Hemomycin, 1 piece, 11.43 g (20 ml), 100 mg/5 ml, powder for oral suspension

Chemomycin 500 mg (tablets)

Antacids

Antacids do not affect the bioavailability of azithromycin, but reduce the maximum blood concentration by 30%, so the drug should be taken at least one hour before or two hours after taking these drugs and eating.

Cetirizine

Concomitant use of azithromycin with cetirizine (20 mg) for 5 days in healthy volunteers did not lead to pharmacokinetic interaction or a significant change in the QT interval.

Didanosine (dideoxyinosine)

The simultaneous use of azithromycin (1200 mg/day) and didanosine (400 mg/day) in 6 HIV-infected patients did not reveal changes in the pharmacokinetic parameters of didanosine compared to the placebo group.

Digoxin (P-glycoprotein substrates)

Concomitant use of macrolide antibiotics, including azithromycin, with P-glycoprotein substrates, such as digoxin, leads to increased concentrations of P-glycoprotein substrate in the blood serum. Thus, with the simultaneous use of azithromycin and digoxin, it is necessary to take into account the possibility of increasing the concentration of digoxin in the blood serum.

Zidovudine

Concomitant use of azithromycin (single dose of 1000 mg and multiple doses of 1200 mg or 600 mg) has little effect on the pharmacokinetics, including renal excretion, of zidovudine or its glucuronide metabolite. However, the use of azithromycin caused an increase in the concentration of phosphorylated zidovudine, a clinically active metabolite in peripheral blood mononuclear cells. The clinical significance of this fact is unclear.

Azithromycin interacts weakly with isoenzymes of the cytochrome P450 system. Azithromycin has not been shown to participate in pharmacokinetic interactions similar to erythromycin and other macrolides. Azithromycin is not an inhibitor or inducer of cytochrome P450 isoenzymes.

Ergot alkaloids

Given the theoretical possibility of ergotism, the simultaneous use of azithromycin with ergot alkaloid derivatives is not recommended. Pharmacokinetic studies were conducted on the simultaneous use of azithromycin and drugs whose metabolism occurs with the participation of isoenzymes of the cytochrome P450 system.

Atorvastatin

Concomitant use of atorvastatin (10 mg daily) and azithromycin (500 mg daily) did not cause changes in atorvastatin plasma concentrations (based on an HMC-CoA reductase inhibition assay). However, in the post-marketing period, isolated case reports of rhabdomyolysis have been received in patients receiving concomitant azithromycin and statins.

Carbamazepine

Pharmacokinetic studies involving healthy volunteers did not reveal a significant effect on the plasma concentrations of carbamazepine and its active metabolite in patients receiving concomitant azithromycin.

Cimetidine

In pharmacokinetic studies of the effect of a single dose of cimetidine on the pharmacokinetics of azithromycin, no changes in the pharmacokinetics of azithromycin were detected when cimetidine was used 2 hours before azithromycin.

Indirect anticoagulants (coumarin derivatives)

In pharmacokinetic studies, azithromycin did not affect the anticoagulant effect of a single 15 mg dose of warfarin administered to healthy volunteers. Potentiation of the anticoagulant effect has been reported after simultaneous use of azithromycin and indirect anticoagulants (coumarin derivatives). Although a causal relationship has not been established, the need for frequent monitoring of prothrombin time should be considered when using azithromycin in patients receiving indirect oral anticoagulants (coumarin derivatives).

Cyclosporine

In a pharmacokinetic study involving healthy volunteers who took azithromycin (500 mg/day once) orally for 3 days, followed by cyclosporine (10 mg/kg/day once), a significant increase in maximum plasma concentration (Cmax) and area under the concentration-time curve (AUC0-5) of cyclosporine. Caution is advised when using these drugs together. If simultaneous use of these drugs is necessary, it is necessary to monitor the concentration of cyclosporine in the blood plasma and adjust the dose accordingly.

Efavirenz

Concomitant use of azithromycin (600 mg/day once) and efavirenz (400 mg/day) daily for 7 days did not cause any clinically significant pharmacokinetic interaction.

Fluconazole

Concomitant use of azithromycin (1200 mg once) did not change the pharmacokinetics of fluconazole (800 mg once). The total exposure and half-life of azithromycin did not change with simultaneous use of fluconazole, however, a decrease in Cmax of azithromycin was observed (by 18%), which had no clinical significance.

Indinavir

Concomitant use of azithromycin (1200 mg once) did not cause a statistically significant effect on the pharmacokinetics of indinavir (800 mg three times a day for 5 days).

Methylprednisolone

Azithromycin does not have a significant effect on the pharmacokinetics of methylprednisolone.

Nelfinavir

The simultaneous use of azithromycin (1200 mg) and nelfinavir (750 mg 3 times a day) causes an increase in the equilibrium concentrations of azithromycin in the blood serum. No clinically significant side effects were observed and no dose adjustment of azithromycin was required when used concomitantly with nelfinavir.

Rifabutin

The simultaneous use of azithromycin and rifabutin does not affect the concentration of each drug in the blood serum. Neutropenia has sometimes been observed with simultaneous use of azithromycin and rifabutin. Although neutropenia has been associated with the use of rifabutin, a causal relationship between the use of the combination of azithromycin and rifabutin and neutropenia has not been established.

Sildenafil

When used in healthy volunteers, there was no evidence of the effect of azithromycin (500 mg/day daily for 3 days) on the AUC and Cmax of sildenafil or its main circulating metabolite.

Terfenadine

In pharmacokinetic studies, there was no evidence of interaction between azithromycin and terfenadine. There have been isolated cases reported where the possibility of such an interaction could not be completely excluded, but there was no concrete evidence that such an interaction occurred.

It has been found that the simultaneous use of terfenadine and macrolides can cause arrhythmia and prolongation of the QT interval.

Theophylline

No interaction has been detected between azithromycin and theophylline.

Triazolam/midazolam

No significant changes in pharmacokinetic parameters were detected with simultaneous use of azithromycin with triazolam or midazolam in therapeutic doses.

Trimethoprim/sulfamethoxazole

Concomitant use of trimethoprim/sulfamethoxazole with azithromycin did not show a significant effect on Cmax, total exposure or renal excretion of trimethoprim or sulfamethoxazole. Azithromycin serum concentrations were consistent with those found in other studies.

1st day

Hemomycin powder for the preparation of suspension for oral administration 100 mg/5 ml bottle 1 pc. in Moscow

The drug is taken orally

1 time/day 1 hour before meals or 2 hours after meals.

Water (distilled or boiled and cooled) is gradually added to the bottle to the mark.

The contents of the bottle are thoroughly shaken until a homogeneous suspension is obtained.

If the level of the prepared suspension is below the mark on the bottle label, add water again to the mark and shake.

The prepared suspension is stable at room temperature for 5 days.

For infections of the upper and lower respiratory tract, skin and soft tissues (except for chronic migratory erythema)

For children:

at the rate of 10 mg/kg body weight 1 time per day for 3 days (course dose 30 mg/kg).

Depending on the child’s body weight, the following dosage regimen is recommended:

For acne vulgaris of moderate severity (adults):

Adults: 500 mg (25 ml of 100 mg/5 ml suspension) 1 time per day for 3 days (course dose 1.5 g).

On days 1, 2 and 3 of treatment, take 500 mg (25 ml of a 100 mg/5 ml suspension) once a day, then take a break from the fourth to seventh days of treatment, from the eighth day of treatment take 500 mg (25 ml) 1 once a week (with an interval of 7 days) for 9 weeks. Course dose: 6 g.

For uncomplicated urethritis and/or cervicitis

cervicitis caused by
Chlamydia trachomatis
- the drug is prescribed to adults: 1 g (50 ml) once.

For Lyme disease (borreliosis)

for the treatment of the initial stage
( erythema migrans )
- 1 time per day for 5 days: on the 1st day at a dose of 20 mg/kg body weight, and then from the 2nd to the 5th day - 10 mg/kg body weight bodies.

The following dosage regimen for the drug suspension is recommended in children with e rythema migrans:

1st day

Immediately after taking the suspension, the child should be given a few sips of liquid (water, tea) to wash off and swallow the suspension remaining in the mouth.

From 2nd to 5th day:

If a dose of the drug is missed, it should be taken immediately, if possible, and then subsequent doses should be taken at intervals of 24 hours. The suspension should be shaken before use.

Patients with impaired renal function

When used in patients with mild to moderate renal impairment (creatinine clearance > 40 ml/min), no dose adjustment is required.

Patients with liver dysfunction

When used in patients with mild to moderate liver dysfunction, no dose adjustment is required.

Elderly patients

In elderly patients, no dose adjustment is required.

The value of azithromycin (Hemomycin) in the treatment of patients with respiratory tract infections

The new macrolides that have appeared in the last 10 years - roxithromycin, clarithromycin and azithromycin do not have significant advantages in the spectrum of action over the first macrolide - erythromycin, but differ from it in pharmacokinetic and pharmacodynamic characteristics, a high safety profile, the ability to reduce the frequency of administration and, in some cases, minimize the duration of treatment, which increases compliance with therapy. Azithromycin has been used for a long time, but does not lose its leading position in terms of frequency of use. A prize from the American Chemical Society was awarded for the creation of the azithromycin molecule. “New” macrolides have taken a strong place in the treatment algorithms for infectious diseases, based on the principles of evidence-based medicine. Exceptional pharmacokinetic properties ensuring good penetration into organs and tissues: creation of high concentrations in cells, which is of fundamental importance for the impact on intracellular infectious agents (chlamydia, mycoplasma, legionella, camilobacter); activity against gram-positive cocci resistant to penicillins distinguishes macrolides from other antibacterial drugs [5,12]. The most popular representative of the “new” macrolides of the azalide group is azithromycin, whose activity against bacteria is associated with its unique 15-membered chemical structure. Consumption of azithromycin is constantly increasing - in 1999, azithromycin was the most prescribed macrolide in the world. Unfortunately, a large-scale pharmacoeconomic analysis has not been carried out in our country, however, domestic data regarding the price/quality ratio reliably indicate that azithromycin occupies a leading position in this criterion. Of the macrolides presented on the domestic market, azithromycin has the most favorable relationship between the cost of treatment and its effectiveness. Therapy with oral azithromycin is somewhat more expensive than some other antibiotics (for example, b-lactams), however, due to the high effectiveness of this macrolide, a significant reduction in the incidence of complications of infectious diseases with its use and a small number of side effects of the drug itself, its use seems preferable and advisable. Treatment of infectious processes in children and the elderly causes fair concern and caution. For them, treatment in an outpatient setting may not always be acceptable not only for medical but also for social factors - more careful medical supervision, monitoring of the implementation of recommendations, and the help of relatives are required. However, when elderly patients are in a hospital, not only the risk of developing nosocamial infections increases, but also the costs associated with prolongation of hospitalization due to a protracted course, complications, decompensation of concomitant pathology, as well as additional examinations and the need for intensive care increase. Another age category - young patients - require not only effective, but also more gentle, safe and “tasty” antibiotics, moreover, outpatient treatment is more preferable from a psycho-emotional point of view (both for children and their parents). Pharmacokinetics/pharmacodynamics of azithromycin Azithromycin is rapidly absorbed from the gastrointestinal tract due to its stability in an acidic environment. After oral administration of azithromycin (Hemomycin) at a dose of 500 mg, Cmax in blood plasma is reached after 2.5–2.96 hours and is 0.4 mg/l. The main sites for creating high and stable concentrations of azithromycin are lung tissue, bronchial secretions, sinuses, tonsils, middle ear, prostate, kidneys and urine. Antibacterial activity is associated with blockade of protein synthesis by the bacterial cell. Thus, it was shown that after taking 500 mg after 12 hours, the concentration of the drug in the tonsils was 3.6 ± 0.5 μg/ml, which was 14 times higher than the concentration of azithromycin in the blood serum, and the concentration of the drug in the tonsils was 30 times higher exceeded the MIC for S. pyogenes, the main causative agent of tonsillopharyngitis. When taking the same dose, the concentration of azithromycin in the bronchial mucosa is 200 times higher than the serum concentration in the bronchoalveolar secretion. In the prostate gland, even 3 weeks after taking 1 g of azithromycin, a concentration above the MIC for C. trachomatis, the most common causative agent of prostatitis, is observed. In the cervical canal, when using a similar dose, an increased content of the antibiotic was also detected. Thus, azithromycin compares favorably with other macrolides in creating high concentrations in the foci of infections - 30–50, and according to some data, 100 times more than in serum. The creation of high concentrations in tissues and long T1/2 are due to the low binding of azithromycin to blood plasma proteins (from 37 to 50%), as well as its ability to penetrate cells and concentrate in an environment with a low pH, characteristic of an inflammatory focus of infection. Excretion of azithromycin occurs through the liver, where its concentration is 20 times higher than in plasma, but even higher concentrations are found in bile - up to 100 times higher than serum values. In patients with renal and hepatic insufficiency and in the elderly, the pharmacokinetics do not change significantly, which makes it possible to use it without apparent concern. In its ability to penetrate histohematic barriers (except the blood-brain barrier), azithromycin is superior to b-lactams and aminoglycosides. Interactions The combination of macrolides with other antibiotics may provide synergistic or additive effects. The combination of macrolides with b-lactams and rifampicin is used in the treatment of severe community-acquired pneumonia. A combination with fluoroquinolones and aminoglycosides is acceptable. Compared to other macrolides, azithromycin does not have an inhibitory effect on the cytochrome P450 3A4 isoenzyme, which makes it possible to use it with drugs metabolized in the same way (theophylline, warfarin, carbamazepine, cyclosporine, ergotomine, methylprednisolone). At the same time, there is evidence of the interaction of azithromycin with digitoxin, the concentration of which may increase and create a threat of glycoside intoxication. There is no convincing evidence in the literature of changes in the prothrombin index when warfarin and azithromycin are co-administered (in usual doses), but for the group of macrolides in combination with warfarin, an increase in anticoagulation is indicated, so patients need more careful monitoring of prothrombin time. Combination with terfenadine, astemizole and cisapride is not recommended due to the risk of developing severe cardiac arrhythmias caused by prolongation of the QT interval, but there is also no reliable evidence on this matter. Azithromycin does not interact with rifabutin, so it can be used to prevent and treat M. avium infections in patients with AIDS. Lincosamines weaken the effectiveness of azithromycin, while tetracycline and chloramphenicol enhance them. Non-antibacterial effects of azithromycin In addition to antibacterial properties, macrolides have also been shown to have anti-inflammatory effects associated with antioxidant activity. Although azithromycin has these properties less pronounced than other macrolides, azithromycin has no equal in terms of the degree of influence on phagocytosis and killing of neutrophils against chlamydia. It should be noted the suppressive effect on the production of toxins by bacterial agents, which sharply reduces the level of damage, as well as the reduction in the formation of biofilm, which is an interacting complex of microorganisms that have a protective matrix, which provides them with increased resistance to antibiotics. In addition, azithromycin inhibits the secretion of inflammatory cytokines - IL 3.5, 8, TNF-a by T lymphocytes and monocytes, which helps to increase the level of anti-inflammatory cytokines IL 10. Noteworthy are reports of a decrease in the severity of bronchial obstruction, a decrease in mucus secretion by goblet cells and enhancing mucociliary clearance when using macrolides, which may play an additional, in addition to antibacterial, role in patients with nonspecific lung diseases. Efficacy and safety The most commonly reported side effect of macrolides, gastrointestinal complaints, is due in part to stimulation of motilin receptors. Unlike other macrolides, azithromycin (Hemomycin) has virtually no effect on these receptors. Azithromycin is an alternative for allergies to penicillins and cephalosporins. Of all antibacterial drugs, macrolides, including azithromycin, have the safest profile, which makes their use possible in pregnant women, nursing mothers and children. An indicator of clinical effectiveness and eradication for bacterial infection is the ratio of the concentration in tissues to the MIC of a given antibiotic for the causative agent of infection. The higher the value of this ratio, the faster the clinical and bacteriological recovery occurs. The non-ionized structure of macrolides ensures their high accumulation in cells, especially azithromycin, so its use in the treatment of bacteremia is ineffective. Macrophages containing azithromycin transport it to the site of infectious inflammation, creating a concentration in it higher than in healthy tissues. The process of diffusion of roxithromycin and clarithromycin into macrophages takes 15–20 minutes. in contrast to azithromycin - up to 24 hours, but its maximum concentration in cells remains much longer - about 48 hours. Thus, azithromycin is selectively distributed in the foci of infection and correlates with the degree of neutrophilic inflammation. Moreover, azithromycin is characterized by a pronounced post-antibiotic effect - persistent inhibition of microorganisms - after one gram of azithromycin its anti-infective effect manifests itself for up to 7 days. Already in therapeutic concentrations, azithromycin has not a bacteriostatic (like all macrolides), but a bactericidal effect on S. pyogenes, H. influenzae, M. cattharalis, b-hemolytic streptococcus, pneumococcus, including its erythromycin-resistant strains. Macrolides differ from tetracyclines and fluoroquinolones in their low toxicity, therefore, for infections caused by intracellular pathogens, macrolides are certainly first-line drugs (evidence level A). The main indications for the use of azithromycin are presented in Table 1. Treatment of nonspecific community-acquired upper respiratory tract infections There is no need to dwell on the fact that ENT diseases and upper respiratory tract infections are the most common in the world. In this case, the main bacterial pathogens are: pneumococcus (S. pneumoniae), Haemophilus influenzae (H. influenzae), Moraxella (M. catarrhalis), b-hemolytic streptococcus group A (S. pyogenes). S. aureus is not often detected. In any age category, the leading etiological bacterial agent in the development of tonsillopharyngitis is S. pyogenes (GABHS) - from 40 to 60% of cases of tonsillitis and 5-20% of cases of pharyngitis. Less commonly, tonsillopharyngitis is caused by streptococci, A. haemolyticum, M. pneumoniae, C. pneumoniae, anaerobes and some other microorganisms. Recently, reports have emerged that Mucoplasma pneumoniae accounts for 7.6–12% of cases of upper respiratory tract disease, and Moraxella catarralis causes 15–20% of cases of ENT diseases. Tonsillopharyngitis of any etiology has a chance to lead to complications, mainly of nearby organs - sinusitis, bronchitis, otitis media. However, the most serious complications are caused by GABHS infection - from early purulent ones, occurring on days 4-6 (sinusitis, otitis, peritonsillar abscess, lymphadenitis), to potentially dangerous non-purulent ones, appearing on days 8-10 of the disease - post-streptococcal glomerulonephritis, toxic shock , rheumatic fever (2–3 weeks after treatment of tonsillopharyngitis). Despite the fact that b-lactams have not lost their relevance, azithromycin is also successfully used, which becomes of paramount importance in case of intolerance to b-lactam antibiotics. The main disadvantage of using b-lactam antibiotics is the long course of use (7–10 days) and frequent frequency of use (up to 3 times), which clearly reduces patient adherence to the prescribed treatment regimen and, as a consequence, leads to chronicity of the process and the development of complications. Acute bronchitis (tracheobronchitis) is characterized by an acute onset and a productive cough. The most common causative agents of acute bronchitis are viruses. In most cases, the use of antibiotics is not required, but if the cough persists for a long time and is accompanied by purulent sputum, the use of antibiotics is necessary. In such cases, preference is given to macrolides (in particular, azithromycin). Azithromycin is most often used in the treatment of community-acquired pneumonia. The clinical and bacteriological effectiveness of azithromycin, prescribed primarily for 3 (less often within 5) days for exacerbations of chronic bronchitis and community-acquired pneumonia, is 82–98% and 52–100%, respectively, not inferior to a longer course of amoxicillin/clavulanate and cefaclor. Numerous clinical studies have not revealed differences in the effectiveness of aminopenicillins, as well as certain representatives of macrolides (azithromycin, clarithromycin) or respiratory fluoroquinolones in the treatment of community-acquired pneumonia (evidence category A). The high activity of azithromycin against atypical pathogens of respiratory tract infections makes it indispensable in the treatment of community-acquired pneumonia caused by intracellular pathogens - Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophilla. It is impossible not to take into account that their detection technique is complex and expensive, and therefore is little used in routine clinical practice. Is it always necessary to prescribe antibiotics when treating exacerbations of chronic bronchitis and COPD? Exacerbation of chronic bronchitis is provoked not only by bacterial agents, but also by viruses, air pollutants, and tobacco smoke. The use of antibiotics during exacerbation of chronic bronchitis is justified only if at least 2 of the 3 classic criteria for exacerbation are present - increased shortness of breath, increased volume of sputum and its purulent component. However, there is some dissonance between the clinical and bacteriological picture. If the onset of clinical remission can be assessed (decrease in shortness of breath and amount of sputum, disappearance of its purulence), then bacteriological recovery is difficult to assess. The fact is that not all patients with exacerbation of chronic bronchitis have bacterial agents in their sputum - in 50% of cases; very often (90% of cases) an exacerbation resolves on its own, and in 25% of patients with chronic bronchitis, bacterial agents in the respiratory tract mucosa were isolated in a state of remission. The only criterion confirming the eradication effect of antibiotics is the duration of remission. It has been shown that azithromycin is 8 or more times more active against H. Inflienzae and M. cattharalis, Campilobabacter, enterobacteria, compared to other macrolides. Although azithromycin has been shown to be effective in the treatment of mild exacerbations of COPD (level A evidence), there are reports that macrolides are inferior to fluoroquinolones. Thus, it was shown that with the use of moxifloxacin, the clinical effectiveness of treating exacerbations of bronchitis was comparable to treatment with macrolides (96.6% and 93.5%, respectively). When assessed after 6 months of use of moxifloxacin, re-exacerbation occurred 4 times less often than with treatment with macrolides. However, the high cost of “respiratory” fluoroquinolones limits their widespread use and is not rational for mild infections. Despite the comparable activity of azithromycin with oral penicillins and cephalosporins, macrolides are inferior to b-lactams and fluoroquinolones in their effect on H. influenzae, but are not inferior in their effect on M. cataralis. The important role of these infectious agents in the exacerbation of chronic bronchitis (30–60% of all cases) should be emphasized [14]. An important guideline when choosing an antibiotic is the severity of bronchial obstruction, which is largely associated with the nature of microbial colonization. Thus, with FEV1>50%, the most common cause of exacerbation is H. influenzae, M. catarrhalis and S. pneumoniae with possible resistance to b-lactams. When FEV1<50%, gram-negative flora (Klebsiella pneumoniae, etc.) joins the above microorganisms, and therefore macrolides are not effective in these patients. Azithromycin Resistance Macrolide resistance varies worldwide depending on clinical use, bacterial species, source of strains, and other factors. Resistance to antibacterial therapy may result from the use of an ineffective antibiotic, the use of inadequate doses, the cessation of effective antibacterial therapy, the continuation of previous therapy in case of superinfection, or irrational combinations. Of course, the widespread use of macrolides has inevitably led to increased resistance, especially among S. pneumoniae and S. pyogenes strains. Resistance to macrolides is associated with three mechanisms: modification of the target of their action (production of erythromycin resistance of methylase), active removal of the drug from the microbial cell and modification of the target cell (ribosomal subunit 50 S). A specific genotype of the stability of pneumococcus, characteristic of a particular region - MET (low stability) or ERM (high level of stability), which is also important. It should not be forgotten that the prolonged persistence of azithromycin in the body in low concentrations, which are not able to suppress the growth of microorganisms, can cause mutations that also contribute to the development of resistance. Popular study by Protek (2002) showed that the prevalence of erythromycin -resisted pneumococcus to erythromycin was 31.5%, and macrolides in different countries ranged from 12 to 36.6% (Great Britain and Spain), and sometimes up to 58 , 1% (France). Also, an almost three -fold increase in the resistance of pneumococcus in the UK was shown for two years - from 1996 to 1998. (from 4.6 to 15%, respectively). Big Prospective study in 1998-1999. and 2000–2001 The resistance of pneumococci in bronchia -league infections of hospitalized patients in Moscow hospitals showed 12.1 and 8.4%resistance to erythromycin, 14.3 and 7.9%to azithromycin. Resistant strains are more often detected with COPD. In general, the level of resistance in Russia to macrolides is low. Despite the increase in the resistance of pneumococcus to macrolides, the clinical significance remains little -studied and, apparently, does not yet have fundamental importance for Russia. The emergence of “new” macrolides, such as azithromycin, largely solved the problem of resistance - strains of gram -positive cocci, which are resistant to the “old” representative of macrolides - erythromycin, most often do not have resistance to “new” generation preparations (azithromycin and clarithromycin). Despite reports of the existence of cross -stability of pneumococcus to penicillins and macrolides, clinical inefficiency is rare. Intracellular pathogens of infections - M. pneumoniae, C. pneumoniae, L. pneumophila - are highly sensitive to macrolides. The development of resistance to them has not yet been described. Today, the market has a large number of azithromycin geners. Firstly, this is due to the widespread use of immaturent infections of the respiratory tract, and secondly, they are the most popular means of empirical therapy. Therefore, the question always arises which of the geners of azithromycin should be preferred. A comparative study was conducted, which set the task of evaluating the clinical and economic efficiency of azithromycin 5 companies in adult patients with a mild pneumatic pneumonia [I. Smolenov, Krasilnikova A.V., 2003], the highest clinical efficiency was registered in groups of patients who received chemomycin and Sumamed (80%). The smallest direct medical costs were registered when using chemomycin compared to the azithromycin of other pharmaceutical companies. The smallest total costs were characteristic of drugs that demonstrated the highest clinical efficiency - chemomycin and Sumamed. However, in order to clarify the above results, a large sample of patients is needed. The conclusion thus, the characteristic of azithromycin is excellent pharmacokinetic and pharmacodynamic qualities that provide their maximum concentration in the foci of infections; low toxicity; the presence of non -antibacterial anti -inflammatory effects; The possibility of one -time administration and a short course of treatment, which increases their compensation, as well as moderate cost and good clinical effect, make their use justified in the therapy of mild respiratory tract infections in patients of different age categories, including young children. The increasing role of intracellular infectious agents in the development of pneumonia makes macrolides (azithromycin) with the drug of choice.

References 1. Arkhipov V.V., Tsoi A.N., Chuchalin A.G. Diagnosis and treatment of pneumonia from the standpoint of medical evidence. Consilium medicum", 2002; vol. 4, no. 12, pp. 620–645. 2. Arkhipov V.V. Antibacterial therapy of lower respiratory tract infections from the perspective of evidence-based medicine. "Atmosphere", 2003; No. 1(8), pp. 40–43. 3. Budanov S.V. Azithromycin (sumamed) main properties and features of use in the treatment of community-acquired pneumonia. Antibiotics and chemotherapy, 2000; N10, pp. 28–37. 4. Budanov S.V. Azithromycin (Sumamed) main properties and features of use in the treatment of community-acquired pneumonia. Antibiotics and chemotherapy. 2000; No. 10, pp. 28–37. 5. Dvoretsky L.I. Azithromycin in the treatment of lower respiratory tract infections. Positions retained RMJ, 2004; Vol. 12, No. 2, pp. 83–87. 6. Karpov O.I. Compliance with Antibiotic Therapy for Respiratory Tract Infections 1999; No. 8, pp. 37–45. 7. Kukes V.G. Metabolism of drugs. Clinical and pharmacological aspects Moscow: Reafarm. 2004. 8. Lukyanov S.V. Macrolides in the treatment of community-acquired respiratory tract infections Consilium Medicum Pulmonology, 2005; 07, No. 1, pp. 12–17 9. Mechanisms of inflammation of the bronchi and lungs and anti-inflammatory therapy. Ed. Fedoseeva G.B. St. Petersburg: Normed-izdat. 1998. 10. Sinopalnikov A.I. New horizons for the use of macrolides for respiratory tract infections. Russian medical news. 2004; No. 2, volume 9, pp. 16–22 11. Smolenov I.V., Krasilnikova A.V. Pharmacoeconomic aspects of the use of azithromycin from various manufacturers for community-acquired pneumonia in adults Farmateka, 2003; No. 13 pp. 78–87.. 12. Smolenov I.V., Krasilnikova A.V. Pharmacoeconomic aspects of the use of azithromycin from various manufacturers for community-acquired pneumonia in adults Farmateka, 2003; No. 13, pp. 78–87. 13. Strachunsky L.S., Kozlov S.N. Macrolides in modern clinical practice. Smolensk: Rusich, 1998. 14. Strachunsky L.S., Belousov Yu.B. Kozlov S.N. Antibacterial therapy. Practical guide. Moscow 2000, pp. 42–47. 15. Rational antimicrobial pharmacotherapy. Guide for practicing physicians. Ed. Yakovleva V.P., Yakovleva S.V. Moscow: Litera. 2003. 16. Rational pharmacotherapy of respiratory diseases. Ed. Chuchalina A.G. Moscow: Litera, 2004. 17. Chuchalin A.G. Current issues in pulmonology. RMJ, 2000; Vol. 8 No. 17, pp. 727–730. 18. Shmelev E.I., Kunitsina Yu.L. Clarithromycin in the treatment of infectious exacerbations of chronic obstructive pulmonary disease (COPD). RMJ, 2002; Vol. 10, No. 23, pp. 1070–1073. 19. Ushlakova E.A. Short courses of Sumamed (azithromycin) for infections of the upper respiratory tract and ENT organs. Pharmateka, 2004; No. 17, pp. 15–21.