Antibiotics of the penicillin series preparations of the release form. List of antibiotics of the penicillin series, indications for taking drugs. Terms of dispensing from pharmacies

Approximately half of the inhabitants of the Earth have eye diseases of one degree or another. Therefore, it will not be superfluous to periodically check your eyes to see if they are susceptible to any pathologies and diseases. There are several very effective diagnostic techniques - and one of them is pachymetry. Let's take a closer look at what it is.

Method definition

Pachymetry is a special instrumental diagnostic method that allows you to measure the thickness of the cornea, that is, the cornea of ​​\u200b\u200bthe eye. Using this research method, you can obtain reliable data on the state of the cornea, which is very important both for diagnosing various diseases and for planning treatment.

Another method that must be used along with pachymetry to provide a qualitative prediction of the condition of the cornea is biomicroscopy.

Application area

There are a number of diseases and pathologies for which this type of diagnosis will be the best solution. These include, among others:

• Keratoconus.
• Keratoglobus.

Also, this diagnosis is the norm if you need to check the condition of the cornea after its surgical transplantation, as well as in preparation for various kinds of operations, first of all - to.

Please note that there are also several contraindications in which you will need to refrain from conducting this diagnosis. These include the following:

Procedure methods

There are two main approaches to this diagnosis. The first is that it is carried out using a slit lamp, the second method occurs using an ultrasound machine.

Carrying out the procedure

If the slit lamp approach (which resembles a microscope) has been chosen, the patient sits on one side of the slit lamp and places their chin on a special stand. The doctor sits on the other side and observes the eye. A special nozzle is put on the lamp. It contains two parallel glass plates. The lower one is stationary, while the upper one rotates along a vertical axis. The doctor directs the lighting to the right place and, by turning the knob, measures the indicators on a special scale.

Slit Lamp Diagnosis

An alternative to this diagnosis is the use of an ultrasound machine. It gives even more accurate results. The procedure is carried out as follows - the patient is placed on the couch near the ultrasound device, anesthesia is injected into his eyes, after which the cornea is touched with the nozzle of the apparatus. As a result, a special monitor automatically calculates the thickness of the cornea in various areas.

Diagnosis with an ultrasound machine

The non-contact slit lamp approach may be less effective, but it has fewer contraindications, for example, it can be used even for injuries and purulent processes in the eyes.

results

The results are directly related to what thickness of the cornea is revealed during the study. If we take its typical thickness, then it is usually in the range of 0.49-0.56 mm. In the limbus area, the indicators may be slightly higher, where the thickness can reach up to 0.9 mm. In this case, the average for men will be 0.551 mm, and for women - 0.542 mm.

Permissible daily change in thickness within 0.6 mm.

As a result, the main thing that they pay attention to is the excess of the normal thickness of the cornea. If it goes beyond 0.6 mm, then this means that the cornea is currently not in order, so it needs to be examined to identify further potential disorders.

Video

conclusions

If you doubt that your eyes are in order, then pachymetry will be an excellent solution for diagnosing. You can get it in virtually any public or private eye clinic.

Thanks

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

What is corneal pachymetry?

Pachymetry technique

The cornea belongs to the outer shell of the eyeball and is located in its anterior part, having a slightly convex ( outside) form. Under normal conditions, the cornea is transparent, as a result of which light rays pass freely through it, entering the inside of the eyeball and then reaching the retina, where images are formed. The cornea belongs to the so-called refractive system of the eye ( it also includes the lens and some other structures of the eyeball). Due to a certain curvature and thickness of the cornea passing through it ( and then through the lens) light rays are refracted and focused at a certain point in the eyeball ( namely on its back wall, right on the retina), which ensures the formation of a clear image of the objects that a person looks at. Violation of the curvature of the cornea, as well as a change in the thickness of the entire cornea or certain sections of it, will be accompanied by a violation of its refractive power, which can cause a violation ( decrease) visual acuity. Measurement of the thickness of the cornea in its various departments allows you to identify the existing pathology and choose the most optimal treatment, as well as evaluate its effectiveness.

How is pachymetry done?

Preparation for pachymetry

Apparatus for conducting and types of pachymetry

To study the thickness of the cornea, use:

• optical pachymetry. For the study, a special slit lamp is used, which can direct a beam of light into the patient's eye in the form of a strip, the length and width of which the doctor can adjust. Using a slit lamp and special lenses allows you to most accurately determine the thickness of the cornea.
• Ultrasonic pachymetry. To conduct this study, ultrasound devices are used that allow you to study the structure and thickness of various tissues of the eyeball.
• computerized pachymetry. For the study, a special apparatus is used ( tomograph), which "sees through" the eye structures, allowing you to get images of the eyeball, cornea and other tissues.

Optical pachymetry

The slit lamp is a kind of "microscope". The lamp allows you to direct a strip of light at the patient's eye, and then study the structures visible in it under high magnification. For pachymetry, two additional lenses are installed on the lamp.

The procedure goes as follows. The patient comes to the ophthalmologist's office and sits down at the table on which the slit lamp is located ( it is quite voluminous and usually tightly fixed to the table). Then he puts his chin on a special stand, and presses his forehead against the fixing arc. The doctor asks him to remain still and not blink, while he adjusts the optical system of the lamp so that it is directly opposite the eye being examined.

After the slit lamp is placed, a beam of light is directed into the patient's eye. The thickness of the cornea is measured using special lenses mounted on a lamp and arranged parallel to each other. One lens is fixed while the other is movable. Slowly rotating a special handle, the doctor changes the angle of the movable lens, as a result of which the nature of the light rays passing through the cornea changes. Based on this, the specialist measures its thickness in various areas.

Ultrasound pachymetry

Before starting the study, anesthesia of the cornea should be performed. The fact is that during the procedure, the working part of the sensor will come into contact with the outer surface of the cornea, which is rich in sensitive nerve endings. Any, even the most insignificant touch to its surface causes a blinking reflex, as a result of which the patient's eyelids involuntarily close. It also stimulates increased lacrimation ( as a protective reaction to corneal irritation). It will be impossible to carry out research in such conditions.

Anesthesia solves these problems. Its essence is as follows. 3 - 6 minutes before the start of the study, a few drops of local anesthetic are instilled into the patient's eyes. This drug penetrates the cornea and temporarily "turns off" the nerve endings located there, as a result of which the patient ceases to feel touching the surface of the cornea.

After performing anesthesia, the doctor proceeds directly to pachymetry. For this, the patient must lie down or sit on the couch and keep his eyes open. Having picked up an ultrasonic sensor, the doctor lightly touches the surface of the cornea of ​​the eye with the working part of the device. Within a few seconds, the device takes measurements, after which the built-in display shows the thickness of the cornea in the examined area.

The essence of the ultrasound method ultrasound) is as follows. Ultrasonic waves generated by a special emitter can propagate in various tissues of the body that they meet on their way. At the border between tissues, the composition of which differs, sound waves are partially reflected and recorded by a sensor located inside the device. The analysis of reflected waves makes it possible to determine the thickness of the examined tissue, as well as to evaluate its structure.

As mentioned earlier, the cornea is the front part of the shell of the eyeball. Behind it is the so-called anterior chamber of the eye, filled with intraocular fluid ( aqueous humor). When the probe is applied to the anterior surface of the cornea, ultrasonic waves begin to propagate along it, however, reaching its posterior border, they are partially reflected from the aqueous humor. Evaluation of the nature of the reflected waves and the time of their reflection and allows you to determine the thickness of the cornea. All this takes about 1-3 seconds from the device. Using this technique, within a few minutes, the doctor can examine the thickness of the cornea along its entire length.

If after the end of the study the patient feels any discomfort in the eyes, he can rinse them with warm clean water. At the same time, it is worth noting that usually the examination is absolutely painless, without causing any inconvenience to the patient. The sensitivity of the cornea is restored after a few minutes or tens of minutes ( depending on the anesthetic used and its dose). In this case, the patient can go about his business immediately after the end of the procedure.

Computed pachymetry

The procedure goes as follows. The patient comes to the ophthalmologist's office and sits in front of the apparatus ( tomograph). He applies his chin and forehead to special fixators ( as in a slit lamp examination), which ensures the immobility of the head throughout the procedure. Next, the doctor brings the working part of the device closer to the examined eye and scans the cornea and ( if necessary) other structures of the eye.

The duration of the procedure usually does not exceed 3-10 minutes, after which the patient can immediately go home, having received the results of the study.

Interpretation of pachymetry results ( norm and pathology)

The normal thickness of the cornea is:

• in central departments– 490 – 620 micrometers ( 0.49 - 0.62 mm).
• In the peripheral areas (along the edges) – up to 1200 micrometers ( 1.2 mm).

Indications for pachymetry

• Edema of the cornea. With corneal edema, its tissue is affected by the pathological process, thickens and deforms. The cause of this pathology may be inflammation of the cornea or other structures of the eye, allergy, foreign body entering the cornea, eye injury, poor hygiene when wearing contact lenses, and so on. The patient may complain of the appearance of fog before the eyes, increased tearing, redness of the eyes, pain in the eyes. When conducting pachymetry, it is possible to detect widespread thickening of the cornea, as well as the appearance of individual "folds" and other deformations in its various parts.
• Corneal ulcers. An ulcer is called a defect ( deepening) in corneal tissue. The cause of the development of an ulcer can be trauma, inflammatory or infectious lesions of the cornea of ​​\u200b\u200bthe eye and other damage to it. With ulceration of the cornea, its thickness in the affected area decreases, resulting in a violation of its refractive power. Patients may complain of pain and burning in the area of ​​the affected eye, increased lacrimation. Pachymetry allows you to determine the depth of the ulcer, as well as evaluate the effectiveness ( or inefficiency) of the treatment.
• Dystrophic diseases of the cornea. Corneal dystrophies are a number of hereditary diseases that are characterized by a violation of the processes of renewal of the corneal tissue. These disorders can be manifested by excessive formation of corneal tissue and its thickening, clouding of the cornea, metabolic disorders and ulceration ( partial or complete) cornea and so on. Pachymetry allows to detect pathological changes at an early stage of the disease. At the same time, the treatment of these pathologies is not always effective, since in most cases they are caused by disorders in the human genetic apparatus ( i.e. considered incurable). The only effective treatment for these pathologies can be considered a corneal transplant from a donor.
• Preparation for operations on the cornea. Before transplanting the cornea, it is important for the doctor to know the thickness of the cornea at the transplant site, its structure and other features of its structure. Pachymetry can help in resolving these issues. In addition, this study can be prescribed before operations on other structures of the eye ( for example, when replacing the lens).
• Assessment of the state of the cornea in the postoperative period. After corneal transplantation, pachymetry allows you to assess whether the donor tissue has taken root, whether corneal edema or other complications develop.

Keratoconus

Diagnosis can usually be made by examining the patient's eyeball ( especially in advanced stages, when the bulge of the cornea becomes extremely pronounced). Pachymetry can be used to determine corneal thickness before surgical treatment of keratoconus. The essence of the operation is that the surgeon performs several incisions on the cornea, which is accompanied by a change in its shape. However, with severe thinning of the cornea ( what is characteristic of keratoconus) the doctor risks piercing it through and through. Pachymetry allows you to determine the exact thickness of the tissue and calculate the required incision depth.

Glaucoma

To determine if a patient has glaucoma, intraocular pressure should be measured. The essence of this procedure is that a special weight with a known mass is placed on the cornea of ​​the patient lying on his back. The lower part of the weight is pre-coated with a special paint. Under its weight, the cornea bends, as a result of which part of the paint is washed off from the surface of the weight, which is directly adjacent to the cornea. The lower the intraocular pressure, the more the cornea will bend and, conversely, the higher the IOP, the less the cornea will bend and the less paint will be washed off the weight. At the final stage of the study, the weight is applied to special paper and the diameter of the ring formed as a result of washing off the paint is determined. This allows you to evaluate the IOP.

The problem of the study is that the measurement does not always take into account the thickness of the cornea. At the same time, it was experimentally established that the IOP parameters measured by the method described above depend on the thickness of the cornea of ​​​​the eye. The fact is that the corneal tissue has a certain elasticity, the thicker it is, the weaker it will sag under the pressure of the weight and, conversely, the thinner the cornea, the more it will sag. So, for example, an increase in the thickness of the cornea by 100 micrometers ( 0.1 mm) can increase intraocular pressure by 3 mmHg. This can lead to a false diagnosis of glaucoma and unreasonable prescribing of treatment that the patient does not need. At the same time, thinning of the cornea may be accompanied by too low IOP, as a result of which the patient's glaucoma may go unnoticed.

Today, in all modern clinics, the measurement of intraocular pressure should be accompanied by pachymetry. After determining the thickness of the cornea, an appropriate correction is made, which allows you to determine the intraocular pressure as accurately as possible.

Contraindications and adverse reactions for pachymetry

Pachymetry is contraindicated:

• Patients in an inadequate condition. These can be both mentally ill people and patients who are in a state of alcohol and / or drug poisoning. In this state, the patient will not be able to sit still during the entire procedure ( 3 – 15 minutes), as well as look straight ahead, which is a prerequisite for pachymetry.

• With perforation of the cornea. In this case, contact pachymetry using an ultrasound probe, which must be applied directly to the cornea, is contraindicated. The fact is that when performing a study, an infection can penetrate through a defect in the cornea of ​​\u200b\u200bthe eye, which can be accompanied by the development of formidable complications, up to complete blindness.
• With purulent-inflammatory diseases of the eye. In this case, contact pachymetry is also contraindicated, since the procedure can provoke the spread of infection and increase the severity of the inflammatory process.
• If you are allergic to local anesthetics. In this case, the patient is also contraindicated in contact ultrasonic pachymetry, during which anesthetics are used. The fact is that instillation of such a drug into the eyes of a patient who is allergic to it can lead to the rapid development of allergic reactions ( from redness and swelling of the eye to anaphylactic shock and death of the patient). Complete patient interview and test execution ( test) for allergies allows you to almost completely eliminate the risk of developing this complication.

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Antibiotics of the penicillin series are characterized by low toxicity, an extended spectrum of action. Penicillin antibiotics have a bactericidal effect on most strains of gram-positive, gram-negative bacteria, Pseudomonas aeruginosa.

The action of drugs from the list of penicillin antibiotics is determined by their ability to cause the death of pathogenic microflora. Penicillins act bactericidal, interacting with bacterial enzymes, disrupting the synthesis of the bacterial wall.

The targets for penicillins are multiplying bacterial cells. For humans, antibiotics of the penicillin group are safe, since the membranes of human cells do not contain bacterial peptidoglycan.

Classification

According to the method of production and properties, two main groups of penicillin antibiotics are distinguished:

• natural - discovered in 1928 by Flemming;
• semi-synthetic - created for the first time in 1957, when the active core of the antibiotic 6-APK was isolated.

A number of natural penicillins obtained from the Penicillum microfungus are not resistant to bacterial penicillinase enzymes. Because of this, the spectrum of activity of the natural penicillin series is narrowed compared to the group of semi-synthetic drugs.

Classification of the penicillin series:

• natural;
  • phenoxymethylpenicillin - Ospen and analogues;
  • benzathine benzylpenicillin - Retarpen;
  • benzylpenicillin - Procaine penicillin;
• semi-synthetic;
  • aminopenicillins - amoxicillins, ampicillins;
  • antistaphylococcal;
  • anti-pseudomonas;
    • carboxypenicillins;
    • ureidopenicillins;
  • inhibitor-protected;
  • combined.

Under the influence of the widespread use of antibiotics, bacteria have learned to produce beta-lactamase enzymes that destroy penicillins in the stomach.

To overcome the ability of bacteria producing beta-lactamase to destroy antibiotics, combined inhibitor-protected agents were created.

Action spectrum

Natural penicillins are active against bacteria:

• gram-positive - staphylococci, streptococci, pneumococci, listeria, bacilli;
• gram-negative - meningococci, gonococci, Haemophilus ducreyi - causing soft chancre, Pasteurella multocida - causing pasteurellosis;
• anaerobes - clostridia, fusobacteria, actinomycetes;
• spirochetes - leptospira, borrelia, pale spirochetes.

The spectrum of action of semi-synthetic penicillins is wider than that of natural ones.

Semi-synthetic groups of antibiotics from the list of the penicillin series are classified according to their spectrum of action, as:

• not active to Pseudomonas aeruginosa;
• antipseudomonal drugs.

Indications

As first-line drugs for the treatment of bacterial infections, antibiotics from the penicillin series are used in the treatment of:

• diseases of the respiratory system - pneumonia, bronchitis;
• ENT diseases - otitis media, tonsillitis, tonsillopharyngitis, scarlet fever;
• diseases of the urinary system - cystitis, pyelonephritis
• gonorrhea, syphilis;
• skin infections;
• osteomyelitis;
• blennorrhea of ​​newborns;
• bacterial lesions of the mucous membranes, connective tissue;
• leptospirosis, actinomycosis;
• meningitis.

natural penicillins

Natural benzylpenicillins are destroyed by both beta-lactamases and gastric juice. Preparations of this group are produced as medicines for injection:

• prolonged action - analogues with the names Bicillins numbered 1 and 5, novocaine salt of benzylpenicillin;
• short-acting - sodium, potassium salts of benzylpenicillin.

For a long time, they are released into the blood when intramuscularly administered depot forms of penicillins are slowly released from the muscle into the blood after an injection:

• Bicellins 1 and 5 - are prescribed 1 time per day;
• Benzylpenicillin novocaine salt - 2 - 3 rubles / day.

Aminopenicillins

Antibiotics from the list of aminopenicillins are effective against most infections caused by bacteria Enterobacteriaceae, Helicobacter pylori, Haemophilus influenzae, and other names of predominantly gram-negative bacteria.

The list of antibiotics of the aminopenicillins of the penicillin series includes drugs:

• ampicillin series;
  • Ampicillin trihydrate;
  • Ampicillin;
• amoxicillin;
  • Flemoxin Solutab;
  • Ospamox;
  • Amosin;
  • Ecoball.

The activity of antibiotics from the list of ampicillins and amoxicillins, the action spectra of drugs of these groups of penicillins are similar.

Antibiotics of the ampicillin series have a weaker effect on pneumococci, however, the activity of Ampicillin and its analogues with the names Ampicillin Akos, Ampicillin trihydrate is higher in relation to shigella.

Antibiotics of the group are prescribed:

• ampicillins - inside in tablets and injections in / m, in / in;
• amoxicillins - for oral administration.

The amoxicillin series is effective against Pseudomonas aeruginosa, but some members of the group are destroyed by bacterial penicillinases. Penicillins from the group of ampicillin antibiotics are resistant to penicillinase enzymes.

Antistaphylococcal penicillins

The group of antistaphylococcal penicillins includes antibiotics of the names:

• oxacillin;
• dicloxacillin;
• nafcillin;
• methicillin.

The drugs are resistant to staphylococcal penicillinases, which destroy other antibiotics of the penicillin series. The most famous of this group is the antistaphylococcal drug Oxacillin.

Antipseudomonal penicillins

Antibiotics of this group have a greater spectrum of action than aminopenicillins, they are effective against Pseudomonas aeruginosa, which causes severe cystitis, purulent tonsillitis, and skin infections.

The list of antipseudomonal penicillins includes:

• carboxypenicillins - drugs;
  • Carbetsin;
  • Piopen;
  • Carbenicillin disodium;
  • Timentin;
• a group of ureidopenicillins;
  • Secureopen;
  • Azlin;
  • baypen;
  • piperacillin Picillin.

Carbenicillin is available only as a powder for intramuscular injection. Antibiotics of this group are prescribed for adults.

Timentin is prescribed for severe infections of the genitourinary, respiratory system. Azlocillin and analogues are prescribed in injections for purulent-septic conditions:

• peritonitis;
• septic endocarditis;
• sepsis;
• lung abscess;
• severe infections of the genitourinary system.

Piperacillin is prescribed primarily for infections caused by Klebsiella.

Inhibitor-protected, combined agents

Inhibitor-protected penicillins include combined preparations, which include an antibiotic and a substance that blocks the activity of bacterial beta-lactamase.

As beta-lactamase inhibitors, of which there are about 500 varieties, are:

• clavulanic acid;
• tazobactam;
• sulbactam.

For the treatment of respiratory, genitourinary infections, mainly protected antibiotics of the penicillin series are used with the names:

• amoxicillin + clavunate;
  • Augmentin;
  • Amoxiclav;
  • Amoxil;
• ampicillin + sulbactam - Unazine.

From infections that occur against the background of weakened immunity, prescribe:

• ticarcillin + clavunate - Timentin;
• piperacillin + tazobactam - Tazocin.

Combined action drugs include the antibacterial agent Ampiox and its analogue Ampiox-sodium, including ampicillin + oxacillin.

Ampiox is available in tablets and as a powder for injection. Ampiox is used in the treatment of children and adults from severe sepsis, septic endocarditis, postpartum infection.

Penicillins for adults

The list of semi-synthetic penicillins, which are widely used for tonsillitis, otitis media, pharyngitis, sinusitis, pneumonia, includes drugs in tablets and injections:

• Hyconcil;
• Ospamox;
• Amoxiclav;
• Amoxicar;
• Ampicillin;
• Augmentin;
• Flemoxin Solutab;
• Amoxiclav;
• Piperacillin;
• Ticarcillin;

Against purulent, chronic pyelonephritis, bacterial cystitis, urethritis, endometritis, salpingitis in women, penicillins are prescribed:

• Augmentin;
• Amoxiclav;
• Ampicillin + sulbactam;
• Medoklav;
• Piperacillin + tazobactam;
• Ticarcillin with clavulanate.

Penicillins are not used against prostatitis, as they do not penetrate the prostate tissue.

With an allergy to penicillins, the patient may have urticaria, anaphylactic shock, and in the case of treatment with cephalosporins.

To avoid an allergic reaction, when allergic to beta-lactam antibiotics, which are penicillins and cephalosporins, antibiotics of the macrolide group are prescribed.

Exacerbation of chronic pyelonephritis in pregnant women is treated:

• Ampicillin;
• Amoxicillin + clavulanate;
• Ticarcillin + clavulanate;
• Oxacillin - with staphylococcal infection.

The list of non-penicillin antibiotics that a doctor may prescribe during pregnancy for tonsillitis, bronchitis or pneumonia includes drugs:

• cephalosporins;
  • Cefazolin;
  • Ceftriaxone;
• macrolides;
  • Azithromycin;
  • Clarithromycin.

Penicillins for the treatment of children

Penicillins are low-toxic antibiotics, which is why they are often prescribed for infectious diseases in children.

Preference in the treatment of children is given to inhibitor-protected penicillins intended for oral administration.

The list of penicillin antibiotics intended for the treatment of children includes Amoxicillin and analogues, Augmentin, Amoxiclav, Flemoxin and Flemoklav Solutab.

They are used to treat children and forms of the antibiotic Solutab of a non-penicillin series, the list includes analogues with names:

• Vilprafen Solutab;
• Unidox Solutab.

Medicines in the form of Solutab dispersible tablets are no less effective than injections, and cause less children's grief and tears during treatment. You can read about antibiotics in the form of dispersible effervescent tablets on the page "Antibiotic Solutab".

From birth, the drug Ospamox and a number of its analogues, which are produced in soluble tablets, granules and powder for suspension preparation, are used to treat children. The dosage is prescribed by the doctor, based on the age and weight of the child.

In children, the accumulation of penicillins in the body is possible, caused by the immaturity of the urinary system or kidney disease. An increased concentration of an antibiotic in the blood has a toxic effect on nerve cells, which is manifested by convulsions.

When such symptoms appear, treatment is stopped, and the antibiotic of the penicillin series is replaced by the child with a drug of another group.

Contraindications, side effects of penicillins

Allergy to penicillin analogues and cephalosporins is a contraindication for the use of the penicillin series. If a rash, itching appears during treatment, you need to stop taking the drugs and consult a doctor.

Allergy to penicillins can manifest as Quincke's edema, anaphylaxis.

The list of side effects of penicillins is small. The main negative manifestation is the suppression of beneficial intestinal microflora.

Diarrhea, candidiasis, skin rash - these are the main side effects from the use of penicillins. Less commonly, side effects of drugs of this series are manifested:

• nausea, vomiting;
• headache;
• pseudomembranous colitis;
• edema.

The use of certain groups of the penicillin series - benzylpenicillins, carbenicillins, can cause electrolyte imbalance with the occurrence of hyperkalemia or hypernatremia, which increases the risk of a heart attack, increased blood pressure.

A wider list of adverse reactions in oxacillin and analogues:

• violation of the leukocyte formula - low hemoglobin, low neutrophils;
• on the part of the kidneys in children - the appearance of blood in the urine;
• fever, vomiting, nausea.

To prevent the development of undesirable effects, it is necessary to follow the instructions for use, take the medicine in the dosage prescribed by the doctor.

For more information about each group of penicillin antibiotics, see the section "Drugs".

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Antibiotics of the penicillin series are still used in medicine.

The discovery of penicillin and its properties

In the 30s of the last century, Alexander Fleming conducted experiments with staphylococci. He studied bacterial infections. After growing a group of these pathogens in a nutrient medium, the scientist noticed that there were areas in the cup that were not surrounded by live bacteria. The investigation showed that the usual green mold, which likes to settle on stale bread, is “guilty” of these spots. The mold was called Penicillium and, as it turned out, produced a substance that kills staphylococci.

Fleming went deeper into this issue and soon isolated pure penicillin, which became the world's first antibiotic. The principle of action of the drug is as follows: when a bacterial cell divides, each half restores its cell membrane with the help of a special chemical element - peptidoglycan. Penicillin blocks the formation of this element, and the bacterial cell simply "resolves" in the environment.

Ask your question to a neurologist for free

Irina Martynova. Graduated from the Voronezh State Medical University. N.N. Burdenko. Clinical intern and neurologist of BUZ VO \"Moscow Polyclinic\".

But difficulties soon arose. Bacterial cells learned to resist the drug - they began to produce an enzyme called beta-lactamase, which destroys beta-lactams (the basis of penicillin).

Expert opinion

Astafiev Igor Valentinovich

Neurologist - City Pokrovskaya Hospital. Education: Volgograd State Medical University, Volgograd. Kabardino-Balkarian State University named after A.I. HM. Berbekova, Nalchik.

The next 10 years there was an invisible war between pathogens that destroy penicillin, and scientists that modify this penicillin. So many modifications of penicillin were born, which now form the entire penicillin series of antibiotics.

Pharmacokinetics and principle of action

The drug for any method of application spreads rapidly throughout the body, penetrating almost all its parts. Exceptions: cerebrospinal fluid, prostate gland and visual system. In these places, the concentration is very low, under normal conditions it does not exceed 1%. With inflammation, a rise of up to 5% is possible.

Antibiotics do not affect the cells of the human body, since the latter do not contain peptidoglycan.

The drug is quickly excreted from the body, after 1-3 hours most of it is excreted through the kidneys.

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Classification of antibiotics

All drugs are divided into: natural (short and prolonged action) and semi-synthetic (anti-staphylococcal, broad-spectrum drugs, antipseudomonal).

Natural

These drugs obtained directly from the mold. At the moment, most of them are outdated, as pathogens have developed immunity to them. In medicine, benzylpenicillin and Bicillin are most often used, which are effective against gram-positive bacteria and cocci, some anaerobic bacteria and spirochetes. All these antibiotics are used only in the form of injections into the muscles, since the acidic environment of the stomach quickly destroys them.

Benzylpenicillin in the form of sodium and potassium salts is a short-acting natural antibiotic. Its action stops after 3-4 hours, so frequent repeated injections are necessary.

Trying to eliminate this drawback, pharmacists have created natural long-acting antibiotics: Bicillin and novocaine salt of benzylpenicillin. These drugs are called "depot forms" because after injection into the muscle they form a "depot" in it, from which the drug is slowly absorbed into the body.

Expert opinion

Mitrukhanov Eduard Petrovich

Doctor - neurologist, city polyclinic, Moscow. Education: Russian State Medical University, Russian Medical Academy of Postgraduate Education, Ministry of Health of the Russian Federation, Volgograd State Medical University, Volgograd.

Examples of drugs: benzylpenicillin salt (sodium, potassium or novocaine), Bicillin-1, Bicillin-3, Bicillin-5.

Semi-synthetic antibiotics of the penicillin group

Several decades after receiving penicillin pharmacists were able to isolate its main active ingredient, and the modification process began. Most drugs, after improvement, acquired resistance to the acidic environment of the stomach, and semi-synthetic penicillins began to be produced in tablets.

Isoxazolpenicillins are drugs that are effective against staphylococci. The latter have learned to produce an enzyme that destroys benzylpenicillin, and drugs from this group prevent their production of the enzyme. But you have to pay for the improvement - drugs of this type are less absorbed in the body and have a smaller spectrum of action compared to natural penicillins. Examples of drugs: Oxacillin, Nafcillin.

Aminopenicillins are broad-spectrum drugs. Inferior to benzylpenicillins in strength in the fight against gram-positive bacteria, but cover a larger range of infections. Compared to other drugs, they stay in the body longer and better penetrate some of the body's barriers. Examples of drugs: Ampicillin, Amoxicillin. You can often find Ampiox - Ampicillin + Oxacillin.

Carboxypenicillins and ureidopenicillins antibiotics effective against Pseudomonas aeruginosa. At the moment, they are practically not used, since infections quickly acquire resistance to them. Occasionally, you can find them as part of a comprehensive treatment.

Examples of drugs: Ticarcillin, Piperacillin

List of drugs

Tablets

Sumamed

Active ingredient: azithromycin.

Indications: Respiratory infections.

Contraindications: intolerance, severe renal failure, children under 6 months of age.

Price: 300-500 rubles.

Oxacillin

Active ingredient: oxacillin.

Indications: infections sensitive to the drug.

Price: 30-60 rubles.

Amoxicillin Sandoz

Indications: respiratory tract infections (including tonsillitis, bronchitis), infections of the genitourinary system, skin infections, other infections.

Contraindications: intolerance, children under 3 years of age.

Price: 150 rubles.

Ampicillin trihydrate

Indications: pneumonia, bronchitis, tonsillitis, other infections.

Contraindications: hypersensitivity, liver failure.

Price: 24 rubles.

Phenoxymethylpenicillin

Active ingredient: phenoxymethylpenicillin.

Indications: streptococcal diseases, infections of mild and moderate severity.

Price: 7 rubles.

Amoxiclav

Active ingredient: amoxicillin + clavulanic acid.

Indications: infections of the respiratory tract, urinary system, infections in gynecology, other infections sensitive to amoxicillin.

Contraindications: hypersensitivity, jaundice, mononucleosis and lymphocytic leukemia.

Price: 116 rubles.

injections

Bicillin-1

Active ingredient: benzathine benzylpenicillin.

Indications: acute tonsillitis, scarlet fever, wound infections, erysipelas, syphilis, leishmaniasis.

Contraindications: hypersensitivity.

Price: 15 rubles per injection.

Ospamox

Active ingredient: amoxicillin.

Indications: infections of the lower and upper respiratory tract, gastrointestinal tract, genitourinary system, gynecological and surgical infections.

Contraindications: hypersensitivity, severe gastrointestinal infections, lymphocytic leukemia, mononucleosis.

Price: 65 rubles.

Ampicillin

Active ingredient: ampicillin.

Indications: infections of the respiratory and urinary tract, gastrointestinal tract, meningitis, endocarditis, sepsis, whooping cough.

Contraindications: hypersensitivity, impaired renal function, childhood, pregnancy.

Price: 163 rubles.

Benzylpenicillin

Indications: severe infections, congenital syphilis, abscesses, pneumonia, erysipelas, anthrax, tetanus.

Contraindications: intolerance.

Price: 2.8 rubles per injection.

Benzylpenicillin novocaine salt

Active ingredient: benzylpenicillin.

Indications: Similar to benzylpenicillin.

Contraindications: intolerance.

Price: 43 rubles for 10 injections.

For the treatment of children, Amoxiclav, Ospamox, Oxacillin are suitable. But Before using the medicine, you must always consult with your doctor to adjust the dose.

Indications for use

Antibiotics of the penicillin group are prescribed for infections, the type of antibiotics is selected based on the type of infection. It can be various cocci, bacilli, anaerobic bacteria, and so on.

Most often, antibiotics treat infections of the respiratory tract and genitourinary system.

Application features

In the case of treating children, you need to follow the instructions of the doctor, who will prescribe the desired antibiotic and adjust the dose.

In case of pregnancy, antibiotics should be used with extreme caution, as they penetrate the fetus. During lactation, it is better to switch to mixtures, as the medicine also penetrates into milk.

For the elderly, there are no special instructions, although the doctor should take into account the condition of the patient's kidneys and liver when prescribing treatment.

Contraindications and side effects

The main and often the only contraindication is individual intolerance. It occurs frequently - in about 10% of patients. Additional contraindications depend on the specific antibiotic and are prescribed in its instructions for use.

List of side effects

• The development of allergies - from itching and fever to anaphylactic shock and coma.
• Instantaneous development of an allergic reaction in response to the introduction of the drug into a vein.
• Dysbacteriosis, candidiasis.

In case of side effects, you should immediately seek medical help, stop the drug and carry out symptomatic treatment.