Macrolide contraindications. Macrolides: a group of antibiotics of the latest generation in the treatment of ENT diseases

Many believe that antibiotics should be used only in extreme cases. However, this is not an entirely correct opinion, since the list of such drugs is replenished with drugs that are relatively safe - macrolides. Such antibiotics, basically without exerting on the human body negative impact, are capable of "in no time" to overcome the infection. The safe profile allows prescribing macrolides to patients undergoing outpatient and inpatient treatment, as well as to children aged 6 months and older (under medical supervision).

Few people know about the properties, origin and effect of such "harmless" remedies. And if you want to get acquainted with such drugs and find out in more detail what a macrolide antibiotic is, we suggest reading our article.

It should be noted immediately that macrolides belong to the group antibiotic drugs, which are the least toxic in relation to the human body, and are well tolerated by patients.

Antibiotics such as macrolides, from the point of view of biochemistry, are complex compounds of natural origin, which consist of carbon atoms, which are in different amounts in the macrocyclic lactone ring.

If we take this criterion, which is responsible for the number of carbon atoms, as the basis for the classification of drugs, then we can divide all such antimicrobial agents into:

Erythromycin, an antibiotic of the macrolide group, was one of the first to be discovered, in 1952. New generation drugs appeared a little later, in the 70s. Since they showed excellent results in the fight against infections, studies of this group medicines actively continued, thanks to which we currently have a fairly extensive list of drugs that can be used to treat both adults and children.

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Mechanism of action and scope

The antimicrobial effect is achieved by affecting the ribosomes of microbial cells, disrupting protein synthesis. Of course, under such an attack of macrolides, the infection weakens and “surrenders”. In addition, antibiotics of this group of drugs are able to regulate immunity, providing immunomodulatory activity. Also, these drugs have anti-inflammatory properties, affecting both the body of adults and children, quite moderately.

Group Tools antibacterial agents new generation are able to cope with atypical microbacteria, gram-positive cocci and similar misfortunes, which often become the causative agents of diseases such as bronchitis, whooping cough, diphtheria, pneumonia, etc.

No less popular are macrolides in the situation that has developed over the past few years, due to addiction. a large number microbes to antibiotics (resistance). This is due to the fact that new generation drugs belonging to this group are able to maintain their activity against a variety of pathogens.

In particular, wide use received macrolide preparations during treatment and as prophylactic from the following diseases:

• Chronical bronchitis;
• acute sinusitis;
• periostitis;
• periodontitis;
• rheumatism;
• endocarditis;
• gastroenteritis;
• severe forms of toxoplasmosis, acne, mycobacteriosis.

List of diseases that can be overcome using new generation antibiotics that have common name- macrolides, can supplement sexually transmitted infections - syphilis, chlamydia and infections that affect soft tissues and skin - furunculosis, folliculitis, paronychia.

Contraindications for use

If your doctor prescribes a similar antibiotic for you, immediately read its contraindications indicated in the instructions for the drug. Unlike most conventional antibiotics, new generation drugs - macrolides are safe, including for children, and less toxic. Therefore the list unwanted effects the antibiotics of this group are not as large as those of similar drugs.

First of all, it is not recommended to use macrolides for pregnant women and mothers during lactation. The use of such drugs in children under 6 months is contraindicated, since the reaction to the drug has not yet been studied. You should not use such drugs as a treatment for people who have individual sensitivity.

macrolide antibiotics with special attention should be prescribed by doctors to patients of mature age. This is due to the fact that most of the older generation have disorders in the functioning of the kidneys, liver and heart.

Side effects can also occur when using macrolides in a mild form - weakness and malaise that appear after taking them. But there may also be:

• vomit;
• nausea;
• headache and pain in the abdomen;
• impaired vision, hearing;
• an allergic reaction in the form of a rash, urticaria (most often occurs in children).

To avoid problems and undesirable consequences after the use of drugs of the macrolide group, it is necessary to strictly follow the recommendations of the doctor, strictly observe the dosage and refrain from drinking alcohol. It is also strictly forbidden to combine the intake of new generation antibiotics with antacids. It is also important not to skip appointments.

Basically, new generation antibiotics should be taken 1 hour before a meal, or 2 hours after a meal. Take the tablets with a whole glass of water. If the doctor has prescribed you an antibiotic of the macrolide group, the release form of which is a powder for the preparation of a suspension, strictly follow the instructions for preparing the medicine and strictly follow the doctor's instructions.

Application and appointment to children

In the fight against bacterial and other diseases that have arisen in children, the first place today is occupied by antibiotics - macrolides. This is one of the few groups of drugs that have earned the respect of specialists and are boldly used in pediatrics. The advantage of such medications, unlike other similar ones, is that they practically do not cause allergic reactions in young patients. In particular, this applies to drugs that have names - "Penicillin" and "Cefalosporin".

Despite the fact that macrolides are safe for children, they have enough effective action. Their impact in a mild form on the child's body is provided by the pharmacokinetic properties inherent in the preparations. One of the most popular means, which represent the group of macrolides, are:

• Clarithromycin;
• Roxithromycin;
• Spiramycin etc.

The dosage of the use of such drugs for children depends on the type of disease and the weight of the child. Therefore, try to follow the doctor's recommendations. In general, the produced forms of such funds are very convenient to use. Some of them are in the form of ointments for external use, and are also intended for parenteral use of the form, which, in turn, is relevant for children in emergency situations.

Summing up, we can safely say that macrolides, like antibiotics, are “white and fluffy”. Virtually no side effects and undesirable consequences, these new generation drugs have found their acceptance among many doctors and specialists. Effective, and able to cope even with severe forms of diseases, such antibiotics are used even in the treatment of children.

Macrolides are a group antibacterial drugs, whose structure is based on a macrocyclic lactone ring. Due to the ability to disrupt the formation of bacterial proteins, macrolide antibiotics stop their vital activity. In high dosages, drugs completely destroy microorganisms.

Macrolide antibiotics are active against:

• gram-positive bacteria (streptococci, staphylococci, mycobacteria, etc.);
• Gram-negative rods (Enterobacteriaceae, Helicobacter pylori, Haemophilus influenzae, etc.);
• intracellular microorganisms (moraxella, legionella, mycoplasma, chlamydia, etc.).

The action of macrolides is mainly aimed at the treatment of infectious diseases of the respiratory tract due to atypical and gram-positive pathogens.

Popular drugs

In the list of antibiotics of the macrolide group, two substances are most often used on this moment:

• clarithromycin;
• azithromycin.

These are representatives of two different generations of macrolide drugs. Of these, azithromycin was later obtained. Despite the fact that they are united by the mechanism of action on microbes and belonging to the same group, there are significant differences:

Compare parameter	Azithromycin	Clarithromycin
Microbial spectrum of action	Intracellular organisms (chlamydia, mycoplasma, ureaplasma, legionella). Streptococci. Staphylococci (except for those resistant to erythromycin - for azithromycin). Anaerobes (clostridia, bacteroids). Gram-negative bacteria (haemophilus influenzae, moraxella, meningococcus, whooping cough).
	Gonococcus. Spirochetes.	Mycobacteria, incl. tuberculosis. Toxoplasma. Meningococcus. Helicobacter pylori.
Effect Speed	Within 2-3 hours. A stable concentration of the drug in the blood appears after 5-7 days of regular intake.	Within 2-3 hours. A stable concentration of the drug in the blood - after 2-3 days of regular intake.
Efficiency	Equal efficacy in the treatment of Helicobacter pylori gastritis. Azithromycin is better distributed to the tissues of the lung in the treatment of lung infection, however, the effectiveness of the drug is similar to clarithromycin in a similar case of administration. Azithromycin is more effective in legionellosis.
Adverse reactions	Central and peripheral nervous system : systemic dizziness, headaches, nightmares, general excitability, hallucinations, sleep-wake rhythm disturbance. heart and vascular bed : palpitations, tachycardia. digestive tract : nausea, vomiting, abdominal pain, diarrhea, short-term increase in liver enzymes (alanine and aspartate aminotransferase), jaundice. Allergic manifestations : rash (urticaria), itching.
	Vaginal candidiasis. Anaphylactic shock (rare). Increased sensitivity to ultraviolet light. Candidiasis of the oral mucosa.	Violation of the electrical conduction of the myocardium in the form of arrhythmias (rarely). Decreased platelet count (rare). Insufficiency of renal function (rarely). Anaphylactic shock. Angioedema. Malignant exudative erythema(Stevens-Johnson syndrome).
Safety for pregnant and lactating patients	You should stop lactating. Use during pregnancy may be allowed if the benefits of the drug are expected to outweigh the risks to the fetus.

Thus, the benefits of azithromycin include a smaller amount adverse reactions in the form of severe life-threatening conditions.

For clarithromycin, the advantages of using are a wider spectrum of action and the rapid achievement of a stable level in the patient's blood.

The main disadvantage for both macrolide antibiotics is unwanted use for pregnant women, which complicates the choice of the drug in this population.

Macrolide classification

All generations of macrolides that have appeared as scientific research has progressed are divided according to their origin into natural and semi-synthetic. The former are derivatives of natural raw materials, the latter are artificially obtained medicinal substances.

It is also important to divide drugs according to their structural features. Depending on how many carbon atoms the macrolide ring of a substance contains, they are divided into 3 large generations:

14 member

Representatives	Tradename	Method of application, price
Oleandomycin	Oleandomycin phosphate	Powder-substance . Outdated macrolide, almost never found in pharmacies.
Clarithromycin	Klacid	Tablets : 0.5 g x 2 times a day, taking 14 days. 500-800 rub.
		Granules for oral suspension in a vial : slowly pour water up to the mark, shake the bottle, drink twice a day (the bottle contains 0.125 or 0.25 g of the substance). 350-450 rub.
		Solution for intravenous administration : 0.5 g x 2 times a day ( daily dose- 1.0 g), after mixing with a solvent. 650-700 rub.
	Clarithrosin	Tablets : 0.25 g x 2 times a day, regardless of food intake, course 14 days. 100-150 rub.
	Fromilid	Tablets : 0.5 g x 2 times a day, regardless of food intake, course 14 days. 290-680 rub.
	Clarithromycin-Teva	Tablets : 0.25 g x 2 times a day for a course of 7 days or increase the dose to 0.5 g x 2 times a day for a course of 2 weeks. 380-530 rub.
Erythromycin	Erythromycin	Tablets : 0.2-0.4 g four times a day before (30-60 minutes) or after meals (after 1.5-2 hours), washed down with water, the course is 7-10 days. 70-90 rub.
		Eye ointment : place on the lower eyelid three times a day, the course is 14 days. 70-140 rub.
		Ointment for external use : on the affected skin with a small layer 2-3 times a day, the duration of the course is determined individually, depending on the severity of the pathology. 80-100 rub.
		Lyophilisate for the preparation of intravenous solution : 0.2 g of a substance diluted with a solvent, 3 times a day. Maximum duration application - 2 weeks. 550-590 rub.
Roxithromycin	Esparoxy	Tablets : 0.15 g x 2 times a day 15 minutes before meals or 0.3 g once, a course of 10 days. 330-350 rub.
	Rulid	Tablets : 0.15 g x 2 times a day, course 10 days. 1000-1400 rub.
	RoxyGEKSAL	Tablets : 0.15 g x 2 times a day or 0.3 mg in one dose, a course of 10 days. 100-170 rub.

15 member

Representatives	Tradename	Method of application, price
Azithromycin	Sumamed	Tablets : 0.5 g x 1 time per day one hour before or 2 hours after meals. 200-580 rub.
		: add 11 ml of water to the contents of the vial, shake, take once a day one hour before or 1.5-2 hours after meals. 200-570 rub.
		Capsules : 0.5 g (1 capsule) once a day one hour before or 2 hours after a meal. 450-500 rub.
	Azitral	Capsules : 0.25 / 0.5 g x 1 time per day before or 2 hours after meals. 280-330 rub.
	Zitrolide	Capsules : 2 capsules (0.5 g) in one dose 1 time per day. 280-350 rub.
	Azitrox	Capsules : 0.25 / 0.5 g x 1 time per day. 280-330 rub.
		Powder for oral suspension in vials : add 9.5 ml of water to the vial, shake, take 2 times a day. 120-370 rub.

16 member

Representatives	Tradename	Method of application, price
Spiramycin	Rovamycin	Tablets : 2-3 tablets (3 million IU each) or 4-6 tablets (6-9 million IU) in 2-3 oral doses per day. 1000-1700 rub.
	Spiramycin-vero	Tablets : 2-3 tablets (3 million IU each) for 2-3 oral doses per day. 220-1700 rub.
Midecamycin	macrofoam	Tablets : 0.4 g x 3 times a day, course 14 days. 250-350 rub.
Josamycin	Wilprafen	Tablets : 0.5 g x 2 times a day, without chewing, drinking plenty of water. 530-610 rubles
	Wilprafen Solutab	Tablets : 0.5 g x 2 times a day, without chewing or dissolving in 20 ml of water. 670-750 rub.

The list of 14-membered macrolides is distinguished by the development of a pronounced resistance of microorganisms to their action. That is why the first subgroup of macrolide antibiotics is not prescribed immediately, but only when other antibacterial agents are ineffective.

These are backup drugs. Oleandomycin and erythromycin are low toxic, almost never cause serious adverse reactions. More often you can meet nausea, vomiting, general malaise, allergies (urticaria, etc.). The first generation of macrolides should not be given to pregnant and lactating patients.

Among the list of 14-member drugs, clarithromycin is the most active against Helicobacter pylori, which made it possible to include it in one of the treatment regimens. chronic gastritis in people infected with this microorganism. It is three times more active than erythromycin in coccal infections and lasts twice as long. Oleandomycin, on the contrary, is almost never used at the present time, as it is outdated and does not show high antimicrobial activity.

Macrolides latest generation- the most modern representatives of the class. In particular, josamycin, with rare exceptions, has no effect on bacteria that have developed resistance. This is an effective and safe medicine that is allowed during the period of bearing a child and breastfeeding. Spiramycin is also acceptable during pregnancy, but is prohibited for lactating women, as it passes into breast milk. The drug midecamycin is a reserve macrolide, not recommended for expectant mothers and lactating women.

Application in childhood

The use of macrolides for children is a separate section: drugs in this group are not always allowed for use without restrictions. In addition, the recommended dosages of drugs are lower than those of the adult population, and are almost always calculated on the body weight of the baby.

Erythromycin intravenous solution can rarely cause acute toxic hepatitis The child has. A substance is prescribed at 30-40 mg per kilogram of mass, this daily dose is divided into 2-4 doses. The duration of the course is unchanged (7-10 days).

Preparations, including the macrolide clarithromycin, are limited to the appointment of newborns and infants up to 6 months. For children over 12 years of age, they are prescribed 250 mg twice a day.

Azithromycin is not used in children:

• up to 16 years (for infusion forms);
• up to 12 years old weighing less than 45 kg (for tablet and capsule form);
• up to six months (for suspension).

At the same time, the dosage for children over 12 years old with a body weight of more than 45 kg is the same as the adult dose. And a child of 3-12 years old with a weight of less than 45 kg is prescribed an antibiotic at a dose of 10 mg per kilogram once a day.

The dose of josamycin is 40-50 microns / kg. It is evenly divided into 2-3 doses per day. It is recommended to prescribe 1-2 grams. Spiramycin tablets of 1.5 million IU are not given to children under 3 years of age, 3 million IU tablets are not given to children under 18 years of age. The maximum dose is 300 IU per kilogram per day.

Bacterial resistance

Bacterial microorganisms are able to develop resistance (immunity) to the action of antibiotics. Macrolides are no exception. Bacteria included in the spectrum of action of macrolides "avoid" their influence in three ways:

• Modification of cellular components.
• antibiotic inactivation.
• Active "ejection" of the antibiotic from the cell.

In recent years, scientists have noted a worldwide increase in the resistance of bacterial organisms to the macrolide series. In the United States and Central and Southern Europe resistance reaches 15-40%. According to the Consilium Medicum portal, in addition to macrolide resistance, there is insufficient efficacy of aminoglycosides and methicillin (up to 30% of cases). For Turkey, Italy and Japanese lands, the immunity of bacteria ranges from 30-50%.

In Russia, the situation is also deteriorating over time. The results of the study under the supervision of the Research Clinical Institute of Otorhinolaryngology named after. L.I. Sverzhevsky state: the resistance of Staphylococcus pneumoniae (pneumococcus) in Moscow patients to 15-membered azithromycin increased by 12.9% (from 8.4% to 21.3%) in the period 2009-2016. In Yaroslavl, there is a low resistance of S. pyogenes to erythromycin (7.5-8.4%). But for Tomsk and Irkutsk this indicator turned out to be higher - 15.5% and 28.3%, respectively.

Macrolide group- one of the safest at present. A wide range of activity of drugs allows them to be successfully used in the treatment of infections of different severity, including as "reserve" drugs. But to prevent the development of microbial resistance, you should not drink these medicines on your own without first consulting a specialist.

Surely every person at least once in his life has encountered an infectious disease, the treatment of which cannot do without taking antibiotics, and many at least in general terms have an idea about the properties of these drugs and the features of their use. Antibiotics are divided into groups, the differences between which are mainly in chemical composition, mechanism of action and spectrum of activity.

In addition, drugs of different generations are classified in each group of antibiotics: antibiotics of the first, second generation, etc. The latest, new generation of antibiotics differs from the previous ones in fewer side effects, greater efficiency, and ease of administration. In this article, we will consider which drugs of the latest generation are included in the list of antibiotics from the macrolide group, and what are their features.

Characteristics and uses of macrolides

antibiotics related to pharmacological group macrolides are considered among the least toxic to the human body. These are complex compounds of natural and semi-synthetic origin. They are well tolerated by most patients, do not cause adverse reactions characteristic of antibiotics of other groups. Distinctive feature macrolides is the ability to penetrate into cells, creating high concentrations in them, quickly and well distributed in inflamed tissues and organs.

Macrolides have the following effect:

• bacteriostatic;
• anti-inflammatory;
• immunomodulatory.

The main indications for taking macrolide antibiotics are:

• infections of the respiratory tract and oral cavity (otitis media, sinusitis, tonsillitis, bronchitis, pneumonia, diphtheria, tuberculosis, etc.);
• diseases of the biliary tract;
• infectious eye diseases (conjunctivitis, trachoma, etc.);
• peptic ulcer;
• skin and soft tissue infections (severe acne, erysipelas, mastitis, etc.);
• urogenital infections, etc.

Modern macrolides

The first macrolide drug was erythromycin. It is worth noting that this drug is used in medical practice to this day, and its use shows good results. However, subsequently invented macrolide preparations, due to the fact that they have improved pharmacokinetic and microbiological parameters, are more preferred.

A new generation macrolide antibiotic is a substance from the azalide group - azithromycin (trade names: Summamed, Azithromax, Zatrin, Zomax, etc.). This drug is a derivative of erythromycin containing an additional nitrogen atom. The advantages of this drug are:

• high level of absorption;
• long half-life;
• acid stability
• the ability to be transported by leukocytes to the focus of inflammation;
• the possibility of reducing the duration of therapy and the frequency of taking the medication (once a day for 3 to 5 days).

Azithromycin is active against:

• staphylococcus;
• streptococcus;
• chlamydia;
• whooping cough;
• gardnerella;
• mycoplasma;
• mycobacteria;
• causative agents of syphilis and some other bacteria.

To a greater extent, the accumulation of the drug is observed in the lungs, bronchial secretions, sinuses, tonsils, and kidneys.

Latest generation macrolides for bronchitis

Preparations based on azithromycin are characterized by the most optimal spectrum antimicrobial activity in relation to typical and atypical pathogens of bronchitis. They easily penetrate bronchial secretions and sputum, block protein synthesis in bacterial cells, thereby preventing bacteria from multiplying. Macrolides can be used both in acute bacterial bronchitis and exacerbation of chronic bronchitis.

ANTIBIOTICS-MACROLIDES

Azithromycin (Azithromycin)

Synonyms: Sumamed.

Pharmachologic effect. Broad spectrum antibiotic. It is the first representative of a new group of macrolide antibiotics - azalides. When creating high concentrations in the focus of inflammation, it has a bactericidal (destroying bacteria) effect.

Gram-positive cocci are sensitive to azithromycin: Streptococcuspneumoniae, S.pyogenes, S.agalactiae, streptococci of groups C, F and G, S.viridans, Staphylococcusaureus; Gram-negative bacteria: Haemophilusinfluenzae, Moraxellacatarrhalis, Bordetellapertussis, B.parapertussis, Legionellapneumophila, H. ducrei, Campylobacterjejuni, Neisseriagonorrhoeae and Gardnerellavaginalis; some anaerobic (able to exist in the absence of oxygen) microorganisms: Bacteroidesbivius, Clostriditimperfingens, Peptostreptococcus spp .; as well as Chlamidiatrachomatis, Mycoplasmapneumoniae, Ureaplasmaurea-lyticum, Treponemapallidum, Borreliaburgdoferi. Azithromycin is not active against Gram-positive bacteria resistant to erythromycin.

Indications for use. Infectious diseases caused by pathogens sensitive to the drug: infections upper divisions respiratory tract and ENT organs - tonsillitis, sinusitis (inflammation of the paranasal sinuses), tonsillitis (inflammation palatine tonsils/gland/), otitis media(inflammation of the middle ear cavity); scarlet fever; lower respiratory tract infections - bacterial and atypical pneumonia(inflammation of the lungs), bronchitis (inflammation of the bronchi); infections of the skin and soft tissues - erysipelas, impetigo (superficial pustular skin lesions with the formation of purulent crusts), secondarily infected dermatoses ( skin diseases); infections urinary tract- gonorrheal and non-gonorrheal urethritis (inflammation urethra) and / or cervicitis (inflammation of the cervix); Lyme disease (borreliosis is an infectious disease caused by the Borrelia spirochete).

Method of application and dose. Before prescribing a drug to a patient, it is desirable to determine the sensitivity of the microflora to it that caused the disease in this patient. Azithromycin should be taken one hour before meals or 2 hours after meals. The drug is taken 1 time per day.

Adults with infections of the upper and lower respiratory tract, infections of the skin and soft tissues are prescribed 0.5 g on the 1st day, then 0.25 g from the 2nd to

5th day or 0.5 g daily for 3 days (course dose 1.5 g).

In acute infections of the urogenital (genitourinary) tract, 1 g is prescribed once (2 tablets of 0.5 g each).

In Lyme disease (borreliosis), for the treatment of the first stage (erythemamigrans), 1 g (2 tablets of 0.5 g) is prescribed on the 1st day and 0.5 g daily from the 2nd to the 5th day (course dose 3 g).

Children are prescribed the drug taking into account body weight. Children weighing more than 10 kg at the rate of: on the 1st day - 10 mg / kg of body weight; in the next 4 days - 5 mg / kg. A 3-day course of treatment is possible; in this case single dose is 10 mg/kg. (Course dose 30 mg/kg of body weight).

Side effect. Nausea, diarrhea, abdominal pain, less often - vomiting and flatulence (accumulation of gases in the intestines). Perhaps a transient (transient) increase in the activity of liver enzymes. Extremely rarely - skin rash.

Contraindications. Hypersensitivity to macrolide antibiotics. Caution is required when prescribing the drug to patients with severely impaired liver and kidney function. During periods of pregnancy and lactation, azithromycin is not prescribed, except in cases where the benefit of using the drug outweighs the possible risk. The drug should be administered with caution to patients with an indication of allergic reactions in history (case history).

Release form. Tablets of 0.125 g of azithromycin dihydrate in a package of 6 pieces; tablets of 0.5 g of azithromycin dihydrate in a package of 3 pieces; capsules of 0.5 g of azithromycin dihydrate in a package of 6 pieces; syrup in vials (5 ml - 0.1 g of azithromycin dihydrate); forte syrup in vials (5 ml - 0.2 g of azithromycin dihydrate).

Storage conditions.

KITAZAMYCIN (Kitasamycin)

Synonyms: Leukomycin.

Pharmachologic effect. An antibiotic from the group of macrolides, acts bacteriostatically (prevents the growth of bacteria). The spectrum of action includes gram-positive (staphylococci producing and non-producing penicillinase - an enzyme that destroys penicillins; streptococci, pneumococci, clostridia, Bacillusanthracis, Corynebacterium diphtheriae) and some gram-negative microorganisms (gonococci, hemophilic and pertussis bacilli, brucella, legionella), as well as mycoplasma, chlamydia, spirochetes, rickettsiae. The drug is active against strains of staphylococci resistant to penicillin, streptomycin, tetracycline. Resistant to the drug gram-negative rods: intestinal, Pseudomonas aeruginosa, as well as shigella, salmonella, etc.

Indications for use. Bacterial infections caused by microorganisms sensitive to the drug: pharyngitis (inflammation of the pharynx), bronchitis (inflammation of the bronchi), pneumonia (inflammation of the lungs), pleural empyema (accumulation of pus between the membranes of the lungs), scarlet fever, tonsillitis (inflammation of the palatine tonsils / tonsils /), mumps (inflammation parotid gland/mumps/), otitis media (inflammation of the middle ear), erysipelas, sepsis (infection of the blood with microbes from the focus of purulent inflammation), septic endocarditis (a disease of the internal cavities of the heart due to the presence of microbes in the blood), osteomyelitis (inflammation of the bone marrow and adjacent bone tissue), mastitis (inflammation of the breast), cholecystitis (inflammation of the gallbladder), diphtheria, whooping cough, rickettsiosis (infectious diseases caused by rickettsia), typhus, gonorrhea, syphilis.

Method of application and dose. Before prescribing a drug to a patient, it is desirable to determine the sensitivity of the microflora to it that caused the disease in this patient. Adults are usually prescribed 1-2 tablets or capsules every 6-8 hours. Children are prescribed a syrup of 2.5 ml (100 mg) per 15 kg of body weight every 4-6 hours. The syrup can be diluted with water. At severe infections the dose may be increased. A single dose for intravenous administration is 0.2-0.4 g for adults; for children - 0.2 g; frequency of administration - 1-2 times a day. The drug is dissolved in 10-20 ml of 5% or 20% glucose solution or isotonic sodium chloride solution and injected slowly intravenously over 3-5 minutes.

Side effect. Rarely - loss of appetite, nausea, vomiting, diarrhea; allergic reactions.

Contraindications. Severe liver dysfunction, hypersensitivity to the drug. Use the drug with caution during pregnancy and lactation. The drug should be administered with caution to patients with an indication of allergic reactions in history (case history).

Release form. Tablets of 0.2 g in a package of 100 and 500 pieces; capsules of 0.25 g in a package of 100, 500 and 1000 pieces; syrup (1 ml - 0.04 g) in bottles of 250 and 500 ml; solution for injection (0.2 g kitazamycin) in ampoules of 10 pieces.

Storage conditions. List B. In a dry, cool, dark place.

MIDEKAMYTSIN (Midecamycin)

Synonyms: Macrofoam.

Pharmachologic effect. Macrolide antibiotic. Inhibits (suppresses) protein synthesis in bacterial cells. In low doses, the drug has a bacteriostatic (preventing the growth of bacteria) effect, and in high doses it is bactericidal (destroying bacteria). Active against both gram-positive (Staphylpcoccusspp., Streptococcusspp., including St. pneumoniae, Listeriamonocytogenes, Clostridiumspp., Corynebacteriumdiphtheriae) and gram-negative microorganisms (Neisseriagonor-rhoeae, Neisseriameningitidis, Mycoplasmapneumoniae, Erysipelothrix, Bordetellapertussis). Midecamycin is active against chlamydia. Also applies to some

strains of Haemophilus influenzae, Legionellae prteumophila and Ureaplasma urealyticum.

Indications for use. Infectious diseases caused by pathogens sensitive to the drug, especially in patients who are contraindicated penicillin antibiotics: infections of the upper and lower respiratory tract; oral infections; skin and soft tissue infections; urinary tract infections; scarlet fever; erysipelas; diphtheria; whooping cough.

Method of application and dose. Before prescribing a drug to a patient, it is desirable to determine the sensitivity of the microflora to it that caused the disease in this patient. Adults appoint an average daily dose of 1.2 g (0.4 g 3 times a day). The maximum daily dose is 1.6 g.

Children with mild forms of infection are prescribed in a daily dose of 20 mg / kg of body weight; with infections of moderate and severe course - 30-50 mg / kg. Multiplicity of appointment - 3 times a day. For young children, it is preferable to prescribe midecamycin in the form of a suspension (suspensions of solid particles of the drug in a liquid). A single dose of the drug depends on the body weight of the child and is: children weighing less than 5 kg - 2.5 ml; 5-10 kg - 5 ml; 10-15 kg - 7.5 ml; 15-20 kg - 10 ml; 20-30 kg - 15 ml. The drug is taken every 8 hours (preferably before meals). To prepare the suspension, add 100 ml of distilled water to the contents of the vial. Shake the contents of the vial well before each use. The prepared suspension is stored in the refrigerator for no more than 14 days.

The duration of treatment is 7-10 days. If necessary, the treatment period is extended.

Side effect. Rarely - anorexia (lack of appetite), a feeling of heaviness in the epigastrium (the area of ​​\u200b\u200bthe abdomen located directly under the convergence of the costal arches and the sternum), nausea, vomiting, diarrhea; transient (passing) increase in the concentration of hepatic transaminases (enzymes) and the concentration of bilirubin (bile pigment) in the blood serum. Skin rash.

Contraindications. Severe forms of liver and kidney failure; hypersensitivity to the drug. The drug should be administered with caution to patients with an indication of allergic reactions in history (case history).

Release form. Tablets on O^G g in a package of 16 pieces; dry matter for the preparation of a suspension for oral administration in 115 ml vials (5 ml - 0.175 ml of midecamycin acetate).

Storage conditions.

Oleandomycin Phosphate (Oleandomyciniphosphas)

Synonyms: Amimicin, Cyclamycin, Matrimycin, Mathromycin, Oleandocin, Oleandomycin, Oleandomycin phosphorus, Romycil, etc.

Obtained from the culture fluid of the Streptomycesantibioticus strain.

Pharmachologic effect. The spectrum of action is similar to erythromycin. Active against gram-positive microorganisms, especially staphylococci, streptococci and pneumococci.

It is well absorbed into the blood, easily diffuses (penetrates) into organs and biological fluids organism. It does not have a cumulative property (the ability to accumulate in the body). Low toxicity.

Indications for use. Pneumonia (inflammation of the lungs), scarlet fever, diphtheria, tonsillitis, sepsis (infection of the blood with microbes from the focus of purulent inflammation), tonsillitis (inflammation of the palatine tonsils / tonsils /), laryngitis (inflammation of the larynx), phlegmon (acute, not clearly delimited purulent inflammation), purulent cholecystitis

(inflammation of the gallbladder), osteomyelitis (inflammation of the bone marrow and adjacent bone tissue), staphylococcal, streptococcal and pneumococcal sepsis and other diseases caused by microorganisms sensitive to it.

Method of application and dose. Before prescribing a drug to a patient, it is desirable to determine the sensitivity of the microflora to it that caused the disease in this patient. Inside after meals, 0.25-0.5 g per day 4-6 times. The highest daily dose for adults is 2g. For children under 3 years old - 0.02 g / kg, from 3 to 6 years old - 0.25-0.5 g, from 6 to 14 years old - 0.5-1 g, over 14 years old - 1-1.5 g per day. The course of treatment is 5-7 days.

Intravenously and intramuscularly administered 3-4 times a day dvze - 1-2 g; children under 3 years old 30-50 mg / kg, from 3 to 6 years old - 0.25-0.5 g, from 6 to 10 years old - 0.5-0.75 g, from 10 to 14 years old - 0.75 -1 g per day. For intravenous administration, the drug is dissolved in a sterile isotonic sodium chloride solution or 5% glucose solution at the rate of 2 mg of the drug per 1 ml of solution, for intramuscular injections- in a 1-2% solution of novocaine at the rate of 100 mg in 1.5 ml.

Side effect. Allergic reactions (skin itch, urticaria, angioedema).

Contraindications. Increased individual sensitivity to the drug, damage to the parenchyma ( functional elements tissues) of the liver. The drug should be administered with caution to patients with an indication of allergic reactions in history (case history).

Release form. Film-coated tablets, 0.125 g (125,000 IU) in a package of 12 pieces; vials containing 0.25 g (250,000 units) of the drug, complete with distilled water.

Storage conditions. List B. In a dry place, at room temperature.

TETRAOLEAN (Tetraolean)

Synonyms: Sigmamycin, Oletetrin.

Pharmachologic effect. Combined preparation containing oleandomycin and tetracycline hydrochloride.

Indications for use. Tetraolean is prescribed for pneumonia (pneumonia) of various etiologies (causes), severe bronchitis (inflammation of the bronchi), tonsillitis, sinusitis (inflammation of the paranasal sinuses), inflammation of the middle ear, brucellosis (an infectious disease transmitted to humans, usually from farm animals), tularemia (an acute infectious disease transmitted to humans from animals), some rickettsiosis ( infectious diseases caused by rickettsia /microorganisms/), cholecystitis (inflammation of the gallbladder), pancreatitis (inflammation of the pancreas), peritonitis (inflammation of the peritoneum), furunculosis (multiple purulent inflammation of the skin), carbuncles (acute diffuse purulent-necrotic inflammation of several adjacent sebaceous glands and hair follicles), osteomyelitis (inflammation of the bone marrow and adjacent bone tissue), inflammatory gynecological and urological diseases, gonorrhea and other infectious diseases.

Method of application and dose. Before prescribing a drug to a patient, it is desirable to determine the sensitivity of the microflora to it that caused the disease in this patient. Assign inside adults 1.0-1.5 g per day, with severe conditions- up to 2 g per day (in 4 doses with 6-hour intervals). The duration of treatment is 5-7 days, rarely up to 14 days. Children are prescribed in the following daily doses: with a body weight of up to 10 kg - 0.125 g, from 10 to 15 kg - 0.25 g, from 20 to 30 kg - 0.5 g, from 30 to 40 kg - 0.725 g, from 40 up to 50 kg - 1 g.

Intramuscularly and intravenously administered only in acute diseases and when it is impossible to take the drug inside.

For intramuscular injection dissolve the contents of the vial in 2 ml of sterile water for injection or isotonic sodium chloride solution. Adults are administered 0.2-0.3 g per day in 2-3 doses (0.1 g each) at intervals of 8-12 hours. Children are administered 10-20 mg / kg per day in 2 doses (after 12 hours) . Subcutaneous injection is not allowed.

For intravenous injections, a 1% solution is used; dissolve 0.25 or 0.5 g of the drug, respectively, in 25 or 50 ml of sterile water for injection. Enter slowly (no more than 2 ml per minute). You can enter the drip method (no more than 60 drops per minute) 0.1% solution prepared for sterile water for injection, 5% glucose solution or isotonic sodium chloride solution.

Solutions are prepared extempore (before use); storage in the refrigerator is allowed no more than 24 hours.

The average daily dose for intravenous administration of the drug for adults is 1 g (in 2 doses of 500 mg with an interval of 12 hours). The maximum daily dose for adults is 2 g (4 injections of 500 mg at intervals of 6 hours). Children are administered 15-25 mg / kg per day (2-4 injections at intervals of 6 or 12 hours).

Intravenous administration should be done with caution.

As soon as this becomes possible, the drug is taken orally.

The same as for the components included in its composition.

Release form. Available in the form of capsules of 0.25 g (83 mg of oleandomycin phosphate or triacetyloleandomycin and 167 mg of tetracycline hydrochloride) and in vials for intramuscular injection of 0.1 g of the drug (33.3 mg of oleandomycin phosphate and 66.7 mg of tetracycline hydrochloride), for intravenous administration - 0.25 and 0.5 g of the drug (83 or 167 mg of oleandomycin phosphate and 167 or 333 mg of tetracycline hydrochloride, respectively).

Storage conditions. List B. In a dry, dark place at room temperature.

ROXITROMYCIN (Roxithromycine)

Synonyms: BD-Roque, Roxybid, Rulel.

Pharmachologic effect. Semi-synthetic macrolide antibiotic for oral administration. Sensitive to the drug: Streptococci! groups A and B, including Str.pyogenes, Str.agalactiae, Str.mitis, saunguis, viridans, Streptococcuspneumoniae, Neisseriameningitidis, Moraxellacatarrhalis; Legionella; Bordetellapertussis; Listeria monocytogenes; Corynebacterium diphtheriae; Clostridium; Mycoplasmapneumoniae; Pasteurellamultocida; Ureaplasmaurealyticum; Chlamydiatrachomatis and psittaci; Legionelapneumophilia; Campylobacter; Gardnerella vaginalis.

Variably sensitive to the drug: Staphylococcus-cusaureus and epidermidis; haemophilus influenzae; Bacteroidesfragilis and Vibrocholerae. Resistant to the drug: Enterobacteriaceae, Pseudomonas. "Akinetobacter. .

Indications for use. Treatment of drug-sensitive infections, including upper and lower respiratory tract infections, skin and soft tissue infections, urinary tract infections (including sexually transmitted infections, except gonorrhea); prevention meningococcal meningitis(purulent inflammation of the meninges) in persons who were in contact with the diseased.

Method of application and dose. Before prescribing a drug to a patient, it is desirable to determine the sensitivity of the microflora to it that caused the disease in this patient. Adults are prescribed 0.15 g of the drug 2 times a day, morning and evening, before meals. In case of liver failure, the drug is prescribed at a dose of 0.15 g 1 time per day. When prescribing the drug to patients with liver failure special care is needed, monitoring of liver function and dose adjustment.

When prescribing the drug to patients with kidney failure, as well as elderly patients, the need for dose adjustment does not arise.

Combined use with ergotamine derivatives and ergotamine-like vasoconstrictor drugs is not allowed, as it can lead to the development of ergotism (poisoning with ergot alkaloids) and necrosis (necrosis) of limb tissues.

At simultaneous application with bromocriptine, it is possible to increase the concentration of this drug in plasma and increase its antiparkinsonian action or dopamine toxicity (dyskinesia / impaired mobility /).

With simultaneous use with cyclosporine, its dose is reduced and kidney function is monitored, since it is possible to increase the concentration of this drug in the blood (due to inhibition of its metabolism) and the level of creatinine (the end product of nitrogen metabolism) in the blood.

Side effect. Nausea, vomiting, abdominal pain, diarrhea, transient (transient) elevation of transaminases and alkaline phosphatase(enzymes); allergic reactions.

Contraindications. Hypersensitivity to macrolide antibiotics; simultaneous administration of drugs such as ergotamine and dihydroergotamine; pregnancy and lactation period. The drug should be administered with caution to patients with an indication of allergic reactions in history (case history).

Release form. Coated tablets, 0.05 g, 0.1 g, 0.15 g and 0.3 g, in a pack of 10 pieces.

Storage conditions. List B. In a dry, dark place.

Erythromycin (Erythromycinum)

Synonyms: Erythrocin, Ermicin, Eriin, Erythran, Erythrocin, Ethromycin, Lubomyin, Pantomycinp, Tortrocin, Eracin, Ilozon, Eric, Meromycin, Monomycin, Erihexal, Erythromen, Erythroped, etc.

Erythromycin is an antibacterial substance produced by Streptomyces Erythreus or other related microorganisms.

Pharmachologic effect. According to the spectrum of antimicrobial activity, erythromycin is close to penicillins. It is active against gram-positive and gram-negative microorganisms (staphylococci, pneumococci, streptococci, gonococci, meningococci). It also works against a number of Gram-positive bacteria, Brucella, Rickettsiae, trachoma (an eye infection that can lead to blindness) and syphilis. It has little or no effect on most gram-negative bacteria, mycobacteria, small and medium viruses, fungi. Erythromycin is better tolerated by patients than penicillins, and can be used for allergies to penicillins.

In therapeutic doses, erythromycin acts bacteriostatically (prevents the growth of bacteria). Resistance to the antibiotic develops rapidly, and cross-resistance is observed with other antibiotics of the macrolide group (oleandomyin). When combined with streptomycin, tetracyclines and sulfonamides, an increase in the action of erythromycin is observed.

Indications for use. Erythromycin is used for pneumonia (pneumonia), pneumopleuritis (combined inflammation of the lung tissue and its membranes), bronchiectasis (bronchial disease associated with the expansion of their lumen) in the acute stage

and in other infectious diseases of the lungs caused by antibiotic-sensitive microorganisms; with septic conditions (diseases associated with the presence of microbes in the blood), erysipelas, mastitis (inflammation of the milk-carrying ducts of the mammary gland), osteomyelitis (inflammation of the bone marrow and adjacent bone tissue), peritonitis (inflammation of the peritoneum), purulent otitis media (inflammation of the ear cavity) and other inflammatory processes. It is also prescribed for patients with syphilis with intolerance to antibiotics of the penicillin group. Through the blood-brain barrier (the barrier between the blood and brain tissue), erythromycin does not penetrate, so it is not prescribed for meningitis (inflammation of the meninges).

Locally (in the form of an ointment) erythromycin is used for pustular skin lesions, infected wounds ah, bedsores (necrosis of tissues caused by prolonged pressure on them due to lying), etc., as well as conjunctivitis (inflammation of the outer shell of the eye), blepharitis (inflammation of the edges of the eyelids), trachoma.

In severe forms of infectious diseases, when oral administration is ineffective or impossible, resort to intravenous administration of a soluble form of erythromycin - erythromycin phosphate.

Method of application and dose. Before prescribing a drug to a patient, it is desirable to determine the sensitivity of the microflora to it that caused the disease in this patient. For oral administration, erythromycin is prescribed in the form of tablets or capsules. Single dose for an adult 0.25 g, with serious illnesses- 0.5 g. Take every 4-6 hours for 1-1 "/2 hours before meals.

The highest single dose for adults: inside 0.5 g, daily 2 g. Children under 14 years old are prescribed in a daily dose of 20-40 mg / kg (in 4 divided doses), over 14 years old - in a dose for adults.

Erythromyin increases the plasma concentration of carbamazepine, theophylline and enhances them toxic effect(nausea, vomiting, etc.).

Side effect. Side effects in the treatment of erythromycin are relatively rare (nausea, vomiting, diarrhea). With prolonged use, liver dysfunction (jaundice) is possible. In some cases, there may be an increased sensitivity to the drug with the appearance of allergic reactions.

With prolonged use of erythromycin, microorganisms may develop resistance to it.

Contraindications. The drug is contraindicated in case of individual hypersensitivity to it and with severe violations liver function. The drug should be administered with caution to patients with an indication of allergic reactions in history (case history).

Release form. Tablets of 0.1 and 0.25 g; tablets of 0.1 and 0.25 g with enteric coating; ointment 1%.

Storage conditions.

ERIDERM (Eryderm)

Pharmachologic effect. The antibiotic erythromyin, which is part of the drug, penetrates into excretory ducts sebaceous glands and inhibits the growth of propionic bacteria. Alcohols, which are part of the drug, help cleanse and dry the skin.

Indications for use. Youth mornings.

Method of application and dose. Before prescribing a drug to a patient, it is desirable to determine the sensitivity of the microflora to it that caused the disease in this patient. The solution is applied to the affected areas of the skin with a cotton swab. Avoid getting the drug on the mucous membranes.

Side effect. Possible hypersensitivity reactions to the components of the drug.

Contraindications. Hypersensitivity to the components of the drug.

Release form. Solution for external use in 60 ml vials (1 ml - 0.02 g of erythromycin). The solvent contains polyethylene glycol, acetone and 77% alcohol.

Storage conditions. List B. In a cool place.

Erythromycin Ointment (Unguentum Erythromycini)

Indications for use. Used to treat infections of the mucous membrane of the eyes, trachoma (an infectious eye disease that can lead to blindness); for the treatment of pustular skin diseases, infected wounds, bedsores (tissue necrosis caused by prolonged pressure on them due to lying), burns of II and III degrees, trophic ulcers(slowly healing skin defects).

Method of application and dose. Before prescribing a drug to a patient, it is desirable to determine the sensitivity of the microflora to it that caused the disease in this patient. For eye diseases, an ointment is applied in the amount of 0.2-0.3 g per lower or upper eyelid 3 times a day, for trachoma - 4-5 times a day.

The duration of treatment depends on the severity and course of the disease and the effectiveness of therapy. The average duration of treatment is 1.5-2 months. The course of treatment for trachoma is up to 4 months.

For skin diseases, the ointment is applied to the affected areas 2-3 times a day, for burns - 2-3 times a week.

Side effect. The ointment is usually well tolerated, but a moderate irritant effect is possible.

Release form. In aluminum tubes, 3; 7; ten; 15 and 30 g. Contains 10,000 units of erythromycin in 1 g.

Storage conditions. List B. At room temperature.

Erythromycin Phosphate (Erythromyciniphosphas)

Phosphate salt of erythromycin.

Pharmacological action and indications for use. Same as for erythromycin.

Method of application and dose. Before prescribing a drug to a patient, it is desirable to determine the sensitivity of the microflora to it that caused the disease in this patient. Intravenously 2-3 times a day, 200 mg. The daily dose may be increased to 1 g. For children, 20 mg/kg per day. Enter slowly (within 3-5 minutes) after

dilution with water for injection or sterile isotonic sodium chloride solution at the rate of 5 mg/ml. Allowed drip introduction in isotonic sodium chloride solution or in 5% glucose solution at a concentration of not more than 1 mg in 1 ml of solvent.

Side effects and contraindications. Same as for erythromycin.

Release form. In hermetically sealed vials of 50; 100 and 200 mg of the active substance (in terms of erythromycin base).

Storage conditions. List B. In a place protected from light at a temperature not exceeding +20 ° C.

Erycycline (Erycyclinum)

A mixture of erythromycin and oxytetracycline dihydrate in the form of granules.

Pharmachologic effect. Possesses a wide range actions against gram-positive microbes. Effective against microflora resistant to penicillin, streptomycin.

Indications for use. Purulent-inflammatory diseases of various etiologies (causes): tonsillitis, pneumonia (pneumonia), bronchitis (bronchitis), cholecystitis (gall bladder inflammation), infections urinary tract, dysentery, wound infection, pyoderma (purulent inflammation of the skin), etc.

Method of application and dose. Before prescribing a drug to a patient, it is desirable to determine the sensitivity of the microflora to it that caused the disease in this patient. Inside, one capsule every 4-6 hours (30-40 minutes after a meal). The maximum daily dose is 8 capsules (2 g). The course of treatment is 7-10 days or more, depending on the severity of the disease.

Side effect. Decreased appetite, nausea, vomiting, diarrhea, with prolonged use, jaundice is possible, allergic skin reactions, angioedema ( allergic edema) and etc.

Contraindications. Hypersensitivity to erythromycin and oxytetracycline dihydrate, fungal diseases; with caution prescribed for violations of the liver and kidneys, with leukopenia (decrease in the level of leukocytes in the blood).

Release form. Capsules of 0.25 g, 10 pieces per pack. Each capsule contains 0.125 g of erythromycin and oxytetracycline dihydrate.

Storage conditions. List B. In a dark place.

Macrolides are naturally occurring antibiotics complex structure and have a bacteriostatic effect. growth inhibition pathogenic microorganisms occurs due to inhibition of protein synthesis in ribosomes.

Increasing the dosage helps to achieve a bactericidal effect.

Macrolides belong to the class of polyketides. Polyketides are polycarbonyl compounds that are metabolic intermediates in animal, plant, and fungal cells.

When taking macrolides, there were no cases of selective dysfunction of blood cells, its cellular composition, nephrotoxic reactions, secondary dystrophic damage to the joints, photosensitivity, manifested by hypersensitivity skin to ultraviolet exposure. Anaphylaxis and the occurrence of antibiotic-associated conditions occur in a small percentage of patients.

Macrolide antibiotics occupy a leading position among the safest antimicrobial drugs for the body.

The main direction in the use of this group of antibiotics is the treatment of nosocomial infections of the respiratory tract caused by gram-positive flora and atypical pathogens. A little background information will help us systematize information and determine which antibiotics are macrolides.

Macrolides are classified according to the method of preparation and the chemical structural basis.

In the first case, they are divided into synthetic, natural and prodrugs (erythromycin esters, oleandomycin salts, etc.). Prodrugs have a modified structure compared to the drug, but in the body, under the influence of enzymes, they turn into the same active drug, which has a characteristic pharmacological effect.

Prodrugs have improved palatability, high rates bioavailability. They are acid resistant.

The classification implies the division of macrolides into 3 groups:

* ex. - Natural.
*pol.- Semi-synthetic.

It is worth noting that azithromycin is an azalide, since its ring contains a nitrogen atom.

Features of the structure of each macro. affect the performance, drug interaction with other drugs, pharmacokinetic properties, tolerability, etc. Mechanisms of influence on microbiocenosis in the presented pharmacological agents are identical.

Consider the main representatives of the group separately.

Er. inhibits the growth of chlamydia, legionella, staphylococci, mycoplasmas and legionella, Pseudomonas aeruginosa, Klebsiella.
Bioavailability can reach sixty percent, it depends on meals. Absorbed in digestive tract partially.

Among the side effects noted: dyslepsy, dyspepsia, narrowing of one of the sections of the stomach (diagnosed in newborns), allergies, "shortness of breath syndrome."

Prescribed for diphtheria, vibriosis, infectious lesions skin, chlamydia, Pittsburgh pneumonia, etc.
Treatment with erythromycin during pregnancy and lactation is excluded.

Inhibits the growth of microorganisms that produce an enzyme that breaks down beta-lactams, has an anti-inflammatory effect. R. is resistant to acids and alkalis. Bactericidal action achieved by increasing the dosage. The half-life is about ten hours. Bioavailability is fifty percent.

Roxithromycin is well tolerated and excreted unchanged from the body.

Prescribed for inflammation of the mucous membrane of the bronchi, larynx, paranasal sinuses, middle ear, palatine tonsils, gallbladder, urethra, vaginal segment of the cervix, infections of the skin, musculoskeletal system, brucellosis, etc.
Pregnancy, lactation and age up to two months are contraindications.

Inhibits the growth of aerobes and anaerobes. Observed low activity in relation to the Koch stick. Clarithromycin is superior to erythromycin in microbiological parameters. The drug is acid-resistant. Alkaline environment affects the achievement of antimicrobial action.

Clarithromycin is the most active macrolide against Helicobacter pylori, which infects various areas stomach, and 12 - duodenal ulcer. The half-life is about five hours. The bioavailability of the drug does not depend on food.

K. is prescribed for infection of wounds, infectious diseases of the upper respiratory tract, purulent rashes, furunculosis, mycoplasmosis, mycobacteriosis against the background of the immunodeficiency virus.
Taking clarithromycin for early dates pregnancy is prohibited. Infant age up to six months is also a contraindication.

Ol. inhibits protein synthesis in pathogen cells. The bacteriostatic effect is enhanced in an alkaline environment.
To date, cases of the use of oleandomycin are rare, as it is outdated.
Ol. prescribed for brucellosis, abscess pneumonia, bronchiectasis, gonorrhea, inflammation of the meninges, the inner lining of the heart, infections of the upper respiratory tract, purulent pleurisy, furunculosis, the entry of pathogenic microorganisms into the bloodstream.

The antibiotic demonstrates high rates of activity against Helicobacter pylori, Haemophilus influenzae, gonococcus. Azithromycin is three hundred times more acid-resistant than erythromycin. Digestibility rates reach forty percent. Like all erythromycin antibiotics, azithromycin is well tolerated. A long half-life (more than 2 days) allows you to prescribe the drug once a day. The maximum course of treatment does not exceed five days.

Effective in the eradication of streptococcus, the treatment of lobar pneumonia, infectious lesions of the pelvic organs, genitourinary system, tick-borne borreliosis, sexually transmitted diseases. During the period of bearing a child, it is prescribed according to vital indications.
The intake of azithromycin by HIV-infected patients can prevent the development of mycobacteriosis.

A natural antibiotic derived from the radiant fungus Streptomyces narbonensis. Bactericidal action is achieved at high concentrations in the focus of infection. J - n inhibits protein synthesis and inhibits the growth of pathogens.

Therapy with josamycin often leads to a decrease in blood pressure. The drug is actively used in otorhinolaryngology (tonsillitis, pharyngitis, otitis), pulmonology (bronchitis, ornithosis, pneumonia), dermatology (furunculosis, erysipelas, acne), urology (urethritis, prostatitis).

Approved for use during lactation, it is prescribed for the treatment of pregnant women. Newborns and children under fourteen years of age are shown a suspension form.

Differs in high indicators of microbial activity and good pharmacokinetic properties. The bactericidal effect is achieved by a significant increase in the dose. The bacteriostatic effect is associated with the inhibition of protein synthesis.

Pharmacological action depends on the type of harmful microorganism, the concentration of the drug, the size of the inoculum, etc. Midecamycin is used for infectious skin lesions, subcutaneous tissue, respiratory tract.

Midecamycin is a reserve antibiotic and is prescribed for patients with hypersensitivity to beta-lactams. Actively used in pediatrics.

The period of lactation (penetrates into breast milk) and pregnancy are contraindications. Sometimes m-n is prescribed for vital indications and if the benefit to the mother outweighs the potential risk to the fetus.

Differs from other macrolides in that it regulates immune system. The bioavailability of the drug reaches forty percent.

The activity of the drug decreases in an acidic environment and increases in an alkaline one. Alkali contributes to an increase in penetrating ability: the antibiotic gets better inside the cells of pathogens.

It has been scientifically proven that spiramycin does not affect embryonic development, so it is permissible to take it while carrying a child. The antibiotic affects breast-feeding, therefore, during lactation, it is worth finding an alternative drug.

Macrolide antibiotics for children should not be administered by intravenous infusion.

In the treatment of macrolides, the occurrence of life-threatening drug reactions. NLR in children are manifested by pain in the abdomen, discomfort in the epigastrium, vomiting. In general, the children's body tolerates macrolide antibiotics well.

Comparatively recently invented drugs practically do not stimulate gastrointestinal motility. intestinal tract. Dyspeptic manifestations as a result of the use of midecamycin, midecamycin acetate are not observed at all.

Clirithromycin deserves special attention, surpassing other macrolides in many respects. In a randomized controlled trial, it was found that this antibiotic acts as an immunomodulator, having a stimulating effect on the protective functions of the body.

Macrolides are used for:

• treatment of atypical mycobacterial infections,
• hypersensitivity to β-lactams,
• diseases of bacterial origin.

They have become popular in pediatrics due to the possibility of injection, in which the drug bypasses the gastrointestinal tract. This becomes necessary in emergencies. A macrolide antibiotic is what the pediatrician most often prescribes when treating infections in young patients.

Therapy with macrolides rarely causes anatomical and functional changes, but the occurrence of side effects is not excluded.

In the course of a scientific study, in which about 2 thousand people took part, it was found that the likelihood of anaphylactoid reactions when taking macrolides is minimal. No cases of cross-allergy have been reported. Allergic reactions are manifested in the form of nettle fever and exanthema. AT isolated cases possible anaphylactic shock.

Dyspeptic phenomena occur due to the prokinetic effect inherent in macrolides. Most patients note frequent bowel movements, pain in the abdomen, impaired taste sensations, vomiting. Newborns develop pyloric stenosis, a disease in which the evacuation of food from the stomach into the small intestine is difficult.

pirouette ventricular tachycardia, cardiac arrhythmia, long QT interval syndrome are the main manifestations of cardiotoxicity of this group of antibiotics. make things worse old age, heart disease, overdosing, fluid and electrolyte disturbances.

A long course of treatment, excess dosage are the main causes of hepatoxicity. Macrolides have different effects on cytochrome, an enzyme involved in the metabolism of foreign to the body chemical substances: erythromycin inhibits it, josamycin affects the enzyme a little less, and azithromycin does not have any effect at all.

Few doctors know when prescribing macrolide antibiotic that this is a direct threat mental health person. Neuropsychiatric disorders most often occur when taking clarithromycin.

Video about the group in question:

Macrolides are a promising class of antibiotics. They were invented more than half a century ago, but are still actively used in medical practice. The uniqueness of the therapeutic effect of macrolides is due to favorable pharmacokinetic and pharmacodynamic properties and the ability to penetrate the cell wall of pathogens.

High concentrations of macrolides contribute to the eradication of pathogens such as Chlamydia trachomatis, Mycoplasma, Legionella, Campylobacter. These properties favorably distinguish macrolides against the background of β-lactams.

Erythromycin marked the beginning of the macrolide class.

The first acquaintance with erythromycin occurred in 1952. Portfolio of the latest pharmaceuticals replenished the international American innovative company"Eli Lilly & Company" (Eli Lilly & Company). Her scientists derived erythromycin from a radiant fungus that lives in the soil. Erythromycin has become great alternative for patients with hypersensitivity to penicillin antibiotics.

Expansion of the scope, development and introduction into the clinic of macrolides, modernized in terms of microbiological indicators, dates back to the seventies and eighties.

The erythromycin series is different:

• high activity against Streptococcus and Staphylococcus and intracellular microorganisms;
• low rates of toxicity;
• no cross-allergy with beta-lactim antibiotics;
• creating high and stable concentrations in tissues.

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Most antibiotics, while suppressing the development of infectious agents, simultaneously have a negative impact on the internal microbiocenosis. human body, but, unfortunately, a number of diseases cannot be cured without the use of antibacterial agents.

The best way out of the situation is the preparations of the macrolide group, which occupy a leading position in the list of the safest antimicrobial drugs.

The first representative of the class of antibiotics under consideration was Erythromycin, obtained from soil bacteria in the middle of the last century. As a result of research activities, it was found that the basis of the chemical structure of the drug is a lactone macrocyclic ring, to which carbon atoms are attached; this feature determined the name of the entire group.

The new tool almost immediately gained wide popularity; it was involved in the fight against diseases provoked by gram-positive bacteria. Three years later, the list of macrolides was replenished with Oleandomycin and Spiramycin.

The development of the next generations of antibiotics of this series was due to the discovery of the activity of early drugs of the group against campylobacter, chlamydia and mycoplasmas.

Today, almost 70 years after their discovery, Erythromycin and Spiramycin are still present in therapeutic regimens. AT modern medicine the first of these drugs is more often used as the drug of choice in patients with individual intolerance to penicillins, the second - as highly effective agent characterized by long antibacterial effect and lack of teratogenic impact.

Oleandomycin is used much less often: many experts consider this antibiotic to be outdated.

There are currently three generations of macrolides; drug research is ongoing.

The classification of drugs included in the described group of antibiotics is based on the chemical structure, method of preparation, duration of exposure and generation of the drug.

Details of the distribution of drugs - in the table below.

Number of attached carbons
14	15	16
Oleandomycin; Dirithromycin; Clarithromycin; Erythromycin.	Azithromycin	Roxithromycin; Josamycin; Midecamycin; Spiromycin.
The duration of the therapeutic effect
short	average	long
Roxithromycin; Spiramycin; Erythromycin.	Flurithromycin (not registered in our country); Clarithromycin.	Dirithromycin; Azithromycin.
Generation
first	second	third
Erythromycin; Oleandomycin.	Spiramycin; Roxithromycin; Clarithromycin.	Azithromycin;

This classification should be supplemented with three points:

The list of group drugs includes Tacrolimus, a drug that has 23 atoms in the structure and simultaneously belongs to immunosuppressants and to the series under consideration.

The structure of Azithromycin includes a nitrogen atom, so the drug is azalide.
Macrolide antibiotics are of both natural and semi-synthetic origin.

To natural, in addition to those already mentioned in historical background medicines include Midecamycin and Josamycin; artificially synthesized - Azithromycin, Clarithromycin, Roxithromycin, etc. Prodrugs with a slightly modified structure stand out from the general group:

• esters of Erythromycin and Oleandomycin, their salts (propionyl, troleandomycin, phosphate, hydrochloride);
• ester salts of the first representative of a number of macrolides (estolate, acistrat);
• Midecamycin salts (Myokamicin).

All drugs under consideration have a bacteriostatic type of action: they inhibit the growth of colonies of infectious agents by disrupting protein synthesis in pathogen cells. In some cases, clinic specialists prescribe an increased dosage of medications to patients: the drugs involved in this way acquire a bactericidal effect.

Antibiotics of the macrolide group are characterized by:

• a wide range of effects on pathogens (including drug-sensitive microorganisms - pneumococci and streptococci, listeria and spirochetes, ureaplasma and a number of other pathogens);
• minimal toxicity;
• high activity.

As a rule, the drugs in question are used in the treatment of genital infections (syphilis, chlamydia), oral diseases that have bacterial etiology(periodontitis, periostitis), diseases respiratory system(whooping cough, bronchitis, sinusitis).

The effectiveness of medicines related to macrolides has also been proven in the fight against folliculitis and furunculosis. In addition, antibiotics are prescribed for:

• gastroenteritis;
• cryptosporidiosis;
• atypical pneumonia;
• acne (severe course of the disease).

For the purpose of prevention, a group of macrolides is used to sanitize carriers of meningococcus, during surgical procedures in the lower intestine.

Modern medicine actively uses Erythromycin, Clarithromycin, Iloson, Spiramycin and a number of other representatives of the considered group of antibiotics in therapy regimens. The main forms of their release are shown in the table below.

Drug names	Packing type
	Capsules, tablets	Granules	Suspension	Powder
Azivok	+
Azithromycin	+	+
Josamycin	+
Zitrolide	+
Ilozon	+	+	+	+
Clarithromycin	+	+		+
macrofoam	+	+
Rovamycin	+			+
Rulid	+
Sumamed	+			+
Hemomycin	+			+
Ecomed	+			+
Erythromycin	+			+

Pharmacy chains also offer consumers Sumamed in the form of an aerosol, lyophilisate for infusion, Hemomycin - in the form of a powder for preparation injection solutions. Erythromycin-liniment is packed in aluminum tubes. Ilozon is available in the form of rectal suppositories.

A brief description of popular tools is in the material below.

Resistant to alkalis, acids. It is prescribed mainly for diseases of the ENT organs, the genitourinary system, and the skin.

It is contraindicated in pregnant and lactating women, as well as in small patients under the age of 2 months. The half-life is 10 hours.

Under the strict supervision of a doctor, it is allowed to use the medication in the treatment of pregnant women (in difficult cases). The bioavailability of the antibiotic is directly dependent on food intake, so the drug should be drunk before meals. Among the side effects are allergic reactions, disruption of the functioning of the gastrointestinal tract (including diarrhea).

Another name for the drug is Midecamycin.

It is used when the patient has an individual intolerance to beta-lactams. It is prescribed to suppress the symptoms of ailments that affect the skin, respiratory organs.

Contraindications - pregnancy, period breastfeeding. Involved in pediatrics.

It is used in the treatment of pregnant, lactating women. In pediatrics, it is used in the form of a suspension. May lower the patient's blood pressure. It is taken regardless of the time of eating.

Stops the symptoms of diseases such as tonsillitis, bronchitis, furunculosis, urethritis, etc.

It is characterized by increased activity against pathogens that cause inflammation in the gastrointestinal tract (among them Helicobacter pylori).

Bioavailability does not depend on the time of eating. Among the contraindications are the first trimester of pregnancy, infancy. The half-life is short, less than five hours.

The effect of the use of the drug increases when it enters the alkaline environment.

Activated when:

• bronchiectasis;
• purulent pleurisy;
• brucellosis;
• diseases of the upper respiratory tract.

New generation drug. Acid resistant.

The structure of the antibiotic differs from most medicines belonging to the described group. When involved in the treatment of HIV-infected patients, it prevents mycobacteriosis.

The half-life is more than 48 hours; this feature reduces the use of the drug to 1 r./day.

Incompatible with Clindamycin, Lincomycin, Chloramphenicol; reduces the effectiveness of beta-lactams and hormonal contraceptives. In severe cases of the disease, it is administered intravenously. It is not used during pregnancy, hypersensitivity to the components of the drug, during lactation.

It is characterized by the ability to regulate the immune system. Does not affect the fetus during the gestation period, is involved in the treatment of pregnant women.

Safe for children (the dosage is determined by the doctor, taking into account the weight, age of the patient and the severity of his disease). Does not undergo cellular metabolism, does not break down in the liver.

Low-toxic macrolides of the latest generation. They are actively used in the treatment of adults and small (from 6 months) patients, since they do not have a significant negative effect on the body. They are characterized by the presence of a long half-life, as a result of which they are used no more than 1 time for 24 hours.

Macrolides of the new generation have practically no contraindications, are well tolerated by patients when involved in therapeutic regimens. The duration of treatment with these drugs should not exceed 5 days.

It is impossible to use macrolides in the treatment of diseases on their own.

It should be remembered: to use antibiotics without first consulting a doctor means to be irresponsible about your health.

Most of the drugs in the group are characterized by slight toxicity, but the information contained in the instructions for the use of macrolide medications should not be ignored. According to the annotation, when using drugs, you may experience:

• disturbances in the work of the gastrointestinal tract (nausea, vomiting, dysbacteriosis), kidneys, liver and central nervous system;
• allergic reactions;
• visual and hearing disorders;
• arrhythmia, tachycardia.

If the patient's history contains individual intolerance macrolides, it is impossible to use medical products of this series in the treatment.

Forbidden:

• drink alcohol during treatment;
• increase or decrease the prescribed dosage;
• skip taking pills (capsules, suspensions);
• stop taking without retesting;
• use medicines that have expired.

In the absence of improvement, the appearance of new symptoms should immediately contact your doctor.

med-antibiotics.ru

Antibiotics are the waste products (of natural or synthetic origin) of viral, bacterial or fungal cells that can inhibit the growth and reproduction of other cells or microorganisms. Drugs may have antibacterial, anthelmintic, antifungal, antiviral and antitumor activity. They are divided into groups depending on the chemical structure.

Macrolide antibiotics are relatively safe representatives of antimicrobial agents. They have the form of complex compounds consisting of carbon atoms, which are attached in various ways to the macrocyclic lactone ring. The drugs are well tolerated by patients.

Classification

The macrolide group has several divisions:

1. Depending on the number of attached carbon atoms:
   • preparations having 14 carbon atoms (for example, Erythromycin, Clarithromycin, Oleandomycin);
   • means with 15 carbon atoms (Azithromycin);
   • macrolides with 16 carbons attached (eg Josamycin, Spiramycin, Roxithromycin);
   • 23 atoms - belong to the only drug (Tacrolimus), which simultaneously belongs to the list of macrolide drugs and immunosuppressants.
2. According to the method of obtaining antibiotics: natural and synthetic origin.
3. Effect duration:
   • short-acting (Erythromycin, Spiramycin, Oleandomycin, Roxithromycin);
   • average duration (Clarithromycin, Josamycin, Flurithromycin);
   • "Long" drugs (Azithromycin, Dirithromycin).
4. Depending on the generation of drugs:
   • means of the 1st generation;
   • macrolides of the 2nd generation;
   • 3rd generation antibiotics (latest generation macrolides);
   • Ketolides are agents whose chemical structure consists of a traditional ring with the addition of a keto group.

The effectiveness of drugs

Antibiotics of this group, especially new generation macrolides, have a wide spectrum of action. They are used to combat gram-positive microorganisms (staphylococci and streptococci). At the present stage, there is a decrease in the sensitivity of pneumococci and some types of streptococci to antibiotics that have 14 and 15 carbon atoms in the composition, however, 16-membered preparations retain their activity against these bacteria.

The drugs are effective against the following pathogens:

• some strains of Mycobacterium tuberculosis;
• gardnerella;
• chlamydia;
• the causative agent of whooping cough;
• mycoplasma;
• bacillus that causes the development of hemophilic infection.

Mechanism of action and benefits

Macrolides are tissue preparations, since their use is accompanied by the fact that the concentration of active substances in soft tissues is much higher than in the bloodstream. This is due to the ability of the substance to penetrate into the middle of the cells. The drugs bind to plasma proteins, but the degree of such action varies from 20 to 90% (depending on the antibiotic).

Action different antibiotics per bacterial cell

The mechanism of action is due to the fact that macrolides inhibit the process of protein production by microbial cells, disrupt the functionality of their ribosomes. In addition, they have a predominantly bacteriostatic effect, that is, they inhibit the growth and reproduction of pathogenic microorganisms. The drugs have low toxicity, do not cause the development of an allergic reaction when combined with other groups of antibiotics.

Additional benefits of the latest generation products:

• long half-life of drugs from the body;
• transportation to the site of infection with the help of leukocyte cells;
• no need for a long course of treatment and frequent use drugs;
• no toxic effect on the digestive system;
• when using tablet forms, absorption from the gastrointestinal tract is more than 75%.

Macrolides in ENT practice

The drugs act on a wide range of pathogens of ENT diseases. Antibiotics are recommended for the treatment of bacterial tonsillitis, tonsillopharyngitis, acute inflammation middle ear and paranasal sinuses, as well as bronchitis and pneumonia. Macrolides are not used in the treatment of paratonsillitis, inflammation of the epiglottis and abscess of the pharynx.

Azithromycin has found the greatest prevalence in the treatment of the upper respiratory tract. The results of the studies confirmed the effectiveness of the drug in children with mild and medium degree severity of inflammatory processes. Clinical manifestations of the effectiveness of treatment are the normalization of body temperature, the elimination of leukocytosis, the subjective improvement in the condition of patients.

Doctors prioritize this group of antibiotics based on the following points:

1. Sensitization to penicillins. In patients with rhinosinusitis or otitis media allergic rhinitis or bronchial asthma penicillin preparations, which are put in the first place, cannot be used because of the allergenic properties. They are replaced by macrolides.
2. The group has an anti-inflammatory effect and a wide spectrum of action.
3. The presence of infections caused by atypical bacteria. Against such pathogens, causing development some types of tonsillopharyngitis, chronic adenoiditis, nasal pathologies, macrolides are effective.
4. A number of microorganisms can form specific films under which pathogens “live”, causing the development chronic processes ENT organs. Macrolides are able to act on pathological cells during their stay under such films.

Contraindications

Macrolides are considered relatively safe drugs, which can be prescribed for the treatment of children, but even they have some contraindications for use. It is undesirable to use the funds of this group during pregnancy and lactation. The use of macrolides in children under 6 months of age is not recommended.

Means are not prescribed in the presence of individual hypersensitivity to active components, with severe pathologies liver and kidneys.

Side effects

Adverse reactions develop infrequently. There may be attacks of nausea and vomiting, diarrhea, abdominal pain. At negative impact on the liver, the patient complains of fever, yellowing of the skin and sclera, weakness, dyspeptic manifestations.

From the side of the central nervous system, cephalgia, slight dizziness, changes in work can be observed. auditory analyzer. Local reactions may develop with parenteral administration drugs (inflammation of the veins with the formation of blood clots in them).

Group representatives

Most macrolides should be taken an hour before a meal or a few hours after it, because when interacting with food, the activity of the drugs decreases. Liquid dosage forms are taken according to the scheme prescribed by the attending physician.

Be sure to observe even intervals between doses of antibiotics. If the patient missed a dose, the medicine should be taken as soon as possible. Double the dosage of the drug at the moment next appointment forbidden. During the period of treatment, you should definitely stop drinking alcohol.

Produced in the form oral forms, suppository, powder for injection. This representative can be used during pregnancy and lactation, but under the strict supervision of the attending physician. For the treatment of newborns, it is not prescribed because of the possibility of developing a narrowing of the output section of the stomach (pyloric stenosis).

Produced in the form of tablets. The spectrum of activity is similar to the previous representative of the group. Its analogues are Rulid, Roxithromycin Lek. Differences from Erythromycin:

• the percentage of the drug entering the blood is higher, does not depend on the intake of food in the body;
• longer withdrawal period;
• better tolerability of the drug by patients;
• interacts well with drugs of other groups.

It is prescribed to combat inflammation of the tonsils, larynx, paranasal sinuses of a streptococcal nature, infection caused by mycoplasmas and chlamydia.

Available in tablets and powders for injection. Analogues - Fromilid, Klacid. Clarithromycin has a high bioavailability and is well tolerated by patients. Not used for the treatment of newborns, pregnant and lactating mothers. The drug is effective against atypical microorganisms.

Macrolide belonging to the class of antibiotics with 15 carbon atoms. Available in the form of tablets, capsules, powders for injection and syrup. Differs from Erythromycin in a large percentage of entry into the bloodstream, less dependence on food, long-term preservation therapeutic effect after the end of therapy.

Antibiotic of natural origin, having 16 carbon atoms in the composition. Effective in the fight against pneumonia pathogens that are resistant to other representatives of macrolides. It can be prescribed for the treatment of women during the period of bearing a child. Introduced orally or into a vein drip.

The active substance is midecamycin. Macrolide of natural origin, acting on those staphylococci and pneumococci that are resistant to other drugs. The agent is well absorbed from the intestinal tract and interacts well with representatives of other groups of medicines.

It has a slightly different spectrum of action than Erythromycin. Josamycin fights those microorganisms that are resistant to a number of macrolides, but is not able to suppress the reproduction of a number of erythromycin-sensitive bacteria. Available in the form of tablets and suspensions.

Conditions for prescribing drugs

For macrolide treatment to be effective, a number of rules must be observed:

1. Making an accurate diagnosis, which allows you to clarify the presence of local or general inflammation in the body.
2. Determination of the causative agent of pathology using bacteriological and serological diagnostics.
3. The choice of the necessary drug based on the antibiogram, localization inflammatory process and the severity of the disease.
4. The choice of the dosage of the drug, the frequency of administration, the duration of the course of treatment based on the characteristics of the drug.
5. The appointment of macrolides with a narrow spectrum of action for relatively mild infections and with a wide spectrum for severe diseases.
6. Monitoring the effectiveness of therapy.

The list of drugs is quite wide. Only qualified specialist can pick up necessary remedy, which will be most effective for each specific clinical case.

anginamed.ru

Many believe that antibiotics should be used only in extreme cases. However, this is not an entirely correct opinion, since the list of such drugs is replenished with drugs that are relatively safe - macrolides. Such antibiotics, basically, without having a negative impact on the human body, are able to overcome the infection “in no time”. The safe profile allows prescribing macrolides to patients undergoing outpatient and inpatient treatment, as well as to children aged 6 months and older (under medical supervision).

Few people know about the properties, origin and effect of such "harmless" remedies. And if you want to get acquainted with such drugs and find out in more detail what a macrolide antibiotic is, we suggest reading our article.

It should be noted right away that macrolides belong to the group of antibiotic drugs that are the least toxic to the human body and are well tolerated by patients.

Antibiotics such as macrolides, from the point of view of biochemistry, are complex compounds of natural origin, which consist of carbon atoms, which are in different amounts in the macrocyclic lactone ring.

If we take this criterion, which is responsible for the number of carbon atoms, as the basis for the classification of drugs, then we can divide all such antimicrobial agents into:

• 14-membered, which include semi-synthetic drugs - Roxithromycin and Clarithromycin, as well as natural - Erythromycin;
• 15-membered, represented by a semi-synthetic agent - Azithromycin;
• 16-membered, including a group of natural drugs: Midecamycin, Spiramycin, Josamycin, as well as semi-synthetic Midecamycin acetate.

Erythromycin, an antibiotic of the macrolide group, was one of the first to be discovered, in 1952. New generation drugs appeared a little later, in the 70s. Since they showed excellent results in the fight against infections, research on this group of drugs has continued actively, so that today we have a fairly extensive list of drugs that can be used to treat both adults and children.

http://youtu.be/-PB2xZd-qWE

The antimicrobial effect is achieved by affecting the ribosomes of microbial cells, disrupting protein synthesis. Of course, under such an attack of macrolides, the infection weakens and “surrenders”. In addition, antibiotics of this group of drugs are able to regulate immunity, providing immunomodulatory activity. Also, these drugs have anti-inflammatory properties, affecting both the body of adults and children, quite moderately.

Means of the group of antibacterial agents of the new generation are able to cope with atypical microbacteria, gram-positive cocci and similar misfortunes, which often become the causative agents of such diseases as: bronchitis, whooping cough, diphtheria, pneumonia, etc.

No less popular are macrolides in the situation that has developed over the past few years, due to the addiction of a large number of microbes to antibiotics (resistance). This is due to the fact that new generation drugs belonging to this group are able to maintain their activity against a variety of pathogens.

In particular, macrolide preparations are widely used in the treatment and as prophylactic agents for the following diseases:

• Chronical bronchitis;
• acute sinusitis;
• periostitis;
• periodontitis;
• rheumatism;
• endocarditis;
• gastroenteritis;
• severe forms of toxoplasmosis, acne, mycobacteriosis.

The list of diseases that can be overcome using new generation antibiotics, which have a common name - macrolides, can be supplemented by sexually transmitted infections - syphilis, chlamydia and infections that affect soft tissues and skin - furunculosis, folliculitis, paronychia.

If your doctor prescribes a similar antibiotic for you, immediately read its contraindications indicated in the instructions for the drug. Unlike most conventional antibiotics, new generation drugs - macrolides are safe, including for children, and less toxic. Therefore, the list of undesirable effects of antibiotics in this group is not as large as that of similar drugs.

First of all, it is not recommended to use macrolides for pregnant women and mothers during lactation. The use of such drugs in children under 6 months is contraindicated, since the reaction to the drug has not yet been studied. You should not use such drugs as a treatment for people who have individual sensitivity.

Antibiotics of the macrolide group with special attention should be prescribed by doctors to patients of mature age. This is due to the fact that most of the older generation have disorders in the functioning of the kidneys, liver and heart.

Side effects can also occur when using macrolides in a mild form - weakness and malaise that appear after taking them. But there may also be:

• vomit;
• nausea;
• headache and pain in the abdomen;
• impaired vision, hearing;
• an allergic reaction in the form of a rash, urticaria (most often occurs in children).

In order to avoid problems and undesirable consequences after the use of drugs of the macrolide group, it is necessary to strictly follow the doctor's recommendations, strictly observe the dosage and refrain from drinking alcohol. It is also strictly forbidden to combine the intake of new generation antibiotics with antacids. It is also important not to skip appointments.

Basically, new generation antibiotics should be taken 1 hour before a meal, or 2 hours after a meal. Take the tablets with a whole glass of water. If the doctor has prescribed you an antibiotic of the macrolide group, the release form of which is a powder for the preparation of a suspension, strictly follow the instructions for preparing the medicine and strictly follow the doctor's instructions.