Antimicrobials and antibiotics. Antibacterial drugs - classification for children and pregnant women

The development of most diseases is associated with infection by various microbes. Antimicrobial drugs available to combat them include not only antibiotics, but also agents with a narrower spectrum of action. Let's take a closer look at this category of drugs and the features of their use.

Antimicrobial agents - what are they?

• Antibacterial agents are the largest group of drugs for systemic use. They are obtained using synthetic or semi-synthetic methods. They can disrupt the processes of bacterial reproduction or destroy pathogenic microorganisms.
• Antiseptics have a wide spectrum of action and can be used when affected by various pathogenic microbes. They are used mainly for local treatment of damaged skin and mucous surfaces.
• Antimycotics are antimicrobial drugs that suppress the viability of fungi. Can be used both systemically and externally.
• Antiviral drugs can influence the reproduction of various viruses and cause their death. Presented in the form of systemic medications.
• Anti-tuberculosis drugs interfere with the vital activity of Koch's bacillus.

Depending on the type and severity of the disease, several types of antimicrobial drugs may be prescribed simultaneously.

Types of antibiotics

It is possible to overcome an illness caused by pathogenic bacteria only with the help of antibacterial agents. They can be of natural, semi-synthetic and synthetic origin. Recently, drugs belonging to the latter category have been increasingly used. Based on the mechanism of action, a distinction is made between bacteriostatic (causes the death of the pathogenic agent) and bactericidal (interferes with the activity of bacilli).

Antibacterial antimicrobial drugs are divided into the following main groups:

1. Penicillins of natural and synthetic origin are the first drugs discovered by man that can fight dangerous infectious diseases.
2. Cephalosporins have similar effects to penicillins, but are much less likely to cause allergic reactions.
3. Macrolides suppress the growth and reproduction of pathogenic microorganisms, having the least toxic effect on the body as a whole.
4. Aminoglycosides are used to kill gram-negative anaerobic bacteria and are considered the most toxic antibacterial drugs;
5. Tetracyclines can be natural or semi-synthetic. They are used mainly for local treatment in the form of ointments.
6. Fluoroquinolones are drugs with a powerful bactericidal effect. They are used in the treatment of ENT pathologies and respiratory diseases.
7. Sulfonamides are broad-spectrum antimicrobial drugs, to which gram-negative and gram-positive bacteria exhibit sensitivity.

Effective antibiotics

Drugs with antibacterial effects should be prescribed for the treatment of a particular illness only if infection with a bacterial pathogen is confirmed. Laboratory diagnostics will also help determine the type of pathogen. This is necessary for the correct selection of medication.

Most often, specialists prescribe antibacterial (antimicrobial) drugs with a wide range of effects. Most pathogenic bacteria are sensitive to such medications.

Effective antibiotics include drugs such as Augmentin, Amoxicillin, Azithromycin, Flemoxin Solutab, Cefodox, Amosin.

"Amoxicillin": instructions for use

The medication belongs to the category of semi-synthetic penicillins and is used in the treatment of inflammatory processes of various etiologies. Amoxicillin is available in the form of tablets, suspension, capsules and solution for injection. It is necessary to use an antibiotic for pathologies of the respiratory tract (lower and upper sections), diseases of the genitourinary system, dermatoses, salmonellosis and dysentery, cholecystitis.

In the form of a suspension, the medicine can be used to treat children from birth. In this case, only a specialist calculates the dosage. Adults, according to the instructions, need to take 500 mg of amoxicillin trihydrate 3 times a day.

Features of application

The use of antimicrobial drugs often causes the development of allergic reactions. This should be taken into account before starting therapy. Many doctors recommend taking antihistamines along with antibiotics to prevent side effects such as rashes and redness of the skin. It is forbidden to take antibiotics if you are intolerant to any of the components of the medicine or if there are contraindications.

Representatives of antiseptics

The infection often enters the body through damaged skin. To avoid this, you should immediately treat abrasions, cuts and scratches with special antiseptic agents. Such antimicrobial drugs act on bacteria, fungi, and viruses. Even with long-term use, pathogenic microorganisms practically do not develop resistance to the active components of these drugs.

The most popular antiseptics include medications such as iodine solution, boric and salicylic acid, ethyl alcohol, potassium permanganate, hydrogen peroxide, silver nitrate, Chlorhexidine, Collargol, Lugol's solution.

Antiseptic drugs are often used to treat diseases of the throat and oral cavity. They are able to suppress the proliferation of pathogenic agents and stop the inflammatory process. They can be purchased in the form of sprays, tablets, lozenges, lozenges and solutions. Essential oils and vitamin C are often used as additional components in such preparations. The most effective antiseptics for treating the throat and oral cavity include the following:

1. "Inhalipt" (spray).
2. "Septolete" (lozenges).
3. "Miramistin" (spray).
4. "Chlorophyllipt" (rinse solution).
5. "Hexoral" (spray).
6. "Neo-angin" (lollipops).
7. "Stomatidin" (solution).
8. Faringosept (tablets).
9. "Lizobakt" (tablets).

When to use Faringosept?

The drug “Faryngosept” is considered a powerful and safe antiseptic. If a patient has an inflammatory process in the throat, many specialists prescribe these antimicrobial tablets.

Preparations containing ambazone monohydrate (like Faringosept) are highly effective in the fight against staphylococci, streptococci and pneumococci. The active substance prevents the proliferation of pathogenic agents.

Antiseptic tablets are recommended for stomatitis, pharyngitis, tonsillitis, gingivitis, tracheitis, tonsillitis. As part of complex therapy, Faringosept is often used in the treatment of sinusitis and rhinitis. The medicine can be prescribed to patients over three years of age.

Drugs for the treatment of fungus

What antimicrobial drugs should be used to treat fungal infections? Only antimycotic drugs can cope with such ailments. Antifungal ointments, creams and solutions are usually used for treatment. In severe cases, doctors prescribe systemic medications.

Antimycotics can have fungistatic or fungicidal effects. This allows you to create conditions for the death of fungal spores or prevent reproduction processes. Effective antimicrobial drugs with an antimycotic effect are prescribed exclusively by a specialist. The following medications are the best:

1. "Fluconazole".
2. "Clotrimazole".
3. "Nystatin"
4. "Diflucan".
5. "Terbinafine".
6. "Lamisil."
7. "Terbizil."

In severe cases, the use of local and systemic antimycotic medications simultaneously is indicated.

Treatment of bacterial infections today is impossible without the use of antibiotics. Microorganisms tend to become resistant to chemical compounds over time, and old drugs are often ineffective. Therefore, pharmaceutical laboratories are constantly looking for new formulas. In many cases, infectious disease specialists prefer to use new generation broad-spectrum antibiotics, the list of which includes drugs with different active ingredients.

Antibiotics act only on bacterial cells and are not able to kill viral particles.

Based on their spectrum of action, these drugs are divided into two large groups:

• narrowly targeted, coping with a limited number of pathogens;
• broad spectrum of action, fighting different groups of pathogens.

In the case where the pathogen is known exactly, antibiotics of the first group can be used. If the infection is complex and combined, or the pathogen has not been identified in the laboratory, drugs of the second group are used.

Based on the principle of action, antibiotics can also be divided into two groups:

• bactericides - drugs that kill bacterial cells;
• bacteriostatics are drugs that stop the proliferation of microorganisms, but are not able to kill them.

Bacteriostatics are safer for the body, therefore, for mild forms of infections, preference is given to this group of antibiotics. They allow you to temporarily restrain the growth of bacteria and wait for them to die on their own. Severe infections are treated with bactericidal drugs.

List of new generation broad-spectrum antibiotics

The division of antibiotics into generations is heterogeneous. For example, cephalosporin drugs and fluoroquinolones are divided into 4 generations, macrolides and aminoglycosides - into 3:

Group of drugs	Generations of drugs	Drug names
Cephalosporins	I	"Cefazolin" "Cephalexin"
	II	"Cefuroxime" "Cefaclor"
	III	"Cefotaxime" "Cefixime"
	IV	"Cefepime" "Cefpirom"
Macrolides	I	"Erythromycin"
	II	"Flurithromycin" "Clarithromycin" "Roxithromycin" "Midecamycin"
	III	"Azithromycin"
Fluoroquinolones	I	Oxolinic acid
	II	"Ofloxacin"
	III	"Levofloxacin"
	IV	"Moxifloxacin" "Gemifloxacin" "Gatifloxacin"
Aminoglycosides	I	"Streptomycin"
	II	"Gentamicin"
	III	"Amikacin" "Netilmicin" "Framycetin"

Unlike older drugs, new generation antibiotics affect beneficial flora much less, are absorbed faster, and have a less toxic effect on the liver. They are able to quickly accumulate the active substance in the tissues, due to which the frequency of doses is reduced and the intervals between them increase.

What medications should I take depending on the disease?

Often the same broad-spectrum drug is prescribed for different diseases. But this does not mean that you can do without preliminary diagnosis. Only a correct diagnosis allows you to adequately select an antibiotic.

Treatment of bronchitis

Bronchitis is a common infectious and inflammatory disease that can lead to serious complications. The following medications may be prescribed to treat bronchitis:

Drug name		Contraindications	Dosage
"Sumamed"		age up to 6 months;	Children over 3 years old – 2 tablets of 125 mg per day. Children under 3 years old – 2.5 to 5 ml of suspension per day.
"Avelox"	A group of fluoroquinolones, the active substance is Moxifloxacin.	pregnancy and lactation; age under 18 years; heart rhythm disturbances; severe liver diseases.	1 tablet 400 mg per day
"Gatispan"	A group of fluoroquinolones, the active substance is Gatifloxacin.	pregnancy and lactation; age under 18 years; diabetes; heart rhythm disturbances; convulsions.	1 tablet 400 mg per day
"Flemoxin Solutab"		lymphocytic leukemia; gastrointestinal pathologies; pregnancy and lactation; Infectious mononucleosis.

Along with antibiotics, mucolytic and anti-inflammatory drugs are used in the treatment of bronchitis.

For pneumonia

Pneumonia should never be treated independently at home. This disease requires mandatory hospitalization and serious therapy with intramuscular or intravenous antibiotics.

The following injection drugs can be used to treat pneumonia in a hospital:

• "Ticarcillin";
• "Carbenicillin";
• "Cefepime";
• "Meropenem."

In some cases, antibiotics are also prescribed in tablets. These may be drugs:

• "Tigeron";
• "Gatispan";
• "Sumamed";
• "Avelox".

The dosage and frequency of doses in this case is determined individually, based on the patient’s condition and therapeutic strategy.

Antibiotics for sinusitis

The decision to prescribe antibiotics for the treatment of sinusitis is made by an ENT doctor. Therapy with these drugs is mandatory if purulent discharge from the sinuses and intense headaches are observed:

Drug name	Group and active substance	Contraindications	Dosage
"AzitRus"	A group of macrolides, the active ingredient is Azithromycin.	severe liver dysfunction; age up to 3 years; individual intolerance.	Adults and children over 12 years old – 1 capsule or tablet of 500 mg per day. Children over 3 years old – 10 mg per 1 kg of weight per day.
"Faktiv"	A group of fluoroquinolones, the active substance is Gemifloxacin.	pregnancy and lactation; age under 18 years; heart rhythm disturbances; severe liver diseases.	1 tablet 320 mg per day
"Flemoclav Solutab"	Penicillin group, active ingredient – ​​Amoxicillin.	lymphocytic leukemia; gastrointestinal pathologies; pregnancy and lactation; age up to 3 years; Infectious mononucleosis.	Adults and children over 12 years old – 1 tablet of 500 mg 3 times a day. Children under 12 years old – 25 mg per 1 kg of weight per day.

Before prescribing antibiotics, an ENT doctor usually gives a referral for a bacterial culture and an antibiogram to determine the type of pathogen and its sensitivity to a particular active substance.

For sore throat

In everyday life, sore throat is commonly called acute tonsillitis - inflammation of the tonsils caused by viruses or bacteria. The bacterial form of sore throat is caused by streptococci or staphylococci, and this disease can only be treated with antibiotics:

Drug name	Group and active substance	Contraindications	Dosage
"Macropen"	A group of macrolides, the active substance is Midecamycin.	liver diseases; age up to 3 years; individual intolerance.	Adults and children weighing over 30 kg – 1 tablet 400 mg 3 times a day.
"Rulid"	A group of macrolides, the active ingredient is Roxithromycin.	age up to 2 months; pregnancy and lactation.	Adults and children weighing over 40 kg – 2 tablets of 150 mg 1-2 times a day. In other cases, the dosage is calculated individually.
"Flemoxin Solutab"	Penicillin group, active ingredient – ​​Amoxicillin.	lymphocytic leukemia; gastrointestinal pathologies; pregnancy and lactation; Infectious mononucleosis.	Adults – 1 tablet 500 mg 2 times a day. Children over 10 years old – 2 tablets of 250 mg 2 times a day. Children over 3 years old – 1 tablet 250 mg 3 times a day. Children under 3 years old – 1 tablet 125 mg 3 times a day.

It is important to understand that if acute tonsillitis is not bacterial, but viral in nature, it is useless to treat it with antibiotics. Only a doctor can distinguish between these two forms of the disease, so you should not take any medications without his consultation.

Colds and flu

Respiratory infections, which in everyday life are called colds, as well as influenza are caused by viruses. Therefore, antibiotics are used in their treatment only in one case: if the disease becomes complicated and a bacterial infection joins the viral infection.

In such situations, therapy is usually started with penicillin antibiotics:

• "Flemoxin Solutab";
• "Flemoklav Solutab".

If no improvement is observed after 72 hours after starting to take these drugs, new generation macrolides are added to therapy:

• "Sumamed";
• "Rulid";
• "AzitRus".

The regimen for taking antibiotics for the treatment of respiratory infections is standard, but medical supervision is also necessary in this case.

Infections of the genitourinary system

Urogenital infections can be caused by pathogens of different nature - viruses, fungi, bacteria, protozoa. Therefore, it makes sense to start treatment only after a thorough laboratory diagnosis and determination of the type of pathogen.

In mild cases, the infection can be removed from the urinary tract using the following medications:

• “Furadonin” – 2 mg per 1 kg of weight 3 times a day;
• “Furazolidone” – 2 tablets 0.05 g 4 times a day;
• “Palin” – 1 capsule 2 times a day.

In more complex situations, when pathogens are highly resistant (resistant) to chemical influences, broad-spectrum antibiotics can be prescribed:

Drug name	Group and active substance	Contraindications	Dosage
"Abaktal"	A group of fluoroquinolones, the active substance is Pefloxacin.	pregnancy and lactation; age under 18 years; hemolytic anemia; individual intolerance.	1 tablet 400 mg 1-2 times a day.
"Monural"	A derivative of phosphonic acid, the active substance is Fosfomycin.	age up to 5 years; individual intolerance; severe renal failure.	Single dose – dissolve 3 g of powder in 50 g of water and take on an empty stomach before bed.
"Cefixime"	A group of cephalosporins, the active substance is Cefixime.	individual intolerance.	Adults and children over 12 years old – 1 tablet of 400 mg 1 time per day. Children under 12 years old – 8 mg per 1 kg of weight 1 time per day.

Along with antibiotics, in the treatment of genitourinary infections, plenty of fluids and diuretics are prescribed. In severe cases, injections of the drug Amikacin are advisable.

Antifungal drugs

To treat fungal infections, drugs with fungistatic or fungicidal effects are used. They differ from the drugs listed above and are classified into a separate class, within which there are three groups:

As in the treatment of bacterial infections, therapy for fungal diseases requires accurate diagnosis of the pathogen and strict supervision by a specialist.

For eye disease

Antibiotics for the treatment of eye diseases are available in the form of ointments or drops. They are prescribed if the ophthalmologist has diagnosed conjunctivitis, blepharitis, meibomitis, keratitis and a number of other infections.

Most often, therapy is carried out using the following drugs:

Inexpensive new generation antibiotics

The cost of new generation antibiotics is never low, so you can save money only by buying inexpensive analogues. They are produced on the basis of the same active ingredients, however, the degree of chemical purification of such drugs may be lower, and the auxiliary substances for their production are the cheapest.

You can replace some expensive antibiotics using the following table:

Another way to save money is to buy older antibiotics, not the latest generation.

For example, in many cases the following proven antibacterial drugs can help out:

• "Erythromycin";
• "Ceftriaxone";
• "Bicillin";
• "Cefazolin";
• "Ampicillin."

If more than 72 hours have passed after starting treatment with inexpensive antibiotics, and no improvement is observed, you should urgently consult a doctor and change the drug.

Can it be used during pregnancy?

Antibiotics during pregnancy are prescribed by doctors only in emergency cases and after a thorough analysis of possible risks.

But even in such situations, drugs of the following groups are not used:

• all fluoroquinolones;
• macrolides based on roxithromycin, clarithromycin, midecamycin;
• all aminoglycosides.

Only the attending physician can decide on the advisability of prescribing antibiotics during pregnancy. Self-administration of any medications, even relatively safe ones and those belonging to the new generation, is strictly prohibited.

According to the spectrum of activity antimicrobial drugs are divided into: antibacterial, antifungal and antiprotozoal. In addition, all antimicrobial agents are divided into drugs with a narrow and wide spectrum of action.

Narrow-spectrum drugs primarily targeting gram-positive microorganisms include, for example, natural penicillins, macrolides, lincomycin, fusidine, oxacillin, vancomycin, and first-generation cephalosporins. Narrow-spectrum drugs primarily targeting gram-negative bacilli include polymyxins and monobactams. Broad-spectrum drugs include tetracyclines, chloramphenicol, aminoglycosides, most semisynthetic penicillins, cephalosporins starting from the 2nd generation, carbopenems, fluoroquinolones. The antifungal drugs nystatin and levorin (only against candida) have a narrow spectrum, and clotrimazole, miconazole, amphotericin B have a wide spectrum.

By type of interaction with a microbial cell antimicrobial drugs are divided into:

· bactericidal - irreversibly disrupt the functions of the microbial cell or its integrity, causing immediate death of the microorganism, used for severe infections and in weakened patients,

· bacteriostatic - reversibly block cell replication or division, used for mild infections in non-weakened patients.

According to acid resistance antimicrobial drugs are classified into:

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

· acid-labile - intended only for parenteral use, for example, benzylpenicillin.

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

¨ Lactam antibiotics

Lactam antibiotics ( table 9.2) Of all antimicrobial drugs, they are the least toxic, since, by disrupting the synthesis of the bacterial cell wall, they have no target in the human body. Their use in cases where pathogens are sensitive to them is preferable. Carbapenems have the widest spectrum of action among lactam antibiotics; they are used as reserve drugs - only for infections resistant to penicillins and cephalosporins, as well as for hospital-acquired and polymicrobial infections.

¨ Antibiotics of other groups

Antibiotics of other groups ( table 9.3) have different mechanisms of action. Bacteriostatic drugs disrupt the stages of protein synthesis on ribosomes, while bactericidal drugs disrupt either the integrity of the cytoplasmic membrane or the process of DNA and RNA synthesis. In any case, they have a target in the human body, therefore, compared to lactam drugs, they are more toxic, and should be used only when it is impossible to use the latter.

¨ Synthetic antibacterial drugs

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

¨ Side effects of antimicrobial drugs,

their prevention and treatment

Antimicrobial drugs have a wide variety of side effects, some of which can lead to serious complications and even death.

Allergic reactions

Allergic reactions can occur when using any antimicrobial drug. Allergic dermatitis, bronchospasm, rhinitis, arthritis, Quincke's edema, anaphylactic shock, vasculitis, nephritis, lupus-like syndrome may develop. Most often they are observed with the use of penicillins and sulfonamides. Some patients develop cross-allergy to penicillins and cephalosporins. Allergies to vancomycin and sulfonamides are often observed. Very rarely, aminoglycosides and chloramphenicol cause allergic reactions.

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

Irritant effect on routes of administration

When administered orally, the irritant effect can be expressed in dyspepsia, and when administered intravenously, it can result in the development of phlebitis. Thrombophlebitis is most often caused by cephalosporins and glycopeptides.

Superinfection, including dysbacteriosis

The likelihood of dysbacteriosis depends on the breadth of the spectrum of action of the drug. The most common candidomycosis develops when using narrow-spectrum drugs after a week, when using broad-spectrum drugs - already from one tablet. However, cephalosporins cause fungal superinfection relatively rarely. Lincomycin ranks first in the frequency and severity of dysbiosis caused. Disorders of the flora during its use can take the form of pseudomembranous colitis - a severe intestinal disease caused by clostridia, accompanied by diarrhea, dehydration, electrolyte disturbances, and in some cases complicated by perforation of the colon. Glycopeptides can also cause pseudomembranous colitis. Tetracyclines, fluoroquinolones, and chloramphenicol often cause dysbacteriosis.

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

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

Organ-specific side effects for various groups of drugs:

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

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

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

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

· Myocarditis is a side effect of chloramphenicol.

· Dyspepsia, which is not a consequence of dysbacteriosis, is typical when using macrolides that have prokinetic properties.

· Various lesions of the central nervous system develop from many antimicrobial drugs. Observed:

Psychoses during treatment with chloramphenicol,

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

Headache and central vomiting when using sulfonamides and nitrofurans,

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

Convulsions when using imipenem,

Excitement when using fluoroquinolones,

Meningism when treated with tetracyclines due to their increase in cerebrospinal fluid production,

Visual impairment during treatment with aztreonam and chloramphenicol,

Peripheral neuropathy when using isoniazid, metronidazole, chloramphenicol.

· Hearing damage and vestibular disorders are a side effect of aminoglycosides, more characteristic of the 1st generation. Since this effect is associated with the accumulation of drugs, the duration of their use should not exceed 7 days. Additional risk factors include old age, renal failure and concomitant use of loop diuretics. Vancomycin causes reversible changes in hearing. If there are complaints of hearing loss, dizziness, nausea, or unsteadiness when walking, it is necessary to replace the antibiotic with drugs from other groups.

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

· Hypofunction of the thyroid gland is caused by sulfonamides.

· Teratogenicity is inherent in tetracyclines, fluoroquinolones, and sulfonamides.

· Paralysis of the respiratory muscles is possible with rapid intravenous administration of lincomycin and cardiodepression with rapid intravenous administration of tetracyclines.

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

Microbiological diagnostics

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

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

Prevention of contamination by other microflora.

Transportation of the material must, on the one hand, ensure the viability of bacteria, and on the other hand, prevent their reproduction. It is advisable that the material be stored at room temperature before the start of the study and for no more than 2 hours. Currently, special tightly closed sterile containers and transport media are used for collecting and transporting material.

To no less an extent, the effectiveness of microbiological diagnostics depends on the competent interpretation of the results. It is believed that the isolation of pathogenic microorganisms, even in small quantities, always allows them to be classified as the true causative agents of the disease. A conditionally pathogenic microorganism is considered a pathogen if it is isolated from normally sterile environments of the body or in large quantities from environments not typical for its habitat. Otherwise, it is a representative of normal autoflora or contaminates the test material during collection or research. Isolation of low-pathogenic bacteria from areas uncharacteristic of their habitat in moderate quantities indicates the translocation of microorganisms, but does not allow them to be classified as the true causative agents of the disease.

It can be much more difficult to interpret the results of a microbiological study when culturing several types of microorganisms. In such cases, they focus on the quantitative ratio of potential pathogens. More often, 1-2 of them are significant in the etiology of this disease. It should be borne in mind that the likelihood of equal etiological significance of more than 3 different types of microorganisms is negligible.

Laboratory tests for the production of ESBLs by Gram-negative microorganisms are based on the sensitivity of ESBLs to beta-lactamase inhibitors such as clavulanic acid, sulbactam and tazobactam. Moreover, if a microorganism of the Enterobacteriaceae family is resistant to 3rd generation cephalosporins, and when beta-lactamase inhibitors are added to these drugs, it demonstrates sensitivity, then this strain is identified as ESBL-producing.

Antibiotic therapy should be aimed only at the true causative agent of the infection! However, in most hospitals, microbiological laboratories cannot establish the etiology of infection and the sensitivity of pathogens to antimicrobial drugs on the day of admission of the patient, so the initial empirical prescription of antibiotics is inevitable. At the same time, the peculiarities of the etiology of infections of various localizations characteristic of a given medical institution are taken into account. In this connection, regular microbiological studies of the structure of infectious diseases and the sensitivity of their pathogens to antibacterial drugs are necessary in each hospital. Analysis of the results of such microbiological monitoring must be carried out monthly.

Table 9.2.

Lactam antibiotics.

Group of drugs		Name	Characteristics of the drug
Penicillins	Natural penicillins	sodium and potassium salts of benzylpenicillin	administered only parenterally, effective for 3-4 hours			highly effective in their spectrum of action, but this spectrum is narrow, in addition, the drugs are lactamase unstable
		bicillin 1,3,5	administered only par-enterally, lasts from 7 to 30 days
		phenoxymethylpenicillin	drug for oral administration
	Antistaphylococcal	oxacillin, methicillin, cloxacillin, dicloxacillin	have less antimicrobial activity than natural penicillins, but are resistant to staphylococcal lactamases, can be used orally
	Amino penicillins	ampicillin, amoxicillin, bacampicillin	broad-spectrum drugs that can be used orally, but not resistant to beta-lactamases
	Combined bathrooms	Ampiox - ampicillin+ Oxacillin	a broad-spectrum drug resistant to beta-lactamases, can be used orally
	Antisinopurulent	carbenicillin, ticarcillin, azlocillin, piperacillin, mezlocillin	have a wide spectrum of action, act on strains of Pseudomonas aeruginosa that do not produce beta-lactamases; during treatment, bacterial resistance to them can quickly develop
	Lactamase protected - preparations with clavulanic acid, tazobactam, sulbactam	amoxiclav, tazocin, timentin, cyazine,	the drugs are a combination of broad-spectrum penicillins and beta-lactamase inhibitors, therefore they act on bacterial strains that produce beta-lactamases
Cephalosporins	1st generation	cefazolin	antistaphylococcal drug for parenteral approx.		you are not resistant to lactactases, they have a narrow spectrum of action		With each generation of cephalosporins, their spectrum expands and toxicity decreases; cephalosporins are well tolerated and occupy first place in frequency of use in hospitals
		cephalexin and cefaclor	applied per os
	2 generations	cefaclor, cefuraxime	applied per os		resistant to lactams, spectrum includes both gram-positive and gram-negative bacteria
		cefamandole, cefoxitin, cefuroxime, cefotetan, cefmetazole	used only parenterally
	3 generations	ceftizoxime, cefotaxime, ceftriaxone, ceftazidime, cefoperazone, cefmenoxime	only for parenteral use, have anti-blue purulent activity		resistant to lactamases of gram-negative bactheniums, not effective against staphylococcal infections
		cefixime, ceftibuten, cefpodoxime, cefetamet	used per os, have anti-anaerobic activity
	4 generations	cefipime, cefpirone	the widest spectrum of action, used parenterally
Cephalosporins with beta-lactamase inhibitors		sulperazon	Has the spectrum of action of cefoperazone, but also acts on lactamase-producing strains
Carbapenems	imipenem and its combination with cilostatin, which protects against destruction in the kidneys - tienam	More active against gram-positive microorganisms		have the widest spectrum of action among lactam antibiotics, including anaerobes and Pseudomonas aeruginosa, and are resistant to all lactamases, resistance to them practically does not develop, they can be used for almost any pathogen, excluding methicillin-resistant strains of staphylococcus, and as monotherapy even for severe infections, have an aftereffect
	meropenem	More active against gram-negative microorganisms
	ertapenem
Mono-bactams	Aztreons	a narrow-spectrum drug, acts only on gram-negative bacilli, but is very effective and resistant to all lactamases

Table 9.3.

Antibiotics of other groups.

Group of drugs	Name	Characteristics of the drug
Glyco-peptides	vancomycin, teicoplamin	have a narrow gram-positive spectrum, but are very effective in it, in particular they act on methicillin-resistant staphylococci and L-forms of microorganisms
Polymyxins		These are the most toxic antibiotics; they are used only for topical use, in particular per os, since they are not absorbed into the gastrointestinal tract
Fuzidin		low toxic but also low effective antibiotic
Levomycetin		highly toxic, currently used mainly for meningococcal, eye and especially dangerous infections
Lincos-amines	lincomycin, clindamycin	less toxic, act on staphylococcus and anaerobic cocci, penetrate well into bones
Tetra-cyclins	natural - tetracycline, semi-synthetic - metacycline, synthetic - doxycycline, minocycline	broad-spectrum antibiotics, including anaerobes and intracellular pathogens, are toxic
Amino-glycosides	1st generation: streptomycinkanamycin monomycin	highly toxic, used only locally for decontamination of the gastrointestinal tract, for tuberculosis	toxic antibiotics with a fairly broad spectrum of action, have a poor effect on gram-positive and anaerobic microorganisms, but enhance the effect of lactam antibiotics on them, and their toxicity decreases in each subsequent generation
	2nd generation: gentamicin	widely used for surgical infections
	3 generations: amikacin, sisomycin, netilmicin, tobramycin	act on some microorganisms resistant to gentamicin; against Pseudomonas aeruginosa, tobramycin is the most effective
Macro leads	natural: erythromycin, oleandomycin	low toxic, but also low effective, narrow-spectrum antibiotics, act only on gram-positive cocci and intracellular pathogens, can be used per os
	semi-synthetic: rock-sithromycin, clarithromycin, flurithromycin	also act on intracellular pathogens, the spectrum is somewhat wider, in particular includes Helicobacter and Moraxella, they pass through all barriers in the body well, penetrate various tissues, and have an aftereffect of up to 7 days
	azolides: azithromycin (sumamed)	have the same properties as semisynthetic macrolides
Rifampicin		used mainly for tuberculosis
Antifungal antibiotics	fluconazole, amphotericin B	amphotericin B is highly toxic and is used when pathogens are not sensitive to fluconazole

Table 9.4.

Synthetic antibacterial drugs.

Group of drugs		Name	Characteristics of the drug
Sulfonamides	Resorptive action	norsulfazole, streptocide, etazol	short-acting drugs	broad-spectrum drugs; pathogens often develop cross-resistance to all drugs in this series
		sulfadimethoxine, sulfapyridazine, sulfalene	long-acting drugs
	Acting in the intestinal lumen	phthalazole, sulgin, salazopyridazine	salazopyridazine - used for Crohn's disease, ulcerative colitis
	Local application	sulfacyl sodium	mainly used in ophthalmology
Nitrofuran derivatives		furagin, furazolidone, nitrofurantoin	have a wide spectrum of action, including clostridia and protozoa; unlike most antibiotics, they do not inhibit, but stimulate the immune system; they are used topically and per os
Quinoxaline derivatives		quinoxidine, dioxidine	have a wide spectrum of action, including anaerobes, dioxidin is used topically or parenterally
Quinolone derivatives		nevigramon, oxolinic and pipemidic acid	act on a group of intestinal gram-negative microorganisms, are used mainly for urological infections, resistance to them quickly develops
Fluoroquinolones		ofloxacin, ciprofloxacin, pefloxacin, lomefloxacin, sparfloxacin, levofloxacin, gatifloxacin, moxifloxacin, gemifloxacin	highly effective broad-spectrum drugs that act on Pseudomonas aeruginosa and intracellular pathogens, are well tolerated against many lactamase-producing strains, are widely used in surgery, ciprofloxacin has the greatest antipseudomonas activity, and moxifloxacin has the greatest antianaerobic activity
8-hydroxyquinoline derivatives		nitroxoline, enteroseptol	act on many microorganisms, fungi, protozoa, are used in urology and intestinal infections
Nitroimide-ash		metronidazole, tinidazole	act on anaerobic microorganisms, protozoa
Specific antituberculosis, antisyphilitic, antiviral, antitumor drugs			used mainly in specialized institutions

These agents can block the spread of pathogenic agents or have a detrimental effect on them. But in order for the fight against them to be successful, it is necessary to establish exactly which ones. In some cases, it is impossible to determine the diagnosis and the best solution is broad-spectrum antimicrobial drugs.

Features of the fight against pathogens

It is important to consider that many antimicrobial drugs have a powerful effect not only on foreign agents, but also on the patient’s body. Thus, they have a detrimental effect on the microflora of the gastric region and some other organs. To cause minimal damage, it is important to begin treatment immediately, as microorganisms spread at a rapid rate. If you miss this moment, the fight against them will be longer and more exhausting.

In addition, if it is necessary to use antimicrobial drugs for treatment, they must be prescribed in maximum quantities so that microorganisms do not have time to adapt. The prescribed course cannot be interrupted, even if improvements are noticed.

It is also recommended to use different antimicrobial drugs in treatment, rather than just one type. This is necessary so that after the completed therapy there are no foreign agents left that have adapted to a particular drug.

In addition to this, be sure to take a course that will strengthen the body. Because many drugs can cause serious allergic reactions, they should be taken only as directed by your doctor.

Sulfa drugs

We can say that they are divided into three types - these are nitrofurans, antibiotics and sulfonamides. The latter agents have their destructive effect because they do not allow microbes to obtain folic acid and other components that are important for their reproduction and life. But premature termination of the treatment course or a small amount of the drug gives the microorganisms the opportunity to adapt to new conditions. In the future, sulfonamides are no longer able to fight.

This group includes well-absorbed drugs: Norsulfazol, Streptotsid, Sulfadimezin, Etazol. Also worth noting are medications that are difficult to absorb: Sulgin, Phthalazol and others.

If necessary, for better results, the doctor may recommend combining these two types of sulfonamide drugs. It is also possible to combine them with antibiotics. Some antimicrobial drugs are described below.

"Streptocide"

This drug is mainly prescribed for the treatment of sore throat, cystitis, pyelitis, and erysipelas. In some cases, the medicine may cause side effects such as headache, severe nausea accompanied by vomiting, and some complications from the nervous, hematopoietic or cardiovascular systems. But medicine does not stand still, and similar drugs are used in practice, but they have fewer adverse reactions. Such drugs include "Etazol" and "Sulfadimezin".

"Streptocide" can also be applied topically to burns, festering wounds, and skin ulcers. In addition, you can inhale the powder through your nose if you have an acute runny nose.

"Norsulfazol"

This drug is effective for cerebral meningitis, pneumonia, sepsis, gonorrhea, etc. This antimicrobial agent quickly leaves the body, but you must drink a large amount of water per day.

"Inhalipt"

Good antimicrobial drugs for the throat, which are prescribed for laryngitis, ulcerative stomatitis, pharyngitis, are those that contain streptocide and norsulfazole. Such means include "Inhalipt". Among other things, it contains thymol, alcohol, mint and eucalyptus oil. It is an antiseptic and anti-inflammatory agent.

"Furacilin"

This is an antibacterial liquid known to many, which has a detrimental effect on various microbes. The medicine can be used externally, treating wounds, washing the nasal and ear canals, as well as internally for bacterial dysentery. Some antibacterial and antimicrobial drugs are produced on the basis of Furacilin.

"Fthalazol"

This slowly absorbed drug can be combined with antibiotics. It is also combined with Etazol, Sulfadimezin and other drugs. It actively works by suppressing intestinal infections. Effective for dysentery, gastroenteritis, colitis.

Nitrofuran

In medicine there are many drugs that are derivatives of Nitrofuran. Such remedies have a broad effect. For example, "Furagin" and "Furadonin" are often prescribed for cystitis, urethritis, pyelonephritis and other infectious diseases of the genitourinary system.

"Penicillin"

The drug is an antibiotic that has a detrimental effect on young microbes. It is ineffective in the fight against influenza, smallpox and other viral diseases. But for pneumonia, peritonitis, abscess, sepsis, meningitis, Penicillin is a good help. Various drugs are obtained from it that are superior to it in action, for example, “Benzylpenicillin”. These medications are low-toxic and cause virtually no complications. That is why it is believed that these are strong antimicrobial drugs for children.

But it is still worth considering that low-quality medicine can cause severe allergies. It can also suppress the natural intestinal microflora in the elderly and newborns. For weakened people or in childhood, vitamins C and B are prescribed simultaneously with Penicillin.

"Levomycetin"

Strains resistant to Penicillin are inhibited by Levomycetin. It has no effect on protozoa, acid-fast bacteria, anaerobes. For psoriasis and skin diseases, this drug is contraindicated. It is also forbidden to take it if hematopoiesis is suppressed.

"Streptomycin"

This antibiotic has several derivatives that help in different situations. For example, some can treat pneumonia, others are effective against peritonitis, and still others cope with infections of the genitourinary system. Note that the use of “Streptomycin” and its derivatives is permissible only after a doctor’s prescription, since an overdose does not exclude such a serious complication as hearing loss.

"Tetracycline"

This antibiotic is able to cope with many bacteria that cannot be treated with other drugs. Side effects may occur. "Tetracycline" can be combined with "Penicillin" in case of severe septic condition. There is also an ointment that copes with skin diseases.

"Erythromycin"

This antibiotic is considered a “backup option”, which is resorted to if other antimicrobial agents have not coped with their task. It successfully defeats diseases caused by the action of resistant strains of staphylococci. There is also erythromycin ointment, which helps with bedsores, burns, purulent or infected wounds, and trophic ulcers.

The main broad-spectrum antimicrobials are listed below:

• "Tetracycline".
• "Levomycetin".
• "Ampicillin."
• "Rifampicin".
• "Neomycin".
• "Monomycin".
• "Rifamcin."
• "Imipenem."
• "Cephalosporins".

Gynecology and antibacterial treatment

If in any other area a disease can be attacked with broad-spectrum antibacterial drugs, then in gynecology it is necessary to strike with a well-selected, narrowly targeted agent. Depending on the microflora, not only medications are prescribed, but also their dosage and course duration.

Most often, antimicrobial drugs in gynecology are used externally. These can be suppositories, ointments, capsules. In some cases, if necessary, treatment is supplemented with broad-spectrum drugs. These may include "Terzhinan", "Poliginax" and others. Faster results can be achieved if you take two or three drugs at the same time. In any case, preliminary consultation with a doctor is important.

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

Types of drugs and their features

Antimicrobial drugs have a number of common specific characteristics and are divided into several types depending on:

• Depending on the area of ​​application (antiseptic, disinfectant)
• Directions of action (antifungal, antiviral)
• Method of production (antibiotics, synthetic agents, natural medicines).

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

Synthetic drugs are usually prescribed if there is intolerance to antibiotics or lack of microflora response to them. They are highly active antimicrobial drugs and are often used for infections of the gastrointestinal tract, respiratory tract and genitourinary system.
Natural remedies help to avoid certain diseases and are used for preventive purposes. These are infusions of herbs, berries, honey and more.

Choice of drug

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