Antibiotics of a series of macrolides. Macrolids in modern therapy of bacterial infections. Features of the spectrum of action, pharmacological properties. Indications for the use of macrolides

28.10.2020 Products

Macrolids are characterized by the presence in the structure
14-, 15- or 16-membered lactone ring;
Exception - Taffolimus with a 23-nuclear ring

Clarithromycin is the most commonly used
in gastroenterology (in particular, with eradication
Helicobacter pylori.) Macrolid. Has 14 membered
Lacton Ring (from above-left)

Erythromycin - Historically, the first medicine
Macrolid. Widespread antibiotic.
Has a 14-membered lactone ring

Azithromycin - macrolide-azalid. Has 15 membered
Lacton ring, different from 14-
membership included in it atom of nitrogen (N),
In the picture - on the left. Antibiotic

Josamamicin - Macrolid with 16-membered lactone
Ring (right at the bottom). Antibiotic

Alebrian - Macrolid with 14-membered lactone
Ring (from above), not an antibiotic.
Considered as a promising prokinics

Tacrolimus - Macrolid and Immunosuppressor
with a 23-membered ring (in the middle)

Macrolids (eng. macrolides.) - Medicinal preparations, in the structure of the molecule of which there are 14-, 15- or 16-membered lactone ring. Most macrolides are antibiotics. Macrolids are agonists of motiline receptors and therefore to some extent stimulate motility gastrointestinal tract, showing the qualities of prokinetics.

General characteristics of the macrolide group

Macrolred antibiotics occupy one of the leading places in the antibacterial therapy of the widest range of diseases. They are the least toxic among antimicrobial means and are well transferred to patients. According to the pharmacokinetic characteristics of the macrolides belong to tissue antibiotics. The peculiarities of the pharmacokinetics of the most frequently appointed antibiotics include the ability of macrolides to a larger concentration in the focus of infection than in the blood plasma.

Historically, the first macrolide is discovered in 1952 a natural antibiotic erythromycin, isolated from the streptomycete of the species Streptomyces Erythreus. (later reclassified as kind Saccharopolyspora Erythraea.).

The first semi-synthetic macrolide is roxitromycin. The most frequently used Clarithromycin clinic is currently applied. Both eritortomycin, and roxitromycin, and clarithromycin - antibiotics and have a 14-membered lactone ring as part of a molecule.

In the group of macrolides, the subgroup of azalides, in which the nitrogen atom is included in the lactone ring in addition to the lactone ring (the ring in this way becomes 15-membered). The most famous azalide is a semi-synthetic antibiotic azithromycin.

Of the 16-membered antibiotics of natural origin, Josamamicine.

14-membered macrolides, in which a keto group is attached to a lactone ring at 3 carbon atoms belong to a subgroup of ketolides. Ketolides were developed to combat resistant to the macrolides of causative agents of respiratory tract infections and did not receive distribution in gastroenterology.

Natural macrolide with a 23-membered ring Tharolimus, first obtained from streptomycetes of the species Streptomyces Tsukubaensis- Immunosuppressive drug that is not an antibiotic. Thanks to the inherent macrolide, the quality of the gastrointestinal intestinal tract, the tacrolimus is the most effective drug among immunosuppressors in the treatment of a gastroprota arising after allogenic transplantation bone marrow And in other similar situations (Galstyan G.M. and others).

Macrolred antibiotics are distinguished by high bioavailability (30-65%), long-lasting half-life (T½), the ability to easily penetrate the tissue (especially azithromycin). Characterized by direct anti-inflammatory effect. It is predominantly a bacteriostatic effect on gram-positive coils (streptococci, staphylococcal) and intracellular microorganisms (legionells, mycoplasma, chlamydia). Clarithromycin is characterized by high activity in relation to infection Helicobacter pylori., acid resistance, high concentration in tissues, long-term T½ (3-7 hours) and good tolerability. Dose: 500 mg 2 times a day; Course treatment 7-10 days. Azithromycin is characterized by high bioavailability (40%), high content in tissues, long-term T½ (up to 55 hours), which allows you to assign it 1 time per day and use short courses of treatment (1-5 days); characterized by a long post-proteotic effect (5-7 days after cancellation), good tolerability; Active in relation Helicobacter pylori.. Dose: 500 mg 1 time per day for 3 days (Zimmerman Ya.S.).

Application of macrolides with Eradication Helicobacter Pylori

The effectiveness of the application of schemes, including macrolides, for eradication Helicobacter pylori. Shown in numerous works. Macrolids provide the maximum bactericidal effect on Helicobacter pylori. Among all the antibiotics applied in the schemes. This effect is dose-dependent and implemented when applied, for example, clarithromycin at a dose of 1000 mg per day. Macrolides also have a significant pronounced anti-inflammatory effect, which is very important for the correction of non-specific secondary chronic duodenitis in patients with ulcerative duodenal disease (DPK), usually persistent and after scarring of ulcers.

Macrolids have a high ability to penetrate the cells and accumulate in the mucous membrane of the stomach and DPK, which increases their effectiveness against Helicobacter pylori.. In addition, macrolides have fewer contraindications to use and side Effects and a higher eradication frequency than in tetracyclines, which can also accumulate in cells.

Most often, side effects give antibiotics such as tetracycline and furazolidon. Macrolids are characterized by good tolerability, and the need to stop therapy is noted more than in 3% of cases (Maev I.V., Samsonov A.A.).

Of all the macrolides the greatest activity in relation Helicobacter pylori. Clarithromycin has. This makes it a major drug from this group recommended for the treatment of Helicobacter infection. The comparative results of the effectiveness of azithromycin and clarithromycin on the eradication frequency indicate the greatest efficiency of the latter by almost 30% (Maev I.V. et al.).

At the same time, the widespread use of macrolides (like other antibiotics) when implementing the screening and treatment strategy may lead to the emergence of resistant pathogens other than Helicobacter pylori.. Use of macrolide in one dose and duration of the shortest mode for eradication Helicobacter pylori. (Clarithromycin 500 mg twice a day for 7 days) increased the resistance of the macrolide-resistant pharynganeal Streptococcus Pneumoniae. In a placebo-controlled study in healthy volunteers. This difference was statistically significant during the entire study within 180 days. The use of macrolides was associated with an increase in resistance Streptococcus pyogenes and Staphylococcus aureus. which are frequent causes of community-friendly infections (Starostinin B.D.).

There is information that macrolides lead to the development of cholestatic phenomena in the liver, which can be reflected in the concentration of secondary toxic salts of bile acids in the bile, violation of the motorcycle of the gastroduodenal zone and the seeding of the pylorial department. The consequence of this can be like an increase in the frequency of biliary reflux, and compensatory hypergastrine with the acidification of the anthral department. Given that the "mixed" version of the reflux has a more pronounced damaging effect on the mucous membrane of the esophagus, it can be assumed that the presence of the relationship and the formation of the cascade of disorders in the acid-producing and acid-imaging functions of the upper gastrointestinal tract (Karimov MM, Akhmathodzhaev A.A.).

Publications for health professionals affecting the use of macrolides when eradication of Helicobacter Pylori

Maev I.V., Samsonov A.A., Andreev N.G., Kochetov S.A. Clarithromycin as a basic element of eradication therapy for diseases associated with helicobacter infection // Gastroenterology. 2011. №1.

Maev I.V, Samsonov A.A. A duodenal ulcer: various approaches to modern conservative therapy // Consilium Medicum. - 2004. - T. 1. - s. 6-11.

Kornienko E.A., Parolova N.I. Helicobacter Pylori antibiotic resistance in children and selection of therapy // Questions of modern pediatrics. - 2006. - Volume 5. - № 5. - with. 46-50.

Parolova N.I. Comparative assessment of the effectiveness of eradication therapy of H.Pylori infection in children. Dismission abstract. K.M.N., 14.00.09 - Pediatrics. SPBGPMA, St. Petersburg, 2008.

Tsvetkova L.N., Goryacheva O.A., Gureev A.N., Nechaeva L.V. A rational pharmacotherapeutic approach to the treatment of duodenal ulcerative disease in children // Materials of the XVIII Congress of Children's Gastroenterologists. - M. - 2011. - P. 303-310.

On the site in the literature catalog there is a section "Antibiotics used in the treatment of gastrointestinal diseases", containing articles on the use of antimicrobial agents in the treatment of diseases of the digestive tract organs.

Macrolids like prokinetics

Erythromycin and other macrolides interact with Motilin receptors, imitating the effect of the physiological regulator of the gastroduodenal migratory motor complex. Erythromycin is able to cause powerful peristaltic cuts, similar to a similar migratory motor complex, accelerating the emptying of the stomach from liquid and hard food, but the erythromycin did not find wide use in the treatment of patients with gastroesophageal reflux disease (GERD) erythromycin, since its effect on the motility of the esophagus is practically absent. In addition, a significant decrease in the effectiveness of erythromycin was found against the background of the stomach atony during its long-term application, which creates obstacles to the use of this drug at GERD (Maev I.V. et al.).

Erythromycin activates the motiline receptors of smooth muscle cells of the gastrointestinal tract and the cholinergic neurons of intertensular nervous plexus. In patients with GERD, erythromycin increases the basal pressure of the lower esophageal sphincter (NPS). Its influence on transient relaxation of the NPC (RNPS) has not been proven. Erythromycin does not affect the amplitude of the primary peristaltic cuts of the esophagus, however, reduces the number of episodes of "unfinished" abbreviations. It improves the emptying of the esophagus and the stomach in patients with gastroparesis, but this effect is absent in patients with GERD. In high doses, erythromycin is poorly tolerated, he did not find wide use in gastroenterological practice (Ivashkin V.T., Trukhmanov A.S.).

Azithromycin in a dose of 250 mg per day in patients with GERD can shift a post-brand acid pocket in the distal direction, which reduces acid reflux, without affecting the total number of refluxs. However, azithromycin did not find widespread use as a prokinett due to side effects (V.G. Avdaev).

A number of drugs-macrolides (alecinal, mites), due to the fact that they are agonists of motiline receptors and are not antibiotics are considered as promising funds for the treatment of functional dyspepsia and in this capacity are referred to in the recommendations of the Russian Gastroenterological Association for Diagnostics and Treatment functional dyspepsia and 2011 (Ivashkin V.T., Sheptulin A.A. et al.), and 2017. (Ivanashkin V.T., Maev I.V. et al.). They are also offered for the treatment of other diseases of the gastrointestinal tract (GERD, reflux-esophagitis, SRK-D, diabetic gastroprota and others). However, none of the macrolides on the results of clinical trials of the second stage could not receive a positive conclusion and today there is a skepticism on clinical use of both macrolides-antibiotics and non-indenticular macrolides as prokinetics: "With regard to prokineetics such as erythromycin, azithromycin, alevisinal The use of functional dyspepsia is not shown in connection with the "non-physiological acceleration of the gastric emptying" "(Sheptulin A.A., Kurbatova A.A.).

Publications for health professionals affecting the use of macrolides as prokineics

Alekseeva E.V., Popova T.S., Baranov G.A. and other prokinetics in the treatment of intestinal insufficiency syndrome // Kremlin medicine. Clinical Bulletin. 2011. № 4. P. 125-129.

Macrolids are antibiotics of natural and semi-synthetic origin, having a macrocyclic lactone ring at the core. Depending on the amount of carbon atoms in the structure of the ring, the antibiotic is divided:

14-ticked (erythromycin, roxitromycin, oleandomycin, clarithromycin);
15-ticked (azithromycin preparations);
16-ticked (drugs of Midekamycin, Sp Ramicin and Josamamicina).

Natural macrolides include Erythromycin, Spiramycin, Josamamicina and Midekamycin preparations. The remaining macrolides belong to semi-synthetic antibiotics.

Preparations of the macrolide row have a bacteriostatic action. Inhibition of the growth of pathogenic microorganisms is due to the braking of protein synthesis in ribosomes.

An increase in dosage helps to achieve a bactericidal action.
Macrolid preparations refer to the least toxic antibacterial agents. With the reception of macrolides, there are no cases of severe nephrotoxic reactions, secondary dystrophic lesions of the joints, photosensibilization, manifesting the hypersensitivity of the skin to the effects of ultraviolet. Anaphylaxis and the emergence of antibiotic-associated states are found in a small percentage of patients.

The main direction in the use of this group of antibiotics is the treatment of nosocomial infections of the respiratory tract caused by gram-positive flora and atypical causative agents of 9 chladdi, mycoplasma, legionella, etc.).

Modern macrolides are similar in structure with their own source-erythromycin, the differences are manifested only in the nature of the side chains and in the amount of carbon atoms (14, 15 and 16). Side chains determine the activity with respect to the blue rod. The basis of the chemical structure of macrolides is a macrocyclic lactone ring.

Macrolids are classified according to the method of obtaining and on a chemical structural basis.

Method of receipt

In the first case, they are divided into synthetic, natural and prodrugs (erythromycin esters, oleandomycin salts, etc.). The prodrugs have a modified structure compared with the drug, but in the body under the influence of enzymes, they turn into the same active medicine having a characteristic pharmacological effect.

Prodrugs have improved taste qualities, high bioavailability. They are resistant to acidity drops.

Chemical structural basis

The classification implies the division of macrolides into 3 groups:

* Pr.- Natural.
** floor - semi-synthetic.

It is worth noting that azithromycin ® is azalid, since its ring contains a nitrogen atom.

Features of the structure of each MACR. affect the indicators of activity, drug interaction with other drugs, on pharmacokinetic properties, tolerability, etc. The mechanisms of influence on microbiocenosis in the presented pharmacological funds are identical.

Macrolid Antibiotics Group: List of Preparations

№	Name and form of release
1	Azivok ® - Capsule Shape
2	Azimycin ® - Tableted form
3	Azitral ® - Capsule Shape
4	Azitroces ® - Capsule
5	Azitromycin ® - capsules, powders
6	Aziterrus ® - Capsule Shape, Powder Form, Tablet
7	Azicide ® - Tableled form
8	Binoklar ® - Tableted form
9	Brillide ® - Tableted form
10	Verozithromycin ® - Capsule Shape
11	Vilprafen ® (Josamicin ®) - Tableted form
12	Gryunomycin Syrup ® - Granules
13	ZI-Factor ® - Tablets, Capsules
14	Zitrolide ® - Capsule
15	Iloson ® - Suspension
16	Clabaks ® - Granules, Tablets
17	Clarithromycin ® - Capsules, Tablets, Powder
18	Clabarrosine ® - Tableted form
19	Clasid ® - lyophilisate
20	Clasid ® - Powder, Tablets
21	Rovamicin ® - Powder Form, Tablets
22	Roxygexal ® - Tableted form
23	Roxide ® - tableted form
24	Roxylor ® - tableted form
25	Roxymis ® - tableted form
26	RULID ® - Tableted form
27	RULYCIN ® - Tableted form
28	Sider Sanovel ® - Tableted shape, granules
29	CP COLENE ® - Tableted form
30	SUMZID ® - Capsules
31	Sauklid ® - Capsules
32	Sumamed ® - capsules, aerosols, powder
33	SUMAMETS ® - Capsules, Tablets
34	Sumamoks ® - Capsules, Tableled Form
35	Solutab Solotab ® - Tableted Form
36	FROMILID ® - Granules, tableted form
37	Chemomycin ® - capsules, pills, lyophilisate, powder
38	EXOSPININ ® - Tableted form
39	Ecomed ® - Tableted form, capsules, powder
40	Erythromycin ® - lyophilisate, eye ointment, outdoor ointment, powder, tablets
41	Ermitzed ® - liquid form
42	Esparoxy ® - tableted form

Characteristics of each macrolide

Consider the main representatives of the group separately.

Erythromy ®.

The drug inhibits the growth of chlamydia, legionell, staphylococcus, mycoplasm and legionelle, a blue chopstick, Klebsiellas etc.

Bioavailability can reach sixty percent, it depends on food receptions. It is absorbed in the digestive tract partially.

Among the side effects are: dyspepsia, nausea, narrowing of one of the stomach departments (diagnosed in newborns), allergies, "shortness of shortness of breath".

Used in the treatment of tonsillitis, otites, sinusites, skin infections, lesteriosis, gonorrhea, diphtheria, legogella, etc.

Treatment with erythromycin during pregnancy and during lactation is contraindicated.

Roxitromycin ®.

Inhibits the growth of microorganisms that produce an enzyme that cleaves beta-lactam antibiotics. The drug is resistant to acids and alkalis. Bactericidal action is achieved due to the increase in dosage. The half-life is about ten o'clock. Bioavailability is equal to fifty percent.

Roxitromycin ® is well tolerated and excreted from the body unchanged.

We are prescribed with inflammation of the mucous membrane of the bronchi, larynx, the incomplete sinuses, the middle ear, the sky, the gallbladder, the urethra, the vaginal segment of the cervix, the infections of the skin, the musculoskeletal system, brucellose, etc.
Pregnancy (can be applied according to life indications), lactation period and age up to two months are contraindications.

Clarithromycin ®.

Inhibits the growth of aerobes and anaerobes. There is a low activity in relation to the koche wand. Excellence erythromycin on microbiological indicators. The preparation has acid resistance. Alkaline medium affects the achievement of antimicrobial action.

Clarithromycin ® is the most active macrolide with respect to the Helicobacter Pilori infecting various areas Stomach, and 12 pans. The half-life is about five hours. The bioavailability of the drug does not depend on food.

The drug is prescribed in infection of wounds, infectious diseases of the ENT organs, purulent rashes, pneumonia, bronchitis, furuncoolose, mycoplasmosis, mycobacteriosis against the background of the immunodeficiency virus. The tool also applies as part of comprehensive treatment schemes of the stomach and 12-two-seaman ulcers.

Infant age up to six months is contraindicated.

Oleandomycin ®.

Oleandomycin ® inhibits proteins synthesis in pathogen cells. Bacteriostatic action is enhanced in an alkaline environment.

To date, cases of oleandomycin are single, as it is outdated.
The remedy is prescribed during brucellosis, abscessive pneumonia, bronchiectatic disease, trypper, inflammation brain shells, the inner shell of the heart, the infections of the upper respiratory tract, purulent pleurite, furunculese.

Azithromycin ®.

This is an antibiotic azalid, which in its structure differs from classic macrolides. K - H inhibits grams +, gramphors, aerobes, anaerobes and acts intracellularly.

The antibiotic has a wide range of action.

Josamamicin ® (Vilprafen Soluteab ®)

Natural antibiotic, obtained from a rainy fungus Streptomyces Narbonensis. Bactericidal action is achieved at high concentrations in the infection focus. Antibiotic ingbirket Synthesis protein and suppresses the growth of pathogens.

Josamicin therapy ® often leads to a decrease arterial pressure. The drug is actively used in otorinolaryngology (angina, pharyngitis, otitis), pulmonology (bronchitis, ornithosis, pneumonia), dermatology (furuncoolosis, corrosive inflammation, acne), urology (urethritis, prostatitis).

It is allowed to use during lactation, it is prescribed for the treatment of pregnant women. Newborn and children under fourteen years have shown a suspension form.

MIDEKAMICIN ® (MACROPEN ®)

Differs high indicators of microbial activity and good pharmacokinetic properties. Bactericidal action is achieved due to a significant increase in the dose. Bacteriostatic effect is associated with inhibiting protein synthesis.

Pharmacological effect depends on the type of malicious microorganism, the concentration of the drug, the size of the inoculum, etc. Midcamicine ® is used in infectious lesions of the skin, subcutaneous tissue, respiratory tract.

Midcamicine ® is a reserve antibiotic, and it is prescribed to patients with hypersensitivity to beta lactams. Actively applied in pediatrics.

Lactation period (penetrates breast milk) and pregnancy are contraindications. Sometimes the drug is prescribed by vital testimony and in the event that the benefit for the mother exceeds the potential risk to the fetus.

Spiramycin ®.

The bioavailability of the drug reaches forty percent.

The activity of the drug is reduced in an acidic medium and increases in alkaline. Alcohol contributes to an increase in penetrating ability: the antibiotic gets better in the cells of pathogens.

It has been scientifically proven that Spiramcine ® does not affect embryonic development, so it is permissible to take it to carry a child.

Breastfeeding for the time of antibacterial therapy is stopped.

Macrolid Group Antibiotics: Titles for children

Macrolides are well transferred and rarely cause severe adverse reactions. Unwanted effects in children can manifest themselves with pain in the abdomen, a sense of discomfort in epigatstray, vomiting, nausea, allergic reactions.

Preparations, invented relatively recently, practically do not stimulate the motility of the gastrointestinal tract. Dyspeptic manifestations As a result of the use of MIDEKAMYCIN ®, MIDEKAMICINE acetate ® are not observed at all.

Clarithromycin ®, superior to other macrolides in many indicators deserves separate attention. Children up to 12 years old this drug It is recommended to assign in the form of a suspension.

Macrolids are used at:

therapies of atypical mycobacterial infections,
hypersensitivity to β-lactams,
diseases of bacterial genesis (sinusitis, otitis, tonsillites, bronchitis, skin infections and soft tissues, acne, helicobacter infection, etc.).

However, macrolide antibiotics should be appointed only by the pediatrician. Self-treatment is unacceptable.

Unwanted medicinal reactions

Macrolid therapy extremely rarely becomes the cause of anato-functional changes, but the occurrence of side effects is not excluded.

Allergy

In the course of scientific studied, in which about 2 thousand people took part, it was revealed that the likelihood of anaphylactoid reactions at the reception of macrolides is minimal. Cases of cross-allergies have not been recorded at all. Allergic reactions are manifested in the form of a nettle fever and rash. In isolated cases, anaphylactic shock is possible.

Zhkt.

Dyspecical phenomena arise due to a prokinetic effect characteristic of macrolides. Most patients celebrate rapid defecation, painfulness In the abdomen, violation of taste sensations, vomiting. Newborn may have a violation of food evacuation from the stomach into the small intestine.

The cardiovascular system

Pyruette ventricular tachycardia, cardiac arrhythmia, the syndrome of the elongated Qt interval is the main manifestations of the cardiotoxicity of this group of antibiotics. Exacerbate the position of old age, heart disease, dosage, water and electrolyte disorders.

Structural and functional liver disorders

CNS.

A long course of treatment, the dosage excess is the main causes of heputoxicity. Macrolids act differently on cytochrome - an enzyme involved in the metabolism of alien to the body of chemicals: erythromycin inhibits it, Josamamicin ® affects the enzyme of a little less, and the azithromycin ® does not have any effect.

History and development

Macrolids are a promising class of antibiotics. They were invented more than half a century ago, but still actively used in medical practice. The uniqueness of the macrolide rendered therapeutic effect It is due to the favorable pharmacokinetic and pharmacodynamic properties and the ability to penetrate the cell wall of pathogens.

High concentrations of macrolides contribute to the eradication of pathogens such as Chlamydia Trachomatis, Mycoplasma, Legionella, Campylobacter. These properties are beneficial to macrolides on the background of β-lactam.

Erythromycin ® laid the beginning of the macrolide class.

The first acquaintance with erythromycin occurred in 1952. Portfolio of the newest pharmaceutical preparations An international American innovative company Ilay Lilly & Company ® (ELI LILLY & COMPANY ®) has replenished. Her scientists brought erythromycin from radiant fungus living in the soil. Erythromycin has become an excellent alternative for patients who have hypersensitivity to penicillin-row antibiotics.

Expanding the scope of application, development and implementation of macrolides, modernized on microbiological indicators, dates from the seventies-eighties.

The erythromycine row is different:

high activity against Streptococcus and Staphylococcus and intracellular microorganisms;
low toxicity indicators;
lack of cross allergies with beta-lactam antibiotics;
creation of high and stable concentrations in tissues.

On our site you can get acquainted with the majority of antibiotics groups, full lists These drugs, classifications, history and other important information. To do this, the "" section is created in the upper menu of the site.

The article provides a list of macrolide antibiotics, familiarization with which will help the patient confidently feel when a collision is confidently taken. This article will give general characteristics Macrolids lists the main representatives of this group of drugs, as well as given general recommendations by receiving antibiotics.

General information about macrolides

Antibiotics are a wide class of means obtained by synthetic or in a natural way, which are able to suppress the vital activity of bacteria in the human body. The main orientation of the mechanism of their action is precisely in the destruction of bacterial infections, but there are also antibiotics, effective against fungi, viruses, helminths, and even against tumors.

The list of drugs that relate to antibiotics is very wide. Substances have a different structure and properties, as well as there are several generations. One of the newest achievements of medicine in the field of combating bacterial infections is considered to be the discovery of macrolidal antibiotics.

Macrolids are chemicals, in most cases with the properties of antibiotics. A group of macrolides has a complex cyclic structure, which is a polynomial ring with attached carbon residues.

Macrolids are considered to be a new generation antibiotics. Their use, subject to the sensitivity of strains, is preferable, because Macrolid antibiotics have a number of significant advantages over the other means:

a wide range of actions that makes it possible to use one drug with combined infections;
low toxicity for the patient's body, due to which the drug can be used even on weakened patients;
high concentrations in tissues allowing you to select a smaller dosage to achieve the desired action.

In addition, the fact that macrolides are antibiotics of a new generation gives the advantage of this group of drugs, because most of the bacterial strains over the years of the use of old generations of antibiotics has gained sustainability to them, while macrolides are effective in the overwhelming majority.

Types of drugs and their effectiveness

All macrolides can be classified on the basis of various signs. First of all, this group of substances have 3 generations, and ketolides are separated separately from them. All these groups of drugs differ in the structure of the chemical structure and some of their properties.

In addition, macrolides can be assigned a classification by origin. Disassemble drugs derived from natural and synthesized ingredients. The duration of action differences the preparations of a short, medium and long effect.

The main targets of the struggle for macrolides are gram-positive staphylococci and streptococci. The most common pathogens against which are prescribed a macrolide antibiotic - these are some strains of tuberculosis, cough, hemophilic infection, chlamydial infection, etc.

Additional advantages of the drug, in addition to the already voiced, include the absence of side effects rendered on the digestion system. Suction of these substances from the gastrointestinal tract is more than 75%. In addition, the antibiotic group of macrolides is able to point to affect the focus of infection, tolerated with the leukocyte transport.

Another fact relating to the benefits of the macrolide group is a long half-life period that allows for long-lasting pauses between taking tablets. Together with good absorption of the gastrointestinal tract, it makes the oral version of the use of the means optimal and most convenient for the patient.

Contraindications and side effects

Due to the fact that macrolides are the least toxic of all groups of antibiotics, contraindications and side effects for them are extremely small. For them, such common side effects such as diarrhea, anaphylactic reactions, photosensibilization and a negative impact on the nervous system are atponed.

Nevertheless, the reception of the drug should be abstained by pregnant women, as well as mothers during lactation and children under the age of 6 months. In addition, it is not recommended to use drugs to patients who have insufficient liver or kidney.

In case of overdose and cases of uncontrolled drug use, such toxic actions may occur as headache, hearing impairment, nausea, vomiting, diarrhea. Skin reactions such as itching or urticaria can occur.

Erythromycin

Erythromycin refers to drugs obtained from natural components. It is produced in various dosage forms: powder for injection, tablets, rectal suppositors. In some cases, its use is permissible even in the case of pregnancy, but the treatment must pass under the strict control of the doctor. The use of erythromycin on newborn patients is dangerous, because It can lead to the development of the abnormalist of the gastrointestinal tract.

Roxitromycin

Roxitromycin is a semi-synthetic preparation produced in the form of tablets. It has a higher percentage of bioavailability, which does not depend on food intake in the gastrointestinal tract. In addition, the drug significantly retains its concentration in tissues much longer, it is much better tolerated by patients and does not have interaction with other antibiotics, which could cause toxic or allergic reactions.

Clarithromycin

Like the previous preparation, refers to semi-synthetic antibiotics. It can be introduced into the body as orally and by injection. The drug has high bioavailability and is often used in the fight against atypical infections. Not applied to the treatment of pregnant and lactating women, as well as newborn children.

Appointment to the use of clarithromycin is very broad - it can be used both for the treatment of infections of respiratory organs and for the treatment of the ulcer of the stomach and intestines, abscesses and furuncular skin, as well as chlamydial infection. Very rare side phenomena are possible, among which reactions nervous system - nightmares, headache, dizziness, etc.

Azithromycin

Azithromycin refers to semi-synthetic azalidam. The most famous representative of the pharmaceutical market, released on the basis of this drug - Sumamed. The medicine is produced in a variety of variations of pharmaceutical forms - tablets, syrups, powders, capsules, as well as injection powders.

Azitromycin is considered optimal for the treatment of many respiratory infections, because It has a higher bioavailability compared, for example, with erythromycin, to a lesser extent depends on meals. The main advantage of this fund is that it has some immunomodulatory effect and has a protective effect even some time after the end of treatment.

Spiramycin

Spiramycin was isolated from natural components (products of the life of bacterial culture). Widely used in the practice of otolaryngology, because Effective in the fight against sustainable pneumonia. In addition, effective in the treatment of meningitis, rheumatism, arthritis, infections urinary tract.

It can also use for the treatment of pregnant women, however, breastfeeding at the time of treatment is better to stop. Released in the form of oral forms, as well as powders for intravenous infusion. The side effects at the use of the drug were recorded extremely rare, but the skin rashes, nausea, vomiting appeared among the marked.

Midcamicine (Macropen)

Also, as the predecessor, is a substance of natural origin. Appointed to combat respiratory infections, skin infections, as well as urinary tract and gastrointestinal tract. Produced in the form of tablets, ready-made suspensions, as well as powder for their preparation. It is used to treat children from 2 months, is well absorbed, quickly and for a long time reaches effective concentration.

Telitromycin

Telitromycin is the only representative of the ketolides obtained by the semi-synthetic method. It differs in its chemical structure from all other macrolides. The drug is used to treat infections of the upper respiratory tract - pneumonia, bronchitis, pharyngitis, tonsillitis, etc. Due to the fact that the drug is learned to a lesser extent, it is not prescribed to children under 12 years old, pregnant and nursing women.

In addition, telitromycin is contraindicated to receiving patients with severe pathologies of liver, kidney and heart, as well as patients suffering from the intolerance to galactose or lactase deficiency.

Antibiotics is a group medicineswhich requires a responsible approach to its application. Despite the fact that macrolides are the safest of them, they can still have toxic effects on the body when ignoring the rules of their reception.

The main danger of the use of antibiotics lies in the rapid adaptability of bacteria. The uncontrolled reception of drugs leads to the formation of sustainable strains, which rather quickly apply from the organism of one patient up to the scale of the epidemic. That is why it is so important that antibiotics discharged a professional.

In addition, no matter what wide range of action spectra for each individual drug, no antibiotic can cover all possible types of bacteria. Therefore, before starting taking medicines, it is necessary to pass analyzes to identify a specific pathogen. The use of an incorrect antibiotic is not only meaningless, but also dangerous.

When taking antibiotics, it is important to comply with the instruction attached to the drug. Some of the drugs are sensitive to the sequence regarding food intake - this affects how they are absorbed and accumulate the concentration in the body, which, in turn, is a determining factor in their effectiveness.

It is important and to abide by the duration of the drug, which is determined by the doctor based on analyzes and severity of infection. The insufficient duration of the antibiotic reception can lead to the formation of superinfection, which is much more difficult to treat and can form a new strain-resistant to the drug.

Antibiotics, even the safest of them, have a negative impact on the elimination bodies - liver and kidneys. Therefore, much better for the patient will be at the time of treatment to observe the mode of diet food.

It is better to exclude red meat from the diet, greasy and acute food - these products are injured by the mucous membrane, disrupting the absorption of the drug, and additionally load the liver. Of course, during treatment it is forbidden to drink alcohol.

Thus, a group of macrolides belongs to the safest and effective means Combating bacterial infections, but this does not remove responsibility for their application from any doctor or patient.

Macrolids are antibiotics of natural origin having a complex structure and possessing a bacteriostatic action. Inhibition of the growth of pathogenic microorganisms is due to the braking of protein synthesis in ribosomes.

An increase in dosage helps to achieve a bactericidal action.

Macrolids belong to the class of polyketides. Polyceticids are polycarbonyl compounds that are intermediate metabolic products in animal, plants and mushrooms.

With the reception of macrolides, there were no cases of selective violation of blood cell functions, its cellular composition, nephrotoxic reactions, secondary dystrophic lesions of joints, photosensitization, manifesting the hypersensitivity of the skin to the effects of ultraviolet. Anaphylaxis and the emergence of antibiotic-associated states are found in a small percentage of patients.

The antibiotics of the macrolide row occupy a leading position among the safest antimicrobial drugs.

The main direction in the use of this group of antibiotics is the treatment of nosocomial infections of the respiratory tract caused by gram-positive flora and atypical pathogens. A small lettering certificate will help us to systematize information and determine which antibiotics refer to macrolides.

Macrolids are classified according to the method of obtaining and on a chemical structural basis.

Prodrugs have improved taste qualities, high bioavailability. They are resistant to acidity drops.

The classification implies the division of macrolides into 3 groups:

* Pr.- Natural.
* floor - semi-synthetic.

It is worth noting that azithromycin is azalid, since its ring contains a nitrogen atom.

Consider the main representatives of the group separately.

ER. Inhibits the growth of chlamydia, Legionell, staphylococci, mycoplasm and legionell, a blue chopstick, Klebsiella.
Bioavailability can reach sixty percent, it depends on food receptions. It is absorbed in the digestive tract partially.

Among the side effects are: Dislepsy, dyspepsia, narrowing of one of the stomach departments (diagnosed in newborns), allergies, "shortness of shortness of breath".

Prescribed in diphtheria, vibriosis, infectious lesions of skin, chlamydia, Pittsburgh pneumonia, etc.
Treatment with erythromycin during pregnancy and in the lactation period is excluded.

Inhibits the growth of microorganisms that produce an enzyme that splitting beta-lactam has an anti-inflammatory effect. R. resistient to acids and alkalis. Bactericidal action is achieved due to the increase in dosage. The half-life is about ten o'clock. Bioavailability is equal to fifty percent.

Roxitromycin is well tolerated and excreted from the body unchanged.

We are prescribed with inflammation of the mucous membrane of the bronchi, larynx, the incomplete sinuses, the middle ear, the sky, the gallbladder, the urethra, the vaginal segment of the cervix, the infections of the skin, the musculoskeletal system, brucellose, etc.
Pregnancy, lactation period and age up to two months are contraindications.

Inhibits the growth of aerobes and anaerobes. There is a low activity in relation to the koche wand. Clarithromycin is superior to erythromycin on microbiological indicators. The preparation has acid resistance. Alkaline medium affects the achievement of antimicrobial action.

Clarithromycin is the most active macrolide with respect to the helicobacter pylori infecting various areas of the stomach, and the 12th intestine. The half-life is about five hours. The bioavailability of the drug does not depend on food.

K. We are prescribed when infection of wounds, infectious diseases of the ENT organs, purulent rashes, furunculese, mycoplasmosis, mycobacteriosis against the background of the immunodeficiency virus.
The reception of clarithromycin in the early periods of pregnancy is prohibited. Infant age up to six months is also contraindicated.

Ol. Inhibits proteins synthesis in pathogen cells. Bacteriostatic action is enhanced in an alkaline environment.
To date, cases of oleandomycin are single, as it is outdated.
Ol. Prescribed in brucellosis, abscessive pneumonia, bronchiectatic disease, tripper, inflammation of the brain shells, the inner shell of the heart, the infections of the upper respiratory tract, purulent pleurite, furunculese, the hit of pathogenic microorganisms in the bloodstream.

The antibiotic demonstrates high indicators of activity in relation to helicobacter pylori, hemophilic chopstick, gonococcus. Azithromycin in three hundred times acid resistant erythromycin. Indicators of digestibility reach forty percent. Like all erythromycinic row antibiotics, azithromycin is well tolerated. The long-lasting period of half-life (more than 2 days) allows you to prescribe a medicine once a day. The maximum course of treatment does not exceed five days.

Effective in the eradication of streptococcus, the treatment of equity pneumonia, infectious lesions of the organs of the small pelvis, the urogenital system, tick-boring borreliosisVenusal diseases. During the length of the child is appointed by life indications.
Acceptors of HIV azithromycin - infected patients prevents the development of mycobacteriosis.

Natural antibiotic, obtained from a rainy fungus Streptomyces Narbonensis. Bactericidal action is achieved at high concentrations in the infection focus. J - H will slow down the synthesis of protein and suppresses the growth of pathogens.

Josamicin therapy often leads to a decrease in blood pressure. The drug is actively used in otorinolaryngology (angina, pharyngitis, otitis), pulmonology (bronchitis, ornithosis, pneumonia), dermatology (furuncoolosis, corrosive inflammation, acne), urology (urethritis, prostatitis).

It is allowed to use during lactation, it is prescribed for the treatment of pregnant women. Newborn and children under fourteen years have shown a suspension form.

Pharmacological effect depends on the type of malicious microorganism, the concentration of the drug, the size of the inoculum, etc. Midcamicine is used in infectious lesions of the skin, subcutaneous tissue, respiratory tract.

Midcamicine is a reserve antibiotic, and it is prescribed to patients with hypersensitivity to beta lactams. Actively applied in pediatrics.

Lactation period (penetrates breast milk) and pregnancy are contraindications. Sometimes Mn appointed vital testimony and in case the benefit for the mother exceeds the potential risk to the fetus.

Differs from other macrolides by adjusting the immune system. The bioavailability of the drug reaches forty percent.

The activity of the drug is reduced in an acidic medium and increases in alkaline. Alcohol contributes to an increase in penetrating ability: the antibiotic gets better in the cells of pathogens.

It has been scientifically proven that spiramycin does not affect embryonic development, therefore it is permissible to take it upon the time to enter the child. Antibiotic affects breast-feedingTherefore, during the lactation, it is worth finding an alternative drug.

Macrolid antibiotics for children should not be administered by intravenous infusion.

In the treatment of macrolides, the occurrence of life-degrading drug reactions is excluded. NLR in children are manifested by pain in the abdomen, a sense of discomfort in epigatstria, vomiting. Generally, children's organism Well tolerate macrolide antibiotics.

Preparations, invented relatively recently, practically do not stimulate the motility of the gastrointestinal tract. Dyspeptic manifestations as a result of the use of midecamicin, midecamicine acetate are not observed at all.

Separate attention deserves Clerythromycin, superior to other macrolides in many indicators. As part of a randomized controlled test, it was revealed that the antibiotic acts as an immunomodulator, providing a stimulating effect on the protective functions of the body.

Macrolids are used at:

therapies of atypical mycobacterial infections,
hypersensitivity to β-lactams,
diseases of bacterial genesis.

They became popular in pediatrics due to the possibility of injecting administration in which the drug minus the gastrointestinal tract. This becomes necessary in emergency cases. The macrolide antibiotic is that most often prescribes a pediatrician in the treatment of infections in small patients.

Macrolid therapy extremely rarely becomes the cause of anato-functional changes, but the occurrence of side effects is not excluded.

In the course of scientific studied, in which about 2 thousand people took part, it was revealed that the likelihood of anaphylactoid reactions at the reception of macrolides is minimal. Cases of cross-allergies have not been recorded at all. Allergic reactions are manifested in the form of a networpiece and examine. In isolated cases, anaphylactic shock is possible.

Dyspecical phenomena arise due to a prokinetic effect characteristic of macrolides. Most patients celebrate rapid defecation, pain in the abdomen, violation of taste sensations, vomiting. The newborn develops pylorostenosis, the disease in which the evacuation of food from the stomach is difficult to the small intestine.

A long course of treatment, the dosage excess is the main causes of heputoxicity. Macrolids act differently on cytochrome - an enzyme involved in the metabolism of alien to the body of chemicals: erythromycin inhibits it, Josamamicin affects the enzyme a little less, and the azithromycin does not at all have any influence.

Few doctors know by appointing a macrolide antibiotic that this is a direct threat to mental health. Neriva-mental disorders are most often occurring at the reception of Clarithromycin.

Video about the considered group:

Macrolids are a promising class of antibiotics. They were invented more than half a century ago, but still actively used in medical practice. The uniqueness of the macrolides of the therapeutic effect is due to the favorable pharmacokinetic and pharmacodynamic properties and the ability to penetrate through the cell wall of pathogens.

Erythromycin laid the beginning of the Class of Macrolides.

The first acquaintance with erythromycin occurred in 1952. The portfolio of the latest pharmaceutical preparations has replenished the international American innovative company Ilay Lilly & Company (Eli Lilly & Company) (ELI LILLY & COMPANY). Her scientists brought erythromycin from radiant fungus living in the soil. Erythromycin has become an excellent alternative for patients who have hypersensitivity to penicillin-row antibiotics.

Expanding the scope of application, development and implementation of macrolides, modernized on microbiological indicators, dates from the seventies-eighties.

The erythromycine row is different:

high activity against Streptococcus and Staphylococcus and intracellular microorganisms;
low toxicity indicators;
lack of cross allergies with beta lactima antibiotics;
creation of high and stable concentrations in tissues.

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lifetab.ru.

Most antibiotics, overwhelming infectious agents, in parallel, have a negative impact on the internal microbiocenosis human organismBut, unfortunately, a number of diseases without using antibacterial agents are simply impossible.

The optimal exit from the situation is the drugs of the group of macrolides that occupy the leading positions in the list of the safest antimicrobial drugs.

The first representative of the class of antibiotics was erythromycin, obtained from soil bacteria in the middle of the last century. As a result of research, it was found that the basis of the chemical structure of the medication is the lactone macrocyclic ring to which carbon atoms are attached; This feature determined the name of the whole group.

The new tool was almost immediately widely popular; It was involved in the fight against diseases provoked by gram-positive bacteria. Three years later, the list of macrolides was replenished with oleandomycin and spyramsycin.

The development of the following generations of antibiotics of this series was due to the detection of the activity of early drugs in relation to Campylobacteria, chlamydia and mycoplasmas.

Today, after almost 70 years from the moment of discovery, erythromycin and spyramcin are still present in therapeutic schemes. In modern medicine, the first of these drugs is often used as a drug selection if patients have individual intolerance to penicillins, the second - as a highly efficient means characterized by a long antibacterial effect and the absence of a thermogenic effect.

Oleandomycin use an order less frequently: many specialists belong to this antibiotic to the number of obsolete.

Currently there are three generations of macrolides; The study of the properties of drugs continues.

The classification of drugs included in the described group of antibiotics is a chemical structure, a method of obtaining, the duration of exposure and a generation of medication.

Details about the distribution of drugs - in the table below.

The number of carbon atoms of the attached
14	15	16
Oleandomycin; Diritromycin; Clarithromycin; Erythromycin.	Azithromycin	Roxitromycin; Josamicine; Midekamicin; Spiromycin.
Therapeutic effect
short	average	long
Roxitromycin; Spiramycin; Erythromycin.	Fluurithromycin (not registered in our country); Clarithromycin.	Diritromycin; Azithromycin.
Generation
first	second	third
Erythromycin; Oleandomycin.	Spiramycin; Roxitromycin; Clarithromycin.	Azithromycin;

Complete the specified classification follows three moments:

The list of drugs includes a tacrolimus - a medication, having a structure 23 atom and at the same time related to immunosuppressants and to the series under consideration.

The azithomycin structure includes a nitrogen atom, so the medicine is azalid.
Macrolid antibiotics have both natural and semi-synthetic origin.

Natural, in addition to the medicines already mentioned in the historical certificate, are Midekamycin and Josamicin; To synthesized artificially - azithromycin, clarithromycin, roxitromycin, etc. From the total group, prodrugs have a somewhat modified structure:

erythromycin ethers and oleandomycin, their salts (propionyl, toleandomycin, phosphate, hydrochloride);
esters of the first representative of a number of macrolides (Estolat, actentrant);
midcamicin salts (myocamicin).

All the preparations under consideration have a bacteriostatic type of action: they oppress the growth of the colonies of infectious agents by disrupting the protein synthesis in pathogens. In some cases, the clinics specialists prescribe to patients an increased dosage of medicines: drugs involved in this way acquire a bactericidal effect.

Antibiotics groups of macrolides are characterized by:

a wide range of exposure to pathogens (among microorganisms sensitive to drugs - pneumococci and streptococci, listera and spirochetes, ureaplasma and a number of other pathogens of diseases);
minimal toxicity;
high activity.

As a rule, the drugs under consideration are used in genitalia therapy (syphilis, chlamydia), oral diseases having bacterial etiology (periodontitis, periostitis), diseases of the respiratory system (cough, bronchitis, sinusitis).

The effectiveness of medicines relating to macrolides and in combating folliculites and furunculosis has been proven. In addition, antibiotics are prescribed at:

gastroenterite;
cryptosporidize;
atypical pneumonia;
acne (severe disease flow).

In order to prevent the macrolide, a group of macrolides is used to rehabilitate Meningococcus carriers, with surgical manipulations in the lower intestinal department.

Modern medicine actively uses in the patterns of erythromycin therapy, clarithromycin, illosone, spiramizin and a number of other representatives of the considered group of antibiotics. The main forms of their release are listed in the table below.

Titles of drugs	Type packing
Titles of drugs	Capsules, tablets	Granules	Suspension	Powder
Azivok	+
Azithromycin	+	+
Josamamicin	+
Zitrolide	+
Iloson	+	+	+	+
Clarithromycin	+	+		+
Macropen	+	+
Rovamicin	+			+
Rulid	+
Sumameried	+			+
Hemomycin	+			+
Ecomed	+			+
Erythromycin	+			+

Pharmacy networks also offer consumers of Summen in the form of an aerosol, lyophilisate for infusion, chemomycin - in the form of powder for the preparation of injection solutions. Erythromycin-liniment is faced into aluminum tubes. Illosone is produced in the form of rectal suppositories.

Brief description of popular funds - in the material below.

Resistant to the effects of alkalis, acids. It is prescribed mainly for diseases of the ENT organs, a genitourinary system, skin.

It is contraindicated in women in position and lactating, as well as small patients under the age of 2 months. Half-life - 10 hours.

Under the strict control of the doctor, the use of medication in the treatment of pregnant women (in difficult cases) is allowed. The bioavailability of the antibiotic directly depends on the meal, so drinking the drug before eating. Among the side effects are allergic reactions, violation of the functioning of the gastrointestinal system (including diarrhea).

Another name is Midcamicine.

It is used if the patient has individual intolerance to beta-lactam. It is assigned to curb the symptoms of the ailments, affecting the skin, respiratory organs.

Contraindications - pregnancy, period of natural feeding. Enabled in pediatrics.

Used in the treatment of pregnant women lactating ladies. Pediatrics are used in the form of a suspension. Can reduce patient hell. It is accepted regardless of the time of food eating.

He stops symptoms of diseases such as angina, bronchitis, furunculese, urethritis, etc.

It is characterized by increased activity in relation to pathogens, causing inflammatory processes in the gastrointestinal tract (among them and Helicobacter pylori).

Bioavailability does not depend on the eating time. Among the contraindications - the first trimester of pregnancy, infant age. The half-life is short, does not exceed five hours.

The effect of the use of the medication increases when it enters an alkaline environment.

Provided with:

bronchiectatic disease;
purulent pleurisy;
brucellosis;
diseases of the upper respiratory tract.

The drug is a new generation. Acid-resistant.

The structure of the antibiotic differs from most medicines belonging to the described group. When involved in the treatment of HIV-infected people prevents mycobacteriosis.

Half-life - more than 48 hours; This feature reduces the use of the drug to 1 r. / day.

Incompatible with clindamycin, lincomycin, chloramphenicol; Reduces the effectiveness of beta-lactams and hormonal contraceptives. For severe course Disease is introduced intravenously. It does not apply during pregnancy, hypersensitivity to the drug component, during lactation.

It is characterized by the ability to adjust the immune system. Does not affect the fetus during the period of tooling, is involved in the treatment of pregnant women.

Safe for children (the dosage is determined by the doctor, taking into account weight, the age of the patient and the severity of his disease). Not subjected to cell metabolism, does not split in the liver.

Low-cellular macrolides last generation. Actively used in the therapy of adults and small (from 6 months) patients, since they do not have a significant negative impact on the body. Characterized by the presence of a long half-life, as a result of which are used no more than 1 time for 24 hours.

The new generation macrolides practically do not have contraindications, are well tolerated by patients when involved in therapeutic schemes. The duration of treatment with these drugs should not exceed 5 days.

It is impossible to use macrolids in the treatment of diseases.

It should be remembered: to use antibiotics without prior consultation with the doctor - it means that it is irresponsible to refer to the state of your health.

Most of the drug preparations are characterized by minor toxicity, but no attention to the information contained in the instructions for the use of macrolide medicines should not be discussed. According to annotation, when using medicines may occur:

violations in the work of the gastrointestinal system (nausea, vomiting, dysbacteriosis), kidneys, liver and CNS;
allergic reactions;
vision disorders, hearing;
arrhythmia, tachycardia.

If the patient's history is present the individual intolerance to the macrolides, it is impossible to use medical products in treatment.

Prohibited:

drink alcohol by treatment;
increase or decrease the prescribed dosage;
skip the reception of tablets (capsules, suspension);
stop accepting without re-passing analyzes;
use medicines with an expired expiration date.

In the absence of improvements, the appearance of new symptoms should immediately apply to the attending physician.

med-antibiotiki.ru.

Antibiotics call products of vital activity (natural or synthetic origin) of viral, bacterial or fungal cells, which are able to coal the growth and reproduction of other cells or microorganisms. Preparations may have antibacterial, anthelminth, anti-grapple, antiviral and antitumor activity. They are divided into groups depending on the chemical structure.

Macrolid antibiotics are relatively safe representatives of antimicrobial funds. They have the form of complex compounds consisting of carbon atoms that join in various ways To the macrocyclic lactone ring. Preparations are well transferred to patients.

Classification

A group of macrolides has several divisions:

Depending on the number of connected carbon atoms:
- preparations having 14 carbon atoms (for example, erythromycin, clarithromycin, oleandomycin);
- funds with 15 carbon atoms (azithromycin);
- macrolides with 16 carbon atoms (for example, Josamamicin, Spiramycin, Roxitromycin);
- 23 atoms - belong to the only drug (tacrolimus), simultaneously relating to the list of drugs of macrolides and immunosuppressants.
According to the method of obtaining antibiotics: natural and synthetic origin.
The duration of the effect:
- short action (erythromycin, spiramycin, oleandomycin, roxitromycin);
- average duration (clarithromycin, josamicin, fluritromycin);
- "Long" preparations (azithromycin, diritromycin).
Depending on the generation of drugs:
- funds 1 generation;
- macrolids 2 generations;
- 3 generation of antibiotics (the latter generation macrolides);
- ketolides - means, the chemical structure of which consists of a traditional ring with the addition of a keto group.

The effectiveness of drugs

Antibiotics of this group, especially the new generation macrolides, have a wide range of action. They are used to combat gram-positive microorganisms (staphylococci and streptococci). At the present stage, there is a decrease in the sensitivity of pneumococci and some types of streptococci to antibiotics having 14 and 15 carbon atoms in the composition, however, 16-membered drugs retain their activity against these bacteria.

Preparations are effective to combat the following pathogens:

some strains of mycobacterium tuberculosis;
gardnerella;
chlamydia;
causative female cough;
mycoplasma;
a wand causing the development of hemophilic infection.

Mechanism of action and advantages

Macrolids are tissue preparations, since their use is accompanied by the fact that the concentration of active substances in soft tissues is much higher than in the bloodstream. This is due to the ability of the substance to penetrate the middle of the cells. Preparations are associated with plasma protein substances, but the degree of such action varies from 20 to 90% (depending on the antibiotic).

Action of different antibiotics on the bacterial cell

The mechanism of action is associated with the fact that macrolides are oppressed by the process of producing protein by microbial cells, violate the functionality of their ribosomes. In addition, they possess mainly a bacteriostatic effect, that is, inhibit the growth and reproduction of pathogenic microorganisms. Preparations have low toxicity, do not cause the development of an allergic reaction when combination with other groups of antibiotics.

Additional benefits of the latest generation:

long period of semi-aligning drugs from the body;
transportation to the hearth infection with leukocyte cells;
lack of need for a long course of treatment and frequent reception of drugs;
lack of toxic influence on the digestion system;
when using tableted forms, suction from the tract of more than 75%.

Macrolids in ENT Practice

Preparations operate on a wide range of pathogens of ENT diseases. Antibiotics are recommended for the treatment of bacterial tonsillitis, tonsillopharygitis, acute inflammation of the middle ear and putty sinusesas well as bronchitis and pneumonia. Macrolids are not used in paraphalitis therapy, inflammation of the epiglottian and abscess of pharmaceutical space.

The highest prevalence in the treatment of upper respiratory tract has found azithromycin. Research results confirmed the effectiveness of the use of the drug in children at easy and middle degree severity of inflammatory processes. Clinical manifestations of the effectiveness of treatment are to normalize the body temperature, eliminate leukocytosis, subjective improvement in patient condition.

Doctors give the priority to this group of antibiotics, based on the following moments:

Sensitization to penicillins. In patients with rhinosinusitis or medium otitis on the background of an allergic cold or bronchial asthma Penicillin preparations that put in the first place cannot be used due to allergizing properties. They are replaced by macrolides.
The group has an anti-inflammatory effect and a wide range of action.
The presence of infections caused by atypical bacteria. Against such pathogens causing the development of certain types of tonsilotlopharygitis, chronic adenoiditis, nasal pathologies, macrolides are effective.
A number of microorganisms can form specific films under which the pathogens "live", causing the development of chronic ENT-organ processes. Macrolids are able to influence pathological cells during their location under such films.

Contraindications

Macrolids are considered to be relatively safe drugs that can be appointed for the treatment of children, but even they have some contraindications to use. It is undesirable to use the means of this group during pregnancy and breastfeeding. The use of macrolides in children under 6 months is not recommended.

Funds are not prescribed in the presence of individual hypersensitivity to active components, with severe pathologies of liver and kidney.

Side effects

Unwanted reactions are developing not often. There may be bouts of nausea and vomiting, diarrhea, abdominal pain. With a negative impact on the liver, the patient complains about an increase in body temperature, yellowing of the skin and scool, weakness, dyspeptic manifestations.

Because of the central nervous system can be observed cepalgia, light dizziness, changing the work of the auditory analyzer. Local reactions can develop during parenteral administration of drugs (veins inflammation with the formation of thromboms in them).

Representatives of the group

Most macrolids need to be taken an hour before meals or a few hours after it, because when interacting with food, the activity of drugs occur. Liquid dosage forms are accepted according to the pattering physician scheme.

Be sure to keep even time intervals between antibiotic techniques. If the patient missed the reception, use the medicine as early as possible. Double the dosage of the drug at the time of the next reception is prohibited. During the treatment period, it is necessary to abandon the use of alcoholic beverages.

Produced in the form of oral forms, suppositors, injection powder. This representative can be used during pregnancy and lactation, but under the strict control of the attending physician. For the treatment of newborns is not appointed due to the possibility of developing the narrowing of the weekend of the stomach (pylorostenosis).

Produced in the form of tablets. The activity spectrum is similar to the previous representative of the group. His analogs - RULID, Roxitromycin Lek. Differences from erythromycin:

the percentage of drug entering the blood is higher, does not depend on the intake of food into the body;
a longer period of elimination;
the best tolerability of the means by patients;
well interacts with the preparations of other groups.

It is appointed to combat inflammation of almonds, larynx, appropriate sinuses of streptococcal nature, infection caused by mycoplasmas and chlamydia.

Produced in tablets and powders for injection. Analogs - fromelide, clasid. Clarithromycin has high bioavailability, is well tolerated by patients. Not used for the treatment of newborns, pregnant and nursing mothers. The drug is effective against atypical microorganisms.

Macrolid related to the class of antibiotics with 15 carbon atoms. Produced in the form of tablets, capsules, injection and syrup powders. It differs from erythromycin in a large percentage of income into the bloodstream, less dependence on food, continuous preservation of therapeutic effect after the end of therapy.

Antibiotic of natural origin having 16 carbon atoms in the composition. Effective in the fight against the pathogens of pneumonia, which are resistant to other representatives of macrolides. It can be appointed for the treatment of women during the period of having a child. It is introduced inside or in Vienna drip.

Active substance - Midekamycin. Natural origin macrolide, acting on those staphylococci and pneumococci, which are resistant to other drugs. The tool is well absorbed from the intestinal tract and interacts perfectly with representatives of other groups of medicines.

It has a somewhat different spectrum of action than erythromycin. Josamamicin struggles with those microorganisms that are resistant to a number of macrolides, but it is not possible to suppress the reproduction of a number of erythromycinous bacteria. Produced in the form of tablets and suspension.

Terms of purpose drugs

In order for the treatment of macrolides to be effective, a number of rules must be followed:

The formulation of an accurate diagnosis that allows you to clarify the presence of local or overall inflammation in the body.
Determination of pathology pathogen with bacteriological and serological diagnostics.
Selection of the required drug on the basis of an antibioticogram, localization inflammatory process and the severity of the disease.
Selecting the dosage of the means, the frequency of administration, the duration of the course of treatment based on the characteristics of the drug.
The purpose of macrolides with a narrow spectrum of action with relatively light infections and with a wide range of severe diseases.
Monitoring therapy effectiveness.

The list of drugs is quite wide. Only a qualified specialist may choose the necessary tool that will be most effective for each particular clinical case.

anginaamed.ru.

Many are confident that antibiotics should be applied only in extreme cases. However, this is not a completely loyal opinion, since the list of such drugs replenish drugs, relatively safe - macrolides. Such antibiotics, mainly without a negative impact on the human body, are capable of "in two bills" to overcome the infection. A safe profile allows you to prescribe macrolides to patients undergoing an outpatient and inpatient treatment course, as well as children aged from 6 months (under the supervision of doctors).

Few people know about the properties, origin and action of such "harmless" treatments. And if you want to get acquainted with such drugs and learn more about what is a macrolide antibiotic, we suggest reading our article.

It is worth noting immediately that macrolides belong to the group of antibiotic drugs, which in relation to the human body are the least toxic, and the patients are transported well.

Antibiotics such as macrolides, from the point of view of biochemistry, complex compounds of natural origin, which consist of carbon atoms, which in different quantities are located in the macrocyclic lactone ring.

If you take as the basis of the classification of drugs, this criterion is responsible for the number of carbon atoms, then all similar antimicrobial means can be divided into:

14-membered, which includes semi-synthetic drugs - roxitromycin and clarithromycin, as well as natural - erythromycin;
15-membered, presented by a semi-synthetic agent - azithromycin;
16-membered, including a group of natural preparations: Midcamicine, Spiramycin, Josamamicin, as well as semi-synthetic Midekamycin acetate.

The antibiotic group of macrolides "Erythromycin" was opened one of the first, in 1952 the drugs of the new generation appeared a little later, in the 70s. Since they have shown in the fight against infections, excellent results, studies of this group of medicines actively continued, so that we have a fairly extensive list of medicines that can be used for treatment and adults and children.

http://youtu.be/-pb2xzd-qwe.

The antimicrobial effect is achieved by exposure to the ribosomes of microbes cells, disturbing protein synthesis. Of course, under such an attack of macrolides, the infection weakens and "surrenders." In addition, antibiotics of this group of drugs are able to regulate immunity, providing immunomodulatory activity. Also, similar drugs have anti-inflammatory properties, affecting both the organism of adults and children, quite moderately.

The means of a group of antibacterial agents of the new generation are able to cope with atypical microbatriors, gram-positive cocks and similar misfortunes, which often become causative agents of diseases such as: bronchitis, cough, diphtheria, pneumonia, etc.

Macrolids are equally popular in the situation in the past few years, due to the addiction of a large number of microbes towards antibiotics (resistance). This is due to the fact that the preparations of a new generation belonging to such a group with respect to the set of pathogens are able to maintain their activity.

In particular, macrolide preparations were widespread in treatment and as preventive tools from the following diseases:

chronical bronchitis;
acute sinusitis;
periostitis;
periodontitis;
rheumatism;
endocarditis;
gastroenteritis;
heavy forms of toxoplasmosis, acne rash, mycobacteriosis.

List of diseases that can be overcome using new generation antibiotics having a general name - macrolides may add infections transmitted by sexual - syphilis, chlamydia and infections affecting soft fabrics And the skin is furunculosis, folliculitis, paronychia.

If your doctor prescribes a similar antibiotic, immediately familiarize yourself with its contraindications specified in the instructions for the drug. Unlike most ordinary antibiotics, the preparations of the new generation - macrolides are safe, including for children, and less toxic. Therefore, the list of unwanted effects in antibiotics of this group is not as big as in similar means.

First of all, it is not recommended to apply macrolides to pregnant women and mommies during lactation. The use of such medicines for children to 6 months is contraindicated, since the reaction to the drug has not yet been studied. You should not use such drugs as the attending agent to persons who have individual sensitivity.

Antibiotics of a group of macrolides with special attention should be appointed by doctors to patients of mature age. This is due to the fact that most of the representatives of the older generation have disorders in the work of the kidneys, liver and heart.

Side effects can also occur when using macrolides in light shape - weakness and indisposition, manifested after their reception. But may also arise:

vomiting;
nausea;
headache and pain in the abdomen;
impairment of vision, hearing;
allergic reaction in the form of a rash, urticaria (most often occurs in children).

So that no problems arose and unwanted consequences After applying the drugs of the macrolide group, it is necessary to clearly follow the recommendations of the doctor, strictly observe the dosage and refrain from alcohol consumption. It is also categorically prohibited to combine the reception of new generation antibiotics with antacids drugs. It is also important not to skip the techniques.

Basically, taking new generation antibiotics is required 1 hour before meals, or 2 hours after meals. Squeeze tablets need a whole glass of water. If the doctor appointed you an antibiotic group of macrolides, whose release form is a powder for making a suspension, strictly follow the instructions when preparing a medicine and clearly observe the prescriptions of the doctor.

Most likely, each of you knows about antibiotics and their properties. Translated from the Greek word "antibiotics" ...

Macrolids in the fight with ... Today, in the fight against various bacterial diseases in children, the first place is occupied by ...

Pregnancy. There are information about the negative effects of clarithromycin on the fruit. Data proving ...

The gastrointestinal tract sucks the macrolides in different ways, so the whole process directly depends on ...

Some causes of application ... Erythromycin usually affects the lesions of the gastrointestinal tract: as a rule, nausea and vomiting, and with ...

Indications for use ... Most often, people prescribe macrolides with the existing intolerance of penicillins and ...

Rovamicin Antibiotic RovamicinPreparation Rovamicin - Natural Antibiotic. Refers to the group of macrolides. On microorganisms ...

Comparative activity ... The first generation of macrolides turned out to be quite effective in terms of gram-positive microorganisms, ...

What is ... Macrolids are some lactones, in which the number of atoms in the cycle is eight or more; In their composition ...

A distinctive feature Claside is its activity in relation wide spectrum Microbes, including atypical pathogenic bacteria that cause infectious inflammatory respiratory diseases. In addition, the antibiotic has high efficiency In the treatment of acute medium otitis, acute bronchitis, pneumonia, pharyngitis or tonsillitis in children.

Varieties, titles, composition and form of release

Currently, the antibiotic Clasid is produced in two types:

Claside;
Clasid CP.

A variety of CR Clasid differs from Clazid in that it is a tablet of prolonged (long) action. There are no other differences between Clacide and CR Claside, therefore, as a rule, both varieties of the drug are combined under the same name "Clasid". We will also use the title "Clasid" to designate both varieties of the drug, specifying what exactly is we talking about only if necessary.

The CP claside is produced in a single dosage form - it is a tablet of prolonged (long) action, and clasid - in three dosage forms, such as:

Lyophilisate for the preparation of a solution for infusions;
Powder for the preparation of a suspension for reception inside;
Pills.

As an active substance, all dosage forms of both varieties contain clarithromycin in various dosages. Thus, the tablets CR Claside contain 500 mg of active substance. The lyophilisate for the preparation of a solution for infusions contains 500 mg of clarithromycin on the bottle. Tablets of the usual duration of the validity of the Clasid are available in two dosages - 250 mg and 500 mg of clarithromycin. Powder for preparing the suspension is also available in two dosages - it is 125 mg / 5 ml and 250 mg / 5 ml. This means that the finished suspension may have a concentration of an active substance of 125 mg per 5 ml or 250 mg per 5 ml.

In everyday life, various dosage forms, varieties and dosages of Clacian are called short and capacious names that reflect their main characteristics. Thus, the tablets are often called Clasid 250 or Clasid 500, where the figure next to the title reflects the dosage of the drug. Suspension, taking into account the same principle, called Clasid 125 or Clasid 250, etc.

Tablets of both dosages of claside and prolonged action Clacide CP have the same biconimous, oval shape and covered with a shell painted in yellow. Tablets are produced in packages of 7, 10, 14, 21 and 42 pieces.

Powder for the preparation of suspension for intakes is small granules, painted in white or practically white color and having a fruit smell. Powder is available in vials of 42.3 g complete with a dosing spoon and a syringe. When the powder is dissolved in water, an opaque suspension is formed, painted white and having a fruit aroma.

The lyophilisate for the preparation of a solution for infusions is available in hermetically visited vials and is a white powder with a slight aroma.

Therapeutic action of Clazida

Clasid is an antibiotic and, accordingly, has a destructive effect on various pathogenic microorganisms that cause infectious inflammatory diseases. This means that when taking the microbic claside, it is killed, which leads to curable infectious inflammatory disease.

Clasid has a wide range of action and delivered with respect to the following types of microorganisms:

Chlamydia Pneumoniae (TWAR);
Chlamydia trachomatis;
Enterobacteriaceae and Rseudomonas;
Haemophilus influenzae;
Haemophilus Parainftuenzae;
Helicobacter (Campilobacter) Pylori;
Legionella Pneumophila;
Listeria monocytogenes;
Moraxella Catarrhalis;
Mycobacterium leprae;
Mycobacterium kansasii;
Mycobacterium Chelonae;
Mycobacterium Fortuitum;
Mycobacterium Avium Complex (Mac) - Complex, including: Mycobacterium Avium, Mycobacterium Intracellulare;
Mycoplasma pneumoniae;
Neisseria Gonorrheae;
Staphylococcus aureus;
Streptococcus pneumoniae;
Streptococcus pyogenes.

Clasid will be effective for the treatment of infectious inflammatory diseases of various organs, only if they are caused by any above-mentioned microorganisms that are sensitive to its action. And since the sensitive to the action of the microbic claside usually causes the diseases of certain organs and systems to which the affinity is used, the drug is usually used to treat infections of a number of organs.

With respect to the following microorganisms are destructive the validity of the claside is shown only during laboratory tests, but not confirmed by clinical practice:

Bacteroides Melaninogenicus;
Bordetella pertussis;
Borrelia Burgdorferi;
Campylobacter jejuni;
Clostridium perfringens;
Pasteurella Multocida;
Peptococcus niger;
PropioniBacterium Acnes;
Streptococcus Agalactiae;
Streptococci (groups C, F, G);
Treponema Pallidum;
Viridans Group Streptococci.

If an infectious disease is caused by any above-mentioned microbes, the sensitivity of which to the claside is shown only in laboratory conditions, it is better to abandon the use of this antibiotic and replace it with others.

Indications for use

Both varieties and all the dosage forms of the Claside have the same following testimony to use:

Infections of the lower sections of the respiratory system (bronchitis, pneumonia, bronchiolites, etc.);
Infections of the upper departments of the respiratory system (pharyngitis, tonsillites, sinusites, otitis, etc.);
Infections of skin and soft tissues (folliculitis, face, infectious cellulite, furunculosis, impetigo, wound infection, etc.);
Infections caused by mycobacteria;
Prevention of infection caused by the Mycobacterium AVIUM complex (Mac) in HIV-infected;
Eradication N.Pylori in order to cure gastritis and ulcerative diseases of the stomach or duodenum;
Treatment and reducing the frequency of recurrences of duodenal ulcers;
Infections of teeth and oral cavity (tooth granuloma, stomatitis, etc.);
Infections caused by Chlamydia Trachomatis, Ureaplasma Urealyticum (Ureaplasma, Colpit, etc.).

The drug is effective with respect to many microorganisms - gram-negative (meningococci, gonococcal, hemophilic sticks, helicobacter pylori, etc.) and gram-positive (staphylococci, streptococcal, pneumococci, Corinbacteria diphtheria, etc.). It is also appointed to combat intracellular microorganisms (chlamydia, mycoplasma, ureaplasma, etc.), as well as with some anaerobic bacteria (peptococci, peptopulatops, bacteroids and clostrids).

Vilplerafen is quickly absorbed from the digestive tract. An hour later, its maximum blood concentration is achieved. At the same time, Vilplerafen has a long therapeutic effect.

The drug overcomes the placental barrier and can be allocated with breast milk.

The medicine is inactive for enterobacteria, therefore practically does not affect the intestinal microflora.

80% of Vilpleraphen is excreted with bile, 20% - with urine.

Macrolids are not only safe, but also quite effective. They are inherent in the huge potential of antimicrobial activity, as well as a magnificent pharmacokinetic effect, which makes it possible much easier to carry their impact in childhood. Eritromycin became the very first antibiotic group of macrolides. After 3 years, two more drugs were released - spiramycin and oleandomycin. To date, there are the best antibiotics of this group for children in the face. azithromycin, roxitromycin, clarithromycin, spiramsycin And some others. It is these antibiotic drugs that are used by modern pediatric doctors to combat infections in children.

To increase the child's immune system and strengthen its body, it is very important to purchase special biologically active additives of Tianshi Corporation such as: biocallations for children, biocinc, anti-lipid tea and so on.

Erythromycin is an antibiotic, which should be taken with a legionellese, in order to prevent acute rheumatic fever (with the impossibility of the use of penicillin), bowel decontamination before the start of colorectal operations.

Clarithromycin is used for therapy and prevention of opportunistic infection with AIDS caused by some atypical mycobacteriums, including for the Eradication of Helicobacter Pylori in diseases of the gastrointestinal tract.

Spiramizin is used for toxoplasmosis therapy, in particular in pregnant women.

Josamamicin is suitable for the treatment of various diseases of the respiratory tract, infections of soft tissues, odontogenic infections.
It is allowed to use josamicin during pregnancy and during breastfeeding according to the testimony. The WHO European Office advises Josamamicin, as a means for properly therapy of chlamydial infection in women awaiting a child.

All macrolides are allowed to take inside.

The advantages towards clarithromycin, spiramycin, roxitromycin, midekamycin and josamamicine in front of erythromycin are better pharmacokinetics, better tolerability and less multiplicity of use.

Contraindications to the use of macrolides are hypersensitivity, pregnancy (Josamamicin, Roxitromycin, Midcamicine, Clarithromycin), breastfeeding stage (Josamamicin, Spiramycin, Clarithromycin, Midekamicin, Roxitromycin).

Macrolids pass through the placenta, absorbed into breast milk.

Side effects. These drugs are not understood well and are one of the most harmless antimicrobial drug groups.

This group of macrolides is natural antibiotics (oleandomycin, erythromycin, spiramycin, etc.), as well as semi-synthetic preparations (azithromycin, roxitromycin, clarithromycin, etc.).
The base of the chemical structure of these drugs becomes a lactone ring, which consists of different antibiotics of 14-16 carbon atoms. A variety of substituents strongly affect the quality of individual compounds are attached to the lactone rings.

The main feature of the semi-synthetic macrolides was high-quality pharmacokinetic properties with an increased (wide spectrum) of antibacterial activity. They are perfectly absorbed and formed in the blood and tissues a long saving high concentrationWhat helps reduce the number of administrations per day to one - two times, reduce the duration of the course, frequency and severity side phenomena. They are effective in respiratory tract infections, diseases of the genital organs and urinary tract, soft tissues, skin, and other illness, which occurred due to gram-negative and gram-positive microorganisms, atypical bacteria, different anaerobes.
penicillin. The distinctive feature of these antibiotics was the fact that various gram-positive microorganisms were sensitive to them, not subject to penicillin, tetracycline, etc. Not just so macrolides in the clinical sphere received the place of "reserve" antibiotics. The emergence of new generations of these drugs only strengthened the position of this pharmacological group. antibacterial drugs. But, nevertheless, it did not speak of the complete refusal to apply an erythromycin well known in the clinical conditions. In fact, Erythromycin is still suitable for use in relation to a large number of types of microorganisms.

However, the antimicrobial activity of erythromycin in vitro is high. It is not worth noting the calculation of the antibiotic bioavailability, which is not so high compared to new macrolides / azalids, high opportunity unwanted influences, as well as the formation of resistant microorganisms.

The choice of macrolide antibiotics becomes especially important, taking into account the pathogen, features clinical manifestations And the move of the disease.

The necessary feature of these preparations of the first generation was insufficient effectiveness against gram-negative bacteria, including mushrooms, brucella, knocardium. New generations of these drugs are more productive in the fight against gram-negative microorganisms and constantly pay attention.

Macrolids are some lactones, in which the number of atoms in the cycle is eight or more; They are able to include a variety of substituents, namely, functional groups, including 1 or 2 communications C \u003d s. They exist with 2 or more lactone groups. This is usually solid substances that are quite well soluble in organic solutions and solvents, but poorly dissolved in water. According to its chemical qualities, they are similar to lower lactones, but have not such a strong reactivity.

Most macrolides are obtained due to bacteria strains, mainly actinomycetes and streptomycetes. Olyandomycin, erythromycin, tetranakin and rosamycin are more known from such substances.
From culture filtrates, such macrolides are obtained by extraction of organic solvents and purified by chromatographic methods. There are also similar substances that are obtained by bacteria, after which they are reworked by the biochemical or chemical method, for example, triacetylolehandomycin. The chemical method, as a rule, synthesize unsubstituted macrolides. They can be done using the lactonization of W-haloxylot or various hydroxyxlot esters.

Chemical synthesis of these substances similar to the one generate bacteria is very difficult. It includes the preparation of hydroxy acid, which has some substituents, and its immediate lactone. Thus, tilosine and some derivatives of erythromycin are synthesized. Macrolled antibiotics stop the growth of gram-positive penicillin allergies to penicillin, a legionell and ricketer infection. For complete-friendly pneumonia Macrolids are able to be first aid antibiotics.

Lincomycin (does not apply to macrolides) has bacteriostatic capabilities that are similar to the work of erythromycin.

Tetracyclines are now applied mainly in the treatment of patients with atypical pneumonias due to the formation of microbial resistance to them. Tetracyclines affect bacterial ribosomes, stopping the synthesis of bacterial protein. Doxycycline correctly falls into light (alveolar macrophages), leukocytes and, therefore, comes in the fight against intracellular pathogens (for example, Legionella).

The presence of toxicity in tetracyclines becomes great complexity. Thus, tetracycles often provoke the appearance of gastrointestinal diseases in patients, affects the appearance of candidiasis and damage to the liver and kidney, mainly in the elderly. Do not properly begin the therapy of patients with outpatient pneumonia with tetracyclines.

Pediatrics. Information about the dangers or benefits of clarithromycin for children until six months is not known. The semi-life of roxitromycin in kids can be upgraded to twenty hours.

Geriatrics. No prohibitions for using macrolides of elderly people were identified, but it should be remembered by the fact that age changes in the liver function are likely, as well as the high risk of increasing hearing when using erythromycin.

Violation of the kidney function. With a decrease in creatinine clearance less than 30 ml / min, the semi-alignment of clarithromycin is capable of climbing up to twenty hours, and its active metabolite is up to forty hours. The period of semi-liquefaction of roxitromycin is able to increase to fifteen hours with a decrease in creatinine clearance to 10 ml / min. In such cases, it may be necessary to change the dosing mode of such macrolides.