Broad spectrum antimicrobials. General rules for taking antibacterial drugs. Antimicrobial drugs and their characteristics

Antibiotics are substances that inhibit the growth of living cells or lead to their death. May be of natural or semi-synthetic origin. Used for treatment infectious diseases caused by the growth of bacteria and harmful microorganisms.

Universal

Broad spectrum antibiotics - list:

1. Penicillins.
2. Tetracyclines.
3. Erythromycin.
4. Quinolones.
5. Metronidazole.
6. Vancomycin.
7. Imipenem.
8. Aminoglycoside.
9. Levomycetin (chloramphenicol).
10. Neomycin.
11. Monomycin.
12. Rifamcin.
13. Cephalosporins.
14. Kanamycin.
15. Streptomycin.
16. Ampicillin.
17. Azithromycin.

These drugs are used in cases where it is impossible to accurately determine the causative agent of the infection. Their advantage is in a large list of microorganisms sensitive to the active substance. But there is also a drawback: in addition to pathogenic bacteria, broad-spectrum antibiotics contribute to the suppression of immunity and disruption of normal intestinal microflora.

List of strong antibiotics of the new generation with a wide spectrum of action:

1. Cefaclor.
2. Cefamandol.
3. Unidox Solutab.
4. Cefuroxime.
5. Rulid.
6. Amoxiclav.
7. Cephroxitin.
8. Lincomycin.
9. Cefoperazone.
10. Ceftazidime.
11. Cefotaxime.
12. Latamoxef.
13. Cefixime.
14. Cefpodoxime.
15. Spiramycin.
16. Rovamycin.
17. Clarithromycin.
18. Roxithromycin.
19. Klacid.
20. Sumamed.
21. Fusidin.
22. Avelox.
23. Moxifloxacin.
24. Ciprofloxacin.

New generation antibiotics are more remarkable deep degree purification of the active substance. Due to this, the drugs have much less toxicity compared to earlier analogues and cause less harm to the body as a whole.

Highly focused:

Bronchitis

The list of antibiotics for coughs and bronchitis usually does not differ from the list of broad-spectrum drugs. This is due to the fact that the analysis of sputum discharge takes about seven days, and until the causative agent of the infection is definitely identified, a remedy with the maximum number sensitive bacteria.

Besides, latest research show that in many cases the use of antibiotics in the treatment of bronchitis is unjustified. The point is that the assignment similar drugs effective if the nature of the disease is bacterial. In the case when the cause of bronchitis is a virus, antibiotics will not have any positive effect.

Commonly used antibiotic drugs for inflammatory processes in the bronchi:

1. Ampicillin.
2. Amoxicillin.
3. Azithromycin.
4. Cefuroxime.
5. Ceflocor.
6. Rovamycin.
7. Cefodox.
8. Lendatsin.
9. Ceftriaxone.
10. Macrofoam.

Angina

List of antibiotics for angina:

1. Penicillin.
2. Amoxicillin.
3. Amoxiclav.
4. Augmentin.
5. Ampiox.
6. Phenoxymethylpenicillin.
7. Oxacillin.
8. Cephradine.
9. Cephalexin.
10. Erythromycin.
11. Spiramycin.
12. Clarithromycin.
13. Azithromycin.
14. Roxithromycin.
15. Josamycin.
16. Tetracycline.
17. Doxycycline.
18. Lidaprim.
19. Biseptol.
20. Bioparox.
21. Ingalipt.
22. Grammidin.

These antibiotics are effective against sore throats caused by bacteria, most often beta-hemolytic streptococci. As for the disease, the causative agents of which are fungal microorganisms, the list is as follows:

1. Nystatin.
2. Levorin.
3. Ketoconazole.

Colds and flu (ARI, ARVI)

Antibiotics for the common cold are not included in the list of necessary drugs, given the rather high toxicity of antibiotics and possible side effects. Recommended treatment with antiviral and anti-inflammatory drugs, as well as restorative means. In any case, it is necessary to consult a therapist.

Sinusitis

List of antibiotics for sinusitis - in tablets and for injections:

1. Zitrolide.
2. Macrofoam.
3. Ampicillin.
4. Amoxicillin.
5. Flemoxin Solutab.
6. Augmentin.
7. Hyconcil.
8. Amoxil.
9. Gramox.
10. Cephalexin.
11. Digital.
12. Sporidex.
13. Rovamycin.
14. Ampiox.
15. Cefotaxime.
16. Vercef.
17. Cefazolin.
18. Ceftriaxone.
19. Duracef.

More than half existing diseases caused by disease-causing viruses or bacteria that enter the body and disrupt its constancy internal environment. For the treatment of such infections, various antimicrobial drugs are prescribed, which are the largest group of drugs. They cause the death of fungi, bacteria, viruses, and also inhibit the growth and reproduction of pathogenic microorganisms. Antimicrobial agents, unlike antibacterial agents, prevent the development of a wider range of harmful organisms.

Types of drugs and their features

Antimicrobials have a number of common specific features and are divided into several types depending on:

• From the field of application (antiseptic, disinfectant)
• Directions of action (antifungal, antiviral)
• Method of obtaining (antibiotics, synthetic agents, natural medicines).

Before prescribing antibiotics, they check the sensitivity of the microflora to the drug and identify the causative agent of the infection. It is advisable to start treatment as early as possible, until the immune system is completely destroyed, and the amount harmful bacteria in the body is not so great. Often such drugs are prescribed for various diseases skin caused by staphylococci and streptococci, as well as fever, headache, chills.

Synthetic drugs are usually prescribed in the presence of intolerance to antibiotics or the absence of a microflora response to them. They are highly active antimicrobials and are often used for infections. gastrointestinal tract, respiratory tract and urinary system.
Natural remedies help to avoid certain diseases and are used in preventive purposes. These are infusions of herbs, berries, honey and more.

Choice of drug

When choosing a medicine for microbes, analysis data, the age of the patient, and the tolerance of the components of the drug are taken into account. During the entire course of treatment, the dynamics of symptoms of infection, as well as the appearance of undesirable consequences. These can be allergic reactions in the form of urticaria or dermatitis, as well as dysbacteriosis, kidney failure, cholestasis, gastritis, colitis. Instructions for use contains the entire list of side effects for each remedy. The doctor prescribes the appropriate doses and route of administration of the drug, which eliminate or minimize the risk negative impact on the patient's body.
Despite the fact that each instruction for use contains information about the indications for use and the required doses of the drug, you should not self-medicate. If you choose wrong antimicrobials, the number of bacteria in the body will only increase, allergic reactions and dysbacteriosis may occur.

There is a widespread misconception among people who encounter medicine exclusively as patients that antibiotics are a panacea against colds, and with severe malaise, you can not do without taking them. This is not entirely true. Indeed, antibiotics are strong 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 difficult 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 intermediate option is 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 not 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 issued in the form active substance for breeding.

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 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 with similar 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 forces of nature immune system person. Therefore, in the treatment viral infections it is important to stay at home bed rest and avoid potential infection situations, 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 outpatient treatment. 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 famous name antibiotic. The selection of tablets should be done by the 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 the latest antibiotics with more wide application than all the previous ones, due to high performance.

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. Negative influence on the kidneys, which can lead to a decrease in their function up to failure.

In general, cephalosporins are among the most safe means among antibiotics with a minimum number of side effects, but these 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 efficient. Macrolides are uncharacteristic of disadvantages regarding low concentrations in tissues. The drug accumulates quickly and is retained in the cells for a long time, which allows you to use minimal effective dose avoiding intoxication of the body.

Fluoroquinolones

- antibiotics, a positive feature of which is rapid tissue permeability 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 lesions fabrics, etc.

Penicillins

Penicillins are the earliest anti-bacterial drugs discovered by mankind. Penicillins are recognized as the most powerful - they have great strength 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 associated with two factors: the "old school" of doctors who are not accustomed to trusting new drugs, and the low cost of penicillins in comparison with contemporary groups medicines.

Thus, today's pharmaceutical market offers several options for groups 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.

Antibiotics are substances that can kill or inhibit the growth of protozoa. Their list includes not only substances natural origin and their derivatives, but also drugs that do not have biological analogues. When it comes to new generation broad-spectrum antibiotics, the list of synthetically created drugs significantly exceeds drugs of biological origin.

Thanks to antibiotics, many incurable diseases the beginning of the 20th century today are treated in less than a week.

The discovery of this group of drugs has become a real revolution in medicine. Subsequent research has led to the creation of effective drugs against bacteria. various kinds.

Why are new antibiotics being developed?

The uncontrolled, often unjustified use of drugs of the antibiotic group leads to constant mutations of bacteria and the formation of resistance to the drugs used in pathogens. In this regard, scientists are constantly working on the creation of new antibiotics and the transformation of those already identified.

Antibiotics of the new generation are less toxic and differ from those created earlier in higher therapeutic efficacy, a decrease in the number side effects and stress on the body as a whole. Their influence is selective - destroyed opportunistic flora, the human microflora is not affected and immunity is not suppressed.

Over the past twenty years, scientists have discovered and developed more than seven thousand substances with strong antimicrobial and bactericidal effects, this has allowed pharmaceutical companies to constantly produce new, more advanced antibiotics.

Only in the previous ten years, about 150 antibacterial drugs were released, and about twenty of them are new generation medicines.

The prices of antibiotics can vary greatly, but they should not become a criterion for choosing a treatment, neither from the position of economy, nor from the position of "expensive means it will help." The doctor's appointment should be the factor of choice!

Types of bacteria

Today at medical science Bacteria are conventionally divided into Gram-negative and Gram-positive.

The essence of separation lies in the properties cell membrane bacteria. The world learned about them thanks to the research of bacteriologist Hans Gram, which consisted in staining colonies of microorganisms.

It turned out that different types bacteria interact with the dye in different ways. Some stained easily and quickly, others slowly stained and quickly discolored.

So different reaction on the dye clearly showed the properties of the cell wall of various bacteria and, accordingly, showed scientists what effect of the drug would be most effective.

• The most large group Gram (+) bacteria are staphylococci and streptococci. They are the causative agents of most infectious ear and eye diseases, as well as diseases of the nasopharynx and respiratory organs.
• Gram (-) bacteria include E. coli, Koch coli, meningococcus, salmonella, gonococcus, and shigella .

The complex structure and the ability to resist the action of drugs for a long time caused scientists to develop the most powerful antibiotics to destroy just such pathogens.

Systematization of antibiotics

The classification of drugs of the antibiotic group occurs according to two main parameters:

• pathogen control mechanism;
• spectrum.

Based on the mechanism of action of the drug on the pathogen, the following are distinguished:

• bactericidal drugs destroy directly the bacteria themselves.
• bacteriostatic drugs inhibit the reproduction function of microorganisms;

According to the spectrum, highly specialized drugs and broad-profile antibiotics are distinguished. Separation occurs depending on the type of microorganisms that are sensitive to the active substance of the drug.

Narrow spectrum antibiotics can affect either Gram (+) or Gram (-) bacteria. They are more gentle for the body, but are effective only when a specific microorganism has become the source of the disease (this is determined using bacteriological culture).

Broad-spectrum antibiotics are capable of infecting both Gram-positive and Gram-negative pathogens.

Combined drugs are used:

• as a preventive measure infectious inflammation after surgery,
• with the threat of transient development of a serious infection,
• with resistance of the pathogen to the active substance of a narrow profile,
• with superinfection, when the disease is provoked simultaneously by several pathogenic agents.
• when prescribing treatment based on clinical picture, if you determine the type of pathogen in laboratory conditions no possibility. So, in the treatment of tonsillitis and respiratory tract infections, spending time on identifying the causative agent of the disease is completely inappropriate. And with heavy and rapidly developing diseases such as meningitis, time to wait for results bacterial culture, simply no. Bacteria quickly begin to infect the brain and the slightest delay in the appointment antibiotic therapy can cause disability or even death.

Side effects and complications

Doctors all over the world call antibiotics of a wide spectrum of effects a real salvation from a number of the most difficult and dangerous infections.

At the same time, the unique ability of broad-spectrum antibiotics to destroy the infection, even when the pathogenic agent is not detected, acts and negative side this group of drugs.

The versatility of a remedy should by no means be considered a reason for patients to treat themselves. Uncontrolled treatment can harm the body.

Only a physician can determine the very advisability of taking antibacterial drugs, choose the optimal medicine, prescribe the dosage and set the duration of administration.

It is important to understand that fever and cough do not always indicate bacterial infection- and against other pathogens, even the most powerful broad-spectrum antibiotic is powerless.

In particular, the following complications are possible:

• The destruction of microorganisms entails an imbalance intestinal flora and can lead to dysbiosis.
• When prescribing antibiotic therapy, the doctor should also prescribe procedures and drugs aimed at restoring the microbiocenosis of the gastrointestinal tract. Most often, doctors prescribe prebiotics and probiotics to help maintain normal condition intestines.
• Non-compliance with the duration of the course or a decrease in the dosage prescribed by the doctor can lead to a decrease in sensitivity to the drug against the background of a new round of the disease. This happens when patients stop taking an antibiotic or decide to reduce the dose when their condition improves. This is absolutely impossible to do. The course must be drunk completely, otherwise, the remaining, and the strongest, bacteria will begin to multiply and cause the return of the disease, but the surviving bacteria will already have a kind of immunity to the substance, and treatment with the same drug will become ineffective.
• Prolonged use of antibiotics can cause serious complications. Medications penicillin group can have a toxic effect on the central nervous system, and streptomycins can affect the functioning of the auditory nerve.
• The demand for new generation antibiotics is associated not only with their high efficiency, but also with improvements aimed at reducing toxicity and minimizing pernicious influence to the intestinal tract.

Characteristics and list of drugs

Antibiotics of the new generation are characterized by a minimum number of side effects, many are protected by inhibitors that can destroy beta-lactamase-producing pathogens and contain clavuanic acid, which neutralizes the detrimental effect of enzymes on active substance medicines.

Among the new generation antibiotics, the most commonly used are:

• Flemoklav Solutab
• Sumamed
• Amoxiclav
• Rulid,

Modified formulations of new antibiotics and a more complex mode of action have made possible impact drugs at the cellular level of the pathogenic agent, without destroying beneficial microflora organism.

Even 10-15 years ago, only narrow-spectrum antibiotics gave such a result, and then in the fight against a small amount pathogens. New generation drugs are effective against a whole group of pathogens at once.

Table of groups and characteristics of modern antibiotics

Issued combined antibiotics in tablets, powders for suspensions, ready-made ampoules and powders for injections, ointments and creams for topical use.

The effectiveness of antibiotics in various diseases

Initially, broad-spectrum antibacterial drugs are prescribed by a doctor based on clinical symptoms.

Based on the results of bacteriological culture, the attending physician can correct the treatment regimen by changing ASHD to narrow-profile drugs.

• With bronchitis, Amoxiclav is most effective. In its chronic forms, Levofloxacin is used to relieve inflammation.
• If pneumonia is suspected, Cefoxin or Ceftriaxone is prescribed.
• If identified fungal infection high efficiency of third-generation cephalosporins.
• The main drugs in complex therapy sinusitis are cefuroxine or cefotaxime. At severe course ailment, the doctor may prescribe a strong broad-spectrum antibiotic Azithromycin or Macropen.
• In the treatment of angina, cephalosporins of the latest generation are recognized to be the most effective.
• With bacterial complications of influenza and other acute respiratory viral infections, therapy using Sumamed, Rulid, Avelox and Clarithromycin shows the maximum efficiency.
• Cystitis responds well to treatment with Unidox Solutab.

The use of broad-spectrum antibiotics in pediatrics

The primary appointment of ASHD for children is justified and advisable only if complications of the disease are suspected or its rapid development.

The change of treatment to narrowly targeted medicines should be made immediately after the laboratory establishment of the causative agent of the disease.

Most often, a broad-spectrum antibiotic is prescribed when acute forms bronchitis, otitis, sinusitis and rhinitis.

In pediatrics are used:

Treatment of children with antibiotic drugs without medical supervision is unacceptable! Even best antibiotics a new generation in case of incorrect prescription or violation of the regimen can harm the child's body.

Only a doctor will be able to correctly prescribe the dosage and duration of the course, evaluate the very feasibility of taking it and weigh all the risks.

So, according to several studies, children who took broad-spectrum antibiotics in the first year of life are more susceptible to developing asthmatic syndrome.

In conclusion, broad-spectrum antibiotics help to heal complex diseases and maintain health only with right approach. The physician should take into account the origin of the infection, the patient's history, weight and age, individual characteristics organism.

Trying to isolate the most powerful broad-spectrum antibiotic, even among new generation drugs, is absolutely pointless. Each drug has its own pharmacological properties, has specific indications for use, contraindications, adverse reactions and application details. In particular, the features of drug interactions with other drugs involved in complex therapy.

According to the spectrum of activity antimicrobials are divided into: antibacterial, antifungal and antiprotozoal. In addition, all antimicrobial agents are divided into narrow-spectrum and broad-spectrum drugs.

Narrow-spectrum drugs mainly against gram-positive microorganisms include, for example, natural penicillins, macrolides, lincomycin, fusidine, oxacillin, vancomycin, cephalosporins of the first generation. Polymyxins and monobactams are drugs with a narrow spectrum of action mainly on gram-negative rods. Broad-spectrum drugs include tetracyclines, chloramphenicol, aminoglycosides, most semi-synthetic penicillins, cephalosporins from the 2nd generation, carbapenems, fluoroquinolones. The antifungal drugs nystatin and levorin (only against Candida) have a narrow spectrum, and clotrimazole, miconazole, amphotericin B have a wide spectrum.

According to the type of interaction with the microbial cell antimicrobials are divided into:

bactericidal - irreversibly disrupt the functions of a microbial cell or its integrity, causing immediate death of the microorganism, are used in severe infections and in debilitated patients,

bacteriostatic - reversibly block cell replication or division, are used for non-severe infections in unimpaired patients.

According to acid resistance antimicrobials are classified into:

acid-resistant - can be used orally, for example, phenoxymethylpenicillin,

acid-resistant - intended for parenteral use only, for example, benzylpenicillin.

Currently, the following main groups of antimicrobial drugs are used for systemic use.

¨ Lactam antibiotics

lactam antibiotics ( tab. 9.2) of all antimicrobial drugs, they are the least toxic, since, by disrupting the synthesis of the bacterial cell wall, they do not have a target in the human body. Their use in the presence of pathogen sensitivity to them is preferable. Carbapenems have the widest spectrum of activity among lactam antibiotics; they are used as reserve drugs - only for infections resistant to penicillins and cephalosporins, as well as for hospital and polymicrobial infections.

¨ Antibiotics of other groups

Antibiotics of other groups ( tab. 9.3) have different mechanisms of action. Bacteriostatic drugs disrupt the stages of protein synthesis on ribosomes, bactericidal drugs violate either the integrity of the cytoplasmic membrane or the process of DNA and RNA synthesis. In any case, they have a target in the human body, therefore, compared to lactam preparations, they are more toxic, and should be used only when the latter cannot be used.

¨ Synthetic antibacterial drugs

Synthetic antibacterial drugs ( tab. 9.4) also have different mechanisms of action: inhibition of DNA gyrase, impaired incorporation of PABA into DHPA, etc. Also recommended for use when it is impossible to use lactam antibiotics.

¨ Side effects of antimicrobials,

their prevention and treatment

Antimicrobials have a wide variety of side effects, some of which can lead to severe complications and even to death.

allergic reactions

Allergic reactions can occur with any antimicrobial drug. May develop allergic dermatitis, bronchospasm, rhinitis, arthritis, angioedema, anaphylactic shock, vasculitis, nephritis, lupus-like syndrome. Most often they are observed with the use of penicillins and sulfonamides. Some patients develop cross-allergy to penicillins and cephalosporins. Allergies to vancomycin and sulfonamides are often noted. Very rarely give allergic reactions aminoglycosides and chloramphenicol.

Prevention is facilitated by careful collection allergic history. If the patient cannot indicate which antibacterial drugs he had allergic reactions to, tests should be performed before the introduction of antibiotics. The development of an allergy, regardless of the severity of the reaction, requires the immediate withdrawal of the drug that caused it. Subsequently, the introduction of even similar chemical structure antibiotics (eg, cephalosporins for penicillin allergy) are allowed only in cases of emergency. Treatment of the infection should be continued with drugs from other groups. With severe allergic reactions intravenous administration of prednisolone and sympathomimetics is required, infusion therapy. In not severe cases antihistamines are prescribed.

Irritant effect on the routes of administration

When administered orally irritant effect can be expressed in dyspeptic phenomena, with intravenous administration- in the development of phlebitis. Thrombophlebitis is most often caused by cephalosporins and glycopeptides.

Superinfection, including dysbacteriosis

The probability of dysbacteriosis depends on the breadth of the spectrum of action of the drug. The most common candidiasis develops with the use of narrow-spectrum drugs after a week, with the use of broad-spectrum drugs - already from one tablet. However, cephalosporins relatively rarely cause fungal superinfection. On the 1st place in terms of frequency and severity of dysbacteriosis caused is lincomycin. Violations of the flora during its use can take on the character of pseudomembranous colitis - serious illness intestines caused by clostridia, accompanied by diarrhea, dehydration, electrolyte disturbances, and in some cases complicated by perforation of the colon. Glycopeptides can also cause pseudomembranous colitis. Often cause dysbacteriosis tetracyclines, fluoroquinolones, chloramphenicol.

Dysbacteriosis requires the abolition of the drug used and long-term treatment eubiotics after preliminary antimicrobial therapy, which is carried out according to the results of the sensitivity of the microorganism that caused inflammatory process in the intestine. Antibiotics used to treat dysbacteriosis should not affect the normal intestinal autoflora - bifidobacteria and lactobacilli. However, in the treatment of pseudomembranous colitis, metronidazole or, alternatively, vancomycin is used. Correction of water and electrolyte disturbances is also necessary.

Impaired tolerance to alcohol- characteristic of all lactam antibiotics, metronidazole, chloramphenicol. It is manifested by the appearance of nausea, vomiting, dizziness, tremors, sweating and a drop in blood pressure with the simultaneous use of alcohol. Patients should be warned not to drink alcohol during the entire period of antimicrobial treatment.

Organ specific side effects for various groups drugs:

Damage to the blood system and hematopoiesis - inherent in chloramphenicol, less often lincosomids, cephalosporins of the 1st generation, sulfonamides, nitrofuran derivatives, fluoroquinolones, glycopeptides. It is manifested by aplastic anemia, leukopenia, thrombocytopenia. Discontinuation of the drug is necessary, in severe cases replacement therapy. Hemorrhagic syndrome can develop with the use of 2-3 generation cephalosporins that disrupt the absorption of vitamin K in the intestine, antipseudomonal penicillins that disrupt platelet function, metronidazole, which displaces coumarin anticoagulants from their bonds with albumin. Vitamin K preparations are used for treatment and prevention.

Liver damage - inherent in tetracyclines, which block the enzyme system of hepatocytes, as well as oxacillin, aztreonam, lincosamines and sulfonamides. Cholestasis and cholestatic hepatitis can cause macrolides, ceftriaxone. Clinical manifestations serves to increase liver enzymes and bilirubin in the blood serum. If it is necessary to use hepatotoxic antimicrobial agents for more than a week, it is necessary laboratory control listed indicators. In the case of an increase in AST, ALT, bilirubin, alkaline phosphatase or glutamyl transpeptidase treatment should be continued with drugs from other groups.

Damage to bones and teeth is typical for tetracyclines, growing cartilage - for fluoroquinolones.

Renal damage is inherent in aminoglycosides and polymyxins, which disrupt tubular function, sulfonamides, which cause crystalluria, generation cephalosporins, which cause albuminuria, and vancomycin. Predisposing factors are old age, kidney disease, hypovolemia and hypotension. Therefore, when treating with these drugs, preliminary correction of hypovolemia, control of diuresis, selection of doses taking into account kidney function and body mass is necessary. The course of treatment should be short.

Myocarditis - side effect chloramphenicol.

Dyspepsia, which is not a consequence of dysbacteriosis, is characteristic of the use of macrolides, which have prokinetic properties.

Various CNS lesions develop from many antimicrobials. Observed:

Psychosis in the treatment of chloramphenicol,

Paresis and peripheral paralysis when using aminoglycosides and polymyxins due to their curare-like action (therefore, they cannot be used simultaneously with muscle relaxants),

Headache and central vomiting when using sulfonamides and nitrofurans,

Convulsions and hallucinations with the use of aminopenicillins and cephalosporins in high doses, resulting from the antagonism of these drugs with GABA,

Seizures with imipenem

Excitation with the use of fluoroquinolones,

Meningism in the treatment of tetracyclines due to their increase in CSF production,

Visual disturbances in the treatment of aztreonam and chloramphenicol,

Peripheral neuropathy with the use of isoniazid, metronidazole, chloramphenicol.

Hearing damage and vestibular disorders - a side effect of aminoglycosides, more characteristic of the 1st generation. Because this effect associated with the accumulation of drugs, the duration of their use should not exceed 7 days. Additional factors risks are old age, renal failure and concomitant use loop diuretics. Reversible hearing changes are caused by vancomycin. If there are complaints of hearing loss, dizziness, nausea, unsteadiness when walking, it is necessary to replace the antibiotic with drugs from other groups.

Skin lesions in the form of dermatitis are characteristic of chloramphenicol. Tetracyclines and fluoroquinolones cause photosensitivity. When treating with these drugs, physiotherapy procedures are not prescribed, and exposure to the sun should be avoided.

Hypofunction thyroid gland cause sulfonamides.

Teratogenicity is inherent in tetracyclines, fluoroquinolones, sulfonamides.

Possible paralysis of the respiratory muscles with rapid intravenous administration of lincomycin and cardiodepression with rapid intravenous administration of tetracyclines.

Electrolyte disturbances are caused by antipseudomonal penicillins. The development of hypokalemia is especially dangerous in the presence of diseases of cardio-vascular system. When prescribing these drugs, monitoring of the ECG and blood electrolytes is necessary. In the treatment, infusion-corrective therapy and diuretics are used.

Microbiological diagnostics

The effectiveness of microbiological diagnostics, which is absolutely necessary for the rational selection of antimicrobial therapy, depends on compliance with the rules for the collection, transportation and storage of the test material. The rules for sampling biological material include:

Taking material from the area as close as possible to the source of infection,

Prevention of contamination by other microflora.

On the one hand, the transportation of the material should ensure the viability of bacteria, and on the other hand, prevent their reproduction. It is desirable that the material be stored before the start of the study at room temperature and no more than 2 hours. Currently, special tightly closed sterile containers and transport media are used to collect and transport the material.

To no lesser extent, the effectiveness of microbiological diagnostics depends on the correct interpretation of the results. It is believed that the isolation of pathogenic microorganisms, even in small quantities, always makes it possible to attribute them to the true causative agents of the disease. Conditionally pathogen considered a pathogen if it is isolated from normally sterile environments of the body or into in large numbers from environments that are not typical for its habitat. Otherwise, it is a representative of the normal autoflora or contaminates the test material during sampling or research. The isolation of low pathogenic bacteria from areas uncharacteristic for their habitation in moderate amounts indicates the translocation of microorganisms, but does not allow them to be attributed to the true pathogens of the disease.

It is much more difficult to interpret the results of a microbiological study when sowing several types of microorganisms. In such cases, they are guided by the quantitative ratio of potential pathogens. Most important in etiology this disease there are 1-2 of them. It should be borne in mind that the probability of equal etiological significance of more than 3 different types of microorganisms is negligible.

ESBL susceptibility to beta-lactamase inhibitors such as clavulanic acid, sulbactam, and tazobactam is the basis of laboratory tests for the production of ESBL by Gram-negative organisms. At the same time, if a microorganism of the Enterobacteriaceae family is resistant to 3rd generation cephalosporins, and when beta-lactamase inhibitors are added to these drugs, it demonstrates sensitivity, then this strain is identified as ESBL-producing.

Antibiotic therapy should be directed only to the true causative agent of the infection! However, in most hospitals, microbiological laboratories cannot establish the etiology of infection and the sensitivity of pathogens to antimicrobials on the day of admission of the patient, therefore, the primary empirical prescription of antibiotics is inevitable. This takes into account the features of the etiology of infections various localizations characteristic of this medical institution. For this reason, regular microbiological research structure of infectious diseases and the sensitivity of their pathogens to antibacterial drugs in each hospital. Analysis of the results of such microbiological monitoring should be carried out monthly.

Table 9.2.

lactam antibiotics.

Table 9.3.

Antibiotics of other groups.

Table 9.4.

Synthetic antibacterial drugs.