Antibiotic 6 capsules name. New generation broad-spectrum antibiotics (list)

Antibiotics are chemicals produced by microorganisms. There are also synthetic antibiotics. Both have a common goal - bacteria. In the environment around us, there are 7300 different species of them. And of course, to fight them you need a real arsenal. Consider the list of antibiotics alphabetically.

Antibiotics in human life

Today there are a large number of antibiotics, more than 10,000 types, with different modes of action. Some, such as penicillin, act on the walls or membranes of bacteria, causing them to break down. The action of others is aimed at blocking their development and survival. Finally, there are antibiotics that act directly at the DNA level of bacteria, preventing them from dividing and proliferation.

But there is one significant problem: the longer we use antibiotics, the more bacteria appear that can resist them. Over the years, the development of pharmaceuticals has circumvented this resistance, thanks to ever newer generations of antibacterial drugs. However, the ability of bacteria to adapt and block the action of antibiotics remains a major public health problem.

Classification of antibiotics. New generation drugs with a wide spectrum of action

There are several classifications of antibiotics. Here are the most common ones:

• biochemical;
• according to their spectrum of action.

Under the spectrum of action is understood the list of types of bacteria that this antibiotic actively affects. A broad spectrum antibiotic acts on a large number of bacteria - bacilli, gram-positive and negative cocci. Narrow-spectrum antibiotics only affect bacilli and Gram-positive cocci.

We are interested in the classification of antibiotics according to the mode of action:

• bactericidal agents that inhibit the synthesis of the bacterial membrane:
• beta lactams;
• glycopeptides;
• fosfomycins;
• antibiotics that inhibit protein synthesis by binding to the bacterial ribosome:
• macrolides;
• tetracyclines;
• aminoglycosides;
• chloramphenicol;
• antibacterial drugs, the action of which is based on the inhibition of the synthesis of nucleic acids:
• quinolones;
• rifampicins;
• sulfonamides.

Given the long and long-term opposition of bacteria and bactericidal agents, all these types of drugs are represented by several generations. Each next generation is distinguished by a more perfect degree of purity of the composition, which makes them less toxic to humans.

We offer you an alphabetical list of new generation antibiotics with a wide spectrum of action:

• "Avelox";
• "Azithromycin";
• "Amoxiclav";
• "Gepacef";
• "Doxycycline";
• "Clarithromycin";
• "Klacid";
• "Lincomycin";
• "Naklofen";
• "Rovamycin";
• "Roxithromycin";
• "Rulid";
• "Supraks";
• "Tazid";
• "Fuzidin";
• "Cefabol";
• "Cefodox";
• Cefumax.

The following is a list of antibiotics in alphabetical order for sinusitis for oral administration and as an injection solution:

• "Amoxiclav";
• "Amoxil";
• "Amoxicillin";
• "Ampioks";
• "Arlet";
• "Grunamox";
• "Zitrolid";
• "Macropen";
• "Ospamox";
• "Rovamycin";
• "Cefazolin";
• "Cephalexin";
• "Cefotaxime";
• "Ceftriaxone";
• "Cifran".

Names of antibiotics in alphabetical order for children:

• In inflammatory diseases of the bronchi and lungs:
• "Amoxiclav";
• "Amoxicillin";
• "Ampicillin";
• "Augmentin";
• "Flemoxin Solutab".
• For the treatment of ENT diseases:
• "Zinacef";
• "Zinnat";
• "Cefutil".
• For bacterial infections of the respiratory tract:
• "Azithromycin";
• "Hemomycin".

Features of taking antibiotics

Taking antibiotics, like any medicine, requires following some simple rules:

• In general, antibiotic treatment involves two or three doses daily. It is important to establish a regular rhythm for taking medications by choosing fixed hours.
• With food or without? In principle, the optimal time is half an hour before meals, but there are exceptions. Some antibiotics are best absorbed with fat and should be taken with meals, so it is important to read the instructions before starting treatment. Tablets and capsules should be taken with water.
• The duration of antibiotic treatment should be sufficient to clear the infection. It is very important not to stop treatment when the symptoms disappear! As a rule, the primary course is 5-6 days or longer as directed by the doctor.
• Never resort to self-medication and follow the doctor's prescription exactly. Watch your body for side effects.

One of the most important problems of antimicrobial therapy is the irrational use of antibacterial drugs, which contributes to the widespread spread of drug-resistant flora.

New mechanisms of bacterial resistance and the lack of results from the use of classical, previously effective drugs, force pharmacologists to constantly work on new, effective antibiotics.

The advantage of using a wide range of agents is explained by the fact that they can be prescribed as a starting therapy for infections with an unspecified pathogen. This is especially important in severe, complicated diseases, when days or even hours are counted and the doctor does not have the opportunity to wait for the results of cultures for the pathogen and sensitivity.

• Avikaz;
• Wilprafen;
• Doribax;
• Zerbucks;
• Zefter;
• Zinforo;
• Isodepem;
• Invanz;
• Caten;
• Cubicin;
• Macrofoam;
• Maximim;
• Maxicef;
• Movisar;
• Pyostacin;
• Rovamycin;
• We chain;
• Cefanorm;
• Ertapenem-Eleas.

The latest antimicrobial agents

Cephalosporins (only injection forms):

• Fourth generation - Cefepim (Maxipim, Movizar, Tsepim, Maxicef), Cefpir (Cefanorm, Isodepem, Keiten).
• Modern antibiotics of the latest generation (fifth, anti-MRSA) are represented by Ceftobiprol (Zeftera), Ceftaroline (Zinforo), Ceftolosan.

At the moment, in Europe and the USA, the Office of Quality Control of Medicines approved the latest medicines from the class of inhibitor-protected cephalosporins - Zerbax and Avikaz. The date of their registration and appearance on sale in Russia is not yet known. Whether it is possible to consider them as a separate, sixth generation is also not specified yet.

Zerbucks

is the trade name for a combination of ceftolosan (5th generation) and tazobactam (a beta-lactamase inhibitor).

It will be used to eradicate highly resistant Pseudomonas aeruginosa species. The conducted studies have proved its high efficiency in the treatment of severe complicated inf. urinary tract and intra-abdominal infections. Wed-in has low levels of toxicity in comparison with polymyxins and aminoglycosides. With mixed flora, its combination with metronidazole is possible.

Avikaz

is a combination of ceftazidime (3rd generation antipseudomonal cephalosporin) and avibactam (a beta-lactamase inhibitor).

It will be prescribed in the absence of an alternative for intra-abdominal infections, as well as inf. urinary tract and kidneys. Highly effective against gram pathogens. It also goes well with metronidazole. Studies have confirmed its high efficacy against strains resistant to carbapenems and capable of producing extended spectrum beta-lactamase.

Of the newest cephalosporins in Russia, Zefter was registered

Wed is highly effective against methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa and gram pathogens.

Can be used as monotherapy for severe community-acquired and hospital-acquired pneumonia. Zefter is also used for severe infections. skin, including diabetic foot.

Cyclic lipopeptides

A new class represented by the natural antimicrobial agent Daptomycin (trade name - Kubicin).

Daptomycin is highly effective in endocarditis, meningitis, osteomyelitis, staphylococcal sepsis, and complicated infections of the skin and subcutaneous fat.

Active against MSSA and MRSA strains. That is, it can be used in diseases caused by gram + polyresistant flora resistant to methicillin, vancomycin and linezolid preparations.

Broad spectrum antibiotic tablets

Lincosamides

New antibiotics of the lincosamide class are represented by a chlorinated derivative of lincomycin - clindamycin:

• Dalacin C (in addition to oral, it also has an injectable release form);
• KlindaGeksal.

Depending on the concentration, they can act both bacteriostatically and bactericidal. The spectrum of activity includes most of the Gram+ and Gram-pathogens. The drug does not affect enterococci, hemolytic bacillus, legionella and mycoplasma.

Macrolides

Now there are 3 generations of antibiotics of the macrolide class. Of the representatives of the third, apply:

• Josamycin (Vilprafen);
• Midecamycin (Macropen);
• Spiramycin (Rovamycin).

Despite the fact that Azithromycin, a broad-spectrum antibiotic prescribed in short courses (3 tablets), cannot be called a representative of the new generation, its effectiveness still allows it to be on the list of the most consumed antimicrobial drugs.

Representatives of the class obtained as a result of a change in the marolide molecule are:

• ketolides;
• streptogramins.

The group of ketolides is represented by telithromycin (trade name Ketek). Sensitive flora is similar to classical macrolides, however, the medium is more active in relation to cocci that are insensitive to lincosamines and streptogramins. Used for respiratory infections.

Streptogramins are active in diseases caused by staphylo- and streptococci, Haemophilus influenzae, methicillin-resistant staphylococci, and vancomycin-resistant enterococci. Are shown at outside and nosocomial pneumonias, and also inf. skin and subcutaneous fat associated with multidrug-resistant Gram+ bacteria.

Class members:

• Quinupristin + Dalfopristin (a combination of two streptogramins);
• Pristinamycin (Piostacin) is an antistaphylococcal agent.

The newest macrolide, solitromycin (Cempra), claimed to be effective in the treatment of community-acquired pneumonia, has not yet been registered.

If the FDA approves its release, it will be able to give rise to a new, fourth generation of macrolides.

The best broad-spectrum antibiotics for empiric treatment of life-threatening diseases with an unspecified causative agent.

Carbapenems

They have only an injection form of release. They belong to the group of beta-lactams, have structural similarities with penicillins and cephalosporins, but are distinguished by a high level of resistance to the action of extended-spectrum beta-lactamases and high efficiency against Pseudomonas aeruginosa, non-spore-forming anaerobes and bacteria resistant to representatives of the third and fourth generations of cephalosporins.

These are powerful drugs that belong to the reserve group and are prescribed for severe nosocomial infections. As an empirical first-line therapy, they can be prescribed only for life-threatening diseases, with an unspecified pathogen.

However, they are not effective against:

• MRSA (methicillin-resistant Staphylococcus aureus);
• Stenotrophomonas maltophilia (gram-negative non-fermentative bacteria that cause nosocomial infections);
• Burkholderia cepacia (opportunistic pathogens that cause severe out-of-hospital and nosocomial infections).

The strongest broad-spectrum antibiotics from the group of carbapenems are Ertapenem and Doripenem.

Broad-spectrum antibiotics in ampoules (injections)

Inwanz (Ertapenem-Eleas)

The active ingredient is Ertapenem. The area of ​​antimicrobial influence includes gram + aerobes and facultative gram - anaerobes.

It is resistant to penicillinases, cephalosporinases and extended spectrum beta-lactamases. Highly active against staphylo- (including penicillinase-producing strains) and streptococci, Haemophilus influenzae, Klebsiella, Proteus, Moraxella, Escherichia coli, etc.

It can be considered a universal remedy against strains resistant to penicillins, cephalosporins, aminoglycosides. The mechanism of bactericidal effect is due to its ability to bind to penicillin-binding proteins and irreversibly inhibit the synthesis of the cell wall of pathogens.

Cmax plasma concentrations are observed 50 minutes after the end of the infusion, with a / m administration - after 1.5-2 hours.

The half-life is about 4 hours. In patients with renal insufficiency, it is almost twice as long. It is excreted mainly in the urine, up to ten percent is excreted in the feces.

Dose adjustment is carried out in renal failure. Liver failure and advanced age do not require changes in recommended dosages.

Used for severe

• pyelonephritis and inf. urinary tract;
• infect. diseases of the small pelvis, endometritis, postoperative inf-yah and septic abortions;
• bacterial lesions of the skin and soft tissues, including diabetic foot;
• pneumonia;
• septicemia;
• abdominal infections.

Invanz is contraindicated:

• with intolerance to beta-lactams;
• up to eighteen years of age;
• with diarrhea;
• during breastfeeding.

Intramuscular administration of lidocaine is prohibited in patients with hypersensitivity to amide anesthetics, low blood pressure and impaired intracardiac conduction.

When using Invanza, it is necessary to take into account the risk of developing severe pseudomembranous colitis, therefore, if diarrhea occurs, the drug is immediately canceled.

The safety of use during childbearing has not been studied, therefore, the appointment of pregnant women is permissible only as a last resort, in the absence of a safe alternative.

There are also no adequate studies on the safe use of children, so the use of up to 18 years of age is possible strictly for health reasons, in the absence of alternative drugs. It is used for a minimum course until the condition stabilizes, at a dosage of 15 mg / kg per day, divided into two injections (up to 12 years old) and 1 gram once a day for children over 12 years old.

Side effects of Ertapenem may include:

• antibiotic-associated diarrhea and pseudomembranous colitis;
• post-infusion phlebitis;
• dyspeptic disorders;
• allergic (anaphylactic) reactions;
• arterial hypotension;
• dysbacteriosis and candidiasis;
• change in taste;
• increased liver transaminases;
• hyperglycemia;
• thrombocytopenia, neutropenia, anemia, monocytosis;
• erythrocyturia, bacteriuria.

Dosages of Invanza

With intravenous infusion, it is diluted with 0.9% saline, the minimum administration time is half an hour. For intramuscular injections, 1-2% lidocaine is used.

It is administered once a day at a dose of 1 gram. The duration of treatment ranges from three to 14 days and depends on the severity of the inflammatory process and its localization. When the condition stabilizes, a transfer to tableted antibiotics is indicated.

Doriprex (Doribax)

The active substance is Doripenem. It is a synthetic antimicrobial drug with bactericidal activity.

It is structurally similar to other beta-lactams. The mechanism of activity is due to the inactivation of penicillin-binding proteins and inhibition of the synthesis of cell wall components. Effective against gram + aerobes and gram - anaerobes.

Resistant to the action of beta-lactamases and penicillinases, weakly resistant to hydrolysis by extended spectrum beta-lactamases. The resistance of some strains is due to enzymatic inactivation of Doripenem and a decrease in the permeability of the bacterial wall.

Enterococcus facium, legionella, methicillin-resistant staphylococci are resistant to the drug. Acquired resistance can be developed by Acinetobacter and Pseudomonas aeruginosa.

Doripenem is prescribed for:

• nosocomial pneumonia;
• severe intra-abdominal infections;
• complicated inf. urinary system;
• pyelonephritis, with a complicated course and bacteremia.

Contraindicated:

• children under eighteen years of age;
• with hypersensitivity to beta-lactams;
• with diarrhea and colitis;
• breastfeeding.

Pregnant women are prescribed with caution, according to vital indications in the absence of an alternative.

Side effects may appear:

• headache;
• vomiting, nausea;
• phlebitis at the injection site;
• increase in liver transaminases;
• colitis and diarrhea;
• anaphylactic shock, itching, rash, toxic epidermal necrolysis;
• dysbacteriosis, fungal infection of the oral mucosa and vagina;
• neutropenia and thrombocytopenia.

Dosages and duration of treatment with Doriprex

Doripenem is applied at five hundred milligrams every eight hours. The duration of the infusion should be at least an hour. With nosocomial pneumonia, it is possible to increase the dose to 1000 mg. Doriprex is administered in 0.9% saline or 5% glucose.

The duration of treatment ranges from five to 14 days and depends on the severity of the disease and the localization of the bacterial focus.

When the patient's condition stabilizes, a transition to tableted antibacterial drugs is carried out. Dose adjustment is necessary for patients with impaired renal function. Liver failure and advanced age are not indications for dose reduction.

Cheap broad spectrum antibiotics

We are chaining

The Russian medicine, produced by the Sintez AKOMP campaign, will cost the buyer about 120 rubles per bottle. This is a fairly inexpensive analogue of Maximim, made in the USA (400 rubles per 1 gram bottle).

The active ingredient is cefepime. It belongs to the 4th generation cephalosporins. and has broad bactericidal activity. The mechanism of influence on pathogens is due to a violation of the processes of synthesis of the components of the microbial wall.

Cefepime is effective against gram- and gram+ pathogens resistant to aminoglycoside preparations and third-generation cephalosporins. Of staphylococci, only methicillin-sensitive types are sensitive, other strains are resistant to its action. Also, wed-in does not work on enterococci and clostridia.

The drug is resistant to bacterial beta-lactamases.

Able to create high concentrations in:

• bronchial secretions and sputum;
• bile and walls of the gallbladder;
• appendix and peritoneal fluid;
• prostate.

The drug has a high bioavailability and absorption. The half-life is about two hours. Dose adjustment is carried out only in patients with renal insufficiency.

The list of indications for the appointment of Tsepim are:

• moderate to severe pneumonia;
• febrile fever;
• complicated urinary tract infections;
• heavy pyelonephritis;
• intra-abdominal inf. with complications (combined with 5-nitroimidazal derivatives - metronidazole);
• infect. skin and subcutaneous fat caused by drug-sensitive staphylo- and streptococci;
• meningitis;
• sepsis.

Also, it can be prescribed to prevent septic postoperative complications.

Tsepim can be used for the empirical treatment of diseases caused by an unspecified pathogen. It is also prescribed for mixed infections (anaerobic-aerobic flora) in combination with antianaerobic drugs.

Cefepime is contraindicated:

• persons with intolerance to beta-lactams and L-arginine;
• children up to two months of life (intravenously);
• patients under 12 years of age (intramuscularly).

Be wary appoint patients with pseudomembranous colitis in history, ulcerative colitis, renal failure, pregnant and lactating.

Possible side effects in the form of:

• phlebitis at the injection site;
• dyspeptic disorders;
• anxiety, headache;
• thrombocytopenia, leukopenia, neutropenia;
• jaundice, increased hepatic transaminases;
• allergies;
• tremor and convulsions;
• candidiasis and dysbacteriosis.

Doses of the drug

Dosage, route of administration and duration of therapy depend on the severity of the disease, the location of the bacterial focus and the state of kidney function.

As a rule, one to two grams of the drug is administered intravenously, every 12 hours. With inf. urinary tract possible intramuscular injection.

With febrile fever, 2 grams are prescribed every eight hours. It is applied from seven to 10 days. With infection. with a severe course, it is possible to lengthen the course.

Babies older than two months are prescribed 50 mg / kg twice a day. With neutropenia - three times a day.

Article prepared
infectious disease doctor Chernenko A.L.

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Antibiotics help to cope with most diseases. Many do not like them, considering drugs dangerous to health (“one is treated, the other is maimed”). But it is difficult to argue with the fact that these drugs have stopped more than one epidemic. Moreover, due to their wide range of applications, people are less likely to die from infectious diseases. As a result, the life expectancy of people has increased significantly.

There is just one problem: viruses and bacteria can mutate and adapt to antibiotics (this property is called antibiotic resistance - the developed resistance of microorganisms to the action of a drug). That is why antibiotics, invented decades ago and considered almost a panacea for all infections, are now poorly effective in treating most diseases.

Scientists are forced to improve drugs, that is, to produce new generation drugs. There are currently four generations of antibiotics in widespread use. In this article, we will compile a list of the most popular modern new generation drugs, analyze their main characteristics, indications, contraindications and prices.

general description

Broad-spectrum antibiotics - drugs of universal action, prescribed to combat a large number of pathogens (including those with an unknown source of infection). Unfortunately, such versatility is a weakness: it is likely that antibiotics will begin to fight against beneficial microflora (for example, if the symbiotic intestinal flora is destroyed, then dysbacteriosis occurs). That is why after treatment with broad-spectrum antibiotics, it is necessary to restore the normal level of beneficial bacteria.

New generation preparations are universal and capable of influencing a large number of pathogenic microbes.

New generation antibiotics are more effective than their predecessors because the bacteria have not yet had time to adapt to them. Besides:

• new generation antibiotics are considered safer (have fewer side effects and are not so pronounced);
• new generation antibiotics are easy to use - the first generation drugs had to be taken 3-4 times a day, and modern antibiotics are enough to take 1-2 times;
• new generation antibiotics are available in different forms. There are even medicines in the form of syrups and patches.

What tools are the most powerful

Having studied the reviews of doctors and patients, we can identify the most common broad-spectrum antibiotics from the latest generation. We get the following list:

1. Sumamed.
2. Cefamandol.
3. Unidox Solutab.
4. Rulid.
5. Amoxiclav.
6. Lincomycin.
7. Cefoperazone.
8. Cefotaxime.
9. Cefixime.
10. Avelox.

Now let's look at each drug on this list in a little more detail.

• Sumamed (Sumamed)

Broad-spectrum antibiotics from the list of new generation macrolides. They act due to azithromycin (in one capsule - 250 ml of the substance).

Sumamed is especially effective for fighting infections that affect the respiratory tract (tonsillitis, sinusitis, bronchitis, pneumonia), skin and soft tissues, the genitourinary system (for example, prostatitis) and the gastrointestinal tract (including intestinal infections). Contraindicated in hypersensitivity to macrolides, as well as in diseases of the liver and kidneys. It has mild side effects, which distinguishes Sumamed from other broad-spectrum antibiotics. It is taken one tablet per day for 3 days (then the course can be extended by a doctor).

The price of Sumemd depends on the form of release and packaging: capsules 250 mg, 6 pieces - from 320 rubles; 6 tablets 125 mg - from 290 rubles; 6 tablets 500 mg - from 377 rubles.

• Cefamandol (Cefamandole)

Drug packaging.

The drug of the cephalosporin group of the latest generation. Rarely causes an adaptive reaction in microorganisms, therefore it is quite effective in combating gram-positive and gram-negative bacteria, mycoplasmas, legionella, salmonella, as well as sexually transmitted pathogens. Often prescribed for colds and intestinal infections. Can be used as an alternative to cephalosporin if resistance to the latter is observed. Effective for the prevention of postoperative infectious complications. Of the minuses of the drug - its high price.

• Unidox Solutab (Unidox Solutab)

A broad-spectrum antibiotic from the list of new generation tetracyclines. The active substance in the composition is doxycycline. Available in the form of tablets of 100 mg (10 tablets per pack).

Effective in the fight against gram-positive and gram-negative microorganisms, protozoa, anaerobes, atypical pathogens. Most often prescribed for the treatment of colds, intestinal infections, prostatitis. Almost does not cause dysbacteriosis. Dosage for adults - 200 mg (2 tablets) once or twice a day. The price of the drug is approximately 280 rubles. for packing.

• Rulid (Rulid)

Fourth generation antibiotic from the list of macrolides. The base substance is roxithromycin. Available in the form of tablets with a dosage of 150 mg. A single daily dose of the drug is sufficient. It is most often prescribed for infections of the upper respiratory tract, urogenital diseases (for example, prostatitis), intestinal, ondotological infections. Not recommended for use in renal failure. It is quite expensive - from 800 rubles. for 10 pieces.

• Amoxiclav (Amoksiklav)

Fourth generation antibiotic packaging.

A new generation antibiotic from the list of the pharmacological group of aminopenicillins. It has a wide spectrum of action, resistance to the action of beta-lactamase strains. It has a mild effect, therefore it is used for both treatment and prevention. Unlike many fourth-generation antibiotics, it can be prescribed to pregnant and lactating women. Manufactured by Lek Pharma and Lek D.D. Available in the form of powder for intravenous administration, powder for oral administration, tablets. The price of powders for injections - from 200 rubles, powders taken orally - from 60 rubles, 375 mg tablets - from 224 rubles.

• Lincomycin (Lincomycin)

Widely used in dentistry.

One of the most affordable antibiotics for a wide range of applications. Sold in the form of ampoules for intravenous and intramuscular administration and in the form of capsules. The selective bacteriostatic action makes it possible to use it in cases where other drugs are ineffective due to the developed resistance. True, the same quality does not allow Lincomycin to be prescribed as a first line medicine. It is quite toxic and has a list of a large number of side effects and contraindications, which should be familiarized with before taking the medicine. The cost of ampoules with a solution is from 68 rubles. for 10 pieces; the cost of capsules - from 73 rubles.

• Cefoperazone (Cefoperazone)

Prices for an antibiotic in pharmacies for different forms and dosages - from 110 to 370 rubles. It has a wide list of applications: respiratory, urinary tract infections, skin and intestinal infections, inflammation of the pelvic organs, prostatitis, prevention after abdominal, gynecological and orthopedic operations. It belongs to the group of cephalosporins. Enough twice daily administration. As a rule, it shows good tolerance, side effects are rare. Unfortunately, it is available only in the form of an injection solution. Price - from 115 rubles.

• Cefotaxime (Cefotaxime)

New generation cephalosporin antibiotic. It is considered one of the most commonly prescribed drugs for most infectious and inflammatory diseases (colds, intestinal, urological, gynecological, prostatitis, etc.). This prevalence is due to the wide spectrum of antibiotic action, affordable price, low toxicity, minimal effect on beneficial bacteria. Can be used for treatment and prevention (for example, in the postoperative period). Available only as a solution for injection.

• Cefixime (Cefixime)

Another name for the antibiotic is Pancef. Available only in the form of capsules and tablets taken orally. It acts bactericidal (prevents the synthesis of cell walls of pathogens). Has a wide spectrum of action (kills intestinal infections, treats colds, prostatitis, used after surgery). Unfortunately, this new generation antibiotic has a rather strong toxic effect on the kidneys and liver, so it is not recommended for use in diseases of these organs. Price - from 397 rubles.

• Avelox (Avelox)

A very strong antibiotic of the latest generation from the group of fluoroquinolones. It is a modern analogue of Moxifloxcin. Effective against many known bacterial and atypical pathogens. Virtually no negative effect on the kidneys and stomach. Such antibiotics can be used as children's medicines, so they are not prescribed in pediatrics. They are quite expensive - from 750 rubles. for 5 pcs.

How to choose

Naturally, it is not enough to get acquainted with the list of new generation antibiotics. I would like to say which broad-spectrum antibiotics are the safest and most effective. Unfortunately, it is impossible to single out a specific drug, since each of the antibiotics has its own characteristics and in each specific case different means will be more effective. That is why you should not prescribe drugs for treatment and prevention on your own if you do not have a medical education. For intestinal infections, prostatitis, tonsillitis or otitis media, various antibiotics will be prescribed. It is better to trust a specialist who prescribes a medicine based on the diagnosis, stage of the disease, comorbidities, as well as the individual characteristics of the patient.

We figured out what broad-spectrum antibiotics are and how they work in various infectious pathologies. Now it's time to get to know the most prominent representatives of various ASSD groups.

List of broad spectrum antibiotics

Let's start with the popular broad-spectrum antibiotics of the penicillin series.

Amoxicillin

The drug belongs to the class of semi-synthetic antibiotics of the penicillin series with a wide spectrum of activity of the 3rd generation. With its help, many infectious pathologies of the ENT organs, skin, biliary tract, bacterial diseases of the respiratory, genitourinary and musculoskeletal systems are treated. It is used in combination with other AMPs and for the treatment of inflammatory pathologies of the gastrointestinal tract caused by a bacterial infection (the infamous Helicobacter pylori).

The active substance is amoxicillin.

Pharmacodynamics

Like other penicillins, Amoxicillin has a pronounced bactericidal effect, destroying the cell wall of bacteria. It has such an effect on gram-positive (streptococci, staphylococci, clostridia, most of the corynobacteria, eubacteria, anthrax and erysipelas) and gram-negative aerobic bacteria. However, the drug remains ineffective against strains capable of producing penicillase (aka beta-lactamase), so in some cases (for example, in osteomyelitis) it is used in conjunction with clavulanic acid, which protects Amoxicillin from destruction.

Pharmacokinetics

The drug is considered acid-resistant, so it is taken orally. At the same time, it is quickly absorbed in the intestine and distributed through the tissues and body fluids, including the brain and cerebrospinal fluid. After 1-2 hours, the maximum concentration of AMP in the blood plasma can be observed. With normal functioning of the kidneys, the half-life of the drug will be from 1 to 1.5 hours, otherwise the process may take up to 7-20 hours.

The drug is excreted from the body mainly through the kidneys (about 60%), some of it in its original form is removed with bile.

Amoxicillin is allowed for use during pregnancy, since the toxic effects of penicillins are weak. However, doctors prefer to turn to antibiotic help only if the disease threatens the life of the expectant mother.

The ability of the antibiotic to penetrate into liquids, including breast milk, requires the transfer of the baby to milk formulas for the period of treatment with the drug.

Contraindications for use

Due to the fact that penicillins are generally relatively safe, there are very few contraindications to the use of the drug. It is not prescribed for hypersensitivity to the components of the drug, with intolerance to penicillins and cephalosporins, as well as with infectious pathologies such as mononucleosis and lymphocytic leukemia.

Side effects

First of all, Amoxicillin is famous for the possibility of developing allergic reactions of varying severity, ranging from rashes and itching on the skin to anaphylactic shock and Quincke's edema.

The drug passes along the gastrointestinal tract, so it can cause unpleasant reactions from the digestive system. Most often it is nausea and diarrhea. Rarely, colitis and thrush can develop.

The liver not taking the drug may respond with an increase in liver enzymes. Rarely, hepatitis or jaundice develops.

The drug rarely causes headache and insomnia, as well as a change in the composition of urine (the appearance of salt crystals) and blood.

Dosage and administration

The drug can be found on sale in the form of tablets, capsules and granules for the preparation of a suspension. It can be taken regardless of food intake with an interval of 8 hours (with kidney pathologies -12 hours). A single dose, depending on age, ranges from 125 to 500 mg (for babies under 2 years old - 20 mg per kg).

Overdose

An overdose can occur when the permissible doses of the drug are exceeded, but usually it is accompanied only by the appearance of more pronounced side effects. Therapy consists in washing the stomach and taking sorbents; in severe cases, they resort to hemodialysis.

Amoxicillin has a negative effect on the effectiveness of oral contraceptives.

Simultaneous administration of the drug with probenecid, allopurinol, anticoagulants, antacids, antibiotics with a bacteriostatic effect is undesirable.

Storage conditions

Best before date

The shelf life of the drug of any form of release is 3 years. The suspension prepared from granules can be stored no more than 2 weeks.

Amoxiclav

Combined preparation of the penicillin series of a new generation. Representative of protected penicillins. It contains 2 active ingredients: the antibiotic amoxicillin and the penicillase inhibitor clavuonic acid, which has a slight antimicrobial effect.

Pharmacodynamics

The drug has a pronounced bactericidal effect. Effective against most gram-positive and gram-negative bacteria, including strains resistant to unprotected beta-lactams.

Pharmacokinetics

Both active substances are quickly absorbed and penetrate into all environments of the body. Their maximum concentration is noted an hour after administration. The elimination half-life ranges from 60 to 80 minutes.

Amoxicillin is excreted unchanged, and clavuonic acid is metabolized in the liver. The latter is excreted with the help of the kidneys, like amoxicillin. However, a small part of its metabolites can be found in faeces and exhaled air.

Use during pregnancy

For vital indications, use during pregnancy is allowed. When breastfeeding, it should be borne in mind that both components of the drug are able to penetrate into breast milk.

Contraindications for use

The drug is not used for violations of liver function, especially associated with the intake of any of the active substances, which is noted in the anamnesis. Do not prescribe Amoxiclav and with hypersensitivity to the components of the drug, as well as if reactions of intolerance to beta-lactams have been noted in the past. Infectious mononucleosis and lymphocytic leukemia are also contraindications for this drug.

Side effects

Side effects of the drug are identical to those observed while taking Amoxicillin. They affect no more than 5% of patients. The most common symptoms: nausea, diarrhea, various allergic reactions, vaginal candidiasis (thrush).

Dosage and administration

I take the drug in the form of tablets, regardless of the meal. Tablets are dissolved in water or chewed with water in the amount of ½ cup.

Usually a single dose of the drug is 1 tablet. The interval between doses is 8 or 12 hours, depending on the weight of the tablet (325 or 625 mg) and the severity of the pathology. Children under 12 years of age are given the drug in the form of a suspension (10 mg per kg per 1 dose).

Overdose

In case of an overdose of the drug, life-threatening symptoms are not observed. Usually everything is limited to pain in the abdomen, diarrhea, vomiting, dizziness, sleep disturbances.

Therapy: gastric lavage plus sorbents or hemodialysis (blood purification).

Interactions with other drugs

It is undesirable to take the drug simultaneously with anticoagulants, diuretics, NVPS, allopurinol, phenylbutazone, methotriexate, disulfiram, probenecid due to the development of side effects.

Concurrent use with antacids, glucosamine, laxatives, rifampicin, sulfonamides and bacteriostatic antibiotics reduces the effectiveness of the drug. He himself reduces the effectiveness of contraceptives.

Storage conditions

Store the drug at room temperature away from sources of moisture and light. Keep away from children.

Best before date

The shelf life of the drug, subject to the above requirements, will be 2 years.

As for the drug "Augmentin", it is a complete analogue of "Amoxiclav" with the same indications and method of application.

Now let's move on to the no less popular group of broad-spectrum antibiotics - cephalosporins.

Ceftriaxone

Among antibiotics of the 3rd generation of cephalosporins, it is a big favorite among therapists and pulmonologists, especially when it comes to severe pathologies that are prone to complications. This is a drug with a pronounced bactericidal effect, the active substance of which is ceftriaxone sodium.

The antibiotic is active against a huge list of pathogenic microorganisms, including many hemolytic streptococci, which are considered the most dangerous pathogens. Most strains producing enzymes against penicillins and cephalosporins remain sensitive to it.

In this regard, the drug is indicated for many pathologies of the abdominal organs, infections affecting the musculoskeletal, genitourinary and respiratory systems. With its help, sepsis and meningitis, infectious pathologies in debilitated patients are treated, infections are prevented before and after operations.

Pharmacokinetics

The pharmacokinetic properties of the drug are highly dependent on the administered dose. Only the half-life remains constant (8 hours). The maximum concentration of the drug in the blood when administered intramuscularly is observed after 2-3 hours.

Ceftriaxone penetrates well into various body media and maintains a concentration sufficient to kill most bacteria during the day. It is metabolized in the intestine with the formation of inactive substances, excreted in equal amounts with urine and bile.

Use during pregnancy

The drug is used in cases where there is a real threat to the life of the expectant mother. Breastfeeding during treatment with the drug should be abandoned. Such restrictions are due to the fact that ceftriaxone is able to pass through the placental barrier and penetrate into breast milk.

Contraindications for use

The drug is not prescribed for severe pathologies of the liver and kidneys with violations of their functions, pathologies of the gastrointestinal tract affecting the intestines, especially if they are associated with the use of AMP, with hypersensitivity to cephalosporins. In pediatrics, they are not used to treat newborns diagnosed with hyperbilirubinemia, in gynecology - in the first semester of pregnancy.

Side effects

The frequency of occurrence of undesirable effects while taking the drug does not exceed 2%. Most often, nausea, vomiting, diarrhea, stomatitis, reversible changes in the composition of the blood, skin allergic reactions are noted.

Less commonly, headache, fainting, fever, severe allergic reactions, candidiasis. Occasionally, inflammation may occur at the injection site, pain during intramuscular administration is removed with lidocaine, administered in the same syringe with ceftriaxone.

Dosage and administration

It is mandatory to conduct a test for the tolerance of ceftriaxone and lidocaine.

The drug can be administered intramuscularly and intravenously (injections and infusions). With i / m administration, the drug is diluted in a 1% solution of lidocaine, with i / v: in case of injections, water for injection is used, for droppers - one of the solutions (saline, solutions of glucose, levulose, dextran in glucose, water for injection).

The usual dosage for patients over 12 years of age is 1 or 2 g of ceftriaxone powder (1 or 2 vials). For children, the drug is administered at the rate of 20-80 mg per kg of body weight, taking into account the age of the patient.

Overdose

With an overdose of the drug, neurotoxic effects and increased side effects are observed, up to convulsions and confusion. Treatment is carried out in a hospital.

Interactions with other drugs

Empirically, antagonism between ceftriaxone and chloramphenicol was noted. Physical incompatibility is also observed with aminoglycosides, therefore, in combination therapy, the drugs are administered separately.

The drug is not mixed with solutions containing calcium (solutions of Hartmann, Ringer, etc.). Co-administration of ceftriaxone with vancomycin, fluconazole, or amsacrine is not recommended.

Storage conditions

Vials with the drug should be stored at room temperature, protected from light and moisture. The finished solution can be stored for 6 hours, and at a temperature of about 5 ° C, it retains its properties for a day. Keep away from children.

Best before date

The shelf life of the antibiotic in powder is 2 years.

Cefotaxime

One of the 3rd generation cephalosporins, showing, like others, a good bactericidal effect. The active substance is cefotaxime.

It is used for the same pathologies as the previous drug, has found wide application in the treatment of infectious diseases of the nervous system, with blood poisoning (septicemia) by bacterial elements. Intended for parenteral administration only.

Active against many, but not all bacterial pathogens.

Pharmacokinetics

The maximum concentration of cefutaxime in the blood is observed already after half an hour, and the bactericidal effect lasts 12 hours. The half-life ranges from 1 to 1.5 hours.

Has good penetrating power. In the process of metabolism, it forms an active metabolite, which is excreted in the bile. The main part of the drug in its original form is excreted in the urine.

Use during pregnancy

The drug is forbidden to use during pregnancy (at any time) and breastfeeding.

Contraindications for use

Do not prescribe with hypersensitivity to cephalosporins and during pregnancy. In case of intolerance to lidocaine, the drug should not be administered intramuscularly. Do not make intramuscular injections and children under 2 and a half years.

Side effects

The drug can cause both mild skin reactions (redness and itching) and severe allergic reactions (Quincke's edema, bronchospasm, and in some cases anaphylactic shock).

Some patients note pain in the epigastrium, stool disorders, dyspeptic symptoms. There are slight changes in the functioning of the liver and kidneys, as well as in laboratory blood parameters. Sometimes patients complain of fever, inflammation at the injection site (phlebitis), deterioration due to the development of superinfection (re-infection with a modified bacterial infection).

Dosage and administration

After testing for sensitivity to cefotaxime and lidocaine, the drug is prescribed at a dosage of 1 g (1 bottle of powder) every 12 hours. In severe infectious lesions, the drug is administered 2 g every 6-8 hours. The dose for newborns and premature babies is 50-100 mg per kg of body weight. The dosage is also calculated for children older than 1 month. Babies up to 1 month are prescribed 75-150 mg / kg per day.

For intravenous injections, the drug is diluted in water for injection, for drip (within an hour) - in saline.

Overdose

An overdose of the drug can cause damage to the brain structures (encephalopathy), which is considered reversible with appropriate professional treatment.

Interactions with other drugs

It is undesirable to use the drug simultaneously with other types of antibiotics (in the same syringe). Aminoglycosides and diuretics can increase the toxic effect of the antibiotic on the kidneys, so combination therapy should be carried out with the control of the state of the organ.

Storage conditions

Store at a temperature not exceeding 25 ° C in a dry, darkened room. The finished solution can be stored at room temperature for up to 6 hours, at a temperature of 2 to 8 ° C - no more than 12 hours.

Best before date

The drug in the original packaging can be stored for up to 2 years.

Hepacef

This drug also belongs to the 3rd generation cephalosporin antibiotics. It is intended for parenteral administration for the same indications as the 2 drugs described above from the same group. The active substance, cefoperazone, has a noticeable bactericidal effect.

Despite being highly effective against many important pathogens, many bacteria that produce beta-lactamase remain antibiotic resistant to it, i.e. remain insensitive.

Pharmacokinetics

With a single administration of the drug, a high content of the active substance in body fluids, such as blood, urine and bile, is already noted. The half-life of the drug does not depend on the route of administration and is 2 hours. It is excreted in the urine and bile, and in the bile its concentration remains higher. Does not accumulate in the body. Re-introduction of cefoperazone is also allowed.

Use during pregnancy

It is allowed to use the drug during pregnancy, but without special need it should not be used. An insignificant part of cefoperazone passes into breast milk, and yet breastfeeding during the period of treatment with Hepacef should be limited.

Contraindications for use

Other contraindications to the use, in addition to intolerance to cephalosporin antibiotics, the drug was not found.

Side effects

Skin and allergic reactions to the drug occur infrequently and are mainly associated with hypersensitivity to cephalosporins and penicillins.

There may also be symptoms such as nausea, vomiting, decreased stools, jaundice, arrhythmias, increased blood pressure (in rare cases, cardiogenic shock and cardiac arrest), exacerbation of tooth and gum sensitivity, anxiety, etc. Superinfection may develop.

Dosage and administration

After a skin test for cefoperazone and lidocaine, the drug can be administered both intravenously and intramuscularly.

The usual adult daily dosage ranges from 2 to 4, which corresponds to 2-4 vials of the drug. The maximum dose is 8 g. The drug should be administered every 12 hours, evenly distributing the daily dose.

In some cases, the drug was administered in large doses (up to 16 g per day) with an interval of 8 hours, which did not have a negative effect on the patient's body.

The daily dose for a child, starting from the neonatal period, is 50-200 mg per kg of body weight. Maximum 12 g per day.

With intramuscular administration, the drug is diluted with lidocaine, with intravenous administration - with water for injection, saline solution, glucose solution, Ringer's solution and other solutions containing the above liquids.

Overdose

The drug does not have acute toxic effects. It is possible to increase side effects, the appearance of convulsions and other neurological reactions due to the drug getting into the cerebrospinal fluid. In severe cases (for example, with renal failure), treatment can be carried out through hemodialysis.

Interactions with other drugs

Do not administer the drug simultaneously with aminoglycosides.

At the time of treatment with the drug, it is necessary to limit the use of alcohol-containing drinks and solutions.

Storage conditions

Best before date

The drug retains its properties for 2 years from the date of issue.

Antibiotics from the group of fluoroquinolones help doctors with severe infectious pathologies.

Ciprofloxacin

A popular budget antibiotic from the fluoroquinolone group, which is available in the form of tablets, solutions and ointments. It has a bactericidal effect against many anaerobes, chlamydia, mycoplasma.

It has a wide range of indications for use: infections of the respiratory system, middle ear, eyes, urinary and reproductive systems, abdominal organs. It is also used in the treatment of infectious pathologies of the skin and the musculoskeletal system, as well as for prophylactic purposes in patients with weakened immunity.

In pediatrics, it is used to treat a complicated course of diseases, if there is a real risk to the patient's life that exceeds the risk of developing joint pathologies during treatment with the drug.

Pharmacokinetics

When taken orally, the drug is rapidly absorbed into the blood in the initial section of the intestine and penetrates into various tissues, fluids and cells of the body. The maximum concentration of the drug in the blood plasma is observed after 1-2 hours.

Partially metabolized with the release of inactive metabolites with antimicrobial activity. The excretion of the drug is carried out mainly by the kidneys and intestines.

Use during pregnancy

The drug is not used at any stage of pregnancy due to the risk of cartilage damage in newborns. For the same reason, it is worth abandoning breastfeeding for the period of drug therapy, since ciprofloxacin freely penetrates into breast milk.

Contraindications for use

The drug is not used to treat pregnant and lactating women. Oral forms of the drug are not used in people with a deficiency of gluose-6-phosphate dehydrogenase and patients under 18 years of age.

Prohibited drug therapy in patients with hypersensitivity to ciprofloxacin and other fluoroquinolones.

Side effects

The drug is usually well tolerated by patients. Only in some cases, various disorders of the gastrointestinal tract can be observed, including bleeding in the stomach and intestines, headaches, sleep disturbances, tinnitus, and other unpleasant symptoms. Rare cases of arrhythmias and hypertension have been reported. Allergic reactions are also very rare.

Can provoke the development of candidiasis and dysbacteriosis.

Dosage and administration

Orally and intravenously (stream or drip), the drug is used 2 times a day. In the first case, a single dose is from 250 to 750 mg, in the second - from 200 to 400 mg. The course of treatment is from 7 to 28 days.

Local treatment of the eye with drops: drip every 1-4 hours, 1-2 drops in each eye. Suitable for adults and children from 1 year old.

Overdose

Symptoms of an overdose of the drug when taken orally indicate an increase in its toxic effect: headache and dizziness, trembling in the limbs, weakness, convulsions, the appearance of hallucinations, etc. In large doses, it leads to impaired renal function.

Treatment: gastric lavage, taking antacids and emetics, drinking plenty of fluids (acidified liquid).

Interactions with other drugs

Beta-lactam antibiotics, aminoglycosides, vancomycin, clindomycin and metronidazole enhance the effect of the drug.

It is not recommended to take ciprofloxacin concomitantly with sucralfate, bismuth preparations, antacids, vitamin and mineral supplements, caffeine, cyclosporine, oral anticoagulants, tizanidine, aminophylline and theophylline.

Storage conditions

Best before date

The shelf life of the drug should not exceed 3 years.

Ciprolet is another popular drug from the fluoroquinolone group, belonging to the category of broad-spectrum antibiotics. This drug is an inexpensive analogue of the drug Ciprofloxacin with the same active ingredient. It has indications for use and release forms similar to the above-named drug.

The popularity of antibiotics of the next group - macrolides - is caused by the low toxicity of these drugs and relative hypoallergenicity. Unlike the above groups of AMPs, they have the ability to inhibit the reproduction of a bacterial infection, but do not completely destroy the bacteria.

Sumamed

A broad-spectrum antibiotic, beloved by doctors, which belongs to the group of macrolides. It is commercially available in the form of tablets and capsules. But there are also forms of the drug in the form of a powder for the preparation of an oral suspension and a lyophilisate for the preparation of injection solutions. The active substance is azithromycin. It has a bacteriostatic effect.

The drug is active against most anaerobic bacteria, chlamydia, mycoplasma, etc. It is used mainly for the treatment of infections of the respiratory and ENT organs, as well as for infectious pathologies of the skin and muscle tissue, STDs, gastrointestinal diseases caused by Helicobacter pylori..

Pharmacokinetics

The maximum concentration of the active substance in the blood is observed 2-3 hours after its administration. In tissues, the content of the drug is ten times higher than in liquids. Excreted from the body for a long time. The elimination half-life can be from 2 to 4 days.

It is excreted mainly with bile and a little with urine.

Use during pregnancy

According to experiments with animals, azithromycin does not have a negative effect on the fetus. And yet, in the treatment of people, the drug should be used only in extreme cases due to the lack of information regarding the human body.

The concentration of azithromycin in breast milk is not clinically significant. But the decision to breastfeed during the period of drug therapy should be well considered.

Contraindications for use

The drug is not prescribed for hypersensitivity to azithromycin and other macrolysis, including ketolides, as well as for renal or hepatic insufficiency.

Side effects

Adverse reactions during the administration of the drug are observed in only 1% of patients. These can be dyspeptic phenomena, stool disorders, loss of appetite, development of gastritis. Sometimes allergic reactions, including angioedema, are noted. May cause inflammation of the kidneys or thrush. Sometimes medication is accompanied by pain in the heart, headaches, drowsiness, sleep disturbances.

Dosage and administration

Tablets, capsules and suspension should be taken once every 24 hours. In this case, the last 2 forms are taken either an hour before meals, or 2 hours after it. You do not need to chew the tablets.

A single adult dose of the drug is 500 mg or 1 g, depending on the pathology. Therapeutic course - 3-5 days. The dosage for a child is calculated based on the age and weight of a small patient. Children under 3 years of age are given the drug in the form of a suspension.

The use of lyophysilate implies a 2-stage process for preparing a treatment solution. First, the drug is diluted with water for injection and shaken, then saline, dextrose solution or Ringer's solution are added. The drug is administered only intravenously as a slow infusion (3 hours). The daily dose is usually 500 mg.

Overdose

An overdose of the drug manifests itself in the form of the appearance of side effects of the drug. Treatment is symptomatic.

Interactions with other drugs

Do not use simultaneously with ergot preparations due to the development of strong toxic effects.

Lincosamines and antacids can weaken the effect of the drug, while tetracyclines and chloramphenicol can increase it.

It is undesirable to take the drug simultaneously with drugs such as heparin, warfarin, ergotamine and its derivatives, cycloseryl, methylprednisolone, felodipine. Indirect anticoagulants and agents subject to microsomal oxidation increase the toxicity of azithromycin.

Storage conditions

It is necessary to store the drug in a dry room with a temperature regime within 15 -25 degrees. Keep away from children.

Best before date

The shelf life of capsules and tablets is 3 years, powder for oral administration and lyophysilate - 2 years. The suspension prepared from powder is stored no more than 5 days.

Broad-spectrum antibiotics for children

Studying the description of various broad-spectrum antibiotics, it is easy to see that not all of them are used to treat children. The danger of developing toxic effects and allergic reactions makes doctors and parents of the baby think a thousand times before offering the child this or that antibiotic.

It is clear that if possible it would be better to refuse to take such strong drugs. However, this is not always possible. And here you already have to choose from the whole variety of AMPs those that will help the baby cope with the disease without causing much harm to his body.

Such relatively safe drugs can be found in almost any of the groups of antibiotics. For young children, forms of preparations are provided in the form of a suspension.

The appointment of drugs with a wide spectrum of antimicrobial activity in pediatrics is practiced when it is not possible to quickly identify the causative agent of the disease, while the disease is actively gaining momentum and carries an obvious danger to the child.

The choice of an effective antibiotic is carried out according to the following principle: the drug must be sufficiently active against the alleged pathogen in the minimum effective doses and have a release form appropriate for the age of the child. The frequency of taking such antibiotics should not exceed 4 times a day (for newborns - 2 times a day).

The instructions for the drug should also indicate how to calculate the effective dose of the drug for a child of the appropriate age and weight.

The following drugs meet these requirements:

• Penicillin group - amoxicillin, ampicillin, oxacillin and some drugs based on them: Augmentin, Flemoxin, Amoxil, Amoxiclav, etc.
• Cephalosporin group - ceftriaxone, cefuroxime, cefazolin, cefamandol, ceftibuten, cefipime, cefoperazone and some drugs based on them: Zinnat, Cedex, Vinex, Suprax, Azaran, etc.
• Aminoglycosides based on streptomycin and gentamicin
• Carbapenems - Imipenem and Moropenem
• Macrolides - Clarithromycin, Klacid, Sumamed, Macropen, etc.

You can learn about the possibilities of using the drug in childhood from the instructions that come with any medicines. However, this is not a reason to prescribe antimicrobials to your child on your own or change doctor's prescriptions at your own discretion.

Frequent sore throats, bronchitis, pneumonia, otitis media, various colds in childhood do not surprise either doctors or parents for a long time. And taking antibiotics for these diseases is not uncommon, because babies do not yet have a sense of self-preservation, and they continue to actively move and communicate even during illness, which causes various complications and the addition of other types of infection.

It must be understood that the mild course of the above pathologies does not require the use of antibiotics with either a wide or a narrow spectrum of action. They are prescribed during the transition of the disease to a more severe stage, for example, with purulent tonsillitis. In viral infections, antibiotics are prescribed only if a bacterial infection is attached to them, which manifests itself in the form of various serious complications of SARS. In the allergic form of bronchitis, the use of AMP is inappropriate.

Doctors' prescriptions for various pathologies of the respiratory and ENT organs may also differ.

For example, with angina, doctors prefer drugs from the macrolide groups (Sumamed or Klacid), which are given to babies in the form of a suspension. Treatment of complicated purulent tonsillitis is carried out mainly with Ceftriaxone (most often in the form of intramuscular injections). Of the cephalosporins, Zinnat suspension can be used for oral administration.

With bronchitis, penicillins (Flemoxin, Amoxil, etc.) and oral cephalosporins (Supraks, Cedex) often become the drugs of choice. With complicated pathologies, they again resort to the help of Ceftriaxone.

With complications of acute respiratory viral infections and acute respiratory infections, protected penicillins (usually Augmentin or Amoxiclav) and macrolides (Sumamed, Macropen, etc.) are indicated.

Usually, antibiotics intended for the treatment of children have a pleasant taste (often raspberry or orange), so there are no particular problems with taking them. But be that as it may, before offering the baby a medicine, you need to find out at what age it is possible to take it and what side effects you may encounter during drug therapy.

Taking penicillins and cephalosporins can cause allergic reactions in a child. In this case, antihistamines Suprastin or Tavegil will help.

Many broad-spectrum antibiotics can lead to the development of dysbacteriosis and vaginal candidiasis in girls. To improve digestion and normalize the microflora of the body will help such safe medicines as probiotics: Linex, Hilak forte, Probifor, Atsilakt, etc. The same measures will help maintain and even strengthen the baby's immunity.

Numerous diseases of the human body can be eliminated after the use of different groups of drugs, but antibiotics are considered the most effective and fastest. But only the attending physician can prescribe such medications, since they involve a list of contraindications and the risks of developing side effects. In addition, irrational use can lead to a number of other disorders in the body.

The most popular today are broad-spectrum antibiotics of the new generation, since these drugs have been improved, they are less toxic due to the modifications that have undergone. But their most important advantage is that a large number of pathogens show resistance to them. Antibiotics should be taken strictly according to the doctor's prescription and the scheme painted by him.

How these drugs work

New antibiotics have an improved formula and principle of action, due to which their active components affect only the pathogenic agent at the cellular level, without disturbing the beneficial microflora of the human body. And if earlier such agents were used in the fight against a limited number of pathogenic agents, today they will be effective immediately against a whole group of pathogens.

For reference! The latest broad-spectrum antibiotics (ABSS) have one primary difference from previous antibiotics - minimal risks of harm to the patient's body.

Some of these agents have a depressing effect on the synthesis of the outer cell membrane, while no negative effect on it is expected (penicillin series or cephalosporins). Others disrupt protein synthesis at the cellular level in bacteria, such as tetracyclines or macrolides.

It is possible to prescribe modern broad-spectrum antibiotics in several cases:

• the pathogen is not susceptible to the active substance of the narrow profile antibiotic;
• with superinfection provoked by several infectious or bacterial agents;
• if you need to prevent infection after surgery;
• in the presence of certain clinical symptoms, but without the possibility of determining the type of pathogen.

Antibiotics of such a plan are strong drugs, so they can be used by doctors in the complex treatment of otitis media, lymphadenitis, colds and other ailments caused by pathogenic microbes and microorganisms.

AB names of the latest generation

Before choosing the right ABSS in a particular case, you need to know the classification of such drugs according to the groups of the active substance. All of them can be produced in different forms - tablets or capsules, solutions for injections or topical agents.

So, there are several groups of ABSS:

• tetracycline group - Tetracycline;
• a group of aminoglycosides - Streptomycin;
• amphenicol antibiotics - Chloramphenicol;
• penicillin series of drugs - Amoxicillin, Ampicillin, Bilmicin or Ticarcycline;
• antibiotics of the carbapenem group - Imipenem, Meropenem or Ertapenem.

Each of these drugs can be used only after determining the type of pathogenic agent that provoked the disease in humans. Therefore, the patient undergoes a comprehensive diagnosis, after which the attending physician chooses a new generation antibiotic, based on the data obtained. ABSS are less toxic, they affect deeply and only on opportunistic flora, without suppressing the immune system and beneficial microflora of the human body.

Bronchitis treatment

The names of bactericidal agents for bronchitis are varied, but most often experts prefer the new generation of ABSS, but always after a study in the laboratory of the patient's sputum. If there is not enough time to study the bronchitis bacteria, doctors may prescribe the following ABSS:

• in case of intolerance to penicillins, macrolides are prescribed - Erythromycin or Clarithromycin;
• penicillin drugs - Amoxiclav, Augmentin, and Panklav;
• chronic bronchitis at the acute stage is treated with fluoroquinolone drugs - Levofloxacin, Ciprofloxacin or Moxifloxacin;
• cephalosporins are also effective (if bronchitis is obstructive) - Ceftriaxone and Cefuroxime.

The above drugs penetrate deep into the human body, revealing the pathogenic agent. As practice has shown, most of them do not cause side effects if used strictly according to the doctor's instructions.

Antibiotics for sinusitis

In medical practice, the most effective for infections of this kind are antibiotics of two groups - macrolides or cephalosporins. And if penicillin agents were used before, today numerous pathogenic microorganisms have developed immunity to them.

It's just elementary! To return and strengthen the potency, you need every evening ...

Treatment of sinusitis is appropriate in the case of the following ABSS:

• Cefuroxin;
• Cefexime;
• Cecefoxitin;
• Cefotaxime;
• Cefachlor;
• Azithromycin;
• Macrofoam.

Moreover, macrolides are prescribed even in the most advanced cases, as they demonstrate the highest percentage of effectiveness against such a disease. It is only important to follow the treatment regimen prescribed by the doctor.

Angina and antibiotics

If earlier in medical practice angina was treated with penicillins, over the years the causative agent of the disease has developed immunity to them. In addition, recent studies have confirmed that cephalosporins and macrolides are most effective against such a pathogen. Today they are most often used in the treatment of bacterial infections of the nasopharynx.

The most popular drugs for angina are as follows:

• Cephalexin;
• Spiramycin;
• Erythromycin;
• Leukomycin;
• Aziromycin;
• Azitral;
• Clarithromycin;
• Dirithromycin.

Macrolides are often prescribed for patients in the treatment of tonsillar pathologies, moreover, they do not affect the digestive organs, do not cause reactions from the nervous system due to minimal toxicity.

Treatment of colds and flu

Common illnesses such as the common cold or the flu are at the top of the list in terms of prevalence and incidence. The following new generation ABSSs are used in the treatment:

• Sumamed- a drug of the macrolide group, despite the broad antibacterial effect, it does not affect the work of the gastrointestinal tract, after the end of treatment it acts for another week. Not allowed in the treatment of children.
• Cefaclor- a second-generation remedy that demonstrates high efficiency in numerous human respiratory diseases.
• Cefamandol- a group of second-generation cephalosporins, the release form is presented in the form of injection solutions. The best antibiotic with a bactericidal effect for intramuscular injection.
• Rulid- a medicine from the group of macrolides of a narrow focus only against agents of respiratory diseases or inflammation of the ENT organs.
• Avelox- a strong drug in the form of tablets, belonging to the latest generation of antibiotics fluoroquinolones, which exhibits a pronounced bactericidal effect.
• Clarithromycin- a macrolide of semi-synthetic composition, which is produced in the form of capsules. Its antibacterial effect concerns numerous pathogenic microorganisms.

For reference! All of these drugs are time-tested, researched by pharmacologists and scientific specialists. In no case should you prescribe such drugs yourself without consulting a doctor. Despite the wide range of influence, only a medical specialist can select the right group of drugs from a specific pathogen.

Urinary tract infections

It is more difficult to select a new generation of ASHS, since there are many more varieties of such diseases, many of them assume different pathogens and etiologies.

1. With cystitis- Monural, Palin, Nocilin or Levomecithin, Ecofomural.
2. With urethritis- cephalosporins Suprax or Ceftriaxone in case of gonococcal origin, if the disease is provoked by trichomoniasis, Metronidazole is used together with Azithromycin.
3. With pyelonephritis- combined antibiotics Amoxicillin or Amoxil, if there is an acute infiltration of the kidneys - Cefaclor, Cefalexin or Ofloxacin.
4. With prostatitis- Amoxiclav, Ofloxacin, Ciprofloxacin, Ceftriaxone, Amoxicillin.

Most of these remedies help to cope with the unpleasant symptoms of inflammation of the genitourinary system already on the first day of use.

Antifungal antibiotics

These diseases need a thorough comprehensive diagnosis, only after an accurate determination of the pathogenic microorganism, you can choose the right drug. Doctors distinguish the following ABSS of the latest generation against fungi:

• AB polyene first generation from candidiasis or dermatomycosis - Amphotericin B, Levorin, Nystatin;
• the second generation from fungi of the genitourinary system - Clotrimazole, Ketoconazole, Miconazole;
• AB third generation - Fluconazole, Terbinafine, Naftifine or Antraconazole from fungi;
• fourth-generation drugs for different strains of fungi - Caspofungin, Posaconazole, Voriconazole or Ravoconazole.

Self-medication with such medicines is unacceptable, since fungal infections tend to quickly spread throughout the body, multiplying en masse.

Treatment of eye diseases

In recent years, ophthalmology has introduced into practice the use of numerous ABSS of the latest generation for local therapy of a variety of diseases. The latest medication and the most effective is Maxakvin, effective in the fight against bacterial keratitis or conjunctivitis of chlamydial etiology. Also, such means as Okatsin, Torbeks, Eubetal, Vitabact or Kolbiotsin are no less popular.

Pneumonia

The treatment of such a disease requires a careful approach of a specialist and accurate diagnosis, since the causative agents of pneumonia can be numerous pathogenic microorganisms - mycoplasmas, staphylococci, streptococci, chlamydia or E. coli bacteria.

ABs for pneumonia are as follows:

• gram-negative bacteria - cephalosporins Ceftriaxone, Cefotaxime or Ceftazidime;
• gram-positive cocci - cephalosporins Cefazolin, Cefuroxime, and Cefoxin;
• pneumocystis form - Cotrimoxazole or AB of the macrolide group;
• atypical form of the flow - Ceftriaxone, Ceftazidime, Azithromycin or Midecamycin;
• anaerobic infections - Metronidazole, Lincomycin, Clindamycin;
• cytomegalovirus pneumonia - Cytotect, Acyclovir or Ganciclovir.

In recent years, more than 7,000 antimicrobial and bactericidal substances have been developed in medicine, against which new improved antibiotics are regularly produced.

Estimates over the past decade have identified more than 160 such drugs, 20 of which are new generation drugs. Some of them are cheap, others cost an order of magnitude more, but the choice of drugs should be solely the recommendations of a specialist.

Most antibiotics work selectively, and broad-spectrum drugs are considered the most powerful - antibiotics that have a devastating effect on both gram-negative and gram-positive bacteria.

Macrolides

These are a type of narrow-acting antibiotics that have a negative effect on gram-positive bacteria. Do not depress the immune system, stop the growth of bacterial cells. The most powerful macrolide antibiotics are josamycin and clarithromycin. This group includes oleandomycin, erythromycin, spiramycin, azithromycin. Used to treat chlamydial infections, sinusitis, otitis, treatment of respiratory tract infections, in dentistry.

They have side effects: phlebitis when injected, allergies, dyspepsia, sensitivity quickly decreases.

Cephalosporins

In this group, broad-spectrum antibiotics are among the most powerful today. They are well tolerated by the body, have a bactericidal effect. The cephalosporin group includes four generations of antibiotics.

1st generation: cefadroxil, cephalexin, cefazolin. Works great in the fight against staphylococci.

2nd generation: cefuroxime, cefamandol, cefaclor. These antibiotics are active against Haemophilus influenzae, Proteus, Escherichia coli, Klebsiella.

3rd generation: ceftriaxone, ceftazidime, cefoperazone, ceftibuten, cefotaxime. Most often, these drugs are used for pyelonephritis, pneumonia, meningitis, osteomyelitis, pelvic and abdominal infections.

4th generation - antibiotics of the most powerful action. This group includes cefepime (maximim). They have an even wider application than all previous generations, but are also characterized by a set of serious side effects: hematotoxicity, nephrotoxicity, dysbacteriosis, neurotoxicity.

Fluoroquinolones

Very powerful antibiotics with a wide spectrum of action. They are divided into 2 generations - early and new. First-generation antibiotics are very active against gram-negative bacteria and Pseudomonas aeruginosa, while second-generation fluoroquinolones are also active against gram-negative bacteria, but are not effective against Pseudomonas aeruginosa. Fluoroquinolones perfectly penetrate into individual tissues and organs, circulate in the blood for a long time.

Norfloxacin is used to treat urinary tract infections.

Ciprofloxacin is effective for meningitis, sepsis, infections of the urinary tract and respiratory organs, infections of soft tissues and skin, suppuration of the joints and bones, STDs.

Ofloxacin is used for gardnerella, Helicobacter pylori, chlamydia.

Lomefloxacin is used to treat tuberculosis and chlamydia.

These are just some representatives of fluoroquinolones, the list of antibiotics of this group is much wider. May have side effects such as dyspepsia, phototoxicity, toxic liver damage, arthrotoxicity.

Penicillins

Among general antibiotics, penicillins are recognized as the most powerful. They are mainly excreted by the kidneys and have low toxicity.

Representatives of this group of antibiotics: oxacillin, ampicillin, ampiox, amoxicillin, phenoxymethylpenicillin.

Penicillins are used to treat infections of the genitourinary system, respiratory organs, skin, intestines and stomach, gonorrhea, syphilis, suppuration of soft tissues. Antibiotics of this group can be drunk in the last two trimesters of pregnancy, they are also prescribed from birth, in some cases they can be prescribed during lactation.

Side effects of antibiotics of the penicillin group: allergies, dyspeptic disorders, toxic effects on the blood.

Carbapenems

They have a wide spectrum of action, very strong. Antibiotics of this group are used as reserve drugs in the treatment of infections caused by resistant anaerobes and enterobacteria.

The group of carbapenems includes: meropenem, thienam. Possible side effects: candidiasis, dyspepsia, allergies, phlebitis.

Tetracyclines

Broad-spectrum antibiotics with antimicrobial effect. Tetracyclines are active against gram-negative and gram-positive bacteria, leptospira, spirochetes, rickettsiae. They suppress protein biosynthesis of microbial cells at the level of ribosomes, are characterized by complete cross-resistance.

Representatives: doxycycline, oxytetracycline, tetracycline.

Tetracyclines are contraindicated in children under 8 years of age, pregnant and lactating women, people with hepatic and renal insufficiency (the exception is doxycycline). Possible side effects: dizziness, headaches, disorders of the gastrointestinal tract, individual intolerance. In most cases, in the absence of violations of the regimen, tetracyclines are well tolerated by the body.

Antibiotics are metabolic products of microorganisms that inhibit the activity of other microbes. As drugs, natural antibiotics are used, as well as their semi-synthetic derivatives and synthetic analogues, which have the ability to suppress pathogens of various diseases in the human body.

According to the chemical structure, antibiotics are divided into several groups:

A. Beta lactam antibiotics.

1. Penicillins.

a) Natural penicillins: benzylpenicillin and its salts, phenoxymethyl-penicillin.

b) Semi-synthetic penicillins:

Penicillinase-resistant with predominant activity against staphylococci: oxacillin, cloxacillin, flucloxacillin;

With predominant activity against gram-negative bacteria (amidinopenicillins); amdinocillin (mecillinam), acidocillin;

Broad-spectrum (aminopenicillins): ampicillin, amoxicillin, pivampicillin;

Broad-spectrum, especially highly active against Pseudomonas aeruginosa and other gram-negative bacteria (carboxy- and urei-dopenicillins): carbenicillin, ticarishin, azlocillin, mezlocillin, piperacillin.

2. Cephalosporins:

a) first generation: cephaloridine, cefazolin, etc.;

b) second generation: cefamandol, cefuroxime, etc.;

c) third generation: cefotaxime, ceftazidime, etc.;

d) fourth generation: cefpir, cefepime, etc.

3. Monobactams: aztreonam.

4. Carbapenems: imipenem, meronem, thienam, primaxine. B. Fosfomycin.

b. Macrolides:

a) first generation: erythromycin, oleandomycin;

b) second generation: spiramycin (rovamycin), roxithromycin (rulid), clarithromycin (clacid), etc.;

c) third generation: azithromycin (Sumamed). D. Lincosamides: lincomycin, clindamycin. D. Fuzidin.

E. Aminoglycosides:

a) first generation: streptomycin, monomycin, kanamycin;

b) second generation: gentamicin;

c) third generation: tobramycin, sisomycin, amikacin, netilmicin;

d) fourth generation: isepamycin. J. Levomycetin.

3. Tetracyclines: a) natural: tetracycline, oxytetracycline, chlortetracycline; b) semi-synthetic: metacycline, doxycycline, minocycline, morphocycline.

AND. Rifamycins: rifocin, rifamide, rifampicin.

TO. Glycopeptide antibiotics: vancomycin, teicoplanin.

L. Ristomycin.

M. Polymyxins: polymyxin B, polymyxin E, polymyxin M.

H. Gramicidin.

O. Polyene antibiotics: nystatin, levorin, amphotericin B.

According to the nature of the antimicrobial action, antibiotics are divided into bactericidal and bacteriostatic. To bactericidal, causing the death of microorganisms, include penicillins, cephalosporins, aminoglycosides, polymyxins, etc. Such drugs can give a quick therapeutic effect in severe infections, which is especially important in young children. Their use is less often accompanied by relapses of diseases and cases of carriage. Bacteriostatic antibiotics include tetracyclines, levomycetin, macrolides, etc. These drugs, by disrupting protein synthesis, inhibit the division of microorganisms. They are usually quite effective for diseases of moderate severity.

Antibiotics are able to inhibit the biochemical processes occurring in microorganisms. According to the mechanism of action, they are divided into the following groups:

1. Inhibitors of the synthesis of the microbial wall or its components during mitosis: penicillins, cephalosporins, carbapenems, monobactams, glycopeptide antibiotics, ristomycin, fosfomycin, cycloserine.

2. Antibiotics that disrupt the structure and function of cytoplasmic membranes: polymyxins, aminoglycosides, polyene antibiotics, gramicidin, glycopeptide antibiotics.

3. Inhibitors of RNA synthesis at the level of RNA polymerase: rifamycins.

4. Inhibitors of RNA synthesis at the level of ribosomes: levomycetin, macrolides (erythromycin, oleandomycin, etc.), lincomycin, clindamycin, fusidine, tetracyclines, aminoglycosides (kanamycin, gentamicin, etc.), glycopeptide antibiotics.

In addition, an important role in the mechanism of action of individual antibiotics, especially penicillins, is their inhibitory effect on the adhesion of microorganisms to cell membranes.

The mechanism of action of antibiotics largely determines the type of effects they cause. Thus, antibiotics that disrupt the synthesis of the microbial wall or the function of cytoplasmic membranes are bactericidal drugs; antibiotics that inhibit the synthesis of nucleic acids and protein usually act bacteriostatically. Knowledge of the mechanism of action of antibiotics is necessary for their correct choice, determination of the duration of the course of treatment, selection of effective combinations of drugs, etc.

To ensure etiotropic therapy, it is necessary to take into account the sensitivity of pathogens to antibiotics. Natural sensitivity to them is due to the biological properties of microorganisms, the mechanism of action of antibiotics and other factors. There are narrow and broad spectrum antibiotics. Narrow-spectrum antibiotics include drugs that predominantly suppress gram-positive or gram-negative bacteria: some penicillins (benzylpenicillin, oxacillin, acidocillin, aztreonam, ristomycin, fusidin, novobiocin, bacitracin, vancomycin, monobactams (aztreonam). Polymyxins B, also have a narrow spectrum, E, M, inhibiting gram-negative bacteria, as well as antifungal antibiotics nystatin, levorin, amphotericin B, amphoglucamine, mycoheptin, griseofulvin.

Broad-spectrum antibiotics include drugs that affect both gram-positive and gram-negative bacteria: a number of semi-synthetic penicillins (ampicillin, amoxicillin, carbenicillin); cephalosporins, especially third and fourth generations; carbapenems (imipenem, meronem, thienam); chloramphenicol; tetracyclines; aminoglycosides; rifamycins. Some of these antibiotics also act on rickettsia, chlamydia, mycobacteria, etc.

When identifying the causative agent of an infectious disease and its sensitivity to antibiotics, it is preferable to use drugs with a narrow spectrum of action. Broad-spectrum antibiotics are prescribed for severe disease and mixed infections.

Among antibiotics, there are drugs that accumulate inside cells (the ratio of intra- and extracellular concentrations is more than 10). These include macrolides, especially new ones (azithromycin, roxithromycin, spiramycin), carbapenems, clindamycin. Rifampicin, chloramphenicol, tetracyclines, lincomycin, vancomycin, teicoplanin, fosfomycin penetrate well into cells (the ratio of intra- and extracellular concentrations is from 1 to 10). Penicillins, cephalosporins, aminoglycosides penetrate cells poorly (the ratio of intra- and extracellular concentrations is less than 1). Do not penetrate into the cells and polymyxins.

In the process of using antibiotics, resistance of microorganisms can develop to them. To penicillins, cefa osporins, monobactams, carbapenems, levomycetin, tetracyclines, glycopeptides, ristomycin, fosfomycin, lincosamides, resistance develops slowly and the therapeutic effect of drugs decreases in parallel. To aminoglycosides, macrolides, rifamycins, polymyxins, fusidine resistance develops very quickly, sometimes during the treatment of one patient.

CHARACTERISTICS OF INDIVIDUAL GROUPS OF ANTIBIOTICS

Penicillins. According to the chemical structure, these antibiotics are derivatives of 6-aminopenicillanic acid (6-APA) containing various substituents (R) in the amino group.

The mechanism of the antimicrobial action of penicillins is to disrupt the formation of the cell wall from pre-synthesized fragments of murein. There are natural penicillins: benzylpenicillin (in the form of sodium, potassium, novocaine salts), bicillins, phenoxymethylpenicillin; semi-synthetic penicillins: oxacillin, cloxacillin, ampicillin (pentrexil), amoxicillin, carbenicillin, carfecillin, piperacillin, mezlocillin, azlocillin, etc.

Benzylpenicillin gives a clear therapeutic effect in the treatment of diseases caused by pneumococci, staphylococci, group A hemolytic streptococci, meningococci, gonococci, spirochete pallidum, corynobacteria, anthrax bacillus and some other microorganisms. Many strains of microbes, especially staphylococci, are resistant to benzylpenicillin, as they produce an enzyme (3-lactamase, which inactivates the antibiotic.

Benzylpenicillin is usually administered intramuscularly, in critical situations intravenously (only sodium salt). Doses vary over a wide range from 30,000-50,000 UDDkhsut) to 1,000,000 UDDkhsut) depending on the pathogen, severity and localization of the infectious process.

Therapeutic plasma concentration occurs within 15 minutes after intramuscular injection and remains in it for 3-4 hours. Benzylpenicillin penetrates well into the mucous membranes and lungs. It enters little into the cerebrospinal fluid, myocardium, bones, pleural, synovial fluid, into the lumen of the bronchi and into the esophagus. With meningitis, endo-lumbar administration of the sodium salt of benzylpenicillin is possible. The drug can be administered into the cavity, endobronchial, endolymphatic. It is found in high concentrations in bile and urine. In children under one month of age, the elimination of benzylpenicillin occurs more slowly than in adults. This determines the frequency of administration of the drug: in the first week of life 2 times a day, then 3-4 times, and after a month, as in adults, 5-6 times a day.

In the treatment of infections that require long-term antibiotic therapy and do not have an acute course (focal streptococcal infection, syphilis), prolonged benzylpenicillin preparations are used to prevent exacerbations of rheumatism: novocaine salt,? bicillins 1, 3, 5. These drugs do not differ in the spectrum of antimicrobial action from the sodium and potassium salts of benzylpenicillin, they can be used in children older than 1 year. All prolonged penicillins are administered only intramuscularly in the form of a suspension. After a single injection of novocaine salt, the therapeutic concentration of benzylpenicillin in the blood lasts up to 12 hours. Bicillin-5 is administered once every 2 weeks. Injections of bicillin-1 and bicillin-3 are made once a week. Basically, bicillins are used to prevent the recurrence of rheumatism.

Phenoxymethylpenicillin- an acid-resistant form of penicillin, is used orally on an empty stomach 4-6 times a day for the treatment of mild infectious diseases. Its spectrum of action is almost the same as that of benzylpenicillin.

Ospen (bimepen) benzathine phenoxymethylpenicillin slowly absorbed from the gastrointestinal tract and maintains a therapeutic concentration in the blood for a long time. Assign in the form of syrup 3 times a day.

Oxacillin, clokeacillin, flucloxacillin- semi-synthetic penicillins, used mainly in the treatment of diseases caused by staphylococci, including those resistant to benzylpenicillin. Oxacillin is able to inhibit (3-lactamase of staphylococci and enhance the effect of other penicillins, such as ampicillin (combined preparation of oxacillin with ampicillin - ampiox). In diseases caused by other microorganisms sensitive to benzylpenicillin (meningococci, gonococci, pneumococci, streptococci, spirochetes, etc.) , these antibiotics are rarely used in practice due to the lack of a positive effect.

Oxacillin, cloxacillin, flucloxacillin are well absorbed from the gastrointestinal tract. In plasma, these drugs are bound to proteins and do not penetrate well into tissues. These antibiotics can be administered intramuscularly (every 4-6 hours) and intravenously by stream or drip.

Amidinopenicillins - amdinocillin (mecillinam) is a narrow-spectrum antibiotic that is inactive against gram-positive bacteria, but effectively suppresses gram-negative bacteria (E. coli, Shigella, Salmonella, Klebsiella). Pseudomonas aeruginosa, Proteus, and non-fermenting gram-negative bacteria are usually resistant to amdinocillin. A feature of this antibiotic is that it actively interacts with PSB-2 (penicillin-binding protein), while most other (3-lactam antibiotics) interact with PSB-1 ​​and PSB-3. Therefore, it can be a synergist of other penicillins, as well as cephalosporins.The drug is administered parenterally, while it penetrates into cells many times better than ampicillin and carbenicillin.Especially high antibiotic efficiency in urinary tract infections.For enteral use, an ether derivative of the drug pivamdinocillin was synthesized.

Semi-synthetic broad-spectrum penicillins - ampicillin, amoxicillin are of the greatest importance in the treatment of diseases caused by Haemophilus influenzae, gonococci, meningococci, some types of Proteus, Salmonella, and, in addition, listeriosis pathogens and enterococci. These antibiotics are also effective for the treatment of infectious processes caused by mixed (gram-positive and gram-negative) microflora. Ampicillin and amoxicillin can be administered orally, for example, in the treatment of infections of the gastrointestinal tract, urinary tract, otitis media. Ampicillin, not absorbed from the gastrointestinal tract, causes irritation of the mucous membranes, leading in a significant percentage of children to vomiting, diarrhea, and skin irritation around the anus. Amoxicillin differs from ampicillin in better absorption, so it can be administered orally not only for mild, but also for moderate infections. Amoxicillin less irritates the mucous membranes of the gastrointestinal tract, rarely causes vomiting, diarrhea. In severe diseases that require the creation of a high concentration of antibiotic in the blood, these drugs are administered parenterally.

Carboxypenicillins- carbenicillin, ticarcillin have an even greater spectrum of antimicrobial action than ampicillin, and differ from it in the additional ability to suppress Pseudomonas aeruginosa, indole-positive strains of Proteus and bacteroids. Their main use is diseases caused by these pathogens. From the gastrointestinal tract, carbenicillin and ticarcillin are absorbed very poorly, so they are used only parenterally (carbenicillin intramuscularly and intravenously, ticarcillin intravenously). Carfecillin is the phenyl ester of carbenicillin. It is well absorbed from the gastrointestinal tract, after which carbenicillin is released from it. Compared with ampicillin, carboxypenicillins penetrate tissues, serous cavities, and cerebrospinal fluid worse. Carbenicillin in active form and high concentrations is found in bile and urine. It is produced in the form of disodium salt, therefore, if kidney function is impaired, water retention in the body and the occurrence of edema are possible.

The use of drugs may be accompanied by the appearance of allergic reactions, symptoms of neurotoxicity, acute interstitial nephritis, leukopenia, hypokalemia, hypernatremia, etc.

Ureidopenicillins (acylaminopenicillins)- piperacillin, mezlocillin, azlocillin - broad-spectrum antibiotics that suppress gram-positive and gram-negative microorganisms. These antibiotics are mainly used in severe gram-negative infections, especially in diseases caused by Pseudomonas aeruginosa (necessarily in combination with aminoglycosides), Klebsiella. Ureidopenicillins penetrate well into cells. In the body, they are little metabolized and excreted by the kidneys by filtration and secretion. The drugs are not very resistant to B-lactamase, so they are recommended to be prescribed with inhibitors of this enzyme. Piperacillin is prescribed for chronic inflammatory diseases of the bronchi, including cystic fibrosis and chronic bronchitis. The drugs can cause leukopenia, thrombocytopenia, neutropenia, eosinophilia, allergic reactions, dysfunction of the gastrointestinal tract, interstitial nephritis, etc.

When appointed semi-synthetic broad-spectrum penicillins: aminopenicillins (ampicillin, amoxicillin), carboxypenicillins (carbenicillin, ticarcillin), ureidopenicillins (piperacillin, mezlocillin, azlocillin) must be remembered that all of these antibiotics are destroyed by staphylococcal B-lactamases, and therefore penicillinase-producing strains of these microbes are resistant to their action.

Combined preparations with B-lactamase inhibitors- clavulanic acid and sulbactam. Clavulanic acid and sulbactam (penicillanic acid sulfone) are classified as B-lactamines, which have a very weak antimicrobial effect, but at the same time, they inhibit the activity of B-lactamase of staphylococci and other microorganisms: Haemophilus influenzae, Escherichia coli, Klebsiella, some bacteroids, gonococci, le -gionella; do not suppress or suppress very weakly B-lactamase of Pseudomonas aeruginosa, enterobacteria, citrobacter. Preparations containing clavulanic acid and sulbactam are intended for parenteral use - augmentin (amoxicillin + potassium clavulanate), timetin (ticarcillin + potassium clavulanate), unazine (ampicillin + sulbactam). They are used in the treatment of otitis, sinusitis, infections of the lower respiratory tract, skin, soft tissues, urinary tract, and other diseases. Unazine is highly effective for the treatment of peritonitis and meningitis caused by microorganisms that intensively produce B-lactamase. Analogues of the drug unazine intended for oral administration are sultamicillin and sulacillin.

Natural and semi-synthetic penicillins(except for carboxy- and ureidopenicillins) - low-toxic antibiotics. However, benzylpenicillin and, to a lesser extent, semi-synthetic penicillins can cause allergic reactions, and therefore their use in children with diathesis and allergic diseases is limited. The introduction of high doses of benzylpenicillin, ampicillin, amoxicillin can lead to an increase in the excitability of the central nervous system, convulsions, which is associated with the antagonism of antibiotics in relation to the GABA inhibitory mediator in the central nervous system.

Prolonged penicillin preparations should be injected very carefully under slight pressure through a large diameter needle. If the suspension enters the vessel, it can cause thrombosis. Semi-synthetic penicillins used orally cause irritation of the gastric mucosa, a feeling of heaviness in the abdomen, burning, nausea, especially when administered on an empty stomach. Broad-spectrum antibiotics can lead to intestinal dysbiocenosis and provoke the appearance of a secondary infection caused by Pseudomonas aeruginosa, Klebsiella, yeast fungi, etc. For other complications caused by penicillins, see above.

Cephalosporins- a group of natural and semi-synthetic antibiotics based on 7-aminocephalosporan acid.

Currently, the most common division of cephalosporins by generation.

Some drugs in this group can be used for oral administration: from cephalosporins of the first generation - cefadroxil, cephalexin, cephradine; II generation - cefuroxime (Zinnat), III generation - cefspan (Cefoxime), cefpodoxime (Orelax), ceftibuten (Cedex). Oral cephalosporins are usually used for moderate disease because they are less potent than parenteral preparations.

Cephalosporins have a wide spectrum of activity.

I generation cephalosporins inhibit the activity of cocci, especially staphylococci and streptococci (with the exception of enterococci and methicillin-resistant strains of staphylococci), as well as diphtheria bacillus, anthrax bacilli, spirochetes, escherichia, shigella, salmonella, moraxell, klebsiella, yersinium, bordetell, proteus and hemophilic rods. Second generation cephalosporins have the same spectrum of action, but they create higher concentrations in the blood and better penetrate tissues than first generation drugs. They have a more active effect on some strains of gram-negative bacteria resistant to the first generation of cephalosporins, including most strains of Escherichia coli, Klebsiella, Proteus, Haemophilus influenzae, Moraxella, whooping cough pathogens, gonococci. At the same time, second-generation cephalosporins do not affect Pseudomonas aeruginosa, "hospital strains" of gram-negative bacteria and have a slightly less inhibitory effect on staphylococci and streptococci compared to first-generation cephalosporins. III generation cephalosporins are characterized by an even wider antimicrobial spectrum, good penetrating ability, high activity against gram-negative bacteria, including nosocomial strains resistant to other antibiotics. They affect, in addition to the above microbes, pseudomonads, morganella, serrations, clostridia (except CY. difficile) and bacteroids. However, they are characterized by relatively low activity against staphylococci, pneumococci, meningococci, gonococci and streptococci. IV generation cephalosporins are more active than III generation drugs in suppressing most gram-negative and gram-positive bacteria. IV generation cephalosporins affect some multi-resistant microorganisms resistant to most antibiotics: Cytobacter, Enterobacter, Acinetobacter.

IV generation cephalosporins are resistant to B-lactamases and do not induce their formation. But they do not affect CY. difficile, bacteroids, enterococci, listeria, legionella and some other microorganisms.

They are used to treat serious diseases, as well as in patients with neutropenia and suppressed immunity.

The highest concentrations of cephalosporins are found in the kidneys and muscle tissue, while the lower ones are found in the lungs, liver, pleural, and peritoneal fluids. All cephalosporins readily cross the placenta. Cephaloridine (ceporin), cefotaxime (claforan), moxalactam (latamoxef), ceftriaxone (longacef), ceftizoxime (epocelin) and others penetrate the cerebrospinal fluid.

Cephalosporins are used in the treatment of diseases caused by microorganisms resistant to penicillins, sometimes in the presence of allergic reactions to penicillins. They are prescribed for sepsis, diseases of the respiratory system, urinary tract, gastrointestinal tract, soft tissues, bones. With meningitis in premature newborns, a high activity of cefotaxime, moxalactam, ceftizoxime, ceftriaxone was found.

The use of cephalosporins may be accompanied by pain at the site of intramuscular injection; phlebitis after intravenous use; nausea, vomiting, diarrhea when taking drugs orally. With repeated use in children with high sensitivity to the drug, there may be a skin rash, fever, eosinophilia. Cephalosporins are not recommended for children with an anaphylactic reaction to penicillins, but their use is acceptable in the presence of other manifestations of allergies - fever, rash, etc. Cross-allergic reactions between cephalosporins and penicillins are observed in 5-10% of cases. Some cephalosporins, especially cephaloridine and cephalothin, are nephrotoxic. This effect is associated with their slow excretion by the kidneys and with the accumulation of lipid peroxidation products in them. The nephrotoxicity of the antibiotic increases with a deficiency of vitamin E and selenium. Drugs can inhibit the microflora of the gastrointestinal tract and lead to dysbiocenosis, cross-infection caused by hospital strains of microbes, candidiasis and vitamin E deficiency in the body.

Aztreonam- synthetic highly effective (3-lactam antibiotic from the monobactam group. It is used to treat respiratory tract infections, meningitis, septic diseases caused by gram-negative, including multi-resistant microorganisms (pseudomonas, moraxella, Klebsiella, Haemophilus influenzae, E. coli, yersinia, serrations , enterobacter, meningococci, gonococci, salmonella, morganella).Aztreonam does not affect gram-positive aerobic and anaerobic bacteria.

Imipenem- (3-lactam antibiotic from the group of carbapenems with an ultra-broad spectrum of action, including most aerobic and anaerobic gram-positive and gram-negative bacteria, including microorganisms resistant to penicillins, cephalosporins, aminoglycoside and other antibiotics. The high bactericidal activity of imipenem is due to easy penetration through the walls bacteria, a high degree of affinity for enzymes involved in the synthesis of the bacterial wall of microorganisms.At present, from the mentioned group of antibiotics, imipenem is used in the clinic in combination with cilastatin (this combination is called thienam).Cilastatin inhibits renal peptidase, thereby inhibiting the formation of nephrotoxic metabolites of imipenem. has a strong antimicrobial activity, a wide spectrum of action.The sodium salt of imipenem-cilastatin is produced under the name primaxin.Imipenem is stable to (3-lactamase, but has little effect on microorganisms located inside the cells. ipenema may be thrombophlebitis, diarrhea, in rare cases, convulsions (especially with impaired renal function and diseases of the central nervous system).

Meronem (meropenem) does not undergo biotransformation in the kidneys and nephrotoxic metabolites are not formed from it. Therefore, it is used without cilastatin. It has less effect on staphylococci than tienam, but is more effective against gram-negative enterobacteria and pseudomonads.

Meronem creates an active bactericidal concentration in the cerebrospinal fluid (CSF) and is successfully used in meningitis without fear of undesirable effects. This compares favorably with thienam, which causes neurotoxic effects, and therefore is contraindicated in meningitis.

Aztreonam and carbapenem are practically not absorbed into the gastrointestinal tract, and they are administered parenterally. They penetrate well into most body fluids and tissues, excreted mainly in the urine in active form. The high efficiency of drugs in the treatment of patients with infections of the urinary tract, osteoarticular apparatus, skin, soft tissues, gynecological infections, gonorrhea was noted. Especially shown is the use of aztreonam in pediatric practice as an alternative to aminoglycoside antibiotics.

Fosfomycin (phosphonomycin)- a broad-spectrum bactericidal antibiotic that disrupts the formation of a microbial wall by suppressing the synthesis of UDP-acetylmuramic acid, that is, its mechanism of action differs from that of penicillins and cephalosporins. It has a wide range of activities. It is able to inhibit gram-negative and gram-positive bacteria, but does not affect Klebsiella, indole-positive Proteus.

Fosfomycin penetrates well into tissues, including bone, as well as cerebrospinal fluid; found in sufficient quantity in bile. The named antibiotic is excreted mainly by the kidneys. It is prescribed mainly for severe infections caused by microorganisms resistant to other antibiotics. It goes well with penicillins, cephalosporins, and when used together with aminoglycoside antibiotics, not only an increase in the antimicrobial effect is observed, but also a decrease in the nephrotoxicity of the latter. Fosfomycin is effective in the treatment of meningitis, sepsis, osteomyelitis, urinary and biliary tract infections. For infections of the oral cavity and intestinal infections, it is prescribed enterally. Fosfomycin is a low-toxic drug. With its use, some patients may experience nausea and diarrhea, other undesirable effects have not yet been identified.

Glycopeptide antibiotics. Vancomycin, teicoplanin - antibiotics that act on gram-positive cocci (including methicillin-resistant staphylococci, strains of staphylococci that form B-lactamase, streptococci, penicillin-resistant pneumococci, enterococci) and bacteria (corynebacteria, etc.). Their influence on clostridia, especially on difficile, is very important. Vancomycin also affects actinomycetes.

Vancomycin penetrates well into all tissues and body fluids, except for cerebrospinal. It is used for severe staphylococcal infections caused by strains resistant to other antibiotics. The main indications for vancomycin are: sepsis, soft tissue infections, osteomyelitis, endocarditis, pneumonia, necrotizing enterocolitis (caused by toxigenic clostridia). Vancomycin is administered intravenously 3-4 times a day, to newborns 2 times a day. In the treatment of very severe staphylococcal meningitis, given the relatively weak penetration of vancomycin into the cerebrospinal fluid, it is advisable to administer it intrathecally. Teicoplanin differs from vancomycin in its slow elimination; it is administered intravenously by drip once a day. In pseudomembranous colitis and staphylococcal enterocolitis, vancomycin is administered orally.

The most common complication of the use of vancomycin is massive - the release of histamine from mast cells, leading to arterial hypotension, the appearance of a red rash on the neck ("red neck" syndrome), head, and limbs. This complication can usually be avoided if the required dose of vancomycin is given for at least an hour and antihistamines are given first. Thrombophlebitis and thickening of the veins during the infusion of the drug are possible. Vancomycin is a nephrotoxic antibiotic and its concomitant use with aminoglycosides and other nephrotoxic drugs should be avoided. When administered intrathecally, vancomycin may cause convulsions.

Ristomycin (Ristocetin)- an antibiotic that suppresses gram-positive microorganisms. Staphylococci, streptococci, enterococci, pneumococci, spore gram-positive rods, as well as corynebacteria, listeria, acid-fast bacteria and some anaerobes are sensitive to it. Gram-negative bacteria and cocci are not affected. Ristomycin is administered only intravenously; it is not absorbed from the gastrointestinal tract. The antibiotic penetrates well into tissues, especially high concentrations are found in the lungs, kidneys and spleen. Ristomycin is used mainly in severe septic diseases caused by staphylococci and enterococci in cases where previous treatment with other antibiotics has been ineffective.

When using ristomycin, thrombocytopenia, leukopenia, neutropenia (up to agranulocytosis) are sometimes observed, and eosinophilia is sometimes noted. In the first days of treatment, exacerbation reactions (chills, rash) are possible, allergic reactions are often observed. Prolonged intravenous administration of ristomycin is accompanied by thickening of the walls of the veins and thrombophlebitis. Oto - and nephrotoxic reactions are described.

Polymyxins- a group of polypeptide bactericidal antibiotics that inhibit the activity of predominantly gram-negative microorganisms, including shigella, salmonella, enteropathogenic strains of Escherichia coli, Yersinia, Vibrio cholerae, Enterobacter, Klebsiella. Of great importance for pediatrics is the ability of polymyxins to suppress the activity of Haemophilus influenzae and most strains of Pseudomonas aeruginosa. Polymyxins act on both dividing and dormant microorganisms. The disadvantage of polymyxins is their low penetration into cells and therefore low efficiency in diseases caused by intracellularly located pathogens (brucellosis, typhoid fever). Polymyxins are characterized by poor penetration through tissue barriers. When taken orally, they are practically not absorbed. Polymyxins B and E are used intramuscularly, intravenously, for meningitis they are administered endolumbally, for infections of the gastrointestinal tract they are prescribed through the mouth. Polymyxin M is used only inside and topically. Inside, polymyxins are prescribed for dysentery, cholera, colienteritis, enterocolitis, gastroenterocolitis, salmonellosis and other intestinal infections.

With the appointment of polymyxins inside, as well as with their local application, adverse reactions are rarely observed. When administered parenterally, they can cause nephro- and neurotoxic effects (peripheral neuropathy, impaired vision and speech, muscle weakness). These complications are most common in people with impaired renal function. Sometimes, when using polymyxins, fever, eosinophilia, and urticaria are observed. In children, parenteral administration of polymyxins is permissible only for health reasons, in the case of infectious processes caused by gram-negative microflora resistant to other, less toxic antimicrobial drugs.

Gramicidin (gramicidin C) active mainly against gram-positive microflora, including streptococci, staphylococci, pneumococci and some other microorganisms. Apply gramicidin only topically in the form of a paste, solutions and buccal tablets. Gramicidin solutions are used to treat the skin and mucous membranes, for washing, irrigating dressings in the treatment of bedsores, purulent wounds, boils, etc. Gramicidin tablets are intended for resorption during infectious processes in the oral cavity and pharynx (tonsillitis, pharyngitis, stomatitis, etc. .). It is impossible to swallow gramicidin tablets: if it enters the bloodstream, it can cause hemolysis of erythromyocytes.

Macrolides. There are three generations of macrolides. I generation - erythromycin, oleandomycin. II generation - spiramycin (rovamycin), roxithromycin (rulid), josamycin (vilprafen), clarithromycin (cladid), midecamycin (macropen). III generation - azithromycin (Sumamed).

Macrolides are broad-spectrum antibiotics. They have a bactericidal effect on microorganisms that are very sensitive to them: staphylococci, streptococci, pneumococci, corynebacteria, bordetella, moraxella, chlamydia and mycoplasma. Other microorganisms - Neisseria, Legionella, Haemophilus influenzae, Brucella, Treponema, Clostridia and Rickettsia - they affect bacteriostatically. Macrolides II and III generations have a wider spectrum of action. So, josamycin and clarithromycin suppress Helicobacter pylori (and they are used in the treatment of stomach ulcers), spiramycin affects Toxoplasma. Preparations of the II and III generations also inhibit gram-negative bacteria: campylobacter, listeria, gardnerella and some mycobacteria.

All macrolides can be administered orally, some drugs (erythromycin phosphate, spiramycin) can be administered intravenously.

Macrolides penetrate well into adenoids, tonsils, tissues and fluids of the middle and inner ear, lung tissue, bronchi, bronchial secretions and sputum, skin, pleural, peritoneal and synovial fluids, and are found in high concentrations in neutriphils and alveolar macrophages. Macrolides penetrate poorly into the cerebrospinal fluid and the central nervous system. Of great importance is their ability to penetrate into cells, accumulate in them and suppress intracellular infection.

The drugs are excreted primarily by the liver and produce high concentrations in the bile.

New macrolides differ from the old ones in greater stability in an acidic environment and better bioavailability from the gastrointestinal tract, regardless of food intake, with a prolonged action.

Macrolides are mainly prescribed for non-severe forms of acute diseases caused by microorganisms sensitive to them. The main indications for the use of macrolides are tonsillitis, pneumonia (including those caused by legionella), bronchitis, diphtheria, whooping cough, purulent otitis media, diseases of the liver and biliary tract, pneumopathy and conjunctivitis caused by chlamydia. They are very effective in chlamydial pneumonia in newborns. Macrolides are also used for diseases of the urinary tract, but to obtain a good therapeutic effect, especially when using "old" macrolides, urine must be alkalized, since they are inactive in an acidic environment. They are prescribed for primary syphilis and gonorrhea.

Synergism is observed with the combined use of macrolides with sulfa drugs and antibiotics of the tetracycline group. Combined preparations containing oleandromycin and tetracyclines are produced under the name oletetr and n, tetraolean, sigmamycin. Macrolides cannot be combined with chloramphenicol, penicillins or cephalosporins.

Macrolides are low-toxic antibiotics, but they irritate the mucous membrane of the gastrointestinal tract and can cause nausea, vomiting, and diarrhea. Intramuscular injections are painful, with intravenous administration, phlebitis may develop. Sometimes when they are used, cholestasis develops. Erythromycin and some other macrolides inhibit the monooxygenase system in the liver, as a result, the biotransformation of a number of drugs, in particular theophylline, is disturbed, which increases its concentration in the blood and toxicity. They also inhibit the biotransformation of bromocriptine, dihydroergotamine (part of a number of antihypertensive drugs), carbamazepine, cimetidine, etc.

Microlides cannot be prescribed together with new antihistamines - terfenadine and astemizole because of the danger of their hepatoxic action and the risk of cardiac arrhythmias.

Lincosamides: lincomycin and clindamycin. These antibiotics suppress predominantly gram-positive microorganisms, including staphylococci, streptococci, pneumococci, as well as mycoplasmas, various bacteroids, fusobacteria, anaerobic cocci, and some strains of Haemophilus influenzae. Clindamycin, in addition, acts, albeit weakly, on toxoplasma, causative agents of malaria, gas gangrene. Most Gram-negative bacteria are resistant to lincosamides.

Lincosamides are well absorbed in the gastrointestinal tract, regardless of food intake, penetrate into almost all fluids and tissues, including bone, but poorly penetrate into the central nervous system and cerebrospinal fluid. For newborns, drugs are administered 2 times a day, for older children - 3-4 times a day.

Clindamycin differs from lincomycin in greater activity against certain types of microorganisms, better absorption from the gastrointestinal tract, but at the same time, it often causes undesirable effects.

Lincosamides are used in the treatment of infections caused by gram-positive bacteria resistant to other antibiotics, especially in cases of allergy to penicillins and cephalosporins. They are prescribed for infectious gynecological diseases and infections of the gastrointestinal tract. Due to good penetration into bone tissue, lincosamides are the drugs of choice in the treatment of osteomyelitis. Without special indications, they should not be prescribed to children with the effectiveness of other, less toxic antibiotics.

When using lincosamides in children, nausea, diarrhea may occur. Sometimes pseudomembranous colitis develops - a serious complication caused by dysbiocenosis and reproduction in the Intestine CY. difficile that release the toxin. These antibiotics can cause liver dysfunction, jaundice, leukneutropenia and thrombocytopenia. Allergic reactions, mainly in the form of a skin rash, are quite rare. With rapid intravenous administration, lincosamides can cause a neuromuscular block with respiratory depression, collapse.

Fusidin. Fusidin's activity against staphylococci, including those resistant to other antibiotics, is of the greatest importance. It also acts on other gram-positive and gram-negative cocci (gonococci, meningococci). Fusidin is somewhat less active in relation to corynebacteria, listeria, clostridia. The antibiotic is not active against all gram-negative bacteria and protozoa.

Fusidin is well absorbed from the gastrointestinal tract and penetrates into all tissues and fluids, except for the cerebrospinal one. The antibiotic penetrates especially well into the focus of inflammation, the liver, kidneys, skin, cartilage, bones, and bronchial secretions. Fusidin preparations are prescribed orally, intravenously, and also locally in the form of an ointment.

Fusidin is especially indicated for diseases caused by penicillin-resistant strains of staphylococci. The drug is highly effective in osteomyelitis, diseases of the respiratory system, liver, biliary tract, skin. In recent years, it has been used in the treatment of patients with nocardiosis and colitis caused by Clostridium (except for CY. difficile). Fusidin is excreted mainly in the bile and can be used in patients with impaired renal excretory function.

A pronounced increase in antimicrobial activity is observed when fusidine is combined with other antibiotics, the combination with tetracyclines, rifampicin and aminoglycosides is especially effective.

Fusidin is a low-toxic antibiotic, but can cause dyspeptic disorders that disappear after the drug is discontinued. With intramuscular administration of an antibiotic, tissue necrosis is observed (!), With intravenous administration, there may be thrombophlebitis.

Aminoglycoside antibiotics. There are four generations of aminoglycosides. Antibiotics of the first generation include streptomycin, monomycin, neomycin, kanamycin; II generation - gentamicin (garamycin); III generation - tobramycin, sisomycin, amikacin, netilmicin; IV generation - isepamycin.

Aminoglycoside antibiotics are bactericidal, have a wide spectrum of action, inhibit gram-positive and especially gram-negative microorganisms. Aminoglycosides II, III and IV generations are able to suppress Pseudomonas aeruginosa. The main practical significance is the ability of drugs to inhibit the activity of pathogenic Escherichia coli, Haemophilus influenzae, Klebsiella, gonococci, Salmonella, Shigella, Staphylococcus. In addition, streptomycin and kanamycin are used as anti-tuberculosis drugs, monomycin is used to act on dysentery amoeba, leishmania, Trichomonas, gentamicin on the causative agent of tularemia.

All aminoglycoside antibiotics are poorly absorbed from the gastrointestinal tract and from the bronchial lumen. To obtain a resorptive effect, they are administered intramuscularly or intravenously. After a single intramuscular injection, the effective concentration of the drug in blood plasma is maintained in newborns and young children for 12 hours or more, in older children and adults for 8 hours. The drugs penetrate satisfactorily into tissues and body fluids, with the exception of cerebrospinal fluid, poorly penetrate into cells. In the treatment of meningitis caused by gram-negative bacteria, aminoglycoside antibiotics are preferably administered endolumbally. In the presence of a severe inflammatory process in the lungs, abdominal organs, small pelvis, osteomyelitis and sepsis, endolymphatic administration of drugs is indicated, which ensures a sufficient concentration of the antibiotic in the organs without causing its accumulation in the kidneys. With purulent bronchitis, they are administered in the form of an aerosol or by installing a solution directly into the lumen of the bronchi. Antibiotics of this group pass well through the placenta, are excreted in milk (in an infant, aminoglycosides are practically not absorbed from the gastrointestinal tract), but there is a high risk of dysbacteriosis.

With repeated administration, accumulation of aminoglycosides is noted in the bags, in the inner ear and in some other organs.

The drugs are not. undergo biotransformation and are excreted by the kidneys in active form. The elimination of aminoglycoside antibiotics is slowed down in newborns, especially premature babies, as well as in patients with impaired renal excretory function.

Aminoglycoside antibiotics are used for complicated infectious diseases of the respiratory and urinary tract, for septicemia, endocarditis, less often for infections of the gastrointestinal tract, for the prevention and treatment of infectious complications in surgical patients.

Aminoglycoside antibiotics administered parenterally are toxic. They can cause ototoxic, nephrotoxic effects, disrupt neuromuscular transmission of impulses and processes of active absorption from the gastrointestinal tract.

The ototoxic effect of antibiotics is a consequence of irreversible degenerative changes in the hair cells of the organ of Corti (inner ear). The risk of this effect is greatest in newborns, especially in premature infants, as well as in birth trauma, hypoxia in childbirth, meningitis, impaired renal excretory function. An ototoxic effect can develop when antibiotics enter the fetus through the placenta; when combined with other ototoxic agents (furosemide, ethacrynic acid, ristomycin, glycopeptide antibiotics).

The nephrotoxic effect of aminoglycoside antibiotics is associated with a violation of the function of many enzymes in the epithelial cells of the tubules of the kidneys, the destruction of lysosomes. Clinically, this is manifested by an increase in urine volume, a decrease in its concentration and proteinuria, that is, the occurrence of neoliguric renal failure.

Antibiotics of this group cannot be combined with other oto- and nephrotoxic drugs. In young children, especially debilitated and debilitated, aminoglycoside antibiotics can inhibit neuromuscular transmission due to a decrease in the sensitivity of skeletal muscle H-cholinergic receptors to acetylcholine and suppression of mediator release; as a result of this, there may be a violation of the function of the respiratory muscles. To eliminate this complication, calcium preparations are prescribed together with prozerin after the preliminary administration of atropine. Accumulating in the intestinal wall, aminoglycosides disrupt the process of active absorption of amino acids, vitamins, sugars in it. This can lead to malabsorption, which worsens the condition of the child. When prescribing aminoglycoside antibiotics, the concentration of magnesium and calcium in the blood plasma decreases.

Due to the high toxicity, aminoglycoside antibiotics should be prescribed only for severe infections, in short courses (no more than 5-7 days).

Levomycetin- bacteriostatic antibiotic, but on Haemophilus influenzae type "B", some strains of meningococci, pneumococci affect bactericidal. It inhibits the division of many gram-negative bacteria: salmonella, shigella, E. coli, brucella, whooping cough; gram-positive aerobic cocci: pyogenic streptococci and group B streptococci; most anaerobic microorganisms (clostridia, bacteroids); cholera vibrio, rickettsia, chlamydia, mycoplasma.

Mycobacteria, CI are resistant to chloramphenicol. difficile, cytobacter, enterobacter, acinetobacter, proteus, Pseudomonas aeruginosa, staphylococci, enterococci, corynebacteria, serrations, protozoa and fungi.

Levomycetin base is well absorbed from the gastrointestinal tract, quickly creating active concentrations in the blood plasma. The antibiotic penetrates well from the blood plasma into all tissues and fluids, including the cerebrospinal one.

Unfortunately, levomycetin itself has a bitter taste and can cause vomiting in children, therefore, at a younger age, they prefer to prescribe chloramphenicol esters - stearate or palmitate. In children of the first months of life, the absorption of levomycetin, prescribed in the form of esters, occurs slowly due to the low activity of lipases that hydrolyze ether bonds and release chloramphenicol base, capable of absorption. Intravenously administered chloramphenicol succinate also undergoes hydrolysis (in the liver or kidneys) with the release of the active chloramphenicol base. Non-hydrolyzed ether is excreted by the kidneys, in newborns about 80% of the administered dose, in adults 30%. The activity of hydrolases in children is low and has individual differences, therefore, from the same dose of levomycetin, its unequal concentrations in blood plasma and cerebrospinal fluid may occur, especially at an early age. It is necessary to control the concentration of levomycetin in the blood of a child, since without this you can either not get a therapeutic effect, or cause intoxication. The content of free (active) chloramphenicol in plasma and cerebrospinal fluid after intravenous administration is usually lower than after oral administration.

Levomycetin is especially important in the treatment of meningitis caused by Haemophilus influenzae, meningococci and pneumococci, for which it acts bactericidal. For the treatment of these meningitis, levomycetin is often combined with B-lactam antibiotics (especially with ampicillin or amoxicillin). With meningitis caused by other pathogens, the combined use of levomycetin with penicillins is not advisable, since in such cases they are antagonists. Levomycetin is successfully used in the treatment of typhoid fever, paratyphoid fever, dysentery, brucellosis, tularemia, whooping cough, eye infections (including trachoma), middle ear, skin and many other diseases.

Levomycetin is neutralized in the liver and excreted by the kidneys. In liver diseases, due to a violation of the normal biotransformation of chloramphenicol, intoxication may occur. In children of the first months of life, the neutralization of this antibiotic occurs slowly, and therefore there is a great danger of accumulation of free chloramphenicol in the body, which leads to a number of undesirable effects. Levomycetin, in addition, inhibits liver function and inhibits the biotransformation of theophylline, phenobarbital, difenin, benzodiazepines and a number of other drugs, increasing their concentration in blood plasma. The simultaneous appointment of phenobarbital stimulates the neutralization of chloramphenicol in the liver and reduces its effectiveness.

Levomycetin is a toxic antibiotic. With an overdose of levomycetin in newborns, especially premature babies, and children of the first 2-3 months of life, a "gray collapse" may occur: vomiting, diarrhea, respiratory failure, cyanosis, cardiovascular collapse, cardiac and respiratory arrest. Collapse is a consequence of a violation of cardiac activity due to inhibition of oxidative phosphorylation in mitochondria. In the absence of help, the mortality rate of newborns from "gray collapse" is very high (40% or more).

The most common complication in the appointment of levomycetin is a violation of hematopoiesis. There may be dose-dependent reversible disorders in the form of hypochromic anemia (due to impaired iron utilization and heme synthesis), thrombocytopenia, and leukopenia. After the abolition of levomycetin, the blood picture is restored, but slowly. Irreversible dose-independent changes in hematopoiesis in the form of aplastic anemia occur with a frequency of 1 in 20,000-1 in 40,000 people taking levomycetin, and usually develop within 2-3 weeks (but may also be 2-4 months) after antibiotic use. They do not depend on the dose of the antibiotic and the duration of treatment, but are associated with the genetic characteristics of the biotransformation of chloramphenicol. In addition, levomycetin inhibits the function of the liver, adrenal cortex, pancreas, can cause neuritis, malnutrition. Allergic reactions when using chloramphenicol are rare. Biological complications can manifest themselves in the form of superinfections caused by antibiotic-resistant microorganisms, dysbiocenosis, etc. For children under 3 years old, chloramphenicol is prescribed only for special indications and only in very severe cases.

Among people who encounter medicine exclusively in the role of patients, there is a widespread misconception that antibiotics are a panacea for colds, and if you are very unwell, you can not do without them. This is not entirely true. Indeed, antibiotics are powerful drugs that can effectively eliminate the growth in the number of pathogens, but in most cases of colds they are useless.

The strongest antibiotics

The concept of "strong antibiotic" is more complicated than it seems at first glance. The fact is that antibiotics are classified into groups depending on their chemical structure. Among this group of drugs, there are both drugs synthesized in laboratories and those obtained from natural raw materials, but the most common is an intermediate option - a natural substance stabilized by laboratory methods.

Each of these substances is effective against a certain number of bacteria. The most powerful antibiotics are broad-spectrum drugs that are effective against gram-negative and gram-positive bacteria at the same time. However, the use of such drugs is far from always justified - as a rule, broad-spectrum antibiotics are highly toxic to the body and negatively affect its microflora.

The most powerful antibiotic in the world is Cefepime, a fourth-generation cephalosporin drug. Its high efficiency is ensured not only due to the wide range of pathogens that the substance acts on, but also due to the novelty of the compound. It is administered in injections, because. it is produced in the form of an active substance for dilution.

The fact is that bacteria are rapidly mutating creatures that can change the configuration of organisms of subsequent generations in such a way that drugs lose their effectiveness in combating such mutated bacteria. Therefore, antibiotics with the latest structure will always be more effective than previous drugs, with rare exceptions.

Strong antibiotics for colds

Treatment is justified only if, after a viral infection, the patient has developed a bacterial complication of the disease. This often happens due to a decrease in immunity. A viral infection weakens the body and makes it more susceptible to infection, and even a small strain of the pathogen becomes enough to infect bacteria.

Often in such situations, even the strongest antibiotic may not help the patient recover, because. it is necessary to carry out antiviral therapy in addition to it. Antibiotics do not help in the case of an uncomplicated viral infection. If ARVI was diagnosed, i.e. the so-called "cold", then the treatment is symptomatic.

Viruses, unlike bacteria, do not have specific treatments. The engine of the healing process is the power of the human natural immune system. Therefore, when treating viral infections, it is important to stay at home, stay in bed and avoid potential situations of infection, i.e. public places.

Antibiotics in tablets

The strongest antibiotics in tablets can belong to different groups of drugs. Tablets, i.e. oral form of the drug, are the most convenient for use. They do not require sterility and special skills; the patient can take them on their own while on an outpatient basis. However, they can not always be used, for example, it is undesirable to take pills for diseases of the gastrointestinal tract.

We list some of the strongest today:

• Avelox;
• Cefixime;
• Amoxiclav;
• Rulid;
• Unidox Solutab;
• Sumamed.

When choosing a medicine, you should not be guided only by the well-known name of the antibiotic. The selection of tablets should be done by a doctor, based on the results of the analysis, the patient's condition, the susceptibility of a particular antibiotic strain to a particular drug, as well as other indicators.

Consider the main groups of the latest antibiotics, which are more widely used than all the previous ones, due to their high rates.

Cephalosporin antibiotics are the most powerful broad-spectrum drugs. These medicines have gone through several generations during their development:

• I generation. Cefazolin, Cefadroxil, Cefalexin - drugs that work against staphylococci.
• II generation. Cefaclor, Cefuroxime, Cefamandol are drugs that can eliminate Escherichia and Haemophilus influenzae.
• III generation. Ceftibuten, Ceftazidime, Cefotaxime, Ceftriaxone - are used in the treatment of pneumonia and infections of the pelvic organs, incl. pyelonephritis.
• IV generation. Cefepime. An effective, but toxic drug from the entire group. Cefepime-based drugs may have side effects such as nephrotoxicity, i.e. a negative effect on the kidneys, which can lead to a decrease in their function up to failure.

In general, cephalosporins are among the safest antibiotics with minimal side effects, but they are still serious drugs that, without due attention to the rules for their use, can harm rather than benefit health.

Macrolides

These drugs are prescribed for damage to the body associated with gram-positive bacteria. They are also considered broad-spectrum antibiotics because within the group of Gram-positive bacteria, they are effective against several groups of pathogens.

We list the popular drugs of the group:

• Azithromycin;
• Josamycin;
• Oleandomycin;
• Erythromycin.

Macrolides act bacteriostatically, i.e. stop the reproduction of bacteria, allowing the natural forces of the body to destroy pathogens. This principle of action is the least toxic for humans and their normal microflora, and at the same time highly effective. Macrolides are uncharacteristic of the disadvantages of relatively low concentrations in tissues. The drug accumulates quickly and is retained in the cells for a long time, which allows you to use the minimum effective dose, avoiding intoxication of the body.

Fluoroquinolones

- antibiotics, the positive feature of which is the rapid permeability in the tissue and prolonged high concentration in the body. They are represented by two generations of substances:

• I generation. Effective against Pseudomonas aeruginosa and a wide range of Gram-negative bacteria.
• II generation. Second-generation fluoroquinolones are also effective against many Gram-negative bacteria, but are not effective against Pseudomonas aeruginosa.

Doctors prescribe drugs of this group for a wide variety of infectious diseases: chlamydia, tuberculosis, purulent tissue lesions, etc.

Penicillins

Penicillins are the earliest anti-bacterial drugs discovered by mankind. Penicillins are recognized as the most powerful - they have great power in the fight against pathogens and act on a wide range of bacteria. These drugs are well excreted, and therefore are considered to be of low toxicity. However, today, despite the fact that these are very strong antibiotics, many bacteria have learned to produce an enzyme - penicillase, as a result of which the drugs of this group do not work on them.

Common drugs in this group are:

• Amoxicillin;
• Ampiox;
• Oxacillin;
• Ampicillin.

Some doctors still use this group of drugs in their daily practice, but most doctors are inclined to believe that it makes no sense to prescribe penicillins now when there are drugs that are much less toxic to the patient. The spread of penicillins in our country is due to two factors: the "old school" of doctors who are not accustomed to trusting new drugs, and the low cost of penicillins compared to modern groups of drugs.

Thus, today's pharmaceutical market offers several options for groups of powerful antibiotics. Each of them, to a greater or lesser extent, covers a wide range of bacteria against which it has an effect.

In order for the treatment to be safe and effective, the patient undergoes a PCR test, during which the laboratory assistants will empirically find out which group of drugs is best suited for treatment.

With a cold, it is unreasonable to use broad-spectrum drugs, as a rule, they are too toxic. Such drugs are necessary for complex bacterial lesions, when two or more types of bacteria act simultaneously.