Antibacterial drugs. Antimicrobials

Despite the undoubted successes and achievements of modern medicine in the fight against infections, the causative agents of which are pathogenic fungi, the number of people suffering from such diseases is not decreasing.

In addition to superficial and urogenital mycoses, deep lesions associated with HIV, organ donation, hemato-oncology, and nursing of newborns are often recorded today.

Antimycotic drugs, used in the implementation of various schemes for the treatment and prevention of fungal infections, should be highly active against the pathogen, have a prolonged action, have a minimum frequency of formation of resistance of the pathogenic organism, be distinguished by good compatibility with pharmaceuticals from other groups, be effective, safe, and convenient to use.

These requirements are met, in particular, by an antimycotic from the azole group - fluconazole, which acts as the active substance of broad-spectrum antifungal drugs. One of them is a drug Diflucan.

Mycosist considered one of the most effective drugs for the treatment of fungal diseases.

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

Antibiotics only act on bacterial cells and cannot kill viral particles.

According to the spectrum of action, these drugs are divided into two large groups:

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

In the case when the pathogen is known exactly, antibiotics of the first group can be used. If the infection is of a complex combined nature, or the pathogen is not detected by laboratory tests, drugs of the second group are used.

According to the principle of action, antibiotics can also be divided into two groups:

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

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

List of new generation broad spectrum antibiotics

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

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

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

What drugs to take depending on the disease?

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

Bronchitis treatment

Bronchitis is a common infectious and inflammatory disease that can lead to severe complications. For the treatment of bronchitis, the following drugs can be prescribed:

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

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

With pneumonia

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

For the treatment of pneumonia in a hospital, the following drugs for injection can be used:

• "Ticarcillin";
• "Carbenicillin";
• "Cefepim";
• "Meropenem".

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

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

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

Antibiotics for sinusitis

The decision to prescribe antibiotics for the treatment of sinusitis is made by the ENT doctor. Therapy with these drugs is carried out without fail if purulent discharge from the sinuses and intense headaches are observed:

Name of the drug	Group and active substance	Contraindications	Dosage
AzitRus	A group of macrolides, the active substance is Azithromycin.	severe liver dysfunction; age up to 3 years; individual intolerance.	Adults and children over 12 years old - 1 capsule or tablet 500 mg per day. Children over 3 years old - 10 mg per 1 kg of body weight per day.
"Faktiv"	A group of fluoroquinolones, the active substance is Gemifloxacin.	pregnancy and lactation; age up to 18 years; heart rhythm disturbances; severe liver disease.	1 tablet 320 mg per day
"Flemoklav Solutab"	The penicillin group, the active substance is Amoxicillin.	lymphocytic leukemia; pathology of the gastrointestinal tract; pregnancy and lactation; age up to 3 years; Infectious mononucleosis.	Adults and children over 12 years old - 1 tablet 500 mg 3 times a day. Children under 12 years old - 25 mg per 1 kg of body weight per day.

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

With angina

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

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

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

Colds and flu

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

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

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

If after 72 hours after the start of taking these drugs there is no improvement, new generation macrolides are connected to therapy:

• "Sumamed";
• "Rulid";
• AzitRus.

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

Urinary tract infections

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

In mild cases, you can remove the infection from the urinary tract using the following drugs:

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

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

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

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

Antifungal drugs

For the treatment of fungal infections, drugs with fungistatic or fungicidal action are used. They differ from the drugs listed above and stand out in a separate class, within which there are three groups:

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

For eye disease

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

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

• "Tsipromed" - drops containing Ciprofloxacin;
• "Albucid" - drops with sulfacetamide;
• "Dilaterol" - drops based on tobramycin;
• "Tobrex" - an analogue of "Dilaterol" in the form of an ointment;
• "Kolbiocin" is a multicomponent ointment containing tetracycline, chloramphenicol and sodium colistimethate.

A specific drug is prescribed based on the diagnosis, the severity of the course of the disease and the individual characteristics of the patient.

Inexpensive new generation antibiotics

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

You can replace some expensive antibiotics based on the following table:

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

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

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

If more than 72 hours have passed since the start of treatment with inexpensive antibiotics, and there is no improvement in the condition, it is urgent to consult a doctor and change the drug.

Can it be used during pregnancy?

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

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

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

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

According to the spectrum of activity antimicrobials are divided into: antibacterial, antifungal and antiprotozoal. In addition, all antimicrobial agents are divided into narrow-spectrum and broad-spectrum drugs.

Narrow-spectrum drugs mainly against gram-positive microorganisms include, for example, natural penicillins, macrolides, lincomycin, fusidine, oxacillin, vancomycin, cephalosporins of the first generation. Polymyxins and monobactams are drugs with a narrow spectrum of action mainly on gram-negative rods. Broad-spectrum drugs include tetracyclines, levomycetin, aminoglycosides, most semi-synthetic penicillins, cephalosporins from the 2nd generation, carbapenems, fluoroquinolones. The antifungal drugs nystatin and levorin (only against Candida) have a narrow spectrum, and clotrimazole, miconazole, amphotericin B have a wide spectrum.

According to the type of interaction with the microbial cell antimicrobials are divided into:

bactericidal - irreversibly disrupt the functions of a microbial cell or its integrity, causing immediate death of the microorganism, are used in severe infections and in debilitated patients,

bacteriostatic - reversibly block cell replication or division, are used for non-severe infections in unimpaired patients.

According to acid resistance antimicrobials are classified into:

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

acid-resistant - intended for parenteral use only, for example, benzylpenicillin.

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

¨ Lactam antibiotics

lactam antibiotics ( tab. 9.2) of all antimicrobial drugs, they are the least toxic, since, by disrupting the synthesis of the bacterial cell wall, they do not have a target in the human body. Their use in the presence of pathogen sensitivity to them is preferable. Carbapenems have the widest spectrum of activity among lactam antibiotics; they are used as reserve drugs - only for infections resistant to penicillins and cephalosporins, as well as for hospital and polymicrobial infections.

¨ Antibiotics of other groups

Antibiotics of other groups ( tab. 9.3) have different mechanisms of action. Bacteriostatic drugs disrupt the stages of protein synthesis on ribosomes, bactericidal drugs violate either the integrity of the cytoplasmic membrane or the process of DNA and RNA synthesis. In any case, they have a target in the human body, therefore, compared to lactam preparations, they are more toxic, and should be used only when the latter cannot be used.

¨ Synthetic antibacterial drugs

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

¨ Side effects of antimicrobials,

their prevention and treatment

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

allergic reactions

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

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

Irritant effect on the routes of administration

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

Superinfection, including dysbacteriosis

The probability of dysbacteriosis depends on the breadth of the spectrum of action of the drug. The most common candidiasis develops with the use of narrow-spectrum drugs after a week, with the use of broad-spectrum drugs - already from one tablet. However, cephalosporins relatively rarely cause fungal superinfection. On the 1st place in terms of frequency and severity of dysbacteriosis caused is lincomycin. Violations of the flora during its use can take on the character of pseudomembranous colitis - a severe intestinal disease caused by clostridia, accompanied by diarrhea, dehydration, electrolyte disturbances, and in some cases complicated by perforation of the colon. Glycopeptides can also cause pseudomembranous colitis. Often cause dysbacteriosis tetracyclines, fluoroquinolones, chloramphenicol.

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

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

Organ specific side effects for different groups of drugs:

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

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

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

Renal damage is inherent in aminoglycosides and polymyxins, which disrupt the function of the tubules, sulfonamides, which cause crystalluria, generation cephalosporins, which cause albuminuria, and vancomycin. Predisposing factors include old age, kidney disease, hypovolemia, and hypotension. Therefore, the treatment with these drugs requires preliminary correction of hypovolemia, control of diuresis, selection of doses taking into account kidney function and body weight. The course of treatment should be short.

Myocarditis is a side effect of chloramphenicol.

Dyspepsia, which is not a consequence of dysbacteriosis, is characteristic of the use of macrolides, which have prokinetic properties.

Various CNS lesions develop from many antimicrobials. Observed:

Psychosis in the treatment of chloramphenicol,

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

Headache and central vomiting when using sulfonamides and nitrofurans,

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

Seizures with imipenem

Excitation with the use of fluoroquinolones,

Meningism in the treatment of tetracyclines due to their increase in CSF production,

Visual disturbances in the treatment of aztreonam and chloramphenicol,

Peripheral neuropathy with the use of isoniazid, metronidazole, chloramphenicol.

Hearing damage and vestibular disorders - a side effect of aminoglycosides, more characteristic of the 1st generation. Since this effect is associated with the accumulation of drugs, the duration of their use should not exceed 7 days. Additional risk factors are senile age, renal insufficiency and concomitant use of loop diuretics. Reversible hearing changes are caused by vancomycin. If there are complaints of hearing loss, dizziness, nausea, unsteadiness when walking, it is necessary to replace the antibiotic with drugs from other groups.

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

Hypofunction of the thyroid gland is caused by sulfonamides.

Teratogenicity is inherent in tetracyclines, fluoroquinolones, sulfonamides.

Possible paralysis of the respiratory muscles with rapid intravenous administration of lincomycin and cardiodepression with rapid intravenous administration of tetracyclines.

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

Microbiological diagnostics

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

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

Prevention of contamination by other microflora.

On the one hand, the transportation of the material should ensure the viability of bacteria, and on the other hand, prevent their reproduction. It is desirable that the material be stored before the start of the study at room temperature and no more than 2 hours. Currently, special tightly closed sterile containers and transport media are used to collect and transport the material.

To no lesser extent, the effectiveness of microbiological diagnostics depends on the correct interpretation of the results. It is believed that the isolation of pathogenic microorganisms, even in small quantities, always makes it possible to attribute them to the true causative agents of the disease. A conditionally pathogenic microorganism is considered a pathogen if it is isolated from normally sterile environments of the body or in large quantities from environments that are not characteristic of its habitat. Otherwise, it is a representative of the normal autoflora or contaminates the test material during sampling or research. The isolation of low pathogenic bacteria from areas uncharacteristic of their habitation in moderate amounts indicates the translocation of microorganisms, but does not allow them to be attributed to the true pathogens of the disease.

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

ESBL susceptibility to beta-lactamase inhibitors such as clavulanic acid, sulbactam and tazobactam is the basis of laboratory tests for the production of ESBL by Gram-negative organisms. At the same time, if a microorganism of the Enterobacteriaceae family is resistant to 3rd generation cephalosporins, and when beta-lactamase inhibitors are added to these drugs, it demonstrates sensitivity, then this strain is identified as ESBL-producing.

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

Table 9.2.

lactam antibiotics.

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

Table 9.3.

Antibiotics of other groups.

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

Table 9.4.

Synthetic antibacterial drugs.

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

Every day our body is attacked by thousands and millions of different bacteria, viruses and microorganisms. He learned to cope with the main part, but some still manage to penetrate the body, causing significant damage to health.

To destroy them, pharmacists have developed antimicrobial, antibacterial and antifungal drugs. Unfortunately, viruses mutate over time, and the old medicines become ineffective. Today, you can purchase broad-spectrum antimicrobials at the pharmacy, which allow you to destroy several viruses at once. In this article, we will consider which of them are most effective, for which diseases their use is indicated and their price category.

Among all medicines, I would like to pay special attention to antibiotics. Many patients simply do not like them, claiming negative consequences after their use. But one cannot but take into account the fact that it is thanks to them that it is possible to stop dangerous epidemics and save millions of human lives.

They have a large radius of influence, due to which they destroy many bacteria. New generation drugs are the most effective due to the fact that microorganisms did not have time to adapt to the new active substance.

Advantages of new generation antibacterial agents over conventional antibiotics:

• compared to antibiotics sold more than ten years ago, there is a relatively smaller list of adverse reactions;
• no need to use three or four times a day, one or two applications are enough;
• different form of release: tablets, solutions for injections, suspensions, ointments, patches.

Remedies for bacteria and microbes are divided into three classes:

1. Sulfonamides.
2. Antibiotics.
3. Nitrofurans.

Some of them have such a pronounced effect that they destroy not only harmful microorganisms, but also all the beneficial microflora in the intestines. That is why it is recommended to take probiotics with them. They also have a negative effect on the liver and kidneys.

In order to prevent viruses and bacteria from adapting and mutating, antibiotics are taken at the maximum dosage prescribed by the doctor. The duration of therapy is determined by the severity of the course of the disease and the type of pathogen.

Important! It is forbidden to reduce or exceed the dosage on your own, as well as to reduce the duration of taking medications!

There are a number of drugs effective against protozoal infections. For example, nitroimidazole derivatives: ornidazole, metronidazole, tinidazole. Metronidazole among them is in special demand, mainly due to the low pricing policy. But tinidazole, although it is its complete analogue, it cannot be administered intravenously and intramuscularly.

Antibacterial agents of a wide range of actions are divided into:

• cephalosporins III and IV generation;
• natural penicillins;
• dioxidins;
• inhibitor-protected and antipseudomonal penicillins;
• aminoglycosides;
• fosfomycin;
• rifampicin;
• aminopenicillins inhibitor-protected;
• tetracyclines;
• chloramphenicol;
• macrolide;
• sulfonamides;
• agents of the nitroimidazole series;
• means of a number of carbapenems;
• means of a number of nitrofurans;
• fluoroquinolones and quinolones.

Narrow range products are not included in this list. They are assigned to the patient when the exact type of pathogen is established. Not used empirically, as well as in the treatment of superinfections.

In tablets

This section will provide a list of antibacterial medicines that have a wide range of new and old generations. They are effective against gram-negative and gram-positive microbes.

List of drugs:

1. Third and fourth generation cephalosporins: Cefantral, Ceftriaxone, Cefotaxime, Tax-o-bid, Cefpir, Loraxim.
2. Aminopenicillins: Amosin, Amoxicillin, Sulbactam, Ecobol, Amoxisar, Clavulanate.
3. Third generation aminoglycosides: Netromycin, Netilmicin, Nettacin.
4. Semi-synthetic 16-mer macrolides: Macropen.
5. Semi-synthetic macrolides 14 and 15: Rulicin, Brilid, Roxibid, Azithromycin.
6. Carbapenems: Invanz, Ertapenem, Meropenem.
7. Fluoroquinolones 3rd and 4th generation: Sparflo, Gatifloxacin, Moxifloxacin, Levofloxacin.
8. Nitrofurans: Furagin, Nifuroxazide, Nitrofurantoin.

For kids

The children's body is extremely susceptible to all kinds of drugs, especially antibacterial ones. Therefore, the list of acceptable drugs is significantly reduced.

New generation drugs for children:

• cephalosporins: Cefalexin, Torocef-Cefazolin;
• aminopenicillins: Femoxin, Summamed, Amosin, Amoxiclav;
• macrolides: Zitrocin, Midecamycin, Rovamycin.

For your information! Treatment with nitrofurans, fluoroquinols, carbapenams is unacceptable. They inhibit bone growth, have a toxic effect on the liver and kidneys. Only the use of Furacillin is not prohibited for treating wounds.

Ointments

At the moment, there is a huge list of ointments, the main active ingredient of which is an antibiotic. Sold in every pharmacy, dispensed without a prescription. Do not cause as much concern in patients as the use of tablets, suspensions or injections.

When choosing, it is necessary to take into account the stage of the wound process. With minor inflammation, superficial wounds, you can get by with antiseptics and antimicrobial ointments, but with deep tissue damage, you will need an antibacterial that relieves pain.

Antibiotics are also available in the form of aerosols, powders.

Broad-spectrum antimicrobial ointments:

1. Tetracycline (tetracycline) used to treat diseases of the eyes and skin.
2. Levomycetin, Levosin, Levomikol (levomycetin). Due to the frequent cases after internal use of the development of aplastic anemia, levomycetin is used only for external treatment of wounds.
3. Zenerite, Erythromycin (erythromycin). Both medicines act gently and gently, therefore they are allowed for the treatment of wounds, superficial rashes, eye diseases for children and adults.
4. Klindovit, Dalacin, Klenzit C (clindamycin). The duration of treatment can be about six months. Used for skin diseases and cosmetic problems.
5. Gentaxan, Gentamycin (gentamicin). Helps to cope with streptoderma. Prohibited for use by children under the age of three, pregnant and lactating women. The ointment is practically not absorbed and does not enter the bloodstream. Only local application is necessary, directly on the affected area.

The use of an ointment will bring results, provided that the bacteria are on the surface and have not affected the internal organs. If the infection begins to spread, the complex use of tablets and ointments is necessary.

Broad-spectrum antimicrobials are a great help for both the doctor and the patient when it is necessary to start treatment urgently, and there is no time to wait for test results. They are effective against many viruses and bacteria.

The most popular drugs are:

• Sumamed;
• Amoxicillin;
• Avelox;
• Cefamandol;
• Cefixime;
• Rulid;
• Cefoperazone;
• Unidox Solutab;
• Lincomycin.

Despite the large list of names, it is impossible to say which one will be the safest and will not cause adverse reactions. Each of them is intended for the treatment of a certain type of disease.

Some effectively deal with intestinal pathogens, while others work only in the upper and lower respiratory tract. Therefore, self-medicating and taking them for prevention is not only useless, but also dangerous to health. The appointment should be dealt with only by a doctor who will make a diagnosis and study the individual characteristics of the patient's body.

Antibacterial medicines - are of artificial and natural origin, they are united by the main task, suppressing the growth of bacteria and fungi. In order for their use to bring a positive result, not to negatively affect health, it is necessary to follow some rules:

1. At the first signs of the disease, you need to visit a doctor. He will make a diagnosis, prescribe a medicine, the duration of its administration and the optimal dosage.
2. It is forbidden to replace the medicine without prior consultation with the attending physician.
3. It is impossible to prolong or interrupt treatment.
4. Self-medication is dangerous to health, it is not recommended to buy pills on the advice of friends who have similar symptoms of the disease as you do.
5. It is strictly forbidden to give antibiotics to children, without the appointment of a pediatrician.

Unfortunately, dangerous viruses, bacteria and fungi gradually mutate. Their susceptibility to active components changes. Accordingly, their effectiveness is reduced, which at some point will cause the lack of results of the treatment. Therefore, pharmacists are working daily to create a new generation of medicines.

Conclusion

Over the entire period of production of antimicrobial drugs, more than seven thousand items have been produced. The bulk is not currently produced due to reduced efficiency, severe side reactions, and bacteria getting used to the main components. Today, about 150 drugs are used, 25 of which are the latest antibiotics, which are mainly prescribed to patients. Do not forget that for successful treatment, any drug should be prescribed only by a specialist.

At one time, the usual rules of hygiene made a real revolution in the approach to infection prevention. Even regular handwashing has significantly reduced the spread of many diseases, including intestinal disorders and purulent lesions. Personal care products are constantly improving, and today the market is full of products with antibacterial effect. We will tell you how effective they are, when they should be used, and in which cases it is better to refuse.

Antibacterial hygiene products - products containing in their composition substances that are antibacterial agents. Triclosan, an antibacterial and antifungal component with a wide spectrum of action, most often plays this role. Most fungi that affect the skin, as well as bacteria of the genera staphylococcus and streptococcus, are sensitive to it.

In some products, an analogue of triclosan, triclocarban, is present in the composition. Also, the antiseptic chlorhexidine, the antimicrobial drug metronidazole and others can act as an antibacterial agent. However, in terms of effectiveness, they are significantly inferior to triclosan, so they are used less often.

Antibacterial hygiene products can be:

• Soap (liquid and solid).
• Shampoos.
• Body gels.
• Gels for intimate hygiene.
• Deodorants.
• Toothpaste.
• Mouthwashes.
• Wet wipes.
• Sprays for hands.

Also, triclosan is part of many household chemicals, in which case they will be marked as antibacterial. These can be gels for washing surfaces, cleaning toilets and even washing powders.

Bacteria are the main cause of many serious diseases. Some types of these microorganisms in the process of life emit exotoxins, which today are considered the most dangerous poisons and are capable of provoking severe generalized infections. It is the bacteria that cause sepsis, purulent inflammation, severe lung damage, intestinal diseases and many other diseases.

Most often, the body is affected by Staphylococcus aureus, Streptococcus aureus, Escherichia coli (the greatest danger is for internal organs). However, all these microorganisms can be found on the skin and mucous membranes of a healthy person and do not provoke the development of the disease. Therefore, they are usually referred to as conditionally pathogenic microflora. This means that with normal immunity and the condition of the skin, microbes do not behave as pathogens, but are able to get along with other microorganisms and not affect health. For example, dangerous Staphylococcus aureus is found in every fourth inhabitant of the planet. And streptococcus can even suppress the reproduction of pathogenic bacteria such as salmonella.

By and large, the microflora that lives on the skin and mucous membranes is always conditionally pathogenic - among the microorganisms there are colonies of various bacteria. They can cause infections if the balance is disturbed - this will enable microbes to multiply uncontrollably.

Triclosan (and its analogues) is a broad-spectrum antibacterial agent, which means that it does not act selectively. When applied to the skin, all representatives of the microflora suffer, thereby seriously disturbing the established balance. This, in turn, creates favorable conditions for the development of infections. Therefore, hygiene products with an antibacterial effect, with frequent use, can cause serious harm to health.

Pathogenic microorganisms are able to develop new defense mechanisms, including against the drugs used. This is called resistance - resistance to the active substance. Staphylococcus aureus, one of the most dangerous microbes, shows this ability especially brightly. Initially, it was easily destroyed by penicillin, but today there are many strains of bacteria that, in the process of evolution, have learned to produce a special enzyme, penicillinase, which simply breaks down the antibiotic.

Every year more and more bacteria are being discovered that are resistant to existing drugs. Doctors attribute this trend to the uncontrolled use of various types of antibacterial agents. Constantly influencing colonies of bacteria, a person thereby accelerates their natural selection - resistant strains survive and further multiply.

In addition to the general harm brought by triclosan as one of the broad-spectrum antibiotics, the harm of the active substance itself has also been proven to date. Latest medical news: triclosan should be excluded from the composition of liquid and solid soaps. This decision was made by the FDA (US Food and Drug Administration). In the state of Minnesota, triclosan has been removed from the list of all types of consumer products. The law will come into force on January 1, 2017.

Such measures are taken on the basis of the results of several studies of the active substance, during which the following conclusions were made:

• Triclosan can cause liver cancer. This is due to the fact that it inhibits the androstane receptor, which is involved in the removal of toxins from the body. As a result, tissues degenerate into fibrous, which provokes oncology.
• Triclosan can cause infertility, adversely affect the course of pregnancy and fetal development. Triclosan can accumulate and has even been found in cord blood.
• The effectiveness of antibacterial products for hands and body with long-term use has not been proven. Bacteria are partially destroyed, and under the influence of the environment, their number is quickly restored.

And yet, the use of antibacterial hygiene products in some cases is justified.

• The antibacterial effect is useful when using various hand cleaning sprays and wet wipes if they are used on trips, hikes and more. This is a temporary use in an environment with a high risk of bacterial infections and limited personal hygiene.
• Triclosan has been proven effective in toothpastes. The substance really reduces the risk of developing gingivitis and other inflammations of the oral cavity, and also reduces the formation of tartar.

It is not necessary to completely abandon antibacterial hygiene products. However, it is still not recommended to use them daily and without significant indications. As with any active substance, antibacterial agents should only be used when clearly needed.