Use the antibiotics that are prescribed. Four generations of penicillins

All living organisms on Earth, as is known, have a cellular structure. Bacterial cells, or the cells that make up fungi, differ to some extent from animal and human cells. Differences may lie in the presence of a cell wall, a different structure of ribosomes or DNA, or in various metabolic processes. These differences make it possible to use some chemical substances to combat diseases caused by bacteria or protozoan fungi. That is, it is possible to use the method of selective toxicity, when a drug kills bacterial cells without affecting the metabolism in human cells.

With viruses, the situation is somewhat more complicated, since they do not have a cellular structure and in order to reproduce they are forced to integrate into the cells of a human or animal body. Therefore, the fight against viruses can only be effective at that stage until they have penetrated human cells, which means the disease does not yet manifest itself symptomatically, and it is extremely difficult to diagnose it.

In the 20s of the last century, substances were discovered that, as it seemed then, should have made most infectious diseases recede. The name of these substances is antibiotics. Their mass use became possible in the 50s and 60s of the 20th century, when the method of deep cultivation of microorganisms was introduced for their production on an industrial scale. Genetic engineering has made it possible to create strains of bacteria with high productivity of antibiotic substances. In other words, antibiotics have become accessible, and their production has become profitable.

The emergence of antibiotics in medicine can be compared to a revolution. It became possible treatment infectious diseases that used to kill hundreds of thousands of people every year. The use of antibiotics in surgery has greatly reduced the occurrence of postoperative complications.

In microbiology, antibiotics are a group of substances of natural origin, that is, produced by certain bacteria and fungi, which have a bacteriostatic or bactericidal effect. Substances that act in a similar way on fungal cells are called antimycotics. If the antimicrobial substance was synthesized chemically, then it is called an antimicrobial chemical. In everyday speech, these concepts are usually mixed and all these substances, regardless of their origin, are called antibiotics.

In nature, there are also a number of substances of plant origin that have an antimicrobial effect. Such substances are found in onions, garlic, thyme, oregano, sage, hops and many other plants. People have long used these plants to preserve food, and also use them in folk medicine.

As for bacteria and fungi that produce antibacterial substances, this mechanism arose in the process of evolution as a protective mechanism in the struggle for the best place “in the sun.” Some bacteria are capable of producing bacteriocins, small protein molecules that can destroy closely related microorganisms. This helps them in the struggle for ecological niches and nutrient substrate. People use this ability of microorganisms in the food industry, for example in the production of salami. The sausage contains a strain of Lactobacillus that produces bacteriocin. During their life, these bacteria synthesize lactic acid, which gives salami its typical sour taste. In addition, by producing bacteriocins, lactobacillus kills pathogenic listeria that may be present in the raw product. Lactobacilli found in “live” yoghurts act in a similar way - by synthesizing bacteriocin, they are able to suppress intestinal pathogens. Yeasts are also capable of synthesizing killer toxins that suppress the vital activity of microorganisms susceptible to them.

Slow-growing bacteria (Streptomyzeten) and fungi (Penicillium, Cephalosporium) are capable of synthesizing substances that differ in their chemical structure, which suppress the vital activity of fast-growing competitors. Such substances—antibiotics—are necessary for the survival of producing microorganisms. However, we should not forget that the evolution of organisms against which antibiotic substances act does not stand still either. Over time, they begin to develop more or less effective defense mechanisms. These mechanisms are called resistance (resistance) of a microorganism to an antibiotic.

Not all naturally occurring antibiotics can be used to treat humans. There are many reasons for this. Some antibiotics are not sufficiently absorbed in the intestine, others are poorly tolerated by humans and have many side effects. There are antibiotics that have a pleiotropic effect, for example, along with a bactericidal effect, they have a cytostatic effect, that is, they have an adverse effect on the cells of the human body.

To complete the picture, we should also mention endogenous antibiotics - substances produced by specialized cells of the body, for example granulocytes or Paneth cells, located in the crypts of the small intestine. These substances also have a broad antimicrobial spectrum of action. These substances include, for example, defensins. These and many other endogenous substances make a major contribution to the body's humoral immune response.

Such opposition to the alien in nature is very widespread. An example is insects, which produce a lot of bactericidal and bacteriostatic substances to combat pathogens. This is the reason that bee honey, for example, unlike jam, does not become moldy.

Use of antibiotics in medicine

The main area of ​​application of industrially produced antibiotics is medicine. In addition, antibiotics have found their wide application in livestock farming. Let me quote a textbook on microbiology, published in 1988, edited by prof. A.E. Vershigory: “Antibiotics improve appetite and use nutrients feed, allowing you to reduce feed consumption by 10-20% per unit of weight gain and fattening periods by 10-15 days. The effect is especially high when raising young animals. Sometimes the growth increases by 50%. With the use of small doses of antibiotics in feeding farm animals (10-20 g/t), the death of young animals from intestinal infections is reduced by 2-3 times.”
As we can see, in the middle and at the end of the last century, very high hopes were placed on antibiotics. General enthusiasm continued until they began to detect emerging large quantities new pathogenic strains of known pathogens that were resistant to the action of most antibiotics used for treatment. The increasingly common cases of dysbacteriosis have made us think about the widespread and uncontrolled use of antibiotics.

The emergence of many resistant strains of infectious agents has made us think that the use of antibiotics needs to be controlled. Otherwise, humanity may lose such a powerful weapon to combat infectious agents. The emergence of multiple antibiotic-resistant strains of tuberculosis bacilli is of great concern. Methicillin-resistant Staphylococcus aureus is becoming a serious problem in modern hospitals. And these examples, unfortunately, are far from the last.

It is almost impossible to imagine modern medicine without antibiotics. No alternative has been found yet. But in order for them to be effective and have minimal side effects, it is necessary to strictly adhere to the rules for taking them. These rules are few:

1. Before using antibiotics, it is necessary to find out what caused the disease.
   Today, antibiotics are prescribed in many cases not as a means of combating a specific infection, but to prevent possible bacterial infection. For example, people with the flu or some other viral infection are prescribed antibiotics to prevent possible bacterial complications. This also includes postoperative antibiotics to prevent the development of possible infection. The line between the need to use antibiotics and the advisability of abstaining from taking them in these cases is very thin.
2. There is not a single antibiotic, including antibiotics wide range action that would be equally effective against all types of bacteria. Therefore, before taking antibiotics, it is necessary to determine the pathogen and its resistance to various antibiotic substances. Often, due to a lack of funds or the seriousness of the patient’s condition, doctors prescribe antibiotics without first searching for the pathogen, based on the symptoms of the disease and their own medical experience.
3. When prescribing an antibiotic to a patient, the doctor should not forget about which area of ​​the body its action should be aimed at. For example, if an antibiotic is needed to treat a wound, then the logical, at first glance, local use of an antibiotic substance in this situation may not bring the desired result, since the penetration of the antibiotic deep into the wound may be hampered by dead tissue located on the surface and around it. Therefore, in this case, it makes sense, along with local, parenteral administration of the antibiotic.
   When using oral antibiotics, you should consider how well the antibiotic is absorbed in the gastrointestinal tract. For example, the absorption of ampicillin is only 60%, and amoxacillin, which has the same spectrum of action, is 80%. There are medications that contain ampicillin esters. Their absorption in the intestine is 90%. When administered parenterally, all these drugs act with equal potency.
4. When taking antibiotics, it is very important to adhere to correct dosage. The basic rule is that the concentration of the antibiotic in the blood should slightly exceed the limit of sensitivity of the infectious agent to it. The concentration of the antibiotic in the blood depends primarily on the dosage of the medication, as well as on the patient’s individual susceptibility to this antibiotic. For example, the concentration of aminoglycosides in the blood with the same intake is sometimes very different even in young people healthy people, not to mention patients who have impaired kidney or liver function.
   In addition, it must be remembered that some organs in human body difficult to reach for many substances. These organs include the prostate, central nervous system, bone and cartilage tissue. If it is necessary for drugs to penetrate these organs, it would be reasonable to use macrolides. These are antibiotics that phagocytes are able to capture in huge quantities and transport them to the site of infection.
   When choosing the optimal antibiotic, it is also necessary to take into account how it is eliminated from the body: if through the kidneys, then its highest concentration is achieved in the kidneys and urinary tract. Examples include cephalosporins: cefotaxime and ceftriaxone. These drugs have an almost identical spectrum of action, but cefotaxime is eliminated from the body almost entirely through the kidneys, and ceftriaxone is eliminated mostly through the liver. Quinolones reach their highest concentrations in mucous membranes and secretions. Therefore, these drugs are successfully used to treat infections caused, for example, by meningococci (Neisseria meningitidis).
5. Another important aspect is the frequency of taking antibiotic drugs. How often you need to take a particular antibiotic depends on the rate of its metabolism. The half-life of a drug, which is usually used in pharmacology to characterize a medicinal substance, depends on many factors: the presence of bonds with protein molecules, the possibility of inactivation or elimination of the substance in the body, and many others. An example is ceftriaxone, which binds to serum albumin and is therefore released slowly from the body through the liver and biliary tract. As for cefotaxime, which has the same spectrum of action, its elimination from the body occurs relatively quickly through the kidneys. The intervals between doses of the drug in the first case are, of course, longer than in the second.
   The frequency of taking a particular antibiotic also depends on the strength of the antibiotic substance’s effect on the pathogen. Some drugs have a strong bactericidal effect. In this case, it is more important to achieve the maximum possible concentration of antibiotic in the blood for a short time than trying to maintain it at the same level for a long time. Such drugs include, for example, aminoglycosides. It is enough to take them once a day. At the same time, the toxic effect of the drug on the body is minimal. Beta-lactam antibiotics, on the contrary, exhibit their bactericidal properties only a few hours after taking them, so their concentration in the blood must remain high for a long time. For the patient, this means that the intervals between doses of the drug should be shorter.
6. Many patients stop taking antibiotics too early - when they feel satisfactory. They do not take into account that the pathogen still remains in the body, many bacteria are in a weakened state, but have not yet been eliminated. When you stop taking the antibiotic, bacteria begin to multiply again, and strains may appear that are not sensitive to this antibiotic substance. A classic example is tonsillitis caused by Streptococcus pyogenes. For this disease, treatment with penicillin should last at least 10 days, even if the external symptoms of the disease disappear earlier. Otherwise, there is a high risk of the emergence of penicillin-resistant strains of streptococcus, which will no longer have anything to treat.

How to take antibiotics correctly

1. Taking antibiotics
   • When taking antibiotics, they should be washed down with one glass of water;
   • it is necessary to observe the time between doses of antibiotic substances;
   • follow the indicated order of taking the antibiotic and food (before, during or after meals);
   • even if you feel better, complete the course of antibiotics prescribed by your doctor;
   • While taking antibiotics, it is necessary to reduce physical stress on the body and completely stop playing sports.
2. Interaction of antibiotics with other drugs
   • Taking some antibiotics may reduce the effect of oral contraceptives. Therefore, during use, if contraception is necessary, it is necessary to use non-hormonal contraception(for example condoms);
   • milk and dairy products weaken the effect of some antibiotics, so these products should be consumed no earlier than 4 hours after taking antibiotics, or avoid dairy products until the end of the course of treatment;
   • Minerals such as magnesium, zinc and iron can also reduce the effect of antibiotics. If these minerals have been prescribed to the patient, the interval between taking them and taking antibiotics should be at least 4 hours.
3. Unwanted Side Effects
   • many patients taking antibiotics suffer from diarrhea;
   • When taking antibiotics, physiological imbalances may occur skin(especially mucous membranes), which increases the likelihood of fungal infections;
   • Some antibiotics may lower your threshold for sensitivity to sunlight. Therefore, exposure to the sun while taking antibiotics should be limited.
4. How else can you help your body fight infection?
   • increase the flow of fluid into the body to 2-3 liters. It can be: mineral water still, green tea, herbal teas, dried fruit decoctions, etc.;
   • it is necessary to frequently ventilate the room and, if possible, be in the fresh air;
   • an important factor in treatment is a balanced, vitamin-rich diet, the main components of which should be fresh vegetables and fruits; refuse at the same time confectionery and canned foods.
5. Additional recommendations
   • additional intake of vitamin C and zinc preparations, which enhance the functioning of the immune system;
   • using natural honey as a sweetener and avoiding sugar;
   • medicinal teas with Echinacea purpurea that strengthen the immune system.

In conclusion, I would like to remind you once again that antibiotics should not be feared like fire. Today there are no more effective means to fight bacterial infections. But in order for the treatment to be as effective as possible and not cause undesirable consequences, it is necessary to remember the rules for taking antibiotics and adhere to them.

Antibiotics are metabolic products of microorganisms that suppress the activity of other microbes. Natural antibiotics, as well as their semi-synthetic derivatives and synthetic analogs, are used as medicines, which have the ability to suppress pathogens of various diseases in the human body.

Based on their chemical structure, antibiotics are divided into several groups:

A. Beta-lactam antibiotics.

1. Penicillins.

a) Natural penicillins: benzylpenicillin and its salts, phenoxymethyl penicillin.

b) Semisynthetic penicillins:

Penicillinase-resistant with primary activity against staphylococci: oxacillin, cloxacillin, flucloxacillin;

With preferential activity against gram-negative bacteria (amidinopenicillins); amdinocillin (mecillinam), acidocillin;

Broad-spectrum (aminopenicillins): ampicillin, amoxicillin, pivampicillin;

Broad spectrum of action, especially highly active against Pseudomonas aeruginosa and other gram-negative bacteria (carboxy- and urea-dopenicillins): carbenicillin, tikarishin, azlocillin, mezlocillin, piperacillin.

2. Cephalosporins:

a) first generation: cephaloridine, cefazolin, etc.;

b) second generation: cefamandole, cefuroxime, etc.;

c) third generation: cefotaxime, ceftazidime, etc.;

d) fourth generation: cefpirome, cefepime, etc.

3. Monobactams: aztreonam.

4. Carbapenems: imipenem, meronem, tienam, primaxin. B. Fosfomycin.

B. Macrolides:

a) first generation: erythromycin, oleandomycin;

b) second generation: spiramycin (Rovamycin), roxithromycin (Rulid), clarithromycin (Klacid), etc.;

c) third generation: azithromycin (sumamed). G. Lincosamides: lincomycin, clindamycin. D. Fuzidin.

E. Aminoglycosides:

a) first generation: streptomycin, monomycin, kanamycin;

b) second generation: gentamicin;

c) third generation: tobramycin, sisomycin, amikacin, netilmicin;

d) fourth generation: isepamycin. J. Levomycetin.

3. Tetracyclines: a) natural: tetracycline, oxytetracycline, chlortetracycline; b) semi-synthetic: metacycline, doxycycline, minocycline, morphocycline.

AND. Rifamycins: rifocin, rifamide, rifampicin.

TO. Glycopeptide antibiotics: vancomycin, teicoplanin.

L. Ristomycin.

M. Polymyxins: polymyxin B, polymyxin E, polymyxin M.

H. Gramicidin.

ABOUT. Polyene antibiotics: nystatin, levorin, amphotericin B.

Based on the nature of their antimicrobial action, antibiotics are divided into bactericidal and bacteriostatic. Bactericidal drugs that cause the death of microorganisms include penicillins, cephalosporins, aminoglycosides, polymyxins, etc. Such drugs can give a quick therapeutic effect in severe infections, which is especially important in young children. Their use is less often accompanied by relapses of diseases and cases of carriage. Bacteriostatic antibiotics include tetracyclines, chloramphenicol, macrolides, etc. These drugs, by disrupting protein synthesis, inhibit the division of microorganisms. They are usually quite effective for moderately severe diseases.

Antibiotics are capable of inhibiting biochemical processes occurring in microorganisms. According to their mechanism of action, they are divided into the following groups:

1. Inhibitors of the synthesis of the microbial wall or its components during mitosis: penicillins, cephalosporins, carbapenems, monobactams, glycopeptide antibiotics, ristomycin, fosfomycin, cycloserine.

2. Antibiotics that disrupt the structure and function of cytoplasmic membranes: polymyxins, aminoglycosides, polyene antibiotics, gramicidin, glycopeptide antibiotics.

3. Inhibitors of RNA synthesis at the level of RNA polymerase: rifamycins.

4. Inhibitors of RNA synthesis at the ribosome level: chloramphenicol, macrolides (erythromycin, oleandomycin, etc.), lincomycin, clindamycin, fusidine, tetracyclines, aminoglycosides (kanamycin, gentamicin, etc.), glycopeptide antibiotics.

Besides, important in the mechanism of action of certain antibiotics, especially penicillins, they have an inhibitory effect on the adhesion of microorganisms to cell membranes.

The mechanism of action of antibiotics largely determines the type of effects they cause. Thus, antibiotics that disrupt the synthesis of the microbial wall or the function of cytoplasmic membranes are bactericidal drugs; antibiotics that inhibit the synthesis of nucleic acids and proteins usually act bacteriostatically. Knowledge of the mechanism of action of antibiotics is necessary for their correct selection, determining the duration of treatment, selecting effective combinations of drugs, etc.

To provide etiotropic therapy, it is necessary to take into account the sensitivity of pathogens to antibiotics. Natural sensitivity to them is due to biological properties microorganisms, the mechanism of action of antibiotics and other factors. There are narrow- and broad-spectrum antibiotics. Narrow-spectrum antibiotics include drugs that suppress predominantly gram-positive or gram-negative bacteria: some penicillins (benzylpenicillin, oxacillin, acido-cillin, aztreonam, ristomycin, fusidin, novobiocin, bacitracin, vancomycin, monobactams (aztreonam). Polymyxins B also have a narrow spectrum. E, M, inhibitory gram-negative bacteria, as well as antifungal antibiotics nystatin, levorin, amphotericin B, amphoglucamine, mycoheptin, griseofulvin.

Broad-spectrum antibiotics include drugs that affect both gram-positive and gram-negative bacteria: a number of semisynthetic penicillins (ampicillin, amoxicillin, carbenicillin); cephalosporins, especially third and fourth generations; carbapenems (imipenem, meronem, tienam); chloramphenicol; tetracyclines; aminoglycosides; rifamycins. Some of these antibiotics also act on rickettsia, chlamydia, mycobacteria, etc.

When identifying the causative agent of an infectious disease and its sensitivity to antibiotics, it is preferable to use drugs with a narrow spectrum of action. Broad-spectrum antibiotics are prescribed for severe course diseases and mixed infections.

Antibiotics include drugs that accumulate inside cells (the ratio of intra- and extracellular concentrations is more than 10). These include macrolides, especially new ones (azithromycin, roxithromycin, spiramycin), carbapenems, and clindamycin. Rifampicin, chloramphenicol, tetracyclines, lincomycin, vancomycin, teicoplanin, fosfomycin penetrate well into cells (the ratio of intra- and extracellular concentrations is from 1 to 10). Penicillins, cephalosporins, aminoglycosides penetrate into cells poorly (the ratio of intra- and extracellular concentrations is less than 1). Polymyxins also do not penetrate into cells.

In the process of using antibiotics, microorganisms may develop resistance to them. To penicillins, cefa osporins, monobactams, carba-penems, chloramphenicol, tetracyclines, glycopeptides, ristomycin, fosfomycin, lincosamides, resistance develops slowly and in parallel the therapeutic effect of the drugs decreases. Resistance to aminoglycosides, macrolides, rifamycins, polymyxins, and fusidine develops very quickly, sometimes during the treatment of one patient.

CHARACTERISTICS OF SEPARATE GROUPS OF ANTIBIOTICS

Penicillins. According to their chemical structure, these antibiotics are derivatives of 6-aminopenicillanic acid (6-APA) containing various substituents (R) in the amino group.

The mechanism of the antimicrobial action of penicillins is to disrupt the formation of the cell wall from pre-synthesized murein fragments. There are natural penicillins: benzylpenicillin (in the form of sodium, potassium, novocaine salts), bicillins, phenoxymethylpenicillin; semisynthetic penicillins: oxacillin, cloxacillin, ampicillin (pentrexil), amoxicillin, carbenicillin, carfecillin, piperacillin, mezlocillin, azlocillin, etc.

Benzylpenicillin gives a clear therapeutic effect in the treatment of diseases caused by pneumococci, staphylococci, hemolytic streptococci of group A, meningococci, gonococci, spirochete pallidum, corynobacteria, coli anthrax and some other microorganisms. Many strains of microbes, especially staphylococci, are resistant to benzylpenicillin, as they produce an enzyme (3-lactamase, which inactivates the antibiotic.

Benzylpenicillin is usually administered intramuscularly, in critical situations intravenously (sodium salt only). Doses vary widely from 30,000-50,000 EDUkg/day) to 1,000,000 EDU/kg/day) depending on the pathogen, severity and localization of the infectious process.

Therapeutic concentration in blood plasma occurs within 15 minutes after intramuscular injection and remains in it for 3-4 hours. Benzylpenicillin penetrates well into the mucous membranes and lungs. It enters little into the cerebrospinal fluid, myocardium, bones, pleural, synovial fluid, into the lumen of the bronchi and into the uterus. For meningitis, endolumbar administration of benzylpenicillin sodium salt is possible. The drug can be administered into the cavities, endobronchially, endolymphatically. It is found in high concentrations in bile and urine. In children up to one month old Elimination of benzylpenicillin occurs more slowly than in adults. This determines the frequency of administration of the drug: in the first week of life 2 times a day, then 3-4 times, and after a month, as in adults, 5-6 times a day.

When treating infections that require long-term antibiotic therapy and do not have an acute course (focal streptococcal infection, syphilis), long-acting benzylpenicillin preparations are used to prevent exacerbations of rheumatism: novocaine salt, ? bicillins 1, 3, 5. These drugs do not differ in the spectrum of antimicrobial action from sodium and potassium salts benzylpenicillin, they can be used in children over 1 year of age. All long-acting penicillins are administered only intramuscularly in the form of a suspension. After a single injection of novocaine salt, the therapeutic concentration of benzylpenicillin in the blood remains for up to 12 hours. Bicillin-5 is administered once every 2 weeks. Injections of bicillin-1 and bicillin-3 are performed once a week. Bicillins are mainly used to prevent relapses of rheumatism.

Phenoxymethylpenicillin- an acid-resistant form of penicillin, used orally on an empty stomach 4-6 times a day for the treatment of mild infectious diseases. Its spectrum of action is almost the same as that of benzylpenicillin.

Ospen (bimepen) benzathine phenoxymethylpenicillin is slowly absorbed from the gastrointestinal tract and maintains therapeutic concentrations in the blood for a long time. Prescribed in the form of syrup 3 times a day.

Oxacillin, cloceacillin, flucloxacillin- semisynthetic penicillins, used mainly in the treatment of diseases caused by staphylococci, including those resistant to benzylpenicillin. Oxacillin is able to inhibit (3-lactamase of staphylococci and enhance the effect of other penicillins, for example ampicillin (a combined drug of oxacillin with ampicillin - ampiox). For diseases caused by other microorganisms sensitive to benzylpenicillin (meningococci, gonococci, pneumococci, streptococci, spirochetes, etc.) , these antibiotics are practically rarely used due to the lack of a positive effect.

Oxacillin, cloxacillin, flucloxacillin are well absorbed from the gastrointestinal tract. In blood plasma, these drugs are bound to proteins and do not penetrate tissues well. These antibiotics can be administered intramuscularly (every 4-6 hours) and intravenously by stream or drip.

Amidinopenicillins - amdinocillin (mecillinam) is a narrow-spectrum antibiotic, inactive against gram-positive bacteria, but effectively suppresses gram-negative bacteria (Escherichia coli, Shigella, Salmonella, Klebsiella). Pseudomonas aeruginosa, Proteus and non-fermenting gram-negative bacteria are usually resistant to amdinocillin. The peculiarity of this antibiotic is that it actively interacts with PSB-2 (penicillin-binding protein), while most other (3-lactam antibiotics) interact with PSB-1 ​​and PSB-3. Therefore, it can be a synergist with other penicillins, as well as cephalosporins. The drug is administered parenterally, and it penetrates into cells many times better than ampicillin and carbenicillin. The effectiveness of the antibiotic for urinary tract infections has been synthesized for enteral use.

Broad-spectrum semi-synthetic penicillins - ampicillin, amoxicillin - are of greatest importance in the treatment of diseases caused by Haemophilus influenzae, gonococci, meningococci, some types of Proteus, salmonella, and, in addition, pathogens of listeriosis and enterococci. These antibiotics are also effective for the treatment of infectious processes caused by mixed (gram-positive and gram-negative) microflora. Ampicillin and amoxicillin can be administered orally, for example, in the treatment of infections of the gastrointestinal tract, urinary tract, and otitis media. Ampicillin that is not absorbed from the gastrointestinal tract causes irritation of the mucous membranes, leading to vomiting, diarrhea, and irritation of the skin around the anus in a significant percentage of children. Amoxicillin differs from ampicillin in better absorption, so it can be prescribed orally not only for mild but also for moderate infections. Amoxicillin is less irritating to the mucous membranes of the gastrointestinal tract and less likely to cause vomiting and diarrhea. For severe diseases that require the creation of a high concentration of antibiotic in the blood, these drugs are administered parenterally.

Carboxypenicillins- carbenicillin, ticarcillin have an even wider spectrum of antimicrobial action than ampicillin, and differ from it in the additional ability to suppress Pseudomonas aeruginosa, indole-positive strains of Proteus and bacteroides. Their main use is diseases caused by these pathogens. Carbenicillin and ticarcillin are absorbed very poorly from the gastrointestinal tract, so they are used only parenterally (carbenicillin intramuscularly and intravenously, ticarcillin intravenously). Carfecillin is a phenyl ester of carbenicillin. It is well absorbed from the gastrointestinal tract, after which carbenicillin is released from it. Carboxypenicillins, compared to ampicillin, penetrate worse into tissues, serous cavities, and cerebrospinal fluid. Carbenicillin is found in active form and in high concentrations in bile and urine. It is produced in the form of disodium salt, so if kidney function is impaired, water retention in the body and edema may occur.

The use of drugs may be accompanied by the appearance of allergic reactions, symptoms of neurotoxicity, acute interstitial nephritis, leukopenia, hypokalemia, hypernatremia, etc.

Ureidopenicillins (acylaminopenicillins)- piperacillin, mezlocillin, azlocillin - broad-spectrum antibiotics that suppress gram-positive and gram-negative microorganisms. These antibiotics are mainly used for severe gram-negative infections, especially for diseases caused by Pseudomonas aeruginosa (necessarily in combination with aminoglycosides), Klebsiella. Ureidopenicillins penetrate well into cells. They are little metabolized in the body and are excreted by the kidneys through filtration and secretion. The drugs are poorly resistant to B-lactamase, so they are recommended to be prescribed with inhibitors of this enzyme. Piperacillin is prescribed for chronic inflammatory diseases of the bronchi, including cystic fibrosis and chronic bronchitis. The drugs can cause leukopenia, thrombocytopenia, neutropenia, eosinophilia, allergic reactions, gastrointestinal dysfunction, interstitial nephritis, etc.

Upon appointment broad-spectrum semisynthetic penicillins: aminopenicillins (ampicillin, amoxicillin), carboxypenia -llins (carbenicillin, ticarcillin), ureidopenicillins (pipipecillin, meslocillin, azlocillin) must be remembered that all the named antibiotics are destroyed by staphylococcal B-lactamasis, and therefore producing producing penalties are pronounced Cillinase strains of these microbes.

Combination drugs with B-lactamase inhibitors- clavulanic acid and sulbactam. Clavulanic acid and sulbactam (penicillanic acid sulfone) are classified as B-lactamines, which have a very weak antimicrobial effect, but at the same time they suppress the activity of B-lactamases of staphylococci and other microorganisms: Haemophilus influenzae, Escherichia coli, Klebsiella, some bacteroides, gonococci, le -gionella; do not suppress or suppress very weakly B-lactamases of Pseudomonas aeruginosa, Enterobacteriaceae, and Citrobacter. Preparations containing clavulanic acid and sulbactam are intended for parenteral use- Augmentin (amoxicillin + potassium clavulanate), timentin (ticarcillin + potassium clavulanate), unasin (ampicillin + sulbactam). They are used in the treatment of otitis, sinusitis, infections of the lower respiratory tract, skin, soft tissues, urinary tract and other diseases. Unazine is highly effective for the treatment of peritonitis and meningitis caused by microorganisms that intensively produce B-lactamase. Analogues of the drug unasin intended for oral administration are sultamicillin and sulacillin.

Natural and semi-synthetic penicillins(except for carboxy- and ureidopenicillins) - low-toxic antibiotics. However, benzylpenicillin and, to a lesser extent, semisynthetic penicillins can cause allergic reactions, and therefore their use in children with diathesis and allergic diseases is limited. The administration of high doses of benzylpenicillin, ampicillin, amoxicillin can lead to increased excitability of the central nervous system and convulsions, which is associated with the antagonism of antibiotics towards the GABA inhibitory transmitter in the central nervous system.

Long-acting penicillin preparations should be injected very carefully under slight pressure through a large-diameter needle. If the suspension enters a vessel, it can cause thrombus formation. Semi-synthetic penicillins used orally cause irritation of the gastric mucosa, a feeling of heaviness in the abdomen, burning, and nausea, especially when administered on an empty stomach. Broad-spectrum antibiotics can lead to dysbiocenosis in the intestines and provoke the appearance of a secondary infection caused by Pseudomonas aeruginosa, Klebsiella, yeast, etc. For other complications caused by penicillins, see above.

Cephalosporins- a group of natural and semi-synthetic antibiotics based on 7-aminocephalosporanic acid.

Currently, the most common division of cephalosporins is by generation.

Some drugs in this group can be used for oral administration: of the first generation cephalosporins - cefadroxil, cephalexin, cefradine; II generation - cefuroxime (zinnate), III generation - cefspan (cefoxime), cefpodoxime (orelax), ceftibuten (cedex). Oral cephalosporins are usually used for diseases moderate severity, since they are less active compared to drugs for parenteral administration.

Cephalosporins have a wide spectrum of action.

Cephalosporins of the 1st generation inhibit the activity of kokki, especially staphylococci and streptococci (the exception is Enterococci and staphylococcus strains resistant to meticillin), as well as diphtheria sticks, Siberian ulcer bacilli, spirochet, eschechius, Shigell, Salmonell, Moraxell, Klebcell ni, bordetall, protrusion and hemophilus influenzae. Second generation cephalosporins have the same spectrum of action, but they create higher concentrations in the blood and penetrate tissue better than first generation drugs. They have a more active effect on some strains of gram-negative bacteria that are resistant to the first generation of cephalosporins, including most strains of Escherichia coli, Klebsiella, Proteus, Haemophilus influenzae, Moraxella, whooping cough pathogens, and gonococci. At the same time, second generation cephalosporins do not affect Pseudomonas aeruginosa, “hospital strains” of gram-negative bacteria and have a slightly less inhibitory effect compared to first generation cephalosporins on staphylococci and streptococci. III generation cephalosporins are characterized by an even greater breadth of the antimicrobial spectrum, good penetrating ability, and high activity against gram-negative bacteria, including nosocomial strains resistant to other antibiotics. They affect, in addition to the above-mentioned microbes, pseudomonads, morganella, serrations, clostridia (except CY. difficile) and bacteroides. At the same time, they are characterized by relatively low activity against staphylococci, pneumococci, meningococci, gonococci and streptococci. IV generation cephalosporins are more active than III generation drugs in suppressing most gram-negative and gram-positive bacteria. IV generation cephalosporins affect some multi-resistant microorganisms that are resistant to most antibiotics: Cytobacter, Enterobacter, Acinetobacter.

IV generation cephalosporins are resistant to B-lactamases and do not induce their formation. But they do not affect SY. difficile, bacteroides, enterococci, listeria, legionella and some other microorganisms.

They are used to treat severe diseases, as well as in patients with neutropenia and suppressed immunity.

The highest concentrations of cephalosporins are found in the kidneys and muscle tissue, lower concentrations are found in the lungs, liver, pleural, and peritoneal fluids. All cephalosporins easily pass through the placenta. Cephaloridin (Zeporin), cefotaxime (Claforan), moxalactam (Latamoxef), ceftriaxone (Longacef), ceftizoxime (Epocelin), etc. penetrate into the cerebrospinal fluid. Most cephalosporins are excreted unchanged by the kidneys through active secretion by tubular cells and partly glomerular filtration.

Cephalosporins are used in the treatment of diseases caused by penicillin-resistant microorganisms, sometimes in the presence of allergic reactions to penicillins. They are prescribed for sepsis, diseases of the respiratory system, urinary tract, gastrointestinal tract, soft tissues, and bones. For meningitis in premature newborns, high activity of cefotaxime, moxalactam, ceftizoxime, and ceftriaxone was detected.

The use of cephalosporins may be accompanied by pain at the site of intramuscular injection; phlebitis after intravenous use; nausea, vomiting, diarrhea when taking drugs orally. With repeated use, children with high sensitivity to the drug may experience skin rash, fever, and eosinophilia. Cephalosporins are not recommended for children with an anaphylactic reaction to penicillins, but their use is acceptable in the presence of other manifestations of allergies - fever, rash, etc. Cross allergic reactions between cephalosporins and penicillins are observed in 5-10% of cases. Some cephalosporins, especially cephaloridine and cephalothin, are nephrotoxic. This effect is associated with their slow excretion by the kidneys and the accumulation of lipid peroxidation products in them. The nephrotoxicity of the antibiotic increases with a deficiency of vitamin E and selenium. Drugs can inhibit the microflora of the gastrointestinal tract and lead to dysbiocenosis, cross-infection caused by hospital strains of microbes, candidiasis and vitamin E deficiency in the body.

Aztreons- highly effective synthetic (3-lactam antibiotic from the monobactam group. Used for the treatment of respiratory tract infections, meningitis, septic diseases caused by gram-negative, including multidrug-resistant microorganisms (pseudomonas, moraxella, klebsiella, hemophilus influenzae, E. coli, yersinia, serracia , enterobacter, meningococcus, gonococcus, salmonella, morganella). Aztreonam does not affect gram-positive aerobic and anaerobic bacteria.

Imipenem- (3-lactam antibiotic from the carbapenem group with an ultra-broad spectrum of action, including most aerobic and anaerobic gram-positive and gram-negative bacteria, including microorganisms resistant to penicillins, cephalosporins, aminoglycosides and other antibiotics. The high bactericidal activity of imipenem is due to easy penetration through the walls bacteria, with a high degree of affinity for enzymes involved in the synthesis of the bacterial wall of microorganisms. Currently, from the mentioned group of antibiotics, imipenem is used in the clinic in combination with cilastatin (this combination is called thiene). Cilastatin inhibits renal peptidase, thereby inhibiting the formation of nephrotoxic metabolites of imipenem. has strong antimicrobial activity, a wide spectrum of action. The sodium salt of imipenem-cilastatin is produced under the name Primaxin. Imipenem is stable to 3-lactamase, but has a weak effect on microorganisms located inside cells. When imipenem is prescribed, thrombophlebitis, diarrhea, etc. in rare cases convulsions (especially in cases of impaired renal function and diseases of the central nervous system).

Meronem (meropenem) does not undergo biotransformation in the kidneys and does not produce nephrotoxic metabolites. Therefore, it is used without cilastatin. It has less effect than tienam on staphylococci, but is more effective against gram-negative enterobacteria and pseudomonads.

Meronem creates an active bactericidal concentration in the cerebrospinal fluid (CSF) and is successfully used for meningitis without fear of undesirable effects. This compares favorably with tienam, which causes neurotoxic effects and is therefore contraindicated for meningitis.

Aztreonam and carbapenem are practically not absorbed into the gastrointestinal tract and are administered parenterally. They penetrate well into most body fluids and tissues and are excreted primarily in the urine in an active form. The drugs have been noted to be highly effective in treating patients with infections of the urinary tract, osteoarticular system, skin, soft tissues, gynecological infections, and gonorrhea. The use of aztreonam is especially indicated in pediatric practice as an alternative to aminoglycoside antibiotics.

Fosfomycin (fosfonomycin)- a broad-spectrum bactericidal antibiotic that disrupts the formation of the microbial wall by suppressing the synthesis of UDP-acetylmuramic acid, that is, its mechanism of action differs from that of penicillins and cephalosporins. It has a wide spectrum of action. It is able to suppress gram-negative and gram-positive bacteria, but does not affect Klebsiella, indole-positive Proteus.

Fosfomycin penetrates well into tissues, including bone and cerebrospinal fluid; is found in sufficient quantities in bile. The named antibiotic is excreted mainly by the kidneys. It is prescribed mainly for severe infections caused by microorganisms resistant to other antibiotics. It combines well with penicillins, cephalosporins, and when used together with aminoglycoside antibiotics, not only an increase in antimicrobial action is observed, but also a decrease in the nephrotoxicity of the latter. Fosfomycin is effective in the treatment of meningitis, sepsis, osteomyelitis, urinary and biliary tract infections. For oral infections and intestinal infections it is prescribed enterally. Fosfomycin is a low-toxic drug. When using it, some patients may experience nausea and diarrhea; no other undesirable effects have been identified to date.

Glycopeptide antibiotics. Vancomycin, teicoplanin are antibiotics that act on gram-positive cocci (including methicillin-resistant staphylococci, strains of staphylococci that form B-lactamase, streptococci, penicillin-resistant pneumococci, enterococci) and bacteria (corynebacteria, etc.). Their effect on clostridia, especially difficile, is very important. Vancomycin also affects actinomycetes.

Vancomycin penetrates well into all tissues and fluids of the body, except the cerebrospinal fluid. It is used for severe staphylococcal infections caused by strains resistant to other antibiotics. The main indications for vancomycin are: sepsis, soft tissue infections, osteomyelitis, endocarditis, pneumonia, necrotizing enterocolitis (caused by toxigenic clostridia). Vancomycin is administered intravenously 3-4 times a day, for newborns 2 times a day. In the treatment of very severe staphylococcal meningitis, given the relatively weak penetration of vancomycin into the cerebrospinal fluid, its intrathecal administration is advisable. Teicoplanin differs from vancomycin in its slow elimination; it is administered intravenously once a day. For pseudomembranous colitis and staphylococcal enterocolitis, vancomycin is prescribed orally.

Most common complication massive use of vancomycin - release of histamine from mast cells, leading to arterial hypotension, the appearance of a red rash on the neck (red neck syndrome), head, and limbs. This complication can usually be avoided if the required dose of vancomycin is administered over at least an hour and pre-administered antihistamines. Thrombophlebitis and hardening of the veins are possible during the infusion of the drug. Vancomycin is a nephrotoxic antibiotic; its combined use with aminoglycosides and other nephrotoxic drugs should be avoided. Vancomycin may cause seizures when administered intrathecally.

Ristomycin (ristocetin)- an antibiotic that suppresses gram-positive microorganisms. Staphylococci, streptococci, enterococci, pneumococci, spore-forming gram-positive bacilli, as well as corynebacteria, listeria, acid-fast bacteria and some anaerobes are sensitive to it. Does not affect gram-negative bacteria and cocci. Ristomycin is administered only intravenously; it is not absorbed from the gastrointestinal tract. The antibiotic penetrates well into tissues; especially high concentrations are found in the lungs, kidneys and spleen. Ristomycin is used mainly for severe septic diseases caused by staphylococci and enterococci in cases where previous treatment with other antibiotics was ineffective.

When using ristomycin, thrombocytopenia, leukopenia, neutropenia (up to agranulocytosis) are sometimes observed, and eosinophilia is sometimes noted. In the first days of treatment, exacerbation reactions (chills, rash) are possible, allergic reactions are quite often observed. Long-term intravenous administration of ristomycin is accompanied by hardening of the vein walls and thrombophlebitis. Oto- and nephrotoxic reactions have been described.

Polymyxins- a group of polypeptide bactericidal antibiotics that suppress the activity of predominantly gram-negative microorganisms, including Shigella, Salmonella, enteropathogenic strains of Escherichia coli, Yersinia, Vibrio cholerae, Enterobacter, Klebsiella. Of great importance for pediatrics is the ability of polymyxins to suppress the activity of Haemophilus influenzae and most strains of Pseudomonas aeruginosa. Polymyxins act on both dividing and dormant microorganisms. The disadvantage of polymyxins is their low penetration into cells and therefore low effectiveness in diseases caused by intracellular pathogens (brucellosis, typhoid fever). Polymyxins are characterized by poor penetration through tissue barriers. When taken orally, they are practically not absorbed. Polymyxins B and E are used intramuscularly, intravenously, for meningitis they are administered endolumbarally, for gastrointestinal infections they are prescribed orally. Polymyxin M is used only internally and topically. Oral polymyxins are prescribed for dysentery, cholera, colienteritis, enterocolitis, gastroenterocolitis, salmonellosis and other intestinal infections.

When polymyxins are prescribed orally, as well as when they are applied topically, adverse reactions are rarely observed. When administered parenterally, they can cause nephro- and neurotoxic effects (peripheral neuropathies, impaired vision and speech, muscle weakness). These complications are most common in people with impaired renal excretory function. Fever, eosinophilia, and urticaria are sometimes observed when using polymyxins. In children, parenteral administration of polymyxins is permissible only for health reasons, in the case of infectious processes caused by gram-negative microflora that are resistant to the action of other, less toxic antimicrobial drugs.

Gramicidin (Gramicidin C) active mainly against gram-positive microflora, including streptococci, staphylococci, pneumococci and some other microorganisms. Gramicidin is used only topically in the form of paste, solutions and buccal tablets. Solutions of gramicidin are used to treat the skin and mucous membranes, for washing, irrigating bandages in the treatment of bedsores, purulent wounds, boils, etc. Gramicidin tablets are intended for resorption during infectious processes in the oral cavity and pharynx (tonsillitis, pharyngitis, stomatitis, etc.). Gramicidin tablets should not be swallowed: if they enter the bloodstream, they can cause hemolysis of erythromytes.

Macrolides. There are three generations of macrolides. I generation - erythromycin, oleandomycin. II generation - spiramycin (Rovamycin), roxithromycin (Rulid), josamycin (Vilprafen), clarithromycin (Cladid), midecamycin (Macropen). III generation - azithromycin (sumamed).

Macrolides are broad-spectrum antibiotics. They have a bactericidal effect on microorganisms that are very sensitive to them: staphylococci, streptococci, pneumococci, corynebacteria, bordetella, moraxella, chlamydia and mycoplasma. They affect other microorganisms - Neisseria, Legionella, Haemophilus influenzae, Brucella, Treponema, Clostridia and Rickettsia - bacteriostatically. Macrolides of the II and III generations have a wider spectrum of action. Thus, josamycin and clarithromycin suppress Helicobacter pylori (and are used in the treatment of peptic ulcer stomach), spiramycin affects toxoplasma. Preparations of the II and III generations also inhibit gram-negative bacteria: Campylobacter, Listeria, Gardnerella and some mycobacteria.

All macrolides can be administered orally, some drugs (erythromycin phosphate, spiramycin) can be administered intravenously.

Macrolides penetrate well into the adenoids, tonsils, tissues and fluids of the middle and inner ear, lung tissue, bronchi, bronchial secretions and sputum, skin, pleural, peritoneal and synovial fluids are found in high concentrations in neutriphils and alveolar macrophages. into the cerebrospinal fluid and central nervous system macrolides penetrate poorly. Great importance has their ability to penetrate cells, accumulate in them and suppress intracellular infection.

The drugs are eliminated primarily by the liver and create high concentrations in the bile.

New macrolides differ from old ones by greater stability in an acidic environment and better bio-absorption from the gastrointestinal tract, regardless of food intake, and prolonged action.

Macrolides are mainly prescribed for mild forms acute diseases caused by microorganisms sensitive to them. The main indications for the use of macrolides are tonsillitis, pneumonia (including those caused by Legionella), bronchitis, diphtheria, whooping cough, purulent otitis, diseases of the liver and biliary tract, pneumopathy and conjunctivitis caused by chlamydia. They are very effective against chlamydial pneumonia in newborns. Macrolides are also used for urinary tract diseases, but to obtain good therapeutic effect, especially when using “old” macrolides, the urine must be alkalized, since they are inactive in an acidic environment. They are prescribed for primary syphilis and gonorrhea.

Synergism is observed when macrolides are used together with sulfonamide drugs and tetracycline antibiotics. Combined preparations containing oleandromycin and tetracyclines are marketed under the names oletetr i n, tetraolean, and sigmamycin. Macrolides cannot be combined with chloramphenicol, penicillins or cephalosporins.

Macrolides are low-toxic antibiotics, but they irritate the mucous membrane of the gastrointestinal tract and can cause nausea, vomiting, and diarrhea. Intramuscular injections are painful; when administered intravenously, phlebitis may develop. Sometimes when they are used, cholestasis develops. Erythromycin and some other macrolides inhibit the monooxygenase system in the liver, as a result of which the biotransformation of a number of drugs, in particular theophylline, is disrupted, thereby increasing its concentration in the blood and toxicity. They also inhibit the biotransformation of bromocriptine, dihydroergotamine (included in a number of antihypertensive drugs), carbamazepine, cimetidine, etc.

Microlides cannot be prescribed together with new antihistamines - terfenadine and astemizole due to the danger of their hepatoxic action and the danger of heart arrhythmia.

Lincosamides: lincomycin and clindamycin. These antibiotics suppress predominantly gram-positive microorganisms, including staphylococci, streptococci, pneumococci, as well as mycoplasmas, various bacteroides, fusobacteria, anaerobic cocci, and some strains of Haemophilus influenzae. Clindamycin, in addition, has an effect, although weakly, on toxoplasma, the causative agents of malaria, and gas gangrene. Most gram-negative bacteria are resistant to lincosamides.

Lincosamides are well absorbed from the gastrointestinal tract, regardless of food intake, penetrate into almost all fluids and tissues, including bone, but poorly penetrate into the central nervous system and cerebrospinal fluid. For newborns, the drugs are administered 2 times a day, for older children - 3-4 times a day.

Clindamycin differs from lincomycin in its greater activity against certain types of microorganisms and better absorption from the gastrointestinal tract, but at the same time it more often causes undesirable effects.

Lincosamides are used in the treatment of infections caused by gram-positive microorganisms resistant to other antibiotics, especially in cases of allergies to penicillin drugs and cephalosporins. They are prescribed for infectious gynecological diseases and gastrointestinal infections. Due to good penetration into bone tissue, lincosamides are the drugs of choice in the treatment of osteomyelitis. Without special indications, they should not be prescribed to children when other, less toxic antibiotics are effective.

When using lincosamides, children may experience nausea and diarrhea. Sometimes pseudomembranous colitis develops - a severe complication caused by dysbiocenosis and reproduction in the Intestine of Cy. difficile, which secretes a toxin. These antibiotics can cause liver dysfunction, jaundice, leukoneutropenia and thrombocytopenia. Allergic reactions, mainly in the form skin rash, are quite rare. With rapid intravenous administration, lincosamides can cause neuromuscular block with respiratory depression and collapse.

Fuzidin. Highest value Fusidine has activity against staphylococci, including those resistant to other antibiotics. It also acts on other gram-positive and gram-negative cocci (gonococci, meningococci). Fuzidin is somewhat less active against corynebacteria, listeria, and clostridia. The antibiotic is not active against all gram-negative bacteria and protozoa.

Fusidine is well absorbed from the gastrointestinal tract and penetrates into all tissues and fluids, except the cerebrospinal fluid. The antibiotic penetrates especially well into the source of inflammation, liver, kidneys, skin, cartilage, bones, and bronchial secretions. Fusidine preparations are prescribed orally, intravenously, and also locally in the form of an ointment.

Fusidine is especially indicated for diseases caused by penicillin-resistant strains of staphylococci. The drug is highly effective for osteomyelitis, diseases of the respiratory system, liver, biliary tract, and skin. In recent years, it has been used in the treatment of patients with nocardiosis and colitis caused by clostridia (except CY. difficile). Fusidine is excreted primarily in bile and can be used in patients with impaired renal excretory function.

A pronounced increase in antimicrobial activity is observed when fusidine is combined with other antibiotics; the combination with tetracyclines, rifampicin and aminoglycosides is especially effective.

Fuzidin is a low-toxic antibiotic, but can cause dyspeptic disorders that disappear after discontinuation of the drug. When an antibiotic is administered intramuscularly, tissue necrosis is observed (!), and when administered intravenously, thrombophlebitis may occur.

Aminoglycoside antibiotics. There are four generations of aminoglycosides. First generation antibiotics include streptomycin, monomycin, neomycin, kanamycin; II generation - gentamicin (garamycin); III generation - tobramycin, sisomycin, amikacin, netilmicin; IV generation - isepamycin.

Aminoglycoside antibiotics are bactericidal, have a wide spectrum of action, and inhibit gram-positive and especially gram-negative microorganisms. Aminoglycosides of the II, III and IV generations are able to suppress Pseudomonas aeruginosa. Of main practical importance is the ability of drugs to inhibit the activity of pathogenic Escherichia coli, Haemophilus influenzae, Klebsiella, gonococci, Salmonella, Shigella, and staphylococci. In addition, streptomycin and kanamycin are used as anti-tuberculosis drugs, monomycin to act on dysenteric amoeba, leishmania, trichomonas, gentamicin - on the causative agent of tularemia.

All aminoglycoside antibiotics are poorly absorbed from the gastrointestinal tract and from the bronchial lumen. To obtain a resorptive effect, they are administered intramuscularly or intravenously. After a single intramuscular injection, the effective concentration of the drug in the blood plasma remains in newborns and young children for 12 hours or more, in older children and adults for 8 hours. The drugs penetrate satisfactorily into tissues and body fluids, with the exception of cerebrospinal fluid, they penetrate poorly into cells. When treating meningitis caused by gram-negative bacteria, aminoglycoside antibiotics are preferably administered endolumbarally. In the presence of severe inflammatory process in the lungs and organs abdominal cavity, pelvis, for osteomyelitis and sepsis, endolymphatic administration of drugs is indicated, which ensures a sufficient concentration of the antibiotic in the organs without causing its accumulation in the kidneys. For purulent bronchitis, they are administered in the form of an aerosol or by installing a solution directly into the lumen of the bronchi. Antibiotics of this group pass well through the placenta and are excreted in milk (in infant aminoglycosides are practically not absorbed from the gastrointestinal tract), but there is a high risk of dysbacteriosis.

With repeated administration, accumulation of aminoglycosides is observed in the tubes, in the inner ear and some other organs.

The drugs are not. undergo biotransformation and are excreted by the kidneys in an active form. Elimination of aminoglycoside antibiotics is slowed down in newborns, especially premature infants, as well as in patients with impaired renal excretory function.

Aminoglycoside antibiotics are used for complicated infectious diseases of the respiratory and urinary tract, for septicemia, endocarditis, and less often for gastrointestinal tract infections, for the prevention and treatment of infectious complications in surgical patients.

Aminoglycoside antibiotics administered parenterally are toxic. They can cause ototoxic, nephrotoxic effects, disrupt neuromuscular transmission of impulses and the processes of active absorption from the gastrointestinal tract.

The ototoxic effect of antibiotics is a consequence of irreversible degenerative changes in the hair cells of the organ of Corti (inner ear). The danger of this effect occurring is greatest in newborns, especially premature infants, as well as in cases of birth trauma, hypoxia during childbirth, meningitis, and impaired renal excretory function. An ototoxic effect can develop when antibiotics reach the fetus through the placenta; when combined with other ototoxic drugs (furosemide, ethacrynic acid, ristomycin, glycopeptide antibiotics).

The nephrotoxic effect of aminoglycoside antibiotics is associated with dysfunction of many enzymes in the epithelial cells of the kidney tubules and destruction of lysosomes. Clinically, this is manifested by an increase in urine volume, a decrease in its concentration and proteinuria, that is, the occurrence of non-oliguric renal failure.

Antibiotics of this group cannot be combined with other oto- and nephrotoxic drugs. In young children, especially malnourished and weakened children, aminoglycoside antibiotics can inhibit neuromuscular transmission due to a decrease in the sensitivity of skeletal muscle H-cholinergic receptors to acetylcholine and suppression of the release of the mediator; As a result, respiratory muscle function may be impaired. To eliminate this complication, calcium preparations are prescribed together with proserin after preliminary administration of atropine. Accumulating in the intestinal wall, aminoglycosides disrupt the process of active absorption of amino acids, vitamins, and sugars. This can lead to malabsorption, which worsens the child's condition. When aminoglycoside antibiotics are prescribed, the concentration of magnesium and calcium in the blood plasma decreases.

Due to their high toxicity, aminoglycoside antibiotics should be prescribed only for severe infections, in short courses (no more than 5-7 days).

Levomycetin- a bacteriostatic antibiotic, but it has a bactericidal effect on Haemophilus influenzae type “B”, some strains of meningococci and pneumococci. It inhibits the division of many gram-negative bacteria: Salmonella, Shigella, Escherichia coli, Brucella, whooping cough pathogen; gram-positive aerobic cocci: pyogenic streptococci and group B streptococci; most anaerobic microorganisms (clostridia, bacteroides); Vibrio cholerae, rickettsia, chlamydia, mycoplasma.

Mycobacteria are resistant to chloramphenicol, CI. difficile, Cytobacter, Enterobacter, Acinetobacter, Proteus, Pseudomonas aeruginosa, Staphylococcus, Enterococcus, Corynebacterium, Serration, protozoa and fungi.

Levomycetin base is well absorbed from the gastrointestinal tract, quickly creating active concentrations in the blood plasma. The antibiotic penetrates well from the blood plasma into all tissues and fluids, including the cerebrospinal fluid.

Unfortunately, chloramphenicol itself has a bitter taste and can cause vomiting in children, so younger age they prefer to prescribe chloramphenicol esters - stearate or palmitate. In children in the first months of life, the absorption of chloramphenicol prescribed in the form of esters occurs slowly due to the low activity of lipases that hydrolyze ester bonds and release chloramphenicol base, which is capable of absorption. Intravenously administered chloramphenicol succinate also undergoes hydrolysis (in the liver or kidneys) with the release of the active chloramphenicol base. Non-hydrolyzed ester is excreted by the kidneys, in newborns about 80% of the administered dose, in adults 30%. The activity of hydrolases in children is low and has individual differences, therefore, from the same dose of chloramphenicol, unequal concentrations in the blood plasma and cerebrospinal fluid may occur, especially at an early age. It is necessary to control the concentration of chloramphenicol in the child’s blood, since without this you may either not get a therapeutic effect or cause intoxication. The content of free (active) chloramphenicol in the blood plasma and cerebrospinal fluid after intravenous administration is usually lower than after oral administration.

Levomycetin is especially important in the treatment of meningitis caused by Haemophilus influenzae, meningococci and pneumococci, on which it has a bactericidal effect. To treat these meningitis, chloramphenicol is often combined with B-lactam antibiotics (especially ampicillin or amoxicillin). For meningitis caused by other pathogens, joint use chloramphenicol with penicillins is inappropriate, since in such cases they are antagonists. Levomycetin is successfully used in the treatment of typhoid fever, paratyphoid fever, dysentery, brucellosis, tularemia, whooping cough, eye infections (including trachoma), middle ear, skin and many other diseases.

Levomycetin is neutralized in the liver and excreted by the kidneys. In case of liver diseases, due to disruption of the normal biotransformation of chloramphenicol, intoxication with it may occur. In children in the first months of life, the neutralization of this antibiotic occurs slowly, and therefore there is a high risk of accumulation of free chloramphenicol in the body, which leads to a number of undesirable effects. Levomycetin, in addition, inhibits liver function and inhibits the biotransformation of theophylline, phenobarbital, diphenin, benzodiazepines and a number of other drugs, increasing their concentration in the blood plasma. The simultaneous administration of phenobarbital stimulates the neutralization of chloramphenicol in the liver and reduces its effectiveness.

Levomycetin is a toxic antibiotic. With an overdose of chloramphenicol in newborns, especially premature infants, and children in the first 2-3 months of life, “gray collapse” may occur: vomiting, diarrhea, respiratory failure, cyanosis, cardiovascular collapse, cardiac and respiratory arrest. Collapse is a consequence of impaired cardiac activity due to inhibition of oxidative phosphorylation in mitochondria. Without help, the mortality rate of newborns from “gray collapse” is very high (40% or more).

The most common complication when prescribing chloramphenicol is a disorder of hematopoiesis. May be dose dependent reversible disorders in the form of hypochromic anemia (due to impaired iron utilization and heme synthesis), thrombocytopenia and leukopenia. After discontinuation of chloramphenicol, the blood picture is restored, but slowly. Irreversible dose-independent changes in hematopoiesis in the form of aplastic anemia occur with a frequency of 1 in 20,000-1 in 40,000 people taking chloramphenicol, and usually develop 2-3 weeks (but can be 2-4 months) after using the antibiotic. They do not depend on the dose of the antibiotic and the duration of treatment, but are associated with the genetic characteristics of the biotransformation of chloramphenicol. In addition, chloramphenicol inhibits the function of the liver, adrenal cortex, pancreas, and can cause neuritis and malnutrition. Allergic reactions when using chloramphenicol are rare. Biological complications can manifest themselves in the form of superinfections caused by antibiotic-resistant microorganisms, dysbiocenosis, etc. For children under 3 years of age, chloramphenicol is prescribed only according to special indications and only in very severe cases.

Antibiotics are substances that inhibit the growth of living cells or lead to their death. May be of natural or semi-synthetic origin. Used to treat infectious diseases caused by the growth of bacteria and harmful microorganisms.

Universal

Broad-spectrum antibiotics - list:

1. Penicillins.
2. Tetracyclines.
3. Erythromycin.
4. Quinolones.
5. Metronidazole.
6. Vancomycin.
7. Imipenem.
8. Aminoglycoside.
9. Levomycetin (chloramphenicol).
10. Neomycin.
11. Monomycin.
12. Rifamcin.
13. Cephalosporins.
14. Kanamycin.
15. Streptomycin.
16. Ampicillin.
17. Azithromycin.

These drugs are used in cases where it is impossible to accurately determine the causative agent of the infection. Their advantage is a large list of microorganisms sensitive to active substance. But there is also a drawback: in addition to pathogenic bacteria, broad-spectrum antibiotics contribute to suppression of the immune system and disruption of normal intestinal microflora.

List of strong new generation antibiotics with a wide spectrum of action:

1. Cefaclor.
2. Cefamandole.
3. Unidox Solutab.
4. Cefuroxime.
5. Rulid.
6. Amoxiclav.
7. Cefroxitin.
8. Lincomycin.
9. Cefoperazone.
10. Ceftazidime.
11. Cefotaxime.
12. Latamoxef.
13. Cefixime.
14. Cefpodoxime.
15. Spiramycin.
16. Rovamycin.
17. Clarithromycin.
18. Roxithromycin.
19. Klacid.
20. Sumamed.
21. Fuzidin.
22. Avelox.
23. Moxifloxacin.
24. Ciprofloxacin.

Antibiotics of the new generation are notable for their deeper degree of purification of the active substance. Thanks to this, the drugs have much less toxicity compared to earlier analogues and cause less harm to the body as a whole.

Narrowly targeted Bronchitis

The list of antibiotics for cough and bronchitis usually does not differ from the list of broad-spectrum drugs. This is explained by the fact that the analysis of sputum takes about seven days, and until the causative agent of the infection is precisely identified, a product with the maximum number of bacteria sensitive to it is needed.

In addition, recent studies show that in many cases the use of antibiotics in the treatment of bronchitis is unjustified. The point is that the purpose similar drugs effective if the nature of the disease is bacterial. If the cause of bronchitis is a virus, antibiotics will not have any positive effect.

Commonly used antibiotic drugs for inflammatory processes in the bronchi:

1. Ampicillin.
2. Amoxicillin.
3. Azithromycin.
4. Cefuroxime.
5. Ceflocor.
6. Rovamycin.
7. Cefodox.
8. Lendatsin.
9. Ceftriaxone.
10. Macropen.

Angina

List of antibiotics for sore throat:

1. Penicillin.
2. Amoxicillin.
3. Amoxiclav.
4. Augmentin.
5. Ampiox.
6. Phenoxymethylpenicillin.
7. Oxacillin.
8. Cefradine.
9. Cephalexin.
10. Erythromycin.
11. Spiramycin.
12. Clarithromycin.
13. Azithromycin.
14. Roxithromycin.
15. Josamycin.
16. Tetracycline.
17. Doxycycline.
18. Lidaprim.
19. Biseptol.
20. Bioparox.
21. Inhalipt.
22. Grammidin.

The listed antibiotics are effective against sore throats caused by bacteria, most often bethemolytic streptococci. As for the disease caused by fungal microorganisms, the list is as follows:

1. Nystatin.
2. Levorin.
3. Ketoconazole.

Colds and flu (ARI, ARVI)

Antibiotics for the common cold are not included in the list of necessary medications, given the fairly high toxicity of antibiotics and possible side effects. Treatment with antiviral and anti-inflammatory drugs, as well as restoratives, is recommended. In any case, it is necessary to consult a therapist.

Sinusitis

List of antibiotics for sinusitis - in tablets and for injections:

1. Zitrolide.
2. Macropen.
3. Ampicillin.
4. Amoxicillin.
5. Flemoxin solutab.
6. Augmentin.
7. Hiconcil.
8. Amoxil.
9. Gramox.
10. Cephalexin.
11. Digital
12. Sporidex.
13. Rovamycin.
14. Ampiox.
15. Cefotaxime.
16. Vertsef.
17. Cefazolin.
18. Ceftriaxone.
19. Duracef.

The concept of infectious diseases refers to the body’s reaction to the presence of pathogenic microorganisms or their invasion of organs and tissues, manifested by an inflammatory response. For treatment, antimicrobial drugs are used that selectively act on these microbes in order to eradicate them.

Microorganisms leading to infectious and inflammatory diseases in the human body are divided into:

• bacteria (true bacteria, rickettsia and chlamydia, mycoplasma);
• mushrooms;
• viruses;
• protozoa.

Therefore, antimicrobial agents are divided into:

• antibacterial;
• antiviral;
• antifungal;
• antiprotozoal.

It is important to remember that one drug can have several types of activity.

For example, Nitroxoline ®, Rev. with a pronounced antibacterial and moderate antifungal effect - called an antibiotic. The difference between such a remedy and a “pure” antifungal is that Nitroxoline ® has limited activity against some species of Candida, but has a pronounced effect against bacteria, which antifungal agent won't work at all.

In the 50s of the twentieth century, Fleming, Chain and Florey received the Nobel Prize in Medicine and Physiology for the discovery of penicillin. This event became a real revolution in pharmacology, completely revolutionizing the basic approaches to the treatment of infections and significantly increasing the patient’s chances of a complete and rapid recovery.

With the advent antibacterial drugs, many diseases that caused epidemics that previously devastated entire countries (plague, typhoid, cholera) turned from a “death sentence” into a “disease that can be effectively treated” and are now practically non-existent.

Antibiotics are substances of biological or artificial origin that can selectively inhibit the vital activity of microorganisms.

That is, the distinctive feature of their action is that they only affect prokaryotic cell without damaging the cells of the body. This is due to the fact that there is no target receptor for their action in human tissues.

Antibacterial agents are prescribed for infectious and inflammatory diseases caused by the bacterial etiology of the pathogen or for severe viral infections, in order to suppress secondary flora.

When choosing adequate antimicrobial therapy, it is necessary to take into account not only the underlying disease and sensitivity of pathogenic microorganisms, but also the patient’s age, pregnancy, individual intolerance to the components of the drug, accompanying pathologies and taking drugs that are not combined with the recommended medication.

Also, it is important to remember that if there is no clinical effect from therapy within 72 hours, the drug is changed, taking into account possible cross-resistance.

For severe infections or for the purpose of empirical therapy with an unspecified pathogen, a combination is recommended different types antibiotics, taking into account their compatibility.

Based on their effect on pathogenic microorganisms, they are divided into:

• bacteriostatic - inhibiting the vital activity, growth and reproduction of bacteria;
• Bactericidal antibiotics are substances that completely destroy the pathogen due to irreversible binding to the cellular target.

However, such a division is quite arbitrary, since many antib. may manifest different activities, depending on the prescribed dosage and duration of use.

If the patient has recently used an antimicrobial agent, re-use should be avoided for at least six months to prevent the emergence of antibiotic-resistant flora.

How does drug resistance develop?

Most often, resistance is observed due to mutation of the microorganism, accompanied by a modification of the target inside the cells, which is affected by types of antibiotics.

The active substance of the prescribed solution penetrates the bacterial cell, but cannot contact the required target, since the “key-lock” binding principle is violated. Consequently, the mechanism for suppressing the activity or destroying the pathological agent is not activated.

Another effective method of protection against drugs is the synthesis by bacteria of enzymes that destroy the main structures of the antibacterial agent. This type of resistance most often occurs to beta-lactams, due to the production of beta-lactamases by the flora.

Much less common is an increase in resistance due to a decrease in the permeability of the cell membrane, that is, the drug penetrates inside in too small doses to provide a clinically significant effect.

To prevent the development of drug-resistant flora, it is also necessary to take into account the minimum concentration of suppression, which expresses a quantitative assessment of the degree and spectrum of action, as well as the dependence on time and concentration. in blood.

For dose-dependent drugs (aminoglycosides, metronidazole), the effectiveness of action depends on the concentration. in the blood and the focus of the infectious-inflammatory process.

Time dependent medications require repeated administrations during the day, to maintain an effective therapeutic concentration. in the body (all beta-lactams, macrolides).

Classification of antibiotics by mechanism of action

• drugs that inhibit the synthesis of bacterial cell walls (penicillin antibiotics, all generations of cephalosporins, Vancomycin ®);
• destroying the normal organization of the cell at the molecular level and interfering with the normal functioning of the tank membrane. cells (Polymyxin ®);
• agents that help suppress protein synthesis, inhibit the formation of nucleic acids and inhibit protein synthesis at the ribosomal level (Chloramphenicol preparations, a number of tetracyclines, macrolides, Lincomycin ®, aminoglycosides);
• inhibit. ribonucleic acids - polymerases, etc. (Rifampicin ®, quinols, nitroimidazoles);
• inhibitory processes of folate synthesis (sulfonamides, diaminopyrides).

Classification of antibiotics by chemical structure and origin

1. Natural - waste products of bacteria, fungi, actinomycetes:

• Gramicidins ® ;
• Polymyxins;
• Erythromycin ® ;
• Tetracycline ® ;
• Benzylpenicillins;
• Cephalosporins, etc.

2. Semi-synthetic - derivatives of natural antibacterials:

• Oxacillin ®;
• Ampicillin ® ;
• Gentamicin ® ;
• Rifampicin ®, etc.

3. Synthetic, that is, obtained as a result of chemical synthesis:

• Levomycetin ®;
• Amikacin ®, etc.

Classification of antibiotics by spectrum of action and purposes of use

Acting mainly on:		Antibacterial products with a wide spectrum of action:	Anti-tuberculosis agents
Gram+:	Gram-:
biosynthetic penicillins and 1st generation cephalosporins; macrolides; lincosamides; drugs Vancomycin ®, Lincomycin ® .	monobactams; cyclical polypeptides; 3rd generation cephalosporins.	aminoglycosides; chloramphenicol; tetracycline; semi-synthetic extended spectrum penicillins (Ampicillin ®); 2nd generation cephalosporins.	Streptomycin ® ; Rifampicin ® ; Florimycin ® .

Modern classification of antibiotics by groups: table

Main group	Subclasses
Beta-lactams
1. Penicillins	Natural; Antistaphylococcal; Antipseudomonas; With an extended spectrum of action; Inhibitor-protected; Combined.
2. Cephalosporins	4 generations; Anti-MRSA cephem.
3. Carbapenems	—
4. Monobactams	—
Aminoglycosides	Three generations.
Macrolides	Fourteen-membered; Fifteen-membered (azoles); Sixteen members.
Sulfonamides	Short acting; Medium duration of action; Long acting; Extra long lasting; Local.
Quinolones	Non-fluoridated (1st generation); Second; Respiratory (3rd); Fourth.
Antituberculosis	Main row; Reserve group.
Tetracyclines	Natural; Semi-synthetic.

Having no subclasses:

• Lincosamides (lincomycin ®, clindamycin ®);
• Nitrofurans;
• Hydroxyquinolines;
• Chloramphenicol (this group of antibiotics is represented by Levomycetin ®);
• Streptogramins;
• Rifamycins (Rimactan ®);
• Spectinomycin (Trobitsin ®);
• Nitroimidazoles;
• Antifolates;
• Cyclic peptides;
• Glycopeptides (vancomycin ® and teicoplanin ®);
• Ketolides;
• Dioxidine;
• Fosfomycin (Monural ®);
• Fusidane;
• Mupirocin (Bactoban ®);
• Oxazolidinones;
• Evernomycins;
• Glycylcyclines.

Groups of antibiotics and drugs in the table

Penicillins

Like all beta-lactam drugs, penicillins have a bactericidal effect. They influence the final stage of the synthesis of biopolymers that form the cell wall. As a result of blocking the synthesis of peptidoglycans, due to their effect on penicillin-binding enzymes, they cause the death of the pathological microbial cell.

The low level of toxicity to humans is due to the absence of target cells for antibacterial agents.

The mechanisms of bacterial resistance to these drugs have been overcome by the creation of protected agents enhanced with clavulanic acid, sulbactam, etc. These substances suppress the action of the tank. enzymes and protect the drug from destruction.

Natural BenzylpenicillinBenzylpenicillin Na and K salts.

Group	Based on the active substance, the drug is divided into:	Titles
Phenoxymethylpenicillin	Methylpenicillin ®
With prolonged action.
Benzylpenicillin procaine	Benzylpenicillin novocaine salt ®.
Benzylpenicillin/ Benzylpenicillin procaine/ Benzathine benzylpenicillin	Benzicillin-3 ® . Bicillin-3 ®
Benzylpenicillin Procaine/Benzathine benzylpenicillin	Benzicillin-5 ® . Bicillin-5 ®
Antistaphylococcal	Oxacillina ®	Oxacillin AKOS ® , sodium salt of Oxacillin ® .
Penicillinase-resistant	Cloxapcillin ®, Alucloxacillin ®.
Extended spectrum	Ampicillin ®	Ampicillin ®
	Amoxicillin ®	Flemoxin solutab ® , Ospamox ® , Amoxicillin ® .
With antipseudomonas activity	Carbenicillin ®	Carbenicillin ® disodium salt, Carfecillin ®, Carindacillin ®.
	Uriedopenicillins
	Piperacillin ®	Picillin ®, Pipracil ®
	Azlocillina ®	Azlocillin ® sodium salt, Securopen ®, Mezlocillin ®.
Inhibitor-protected	Amoxicillin/clavulanate ®	Co-amoxiclav ®, Augmentin ®, Amoxiclav ®, Ranklav ®, Enhancin ®, Panclave ®.
	Amoxicillin sulbactam ®	Trifamox IBL ® .
	Amlicillin/sulbactam ®	Sulacillin ® , Unazin ® , Ampisid ® .
	Piperacillin/tazobactam ®	Tazocin ®
	Ticarcillin/clavulanate ®	Timentin ®
Penicillin combination	Ampicillin/oxacillin ®	Ampioks ®.

Cephalosporins

Due to low toxicity, good tolerability, the ability to be used by pregnant women, as well as a wide spectrum of action, cephalosporins are the most commonly used antibacterial agents in therapeutic practice.

The mechanism of action on the microbial cell is similar to penicillins, but is more resistant to the effects of the drug. enzymes.

Rev. cephalosporins have high bioavailability and good absorption by any route of administration (parenteral, oral). Well distributed in internal organs(with the exception of the prostate gland), blood and tissues.

Only Ceftriaxone ® and Cefoperazone ® are capable of creating clinically effective concentrations in bile.

High level of patency through the blood-brain barrier and effectiveness against inflammation meninges, noted in the third generation.

The only cephalosporin protected by sulbactam is Cefoperazone/sulbactam ® . It has an expanded spectrum of effects on flora, due to its high resistance to the influence of beta-lactamases.

The table shows groups of antibiotics and the names of the main drugs.

Generations	Preparation:	Name
1st	Cefazolinam	Kefzol ® .
	Cephalexin ® *	Cephalexin-AKOS ®.
	Cefadroxil ® *	Durocef ®.
2nd	Cefuroxime ®	Zinacef ® , Cephurus ® .
	Cefoxitin ®	Mefoxin ® .
	Cefotetan ®	Cefotetan ® .
	Cefaclor ® *	Ceclor ® , Vercef ® .
	Cefuroxime-axetil ® *	Zinnat ®.
3rd	Cefotaxime ®	Cefotaxime ® .
	Ceftriaxone ®	Rofecin ® .
	Cefoperazone ®	Medocef ® .
	Ceftazidime ®	Fortum ® , Ceftazidime ® .
	Cefoperazone/sulbactam ®	Sulperazon ® , Sulzoncef ® , Bakperazon ® .
	Cefditoren ® *	Spectracef ® .
	Cefixime ® *	Suprax ®, Sorceph ®.
	Cefpodoxime ® *	Proxetil ® .
	Ceftibuten ® *	Tsedex ®.
4th	Cefepime ®	Maximim ®.
	Cefpiroma ®	Katen ® .
5th	Ceftobiprole ®	Zeftera ® .
	Ceftaroline ®	Zinforo ®.

* They have an oral release form.

Carbapenems

They are reserve drugs and are used to treat severe nosocomial infections.

Highly resistant to beta-lactamases, effective for the treatment of drug-resistant flora. In case of life-threatening infectious processes, they are the first-priority means for an empirical regimen.

The teachers are distinguished:

• Doripenema ® (Doriprex ®);
• Imipenema ® (Tienam ®);
• Meropenem ® (Meronem ®);
• Ertapenem ® (Invanz ®).

Monobactams

• Aztreonam ® .

Rev. has a limited range of applications and is prescribed to eliminate inflammatory and infectious processes associated with Grambacteria. Effective in treating infections. processes of the urinary tract, inflammatory diseases of the pelvic organs, skin, septic conditions.

Aminoglycosides

The bactericidal effect on microbes depends on the concentration level of the agent in biological fluids and is due to the fact that aminoglycosides disrupt the processes of protein synthesis on bacterial ribosomes. They have a fairly high level of toxicity and many side effects, however, they rarely cause allergic reactions. Practically ineffective when taken orally due to poor absorption in the gastrointestinal tract.

Compared to beta-lactams, the rate of penetration through tissue barriers is much poorer. They do not have therapeutically significant concentrations in bones, cerebrospinal fluid and bronchial secretions.

Generations	Preparation:	Bargain. Name
1st	Kanamycin ®	Kanamycin-AKOS ® . Kanamycin monosulfate ® . Kanamycin sulfate ®
	Neomycin ®	Neomycin sulfate ®
	Streptomycin ®	Streptomycin sulfate ® . Streptomycin-calcium chloride complex ®
2nd	Gentamicin ®	Gentamicin®. Gentamicin-AKOS ® . Gentamicin-K ®
	Netilmicin ®	Netromycin ®
	Tobramycin ®	Tobrex ® . Brulamycin ® . Nebtsin ® . Tobramycin ®
3rd	Amikacin ®	Amikacin ® . Amikin ® . Selemicin ® . Hemacin ®

Macrolides

Provide inhibition of the process of growth and reproduction pathogenic flora, caused by the suppression of protein synthesis on cell ribosomes. bacterial walls. With increasing dosage, they can have a bactericidal effect.

Also, there are combined teachers:

1. Pilobact ® is a complex solution for the treatment of Helicobacter pylori. Contains clarithromycin ® , omeprazole ® and tinidazole ® .
2. Zinerit ® is a product for external use to treat acne. The active ingredients are erythromycin and zinc acetate.

Sulfonamides

They inhibit the growth and reproduction of pathogenic microorganisms due to their structural similarity to para-aminobenzoic acid, which is involved in the life of bacteria.

Have high rate resistance to its action in many representatives of Gram-, Gram+. Used in the composition complex therapy rheumatoid arthritis, retain good antimalarial activity, and are effective against toxoplasma.

Classification:

For local use Silver sulfathiazole (Dermazin ®) is used.

Quinolones

Due to the inhibition of DNA hydrases they have a bactericidal effect and are concentration-dependent agents.

• The first generation includes non-fluorinated quinolones (nalidixic, oxolinic and pipemidic acids);
• Second pok. represented by Gram-drugs (Ciprofloxacin ®, Levofloxacin ®, etc.);
• The third is the so-called respiratory means. (Levo- and Sparfloxacin ®);
  Fourth - Rev. with antianaerobic activity (Moxifloxacin ®).

Tetracyclines

Tetracycline ® whose name was given separate group antib., first obtained chemically in 1952.

Active ingredients of the group: metacycline ®, minocycline ®, tetracycline ®, doxycycline ®, oxytetracycline ®.

On our website you can get acquainted with most groups of antibiotics, full lists drugs included in them, classifications, history, etc. important information. For this purpose, a section “” has been created in the top menu of the site.