Antibiotics for the treatment of chlamydial infection. Chlamydia: rational treatment

04.04.2020

The most common sexually transmitted infection caused by the smallest microorganisms - chlamydia, is difficult to treat. In the overwhelming majority of cases, its course is asymptomatic, patients come to the attention of the doctor, already having an advanced form of the disease. The consequences of chlamydia are impressive. This is not only the inflammatory processes of the genitourinary organs and, as a result, a violation reproductive function for persons of both sexes, and serious illness eyes, joints, lymph nodes... Antibiotics for chlamydia are prescribed to destroy the pathogen and eliminate inflammatory processas well as preventing dangerous complications. They must be taken in strict accordance with medical recommendations. The choice of the drug depends on the form and stage of the disease.

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Indications for the use of antibiotics for chlamydia

Infectious and inflammatory diseases of the genitourinary organs: non-gonococcal urethritis in both sexes; cervicitis, salpingitis, endometritis - in women, prostatitis and orchiepididymitis - in men, combined lesions of the genitourinary organs, eyes and joints (Reiter's syndrome).

Antibiotics are given to people with positive laboratory tests for chlamydia, their sexual partners, and newborns from mothers with chlamydia.

Pharmacodynamics

Chlamydiae are intracellular microorganisms, therefore, all drugs prescribed for their eradication have the ability to penetrate into the cell.

Semi-synthetic macrolide Azithromycin is the preferred drug in the treatment of chlamydia. This is due to several reasons, firstly, the ability to cure the infection with a single dose (it is easy to follow all the rules), and secondly, it is active against many combined infectious agents, in particular, ureaplasma and gonococci, although it is not a first-line drug in the treatment of gonorrhea ... Renders in therapeutic doses bacteriostatic action, like all representatives of this group, penetrates the cell wall and binds to a fragmentary region of the bacterial ribosome, interferes with the normal synthesis of its protein, inhibiting the transfer of peptides from the acceptor site to the donor site. In addition to bacteriostatic, antibiotics of this group have the ability to somewhat stimulate the immune system and suppress the activity of pro-inflammatory mediators.

Erythromycin- the first antibiotic of this class, it is considered the most non-toxic, has a natural origin. It is considered an alternative, used in the treatment of pregnant women, adolescents and newborns. The spectrum of action is similar to the previous one, however, many microorganisms have already acquired resistance to this drug and its effectiveness is considered lower than that of later macrolides.

Josamycin, a representative of the same class of antibiotics, has a natural origin and a higher activity than the previous two. Unlike others, it practically does not inhibit the beneficial microflora of the gastrointestinal tract. Resistance to it develops less often than to other members of this group.

From macrolides in the treatment of chlamydia as alternative drugs can also be used Clarithromycin and Roxithromycin.

Tetracycline antibiotic Doxycycline it is also prescribed quite often for chlamydia. Since many pathogens have already developed resistance to drugs of this series, it is recommended to use it in primary patients with uncomplicated disease. Renders pharmachologic effect, inhibiting the production of proteins in bacterial cells, interfering with the transmission of its genetic code. Has a wide range of activity, in particular against chlamydia and gonococci. Its disadvantage is also the widespread resistance of pathogens to tetracycline antibiotics.

Fluorinated quinolones are considered reserve drugs and are used in cases where the previous ones are not effective. They exhibit a bactericidal effect - they inhibit the enzymatic activity of two microbial topoisomerases of the second type at once, which are necessary for the vital activity of bacteria - the process of implementing their genetic information (DNA biosynthesis). For the eradication of chlamydia, second-generation drugs can be prescribed Norfloxacin, Ofloxacin or Ciprofloxacin, also showing anti-gonococcal activity. Ureaplasma, in most cases, is insensitive to these drugs. If a mixed infection includes this pathogen, then apply Levofloxacin or Sparfloxacin, belonging to the third generation of this group of antibiotics.

Pharmacokinetics

Azithromycin is absorbed from the gastrointestinal canal at a good rate, since this drug is acid resistant and has an affinity for fats. The highest plasma concentration is determined after a period of time from 2.5 to three hours. About 37% of the administered dose enters the bloodstream unchanged. Well distributed in all tissues. All antibiotics of this group are characterized by a high tissue, rather than plasma, concentration, which is due to a low affinity for proteins, as well as the ability to penetrate the cells of pathogenic microorganisms and accumulate in lysosomes. Azithromycin is transported to the foci of infection by phagocytic cells, where it is released during their activity. A higher concentration of the drug in infected tissues compared to healthy tissues is determined, comparable to the degree of inflammatory edema. The function of phagocyte cells is not impaired in this case. Healing concentration medicinal product persists in places of localization of the inflammatory process for five to seven days from the moment of its last intake. It is this ability that allows you to take Azithromycin once or in short courses. Elimination from serum is long-term and two-stage, which explains its appointment once a day.

Absorption rate Erythromycin in the alimentary canal is determined by the characteristics of the patient's body. The highest plasma concentration is recorded two hours after taking the drug, it binds to plasma albumin from 70 to 90% of the dose taken. Distribution occurs mainly in tissues and body fluids, is capable of being absorbed by 30-65%. Low toxicity, crosses the placental barrier and is determined in breast milk.

It is broken down in the liver, metabolic products are excreted almost completely with bile, a small part - unchanged through the urinary tract. Normal functioning kidneys ensure that half of the dose of erythromycin taken is eliminated within two hours after administration.

Josamycin almost completely absorbed from the digestive tract at a good rate. Unlike other macrolides, its bioavailability is independent of food intake. The greatest serum concentration is determined after an hour, about 15% of the active substance taken is bound to plasma albumin. It is well distributed in tissues, crosses the placenta and is determined in breast milk. It is broken down in the liver. Metabolites slowly leave the body through the biliary tract, less than 15% through the urinary organs.

Doxycycline absorbed quickly, regardless of the presence of food in the gastrointestinal tract, and its elimination is slow. The therapeutic concentration in the blood serum is determined within 18 or more hours after administration, the connection with plasma albumin is approximately 90%. The active substance is rapidly distributed in liquid substances and body tissues. Elimination occurs through the gastrointestinal tract (about 60%), with urine - the rest. The half-life is from 12 hours to a day.

Fluorinated quinolones well, quickly and ubiquitously distributed in tissues and organs different systems, creating significant concentrations of the active substance. In addition to Norfloxacin, which is maximally concentrated in the intestine, urinary tract and the prostate gland, where infection is more often localized in male patients.

The highest level of tissue saturation of various localizations is observed during therapy with Ofloxacin, Levofloxacin, Lomefloxacin, Sparfloxacin.

They have an average ability among antibiotics to penetrate through the cell walls into the cell.

The rate of biotransformation and elimination depends on physical and chemical properties active substance. In general, the drugs in this group are characterized by rapid absorption and distribution. The most actively metabolized is Pefloxacin, the least - Ofloxacin, Levofloxacin, the bioavailability of which is almost one hundred percent. The bioavailability of Ciprofloxacin is also high, at the level of 70-80%.

Fluorinated quinolones have a wide time range from three to four hours for Norfloxacin to 18-20 hours for Sparfloxacin in the fluorinated quinolones half-dose elimination period. Most of excreted through the urinary organs, and from three to 28% (depending on the drug) - by the intestines.

Renal dysfunction in a patient lengthens the half-life of all drugs in this group, especially ofloxacin and levofloxacin. In cases of severe renal impairment, it is necessary to adjust the dose of any fluorinated quinolone.

Antibiotics for chlamydia in men are prescribed individually, depending on the form and stage of the disease, the location of the infection, the presence of complications and concomitant infections. When choosing a drug, the patient's tolerance of a certain group is also taken into account. antibacterial agents, the need to combine them with taking any other drugs if the patient has chronic diseases, the sensitivity of infectious agents to certain drugs.

Doctors are guided by the same principles when choosing antibiotics for chlamydia in women. Expectant mothers constitute a special category of patients.

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Antibiotic use for chlamydia during pregnancy

Doxycycline and antibiotics belonging to the group of fluoroquinolones are not prescribed for women carrying a child.

The antibiotic of the tetracycline group Doxycycline can provoke abnormalities in the formation of bone tissue in the fetus.

Fluoroquinolones are classified as toxic antibiotics, however, there is no reliable data on the teratogenicity of these drugs. There, however, in studies on laboratory animals, their offspring developed arthropathies, moreover, there are reports of isolated cases of hydrocephalus, intracranial hypertension in newborns whose mothers took drugs of this group during gestation.

Macrolide antibiotics, although they penetrate the placental barrier, are considered non-teratogenic and low-toxic. Therefore, a drug for the treatment of chlamydia in pregnant women is chosen from this group. The safest of them is Erythromycin, however, Wilprafen (Josamycin) and Spiramycin, natural sixteen-membered macrolides, are considered more effective. Azithromycin is prescribed only for health reasons. The effect of other drugs in this group on the fetus has been little studied, so they are not recommended for the treatment of pregnant women. Clarithromycin has been reported to have negative effects.

Contraindications

A common prohibition on the use of all antibiotics is a known allergic reaction to the drug.

Fluoroquinolones and Doxycycline are contraindicated in pregnant and lactating women.

Doxycycline is not prescribed for children from birth to the full seven years, as well as for patients with severe liver pathologies.

Fluorinated quinolones are not used in pediatrics and for the treatment of patients with congenital enzymatic insufficiency of glucose-6-phosphate dehydrogenase, epileptics and persons with pathological changes in the tendons after a course of drugs of this group.

Macrolide antibiotics of the second stage (Clarithromycin, Midecamycin, Roxithromycin) are not used to treat expectant mothers and breastfeeding patients. Josamycin and Spiramycin, which can be used to treat chlamydia during pregnancy, are not prescribed during lactation.

A ban on the use of any macrolides is severe dysfunction of the liver and biliary tract.

Side effects of antibiotics for chlamydia

Antibiotics cause all kinds of allergic reactions from itchy skin rashes and swelling to severe bronchial asthma and anaphylaxis.

The general actions of antibiotics include disorders of the digestive organs - dyspeptic symptoms, abdominal discomfort, lack of appetite, stomatitis, colitis, violation of the intestinal microflora, in addition, fluoroquinolones can also cause intestinal perforation and hemorrhage, as well as various liver disorders, jaundice, moderate cholestasis. This is where the list of side effects of macrolide antibiotics ends.

Doxycillin and fluoroquinolones can cause changes in the blood formula: a decrease in the level of erythrocytes, platelets, neutrophils, hemoglobin; pancytopenia, eosinophilia; the use of the latter can cause the appearance of pinpoint or larger hematomas, nosebleeds.

These drugs are capable of provoking the development of superinfection, reinfection, mycoses, the emergence of resistant strains of bacteria, the phenomenon of photosensitization.

Doxycillin causes permanent discoloration of tooth enamel.

Fluorinated quinolones have the longest list of side effects. In addition to those already mentioned, these drugs can cause:

metabolic and metabolic disorders;
mental disorders, manifested in an overexcited state, insomnia and nightmares, paranoid and depressive disorders, phobias, disorientation in space, attempts at suicide and others;
disorders of the central and peripheral nervous system;
visual disturbances (photophobia, diplopia, conjunctivitis, nystagmus);
hearing impairment and coordination of movements;
disturbances in the work of the heart up to its arrest and cardiogenic shock, thrombosis of cerebral vessels;
disorder of the respiratory organs up to respiratory arrest;
pain in muscles, joints, tendons, damage and rupture of their tissue, and during the first two days of taking the drug; muscle weakness;
all kinds of disorders of the urinary organs, candidiasis, the formation of kidney stones;
in patients with hereditary porphyria - exacerbation of the disease;
in addition - asthenic syndrome, back pain, hyperthermia, fever, weight loss, perversion of taste and smell.

Method of administration and dosage

The most commonly prescribed course of antibiotics for chlamydia is:

a single dose of Azithromycin at a dosage of 1000 mg (two 500 mg tablets) one hour before a meal or a seven-day course of Doxycycline 100 mg (one capsule) every 12 hours with plenty of water.

Second-line drugs are taken during the week:

Erythromycin - every six hours, 500 mg one hour before a meal with plenty of water;

Josamycin - 750 mg every eight hours;

Spiramycin - every eight hours, 3 million U;

Ofloxacin - 300 mg every twelve hours;

Ciprofloxacin - 500-750 mg every twelve hours in complicated cases.

Pregnant women are prescribed the usual regimens of therapy with Erythromycin, Josamycin, Spiramycin.

During treatment, it is necessary to observe an adequate water regime (at least 1.5 liters of water per day).

The course of treatment is required for both partners. In complicated cases, two different antibiotics can be used. pharmacological groupsfor example Azithromycin or Doxycycline in combination with Ciprofloxacin.

An indicator of the effectiveness of treatment is considered to be a negative result of polymerase chain reaction of smears of the urogenital tract one and a half to two months after the end of treatment.

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Overdose

Exceeding the dose of macrolides is manifested by symptoms of a disorder of the digestive system (diarrhea, nausea, abdominal pain, sometimes vomiting).

An overdose of Doxycycline or fluorinated quinolones manifests itself as a neurotoxic reaction - dizziness, nausea, vomiting, convulsions, loss of consciousness, headache.

Treatment: gastric lavage, intake of activated charcoal.

Interaction with other drugs

This factor must be taken into account in order to achieve maximum efficiency from drug treatment and neutralize the resulting negative effects.

Mostly mutual influence macrolide antibiotics with various drugs is associated with the inhibition of the cytochrome P-450 system by these drugs. The ability to inhibit this system increases in the indicated group of antibacterial agents in the following sequence: Spiramycin → Azithromycin → Roxithromycin → Josamycin → Erythromycin → Clarithromycin.

With the appropriate intensity, representatives of the specified pharmacological class slow down biological transformation and increase the serum density indirect anticoagulants, theophylline, finlepsin, valproate, disopyramide derivatives, ergot-based drugs, cyclosporine, respectively, increasing the likelihood and severity of side effects of these drugs. Therefore, it may be necessary to change the dosage regimen.

It is undesirable to use simultaneously macrolide antibiotics (with the exception of Spiramycin) with the preparations of fexofenadine, Cisapride, Astemizole, since this combination significantly increases the risk of severe arrhythmias caused by prolongation of the QT interval.

Antibiotics of this series help to improve the absorption of oral digoxin, as they reduce its inactivation in the intestine.

Antacid medicines reduce the absorption of macrolide antibacterial agents in the alimentary canal, in particular, Azithromycin is subject to this effect.

The anti-tuberculosis antibiotic Rifampicin accelerates the process of biotransformation of macrolides by the liver and, accordingly, reduces their plasma concentration.

The use of alcohol in the course of treatment with any antibiotics is unacceptable, but it should be noted that Erythromycin, especially its intravenous injections, increase the risk of acute alcohol intoxication.

Suction Doxycycline reduce antacid preparations and laxatives, which contain magnesium salts, antacids containing aluminum and calcium salts, medicines and vitamins containing iron, sodium bicarbonate, cholestyramine and colestipol, therefore, when they are combined, the reception is diluted in time, making the interval not less than three hours.

Since the drug violates the intestinal microbiocenosis, thrombocytopenia and requires a change in the dose of indirect anticoagulants.

Simultaneous reception with drugs of the penicillin and cephalosporin series, as well as others, the mechanism of action of which is based on a violation of the synthesis of the membrane bacterial cells, inappropriate, since it negates the effect of the latter.

Increases the risk of unwanted pregnancy in combination with the use of estrogen-containing contraceptives.

Substances that activate the process of microsomal oxidation ( ethanol, barbiturates, rifampicin, finlepsin, phenytoin and others), increase the rate of degradation of doxycycline and lower its serum concentration.

The combination with methoxyflurane is fraught with the risk of developing acute renal failure and even the death of a patient.

Taking vitamin A during therapy with Doxycycline can provoke an increase in intracranial pressure.

Simultaneous inclusion in the reception scheme fluorinated quinolones with medicines, which contain ions of bismuth, zinc, iron, magnesium, are absorbed much worse due to the creation of non-absorbed chelate compounds with them.

Ciprofloxacin, Norfloxacin and Pefloxacin reduce the excretion of methyl xanthine derivatives (theobromine, paraxanthine, caffeine) and increase the likelihood of mutual toxic effects.

The neurotoxic effect of fluorinated quinolones increases when combined with non-steroidal anti-inflammatory drugs, as well as nitroimidazole derivatives.

Not compatible with nitrofuran-based medicines.

Ciprofloxacin and Norfloxacin have the ability to upset the process of biotransformation in the liver of indirect anticoagulants, as a result of which the likelihood of blood thinning and hemorrhagic events increases (it may be necessary to adjust the dose of the anti-thrombotic drug).

Fluoroquinolones are not prescribed in the same regimen with cardiac drugs that increase the QT interval, due to the high likelihood of cardiac arrhythmias.

Combined use with glucocorticoid hormones is a dangerously high probability of tendon injuries; elderly patients are at increased risk.

The appointment of Ciprofloxacin, Norfloxacin and Pefloxacin while taking medications with the effect of urine alkalinization (sodium bicarbonate, citrates, carbonic anhydrase inhibitors), increases the likelihood of calculus formation and the nephrotoxic effect of such a combination of medications.

While taking azlocillin or cimetidine, due to a decrease in tubular secretion, the rate of elimination of fluoroquinolone antibiotics from the body decreases and their plasma concentration increases.

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Patient information

It is necessary to observe the storage conditions of the drug and the expiration date indicated on the package. Under no circumstances use medicinal products that have expired or changed. appearance drug (color, smell, etc.).

Currently, macrolides are positioned as the most effective antibiotics for chlamydia. They have the highest ability among other antibacterial drugs to penetrate into the cell and affect the pathogens that have settled there. They are effective, microbes have not yet lost their sensitivity to them. The low toxicity of macrolide antibiotics is also a positive factor in favor of their use. However, a single approach to all patients does not exist and cannot be, since the choice of a treatment regimen is influenced by many factors - from individual tolerance to the degree of neglect of the disease and the patient's state of health.

Treatment, as practice shows, is not always effective. And the question often arises, why do the symptoms of chlamydia not disappear after antibiotics? There are many reasons for this. First of all - the irresponsibility of the patient himself. Not everyone strictly follows medical prescriptions, adhere to the regimen during the entire treatment course. They also maintain its duration and do not stop treatment without control tests.

In addition, both partners must be treated. Chlamydia can be contracted countless times, especially if the source of the infection is nearby.

During the course of treatment, it is necessary to abstain from sex. If you took Azithromycin once, then you need to make sure that you are cured after a week. It is recommended to undergo a follow-up examination after three months or later to make sure that the pathogen has been eradicated.

If symptoms return again, you should definitely see a doctor. Re-infection is fraught with serious complications.

The question often arises: how to cure chlamydia without antibiotics? The official answer: eradication of chlamydia without antibiotics is not yet possible. Science does not stand still, however, such treatment is a task for the future. True, several options for the treatment of chlamydia with herbs and dietary supplements are listed on the Internet. Trying alternative methods is not forbidden to anyone, you just need to take into account that by delaying the process, you risk complicating the course of the disease, and then getting rid of it will be much more difficult.

Common, unfortunately, infection, which is transmitted in most cases sexually. The causative agent is Chlamydia trachomatis, which, once in the cell, feeds on its substance and multiplies there. When a cell is destroyed, much more intracellular parasites are released, and they attack other cells. Chlamydia can damage the genitals, organs of vision, mucous membranes respiratory tract, synovial lining of joints, heart, blood vessels, teeth.

Chlamydia trachomatis can be transmitted by airborne sneezing

In addition, 15% of all cases of pneumonia are atypical chlamydial pneumonia, which can be transmitted by sneezing or sharing objects. The treatment of this disease is especially long and difficult and can take several months. In addition to pneumonia, chlamydia can provoke bronchitis, sinusitis, pharyngitis.

Expert opinion

In 45% of men, the disease proceeds without symptoms, in the rest, the first sign of the disease is a slight inflammation of the urethra, accompanied by itching and burning. Unfortunately, it is rather difficult to detect chlamydia by conventional methods. It is required to carry out PCR in order to be thoroughly sure of the cause of the discomfort.

Treatment regimen

Chlamydia quickly passes into the stage of chronic course, therefore, a standard course of antibiotics in treatment will only help if there is an uncomplicated stage (only bottom part of the urogenital tract). If the form of chlamydial infection is complicated (already affected top part), the drugs are prescribed in combination and for a long time. The exclusion of at least one position from the course leads to a decrease in the effectiveness of therapy. When choosing a treatment regimen, the symptoms of the disease are taken into account, which organs are already involved in the process, the patient's immune status, the duration of the course of the disease, and previous treatment. If treated married man, then both spouses must undergo treatment at the same time. So, what medications for chlamydia for men do doctors usually prescribe?

If chlamydia is detected at an early stage, the treatment process will be easier and faster. In all other cases, a whole complex of drugs is prescribed, among which must be:

antibiotics;
immunomodulators;

enzymes;
vitamins;

hepatoprotectors;
probiotics.

Chlamydia pills for men

How is chlamydia in men treated? Let's take a look at what drugs are taken to effectively treat an infection. Necessarily the treatment regimen includes several antibiotics. The choice depends on the symptoms present: the form of the course, the presence of inflammation of the urethra, whether the prostate and kidneys are affected.

tetracyclines;

macrolides;

fluoroquinolones.

For antibiotic therapy, courses of treatment are used from 7 to 14 days. If the infection is uncomplicated, treatment begins directly with an antibiotic. In chronic forms, therapy should be comprehensive. In the hospital, immunotherapy is carried out before the appointment of an antibiotic. For home treatment, an antibiotic is given along with immunotherapy.

Tetracycline antibiotics

Tetracycline medications - basic medications, which are prescribed for the treatment of chlamydia. When using them, it is necessary to follow a diet (except for Doxycycline) due to the binding of tetracyclines in the body with calcium ions. Common side effects include nausea, vomiting, and allergies. During the period of treatment, patients need to avoid sun exposure due to the high likelihood of photosensitivity.

Doxycycline - the drug of the first choice. It is prescribed in a dosage of 100 mg twice a day for a course of at least a week. The first dose is 200 mg. According to the medical literature, the effectiveness of doxycycline is 95-100%. The drug has high bioavailability and is easily tolerated.
Tetracycline often prescribed as an alternative to honey. the drug, 500 mg, 4 r per day from 7 to 10 days.
Metacyclin - in uncomplicated forms, after a meal, the first intake of 600 mg, then 300 mg every 8 hours for a week. For other forms, treatment lasts 10 days.

To choose drugs for the treatment of chlamydia in men, you need to study the indications and contraindications well. In this article, you can explore.

Macrolides

Macrolides are highly active. When taking macrolides, painful manifestations of the gastrointestinal tract and liver can often be observed.

These include:

Azithromycin (Sumamed) - enters the cell and accumulates in leukocytes with slow release. The uniqueness of honey. the drug is based on its exceptional pharmacokinetics. High levels the concentration of the active substance at the site of infection after taking one tablet remains for a long time - up to 10 days. A single dose of 1 g is recommended regardless of food intake in uncomplicated form. In a chronic course, the instruction is simple: the first day is 1 g, the second-third days are 0.5 g each, from the fourth to the seventh day, 0.25 g each.
Josamycin (Wilprafen) - in uncomplicated form, 7 days, 500 mg every 12 hours.
Clarithromycin (Klacid) - in uncomplicated forms, 250 mg twice a day for 7 days, in chronic - 400 mg 1 r per day for 14-15 days.
Roxithromycin - 150 mg (1 tab.) twice a day or 300 mg (2 tab.) 1 p per day for 2 weeks.
Midecamycin (Macropen) - 400 mg three times a day for 10 days.
Erythromycin - 500 mg twice a day for 10 days or 250 mg 4 r per day for 7 days. The drug is rather difficult to tolerate in comparison with the more modern antibiotics listed above.

Fluoroquinolones

Some fluoroquinolones also have anti-chlamydial activity, but they are more of an alternative antibiotic. Such limitations are due to the fact that, in comparison with the above groups, the percentage of relapses after therapy is rather high. An indication for their use may be a combination of the pathogen with other microorganisms sensitive to these antibiotics, or gonorrheal-chlamydial infection.

Side effects may include dyspepsia, vomiting, nausea, dizziness.

Ofloxacin appoint 400 mg twice a day for 10 days. Today it is the only fluoroquinolone antibiotic recommended for the treatment of chlamydia. Its advantage over other fluoroquinolones is considered to be almost 100% bioavailability.
Pefloxacin - in case of uncomplicated course, 600 mg is taken once a day for 7 days. In the case of a chronic course - up to 12 days.
Levofloxacin - 250-500 mg once a day.

Which drug do you think is best for treatment?

OfloxacinPefloxacin

Probiotics

Long-term use of antibiotics negatively affects the work of almost all body systems: on the gastrointestinal tract (disrupting the intestinal microecology), urinary, nervous, immune (suppressing immunity) systems. Therefore, after the treatment of chlamydia, restorative therapy with probiotics and hepatoprotectors is required, if necessary. Probiotics are drunk regardless of the identified form of chlamydia.

The most commonly prescribed probiotics are:

Bifidumbacterin shown with a decrease in the content of bifidobacteria.
Bificol drink for violations of both aerobic (E. coli) and anaerobic (bifidobacteria) elements of the intestinal microflora.
Acylact drink with a decrease in the level of lactobacilli.

Expert opinion

Madmuzev \u200b\u200bArmen Davidovich, specializes in male venereal diseases

All drugs are drunk 5 doses 3 r per day, 20 minutes before meals.

Rectal suppositories

Some drugs come in the form rectal suppositoriesintended for introduction into the rectum. Most often, immunomodulators are produced in this way.

Of the immunomodulators, polyoxidonium and a-interferon are considered the most effective:

Polyoxidonium raise the body's immunity by stimulating the appearance of new antibodies. Accordingly, their use increases the effectiveness of antibiotics. When taking Polyoxidonium, its active substances help to fight leukocytes and phagocytes with chlamydia, which makes it possible to reduce the course of taking antibiotics.
Viferon also act as an immunostimulant. Active substance destroys the bonds in the cells of microorganisms. The course of the drug can be quite long.
Interferon alpha 2b It is also injected rectally in two five-day cycles with an interval of 2 weeks between them. The total dose for the course should be 10 million IU.
Genferon - an antibacterial agent that can also be administered rectally. Genferon fights well with chlamydia, mycoplasmosis, candida, Trichomonas, etc.

Immunomodulators must be prescribed as part of complex therapy in the chronic course of the disease or in its complicated forms. Moreover, in these cases, immunotherapy precedes antibiotic therapy. This approach allows you to achieve 90% effectiveness of the drug.

Vitamins

To increase immunity and maintain sexual functions, vitamins are prescribed for men during treatment for chlamydia - as soon as an infection is detected. Vitamins can be prescribed in long courses. The most commonly taken vitamin E, thiosulfate, vitamin C, glutamic acid.

The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

Andrey Andreevich asks:

What antibiotics are used to treat chlamydia?

Antibiotic therapy is a key focus of treatment chlamydia... It is antibacterial drugs that directly affect the causative agent of the disease, preventing its growth and reproduction. However, with chlamydia antibiotics must be used with caution. The fact is that the disease can proceed both acutely and latently, without obvious symptoms and manifestations. This usually indicates a chronic course of chlamydia.
In the inactive phase, bacteria are almost immune to any medication. At the same time, antibiotic resistance can develop in the process. Therefore, the course antibacterial drugs with chlamydia, the attending physician should prescribe after all the necessary tests.

In the treatment of chlamydia with antibiotics, attention is paid to the following features:

High doses. Relatively high doses of antibiotics are used in the treatment of chlamydia. This is due to the need to quickly kill the pathogen so that it does not have time to go into the protective L-form.
Combination of drugs. In the chronic course of chlamydia, several courses of antibiotic therapy may be required. From one course to another, drugs can change.
Reception of immunomodulators. Taking immunomodulators stimulates the body's immune system to produce specific antibodies against chlamydia. This increases the effectiveness of antibiotic therapy.
Periodic reception. Usually, doctors try to prescribe antibiotics in courses that correspond to the phases of exacerbation of the disease. During this period of time, chlamydiae are most sensitive to drugs. With a recurrent course with phases of remission ( attenuation of symptoms) and exacerbations, periodic administration of antibiotics is required.

If we talk directly about the sensitivity of chlamydia to antibiotics, then a fairly wide range of medicines is suitable for treatment. Difficulties often arise with the correct selection of doses and an accurate determination of the phase of the disease. The selection of drugs can be difficult for those patients who have already treated chlamydia in the past. Their bacterial strains may be resistant to previously used drugs. However, here, too, you can find a way out. In such cases, resort to the cultivation of chlamydia taken from the patient in the laboratory. This analysis is relatively time consuming, time consuming and expensive, so it is not used for every patient, but only when necessary, at the discretion of the doctor. The grown colony allows you to determine the sensitivity of chlamydia to various drugs and select those that are most effective.

The standard drugs used to treat chlamydia are the following groups of antibiotics:
1. tetracyclines.
2. macrolides;
3. fluoroquinolones.

Tetracyclines.

From this group of drugs, tetracycline itself is used ( 500 mg 4 times a day for 1 to 2 weeks). However, this antibiotic is dangerous due to possible side effects. It is not prescribed for children or pregnant women. Slightly lower doses ( 100 mg 2 times a day) requires doxycycline, so it is more commonly found in medical practice in the treatment of chlamydia. The duration of treatment with doxycycline is also 7-14 days.

Macrolides.

Macrolides are widely used to treat chlamydia in both adults and children. In most cases, they effectively defeat the disease in the acute phase, preventing chronicity. In the treatment of chronic infection, interchange and combination of drugs of this group is possible. Macrolides and their dosage in the treatment of chlamydia are presented in the table.

Dosage of macrolides in the treatment of urogenital chlamydia in adults and children.

Drug name	Common analogues	Dosage for adults	Dosage for children
		On the first day - 1 g one hour before meals or 2 hours after meals. From the second day to the end of the course - 500 mg per day at a time. The course of treatment lasts 5-10 days. At the discretion of the doctor for a particular patient, it is possible to reduce the dose of the drug.	On the first day - 10 mg / kg one hour before meals or 2 hours after meals. From the second day to the end of the course - 5 mg / kg. The course of treatment lasts 5 to 7 days.
		250 mg twice a day for 10 to 14 days. With a protracted course of the disease, it is possible intravenous administration the drug in a dose of 500 mg per day for 2 days.	7.5 mg / kg per day in two divided doses. The course of treatment lasts 10-14 days.
		150 mg twice a day 15 minutes before meals. The course of treatment lasts 1 to 2 weeks.	5 - 8 mg / kg per day is divided into two doses. The course of treatment lasts on average 1 - 2 weeks ( maximum allowed - 21 days)
Spiramycin	Rovamycin	3 million units three times a day. The course of treatment lasts 10 days.	Children weighing more than 20 kg - 1.5 million units per day for every 10 kg of weight. The dose is divided into 2 - 3 doses. The course of treatment lasts 7-14 days.
Josamycin	Wilprafen	500 mg 2 times a day for 10 days.	30-50 mg / kg per day is divided into 3 doses. The course of treatment lasts 10 days.
	400 mg 3 times a day. The course of treatment is 2 weeks.	The use in pediatrics is limited.
		500 mg 2 times a day or 250 mg 4 times a day for 7 days.	Pediatric use is limited due to side effects.

Fluoroquinolones.

Fluoroquinolones play a minor role in the treatment of chlamydia. Most often they are resorted to when the infection is resistant to macrolides and tetracyclines. Of a number of fluoroquinolones, ofloxacin can be used in the treatment of chlamydia. The drug is taken at 200 mg twice a day, or 400 mg once a day for 9 days. Ciprofloxacin is used much less often, since many strains have already shown resistance to it.

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Chlamydia treatment has its own characteristics:

the dosages of antibiotics are quite high;
often several courses are prescribed with different drugs;
antibiotic therapy is combined with the intake of immunomodulators;
antibiotics for chlamydia are prescribed in the acute phase of the disease.

The pharmaceutical industry offers a wide range of antibacterial agents, however, choosing a drug and calculating an adequate dosage is not easy. In each case, the doctor approaches the development of a treatment regimen individually. After all, chlamydial infection can be aggravated by other infectious processes, and the immunity of all patients is different.

The situation is aggravated by the fact that the drug does not work when chlamydia is re-treated - they adapt to its formula. If the patient has previously had an infection, it is necessary to select another drug with the same effect, but with a different dosage formula.

In addition to taking capsules and injections, local agents are used - suppositories, ointments and creams.

If it is impossible to defeat the infection with the selected treatment regimens, a test for a bacterial strain is taken from the patient in order to find out the cause of resistance to medicines... It takes time and costs money. However, only after laboratory research you can choose the right medicine.

Treatment rules

Patients should understand that antibacterial treatment involves strict adherence to certain rules, otherwise the effect will not be achieved. Bacteria behave like completely intelligent creatures and try to survive in any conditions, so only strict adherence to the verified dosage and medication regimen will help defeat the infection.

Follow the instructions:

medications are taken strictly at the appointed time;
after the symptoms disappear, taking antibiotics continues for the time indicated by the doctor;
the course is prescribed for both sexual partners, even if one of them has no signs of infection;
before starting treatment, you should pass all the necessary tests, on the basis of which a treatment regimen will be developed;
for the duration of treatment, sexual activity is completely excluded.

Remember that neglecting one of the instructions will lead to unpredictable results.

The antibiotic treatment regimen for chlamydia in men and women is the same. The dosage of drugs is determined individually.

The scheme of the acute course of the disease involves three stages:

preparation of the body for taking antibiotics with the help of immunomodulators and treatment of infected areas with Chlorhexidine;
use of prescribed drugs - 7/10/14 days;
restoration of disturbed intestinal microflora, liver cells.

The chronic course changes the scheme of therapeutic procedures:

The first stage involves the use of antibacterial agents along with immunomodulators, antioxidants and vitamin complexes.
The second step is to use anti-fungal and anti-enzyme agents.
The third stage consists in taking medications that restore the liver, as well as visiting the physiotherapy room.

Thus, the chronic stage is subject to three weeks of drug exposure, the acute form is treated within two weeks. The duration is due to the destruction of chlamydia at all stages of development.

Description of drugs

Antibacterial drugs have either a wide spectrum of action, that is, they destroy bacteria throughout the body, or they fight certain types of microorganisms. In the case of chlamydia treatment, drugs are needed that can destroy bacteria in the intracellular structures. However, chlamydia is complicated by the addition of other forms of microorganisms, which together with it attack the human reproductive organs and cause severe inflammatory processes.

Therefore, doctors prescribe a set of drugs that can fight all types of manifestations of genital tract infection. There are three large groups medicines:

tetracyclines;
fluoroquinolones;
macrolides.

Other medicines cannot have an adequate effect on these microorganisms, therefore, they do not differ in effectiveness. Incorrectly selected medicines will not only not have a positive effect on the course of healing, but may contribute to an increase in the activity of bacteria and their reproduction.

Tetracyclines

Tetracycline and, as its derivative, can fight a fresh infection in the body, which has not yet had time to strengthen its position. Tetracycline preparations are prescribed for use at 400 mg x 4 times for a week / two. Doxycycline has a different regimen - 100 mg x 2 times a day.

Doxycycline is considered the most effective for chlamydia, however, it has strong side effects. These include a disorder of the functionality of the gastrointestinal tract, and the occurrence of thrush, stomatitis or glossitis. However, this applies to patients with severely weakened immune defenses.

Note! Preparations of the tetracycline group destroy bone structure and tooth enamel. For children, these drugs are prescribed after eight years, they are contraindicated for pregnant women.

The next active antibiotic is Azithromycin. This drug also causes undesirable side effects associated with upset gastrointestinal tract, therefore, sensitivity testing should be performed before use. If side effects increase, notify the doctor. In case of drug intolerance, the doctor will select a less effective, but safe for the body.

Unidox Solutab based on doxycycline monohydrate is best tolerated by patients, since it does not have a strong negative effect on the body. It is recommended for patients with gastric problems - it does not irritate the mucous membranes.