"Amoxiclav" is an effective a drug, used to combat infections of bacterial origin.

Release form

"Amoxiclav" is available in three different forms:

1. film-coated tablets;
2. powder for the preparation of suspension for oral administration;
3. powder for the preparation of solution for intravenous administration.

Contraindications

« Amoxiclav"has a number of contraindications:

• hypersensitivity to the main components of the drug;
• Infectious mononucleosis;
• infectious lymphocytic leukemia;
• liver diseases;
• pregnancy;
• lactation.

Indications for use

• bronchitis;
• abscess of lung tissue;
• pneumonia;
• sinusitis;
• otitis;
• tonsillitis;
• cholecystitis;
• dysentery;
• salmonellosis;
• pyelonephritis;
• cystitis;
• urethritis;
• prostatitis;
• vaginitis;
• gonorrhea;
• erysipelas;
• meningitis;
• osteomyelitis, etc.

"Amoxiclav" for cystitis

For inflammation of the bladder in women, “ Amoxiclav /clavulanic acid (INN) (novolate" The drug began to be prescribed for cystitis relatively recently, but has already gained the trust of patients and doctors due to its effective action.

Only a doctor can determine the required dosage for Amoxiclav, since it depends on the patient’s health status, as well as on the form of development of cystitis. In most cases, 625 mg of medication is prescribed twice a day. A significant improvement in well-being (and sometimes complete recovery) occurs within three days. If necessary, the dosage can be reduced to 365 mg once a day - course treatment at the same time longer (such a “softening” of treatment is explained by the presence of other diseases in the patient or hypersensitivity to the components of the drug). Treatment with this antibiotic also prevents recurrence of cystitis.

Remember, exceeding the recommended dosage will not speed up treatment, but, on the contrary, can cause severe intoxication of the body, causing nausea, vomiting and loss of consciousness. If you want to make treatment faster, carefully follow all medical instructions, in particular, give up alcohol, stick to a diet, lead a measured lifestyle without strenuous physical activity, and also make sure that your body is always warm.

"Amoxiclav" at prostatitis

Amoxiclav is regularly prescribed to patients suffering from prostatitis, as the antibiotic has a powerful antimicrobial effect. This antibiotic contains clavulanic acid, which significantly enhances its effectiveness and allows you to cope with inflammation of the prostate gland within a few days.

Amoxiclav tablets must be diluted in water before use - this will allow the drug to take effect faster. If you don’t have water at hand, it is advisable to chew the medicine as thoroughly as possible and only then swallow it. When fighting acute prostatitis, suspensions are best suited - they are more easily absorbed and the active substances penetrate the blood faster. For severe painful spasms during urination, it is better to take Amoxiclav in powder form, from which intravenous solutions are prepared - this is the fastest way to “deliver” the drug to the site of inflammation. Your doctor will help you choose the appropriate form of medication for your particular case; do not take an antibiotic without an appropriate medical prescription.

To determine the nature of the development of prostatitis, the patient is prescribed a series of tests, including blood and urine tests - which show what dosage of Amoxiclav needs to be taken in order to achieve the fastest possible effect from treatment diseases. Remember, if an antibiotic is taken incorrectly, it can have the opposite effect and provoke the development of chronic prostatitis. In addition, it is important to carefully monitor the body’s reaction, and if an allergy develops, immediately stop treatment and select other types of medications.

Directions for use and dosage:

Amoxiclav tablets: taken orally before meals. The dosage depends on the individual characteristics of the person, as well as the clinical picture of the disease - it is selected individually.

In most cases, the course of treatment lasts from 3 to 14 days (longer treatment is possible with a reduced dosage).

Standard dosage (for adults, from 13 years and 41 kg) – 1 tablet every 6-9 hours (at a dosage of 250 mg) or 1 tablet every 11-13 hours (at a higher dosage). Children from 6 to 13 years old - no more than 40 mg per day. Children from 0 to 6 years old are not recommended to take Amoxiclav in tablet form.

Powder for suspension: applied orally before meals. The dosage depends on the individual characteristics of the person, as well as the clinical picture of the disease - it is selected individually.

Standard dosage (for adults, over 13 years and 41 kg) is 125 mg.

Powder for the preparation of solution for intravenous administration. The dosage depends on the individual characteristics of the person, as well as the clinical picture. diseases this is a state of the body expressed in a violation of its normal functioning, life expectancy, and its ability to maintain its homeostasis– selected individually.

Standard dosage (for adults, from 13 years and 41 kg) is 1200 mg. the drug every 6-8 hours.

In most cases the course treatment a process whose purpose is to alleviate, relieve or eliminate the symptoms and manifestations of a disease or injury, pathological condition or other disability, lasts from 3 to 14 days (possibly longer treatment a process whose purpose is to alleviate, remove or eliminate the symptoms and manifestations of a particular diseases this is a state of the body expressed in a violation of its normal functioning, life expectancy, and its ability to maintain its homeostasis or injury, pathological condition or other disability, at a reduced dosage).

Side effects

Amoxiclav is a fairly “mild” antibiotic, but its use can lead to a number of side effects. These include:

• nausea;
• vomit;
• diarrhea;
• constipation;
• skin rashes;
• hives;
• skin itching;
• increased heart rate.

Interaction with other drugs

• aminoglycoside antibiotics;
• bactericidal antibiotics;
• ethinyl estradiol;
• allopurinol.

Throughout the course of treatment with Amoxiclav, it is necessary to constantly monitor the condition of the liver, undergo regular tests and be examined by a specialist.

The drug must be taken strictly before meals - this will help to avoid disturbances in the gastrointestinal tract. It is also recommended to take antifungal agents in parallel.

Average cost: from 90 to 115 rubles (cost depends on dosage).

Levofloxacin: analogues, review of main drugs drugs Drug (from Latin praeperetum - medicine, drug) - a substance or mixture of substances of synthetic or natural origin in the form of a dosage form (tablets, capsules, solutions and, similar

According to the latest medical statistics, the spread prostatitis term defining inflammatory lesions of the prostate gland and its forms have recently begun to increase. The reasons for this situation can be called a lot of factors, among which the main place is occupied by a man’s unsatisfactory attitude towards his health, poor ecology, poor-quality food products, etc.

Therefore, it is not surprising how seriously pharmacologists have to work to offer patients the latest and most effective drugs for the treatment of prostatitis. Among these is Levofloxacin, a latest generation antibiotic with a wide spectrum of action.

This type of drug, like Amoxiclav, is a broad-spectrum antibiotic and is ideal for the systemic treatment of various diseases, including prostatitis (acute, chronic, bacterial).

Form can mean: The shape of an object - the relative position of the boundaries (contours) of an object, object, as well as the relative position of points on a line release of the medicine - these are tablets or solutions for injections. Any form of the drug is quickly absorbed into the blood, affects the body at the cellular level, and the targeted action of the drug allows you to effectively kill entire colonies of harmful microorganisms. For people suffering from infectious and bacterial diseases, it will be much cheaper to purchase such a medicine than to buy other synonyms and antibiotic substitutes, which also have side effects and contraindications.

Levofloxacin analogues have the following properties:

• They have a wide and active spectrum of effects on the body.
• Able to quickly penetrate prostate tissue.
• Show a high degree of activity and direction action an ambiguous word that can mean: Act of activity.

Before taking the medicine, you should read all the information provided in the instructions for taking the medicine. Like any other antibiotic, domestic or imported, Levofloxacin can cause side effects and individual intolerance.

Today you can choose not only Levofloxacin; analogues of this drug, similar in composition, action and release form, are presented on the market in large quantities.

Tavanic is an equally effective antibiotic that is prescribed for a variety of diseases. Characterized by a high degree of medicinal activity and impact on groups of harmful microorganisms, its use allows you to obtain positive treatment results in the shortest possible time of therapy. The price of the product depends on the form of release: tablets can be bought from 600 rubles, an injection solution will cost you 1,620 rubles.

Ciprofloxacin is an active antibiotic with a broad spectrum of action. It is used to treat infectious diseases of internal organs and tissues, in particular the genitourinary system. The drug is available in different forms, for example, eye drops, suspensions and solutions for injections, tablets and capsules. Price antibiotic substances that inhibit the growth of living cells, most often prokaryotic or protozoan low, from 18 rubles, and any pharmacy can offer you this medicine.

Along with the Russian analogues discussed above, there are also foreign analogues of Levofloxacin on the market that can defeat any infectious disease.

Eleflox, produced by an Indian pharmaceutical company, is actively used to treat various forms of prostatitis and inhibits the activity of harmful microorganisms. It is used in systemic treatment, in which the disease is quickly treatable.

Glevo is a product of Indian pharmacology, with a wide spectrum actions an ambiguous word that can mean: Act of activity, great for treating everyone forms can mean: The shape of an object - the relative position of the boundaries (contours) of an object, object, as well as the relative position of points on a line prostatitis.

Levofloxacin belongs to the group of fluoroquinols. The same group with the active substance levofloxacin includes:

• Tavanik.
• Glevo.
• Eleflox.
• Ciprofloxacin.

All antibiotics in this group are very effective in treating prostatitis. Therefore, your choice of drug can only be influenced by the presence of individual intolerance to the components of one of them, the severity of the disease, in which it is necessary to use complex treatment, in which not all antibiotics may be compatible with other drugs. All drugs have detailed instructions, after reading which you will find out what side effects you can expect, what contraindications in your case may affect the choice of drug.

Tavanic or Levofloxacin, which is better?

As we have already noted, both of these drugs belong to the group of fluoroquinols, with active substance one of the forms of matter consisting of fermions or containing fermions along with bosons; has a rest mass, unlike some types of fields, such as electromagnetic- levofloxacin, which quickly penetrates the blood, is then taken up by the plasma and distributed to all tissues of the body.

The drug Levofloxacin has an active effect on various tissue areas affected by harmful microorganisms, and acts directly at the cellular level, which speeds up treatment and gives positive results. With prostatitis, different groups of bacteria may be present in the body, affecting the organ and causing the disease: anaerobic gram-positive and gram-negative, simple microorganisms and chlamydia. The drug fights all these “pests” very effectively.

Tavanik is antibiotic substances that inhibit the growth of living cells, most often prokaryotic or protozoan the latest generation with high rates of effectiveness in the treatment of diseases of various internal organs and bone tissue.

The active substance in the medicine is levofloxacin medicine, antibacterial drug, part of the group of fluoroquinolones of the third generation medicine, antibacterial drug, part of the group of fluoroquinolones of the third generation, auxiliary - crospovidone, cellulose, titanium dioxide, macrogol 8000, iron oxide red and yellow. When taking the drug, its concentration in the blood remains for a fairly long period.

The antibacterial drug gives the fastest and most positive results in the treatment of various forms of prostatitis, ranging from mild to chronic, as it affects tissue cells, their membranes and walls. Particularly effective in complex treatment, because its current and active component is levofloxacin, which interacts well with other drugs.

If we compare Tavanic or Levofloxacin, which is better, then the first drug has fewer side effects and has a faster effect and the spectrum of its effect is much wider.

Comparing the cost of drugs, it can be noted that you can buy Levofloxacin at a price of 77 rubles, and Tavanik - from 590 rubles.

Most often, when a doctor has prescribed a course of treatment with this drug, the patient is prescribed 2 doses.

The average daily dose of the medicine at each dose is from 500 ml to 1 g, depending on the form of the disease in the prostate gland. If injections are prescribed, the daily dose of liquid is from 250 to 500 ml, depending on the severity of the disease. The medicine is taken regardless of food intake, because the mucous membrane quickly absorbs the drug substances.

For mild forms of prostatitis, as well as for diseases that affect the bronchi, the course treatment a process whose purpose is to alleviate, remove or eliminate the symptoms and manifestations of a particular diseases this is a state of the body expressed in a violation of its normal functioning, life expectancy, and its ability to maintain its homeostasis or injury, pathological condition or other disability, can range from 14 to 28 days. In this case, the daily dose is from 500 ml to 1 g.

Your attending physician will help you decide whether Tavanic or Levofloxacin is better, who will select the optimal antimicrobial drug for effective therapy.

Levofloxacin or Ciprofloxacin: comparative evaluation of drugs

Today on the market you can also buy one a drug Drug (from Latin praeperetum - medicine, drug) - a substance or mixture of substances of synthetic or natural origin in the form of a dosage form (tablets, capsules, solutions and, like Ciprofloxacin, also belonging to the group of fluoroquinols.

The medicine has a wide spectrum of action, inhibits the vital activity of various microorganisms, quickly penetrates the blood, is distributed throughout the tissues of the body, and any infection is amenable to such therapy.

The drug is prescribed by a doctor who calculates the daily dose of the drug.

The course of treatment can range from 1 to 4 weeks, depending on the degree of the disease.

If we consider Levofloxacin and Ciprofloxacin, the difference is that the first is more effective and can interact with other drugs, while Ciprofloxacin is influenced by others drugs Drug (from Latin praeperetum - medicine, drug) - a substance or mixture of substances of synthetic or natural origin in the form of a dosage form (tablets, capsules, solutions and, may reduce your concentration and activity, which prolongs the course treatment a process whose purpose is to alleviate, relieve or eliminate the symptoms and manifestations of a disease or injury, pathological condition or other disability,.

Both drugs, Levofloxacin and Ciprofloxacin, are antibiotics substances that inhibit the growth of living cells, most often prokaryotic or protozoan, which should be taken only on the recommendation of a doctor who considers each clinical case individually.

The main difference between the two antibiotics substances that inhibit the growth of living cells, most often prokaryotic or protozoan is the active substance: in the first drug it is levofloxacin, and in the second it is ofloxacin. At action an ambiguous word that can mean: Act of activity Ofloxacin, not all groups of bacteria can be destroyed, since microorganisms have different degrees of sensitivity to ofloxacin, so therapy prostatitis term defining inflammatory lesions of the prostate gland may vary due to disease causes and effectiveness treatment a process whose purpose is to alleviate, relieve or eliminate the symptoms and manifestations of a disease or injury, pathological condition or other disability, may also differ.

Levofloxacin Astrapharm: description of the drug and its distinctive features

Not so long ago, a new drug appeared in pharmacies - medicine, antibacterial drug, part of the group of fluoroquinolones of the third generation Astrapharm, (manufactured in Ukraine), which belongs to the quinol group, is a broad-spectrum antibiotic with the active substance levofloxacin. The nature of the action is due to the fact that the product contains an active isomer of ofloxacin, with very high mobility, the mechanism of action is bactericidal.

Distinctive features from Levofloxacin

Levofloxacin Astrapharm is able to inhibit the activity of gram-positive and gram-negative microbes, while Levofloxacin acts on all groups of bacteria.

More often, medicine, antibacterial drug, part of the group of fluoroquinolones of the third generation Astrapharm is used for the effective treatment of chronic bacterial prostatitis term defining inflammatory lesions of the prostate gland.

When therapy with Levofloxacin is used, positive dynamics are observed already in the middle of treatment, and this occurs regardless of the form diseases this is a state of the body expressed in a violation of its normal functioning, life expectancy, and its ability to maintain its homeostasis.

If we talk about Levofloxacin Astrapharm blister, it is more effective in the treatment of mild and moderate forms of prostatitis.

Regardless of what choice you make when treating prostatitis, you must remember that only systemic, well-chosen treatment can give positive dynamics and results.

Due to the presence of zinc in the composition, the drug reduces the likelihood of the formation of prostate tumors, significantly improves the functioning of the reproductive system, increases sexual desire and normalizes sperm quality. Another advantage of the product is the high content of tocopherol, which is more familiar to us as vitamin E. The substance has excellent anti-inflammatory and antibacterial properties, prevents the development of infertility and atherosclerosis.

The active ingredient of Prostatilen Zinc is a protein that is extracted from the prostate gland of specially raised bulls. This component tones the bladder muscles, significantly improves sperm activity, relieves swelling and eliminates the inflammatory process in the prostate.

Another advantage of the medication is that it does not cause side effects such as burning, stinging and itching in the anus. But allergies cannot be ruled out, so after the first use of suppositories it is necessary to monitor the body’s reaction. The duration of the course can vary from five to ten days, depending on the complexity and course of the disease. It is recommended to insert suppositories into the anus twice a day. Thus, Prostatilen Zinc is definitely more effective than ordinary Prostatilen.

In modern medicine, broad-spectrum antibiotics – Ciprofloxacin and Amoxiclav – are very popular. Specific medications are especially effective against aerobic and anaerobic bacteria and strains. The main goal of antibacterial treatment is to destroy pathogenic flora and ensure the removal of microbes from the body without harm to health.

Comparison of drugs

Many patients, for medical reasons, ask the main question: which is better to buy Ciprofloxacin or Amoxiclav, which antibiotic to give their preference? Both medications are indicated to be taken for sore throat, tonsillitis, pharyngitis, laryngitis, and other infectious diseases of the lower respiratory tract.

These antibiotics fall into the “good medicine” category and are recommended for use by adults and children, according to the prescribed dosages. When prescribing an antibiotic, it is important to follow not so much the instructions for use, but the recommendations of the attending physician. Below are the main differences between the two medications that will help the patient make a choice.

Main differences

1. Amoxiclav is a prominent representative of the penicillin series, while the medical drug Ciprofloxacin belongs to the pharmacological group of broad-spectrum fluoroquinolone antibiotics.
2. The active components of Amoxiclav are amoxicillin and clavulanic acid, which support the therapeutic effect of the antibiotic. The active substance of Ciprofloxacin is ciprofloxacin, which inhibits the activity of the enzyme responsible for the synthesis of bacterial DNA.
3. The prescription of Amoxiclav is appropriate for increased activity of staphylococci, streptococci, echinococci, Proteus, Shigella. Taking the medication Ciprofloxacin is more suitable for infection with gram-positive and gram-negative bacteria.
4. The use of Amoxiclav is appropriate during pregnancy if the daily dosage has been agreed upon with the attending physician. The use of a second general antibiotic during pregnancy and breastfeeding is contraindicated.
5. Oral administration of Amoxiclav is permitted for use by patients from 3 months of age, while treatment with Ciprofloxacin is permitted starting from the age of 18 years.

Reviews about Ciprofloxacin

These tablets help to successfully cure throat infections, and many patients over 18 years of age have turned to its help. Doctors warn about side effects due to the systemic action of the antibiotic, but in practice such anomalies are extremely rare. Reviews from specialists are positive, but here is what patients write after completing the course of treatment:

- The drug Ciprofloxacin is reliable, improvements began already on the 3rd day after starting treatment, although before that I could not get out of bed for almost a week, the temperature was very high, I constantly felt sick, I did not eat anything.

- The antibiotic does not cause side effects when taken orally and helps to overcome a sore throat. In this way, I cured tonsillitis in a week; it’s still not recommended to take the medication orally for longer.

Reviews about Amoxiclav

Real notes about a typical medication on thematic forums are often left by young parents who gave Amoxiclav to their children. There are no complaints about such home treatment; the antibiotic acts gently and purposefully. Here's what patients write:

- In this way, I cured a sore throat for a 2-year-old child in 5 days, acting strictly according to the indications and recommendations of the pediatrician. I am satisfied with the treatment, there were no complications.

- Amoxiclav removes infection from the body, helps normalize high temperature and remove inflammation. The effect of the tablets is almost instantaneous.

What's better?

The answer to this question depends on medical indications, the age of the patient and the individual characteristics of each organism. For example, Amoxiclav or analogues of the drug are allowed to be given to young children and pregnant women with obvious benefits of such a prescription. If it is not Amoxiclav, infections can be successfully treated with Flemoxin Solutab and Augmentin.

Ciprofloxacin is a more serious antibiotic with strict contraindications and an extensive list of side effects. Its complete analogue, identical in chemical composition, is Tsiprolet, produced in the form of tablets. Both medications should be prescribed by a doctor to patients over 18 years of age, and daily doses should be adjusted individually. Otherwise, symptoms of overdose are observed, represented by increased side effects.

What is more effective?

Both antibiotics are highly effective, but taking them in the same intensive care regimen is strictly contraindicated. An increase in the concentration of active components of synthetic origin in the blood leads to poisoning of the entire body. Due to the systemic action of both medications, side effects can affect the nervous system, gastrointestinal tract, cardiovascular and respiratory systems.

Each patient independently determines which antibiotic is best. Amoxiclav acts gently, but the therapeutic effect does not occur immediately. The action of Ciprofloxacin is more radical and targeted, but the number of complaints from patients about such a prescription is much greater in extensive medical practice. Otherwise, the specialist has the final say.

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Broad-spectrum antibiotics help fight a wide range of infectious diseases. The instructions for use describe Cifran as a combined antibiotic that is effective against a large number of microorganisms.

Ciprofloxacin, what kind of antibiotic?

Cifran combines two antibiotics - ciprofloxacin and tinidazole. This is a broad-spectrum antibiotic. It belongs to the group of fluoroquinolones. Tsifran works by suppressing DNA gyrase and inhibiting DNA synthesis in bacteria.

Effective against most groups of gram-negative microorganisms. It also affects all microorganisms that produce β-lactamase. It is used in the treatment of amebic and bacterial mixed infections, as well as in the combination of aerobic and anaerobic flora.

The main advantage of this medicine is that it is quickly absorbed when taken orally. In this case, it does not matter whether you eat food, since it does not critically affect the absorption rate. Biological availability after administration - 70%. The connection with plasma proteins reaches 40%.

Two hours after use, the maximum concentration of the active substance is observed. Removal of residues is carried out by the kidneys. Most of it is excreted in the urine, but a certain percentage of residual substances are excreted through the intestines.

Penetrates into the cerebrospinal fluid. Its concentration there depends on the presence of inflammation. If the membranes of the spinal cord are inflamed, then it is up to 40%.

Indications for use:

1. Postoperative infections.
2. Bacterial infections of the abdominal organs.
3. Respiratory tract.
4. Acute and subacute conjunctivitis.
5. Infections after injuries to the eyes and cornea.
6. Support for patients with reduced immunity.
7. Infectious lesions of joints, bones and skin.

The drug must be used after consultation with a doctor.

Important! Taking antibiotics that you prescribe for yourself can be dangerous to your health.

Tsifran and all its types

Cifran is produced by the largest Indian pharmaceutical company, Ranbaxy Laboratories Limited. It contains several components, but the active ingredient is ciprofloxacin hydrochloride. The film coating on the tablets contains purified talc, water and Opadry-OY-S58910.

Excipients - magnesium stearate, corn starch, cellulose, purified water and anhydrous flint.

Release form: film-coated tablets. There are two main types of the drug:

1. Tablets with an extended mechanism of action (EA) do not contain anything other than ciprofloxacin, and they can be taken once every 24 hours. This form completely suppresses the ability of pathogenic bacteria to grow and multiply. 1 tablet contains 1000 mg of active substance. This type of drug is produced in 5 pieces in a blister. Number of blisters 1 or 2 per package.
2. The combined drug ST also contains a second active substance - tinidazole. One tablet of the drug contains 500 mg of ciprofloxacin and 600 mg of tinidazole. The package contains from 1 to 10 blisters, each containing 10 tablets.

A dosage form is also available in the form of eye drops and a solution for injections.

The solution for injection is available in ampoules containing 200 mg of ciprofloxacin per 100 ml of solution.

Eye drops. One 10 ml bottle contains 30 mg of active ingredient. There is also an eye ointment that is used for eyelid infections and bacterial infections of the cornea.

Indications for use

Cifran tablets are prescribed by a doctor and are effective for the following pathologies:

• Mixed and dysentery infections of the gastrointestinal tract.
• Gonorrhea.
• Respiratory tract infections, including those with purulent complications.
• Severe gynecological infections, including complications after abortion.
• It is used for sore throat, pyelonephritis, and many other infections.

The procedure for taking Cifran differs depending on what form of release (OD or ST).

ST should be taken orally after meals with a glass of clean water. The tablets must be swallowed whole, without breaking or chewing. The dosage is as follows: for an adult patient 500+600 mg 2 times a day, or 250+300 mg, two tablets every twelve hours. The course of treatment is 10-14 days.

Receiving OD. Depends on the specific infection and severity of the disease:

• Gonorrhea. If acute - once a day, 500 mg once. Acute complicated - once a day, 500 mg for up to 5 days.
• Acute sinusitis. Once a day for 10 days, 1000 mg.
• Urinary tract diseases. Once a day for 2 weeks. If a difficult case is 1500 mg, in the rest - 1000 mg.
• Bacterial prostatitis in chronic form. For 28 days, 1000 mg once a day.
• Typhoid fever. 10 days, one tablet of 1000 mg once a day.
• Bone and joint infections. 1000 – 1500 mg once a day for up to 6 weeks.
• Infectious diarrhea - 5-7 days, 1000 mg.
• Respiratory tract infections. 1000 – 1500 mg for 2 weeks.

When prescribing this drug, the specialist is guided by the indicators of kidney function, the age and weight of the patient.

Useful video: about the diagnosis and treatment of prostatitis

Indications for the use of injections

Injections of the drug Cifran are given intramuscularly or intravenously. The dosage depends on the severity of the infection and the characteristics of the patient’s body. Injections are prescribed to people over 18 years of age. Children should not inject this substance.

The dosage is as follows:

1. Upper respiratory tract diseases - 100 – 200 ml 2 times a day
2. Cystitis - once 50 ml.
3. Infectious diarrhea - 100 ml 2 times a day. The course of treatment is a week.
4. Pulmonary anthrax - 200 ml 2 times a day.

Treatment with injections can last from 1 day to 2 months, but not longer, since the risk of side effects increases and the negative load on the kidneys increases.

Doctors prescribe the longest course for osteomyelitis. The average course is 7-14 days for most infections. If the solution is administered via a dropper, a slight increase in the dosage of the antibiotic is allowed.

Tsifran for prostatitis

Antibacterial treatment is prescribed for prostatitis when inflammation of the prostate occurs due to infection. Its effectiveness in treating this disease has been confirmed by both clinical studies and the experience of many doctors.

The fluoroquinolones group, to which Cifran belongs, has proven itself in the fight against bacterial prostatitis. If the disease is non-bacterial, antibiotics cannot be taken. Bacterial prostatitis can be caused by bacteria of several groups:

• Gram-positive, for example, staphylococcus.
• Gram-negative - salmonella, E. coli.
• Intracellular - chlamydia, brucella.

The advantage of Tsifran over other drugs is its rapid absorption, and also the fact that after a full course, for a few more days, the concentration of the active substance in the blood is high enough to prevent bacteria from multiplying.

Treatment must be started as early as possible, since chronic prostatitis can lead to problems with potency and erectile dysfunction.

It is used both in the form of tablets and injections. The course of treatment for chronic prostatitis is a week. Dosage per day - 250-500 mg. If we are talking about injections, then 200-400 mg.

An increase in dosage is prescribed only by a doctor, in case of complications or an advanced stage of the disease.

The advantages of this medicine for inflammation of the prostate gland are obvious:

• Destroys all bacteria, including inactive ones.
• Combines with other substances and does not affect them.
• Cheap compared to many analogues.
• The bacteria do not have time to get used to the antibiotic and it remains effective.

As a result, all the advantages make Ciprofloxacin a popular substance in terms of the number of prescriptions. Reviews from doctors and patients about the results of the action are positive. The disadvantages of the drug are common to other antibiotics, for example, dysbiosis. Therefore, the choice of Tsifran as a drug for the treatment of prostate infections is completely justified.

Useful video: the benefits and harms of antibiotics

Side effects and contraindications

Side effects of antibiotics are common, so you should consult your doctor before starting treatment. Only a doctor should prescribe a specific drug, as well as its dosage. Side effects can occur in several body systems:

1. Gastrointestinal tract - nausea, diarrhea, vomiting.
2. Nervous system - increased fatigue, anxiety, dizziness, weakness, and in rare cases, convulsions.
3. The cardiovascular system. Arrhythmia, fainting, pain in the chest.
4. Circulatory system. A drop in the level of red blood cells, platelets and white blood cells.
5. Allergic reactions of varying severity.
6. Increased sensitivity to ultraviolet radiation, therefore, when treating with the drug, you should not stay in the sun for a long time without special creams.

If any of the adverse reactions occur, you should immediately consult a doctor, he will either adjust the dose or discontinue this medication.

The product also has contraindications for use:

• pregnancy;
• age up to 8 years;
• blood diseases with inhibition of hematopoietic function;
• seizures and epilepsy;
• lactation;
• mental problems;
• atherosclerosis and other disorders of the brain;
• allergy to the components of the drug.

If there is any contraindication, the medicine is not prescribed and is replaced with another antibiotic.

Analogues

In pharmacies you can easily find several analogues of Ciprofloxacin, both domestic and imported. They are similar in composition and in the principle of influence. There may be differences in price, as well as in the number of side effects.

Cifran or Levofloxacin

Levofloxacin belongs to the same group as the drug in question. The use depends directly on the type of pathogens. For example, Levofloxacin is more effective against pneumococci, as well as atypical pathogens.

In turn, Tsifran will show better results when fighting Pseudomonas aeruginosa. Clinical trials have proven that a pathogen that does not respond to Ciprofloxacin may well be sensitive to Levofloxacin.

Important! Both drugs are well absorbed and do not react to foods other than milk and its components.

Adverse reactions are similar for both drugs.

As for the price, buyers here are on the side of Tsifran, since it is several times cheaper than its modern counterpart. In any case, Ciprofloxacin and Levofloxacin should be prescribed by a doctor, taking into account the individual characteristics of the body and the complexity of the disease.

The doctor can change one drug to another if necessary, but in any case the price category will have to be taken into account.

Tsifran or Tsiprolet

Both medicines contain the same active ingredient. Both drugs have a similar principle of action, side effects, and contraindications. Therefore, you should not use them together, and your doctor should prescribe one of the antibiotics. Tsiprolet does not have a prolonged effect, like one of the types of Tsitrofan.

Since the contraindications are also similar, it is also not recommended to prescribe the second to patients for whom one of the drugs is not suitable. It is worth noting that Tsiprolet is easier to tolerate by patients with gastrointestinal problems. The difference in price is minor, but it is there. Digital is cheaper.

Tsifran or Amoxiclav

Amoxiclav is easier to tolerate by the body and produces fewer side effects. Tsifran has a wider spectrum of action and can fight Pseudomonas aeruginosa, against which Amoxiclav is powerless. Ciprofloxacin is more effective for older people, while its analogue has a more convenient release form - a suspension.

Other analogues

There is more than one drug that is considered an analogue of Tsifran and can successfully replace it:

1. Nolicin is a medicine from Slovenia from the group of fluoroquinolones. The active ingredient is norfloxacin. Can be taken at the same time, but under medical supervision.
2. Ofloxacin is available only in tablet form, the active ingredient is Ofloxacin. The dosage is prescribed strictly individually.
3. Doxycycline is a group of tetracyclines. It has a much gentler effect on the intestinal microflora. It differs in the principle of action, since it affects not the DNA of bacteria, but the proteins of protein cells.

When choosing, you need to pay attention not to personal preferences, but to the doctor’s advice. Any antibiotic should be taken only on the advice of a specialist.

Useful video: effective treatment of prostatitis in men

Conclusion

Antibacterial drugs have filled the shelves of pharmacies. New generation products are appearing that are more effective. Broad-spectrum antibiotics from the fluoroquinolone group are capable of affecting a huge number of different groups of bacteria.

Therefore, Ciprofloxacin is effective against a large number of infectious diseases, including prostatitis. But the medicine must be prescribed strictly by a doctor, based on the specific situation.

Tavanik is an antibiotic with a wide therapeutic effect. It is able to cure many infectious diseases, the pathogens of which are sensitive to levofloxacin.

It copes well with acute sinusitis, bronchitis, pneumonia, as well as infections of the genitourinary system.

Manufacturer and release form

The original drug Tavanik is produced by the German company SANOFI-AVENTIS.

There are two dosage forms available in pharmacies:

• biconvex tablets coated with a dim yellow-pink shell and having dividing grooves. Packed in 3/5/7/10 pieces;
• sterile transparent greenish-yellow injection solution placed in glass vials (100 ml).

The active substance is the antibiotic levofloxacin. Tablets may contain 250 or 500 mg, which is indicated on their packaging. The bottle of solution (100 ml) also contains 500 mg of antibiotic.

The tablets additionally include:

• crospovidone;
• hypromellose;
• cellulose;
• titanium dioxide;
• talc;
• macrogol 8000;
• red/yellow iron dioxide.

The injection solution also contains:

• hydrochloric acid;
• sodium hydroxide/chloride;
• water (deionized).

Therapeutic effect and scope of application

Levofloxacin, like all systemic quinolones belonging to the 3rd generation, has a wide range of therapeutic effects.

It disrupts the DNA structure of harmful microorganisms, causing severe changes in the cytoplasm and cell walls, which leads to their death. By killing pathogens, the drug successfully fights the inflammatory processes caused by them.

Tavanik is effective for:

• sinusitis (acute);
• pneumonia;
• bronchitis;
• urinary tract infections;
• bacterial chronic prostatitis;
• infectious skin diseases;
• sepsis;
• intra-abdominal infections.

Instructions for use, features of reception

The daily dose of the medicine for almost all diseases is 250/500 mg, taken 1 - 2 times.

The tablets are swallowed whole with water (0.5 - 1 glass). It is not recommended to bite or chew them. If you need to take half a tablet, divide it using the dividing groove. Absorption of the drug into the blood occurs quickly and completely.

Taking Tavanik does not depend on food intake. It can be drunk at any time. But if complex therapy is carried out, then when combined with antacid or iron-containing drugs, as well as Sucralfate, the interval between taking them and Tavanik should be 2 hours.

The injection solution should be delivered slowly. At least an hour should be allowed for the complete administration of one bottle. It is not recommended to store this drug in strong light conditions for more than 3 days.

Intravenous administration of Tavanik is allowed together with solutions:

• physiological;
• dextrose (5%);
• Ringer's with dextrose (2.5%);
• nutritious (carbohydrates + microelements + amino acids).

But simultaneous administration with sodium bicarbonate solution is prohibited.

Injections are recommended for severe forms of the disease. When the patient's condition improves, the administration of the solution is replaced by taking tablets. If the patient's body temperature returns to normal, then after 3 days the antibiotic is discontinued.

During treatment, you should not visit a solarium; direct bright sun and ultraviolet radiation should be avoided. Long-term use of the drug sometimes causes dysbacteriosis; a weakened body may be susceptible to fungal infection.

These negative properties of Tavanik can be easily removed by taking them together with Bifidumbacterin, Linex, and antifungal agents. The dose of the drug depends on the nature/severity of the disease, as well as the presence/absence of renal failure.

For patients who do not have kidney problems, daily dosages are as follows:

• sinusitis (acute) – 500 mg/1 time/1.5-2 weeks;
• chronic bronchitis (exacerbation) – 250-500 mg/1 time/7-10 days;
• pneumonia – 500 mg/2 times/1-2 weeks;
• urinary tract infections (uncomplicated) – 250 mg/1 time/3 days;
• bacterial prostatitis (chronic) – 500 mg/1 time/4 weeks;
• skin infections – 250-500 mg/2 times/1-2 weeks;
• sepsis – 500 mg/2 times/1.5-2 weeks;
• infections of the retroperitoneal organs – 500 mg/1 time/1-2 weeks;
• tuberculosis (treatment of resistant forms as part of the complex) – 500-1000 mg/2 times/3 months.

For people with kidney failure, the first dose of the medicine should be taken in accordance with this table, and subsequent doses should be taken at half the dosage. If during treatment the Tavanika tablet was not taken on time, it should be taken as soon as possible, and then follow the established regimen.

Older adults who do not have kidney problems can use this medicine at the usual dosage. But it should not be given to children, since levofloxacin can disrupt the growth of cartilage tissue, which will make the joints fragile.

The drug is prescribed with great caution to people predisposed to seizures. This group includes people who have suffered:

• stroke;
• head injury.

Side effects

Sometimes, with long-term use of Tavanic, pseudomembranous colitis may develop (symptom: bloody diarrhea).

In this case, treatment with the drug should be stopped and the “side effects” should be eliminated. Rare cases of tendinitis that threatens tendon rupture have been observed.

If this happens, stop taking this medication immediately. If problems occur in the nervous system, you should also stop using this drug.

Since Tavanik sometimes has an effect on the central nervous system, which manifests itself in drowsiness, dizziness, slow reaction, while taking it you should not drive a vehicle or engage in other activities that require concentration.

Overdose

Taking an excessive dose of the drug can lead to:

• confusion;
• dizziness;
• hallucinations;
• convulsions;
• tremor;
• nausea, other digestive disorders;
• erosion of the gastrointestinal mucosa.

If these symptoms occur, you should rinse your stomach and take antacids.

For prostatitis

This medicine is very effective in the fight against bacterial prostatitis, especially in combination with a special diet, prostate massage, and other physical procedures.

During a long 4-week course, patients should take a single dose of 500 mg of the drug daily. The success of treatment is assessed by examining prostate secretions.

If it is necessary to speed up the treatment process, and the patient has no special contraindications, the doctor may prescribe another treatment regimen:

• first week – 1000 mg/day;
• the next 10 days – 500 mg/day.

As a result, the course of treatment is shortened to 2.5 weeks. When treating acute prostatitis, the first half of the course should be given injections of the drug, and then proceed to taking tablets.

In the chronic course of the disease, you can limit yourself to only the tablet form of Tavanik. The drug enters the prostate quite quickly and in large volumes, outstripping the strength of many antibiotics used for diseases of this organ.

For cystitis and chlamydia

For uncomplicated (no blood/pus in urine) acute cystitis, the drug should be taken for 3-5 days. 250 mg once a day. In case of chronic cystitis and the presence of complications, the same dose of medication should be taken for 1.5-2 weeks.

For the genital form of the disease, take 500 mg of Tavanik for 10 days. The pulmonary form, which causes pneumonia, requires intravenous administration of the same volume of medication for 7-10 days.

Alcohol compatibility

Ethanol increases the likelihood of side effects, while reducing the therapeutic effectiveness. Therefore, you should stop using it for the entire period of treatment.

Contraindications

Tavanik has a number of absolute contraindications, in which its use is unacceptable, and relative contraindications, in which the drug should be taken with caution.

Absolute is the presence of:

• epilepsy;
• tendinitis;
• pregnancy;
• under 18 years of age;
• allergic reaction to Tavanic.

The following are considered relative:

• predisposition to seizures;
• renal/heart failure;
• low magnesium/potassium levels;
• taking sugar-lowering drugs;
• the presence of pseudoparalytic myasthenia gravis.

Video on the topic

Doctor's reviews about the drug Tavanik:

Tavanic is an effective antibiotic that confidently copes with pathogens of many diseases. But it can also cause unwanted reactions. Therefore, only a doctor should prescribe it.

Canephron (tablets): composition, principle of action of the drug, indications and features of use

In the vast majority of cases, doctors are wary of herbal medicine, preferring stronger drugs with proven activity and experience in clinical use.

However, the effectiveness of the drug Canephron (tablets) has been confirmed by its long-term use for the treatment of various diseases of the urinary system.

Moreover, this medicine in the form of pills or drops is recommended both for their therapy (usually in combination with other medications) and for prevention.

Until recently, the use of medicinal plants was mainly limited to taking infusions and decoctions prepared at home. But patients usually do not pay due attention to the principles of storing herbs and make mistakes in dosage and manufacturing technology. This simply nullifies the effectiveness of such treatment. Such flaws are eliminated when using a ready-made herbal medicine - Canephron tablets.

However, when prescribing them, the following rules must be observed:

1. In the acute period, tablets are taken only with antibiotics or uroseptics.
2. Combinations with other drugs should be selected carefully, taking into account the possible impact on effectiveness and the risk of complications.
3. Accurately calculate the dosage, which depends on age and the presence of concomitant diseases.
4. The course of treatment should be long enough to provide the desired effect, but not very long due to the likely risk of developing resistance of the pathogenic flora of the urinary tract to the action of the drug.

With adequate selection of the dose and combination with an antibacterial drug, Canephron tablets enhance and maintain the antimicrobial activity of the antibiotic for a certain time (essential oils destroy the membrane of the pathogenic cell). At the same time, the herbal medicine is devoid of serious side effects that antibacterial drugs have. First of all, it has a negative effect on the digestive and immune systems.

In addition, Canephron tablets have the following additional effects:

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• diuretic due to improved blood flow in the kidneys and accelerated filtration in the glomerular system;
• antispasmodic and, as a consequence, analgesic;
• anti-inflammatory;
• nephroprotective;
• stimulates the secretion of uric acid salts and normalizes urine pH, that is, it affects the main causes of urolithiasis.

Canephron (tablets) are safe for almost all categories of patients, since the drug contains only herbal ingredients. This:

• Centaury herb (Centaurium umbellatum) contains bitterness, flavonoids, alkaloids and other beneficial substances. It has moderate antibacterial activity against the main pathogens of urinary tract diseases, stops inflammatory processes, normalizes the condition of the walls of blood vessels in the kidneys and stimulates diuresis.
• Lovage root (Levisticum officinale) owes its diuretic effect to a large number of essential oils; foreign medical articles repeatedly emphasize the antimicrobial activity of this plant.
• Rosemary leaves (Rosmarinus officinale) contain alkaloids and tannins, but their main component is essential oil, which stimulates blood flow in the renal vessels, promotes urine output, relieves spasms and symptoms of inflammation. But its main effect is its pronounced activity against almost all representatives of the pathogenic flora of the urinary tract, in particular, staphylococcus and streptococcus.

First of all, Canephron tablets act on neurotropic bacteria, even those that form a protective film. Also, the components of the drug relieve spasms of the urinary tract, activate the emptying of the bladder from residual urine, which is an excellent breeding ground for the development of bacteria.

Canephron tablets also have a therapeutic anti-inflammatory effect, stopping the synthesis of leukotrienes, prostaglandins, cytokines, toxic enzymes and other mediators that stimulate swelling and pain. The manufacturer of the drug is a German company specializing in the production of herbal medicines, Bionorica.

The main principle of the corporation's work is phytoniring, that is, a strictly scientific approach and the use of modern technologies to get the maximum effect from a combination of plant components. For ease of use at any age, Canephron is available in the form of tablets and solution (drops).

According to the annotation, the indications for use of the drug are:

• cystitis;
• pyelonephritis;
• uric acid diathesis (presence of sand in the kidneys or bladder);
• recovery after stone removal (by any means);
• kidney inflammation of non-bacterial etiology (for example, glomerulonephritis or interstitial nephritis);
• treatment and prevention of relapse of urolithiasis.

In the presence of microbial flora in the acute phase of the inflammatory process, Canephron tablets are used only in combination with basic antibacterial therapy.

Most patients do not experience any complications while taking the drug. If you are prone to allergic reactions, itchy rashes may appear on the skin. The components that make up the medicine stimulate the digestive tract, so patients may experience nausea, or less often, vomiting or diarrhea.

If blood appears in the urine or acute pain in the lower abdomen, you should immediately stop taking Canephron tablets and consult a doctor.

Contraindications to the use of the drug are:

• hypersensitivity to both the main ingredients of the drug and auxiliary components (including sucrose, lactose, castor oil);
• stomach ulcer during exacerbation;
• swelling caused by pathologies of the cardiovascular system.

Patients with diabetes should take Canephron tablets with caution, since their shell contains small amounts of sucrose. In addition, the drug is strictly contraindicated for monotherapy of renal failure.

Canephron: instructions for use, tablets and drops

In accordance with the instructions for use, the dosage of Canephron tablets is standard and does not depend on the disease. When the first symptoms appear, 2 tablets are prescribed three times a day. Moreover, the drug should be continued for at least 2-4 weeks after all clinical manifestations of the pathology have disappeared.

But it is worth paying attention that for cystitis, Canephron is recommended to be taken only in combination with uroseptics. The fact is that the antibacterial activity of the plant components of the medicine may not be enough to suppress pathogenic microflora, and this can lead to the disease becoming chronic. Usually a combination of an antibiotic, uroseptic, antispasmodic or analgesic is prescribed.

Antibacterial drugs prescribed for cystitis include:

• II - III generation cephalosporins (Zinnat, Tseklor, Suprax, Tsedex), the dosage is calculated individually, in some cases the maximum allowable amount of medication is required;
• fluoroquinolones (Ciprofloxacin, Levofloxacin);
• penicillins (Augmentin, Amoxiclav), usually used for the first episode of cystitis;
• uroseptics, fosfomycin (Monural), furazidin (Furamag) are often prescribed.

In case of severe cystitis, combine an antibacterial agent and Canephron tablets in a dosage according to the instructions for use. Doctors emphasize that the effectiveness of the herbal medicine is not enough to eliminate edema of renal etiology. Additionally, diuretics are prescribed (Lasix, Mannitol, Veroshpiron, Triamterene). In addition, therapy is necessary for the underlying disease, which provoked the development of such symptoms.

For edema of renal origin, Canephron tablets are taken according to the instructions for use - 2 tablets three times a day. Pathology of the urinary system often occurs in childhood. In girls, this is usually associated with poor perineal hygiene, with the bacterial flora spreading upward after vulvovaginitis. This is often the cause of not only cystitis, but also pyelonephritis.

Sometimes such pathologies are caused by congenital structural features of the pelvic organs. At an early age, inflammatory diseases of the urinary tract tend to recur frequently. Canephron will help you avoid long-term use of antibiotics and other synthetic medications. Unlike adults, it is dangerous to give pills to a child, so doctors recommend using drops. They are more convenient and safer in terms of dosage.

Canephron tablets are contraindicated for the treatment of kidney and bladder diseases in children under 6 years of age.

The dosage of the solution is 15-25 drops (depending on age) three times a day. Children under 3-4 years of age should use the drug with caution due to the ethanol content. A positive property of Canephron tablets is the possibility of use during pregnancy and lactation.

Gynecologists often prescribe this medication to women with a history of kidney disease and cystitis, when urolithiasis is detected, for prevention and as part of complex therapy for preeclampsia in a standard dosage. The pills also need to be taken up to 2 weeks after birth. As a preventative measure, the amount of medication is reduced to 2 pills per day (morning and evening). However, taking Canephron tablets on your own, even according to the instructions for use, and in combination with other drugs is unacceptable.

Medicine Canephron: analogues, cost, reviews

In addition to the drug Canephron, doctors may also suggest other herbal remedies. The most common is Cyston. The composition of this herbal medicine is more diverse. It contains more than 10 active components.

Among them:

• Flowers of double-carp. The plant regulates calcium metabolism and increases the effectiveness of urolithiasis therapy. Also has antimicrobial activity.
• Saxifraga herb. In folk medicine it is widely used as a bactericidal and anti-inflammatory agent.
• Madder herb. Usually they use infusions and decoctions from the roots of the plant, ignoring its above-ground part. Madder leaves and stems remove toxins and have a general tonic effect.
• Rhizomes of satiety membranous. It has long been used in oriental medicine as an anti-inflammatory and antiseptic agent.
• Seeds of rough strawflower have diuretic, antispasmodic, antipyretic and antimicrobial effects.
• Flowers, leaves and stems of Onosma bracts promote rapid healing of the epithelium of the ureters and urethra damaged after the passage of the stone, and has a general tonic effect.
• Vernonia ashy (whole plant) is known for its antibacterial activity.
• Mumiyo. Many people note the stimulating and tonic effect of this remedy; with long-term use, mumiyo strengthens the immune system and increases the body's resistance to various pathogenic factors.

The indications for taking Cyston are the same as for the drug Canephron. For urolithiasis, take 2 tablets three times a day for six months or until the stones leave the kidneys completely.

After surgical removal of stones, Cyston is taken in the same dosage for a month, then 1 tablet twice a day for another 5 weeks.

For bacterial urinary tract infections it is also prescribed in combination with antibiotics. The course of treatment is up to 3 months in the amount of 2 pills 2-3 times a day. Taking Cyston, like the medicine Canephron, is not contraindicated during pregnancy and breastfeeding. But this drug is produced only in tablet form, so its use in childhood is limited.

Another herbal preparation for the treatment of various urinary tract diseases is Phytolysin, which contains:

• goldenrod herb, stimulates metabolic processes, removes toxins and has a general anti-inflammatory effect;
• horsetail herb, a diuretic known in folk medicine;
• knotweed grass (knotweed), fenugreek seeds and wheatgrass rhizomes regulate salt metabolism, promote the prevention and slow dissolution of kidney stones;
• onion peel, relieves spasms of the urinary tract, has a mild bactericidal and diuretic effect;
• birch leaves and parsley root have a diuretic and antiseptic effect.

In addition, Phytolysin contains general tonic ingredients - peppermint, pine, and orange oils. The disadvantages of the drug include the release form; it is produced in the form of a paste, which is not convenient for everyone to take. The Ukrainian pharmaceutical company relatively recently mastered the production of a complete analogue of the drug Canephron - Trinephron. But today the drug is not registered in Russia, although it costs less than the original medicine.

As for the price of Canephron, you will have to pay about 450 rubles for a package containing 60 tablets, and 430 rubles for a bottle of drops (100 ml). Feedback from patients after therapy with this herbal medicine is overwhelmingly positive. This is especially true for the treatment of young children. When monitoring the child for a year, not a single case of relapse was identified. But doctors note that the effect of Canephron, like any other herbal medicine, develops slowly. Therefore, it is important to follow the dosage and regimen of use.

Catad_tema Respiratory diseases - articles

Errors in antibacterial therapy of respiratory tract infections in outpatient practice

Published in the magazine:
Attending doctor, 2003, №8 L. I. Dvoretsky, Doctor of Medical Sciences, Professor
S. V. Yakovlev, Doctor of Medical Sciences, Professor
MMA im. I. M. Sechenova, Moscow

The problem of rational antibacterial therapy for respiratory tract infections remains relevant today. The presence of a large arsenal of antibacterial drugs, on the one hand, expands the possibilities for treating various infections, and on the other, requires the clinician to be aware of numerous antibiotics and their properties (spectrum of action, pharmacokinetics, side effects, etc.), and to be able to navigate issues of microbiology, clinical pharmacology and other related disciplines.

According to I.V. Davydovsky, “medical errors are a type of conscientious errors made by a doctor in his judgments and actions when performing certain special medical duties.” Errors in antibacterial therapy of respiratory tract infections have the largest share in the structure of all treatment and tactical errors made in pulmonary practice and have a significant impact on the outcome of the disease. In addition, incorrect prescription of antibacterial therapy can have not only medical, but also various social, deontological, economic and other consequences.

When choosing a method of antibacterial therapy in outpatient practice, it is necessary to take into account and solve both tactical and strategic problems. The tactical tasks of antibiotic therapy include the rational choice of an antibacterial drug that has the greatest therapeutic and least toxic effects.

The strategic goal of antibiotic therapy in outpatient practice can be formulated as reducing the selection and spread of resistant strains of microorganisms in the population.

In accordance with these provisions, tactical and strategic errors should be identified when conducting antibacterial therapy for respiratory tract infections in outpatient practice (see Table 1).

Table 1. Errors in antibacterial therapy in outpatient practice.

Tactical errors of antibacterial therapy

1. Unreasonable prescription of antibacterial agents

The indication for prescribing an antibacterial drug is a diagnosed or suspected bacterial infection.

The most common mistake in outpatient practice is the prescription of antibacterial drugs for acute respiratory viral infections (ARVI), which occurs in both therapeutic and pediatric practice. In this case, errors can be caused by both incorrect interpretation of symptoms (the doctor mistakes ARVI for a bacterial bronchopulmonary infection in the form of pneumonia or bronchitis), and the desire to prevent bacterial complications of ARVI.

With all the difficulties of decision-making in such situations, it is necessary to be aware that antibacterial drugs do not affect the course of a viral infection and, therefore, their prescription for ARVI is not justified (see Table 2). At the same time, the supposed possibility of preventing bacterial complications of viral infections by prescribing antibacterial drugs has not been confirmed in clinical practice. In addition, it is obvious that the widespread unjustified use of antibacterial drugs for ARVI is fraught with the formation of drug resistance and an increased risk of adverse reactions in the patient.

Table 2. Infectious diseases of the respiratory tract, predominantly of viral etiology
and do not require antibiotic therapy.

One of the common mistakes when carrying out antibacterial therapy is the prescription of antifungal agents simultaneously with an antibiotic in order to prevent fungal complications and dysbacteriosis. It should be emphasized that when using modern antibacterial agents in immunocompetent patients, the risk of developing fungal superinfection is minimal, so the simultaneous prescription of antifungals in this case is not justified. The combination of an antibiotic with an antifungal agent is advisable only in patients receiving cytostatic or antitumor therapy or in HIV-infected patients. In these cases, prophylactic administration of systemic antimycotics (ketoconazole, miconazole, fluconazole), but not nystatin, is justified. The latter is practically not absorbed in the gastrointestinal tract and is not able to prevent fungal superinfection of another location - the oral cavity, respiratory or urinary tract, genitals. The often practiced prescription of nystatin for the prevention of intestinal dysbiosis does not find a logical explanation at all.

Often the doctor prescribes nystatin or another antimycotic if fungi of the genus are detected in the oral cavity or urine Candida. At the same time, he focuses only on microbiological research data and does not take into account the presence or absence of symptoms of candidiasis, as well as risk factors for the development of fungal infection (severe immunodeficiency, etc.).

Isolation of fungi of the genus Candida from the oral cavity or urinary tract of patients in most cases serves as evidence of asymptomatic colonization, which does not require corrective antifungal therapy.

II. Errors in choosing an antibacterial drug

Perhaps the largest number of errors that occur in outpatient practice is associated with the choice of antibacterial agent. The choice of antibiotic should be made taking into account the following basic criteria:

spectrum of antimicrobial activity of the drug in vitro;

regional level of pathogen resistance to antibiotics;

proven effectiveness in controlled clinical trials;

safety of the drug. The determining factor in choosing a drug should be the spectrum of natural activity of the antibiotic: it must cover the main pathogens of community-acquired respiratory tract infections (see Table 3). Table 3. The most significant pathogens of community-acquired respiratory tract infections. In addition, when choosing a drug, the level of acquired resistance of pathogens in the population should be taken into account. The main trends regarding pathogen resistance noted in recent years are reflected in Table 4. Table 4. Current problems of resistance of the most common pathogens of community-acquired respiratory tract infections.

Microorganisms	Modern problems of treatment
Streptococcus pneumoniae	Reduced sensitivity to beta-lactams; resistance to penicillin in Russia does not exceed 2%, but strains with moderate sensitivity range from 10 to 20%. b-lactams (amoxicillin, ampicillin, III-IV generation cephalosporins, carbapenems) retain full clinical efficacy against penicillin-resistant pneumococci, while at the same time, the effectiveness of I-II generation cephalosporins may be reduced. Low natural activity of oral cephalosporins of the third generation, primarily ceftibuten. Increasing resistance to macrolides: in Europe from 8 to 35%, in Russia - about 12%; resistance is associated with clinical failure of therapy. High frequency of resistance to co-trimoxazole and tetracyclines in Russia (>50%). Low natural activity of early fluoroquinolones; in recent years, an increase in the frequency of resistant strains has been noted; high activity of new fluoroquinolones - minimal resistance.
Streptococcus pyogenes	Increasing resistance to macrolides: in Europe up to 50%, in Russia 10-20%. The increase in resistance is directly related to the increase in the frequency of consumption of macrolides, mainly long-acting drugs (azithromycin, clarithromycin). High resistance to tetracyclines (>50%). Low natural activity of early fluoroquinolones V. Resistance to penicillin and other b-lactams has not been described.
Haemophilus influenzae	The production of b-lactamases is 1 - 40%, in Russia it does not exceed 10%; Clinically, amoxicillin is not inferior to protected penicillins. There is practically no resistance to amoxicillin/clavulanate, cephalosporins of II-IV generations, or fluoroquinolones. First generation cephalosporins are not active. The natural activity of macrolides is low, the risk of bacteriological treatment failure is high. Resistance to co-trimoxazole in Russia is about 20%.

The most significant problems associated with the use of basic antibacterial agents for respiratory tract infections can be formulated as follows. b-lactams:

high in vitro activity against major pathogens, with the exception of atypical ones;

low level of resistance in Central Russia (however, the trend towards its increase is alarming);

reliable clinical and bacteriological effectiveness. Macrolides:

increase in resistance S. pneumoniae And S. pyogenes; resistance may be accompanied by decreased clinical efficacy;

low activity against N. influenzae- high frequency of bacteriological failure of therapy (persistence of pathogens). Early fluoroquinolones:

low natural activity against S. pneumoniae And S. pyogenes;

increase in resistance S. pneumoniae. New fluoroquinolones:

high activity against S. pneumoniae including strains resistant to penicillin and macrolides; stability is minimal. Co-trimoxazole:

high level of resistance S. pneumoniae and N. influenzas. Tetracyclines:

high level of sustainability S. pneumoniae. Taking into account the above, b-lactam antibiotics and new fluoroquinolones can currently be recognized as the optimal drugs for the treatment of community-acquired respiratory tract infections (see Table 5). The use of macrolides should be limited - drugs can be prescribed for mild pneumonia in children or young patients, especially if there are signs of an atypical course (mycoplasma, chlamydia). Table 5. The value of antibacterial agents for lower respiratory tract infections in outpatient practice. It should be emphasized that the prescription of some antibacterial drugs used in outpatient practice for respiratory infections cannot be considered rational. These drugs primarily include:

gentamicin - lack of activity against the most common pathogen S. pneumoniae and potentially high toxicity;

co-trimoxazole - high level of resistance S. pneumoniae And N. influenzae;

early fluoroquinolones (ciprofloxacin, ofloxacin, pefloxacin, lomefloxacin) - low activity against S. pneumoniae;

III generation oral cephalosporins (ceftibuten) - low activity against S. pneumoniae;

Ampiox is an irrational combination, the doses of ampicillin and oxacillin (0.125 mg each) are significantly lower than therapeutic ones. Table 6 shows current recommendations for antibacterial therapy of community-acquired respiratory infections, taking into account all the required criteria and proven effectiveness in controlled clinical trials. Table 6. Antibacterial drugs recommended for the treatment of community-acquired respiratory infections. 1 Mainly with recurrent course
2 For atypical etiology (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumopriila) The recommendations presented are of the most general nature. At the same time, from a practical point of view, the choice of the optimal antibacterial drug should also be made taking into account the characteristics of the patient and the disease. For example, in young and middle-aged patients with pneumonia without aggravating factors, amoxicillin, macrolides, protected penicillins and new fluoroquinolones have a therapeutic effect. However, in elderly patients, the etiology of the disease becomes more important. S. aureus and gram-negative bacteria, which explains the decreased effectiveness of amoxicillin and macrolides in this category of patients. Another common mistake in medical practice is refusing to prescribe antibacterial therapy for pneumonia in pregnant women due to fear of the negative impact of the drugs on the fetus. It should be noted that the list of antibacterial drugs, the use of which is undesirable during pregnancy due to the risk of embryotoxic action, is limited - tetracyclines, chloramphenicol, sulfonamides, co-trimoxazole, fluoroquinolones, aminoglycosides. Other antibiotics, in particular b-lactams and macrolides, can be used in pregnant women. Other possible factors influencing the choice of antibacterial drug are presented in Table 7. Table 7. Special clinical situations for community-acquired lower respiratory tract infections. It is not uncommon to make mistakes when choosing an antibacterial drug if the initial one is ineffective. Here it is also necessary to dwell on the errors of antibacterial therapy, which relate to untimely assessment of the ineffectiveness of the initial antibiotic. The generally accepted critical period for assessing the effectiveness (or ineffectiveness) of antibacterial therapy is considered to be 48-72 hours from the moment of its prescription. Unfortunately, we often encounter cases where a patient continues to receive a prescribed antibiotic for a week or more, despite the absence of an obvious clinical effect. Typically, the criterion for the effectiveness of antibacterial therapy is a decrease or normalization of the patient’s body temperature and a decrease in signs of intoxication. In those cases (not so frequent) when there is no fever from the very beginning of the disease, one has to focus on other signs of intoxication (headache, anorexia, cerebral symptoms, etc.), as well as on the lack of progression of the disease during the period of treatment. Continuing antibiotic therapy, despite its ineffectiveness, has many negative consequences. At the same time, the prescription of another, more adequate antibiotic is delayed, which leads to the progression of inflammation (especially important in severe pneumonia, in patients with concomitant pathologies) and the development of complications, and also lengthens the treatment period. In addition, the risk of side (toxic) effects of drugs, as well as the development and strengthening of antibiotic resistance, increases. Continuing treatment, despite the ineffectiveness of the therapy, undermines the trust of the patient and his relatives in the attending physician. The uneconomical nature of such erroneous tactics of antibacterial therapy is also obvious (waste of ineffective antibiotics, additional costs for treating toxic effects, etc.). In addition, errors occur when replacing an ineffective antibiotic with another, i.e., when changing a drug. At the same time, the doctor forgets that the principle of choosing an antibacterial drug remains the same, i.e., one should focus on the clinical situation, taking into account, however, the ineffectiveness of the initial drug and a number of other additional signs. The lack of effect from the initially prescribed antibiotic to a certain extent should serve as an additional guideline to justify the choice of a second drug. For example, the lack of effect from the use of b-lactam antibiotics (penicillins, cephalosporins) in a patient with community-acquired pneumonia suggests an atypical etiology of pneumonia (mycoplasma, chlamydial or legionella), taking into account, of course, other clinical signs. Clinical signs of atypical pneumonia caused by Mycoplasma pneumoniae or Chlamydia pneumonias:

gradual onset (over three to seven days);

often low-grade fever;

nonproductive cough;

absence of purulent sputum;

extrapulmonary symptoms (pharyngitis, myalgia, headache, diarrhea);

interstitial infiltrates;

bilateral defeat. The presence of clinical signs of atypical pneumonia makes it justified to prescribe antibacterial drugs from the group of macrolides, doxycycline or fluoroquinolones (levofloxacin, moxifloxacin, ofloxacin). III. Errors in choosing the dosage regimen of an antibacterial drug Errors in choosing the optimal dose of an antibacterial agent may involve prescribing either an insufficient or an excessive dose of the drug. Both mistakes are fraught with negative consequences. If the dose of an antibiotic is insufficient and does not create a concentration in the blood and tissues of the respiratory tract that exceeds the minimum dose to suppress the main infectious agents, which is a condition for the eradication of the corresponding pathogen, then this not only can serve as one of the reasons for the ineffectiveness of therapy, but also creates real preconditions for the formation resistance of microorganisms. Errors in choosing the optimal dose can be associated both with the prescription of an insufficient single dose and with an incorrect dosage regimen (insufficient frequency of administration). An example of an inadequate antibiotic dosage regimen for community-acquired pneumonia is amoxicillin, which was previously recommended in a daily dose of up to 1 g. However, modern recommendations suggest the use of amoxicillin in a daily dose of 1.5 and even 3 g to overcome possible resistance S. pneumoniae. Examples of inadequate dosing regimens of antibiotics in outpatient practice for respiratory infections are given in Table 8. Table 8. Inadequate dosing regimens of oral antibacterial drugs in outpatient practice for respiratory infections in adults.

Examples	It is advisable
Amoxicillin orally 0.75-1 g per day	0.5-1 g three times a day
Ampicillin IV 2 g per day	1 g four times daily
Amoxicillin/clavulanate orally 0.375 g three times a day	0.625 g three times a day or 1 g twice daily
Cefuroxime axetil orally 0.5 g per day	0.5 g twice daily
Erythromycin orally 1 g per day	0.5 g four times a day
Clarithromycin orally 0.5 g per day	0.5 g twice daily
Ciprofloxacin orally 0.5 g per day	0.5-0.75 g twice a day
Oxacillin orally 1-1.5 g per day	Not recommended
Ampiox orally 0.25-0.5 g three times a day	Not recommended

The incorrect choice of intervals between administrations of antibacterial drugs is usually due not so much to the difficulties of parenteral administration of drugs in an outpatient setting or the negative attitude of patients, but to the lack of awareness of practicing physicians about some pharmacodynamic and pharmacokinetic features of drugs, which should determine their dosage regimen. A typical mistake is to prescribe benzylpenicillin in outpatient pediatric practice for pneumonia with a frequency of administration twice a day, since more frequent administration is inconvenient for the patient. It should be noted that in cases of mild pneumonia, the desire of some doctors to compulsorily prescribe parenteral antibiotics is hardly justified. Modern antibacterial drugs are characterized by good bioavailability when taken orally, as well as the same clinical effectiveness as parenteral drugs, so in the vast majority of cases treatment with oral drugs is justified. If parenteral antibiotics are truly necessary, a drug with a long half-life (eg, ceftriaxone) should be selected, allowing for once-daily dosing. IV. Errors when prescribing antibiotics in combination One of the mistakes in antibacterial therapy for community-acquired respiratory infections is the unreasonable prescription of a combination of antibiotics. Doctors of older generations remember the time (50-70s of the last century) when the use of penicillin and streptomycin was considered mandatory in the treatment of pneumonia, as evidenced by many textbooks and manuals. This was a kind of standard treatment for pneumonia for that time. Somewhat later, along with antibiotics, the prescription of sulfonamides was recommended, taking into account the data obtained at one time by Z.V. Ermolyeva on the chemotherapeutic synergism of sulfonamides and penicillin. In the modern situation, with the availability of a large arsenal of highly effective broad-spectrum antibacterial drugs, indications for combination antibacterial therapy are significantly narrowed, and monotherapy remains the priority in the treatment of respiratory infections. Numerous controlled studies have shown the high clinical and bacteriological effectiveness of adequate antibacterial agents in the treatment of respiratory infections in monotherapy (amoxicillin, amoxicillin/clavulanate, cephalosporins of II - III generations, new fluoroquinolones). Combination antibacterial therapy has no real advantages either in the severity of the effect or in preventing the development of resistant strains. The main indications for combination antibacterial therapy are severe pneumonia - in this case, the combined prescription of a third-generation parenteral cephalosporin (cefotaxime or ceftriaxone) and a parenteral macrolide antibiotic (erythromycin, or clarithromycin, or spiramycin) becomes the generally accepted standard of treatment; the latter are included in the combination to affect probable atypical microorganisms (legionella or mycoplasma). It should be noted that new antibacterial drugs (levofloxacin, moxifloxacin) with high activity against both typical and atypical pathogens have now appeared in clinical practice, which allows them to be prescribed as monotherapy even in severe pneumonia. Another clinical situation that justifies the combined prescription of antibiotics is pneumonia in immunocompromised patients (treatment with cytostatics, AIDS), in which there is a high probability of association of pathogens (see Table 7). Unfortunately, in outpatient practice we often encounter situations in which patients with mild pneumonia, in the absence of complications or severe background pathology, are prescribed two antibiotics. There is no logical rationale for this treatment strategy, and possible drug antagonism, a higher risk of adverse reactions and increased treatment costs must be taken into account. It should be noted that irrational combinations of antibacterial drugs also have official dosage forms that are produced by the domestic pharmaceutical industry, for example, ampiox, oletethrin. Of course, the use of such drugs is unacceptable. V. Errors associated with the duration of antibacterial therapy and clinical effectiveness criteria In some cases, unreasonably long-term antibiotic therapy is carried out. This erroneous tactic is due, first of all, to an insufficient understanding of the purpose of antibacterial therapy itself, which comes down primarily to eradication of the pathogen or suppression of its further growth, i.e., aimed at suppressing microbial aggression. The actual inflammatory reaction of the lung tissue, which is manifested by various clinical and radiological signs (auscultation pattern, persistent radiological infiltration, accelerated ESR) regresses more slowly and does not require continued antibacterial therapy (see Table 9). In this regard, the tactics according to which a patient with persistent radiological signs of pulmonary infiltration, crepitating wheezing (crepitacio redux), an increase in ESR with normalization of body temperature and the disappearance (or decrease) of signs of intoxication continue to undergo antibacterial therapy should be considered erroneous. Table 9. Timeframe for disappearance of symptoms with effective antibacterial therapy for community-acquired pneumonia. Even more erroneous is the tactic of replacing one antibiotic with another in such situations, which are regarded by the doctor as the ineffectiveness of the prescribed antibacterial therapy. In some patients, after the disappearance of signs of intoxication and even regression of inflammatory changes in the lungs, weakness, sweating, and low-grade fever may persist for a long time. The latter is regarded by the doctor as a manifestation of an incompletely controlled bronchopulmonary infection, which is “confirmed” by x-ray data in the form of changes in the pulmonary pattern or “residual effects of pneumonia” and usually entails the prescription of an antibacterial drug, despite the absence of changes in the blood. Meanwhile, such a clinical situation is often caused by autonomic dysfunction after a pulmonary infection (post-infectious asthenia) and does not require antibacterial therapy, although, of course, in each specific case a thorough examination of the patient and decoding of all existing symptoms are necessary. The recommended duration of use of antibacterial drugs for bronchopulmonary infections is shown in Table 10. Table 10. Duration of antibacterial therapy for bacterial respiratory infections in outpatient practice.

*	The effectiveness of cefuroxime axetil, telithromycin and azithromycin in five-day courses has been shown; benzathine penicillin is administered intramuscularly once
**	The effectiveness of ceftriaxone (50 mg/kg per day) for three days has been shown
***	The effectiveness of new fluoroquinolones (levofloxacin, moxifloxacin) in five-day courses has been shown
****	Typically, the recommended treatment period is three to four days after the temperature normalizes; The average treatment time is five to ten days. For staphylococcal etiology of pneumonia, a longer course of antibacterial therapy is recommended - two to three weeks; for atypical pneumonia (mycoplasma, chlamydial, legionella), the expected duration of antibacterial therapy is 10-14 days.

In clinical practice, the use of antimicrobial agents can be empirical (drugs are selected taking into account the spectrum of action on the suspected pathogen) or etiological, based on the results of bacteriological culture to determine the sensitivity of the flora to antibacterial drugs.

Many infectious diseases, such as pneumonia or pyelonephritis, require the use of a combination of antibiotics.

To competently draw up such treatment regimens, it is necessary to clearly understand the types of pharmacological interactions between drugs and know which drugs can be used together and which are strictly contraindicated.

Also, when drawing up complex therapy, not only the underlying disease and its causative agent are taken into account, but also:

• patient’s age, pregnancy and lactation period;
• clinical contraindications and history of allergic reactions;
• kidney and liver function;
• chronic diseases and basic medications taken by the patient (hypertensive therapy, correction of diabetes mellitus, anticonvulsants, etc.), prescribed antibiotics (hereinafter referred to as ABP) should be well combined with planned therapy.

The result of pharmacodynamic interaction of drugs can be:

• synergism (increased pharmacological effect);
• antagonism (reduction or complete elimination of drug effects on the body);
• reducing the risk of side effects;
• increased toxicity;
• lack of interaction.

As a rule, pure bactericidal (destroying pathogens) and bacteriostatic agents (suppressing the growth and reproduction of representatives of pathogenic flora) are not combined with each other. This is explained, first of all, by their mechanism of action. Bactericidal drugs act most effectively on organisms at the stage of growth and reproduction, so the use of bacteriostatics can cause the development of drug resistance.

It is important to understand that this division according to the type of effect on bacteria is not absolute, and different antibacterial drugs may have different effects depending on the prescribed dose.

For example, increasing the daily dose or duration of use of a bacteriostatic agent leads to its bactericidal effect.

Also, selectivity of action on certain pathogens is possible. Being bactericidal antibiotics, penicillins have a bacteriostatic effect against enterococci.

Antibiotic compatibility table by type of action

Bactericidal	Bacteriostatic

The combination of antibiotics with each other, taking into account the dosage and type of action on the flora, allows you to expand the spectrum of action and increase the effectiveness of the therapy. For example, in order to prevent antibacterial resistance in Pseudomonas aeruginosa, it is possible to combine antipseudomonas cephalosporins and carbapenems, or aminoglycosides with fluoroquinolones.

1. Rational combinations of antibiotics for the treatment of enterococci: the addition of penicillins with aminoglycosides or the use of trimethoprim in combination with sulfamethoxazole.
2. The second generation combination drug has an extended spectrum of action: it combines Tinidazole ®.
3. A combination of cephalosporins and metronidazole ® is effective. Tetracyclines are combined with gentamicin to enhance the effect on intracellular pathogens.
4. Aminoglycosides are combined with rifampicin to enhance the effect on serrations (often recurrent diseases of the upper respiratory tract). Also combined with cephalosporins to increase effectiveness against enterobacteria.

Compatibility of antibiotics with each other: table

Combinations are strictly prohibited
Cephalosporins and Aminoglycosides.	Due to the mutual potentiation of the nephrotoxic effect, the development of acute renal failure and interstitial nephritis is possible.
Chloramphenicol ® and Sulfonamides.	Pharmacologically incompatible.
, , Aminoglycosides and Furosemide ® .	A sharp increase in the ototoxic effect, up to complete hearing loss.
Fluoroquinolones and nitrofurans.	Antagonists.
Carbapenem ® and other beta-lactams.	Pronounced antagonism.
Cephalosporins and Fluoroquinolones.	Severe leukopenia, obvious nephrotoxic effect.
It is forbidden to mix and administer in one solution (syringe):
Penicillins are not mixed with ascorbic acid, B vitamins ® , or aminoglycosides.
Cephalosporins (especially ceftriaxone ®) are not combined with calcium gluconate.
and hydrocortisone.
Carbenicillin ® with kanamycin ® , gentamicin ® .
Tetracyclines with sulfonamides should not be combined with hydrocortisone, calcium salts, or soda.
All antibacterial drugs are absolutely incompatible with heparin.

Penicillins

Antibiotics of this series are not prescribed simultaneously with allopurinol, due to the risk of developing an “ampicillin rash”.

Additive synergism of antibiotics (summation of the results of action) occurs when prescribed with macrolides and tetracyclines. Such combinations are highly effective for community-acquired pneumonia. Prescription with aminoglycosides is permissible - separately, since when mixing the drugs, their inactivation is observed.

When prescribing oral medications, women need to clarify whether they are using oral contraceptives, since penicillins interfere with their effect. In order to prevent unwanted pregnancy, it is recommended to use barrier methods of contraception during antibacterial therapy.

Penicillins are not prescribed with sulfonamides due to a sharp decrease in their bactericidal effect.
It is important to remember that their administration to patients who have been using anticoagulants, antiplatelet agents and non-steroidal anti-inflammatory drugs for a long time is undesirable due to the potential for bleeding.

Benzylpenicillin salt is not combined with potassium and potassium-sparing diuretics, due to the increased risk of hyperkalemia.

Penicillins and fluoroquinolones are compatible

It is possible to combine protected or extended-spectrum penicillins for oral use with local administration of fluoroquinolones (drops), as well as combined systemic use (Levofloxacin ® and Augmentin ® for pneumonia).

Cephalosporins

Due to the high risk of cross-allergic reactions, the first generation is not prescribed together with penicillins. Prescribe with caution to patients intolerant to beta-lactam antibiotics. in the anamnesis.

Combination with anticoagulants, thrombolytics and antiplatelet agents reduces coagulation and can cause bleeding, usually gastrointestinal due to hypoprothrombinemia.
Combined administration with aminoglycosides and fluoroquinolones leads to a pronounced nephrotoxic effect.

Antib use. after taking antacids, it reduces the absorption of the drug.

Carbapenems

Ertapenem ® is strictly incompatible with glucose solution. Also, carbapenems are not prescribed concomitantly with other beta-lactam drugs due to the pronounced antagonistic interaction.

Aminoglycosides

Due to physical and chemical incompatibility, they cannot be mixed in the same syringe with beta-lactams and heparin.

The simultaneous use of several aminoglycosides leads to severe nephro- and ototoxicity. Also, these drugs are not combined with polymyxin ®, amphotericin ®, vancomycin ®. Not prescribed together with furosemide.

Concomitant use with muscle relaxants and opioid analgesics can cause neuromuscular blockade and respiratory arrest.

Nonsteroidal anti-inflammatory drugs slow down the elimination of aminoglycosides due to slowing renal blood flow.

Group of quinolones (fluoroquinolones)

Concomitant use with antacids reduces the absorption and bioavailability of the antibiotic.

They are not prescribed simultaneously with NSAIDs and nitroimidazole derivatives due to high toxicity to the nervous system and the possible occurrence of seizures.

They are antagonists and derivatives of nitrofuran, so this combination is not prescribed.

Ciprofloxacin ® , Norfloxacin ® , Pefloxacin ® are not used in combination with sodium bicarbonate, citrates and carbonic anhydrase inhibitors, due to the risk of crystalluria and kidney damage. They also disrupt the metabolism of indirect anticoagulants and can cause bleeding.
Prescription to patients receiving glucocorticosteroid therapy significantly increases the possibility of tendon rupture.

They interfere with the action of insulin and sugar-lowering tablets and are not prescribed to diabetics.

Macrolides

Do not use together with antacids, due to reduced effectiveness. Administration with rifampicin ® reduces the concentration of macrolides in the blood. Also not compatible with amphinecol ® and lincosamides. Use in patients receiving statins is not recommended.

Sulfonamides

They have a pronounced toxic effect in combination with anticoagulants, antidiabetic and anticonvulsant drugs.

Not prescribed with estrogen-containing contraceptives due to the risk of uterine bleeding.

It is prohibited to combine with drugs that inhibit bone marrow function.

Sulfamethoxazoline/trimethoprim ® (Biseptol ®) and other sulfonamide antibiotics are compatible with polymyxin B ®, gentamicin ® and sisomycin ®, and penicillins.

Tetracyclines

Not prescribed in conjunction with iron supplements. This is due to impaired absorption and digestibility of both drugs.

Combination with vitamin A can cause pseudotumor cerebri syndrome.
Do not combine with indirect anticoagulants and anticonvulsants, tranquilizers.

Interaction of antibiotics with food, alcohol and herbs

Taking foods that increase the secretion of hydrochloric acid in the stomach (juices, tomatoes, tea, coffee) leads to a decrease in the absorption of semisynthetic penicillins and erythromycin ®.

Dairy products with a high calcium content: milk, cheese, cottage cheese, yoghurts, significantly inhibit the absorption of tetracyclines and ciprofloxacin ®.

When consuming chloramphenicol ® , metronidazole ® , cephalosporins, sulfonamides with alcoholic drinks, an Antabuse-like syndrome may develop (tachycardia, heart pain, skin hyperemia, vomiting, nausea, severe headache, tinnitus). This complication is a life-threatening condition and can cause death.

These drugs should not be combined even with alcoholic tinctures of medicinal herbs.

The combination of sulfonamides and tetracyclines with St. John's wort can provoke a sharp increase in skin sensitivity to ultraviolet rays (drug photosensitization).