Azithromycin (Sumamed): dosage form for intravenous administration. Azithromycin in the treatment of lower respiratory tract infections Method and dosage

08.07.2023

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Azithromycin: respiratory specificity and uniqueness

Authors: D.B. UTESHEV, Department of Hospital Therapy, Moscow Faculty of Russian State Medical University, I.A. KRYLOV, O.V. BUYUKLINSKAYA, Northern State Medical University, Arkhangelsk

Azithromycin is a member of the azalides, a subclass of macrolide antibiotics. Chemically, it differs from macrolides by the presence of a 15-membered lactone ring containing a nitrogen atom. In the arsenal of antibacterial agents intended for the treatment of respiratory infections, azithromycin invariably retains a leading position: depending on the nosological form, it is used as a first-line drug, an alternative agent, or in combination with other antibiotics. This is due to a number of exceptional features of azithromycin, which make it stand out among other antibacterial agents.

Spectrum of antibacterial activity

Azithromycin has a broad spectrum of antibacterial activity, which covers most types of bacteria that cause respiratory tract infections. The drug is effective against gram-positive microorganisms, including those producing β-lactamases (streptococci, staphylococci), as well as gram-negative bacteria (enterococci, Escherichia coli, Haemophilus influenzae, Shigella, salmonella), atypical pathogens (Chlamydia pneumoniae, Legionella pneumophila, Mycoplasma pneumoniae), anaerobes and spirochetes. Azithromycin is 2-4 times less active against staphylococci and streptococci than erythromycin, but is superior in its effect on Haemophilus influenzae and gram-negative cocci. A positive feature of azithromycin is the low level of resistance of microorganisms to it.

Features of pharmacokinetics

Azithromycin has unique pharmacokinetic characteristics: first of all, a high degree of accumulation in tissues and inside cells, where its levels are 10-100 times higher than in blood plasma. This property is due to the high lipophilicity of the drug. The maximum concentration of azithromycin is determined in the lung tissue (compared to erythromycin, which has no differences in levels in the blood plasma and in the lungs). Due to the accumulation of azithromycin in phagocytes, the drug is distributed to foci of infectious inflammation. The concentration of azithromycin in the site of infection is significantly higher than in unaffected tissues.

Azithromycin is characterized by metabolic stability. It acts for a long time (half-life 2-4 days), with a post-antibiotic effect (maintaining effective concentrations at the site of infection for 3-5 days after discontinuation of the drug) against S.pyogenes, S.pneumoniae, H.influenzae, L.pneumophila. Duration of post-antibiotic effect in relation to H.influenzae And L.pneumophila azithromycin has more than clarithromycin. This determines the exceptional feature of the use of azithromycin in the treatment of respiratory tract infections - the effectiveness of 3-5-day courses of treatment.

The drug does not penetrate the blood-brain barrier. Elimination occurs unchanged in urine and bile. In case of renal and liver failure, the half-life does not change. The drug does not affect the liver microsomal system, therefore, there is no risk of undesirable effects inherent in this interaction.

In the USA, a new oral dosage form of azithromycin—sustained-release microspheres (SR)—was created and introduced into clinical practice. The US Food and Drug Administration (FDA) has approved the use of azithromycin ZV for the treatment of community-acquired pneumonia and mild/moderate sinusitis at a single dose per course. Compared to the conventional dosage form, azithromycin ZV is absorbed more slowly in the intestine, the maximum concentration in plasma is reached after 2.5 hours, and the bioavailability is 82.8%. The use of azithromycin ZV is characterized by a lower incidence of dyspeptic disorders. The combined use of antacid drugs does not have a significant effect on the pharmacokinetic parameters of azithromycin ZV (maximum plasma concentration, area under the pharmacokinetic curve). The introduction of azithromycin ZV made it possible not only to achieve high efficiency of antibacterial therapy, but also to increase compliance: the drug is prescribed once and has a favorable safety and tolerability profile.

Clinical Application

Azithromycin has become justifiably widespread in the treatment of pathologies of the respiratory system. This is due to the favorable spectrum of antibacterial activity, the low level of resistance of pathogens to it, the characteristics of pharmacokinetics (high pulmonary deposition) and good tolerability.

A comparative study of azithromycin, amoxicillin/clavulanate and the combination of cefuroxime with erythromycin for community-acquired pneumonia established the same clinical effectiveness of the compared regimens, however, azithromycin was characterized by better tolerability and a lower incidence of adverse effects (12%). In the group of patients receiving cefuroxime in combination with erythromycin, the incidence of adverse effects was 48% (mainly dyspeptic symptoms). When pharmacoeconomically comparing empirical therapy with azithromycin or the combination of cefuroxime with erythromycin in stepwise therapy regimens, the equivalent cost of these regimens was established (the cost reduction in the azithromycin group due to the lower frequency of undesirable effects, simplification of the treatment process and reduced staff labor costs was not taken into account).

Azithromycin, along with other macrolide antibiotics, is the drug of choice for the treatment of atypical (mycoplasma, legionella, chlamydial) pneumonia. According to some data, these intracellular pathogens account for more than 30% of all cases of community-acquired pneumonia, and verification of these pathogens requires the use of expensive techniques. In this regard, the empirical use of azithromycin in the treatment of community-acquired pneumonia appears justified. In severe pneumonia, the empirical prescription of a combination of azithromycin and ceftriaxone is justified.

A new form of azithromycin (sustained-release microspheres) was used in a single dose of 2 g per course for the empirical treatment of community-acquired pneumonia and mild to moderate bacterial sinusitis. A single dose of azithromycin was comparable in effectiveness to the use of levofloxacin or clarithromycin for 7 days for community-acquired pneumonia or levofloxacin for 10 days for sinusitis. The use of a new form of azithromycin showed high compliance and good tolerability.

It is justified to prescribe azithromycin as a drug of choice for the treatment of exacerbations of chronic bronchitis, the causative agents of which, as a rule, are S.pneumoniae, M.catarrhalis, H.influenzae. The use of other macrolides is considered inappropriate due to the lack of clinically significant activity against H.influenzae.

Long-term use of azithromycin in low doses in patients with cystic fibrosis with chronic infection Pseudomonas aeruginosa was accompanied by a decrease in the number of exacerbations, a positive effect on pulmonary function, improved nutritional status and good tolerability of the drug.

Of interest are the data on the organoprotective properties of azithromycin, which may be due to the nonspecific anti-inflammatory activity and antioxidant effect of azithromycin. Thus, one study demonstrated that azithromycin protects the lungs from smoking-induced damage. Azithromycin inhibits tobacco smoke-induced damage to type II alveolocytes, activation of nuclear factor k B and an increase in the concentration of tumor necrosis factor a. This effect is undoubtedly an advantage of this antibiotic in the treatment of bronchopulmonary pathology.

Of independent interest are data on the use of azithromycin for the treatment of infectious processes of other localizations: urogenital chlamydia, syphilis, chronic bacterial prostatitis (in combination with ciprofloxacin), acne, Lyme disease, chronic periodontitis.

Conclusion

Unique pharmacokinetic characteristics (accumulation in tissues, metabolic stability, a long half-life characteristic exclusively of azithromycin), a wide range of antibacterial activity, including atypical pathogens, the presence of a post-antibiotic effect, good tolerability, high compliance, low level of resistance of pathogens, the presence of organoprotective properties (anti-inflammatory and antioxidant activity) - all this provides grounds for the widespread use of azithromycin for respiratory infections. The clinical effectiveness of azithromycin in the empirical treatment of bronchopulmonary infections (in monotherapy and in combination with β-lactams) in outpatient settings and in hospitals has been proven in a number of multicenter studies.

Bibliography

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Broad-spectrum antibiotic of the azalide subgroup of the macrolide group. When a high concentration of the active substance is created at the site of inflammation, azithromycin has a bactericidal effect. Compared to other macrolide antibiotics, it has the most pronounced bactericidal effect, the ability to penetrate tissues, cells and body fluids, and the maximum half-life. To achieve a clinical effect, in most cases a 3-day course of therapy is sufficient. Like all erythromycin antibiotics, azithromycin is well tolerated; active against gram-positive aerobic microorganisms (including strains producing β-lactamases): Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus agalactiae, Streptococcus pyogenes, Streptococcus viridans, streptococci of groups C, F and G. Gram-positive microorganisms resistant to erythromycin are cross-resistant to azithromycin. Most strains Enterococcus faecalis and methicillin-resistant staphylococci are resistant to azithromycin.
Of the gram-negative aerobic microorganisms that are sensitive to azithromycin: Bordetella pertussis, Bordetella parapertussis, Campylobacter jejuni, Escherichia coli, Gardnerella vaginalis, Haemophilus influenzae, Haemophilus parainfluenzae, Haemophilus ducreyi, Legionella pneumophila, Moraxella catarrhalis, Neisseria gonorrhoeae, Shigella spp. , Salmonella spp., Yersinia spp. From anaerobes - Bacteroides bivius, Clostridium perfringens, Peptostreptococcus spp.
The following are sensitive to azithromycin: Borrelia burgdorferi, Chlamydia trachomatis, Mycoplasma pneumoniae, Treponema pallidum, Ureaplasma urealyticum.
When administered orally, azithromycin is well absorbed and rapidly distributed in the tissues of the body, reaching high concentrations many times higher than the concentration in the blood plasma. High antimicrobial activity is also ensured due to the ability of azithromycin to penetrate and accumulate intracellularly in leukocytes (granulocytes and monocytes/macrophages), with which it is transported to sites of inflammation, as a result of which the concentration of the antibiotic is 6 times higher in the site of inflammation compared to intact tissues. Azithromycin is slowly eliminated from the body, which makes it possible to take it once a day and reduce the duration of treatment to 5 days; in tissues, high concentrations of the active substance remain for another 5-7 days after taking the last dose of azithromycin.

Indications for use of the drug Azithromycin

Infections caused by microorganisms sensitive to azithromycin, including infections of the respiratory tract and ENT organs (acute pharyngitis and tonsillitis; scarlet fever; acute otitis media; acute sinusitis; acute bronchitis, exacerbation of chronic bronchitis, pneumonia); infections of the skin and subcutaneous fat (erysipelas, impetigo, secondary infected dermatoses); infections of the urinary tract and genital organs (acute nonspecific (chlamydial) or gonococcal urethritis, cervicitis, colpitis).

Use of the drug Azithromycin

Orally 1 hour before or 2 hours after meals. For adults with infections of the upper and lower respiratory tract, skin and subcutaneous fat, 500 mg per dose is prescribed on the 1st day of treatment, from the 2nd to 5th day - 250 mg once a day; for acute sexually transmitted infections, taking 1 g of azithromycin once is most often sufficient.
For children over 1 year of age, azithromycin is prescribed on the 1st day at the rate of 10 mg per 1 kg of body weight, and in the next 4 days - 5 mg/kg 1 time per day.
Pharmacokinetic properties allow the use of azithromycin for a short time, from 3 to 5 days, maximum 7 days. Only in rare cases of chronic infectious and inflammatory diseases when other antibiotics are ineffective, longer treatment in combination with various antimicrobial agents is required. Sometimes a combination with immunomodulatory therapy is recommended.

Contraindications to the use of the drug Azithromycin

Hypersensitivity to macrolide antibiotics.

Side effects of the drug Azithromycin

Possible nausea, vomiting, lack of appetite, diarrhea; transient increase in the activity of liver enzymes, allergic reactions (may occur 2-3 weeks after taking the last dose of the antibiotic).

Special instructions for the use of Azithromycin

Caution is required when prescribing azithromycin to patients with severely impaired liver and kidney function. Experimental studies have not revealed a negative effect of azithromycin on animals and their offspring, but since clinical experience is insufficient, caution should be exercised when prescribing azithromycin during pregnancy and lactation.

Drug interactions Azithromycin

The absorption of azithromycin does not change significantly with the simultaneous use of antacids or H2-histamine receptor blockers, however, it is recommended that the interval between taking the above drugs be at least 2 hours. There is no interaction of azithromycin with digoxin, ergotamine, cyclosporine, carbamazepine, theophylline, phenytoin or oral anticoagulants.

List of pharmacies where you can buy Azithromycin:

Saint Petersburg

Azithromycin and Ceftriaxone are antibacterial agents that have a wide range of applications. It is worth figuring out whether a combination of these medications is possible.

Characteristics of Azithromycin

Azithromycin is an antibiotic belonging to the macrolide group. It is considered a derivative of Erythromycin. Its principle of action is that the production of proteins that ensure the vital activity of bacteria is blocked. After use, the medication is distributed throughout the tissues of the body. Part of the active substance is excreted in the urine.

The main advantage of the drug is its stability. This medication is not destroyed by gastric juice and acids. As for the indications for the use of such a drug, it is used for the following pathologies:

in case of meningitis;
for prostatitis and pneumonia;
when the patient has pulmonary or genitourinary infections;
with otitis media and sinusitis;
in case of skin damage.
This drug is also effective in the treatment of chlamydia.

This medicine is used to treat patients who have advanced stomach damage. A similar medication also helps with duodenal ulcers.

Characteristics of Ceftriaxone

Ceftriaxone is used to treat meningitis and gonorrhea. It is effective:

With insufficient liver and kidney function.
As a prophylactic after surgery.
In case of infection of joints and bones.
With pyelonephritis.

Separately, it is worth mentioning the pharmacokinetics of such a medication. An increased concentration of Ceftriaxone is achieved in the bile.

This medication is recommended to be used with caution if you are sensitive to individual components of the drug. It is undesirable to use it in cases of severe renal dysfunction. For newborns who have congenital hyperbilirubinemia (which occurs in premature babies), this drug can be used under the supervision of a doctor.

It is undesirable for such a drug to interact with medications that reduce platelet aggregation, for example, Sulfinpyrazone, because the likelihood of bleeding increases. The anticoagulant effect is enhanced when this medicine is used simultaneously with anticoagulants.

Which is better Azithromycin or Ceftriaxone

The difference between these medications is their side effects. Thus, when consuming Azithromycin, side effects from the sensory organs and nervous system are possible: dizziness and drowsiness may occur. Children may develop conjunctivitis and anxiety.

Also, when consuming Azithromycin, side effects from the cardiovascular system are possible. Palpitations and pain in the chest area often appear.

As for the gastrointestinal tract, diarrhea and vomiting may occur. In addition, patients complain of abdominal pain, jaundice and increased bilirubin concentrations. Side effects from the urinary system include nephritis and candidiasis.

An allergic reaction also occurs. Its symptoms are urticaria, rash. Anaphylactic shock rarely develops. Neutrophilia and bronchospasm also rarely appear.

The use of Ceftriaxone can lead to side effects such as erythema and urticaria. From the gastrointestinal tract, diarrhea and nausea may occur. Taste sensations may be impaired.

A common side effect is glossitis (inflammation of the tongue). Stomatitis and abdominal pain in the abdominal area may develop.

Is it possible to take Azithromycin and Ceftriaxone at the same time?

The combination of Azithromycin and Ceftriaxone is often used to treat tuberculosis. The double effect of such antibiotics enhances the bactericidal properties and allows the patient to recover faster.

When combining these medications, you should be careful because the likelihood of side effects increases.

To quickly get the effect of therapy, it is recommended to simultaneously use tablet and injection forms of antibiotics. It should also be remembered that it is undesirable to combine Ceftriaxone with fluoroquinolones.

Indications for joint use

Azithromycin and Ceftriaxone are taken together for tonsillitis and sinusitis. In addition, their combined use is possible in the case of erysipelas, dermatosis, when the patient is diagnosed with urethritis or Lyme disease.

Doctors prescribe a combination of these medications in case of stomach diseases caused by the Helicobacter bacteria. Their combination is also effective in the treatment of impetigo.

Sexually transmitted infections are the scourge of our time. Almost 50% of adults are carriers of dangerous infections. Azithromycin is an effective remedy for their destruction.

Azithromycin is an antibiotic with a broad spectrum of action, which belongs to the group of macrolides. The main active ingredient is the substance of the same name - a semi-synthetic antibiotic, the first of the azalide subclass.

Azithromycin is actively used to treat various infectious diseases, since the drug has a pronounced bactericidal effect. The main areas of therapy: colds, skin and genital infections. The advantage of the drug is a short list of possible side effects.

Usually the drug is prescribed for a short course and in small doses, which allows it to be classified as a new generation of antibiotics.

pharmachologic effect

Azithromycin is capable of destroying colonies of streptococci (G, CF), gram-positive cocci, anaerobic microbes and gram-negative microorganisms. The bactericidal properties of the drug are well revealed in the treatment of diseases caused by Treponema pallidum, chlamydia, mycoplasmas, ureaplasmas and the spirochete Borrelia.

The drug can be prescribed only after laboratory tests. In cases where the disease is caused by different bacteria, it is often necessary to combine Azithromycin with antibiotics from other groups.

The active substances of the drug are quickly absorbed into the blood, and in full, since azithromycin is resistant to the acidic environment of the stomach. The maximum concentration of components in plasma is achieved 2-3 hours after administration.

The drug is able to penetrate any tissue and liquid, so it continues to fight pathogenic microorganisms for a long time (about a week). This property of the drug makes it possible to treat many diseases with Azithromycin, excluding relapses. The active substances do not disrupt the natural microflora, which makes the drug safe for different categories of patients.

Advantages

The antibiotic has the most pronounced accumulative ability among all antibacterial drugs. During microbial inflammation, active substances settle in the organs of the reproductive system, gastrointestinal mucosa and lungs, prostate gland and urethra.

Macrolides persistently accumulate in the cytoplasm and phagolysosomes - the habitat of chlamydia, mycoplasma and legionella. Namely, these microorganisms have recently increasingly become the cause of urethritis and prostatitis.

The great advantage of Azithromycin is its ability to suppress the proliferation of atypical and intracellular pathogens, which are insensitive to most antibiotics. The drug is also widely used in the treatment of sexually transmitted infections.

Among all macrolides, Azithromycin has the highest degree of penetration into leukocytes, which increases anti-infective protection. Anti-inflammatory, immunomodulatory and mucoregulatory abilities of the drugs have been proven clinically and experimentally.

Due to its unique ability to accumulate in tissues, short courses of Azithromycin are most often prescribed for sexually transmitted infections.

Indications

Azithromycin is one of the few antibiotics approved for children and pregnant women (due to low toxicity). It is widely used to prevent inflammation of the pelvic organs.

Often prescribed for the following diseases:

inflammatory processes in the upper and lower respiratory tract, as well as diseases of the ENT organs (sinusitis, tonsillitis, sinusitis, tonsillitis, pneumonia, bronchitis);
infections of soft tissues and skin (erysipelas, dermatosis, impetigo);
acute infections that most often occur in children (measles, scarlet fever);
inflammatory diseases of the genitourinary system;
Lyme disease.

Sometimes this antibiotic is prescribed for chancroid, nongonococcal urethritis and granuloma inguinale. In severe forms of infections, intravenous administration of the drug is possible.

Standard dosage regimen

The drug should be taken once a day. You need to choose a time an hour before or after a meal. The medicine does not cause side effects from the digestive system, but the doctor should be warned about the presence of gastrointestinal diseases.

Standard regimen for taking Azithromycin for infection:

One tablet (500 mg) or two tablets (250 mg each) once on the first day.
250 mg daily from the second to the fifth/seventh days.
Certain pathologies are treated with a single dose of 500 mg of antibiotic ().
Three days, 500 mg per day for intestinal infections.

Azithromycin should not be taken uncontrollably for sexually transmitted infections and colds.

In recent years, complications (prostatitis, urethritis, epididymitis) are treated with a course of 1-7-14, 1 g per day. Typically, the cause of urogenital infection is chlamydia combined with other microorganisms. This treatment regimen (pulse therapy) can reduce the number of relapses to 1.2% in men and 2.5% in women. A similar effect cannot be achieved by any other macrolides or tetracyclines.

Only laboratory diagnostics can determine the correct dosage, otherwise the treatment will be ineffective or even destructive. Incorrect self-medication leads to the fact that the symptoms are “blurred” and complicates the diagnosis of the true cause of the disease.

Azithromycin for chlamydia

Treatment for chlamydia may include various drugs. The main ones are macrolides, fluoroquinolones and tetracyclines. Azithromycin is a leader in the treatment of chlamydial infection.

When treating chlamydia, monotherapy is assumed. This is due to the fact that, accumulating in the affected tissues, the active substances do not always adequately interact with other drugs (antimicrobial agents are acceptable). However, it should be remembered that taking Azithromycin exclusively is permissible only at the initial stage of chlamydia development.

Even the standard dosage regimen and dosage indicated in the instructions can be dangerous. If chlamydia is not treated correctly, the disease becomes chronic. Often, self-treatment of infections with antibiotics leads to the development of complications.

At an early stage, take one tablet (1 g) per day two hours before meals.
For mild symptoms, take one tablet on the first day, then 0.5 g for another two to three days. From the fourth to the seventh days, 0.25 g is prescribed.

The patient should receive approximately 3 g of Azithromycin per week. Often this is enough to adequately affect chlamydia. The regimen is acceptable for both women and men, but you should also consult your doctor on this issue. When treating chlamydia with Azithromycin, some side effects may occur: diarrhea, allergic rash, drowsiness, tinnitus, and rarely chest pain.

Treatment of ureaplasmosis

It begins only after testing for Trichomonas. The causative agent of the disease, ureaplasma, is able to live inside these microorganisms, using them as protection against antibiotics. The results of the analysis help you choose the right treatment regimen.

Possible dosages of Azithromycin for ureaplasmosis:

Before treatment with antibiotics, an injection course of immunomodulators should be started. Cycloferon is usually prescribed (every two days intramuscularly). Injections should be continued during antibiotic therapy.
The second stage is bactericidal antibiotics. For these purposes, Oflox is prescribed (400 mg in the first two days in the morning and evening, the remaining days 200 mg).
After a course of bactericidal agents, Azithromycin is prescribed (in the first six days, an hour and a half before breakfast, 1 g of the drug, a break of five days, again 1 g, break, third dose of 1 g).

Treatment of ureaplasmosis with Azithromycin takes 15-16 days. Often, along with an antibiotic, antifungal agents are prescribed at a dose of 150-400 mg two to three times a day. After a course of antibiotics, restorative therapy should be carried out to normalize the functioning of the gastrointestinal tract and liver. It usually lasts two weeks and includes one tablet per day. Medicines to strengthen the liver are prescribed three times a day before meals.

Treatment of urethritis with antibiotics

For inflammation of the urethra, antibiotics are most effective. Azithromycin is considered one of the best for therapy.

Advantages of this antibiotic:

ability to overcome cell membranes;
rapid absorption and accumulation in tissues;
prolonged effect (long-lasting);
resistance to acidic environments.

For urethritis, this antibiotic is effective due to its ability to suppress protein synthesis in pathogenic microorganisms. Small doses of the antibiotic can slow down the growth and reproduction of bacteria, and high doses can destroy colonies and prevent relapse of urethral inflammation.

Azithromycin is the best choice for urethritis, which is caused by microplasmas, chlamydia, spirochetes, treponema and ureaplasmas. If the cause is streptococci, staphylococci or enterococci, you should take Erythromycin.

For urethritis, the drug is usually prescribed at an early stage. The standard course includes taking one 0.5 g tablet daily for three days. A course is possible that includes taking two tablets of 0.5 g once a day, maintaining an interval.

It is better to take the antibiotic before meals, preferably an hour or two hours after. However, for gastrointestinal disorders, the drug can be taken with meals. This reduces the rate of absorption, which, however, does not affect the effectiveness.

When treating with Azithromycin, all citrus fruits are excluded from the diet: their components, in combination with the active substances of the drug, can impair the functioning of the heart muscle.

Azithromycin for ovarian inflammation

– inflammation of the fallopian tubes and ovaries, which is infectious in nature. It is most common among women 20-30 years old, and poses a serious danger to reproductive function.

For adnexitis, Azithromycin is indicated at the initial stage of disease development, followed by a transition to other antibacterial agents (Amoxiclav). To preserve reproductive function, treatment of adnexitis should be started in a timely manner.

The high effectiveness of the drug against various infections allows the treatment of acute adnexitis without test results. The effectiveness of the drug makes it possible to avoid tubal infertility.

Treatment regimen for adnexitis with Azithromycin:

500 mg once a week, combined with Amoxiclav.
Combination of different drugs: Azithromycin, Metronidazole, Ceftriaxone.

Acute inflammation requires a short course of antibiotics. The drug combines well with antimicrobial drugs; it is ineffective only against certain types of microbes.

Azithromycin after abortion

After termination of pregnancy, restorative therapy is prescribed.

Recovery after a miscarriage includes:

antibiotics to prevent inflammation;
combined oral contraceptives that restore hormonal levels;
vitamin supplements that strengthen the immune system.

Antibiotics should be taken in any case. They protect the body from infections, so doctors prescribe strong drugs (Metronidazole). Azithromycin is indicated on the day of abortion (1 g). Thus, the risk of infectious post-abortion complications is reduced by 88%.

Can it be given to children?

Children over 3 years of age should take Azithromycin according to an individual regimen, which is based on the baby’s weight. For children under 10 kg, the drug is prescribed extremely rarely (in case of danger to life); it is replaced with gentle analogues.

The safety of the drug for adult patients does not guarantee an adequate response of the child’s body. Only the attending physician, based on test results, can prescribe Azithromycin to a child.

Complications, contraindications and side effects

There is an opinion that Azithromycin can be an indirect cause of infertility, like many other strong antibiotics. Improper use of such drugs leads to the fact that the patient weakens the symptoms, but does not cure the sexually transmitted disease.

The drug is not prescribed to patients who are allergic to macrolide antibiotics. At risk are people with kidney failure, pregnant and lactating women. When carrying a child, the drug is prescribed only as a last resort, so if you have symptoms of infection, you should definitely consult a doctor.

Side effects during treatment with Azithromycin are very rare. Sometimes patients complain of dizziness, headaches, nervousness and symptoms of indigestion, fatigue, vaginitis and nephritis.

Side effects are observed in only 1% of cases, 64% of which are mild. When Azithromycin is included in therapy for pregnant women, there is no risk of harm to the fetus. The drug does not have a toxic effect on the unborn child.

A popular and reliable modern antibiotic, available in almost any pharmacy, is Azithromycin. The instructions for use of the drug indicate that the medication belongs to the category of antimicrobial compounds that are broad in their effect. Belongs to the group of macrolides. The name of the drug was given by the active component - azithromycin, which is part of the azalide class. The drug is available in pharmacies in capsules, tablets and suspension. Suitable for treating children and adults.

What's on sale?

Most often, patients visit the pharmacy to buy Azithromycin tablets. Instructions for use and packaging of the drug contain a mention of the amount of the active ingredient in one dose. There are three release options: 125, 250, 500 mg. 250 mg is an option available not only in tablets, but also in capsules. Distinctive features are additional components used in the production of the drug. A complete list must be specified in the instructions for use. Azithromycin may contain substances that are intolerable to a particular patient, so it is important to study the accompanying documentation.

Manufacturers most often use the following as auxiliary connections:

cellulose;
lactose;
povidone;
magnesium stearate;
aerosil.

Drug dynamics

The manufacturer in the instructions for use of Azithromycin indicates that the drug belongs to the class of azalides, that is, medications based on macrolides. The main effect of application is bacteriostatic. Soon after penetration into the body, the active substance enters into strong bonds with the components of the ribosome, which means it slows down the translation of peptide translocase. In the molecule of a pathological microorganism, the processes of formation of protein structures are inhibited, growth and reproduction are prevented, so colonies cannot develop.

The manufacturer also indicates in the instructions for use: “Azithromycin” in a high dose can have a bactericidal effect.

The drug is effective both against pathogens capable of invading a cell and during infection with extracellular forms. Activity was detected in relation to certain representatives of the following species and groups:

staphylo-, strepto-, peptrostreptococci;
chlamydia;
clostridia;
Neisseria;
legionella;
hemophilus influenzae;
Moraxella;
campylobacter;
bordetella;
urea-, mycoplasma;
mycobacteria;
Treponema.

Drug kinetics

According to the instructions for use, Azithromycin (500 mg capsules, tablets, powder for suspension) is based on an active component that is absorbed into the body at a relatively high rate after oral administration. The substance is lipophilic and shows an increased level of resistance to acids. Bioavailability after a single dose of 500 mg is estimated at 37%. The indicator is determined by passage through liver cells. The highest parameters in the blood of azithromycin are observed at a level of 0.4 mg/l. The time period required to achieve this indicator is from two and a half to three hours.

As follows from the instructions for use of Azithromycin, 500 mg of the active component upon initial administration is orally distributed in a volume varying around 31.1 l/kg. In the tissues and cells of the body, the substance accumulates more actively than in the blood plasma, 10-50 times.

Studies have shown that in any dosage (150, 250, 500 mg) Azithromycin (the manufacturer draws attention to this fact in the instructions for use) is able to penetrate the barriers present in the body. Quite quickly, the active component enters the soft tissues and organs of the respiratory system, reproductive and urinary systems, prostate gland, and skin. The cumulative effect is observed in environments characterized by low levels of acidity. "Azithromycin" is able to accumulate in lysosomes. This effect has found application for the eradication of pathogens that invade cell cavities.

Biological chemistry

In the body, the active component of the drug is transported by macrophages, phagocytes, and certain categories of leukocytes. The instructions for use for Azithromycin (500 mg capsules and other release options) indicate the ability to penetrate cell membranes. As it was revealed during specific studies, in the infected lesion the active compound accumulates in quantities that are a quarter, sometimes even a third higher than the content in other tissues of the body. Specific indicators are determined by the intensity of the inflammatory process.

If you take Azithromycin tablets, syrup, capsules with food according to the instructions for use (500 mg or another volume as recommended by the doctor), after the last dose is received in the tissues and cells of the body, the active substance remains in sufficient concentrations to have a bactericidal effect, a few more days: from five to seven.

The level of binding to plasma proteins in a particular case is almost impossible to predict. In the instructions for use of Azithromycin capsules, tablets and suspension, the manufacturer indicates that in some patients the parameter was estimated at only 7%, while in others it reached half of the entire dose used. The degree of binding to plasma proteins is inversely proportional to the concentration of the components of the drug in the circulatory system.

Once in the liver cells, azithromycin enters into chemical reactions, which result in the formation of products that do not have a pharmacological effect on the patient’s body. Plasma clearance, as indicated in the instructions for use of Azithromycin in capsules, tablets, powder, is estimated at 630 ml/min. Removal from the circulatory system occurs in two stages:

14-20 hours in the interval 8-24 hours after using the medication for food;
41 hours - within 24-72 hours after administration.

Elimination of about half of the substance entering the body occurs through the bile ducts; the drug leaves the body without being transformed. About 6% are excreted in urine.

In the instructions for use of Azithromycin (500 mg and other dosage options), the manufacturer indicates a strong influence on the kinetics of the drug from food. If you take the substance during a meal, the highest concentrations are reduced by more than half. In old age, mainly in men, the pharmacological kinetics remain the same as in younger patients. In women, the highest concentration levels usually increase by a third, and sometimes by half, relative to typical middle-aged and young patients.

When will it help?

The instructions for use of Azithromycin (500 mg, 125 and 250 mg) indicate the following diagnoses for which the drug shows pronounced effectiveness:

Lyme disease (initial stage);
cervicitis;
tonsillitis;
urethritis;
erysipelas;
dermatosis;
bronchitis;
pulmonary inflammation;
impetigo;
angina;
otitis;
sinusitis.

Before taking it, it is reasonable to conduct a test to determine the sensitivity of pathological microorganisms to azithromycin. Efficiency (special attention is paid to this in the instructions for use of Azithromycin - capsules of 250, 125 and 500 mg, tablets, suspensions) is expressed only if the disease is caused by strains sensitive to the antimicrobial drug.

Restrictions

The manufacturer indicates that Azithromycin is not intended for use by persons suffering from hypersensitivity to medications from the macrolide category.

Particular attention should be paid to patients who have established insufficient functioning of the kidneys and liver. Such health problems are not absolute contraindications for use, but improper use can cause adverse reactions.

Rules and volumes

The choice of dosage and format must be subordinated to:

diagnosis;
sensitivity of pathological life forms to antibiotics;
individual characteristics of the patient (weight, age).

As a rule, the doctor orders tests to determine the specifics of the pathological microflora. Based on the information received, the doctor prescribes the drug and writes a prescription for it (in any form, the drug is not dispensed from pharmacies without it, as indicated in the instructions for use). For adults, Azithromycin is often recommended in the form of tablets and capsules. The manufacturer advises using the medicine in this form one hour before a meal or 120 minutes after it. Azithromycin is taken once a day.

If infection of the skin, soft tissues, or organs of the respiratory system is established, for adult patients the optimal course format is:

0.5 g on the first day;
0.25 g for another 2-5 days.

How is borreliosis treated at the initial stage? According to the instructions for use, Azithromycin: 250 mg (four capsules) or 500 mg (two capsules) on the first day, then the dosage is halved.

When drawing up a dosage regimen for minors, it is necessary to focus not only on age, but also on body weight. The optimal format is a suspension for children. The instructions for use of Azithromycin indicate that if you weigh more than 10 kg on the first day, the drug is used in an amount of 10 mg per kilogram of weight, then the dosage is halved and maintained at this level until the end of the program. An alternative option is a three-day course, each day the dose is calculated as 10 mg per kilogram of body weight.

Features of use

The manufacturer points out that if a dose is missed, it is necessary to replenish this amount as quickly as possible. The next dose should be one day after consuming the missed amount.

As tests have shown - and this is recorded in the instructions for use - Azithromycin (250 mg, 500, 125 mg) is characterized by increased resistance to acid influence. The product is quickly and effectively absorbed when passing through the gastrointestinal tract, penetrates the skin, other organs and tissues.

Increasing the concentration of azithromycin in the inflammatory focus allows you to achieve a bactericidal effect, the duration of which is up to a week after the last dose is consumed. Therefore, you can use the product for a very short course, following the instructions for use. Reviews of Azithromycin contain information about the effectiveness of the composition even if it is treated for only three days. Sometimes a five-day intake is necessary, but it is almost always enough to achieve a pronounced result.

Patients using an antimicrobial drug in combination with antacids deserve special attention. At least two hours must pass between taking these groups of drugs, otherwise the effectiveness of the antibacterial composition will be too low.

Negative effects: what to prepare for?

In general, the drug is tolerated quite well, so its use is practiced even for the treatment of children. And yet, as can be seen from the responses to the drug (as well as from the text of the instructions for use), Azithromycin (suspension, tablets, capsules) can cause:

vomiting;
nausea;
increased gas formation;
activation of liver enzymes.

A small percentage of patients experienced skin rashes while using the composition.

If you feel sick and vomit very badly, your stool is disrupted, your hearing deteriorates, the patient probably took too much Azithromycin. To alleviate the condition, urgent gastric lavage is required. Therapy is carried out based on disturbing symptoms. There is no specific antidote to the antimicrobial drug.

Requires attention!

As indicated for different dosage options (125, 500, 250) in the instructions for use, Azithromycin can cause some harm to children in the womb, so use of the product by pregnant women is allowed only in extremely rare cases. The doctor evaluates the obvious benefits of the medication, the possible dangers, informs the woman, and only then makes a decision about using the medication.

Since studies have shown that the active components can penetrate into mother's milk, in order to avoid the effect of Azithromycin on children, the instructions for use indicate the need to stop breastfeeding for the duration of treatment until the composition is completely eliminated from the mother's body.

In rare cases, the antimicrobial composition can cause side effects for vision and the nervous system. This forces you to be especially careful when using tablets, when driving vehicles and other units and devices that require increased care. At the same time, there are no strict restrictions on such activities, since the risk of developing negative side effects is assessed as low.

Mutual influence

Digoxin and azithromycin in combination can cause an increase in P-glycoprotein in the blood serum. In some cases, the amount of cardiac glycosides in the blood plasma increases significantly, which means that the likelihood of glycoside poisoning increases.

The combination of zidovudine and azithromycin may cause the low effectiveness of the first compound, since the kinetics may change with a single use of one gram of azithromycin in food or repeated doses of 0.6-1.2 g. It is known that the combination of azithromycin and zidovudine can cause an increase in mononuclear cells in the peripheral circulatory system of the active product of zidovudine processing. At present, the clinical significance of this phenomenon has not been established.

Azithromycin reacts to a low degree with cytochrome isoenzymes. The simultaneous use of an antimicrobial composition and ergot alkaloids is accompanied by a risk of ergotism, so combining these groups of drugs should be avoided.

Daily use of 0.5 g of azithromycin and 10 mg of atorvastatin does not provoke changes in the concentration of the second substance in the circulatory system during the course, but it is known that rhabdomyolysis has been observed in some patients with the combination of an antimicrobial composition and some statins.

Terfenadine and azithromycin in combination can lead to heart rhythm disturbances and an increase in the QT interval. Ventricular fibrillation is possible when combining an antibiotic and disopyramide. Rhabdomyolysis is possible when combined with lovastatin, and in combination with rifabutin the risk of neutro- and leukopenia increases.

The simultaneous intake of cyclosporine and the drug in question leads to improper processing of the first compound, which means that the risk of poisoning and side effects characteristic of cyclosporine increases.

Antacids that contain aluminum, magnesium, ethanol, and food can reduce the absorption of the antimicrobial substance.

What else should you pay attention to?

In the instructions, the manufacturer mentions that the combination of the drug with warfarin can provoke an adjustment in prothrombin time if the formulations are used in doses greater than those recommended by the manufacturers. At the moment, no such cases have been recorded, but the experience of combined use of warfarin and macrolides shows that patients require special monitoring and periodic monitoring of the quality of the circulatory system.

The combination of the drug in question and dihydroergotamine, ergotamine can cause poisoning with the latter. The condition manifests itself as vasospasm and dysesthesia. When combined with triazolam, clearance is weakened, which means the pharmacological effect becomes more pronounced.

Azithromycin can cause slow elimination, an increase in the amount of substances in the plasma, as well as toxicity beyond the norm for the following drugs:

cycloserine;
coagulants that have an indirect effect on the body;
methylprednisolone;
felodipine;
substances that are oxidized at the microsomal level.

Azithromycin acts more pronounced if the antibiotic is combined with tetracycline or chloramphenicol. A decrease in the effectiveness of administration is observed when the drug in question and lincosamides are ingested simultaneously.

Analogs

The instructions for use of Azithromycin indicate that the active component of this drug is called the same as the medication itself - azithromycin. Medicines are based on it:

"Hemomycin";
"Azimitsin";
"Sumamed."

It is possible to replace the medicine in question with Ecomed or Zitrocin.

Based on the diagnosis, the patient’s condition, and the individual characteristics of the body, the doctor may recommend the following medications as an alternative:

"Fromilid";
"Lecoclar";
"Rovamycin".

The antibiotics Macropen and Spiramycin have a good reputation. Recently, Clarithromycin and Erythromycin have been widely used. The drugs Arvicin and Oleandomycin have a pronounced effect and a wide spectrum of action.

It is better to entrust the choice of replacement to your doctor. Incorrect selection of a drug can cause ineffective therapy, negative side reactions, and unpredictable acquisition of immunity to medications by pathological life forms.

Will it help?

As can be seen from the responses, Azithromycin is most often used due to chlamydia, tonsillitis and sinusitis. The instructions for using Azithromycin for children attract the attention of many, since the drug is one of those few antimicrobials that can be used before reaching adulthood. The list of microorganisms sensitive to the active component is quite wide, which means that the product shows a pronounced effect for a wide variety of diagnoses.

It is noted that the drug often provokes side effects if used without a doctor’s recommendation, at your own discretion. Children are especially susceptible to them. In the instructions for use of Azithromycin (250 mg and other dosage options), the manufacturer draws attention to the need to sell the medicine strictly according to a doctor’s prescription, but in reality this rule is often not followed. Having decided to use the medicine at your own discretion, you need to understand that negative reactions can be very different, often unpredictable, but no one can guarantee the effectiveness of the course. To play it safe, it is better to seek help from a doctor.

Azithromycin usually shows a pronounced effect, since the antibacterial agent is strong and effective against different strains. All adverse reactions that appear during the course disappear soon after completion of the therapeutic program. As can be seen from the responses, few people encounter them: more often, Azithromycin does not provoke side effects.