and other 14-membered drugs, which are stimulants of motiline receptors, it occurs significantly more often).
Unwanted effects on the part of the central nervous and cardiovascular systems are not familiar and occur in less than 1% of cases.
In contrast to therapy by beta-lactam antibiotics, dysbacteriosis and associated complications in the treatment of azithromycin are uncharacteristic, since it, like the remaining macrolides, does not affect the normal intestinal microflora.
Allergic reactions to azithromycin are found in less than 1% of cases, while on penicillins they develop at 10%, and on cephalosporins - in 4% of cases. Allergic reactions developed for 3-4 weeks are described. After canceling azithromycin. There is a cross-allergy with other macrolides.
Azithromycin is contraindicated with increased sensitivity to macrolides, liver failure, in the first trimester of pregnancy (except in cases where the expected benefit for the mother exceeds the potential risk to the fetus) and during breastfeeding period.
The overwhelming majority of clinical studies of azithromycin was devoted to the study of its effectiveness in the infections of the upper and lower respiratory tract.
From 1991 to 2001, the effectiveness of azithromycin in the infections of the upper respiratory tract was studied in 29 studies in general in 7,240 patients, including 4,263 children. In 5 studies (N \u003d 1687), the effectiveness of a 3-day course of azithromycin therapy was studied, and roxitromycin, clarithromycin, co-amoxyclove or cefaclor for 7-14 days were used as comparison preparations. In three studies, azithromycin on clinical and bacteriological efficacy was comparable to comparison preparations, and 1 - superior to them. In 1 study, the results of the 3- and 5-day course of the azithromycin treatment were evaluated, which were comparable.
For 10 years, the effectiveness of azithromycin in the infections of the lower respiratory tract was studied in 29 large randomized controlled studies in 5,901 patients, including 762 children. In 12 studies, patients with various infections were included, in 9 - patients with exacerbation chronic bronchitis, In 9 - patients with pneumonia. In 22 studies, the effectiveness of a 3-day course of azithromycin therapy, in 5 - 5-day, in 2-step therapy (intravenously, and then inside) and in 1 - one-time reception. Macrolides (erythromycin, clarithromycin, roxitomycin, diritromycin), in 13 - penicillins (co-amoxicllaw, amoxicillin, benzylpenicillin), in 4 - oral cefuralosporins (cefaclor, cefuroxime, cefuroxy, Cefuroxy, in 1 - Fluoroquinolones (Moxifloxacin). Most often (9 studies) azithromycin was compared with co-amoxyclav. The duration of the use of comparison drugs was usually 10 days. The effectiveness of both 3-day and 5-day azithromycin therapy courses was high and in most studies turned out to be comparable with the effectiveness of 10-day courses of comparison drugs. In 5 studies, azithromycin exceeded comparison preparations (co-amoxiclav, erythromycin, benzylpenicillin and cefibutene). The portability of therapy in the main and control groups was generally comparable, although in 4 studies azithromycin caused undesirable effects less frequently than co-amoxiclav or cefuroxime Axietyl. The difference was mainly due to the lower frequency of gastrointestinal disorders. In no study, azithromycin on tolerance was not inferior to comparison drugs.
The effectiveness of azithromycin in the infections of the lower airways in children, such as acute purulent bronchitis and community-hospital pneumonia, as high as adults. The results of comparative controlled studies indicate that under clinical efficacy, which exceeds 90%, azithromycin with such infections is not inferior to erythromycin, josamicin, co-amoxyxiklava and cefaclor. In a multicenter double-blind study, a high efficiency of azithromycin with mycoplasma pneumonia in children was revealed.
With community-friendly pneumonia in children (39 people received azithromycin 10 mg / kg 1 time per day and 34 - co-amoxiclav 40 mg / kg in 3 reception) clinical efficacy was 100 and 94%, respectively.
In a comparative study of azithromycin (10 mg / kg 1 time per day) and co-amoxiclava (40 mg / kg in 3 receptions), 97 and 96 children with infections of the lower respiratory tract, clinical efficiency amounted to 97 and 96%, respectively. At the same time, in children who received azithromycin, recovery occurred reliably faster, and the frequency of side effects of therapy was less.
In general, it is shown to compare the effectiveness of a short course of azithromycin and traditional courses of treatment. complete Pneumonia in children.
Certificate of high efficiency of short azithromycin courses (3-day course when appointing inwards 1 times a day, 500 mg of adults and 10 mg / kg children) in the treatment of acute infections of the upper and lower respiratory tract of various localization are the results of prospective incomparable examination of the drug in 235 medical centers In 1574 adults and 781 children. The cure or rapid improvement was observed in more than 96% of cases, the eradication of pathogens is 85.4%.
Azithromycin, prescribed on the first day at a dose of 10 mg / kg, and in the next 4 days - 5 mg / kg, led to clinical cure and eradication of B. pertussis with cough in children. In a comparative controlled study, it was found that the bacteriological efficacy of azithromycin (10 mg / kg per day for 5 days) exceeds erythromycin (40-50 mg / kg per day for 2 weeks) - 100 and 89%, respectively.
Finally, azithromycin shows the best "treatment commitment" (complence) not only among macrolides, but also compared to the preparations of other groups, as it is used only 1 time per day, on average within 3 days. It is of great importance, since the smaller the multiplicity of admission and shorter the course of treatment, the greater the number of patients it is capable of complying with the prescribed mode of antibiotic therapy. In pediatric practice, organoleptic properties of the drug (the taste of suspensions, their consistency, homogeneity) is also significant effect on the treatment compliance. In two double-blind studies, azithromycin suspension was one of the most preferred antibiotic suspensions.
Thus, azithromycin, the first representative of 15-membered macrolide antibiotics (azalides), can be considered as one of the drugs for selecting therapy of non-hospital infections of the respiratory tract in children and as a preparation of the first row in the event that there is reason to consider the disease caused by intracellular causative agents. Compared to erythromycin, azithromycin is more active against the gram-negative flora (especially H. influenzae), it does not destroy in the acidic stomach environment, it creates higher and stable concentrations in the tissues, has a long half-life period (which makes it possible to a single reception of the drug per day), is used short a course (3 or 5 days), rarely causes unwanted reactions and medicinal interactions. The use of azithromycin can significantly simplify treatment, improve the "adherence to treatment" and, therefore, increase the effectiveness of antibacterial therapy.

Literature
1. Acute respiratory diseases in children: treatment and prevention / scientific-practical program of the Russian pediatrician union ed. Acad. Ramne A.A. Baranova. M.: 2002.
2. Medicine Guide. Diagnostics and therapy / ed. R. Berkou. M.: 1997; 1: 449-450.
3. Samshygin G. A., Zaitseva O. V., Brasnina N. P., Kazyukova T. V. // Pediatrics. 1998; 3: 50-53.
4. Samshygin G. A., Okhlopkov K. A., Suslova O. V. Disease of the respiratory organs in children. Mater. conf. M.: 21-22.09.99: 112.
5. Belousov Yu.B., Shatunov S.M. Antibacterial chemotherapy. 2001; M.: Remedium, 2001.
6. Mizernitsky Yu.L. .Soroin E.V. Macrolides in the infections of the respiratory tract in children: modern ideas about the mechanisms of action // Sonsilium-Medicum 2006; eight.
7. Lukyanov S.V. Clinical pharmacology macrolides // Consilium Medicum 2004; 6: 10: 769-773,
8. Lukyanov S.V. Pharmacology I. clinical application azithromycin in children // Consilium Medicum 2005; 07: 1.
9. Equi A., Balfour-Lynn i.M., Bush A., Rosenthal M. Long Term Azithromycin in Children With Cystic Fibrosis: A Randomized, Placebo-Controlled Crossover Trial // Lancet 2002; 360: 978-984.
10. Hopkins S.J. Clinical Toleration and Safety of Azithromycin in Adults and Children // REV CONTEMP PHARMACOTHER 1994; 5: 383-389.
11. Moiseev S.V., Levshin I.B. Azitromycin: old and new testimony. Wedge. Pharmal and Ter 2001; 10: 5.
12. Stachinsky L.S., Kozlov S.N. Macrolids in modern clinical practice. http://www.antibiotic.ru, 09/27/2007.
13. Tredway G., Goyo R., Suares J. et al. Comparative Study of Azithromycin And Amoxicillin / Clavulanic Acid (Co-Amoxiclav) in the Treatment of Community-Asquired in Peadiatric Patients. Zithromax Icmas Poster Book. 1996; p. 82-83.
14. Stachinsky L.S., Zharkova L.P., Kvirkvelia M.A. and others. Treatment of community-hospital pneumonia in children with a short-term azithromycin rate // Pediatrics 1997; 5: 91-96.
15. Foulds G, Johnson RB. Selection of dose regimens of azithromycin. J Antimicrob Chemother 1993; 31: Suppl E: 39-50.
16. Budanov S.V. Azitromycin (Sumamed): the main properties and features of the use of non-hospital pneumonia // Antibiotics and chemotor 2000; 10: 28-37.
17. Karpov O.I. Compliance of antibiotic therapy of respiratory infections // Antibiotics and chemotor 1999; 8: 37-45.

This article allows you to familiarize yourself with the instructions for the use of the drug. Azithromycin. The reviews of site visitors - consumers of this medicine are presented, as well as the opinions of medical professionals in the use of azithromycin in their practice. A big request to more actively add your reviews about the preparation: helped or did not help the medicine to get rid of the disease, which complications were observed and side effects, possibly not stated by the manufacturer in annotations. Analogs of azithromycin in the presence of available structural analogs. Use for the treatment of angina, pneumonia and other infections in adults, children, as well as in pregnancy and breastfeeding.

Azithromycin - Antibiotic wide range of action. He is a representative of the subgroup of macrolide antibiotics - azalides, acts bacteriostatically. When creating in the hearth inflammation of high concentrations has a bactericidal effect.

Acts on off-and intracellular causative agents. The azithromycin is sensitive gram-positive and gram-negative microorganisms; Some Anaerobic Microorganisms: Bacteroides Bivius, Clostridium Perfringens, PepTostReptococcus SPP; And also Chlamydia Trachomatis, Mycoplasma Pneumoniae, Ureaplasma Urealyticum, Treponema Pallidum, Borrelia Burgdorferi. Azithromycin is not active against gram-positive bacteria resistant to erythromycin.

Activities also in relation to Toxoplasma Gondii.

Pharmacokinetics

Azithromycin is quickly absorbed from the gastrointestinal tract, which is due to its resistance in an acidic environment and lipophilicity. Azithromycin penetrates well into the respiratory tract, organs and tissues of the urogenital tract (in particular in prostate gland), in the skin and soft fabrics. The ability of azithromycin to accumulate mainly in lysosomes is especially important for the elimination of intracellular causative agents. It has been proven that phagocytes deliver azithromycin to the location of the infection, where it is released in the phagocytosis process. The concentration of azithromycin in the foci of infection is reliably higher than in healthy tissues (on average by 24-34%) and correlates with a degree of inflammatory edema. Despite high concentration In phagocytes, azithromycin does not have a significant effect on their function. Azithromycin is preserved in bactericidal concentrations within 5-7 days after receiving the last dose, which made it possible to develop short (3-day and 5-day) courses of treatment. In the liver dememilated, the resulting metabolites are not active. 50% is excreted with biliary in a constant form, 6% - kidneys.

Indications

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

• infections of the upper heights of the respiratory tract and ENT organs (sinusitis, sinusitis, tonsillitis, pharyngitis, middle otitis);
• scarlet fever;
• infections of the lower respiratory tract (incl. caused by atypical pathogens);
• skin and soft tissue infections (face, impetigo, secondary infected dermatoses);
• infections of the urogenital tract (uncomplicated urethritis and / or cervicitis);
• lyme disease (borreliosis), for treatment initial stage (Erythema Migrans);
• gastric Diseases I. duodenal gutassociated with HelioBactCr Pylori (as part of combined therapy).

Forms of release

Tablets coated with film shell 250 mg and 500 mg.

Capsules 250 mg and 500 mg.

Instructions for use and dosage

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

Adults in the infections of the upper and lower respiratory tract - 500 mg per day for 1 reception within 3 days (term dose - 1.5 g).

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

For acute infections The urinary organs (uncomplicated urethritis or cervicitis) is 1000 mg once.

In case of lyme disease (borreliosis) for treating the 1st stage (Erythema Migrans) - 1000 mg on the first day and 500 mg daily from 2 to 5 day (term dose - 3 g).

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

In the treatment of Erythema Migrans in children dose - 1000 mg on the first day and 500 mg daily from 2 to 5 day.

Side effect

• diarrhea;
• nausea;
• abdominal pain;
• dyspepsia (meteorism, vomiting);
• constipation;
• anorexia;
• a change in taste;
• candidation of the mucous membrane of the oral cavity;
• heartbeat;
• pain in the chest;
• dizziness;
• headache;
• drowsiness;
• neurosis;
• sleep disturbance;
• vaginal candidiasis;
• rash;
• swelling quinque;
• itching skin;
• hives;
• conjunctivitis;
• increased fatigue;
• photosensitization.

Contraindications

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

Application in pregnancy and breastfeeding

It can be used during pregnancy, when the benefits of its application significantly exceeds the risk that exists always when using any drug during pregnancy.

If it is necessary to appoint the drug during the lactation, it is necessary to resolve the issue of cessation of breastfeeding.

special instructions

In the case of a dose acceptance, the missed dose should be taken as early as possible, and the subsequent - with an interval of 24 hours.

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

Medicinal interaction

Antacids (aluminum and magnesium containing), ethanol (alcohol) and food slow down and reduce absorption. With the joint appointment of warfarin and azithromycin (under normal doses), the prothrombin time changes were not identified, however, given that in the interaction of macrolides and warfarin, it is possible to strengthen the anticoagulative effect, patients need careful control of prothrombin time.

Digoxin: increasing the concentration of digoxin.

Ergotamine and Dihydroergotamine: Strengthening toxic action (Vazospasm, Diesesthesia).

Triazoles: reduced clearance and an increase in the pharmacological effect of triazolam. Slows down elimination and increases plasma concentration and cycloserine toxicity, indirect anticoagulantov, methylprednisolone, felodipine, as well as drugs subjected to microsomal oxidation (carbamazepine, terphelanadine, cyclosporine, hexo-barbital, alkaloids of springs, rolling acid, dyspeciramide, bromocriptine, phenytoin, oral hypoglycemic drugs, theophylline and other xanthin derivatives) - due to inhibition Microsomal oxidation in hepatocytes azithromycin.

Lincosamines weaken efficiency, tetracycline and chloramphenicol - reinforce.

Antertainment Azithromycin Analogs

Structural analogues for the acting substance:

• Azivok;
• Azimycin;
• Azistral;
• Azitroces;
• Azithromycin fort;
• Azithromycin-OBL;
• Azithromycin-Mackelood;
• Azithromycin dihydrate;
• Azitrus;
• Azitrus Forte;
• Azicid;
• Faith-azithromycin;
• Zetamax Retard;
• Zi factor;
• Skin;
• Zitrolide;
• Zitrolide Forte;
• Zitrocin;
• Mad;
• Sauklid;
• Sumamed;
• Sumamed Fort;
• SUMAMET;
• Summamen Forte;
• Sumamoks;
• Solutab Solotab;
• Tremba Sanovel;
• Chemomycin;
• Ecomed.

In the absence of analogues of drugs on the active substance, you can follow the links below on the disease, which helps the appropriate drug, and see the analogues on therapeutic effects.

Before buying an antibiotic azithromycin, you must carefully read the instructions for use, methods of application and dosage, as well as another useful information on the drug azithromycin. On the "Encyclopedia of Diseases" you will find all the necessary information: Instructions for regular applicationrecommended by dosage, contraindications, as well as patient reviews that have already used this drug.

Azithromycin - composition and form of release

Release form: Capsules. Pills.

The drug is produced in the form of convex oval tablets of white shade, dosage of 500, 250 or 125 mg. In a cardboard box of 3 or 6 tablets.

1 tablet contains: azithromycin (in the form of dihydrate) 125 mg., 250 mg, 500 mg.

1 capsule contains: azithromycin (in the form of dihydrate) 500 mg., 250 mg.

Packaging: 3, 6, 9, 10, 12, 15, 18, 20, 24, 30, 36, 40, 50, 60 or 100 pcs.

Azitromycin - Pharmacological action

Azithromycin - This is an antibiotic means of an extensive spectrum of use, which refers to the class of macrolides of bactericidal impact.

Azithromycin is a fairly popular antibiotic with an extensive spectrum of use. Numerous positive feedback on the preparation confirm its effectiveness in relation to various infectious pathologies, provoked by chlamydia, an angina, hymorite, etc.

Azitromycin is the first representative of the new subgroup of macrolide antibiotics - azalides. When creating in the hearth inflammation of high concentrations has a bactericidal effect.

Azitromycin Sensitive gram-positive coils: Streptococcus Pneumoniae, str.pyogenes, Str.aglaactiae, Streptococci groups CF and G, Staphylococcus Aureus, S.Viridans; Gram-negative bacteria: Haemophilus Influenzae, Moraxella Catarrhalis, Bordetella Pertussis, B.parapertussis, Legionella Pneumophila, H. Ducrei, Campylobacter Jejuni, Neisseria Gonorrhoeae and Gardnarella Vaginalis; Some Anaerobic Microorganisms: Bacteroides Bivius, Clostridium Perfringens, PepTostReptococcus SPP; And also Clamydia Trachomatis, Mycoplasma Pneumoniae, Ureaplasma Urealyticum, Treponema Pallidum, Borrelia Burgdoferi. Azithromycin is inactive against gram-positive bacteria resistant to erythromycin.

The drug effectively eliminates bacterial infectionsis relatively easily tolerated, rarely has negative consequences, which, as a rule, stop after therapy.

Azithromycin is derived from erythromycin, however, has a less negative impact on the operation of gastrointestinal intestinal tract.

Azithromycin belongs to bactericidal antibiotic means of an extensive spectrum of action, has antimicrobial ability. The drug is able to coagulate the production of proteins of microbial bodies, suppress peptidranslocase, inhibit the development and reproduction of microbes.

The drug destroys gram-positive and gram-negative microbes, anaerobic bacteria that can acquire resistance to the effects of the means.

When used inside the agent is perfectly dissolved and quickly distributed through the body, passing through the cell structure, weakening the pathogens inside the cells.

The half-life is 35-50 hours, from fabrics - more than 50 hours.

The therapeutic effect of the drug is able to persist up to 1 week.

50% of azithromycin is excreted by an intestinal system, 6% - renal system.

Azitromycin - Indications for use

Azithromycin is appointed by a doctor with infections and inflammatory pathologies that are provoked by the target-sensitive bacteria. The testimony are:

Infectious processes of ENT organs and upper respiratory systems: sinusitis, pharyngitis, sinusitis, otitis;

Diseases of the lower respiratory tract: pneumonia provoked nonpich bacteria, bronchitis in the acute and chronic stage;

Infection of skin and fabrics, dermatosis infectious, face, acne, impetigo, furuncula;

Borreliosis B. early stage infectious allergic nature;

Infectious diseases of the urogenital tract, provoked by Chlamydia trachomatis: inflammation of the cervix, urethritis.

Azitromycin - Method of application and dose

Azithromycin is prescribed to adults and children from 12 years having weight over 45 kg, 1 time per day 60 minutes before or 2 hours after meals.

The most effective drug at:

The pathologies of the respiratory and skin organs are taken by a course of 1500 mg, 500 mg per one reception. The duration of treatment is 3 days.

Lyme diseases at an early stage use 1 time a day for 5 days. Dosage is: in the first day - 1000 mg, from 2 to 5 day - 500 mg every day. Dose for the whole course of therapy should not exceed 3 g

Acne treatment diagram Next: 1st, 2nd and 3rd day - 500 mg, 8th day - 500 mg, then 500 mg 1 time per week, for 9 weeks. Weekly doses take strictly with an interval of 7 days.

Infections of the urogenital tract, provoked by chlamydia trachomatis, the means is taken once, in an amount of 1000 mg.

The ulcer of the stomach or duodenum caused by Helicobacter pylori, azithromycin is prescribed 1 g (4 caps. 250 mg) per day for 3 days as part of combination therapy.

Children consume a means, depending on their weight: 10 mg per 1 kg of weight, 1 time per day, the duration of therapy is 3 days. The dosage for the entire course is 30 mg / kg.

Patients having disorders of the functioning of the renal system at a moderate stage, not required of the dose adjustment.

Azitromycin - contraindications

The drug is prohibited:

With increased sensitivity to the antibiotic means of the macrolide group;

In pathologies of liver and kidney;

Children under 12 years old and weighing less than 45 kg;

In the breastfeeding period.

Also, azithromycin is not accepted together with ergotamine and dihydroergotamine.

Azithromycin during pregnancy and lactation

The drug can be applied during the period of tooling the child only if the probable benefit for a woman prevails over the possible danger of negative manifestations of the fetus. The decision should take the attending physician.

When breastfeeding, it is necessary to suspend lactation for the treatment time by the drug.

Azitromycin - Side effects

From the side of the blood formation and lymph system: reducing the number of platelets, accompanied by increased bleeding, agranulocytosis.

From the CNS: Headache, dizziness, convulsive syndrome, increased drowsiness, sleep disorder, feeling of numbness, tingling, goosebumps, asthenic syndrome, elevated excitability, anxiety, conflict.

From the side of the peripheral system: hearing disorder, a feeling of stunning, the feeling of noise in the ears, a change in taste, a decrease in smelling sensitivity.

From the heart and vessels: rapid heartbeat, interruptions in the work of the heart, tachycardia.

From digestion: nausea, diarrhea, vomit reflexes, change in coloring language, colic, bloating process, violation of food digestion, liver failure, loss of appetite, constipation, inflammation of the large intestine, jaundice, hepatitis, dying of liver tissues. Rarely fatal outcome.

Allergic manifestations are angiooretic swelling, urticaria, excessive skin sensitivity to ultraviolet, anaphylactic reactions, malignant exudative erythema, itching, rash, Liella syndrome.

From the skeletal-muscular organs: articular pain.

From the urogenital tract - inflammatory pathology of the kidneys, the failure of the kidney and metabolism.

Azitromycin - Medicinal Interactions

Antacids (aluminum and magnesium-containing), ethanol and food slow down and reduce absorption. With the joint appointment of warfarin and azithromycin (under normal doses), the prothrombin-time changes were not identified, however, considering that in the interaction of macrolides and warfarin, it is possible to strengthen the anticoagulation effect, patients need careful control of prothrombin time. Digoxin: increasing the concentration of digoxin. Ergotamine and Dihydroeergotamine: Strengthening of toxic action (Vazospasm, Diesesthesia). Triazoles: reduced clearance and an increase in the pharmacological effect of triazolaan. Slows output and increases concentration in plasma and toxicity of cycloserine, indirect anticoagulants, methylprednisolone, felodipine, as well as drugs subjected to microsomal oxidation (carbamazepine, terphelanadine, cyclosporine, hexobarbital, alkaloids, valprooic acid, diecopyramide, phtenitine bomocriptin, phenytoin, oral hypoglycemic agents , Theophylline and other xanthine derivatives) - by inhibiting microsomal oxidation in azithromycin hepatocytes). Lincosamines weaken efficiency, tetracycline and chloramphenicol - reinforce. Pharmaceutically incompatible with heparin.

Azitromycin - special instructions

In the event of a dose acceptance, the missed dose should be taken as early as possible, and the subsequent - with an interval of 24 hours. It is necessary to observe a break in 2 hours with simultaneous use of antacids.

It is definitively not established the safety of destination (in / in, as well as in the form of capsules and tablets) of azithromycin in children and adolescents under 16 years of age (it is possible to use in the form of an oral suspension in children from 6 months and older).

After canceling the treatment of hypersensitivity reactions, some patients may be maintained, which requires specific therapy under the supervision of the doctor.

Azithromycin - analogs

To date, the cheaper analogues of azithromycin does not exist. One can only say that there is a more expensive drug, such as Sumamed, who has absolutely the same composition, but only the price is already several times higher.

Addressing the pharmacy, many patients face that the pharmacists are trying to sell Sumamed, even if the azithromycin is asked, justifying it with the best effect. In fact, these are two absolutely identical drugs simply produced in different countries.

Azitromycin - Reviews

Among the positive sides of the antibiotic azithromycin, according to consumers, can be allocated: an affordable price; ease of use, since the number of capsules in the package is just calculated for a full course of treatment; fast action: On the second day after the start of reception, patients note an improvement in the state.

Not all patients agree that azithromycin is a practically universal drug, since in some cases it does not help. But it should be noted one thing: all doctors say that if the course of treatment with antibiotics, they need to be drunk to the end. And if the course was interrupted, then the next time after appointing the same drug there will be no effect, because the bacteria have already become resistant to it.

Before starting treatment with the drug, you need to consult with the attending physician to give him a recipe. Because today most of the pharmacies do not sell it without a prescription due to the fact that some patients take the drug not for their intended purpose.

Storage Terms and Conditions

The shelf life of the drug is 24 months.

Store azithromycin follows in a dry dark place at a temperature not higher than 25 ° C. Take care of children.

The drug in the pharmacy is purchased according to the recipe.

We want to pay special attention that the description of the antibiotic azithromycin is presented exclusively for informational purposes! For more accurate and detailed information about the drug Azithromycin, please contact the manufacturer's annotation! In no case do not self-medicate! You must refer to the doctor before the start of the use of the drug!

Use of azithromycin with pneumonia and colds

With the arrival of cold weather, the body begins to drag a lot. So I got sick! Standing at the bus stop, I waited a long time for the minibus, very much frozen and here! Temperature 39, weakness, strong cough, after which the throat hurts and lungs. Caused an ambulance. The doctor appointed azithromycin at pneumonia (yes - yes, it was his found it)

Indications for use

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

It is worth noting that today azithromycin takes the first position among efficient 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 implemented by the most affordable prices. Azithromycin is your assistant in the fight against the hated cough.

Specialists appoint Azithromycin to people with pneumonia, as an excellent antimicrobial agent, which in the shortest possible time will bring the body from such a critical state.

Everyone knows that pneumonia is serious diseasewhich requires treatment only by antibiotics. In this case, it will help precisely azithromycin, since it is considered the most powerful antibiotic of a wide range of action. It eliminates gram-positive bacteria and anaerobic microorganisms.

It is produced only in capsules. He is very rapidly absorbed into the gastrointestinal tract, and from there he gets into the blood and spread throughout the body.

Contraindications

There are also some contraindications to use this drug. It can not be prescribed to children under 12, as well as people with renal and liver failure.

It is also prohibited to the appointment of this drug pregnant and nursing, as well as those who have allergic reactions to the components of this medication.

Side effects

Experts warn that azithromycin must be taken strictly at the direction of the doctor - a specialist, as it has a lot of side effects.

They are observed from the central nervous side, blood Systems, senses, as well as gastrointestinal tract. When symptoms of overdose, the drug must necessarily clean the stomach method of washing and call an ambulance!

It is also necessary to very carefully apply it with other drugs, as it is not enough with something compatible.

How to drink azithromycin

The usual dose of the drug, which is prescribed by doctors is 1 mg. It is necessary to take it once a day and preferably in an hour or two after meals.

The dosage depends on the disease, weight and age of the patient. It should be noted that it is necessary to treat the drug very seriously and in case you forgot to take another dose on time, you do not need to wait for the next reception, and to drink, as soon as I remembered. The following medication techniques are taken in the usual chart, as a doctor has appointed - a specialist.

Since the azithromycin is a drug of a group of antibiotics, it is necessary to take anti-grab therapy with it. During treatment with this drug, it is necessary to abandon the driving of the car, as well as not to engage in activities that require maximum concentration of attention.

My results and results

This drug helped me quickly stand up to your feet. Azithromycin eliminated the whole cough and thus helped me get rid of pain in the chest. After the first use, the body temperature stabilized, weakness disappeared.

I am very grateful to azithromycin that I got up so quickly. Recomend for everybody!

Treatment of pneumonia azithromycin

Inflammation of lungs is the most frequent cause mortality in the world from infections. Every year millions of people carry it dangerous disease, Therefore, so far the correct selection of antibacterial drugs remains relevant. The choice of medication for the treatment of pneumonia is carried out by relying 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 choosing a medication plays a method of application and treatment frequency. Azithromycin with pneumonia often becomes a drug of choice number 1, since this antibiotic is destructive effect on many pathogenic microorganisms, and it only needs to take it once a day.

The principle of choosing an antibiotic in pathologies of lungs

Experts select antibiotics for the treatment of lower respiratory tract infections, based on the data on the most frequent pathogens of these pathologies.. Such an approach is due to the fact that not in all polyclinics it is possible to quickly make Bakposev sputum and determine which microorganism provoked a disease. In some cases, with inflammation of the lungs, an unproductive cough is observed, so it is very difficult to take spots of sputum.

The choice of antibiotics is often hampered by the fact that the doctor does not have the ability to constantly monitor the course of the disease and, if necessary, quickly adjust treatment. Different antibiotics have a different pharmacological effect, they penetrate differently in different tissues and fluids in the body. So in the cells, only a few species of antibiotics - macrolides, tetracyclines and sulfonamides penetrate.

In the event that the causative agent is sensitive to the antibacterial drug, but the medicine reaches the focus of inflammation in insufficient concentration, the effect of such treatment will not be. But it is necessary to understand that with such a receipt of improving the condition of the patient, it is not observed, and the stability of the microbes to the antibiotic appears.

Highly an important aspect When choosing antibiotics is the safety of the drug. In conditions home Treatment The choice is most often given to oral administration.. Doctors try to select such drugs, the multiplicity of reception of which is minimal, and the effectiveness is high.

In pediatric practice, when choosing antibacterial drugs, syrup and suspensions with an active substance of a wide range of action are preferred.

What causative agents are pneumonia

Walled diseases in children and adults often transfers to obstructive bronchitis, and in the absence of proper treatment and attachment, bacterial microflora can go into pneumonia.

Pneumococcus remains the most frequent causative agent of pneumonia, less often the disease provoke mycoplasm, chlamydia and hemophilic stick. In young people, the disease is most often caused by one pathogen. Olders, with concomitant diseases, the disease provokes a mixed microflora, where both gram-positive and gram-negative bacteria are present.

Share pneumonia in all cases is caused by Streptococcus. Staphylococcal pneumonia is less likely, mainly in people of old age, in people with bad habits, as well as in patients who are long on hemodialysis or having fun.

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

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

Azithromycin refers to a group of macrolides. This antibacterial drug is often prescribed in the intolerance to antibiotics from the penicillin group.

General description of azithromycin

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

The shelf life of the drug is 2 years. It is necessary to store it in a cool place, at a temperature not higher than 25 degrees.

Application for pneumonia

In the instructions for the use of azithromycin at pneumonia it is indicated that the drug is necessary in such dosages:

• Children over 12 years old and adults drink 1 capsulewhich 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 are taken 1 capsule, which contains 250 mg of the active substance, just once a day.
• Children under 6 years old should be appointed suspension. The dosage calculates the attending physician individually, depending on the age of a small patient.

In the manual for the drug, it is said that the interval between the antibiotic techniques should be about a day. In this case, the blood concentration is constantly maintained in the blood.

Features of the treatment of azithromycin

Azithromycin with inflammation of light caution is used in patients with chronic diseases liver, so can develop hepatitis and heavy liver failure. If there are signs of violation of the liver, which are manifested by jaundice, urine darkening and a tendency to bleeding, then therapy with an antibacterial drug is terminated and a patient survey is carried out.

If the patient has a moderate impairment of the kidney function, then the treatment of inflammation of light azithromycin should be carried out under the control of the doctor.

If an antibacterial drug is used to treat more than 3 days, pseudomambranous colitis can develop. This condition may be accompanied by dyspeptic disorders, including a strong diarrhea.

In the treatment of antibiotics from a group of macrolides, the risk of developing cardiac arrhythmias increases. This must be considered 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 choose dosage form drug. For the treatment of children up to 6 years old, it is necessary to take a suspension, as it is very problematic capsule capsule very problematic, and if you pour a capsule powder, then the baby does not want to swallow it because of too bitter taste.

For heavy infections The lower respiratory tract dosage is calculated by the attending physician, it also determines the duration of therapy. In most cases, the course of treatment lasts three days, but during the gross flow of pneumonia, a weekly course can be recommended. The child must take medicine at the same time. This ensures a constantly high concentration of antimicrobial agent in the blood.

It is impossible to interrupt treatment while improving the condition of the patient. If you do not drink a full course of antibiotics, superinfection can develop, which is poorly treated.

Azithromycin is a wide spectrum antibiotic, prolonged action. After receiving the last capsule, the therapeutic concentration of the active substance in the blood is maintained throughout the three days. Thanks to this property, this macrolide becomes a drug selection No. 1 in the treatment of pneumonia.

It has bacteriostatic, and in high doses and bactericidal effects in relation to the main pathogens of the infections of the lower respiratory tract: pneumococcus, golden staphylococcus, hemophilic stick and others, and also active against intracellular atypical pathogens, such as chlamydia, mycoplasma and legionella.

With what form of the disease are prescribed

The drug has proven itself in the treatment of non-high-headed pneumonias, including as an empirical antimicrobial therapy (therapy begun before receiving information about the pathogen and its sensitivity to antibiotics), as well as in the treatment of pneumonia caused by so-called atypical pathogens (intracellular), The share of which, according to some data, accounts for up to 40 percent of all cases of community-friendly pneumonia.

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

Advantages and disadvantages of azithromycin in treatment

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

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

Today, azithromycin is the only antibacterial drug in the world, the course of which is only three for non-heavy respiratory infections. At the same time, the effect of the drug continues within 5-7 days after the end of the course of treatment.

Another incomprehensible plus of azithromycin - its ability to accumulate at great concentrations in the focus of infection, in this case - in the bronchopulmonary structures. So, when taking 500 mg of azitromycin, its concentration in the bronchial mucosa is 200 times, and in the bronchoalveolar secret 80 times the serum.

The disadvantages of the drug include the fact that it is not recommended to use intravenously in children under 16, and in a tablet form - in children under 12 years old, as well as albeit not too frequent, but still possible unwanted side effects, including the likelihood of hearing impairment with intravenous introduction of large doses of the drug.

Also as empirical therapy Pneumonia is important to take into account situations in which infection is assumed to be infected with Pneumococcus resistant to penicillin and macrolides, which is often found in children and elderly patients.

Method of application and dosage

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

Adults with non-heavy-hospital pneumonia are usually prescribed 500 mg once a day. The course of treatment can be from 3 to 7 days.

With severe, requiring hospitalization, the flow of pneumonia azithromycin is administered within two days in the same dosage intravenously, and then go to oral administration to a total course of 7-10 days.

Dose for children with a mass of up to 45 kg is calculated, based on their weight - 10 mg / kg per day.

Oral forms of drugs should be taken an hour before or two hours after meals. It is also important to observe equal gaps in the time between the drug intake, and when skipping, strive to take the drug as early as possible.

Contraindications

Azithromycin in tablet form and in the form of intravenous injection is contraindicated to children. Patients of 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.

With caution, it is used for pregnancy, lactation, arrhythmia, lengthened ventricular complex on ECG and with simultaneous reception of such drugs as digoxin and warfarine.

Cautions

Antacids and alcohol reduce the absorption of azithromycin. And the antibiotics of the tetracycline row, on the contrary, enhance its action. Incompatible azithromycin with heparin.

S.V.Miseiseev
Department of Therapy and Prof Persecution MMA them. I.M. Suchenova, Moscow State University. M.V. Lomonosov

In recent years, it would seem that everything that is possible, about community-wide pneumonia, but attention to this problem is not weakened, the reflection of which is the constant flow of publications and recommendations on the diagnosis and treatment of pneumonia. Such an interest is completely understood. On the one hand, community-hospital pneumonia remains one of the most common infectious diseasesOn the other hand, the changing epidemiological situation makes the existing approaches to treatment and reassess the role of those or other antibacterial drugs. Currently, a clearly defined list of antibiotics, which in the world are considered possible to use for empirical therapy of community-friendly pneumonia. One of them is azithromycin (Sumamed), which appears in all the recommendations on this disease. The choice of this azalide antibiotic is determined by the spectrum of action, which includes the main pathogens of community-hospital pneumonia, the peculiarities of pharmacokinetics / pharmacodynamics, making abbreviated treatment courses, a variety of output forms, allowing to prescribe a drug in any situations. What is the place of azithromycin in modern therapy Complete Pneumonia?

Results of controlled clinical studies

The effectiveness of azithromycin in the treatment of community-hospital pneumonia is proved in numerous controlled studies. For 10 years (1991-2001), 29 such studies were published as a whole in a 5901 patient, including 762 children. In 12 studies included patients with various infections, at 8 - with exacerbation of chronic bronchitis and in 9 with pneumonia. Macrolids (erythromycin, clarithromycin, roxitromycin, diritomycin) were used as comparison preparations in 8 studies, penicillins (co-amoxicline) in 13, cephalosporins (cefaclor, cefuroxime Axietyl, cefybutene) 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 azithromycin therapy courses was high and in most studies turned out to be comparable with such 10-day courses of comparison drugs. In 5 studies, azithromycin exceeded comparison preparations (co-amoxiclav, erythromycin, benzylpenicillin and cefibutene). It should be noted that a small but statistically significant superiority of azithromycin over co-amoxiclav was noted in two major studies in 759 patients with exacerbation of chronic bronchitis (clinical efficacy of 89.7 and 80.2%, respectively, p \u003d 0.0003) and 481 patients With the infections of the lower respiratory tract (95.0 and 87.1%, p \u003d 0.0025). The portability of therapy in the basic and control groups was generally comparable, although in 4 studies azithromycin caused unwanted reactions less frequently than co-amoxiclav or cefuroxime. The difference was mainly due to the lower frequency of gastrointestinal disorders.

Empirical therapy of pneumonia in outpatient conditions

The etiology of non-hospital pneumonia depends on many factors and can differ significantly in different studies. The main causative agent remains Streptococcus Pneumoniae. In modern conditions, the role of atypical microorganisms is growing in the etiologists of non-hospital pneumonia, including M. Pneumoniae, C. Pneumoniae, L. Pneumophila. Much less often pneumonia N. influenzae, as well as S. aureus, Klebsiella and other enterobacteria. Often, patients find a mixed or co-infection. In recent years, the main concern among specialists causes the distribution of pneumococcal resistant to penicillin, which often exist resistance to several classes of antibacterial drugs, i.e. are poly-resistant. In some countries, the share of such strains reaches 40-60%. However, for Russia, this problem is as apparently not relevant. According to monitoring resistance of clinical strains S. Pneumoniae. In a multicenter Russian study, Pegasus, the proportion of stable strains remains low. Macrolids, including azithromycin, were sustainable only 6-9% of pneumococcus strains.

When should Azithromycin prescribe? Any antibiotic intended for empirical therapy of community-friendly pneumonia must have activity against S. pneumoniae. It is also desirable that he act on atypical pathogens. Macrolid antibiotics meet these requirements, so in all the recommendations they are referred to as election in the treatment of community-wide pneumonia light and middle severitynot requiring hospitalization. The advantage of azithromycin in front of most of the other macrolides is activity in relation N. influenzae, which additionally expands the testimony to its application. The spectrum of drugs with activity against pneumococcus and atypical pathogens is not so wide. In addition to macrolides, they include respiratory fluoroquinolones (levofloxacin, moxicfloxacin) and tetracyclines. For wider use of the first in ordinary clinical practice, there are no reasons (including due to high cost), while the use of tetracycline is constrained by the spread of sustainable pneumococcal strains. The advantages of azithromycin in front of amoxicillin and other beta lactams are particularly obvious if the likeplicity of atypical pneumonia is high (gradual start, symptoms of the upper respiratory tract, unproductive cough, headache, etc.). Mycoplasma pneumoniae. It is the main causative agent of pneumonia in children of school age, therefore, in such cases, it should always be preferred to macrolids, especially if they are produced in the form of a suspension. In the pediatric practice of the macrolide, they do not have competitors in essence, since Fluoroquinolones cannot be prescribed to children. In the treatment of pneumonia, young children are of particular importance to the possibility of assigning azithromycin once a day and a short course of therapy (3-5 days).

In all recommendations, situations are allocated when the usual spectrum of pneumonia pathogens changes and, accordingly, it becomes necessary to modify approaches to empirical therapy. In the draft domestic recommendations on the diagnosis and treatment of community-hospital pneumonia (2005) adult patients are invited to divide into two groups depending on age (younger or over 60 years) and the presence of a number of unfavorable prognostic factors:

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

Elderly patients with specified factors risk increases etiological role N. Influenzae. and other gram-negative bacteria. Accordingly, in this case it is better to use amoxicillin / clavulanate or respiratory fluoroquinolones. It should however, it should be noted that the question of the etiologies of the community-friendly pneumonia in the elderly difficult people. For example, in Finn's study, 48% of 345 patients under the age of 60, the cause of pneumonia was S. Pneumoniae, in 12% - S. Pneumoniae, 10% - M. Pneumoniae. and only 4% - N. Influenzae. A similar spectrum of pathogens "perfect" corresponds to the spectrum of azithromycin activity. The results of controlled studies did not confirm the advantages of co-amoxiclava before azithromycin and in patients with COPD exacerbation (see above). R.Panpanich et al. conducted a meta-analysis of comparative studies of azithromycin and amoxicillin (amoxicillin / clavulanate) more than 2500 patients sharp bronchitis, pneumonia and exacerbation of chronic bronchitis. In general, reliable differences between these drugs on clinical and microbiological efficacy were not revealed, although the azithromycin had certain advantages in some studies. In addition, its use is associated with a lower frequency of unwanted effects (relative risk 0.75).

In American recommendations, azithromycin is attributed to the number of drugs in the treatment of community-hospital pneumonia in patients with concomitant diseases (COPD, diabetes, renal or heart failure or malignant tumor) who have not received antibiotics. If the patients recently carried out antibiotic therapy, then macrolides should be combined with beta lactams. The possibility of combined therapy is indicated in domestic recommendations.

Empirical therapy of pneumonia at hospitalized patients

In accordance with modern representations, a significant number of patients with community-hospital pneumonia can receive antibacterial drugs inside and, accordingly, do not need inpatient treatment. In this regard, it is very important to correctly identify patients to be hospitalized. Symptoms of pneumonia are the greatest importance for solving this issue, for example, high fever (\u003e 40 ° C), tachypnee, arterial hypotension, pronounced tachycardia, disturbances of consciousness, lesion more than one loba lobe, the presence of decay cavities, pleural effusion, etc. Foundations for hospitalization can serve elderly age, serious accompanying diseases, the impossibility of organizing treatment at home, the ineffectiveness of previous antibacterial therapy, the desire of the patient or his relatives. Patients, the severity of the state of which dictates the need for emergency hospitalization into the separation of intensive care and intensive therapy (rapid progression of infiltrative changes in the lungs, septic shock, acute renal failure, etc.) is deemed. For an objective assessment of the state of patients and the forecast, it is proposed to use various scales (for example, Pneumonia Outcomes Research Team - Port), but in normal practice they are rarely used.

A group of hospitalized patients with non-hospital pneumonia is heterogeneous. Among them, there may be quite a significant proportion of patients with non-heavy pneumonia (simplified hospitalization in departmental medical institutions can be promoted). Therefore, in many cases, approaches to the treatment of pneumonia in ambulatory and hospitalized patients coincide and suggest oral application Antibiotics, including azithromycin, although doctors usually prefer their parenteral administration. When choosing parenteral antibiotics for the treatment of pneumonia, more severe flow should consider the possible etiological role of gram-negative pathogens (H. Influenzae, Enterobacteriaceae), Therefore, inhibitory-speaking penicillins and cephalosporins II-III (Ceftriaxone, Cefotaxim, etc.) are usually considered to be selection preparations. However, the causes of pneumonia in hospitalized patients may also be atypical pathogens. For example, a well-known role Legionella Pneumophila. In the development of severe pneumonia, requiring hospitalization in Orit. To completely block the spectrum of the most likely pathogens of pneumonia, the macrolides should always be included in combination therapy. This point of view is reflected in the project of domestic recommendations (Table 1) and in American recommendations for the treatment of pneumonia. The choice of the method of applying a macrolide antibiotic depends on the severity of the patient's condition. In more severe cases, preferably intravenous administration of azithromycin.

Use of azithromycin with pneumonia and colds

With the arrival of cold weather, the body begins to drag a lot. So I got sick! Standing at the bus stop, I waited a long time for the minibus, very much frozen and here! Temperature 39, weakness, strong cough, after which the throat hurts and lungs. Caused an ambulance. The doctor appointed azithromycin at pneumonia (yes - yes, it was his found it)

Indications for use

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

It is worth noting that today azithromycin takes the first position among efficient 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 implemented at the most affordable prices. Azithromycin is your assistant in the fight against the hated cough.

Specialists appoint Azithromycin to people with pneumonia, as an excellent antimicrobial agent, which in the shortest possible time will bring the body from such a critical state.

Everyone knows that pneumonia is a serious illness that requires treatment only by antibiotics. In this case, it will help precisely azithromycin, since it is considered the most powerful antibiotic of a wide range of action. It eliminates gram-positive bacteria and anaerobic microorganisms.

It is produced only in capsules. He is very rapidly absorbed into the gastrointestinal tract, and from there he gets into the blood and spread throughout the body.

Contraindications

There are also some contraindications to the use of this drug. It can not be prescribed to children under 12, as well as people with renal and liver failure.

It is also prohibited to the appointment of this drug pregnant and nursing, as well as those who have allergic reactions to the components of this medication.

Side effects

Experts warn that azithromycin must be taken strictly at the direction of the doctor - a specialist, as it has a lot of side effects.

They are observed from the central nervous, blood systems, sense organs, as well as the gastrointestinal tract. When symptoms of overdose, the drug must necessarily clean the stomach method of washing and call an ambulance!

It is also necessary to very carefully apply it with other drugs, as it is not enough with something compatible.

How to drink azithromycin

The usual dose of the drug, which is prescribed by doctors is 1 mg. It is necessary to take it once a day and preferably in an hour or two after meals.

The dosage depends on the disease, weight and age of the patient. It should be noted that it is necessary to treat the drug very seriously and in case you forgot to take another dose on time, you do not need to wait for the next reception, and to drink, as soon as I remembered. The following medication techniques are taken in the usual chart, as a doctor has appointed - a specialist.

Since the azithromycin is a drug of a group of antibiotics, it is necessary to take anti-grab therapy with it. During treatment with this drug, it is necessary to abandon the driving of the car, as well as not to engage in activities that require maximum concentration of attention.

My results and results

This drug helped me quickly stand up to your feet. Azithromycin eliminated the whole cough and thus helped me get rid of pain in the chest. After the first use, the body temperature stabilized, weakness disappeared.

I am very grateful to azithromycin that I got up so quickly. Recomend for everybody!

Treatment of pneumonia azithromycin

Inflammation of lungs - this is the most common cause of mortality in the world of infections. Each year, millions of people endure this dangerous disease, so the correct selection of antibacterial drugs remains relevant to now. The choice of medication for the treatment of pneumonia is carried out by relying 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 choosing a medication plays a method of application and treatment frequency. Azithromycin with pneumonia often becomes a drug of choice number 1, since this antibiotic is destructive effect on many pathogenic microorganisms, and it only needs to take it once a day.

The principle of choosing an antibiotic in pathologies of lungs

Experts select antibiotics for the treatment of lower respiratory tract infections, based on the data on the most frequent pathogens of these pathologies.. Such an approach is due to the fact that not in all polyclinics it is possible to quickly make Bakposev sputum and determine which microorganism provoked a disease. In some cases, with inflammation of the lungs, an unproductive cough is observed, so it is very difficult to take spots of sputum.

The choice of antibiotics is often hampered by the fact that the doctor does not have the ability to constantly monitor the course of the disease and, if necessary, quickly adjust treatment. Different antibiotics have a different pharmacological effect, they penetrate differently in different tissues and fluids in the body. So in the cells, only a few species of antibiotics - macrolides, tetracyclines and sulfonamides penetrate.

In the event that the causative agent is sensitive to the antibacterial drug, but the medicine reaches the focus of inflammation in insufficient concentration, the effect of such treatment will not be. But it is necessary to understand that with such a receipt of improving the condition of the patient, it is not observed, and the stability of the microbes to the antibiotic appears.

A very important aspect when choosing antibiotics is the safety of the medicinal preparation. In conditions of home treatment, the choice is most often given to oral administration. Doctors try to select such drugs, the multiplicity of reception of which is minimal, and the effectiveness is high.

In pediatric practice, when choosing antibacterial drugs, syrup and suspensions with an active substance of a wide range of action are preferred.

What causative agents are pneumonia

Walled diseases in children and adults often transfers to obstructive bronchitis, and in the absence of proper treatment and attachment, bacterial microflora can go into pneumonia.

Pneumococcus remains the most frequent causative agent of pneumonia, less often the disease provoke mycoplasm, chlamydia and hemophilic stick. In young people, the disease is most often caused by one pathogen. Olders, with concomitant diseases, the disease provokes a mixed microflora, where both gram-positive and gram-negative bacteria are present.

Share pneumonia in all cases is caused by Streptococcus. Staphylococcal pneumonia is less likely, mainly in people of old age, in people with bad habits, as well as in patients who are long on hemodialysis or having fun.

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

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

Azithromycin refers to a group of macrolides. This antibacterial drug is often prescribed in the intolerance to antibiotics from the penicillin group.

General description of azithromycin

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

The shelf life of the drug is 2 years. It is necessary to store it in a cool place, at a temperature not higher than 25 degrees.

Application for pneumonia

In the instructions for the use of azithromycin at pneumonia it is indicated that the drug is necessary in such dosages:

• Children over 12 years old and adults drink 1 capsulewhich 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 are taken 1 capsule, which contains 250 mg of the active substance, just once a day.
• Children under 6 years old should be appointed suspension. The dosage calculates the attending physician individually, depending on the age of a small patient.

In the manual for the drug, it is said that the interval between the antibiotic techniques should be about a day. In this case, the blood concentration is constantly maintained in the blood.

Features of the treatment of azithromycin

Azithromycin with inflammation of lightness with great care in patients with chronic liver diseases, hepatitis and heavy liver failure can develop. If there are signs of violation of the liver, which are manifested by jaundice, urine darkening and a tendency to bleeding, then therapy with an antibacterial drug is terminated and a patient survey is carried out.

If the patient has a moderate impairment of the kidney function, then the treatment of inflammation of light azithromycin should be carried out under the control of the doctor.

If an antibacterial drug is used to treat more than 3 days, pseudomambranous colitis can develop. This condition may be accompanied by dyspeptic disorders, including a strong diarrhea.

In the treatment of antibiotics from a group of macrolides, the risk of developing cardiac arrhythmias increases. This must be considered 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 properly select the drug form of the drug. For the treatment of children up to 6 years old, it is necessary to take a suspension, as it is very problematic capsule capsule very problematic, and if you pour a capsule powder, then the baby does not want to swallow it because of too bitter taste.

With heavy infections of the lower respiratory tract, the dosage is calculated by the attending physician, it also determines the duration of therapy. In most cases, the course of treatment lasts three days, but during the gross flow of pneumonia, a weekly course can be recommended. The child must take medicine at the same time. This ensures a constantly high concentration of antimicrobial agent in the blood.

It is impossible to interrupt treatment while improving the condition of the patient. If you do not drink a full course of antibiotics, superinfection can develop, which is poorly treated.

Azithromycin is a wide spectrum antibiotic, prolonged action. After receiving the last capsule, the therapeutic concentration of the active substance in the blood is maintained throughout the three days. Thanks to this property, this macrolide becomes a drug selection No. 1 in the treatment of pneumonia.

How many days to take azithromycin at pneumonia?

The drug azithromycin with pneumonia in adults often becomes basic medicine in therapy. The choice of medication with lung inflammation depends on many factors.

Azithromycin acts detrimental to most of the harmful bacteria, so it is often prescribed at pneumonia. A specialist picks up an antibiotic to eliminate the infection, based on the results of analyzes, medical knowledge about the most frequent types of pathogens and the effectiveness of modern medication. It is not always possible to hand over Bakposev allocations and determine the type of causative agent of the disease. And the use of a drug medication azithromycin helps to overcome community-hospital pneumonia.

Action of the drug

Positive effects of azithromycin with pneumonia has repeatedly been proven for many years clinical studies. During the various tests, drugs from the group of macrolides were used in the elimination of the infectious process. Medicine Azithromycin compared with the effects of many drugs. In most studies of the treatment of pneumonia, it is azithromycin that showed the best therapeutic results.

The superiority of azithromycin over other drugs is caused by its pharmacological properties.

In the human body azithromycin:

• suppresses the pathogens of pneumonia;
• has a pronounced anti-inflammatory effect;
• affects the anaerobic types of bacteria;
• eliminates chills and normalizes the temperature;
• reduces cough;
• enhances the work of immunity.

Pneumonia is often the exacerbation of obstructive bronchitis. In the process of the inflammatory process, the bacterial flora is attached, and pathology affects pulmonary fabrics. The main causative agent of pneumonia is pneumococcal bacteria. They penetrate the blood of the body and cause the destruction of pulmonary cells. Also, the disease can provoke chlamydia, mycoplasma, hemophilic sticks.

In the absence of competent therapy, the infection develops further and may even lead to a fatal outcome. Treatment of pneumonia azithromycin is advisable to conduct various forms Diseases under the supervision of the doctor. The drug perfectly copes with causative agents of infection with a mixed microflora in the lower lung tissues. Therapy with an antibiotic azithromycin is carried out according to the instruction that the manufacturer is attached to the packaging.

If it is impossible to determine the accurate causative agent of the disease, the selection of drugs for pneumonia is carried out by samples. Antibacterial drug Azitromycin has proven itself in the treatment of pneumonia. It is well tolerated by patients of different ages and less often than other medicines, causes side effects.

Azithromycin with lung inflammation has a pronounced effect on the production of polynucleotides and inhibits the inflammatory process in the body. He actively struggles with inflammation of the lungs and eliminates his symptoms. The effect of the drug at pneumonia is aimed at improving well-being, a decrease in the symptoms of the disease. The drug reduces active compounds that affect cellular links immune system. It reduces the action of nitrogen oxide, which prevents the lesion of organic cells. The medicine also increases the synthesis of cytokines that are actively struggling with inflammatory process In pulmonary fabrics.

Application

The dosage of azithromycin at pneumonia is 500 mg per day. Take a medicine on one tablet once a day. The tablet swallows entirely, it is not recommended to rush it. Putting a means of 1 cup of clean water. Take a medicine 1 hour before meals either after 2 hours after.

The drug is intended for systemic use and is a powerful antimicrobial agent. With pneumonia, azithromycin drink 3-5 days, the course duration regulates the doctor. If necessary, the dose may decrease to 250 mg per day.

Adverse reactions

In some cases, when azithromycin admit, during the elimination of pneumonia, some side effects are possible.

May be observed:

• meteorism and abdominal pain;
• disorders of digestion and chair;
• various types of colitis;
• jaundice;
• vomiting or nausea;
• nervous excitement;
• dizziness;
• rash on the skin and itching;
• arthralgia;
• neutropenia.

With the appearance of any adverse Reactions It should be reported to the doctor. It is possible that the doctor to reduce the recommended dose of the medicine to an adult person either turn on the treatment of another drug.

Treatment of children's pneumonia

With pneumonia in children, azithromycin has a pronounced anti-inflammatory effect and helps the child to cope with the disease faster. Children's organism Maybe quite violently react to the medicine. However, with a competently selected dosage, pneumonia therapy passes without complications.

Azitromycin:

• contributes to the discharge of coping in light sputum;
• manifests optimal activity against pathogenic agents;
• improves the state of the epithelium alveol;
• supports the balance of fluid in the pulmonary tissues;
• reduces the number of bronchial secret;
• restores the mucous membrane of respiratory paths.

In its effectiveness, treatment with azithromycin of pneumonia is not inferior to therapy with other antibacterial drugs. Medical studies have been proven that the elimination of pneumonia azithromycin for 5 days in patients aged 7-6 years old has a very powerful healing result and does not differ from treatment with such medicines as amoxicillin, erythromycin, Sumamed. The kids of preschool age, the course of treatment with azithromycin with pneumonia passes, mainly without adverse reactions.

Azithromycin has a high degree of security and is a rather effective macrolide. It is metabolized in hepatic structures, does not contribute to the injury and interact well with other medicines. Medicase components unchanged are derived from the body with bile and kidneys.

The total frequency of adverse undesirable manifestations when using macrolide in patients children's age is approximately 10%. Whereas others medications Show a significantly greater percentage. Possible cancellation of this drug medicine due to the development of undesirable phenomena did not exceed 0.6% at pneumonia. These research results are entered into the relevant protocols.

Considering low level The resistance of pathogenic microbes to azithromycin, this remedy relates to doctors to priority drugs with pneumonia in children. It is clinically recommended to carry out the treatment of community-hospital pneumonia ashithromycin of weak and premature children. According to the observations of doctors, atypical mixed-type pneumonia prevails in children over 5 years. Azitromycin is an effective medicine in its treatment.