Mycoplasma hominis. Routes of infection, symptoms of the disease, treatment

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Do you feel bad, but you don't know why? Are you trying to help yourself with medications, but even long-term treatment does not give any results? Perhaps the reason is mycoplasmas - pathogenic microorganisms that cause urogenital infections in men and women. This group of microorganisms was discovered relatively recently and therefore much is not known about their effects on the body. The pathogenicity of these organisms is questionable because they are found in many healthy people.

What is mycoplasmosis?

Mycoplasmosis is an infectious disease of the urogenital tract, caused by Mycoplasma genitalium and Mycoplasma hominis.

In women, this flora can cause:

• Vaginitis (colpitis) is an inflammatory process of the vagina;
• Cervicitis is an inflammation of the cervix, which can affect both the vaginal part of the cervix (exocervicitis) and the cervical canal (endocervicitis);
• Endometritis is an inflammatory process of the uterine mucosa;
• Salpingoophoritis is an inflammation of the appendages (fallopian tubes and ovaries).

Mycoplasmas are opportunistic microflora for the female body. This means that women can have them in a certain amount in a physiological state. That is, in a certain titer they are part of the normal microflora of the vagina. This condition does not require any treatment.

When exposed to certain provoking factors, the number of mycoplasmas in a woman’s vagina may increase, going beyond normal limits. Then this condition is called mycoplasmosis. And, accordingly, requires therapy.

Pathways of pathogen transmission

Mycoplasma pathogens are highly contagious (infectious). The cause of mycoplasmosis is infection during unprotected intimacy. The danger of infection is posed by vaginal contact, since the mucous membrane of the genitourinary organs is a favorable environment for mycoplasma. The risk of transmission of infection through oral and anal sex is negligible.

Unidentified or unresolved mycoplasmas in a pregnant woman are transmitted to the child during delivery. Infection occurs when the baby passes through the birth canal and the baby’s skin comes into contact with female biological secretions.

The hypothesis of infection through household contact is unfounded. Mycoplasma genitalium, Mycoplasma hominis are anaerobes that are unable to live and reproduce in an oxygen environment.

Symptoms of mycoplasmosis in women

The incubation period for mycoplasmosis during infection ranges from one week to several months. When diagnosed with mycoplasma infection, the symptoms of the pathological process will appear depending on the location of the inflammatory process (vaginitis, cervicitis, endometritis, salpingoophoritis).

Symptoms of mycoplasmosis:

• Itching and burning in the area of ​​the external genitalia and vagina;
• Hyperemia of the external genitalia;
• The appearance of increased volume of discharge with an unpleasant odor;
• Dyspareunia (painful sexual intercourse);
• Increased body temperature;
• Pain in the lower abdomen, depending on the location of the pathological process. When endometritis occurs, the pain will be located mainly in the lower abdomen in the center; when salpingoophoritis develops, it will be more on the right or left, depending on the area of ​​the lesion.
• Disorders of the ovarian-menstrual cycle;
• Infertility, miscarriage.

How does mycoplasma manifest in men?

The incubation period from the moment of infection lasts 1-5 weeks. But the signs of mycoplasmosis in men, as a rule, are not clearly expressed and most often appear in advanced cases. At an early stage, a man may have some signs of urethritis:

• clear discharge from the urethra;
• pain, burning along the urethra when urinating;
• pain and discomfort during sexual intercourse;
• redness of the urethral sponges.

In the later stages, nagging pain in the groin area may be disturbing, indicating that the inflammatory process has affected the internal organs. There is a slight enlargement of the testicles and lymph nodes. The patient may also experience signs of intoxication.

If left untreated, the disease becomes chronic. In this case, mycoplasma in men can cause consequences in the form of prostatitis, infertility, pyelonephritis, arthritis, etc.

Experienced doctors at our medical center will help you correctly identify mycoplasmosis and its clinical form. The diagnostic laboratory of the clinic is equipped with the latest equipment. The qualifications of the laboratory staff and modern technical means ensure a wide range of studies of any complexity.

Diagnostics

Diagnosis of mycoplasma infection currently does not present any difficulty.

Diagnostic procedures include:

• Collection of complaints and medical history by a doctor, followed by a gynecological examination and collection of secretions for research;
• Conducting a microscopic examination of discharge from the vagina, cervical canal, urethra;
• Examination of a smear using the PCR technique (detection of DNA and RNA of viruses and bacteria). Is an accessible and informative study. However, it is impossible to diagnose mycoplasmosis solely by PCR diagnostics, since, as mentioned earlier, mycoplasma can be a component of the normal microflora of the female body. Quantitative PCR diagnostics are required. If the number of mycoplasmas is detected more than 104 CFU/ml, etiotropic therapy must be prescribed.
• ELISA is an enzyme-linked immunosorbent assay that is used to identify antibodies in venous blood;
• Bacteriological research. Conducting a cultural study is necessary to determine the sensitivity of the flora to antibacterial drugs. This is necessary in order to correctly prescribe etiotropic therapy.

Mycoplasma hominis during pregnancy

Presence of Mycoplasma hominis

in a smear from the cervical canal is observed in approximately 10% of pregnant women. Mycoplasma infection can cause inflammation of the urethra and cervix; as the disease progresses, complications develop: inflammation of the placenta and membranes. Inflammation of the membranes can lead to their rupture, resulting in miscarriage or premature birth.

In addition, infection with Mycoplasma hominis

can lead to intrauterine infection, resulting in intrauterine infection, the fetus may develop pneumonia, inflammation of the meninges or bacteremia.

Treatment of mycoplasma infection

Treatment of mycoplasma infection must be carried out when Mycoplasma genitalium is identified in the vagina, as well as Mycoplasma hominis in titers that exceed normal levels.

Mycoplasma: how to treat?

• Systemic antibacterial therapy. First of all, competent antibacterial therapy should be prescribed, taking into account the sensitivity of the pathogen. In most cases, drugs from the group of macrolides, cephalosporins, tetracyclines, fluoroquinolones and others effectively combat mycoplasmosis.
• Probiotic preparations. These are agents that restore intestinal flora after antibacterial therapy.
• Local treatment with suppositories, vaginal tablets, which contain antibacterial substances (metronidazole, clindamycin).
• If necessary, antifungal medications may also be prescribed.
• After prescribing antibacterial drugs in the form of vaginal suppositories, suppositories with lactobacilli are used to restore the vaginal flora.
• Immunomodulators that have a pronounced effect in increasing the protective properties of the body.
• Multivitamin complexes that contribute to the overall strengthening of the body.

How to cure mycoplasmosis besides medications?

In addition to drug therapy, proper diet is important.

Foods that inhibit the effect of medications are excluded from the diet:

• Pickled vegetables;
• Smoked products (fish, meat products, lard);
• Hot sauces or seasonings;
• Dairy products;
• Fast food;
• Alcohol.

It is recommended to include fresh vegetables and fruits, legumes and grains, and olive oil in the diet. It is mandatory to take control tests after treatment. As for bacteriological culture of vaginal discharge, this analysis can be repeated after 2-3 weeks. PCR diagnostics and enzyme immunoassay are recommended to be taken a month after the end of therapy.

If mycoplasma is detected, how to treat it and should the sexual partner do it?

If mycoplasmosis is present, not only the woman, but also the sexual partner should receive examination and treatment. He should contact a urologist for examination and treatment.

To a woman about preparing for tests

The objectivity of the results is enhanced by preliminary preparation for taking a blood test, including:

• refusal to take medications, drink alcoholic beverages;
• limiting physical activity on the eve of blood sampling;
• fasting for 8–12 hours before taking the test;
• quitting nicotine an hour before the procedure.

The rules for preparing for a smear collection include:

• three-day sexual abstinence;
• avoiding douching and vaginal suppositories before visiting a doctor;
• refusal to drink heavily on the day of the test;
• One hour before the procedure, you are prohibited from emptying your bladder.

A smear is taken on any day of the menstrual cycle, except for the first week of the follicular phase (the period of bleeding).

Complications after mycoplasmosis

• Endometritis. In the absence of competent and timely therapy, the infection can ascend into the uterine cavity and cause endometritis (an inflammatory process of the uterine mucosa). Endometritis can subsequently affect a woman’s fertility, causing infertility.
• Salpingo-oophoritis. Inflammation of the fallopian tubes and ovaries. After suffering salpingo-oophoritis, adhesions can form, due to which obstruction of the fallopian tubes is formed, causing tubal infertility.
• Diseases of a rheumatic nature (Reiter's disease).
• With the development of a tubo-ovarian formation filled with purulent contents and a violation of its integrity, peritonitis can develop, which threatens not only the health, but also the life of the woman.

Why is mycoplasma dangerous?

A disease such as mycoplasmosis is very often asymptomatic, but it cannot be cured on its own. The latent infection continues to progress and pose a possible threat. If left untreated, mycoplasmosis can cause consequences such as pyelonephritis and infertility. The infection can remain in the body for a long time, which leads to the following dangerous conditions:

1. decreased immune defense;
2. addition of other pathogens;
3. spread of the infectious process to the bladder, kidneys, genitals, with the development of foci of chronic infection and infertility.

That is why treatment of mycoplasmosis is necessary, of course, under the supervision of a doctor.

Mycoplasmosis: prevention

Such an area as the prevention of mycoplasmosis is preferable in gynecological practice rather than the treatment of the disease itself and its complications.

• Avoid unprotected sexual intercourse. Only the use of barrier methods of contraception (condom) can protect almost 100% from the transmission of sexually transmitted infections.
• Support of the immune system, which can be achieved by eliminating low-quality and unhealthy foods from the diet and giving up bad habits.
• Compliance with the rules of intimate hygiene.
• Regularly scheduled examinations with a gynecologist.

Methods of infection

When considering the etiology of mycoplasmosis, it is necessary to take into account that many opportunistic representatives of these bacteria can be present in human mucous membranes without clinical manifestations. The prevalence of carriage of the infection varies from 8% to 16%. Exclusively pathogenic types of mycoplasmas are transmitted sexually, but other modes of infection are also possible.

Methods of infection and risk factors.

1. Unprotected oral or vaginal intercourse. Mycoplasmosis, transmitted in this way, is often combined with herpes, candidiasis and chlamydia.
2. Household transmission due to the sharing of personal care items.
3. Intrauterine damage to the fetus and transmission of infection during childbirth.
4. Disruption of the immune system, leading to active reproduction of opportunistic flora.
5. Personal history of other genitourinary infections.
6. Promiscuous sexual intercourse.

Due to their asymptomatic course, patients can continue to infect other people, so it is important to be screened for genitourinary infections even in the absence of complaints. It is noted that carriage and latent course of mycoplasmosis is more typical for women.

Get tested for mycoplasmosis

Mycoplasma respiratory tract infection (RTI), or respiratory mycoplasmosis, is an anthroponotic infectious disease that occurs as an infection of the upper (rhinosinusitis, nasopharyngitis, laryngitis, tonsillitis, tracheitis) and lower RR (bronchitis, pneumonia) [1].

Respiratory mycoplasmosis is one of the most common community-acquired infections of the respiratory tract. Thus, its frequency in acute respiratory diseases is 10–16% during non-epidemic periods, and during epidemic outbreaks it can reach 25–50% [1]. The prevalence of respiratory mycoplasmosis depends on age. The most common acute respiratory infections are caused by Mycoplasma. pneumoniae, occur in children over 5 years of age, adolescents and under the age of 40 years. Damage to the DP by mycoplasmas can occur as a monoinfection, but associations of mycoplasmas with viruses (influenza, parainfluenza, adenovirus, respiratory syncytial virus) and bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Chlamydia рneumonia, Moraxella catarrhalis) are often found [1, 2].

Respiratory mycoplasma infection, as a rule, has a mild to moderate course. Complications and deaths are usually rare. In particular, the mortality rate for mycoplasma pneumonia is 1.4%. A more severe course of mycoplasmosis DP is observed in the presence of microbial associations [3]. In addition, the presence of immunodeficiency states in the absence of specific antibacterial therapy can lead to generalization of infection, chronicity of the inflammatory process and microbial carriage. It has been established that mycoplasmas can cause immune disorders in the human body [4].

Microbiological characteristics of the pathogen The causative agent of respiratory mycoplasmosis is M. pneumoniae, a bacterium belonging to the genus Mycoplasma of the Mycoplasma-taceae family of the Mollicutes class. This microorganism is a prokaryote, occupying an intermediate position between viruses and bacteria, characterized by a pronounced polymorphism of structure and very small sizes - from 125 to 250 microns. Mycoplasma does not have a cell wall, which determines the plasticity of the cell, as well as high sensitivity to environmental factors and natural resistance to beta-lactam antibiotics. This microorganism is not able to synthesize sterols necessary for the formation of lipid layers of the cytoplasmic membrane. As a result of this, the pathogen fulfills its needs for sterols by recycling them from the infected tissues of the macroorganism. M. pneumoniae is a membrane parasite capable of persisting in intracellular intussusceptions. This leads to the fact that clinical improvement that occurs after active antibacterial therapy is not always accompanied by the death of M. pneumoniae, which can contribute to the transition of the acute form of infection to chronic [5, 6].

Epidemiology of respiratory mycoplasmosis

It is believed that the source of infection is sick people with manifest and subclinical forms of the disease. Transmission of infection is usually carried out by airborne droplets during close contacts between people, which is due to the instability of the pathogen in the environment. A household contact route through hands or household items contaminated with the pathogen is also possible. For M. pneumoniae, family foci of infection are typical, with the highest incidence rate noted in organized closed groups (schoolchildren, students, military personnel, etc.). The highest prevalence of infection is observed in the autumn-winter period [4, 5, 7].

Many authors note the genetic determination of the human body’s sensitivity to mycoplasmas, and the human population is heterogeneous on this basis. Persons with immunodeficiencies due to systemic, lymphoproliferative and somatic diseases, HIV infection, persons with Down syndrome are more likely to be infected with M. pneumoniae. Post-infectious immunity usually lasts 5–11 years or more [8].

Pathogenesis of mycoplasma infection DP

Infection of the human body with M. pneumoniae and the development of clinically manifest forms of respiratory mycoplasmosis are caused by a decrease in the activity of the immune system. The pathogen is capable of infecting the epithelium of the mucous membrane of all parts of the DP with the development of peribronchial and perivascular inflammatory-infiltrative processes, thrombosis of arterioles and venules. Mycoplasmas activate the processes of lipid peroxidation, cause a blockade of mucociliary clearance mechanisms and, ultimately, the death of epithelial cells. Later, alveolocytes are involved in the inflammatory process. Immune cellular reactions in lesions caused by M. pneumonia allow us to classify them as changes occurring as delayed-type hypersensitivity. The outcomes of severe respiratory mycoplasmosis are often interstitial pulmonary fibrosis, deforming bronchitis and bronchiectasis [9]. The presence of mycoplasmas in the body negatively affects the functioning of the immune system itself, causing suppression of the T-cell and phagocytic components of immunity. In parallel, changes occur in the humoral component, as evidenced by an increase in B lymphocytes (CD20+), an increase in the levels of IgM and circulating immune complexes [10]. Clinically, this can be expressed by the development of non-respiratory autoimmune manifestations of mycoplasmosis - myocarditis, meningoencephalitis, arthritis, nephritis, hepatitis, immune cytopenias, bronchial asthma, Stevens-Johnson syndrome [8, 11].

Clinical picture and diagnosis of respiratory mycoplasmosis

The incubation period of the disease ranges from 1 to 4 weeks. The period when infection is possible in case of mycoplasma infection of the upper DP is 5–7 days, in case of mycoplasma pneumonia – up to 2–3 weeks. The severity of clinical manifestations of infections caused by M. pneumoniae is quite variable and can be characterized by a subclinical or manifest course. The main symptom of the disease is a long, debilitating, unproductive cough. Manifest forms of respiratory mycoplasmosis can be manifested by acute inflammatory changes in the upper airways: rhinosinusitis, nasopharyngitis, laryngitis, tonsillitis, tracheitis. It should be noted that the symptoms of mycoplasma lesions of the upper respiratory tract have few specific features and are practically no different from respiratory infections of other etiologies [12, 13].

Mycoplasma infection of the lower respiratory organs is accompanied by the development of inflammation of the bronchi and lungs. The clinical debut of mycoplasma bronchitis and pneumonia resembles the development of mycoplasma infection of the upper airways, but in these cases febrile fever persists for a longer time. In this case, the symptoms of intoxication are usually moderate. A few days after the onset of the disease, a paroxysmal, dry and obsessive cough appears, which usually persists for quite a long time - from several weeks to several months. The cough usually intensifies over time and gradually becomes moist, viscous and scanty mucopurulent sputum appears. During auscultation of the lungs, scattered dry and varied wet rales are heard [14].

A feature of MP is the paucity of physical data and their inconsistency with pronounced radiological changes in the lungs [15].

In the blood count, leukocytosis is absent or insignificant; leukopenia can be detected; moderate lymphocytosis and an increase in ESR are detected. In the vast majority of cases, pneumonia is not severe and is characterized by the absence of respiratory failure or its mild severity. Disturbances from the cardiovascular system are usually not pronounced. At the same time, patients with immunodeficiencies have a risk of developing complications - exudative pleurisy, myocarditis, pericarditis, meningoencephalitis, myelitis, nephritis, polyarthritis. Based only on clinical data, it is almost impossible to diagnose MP, but radiologically this pneumonia is easily diagnosed [16]. Its peculiarity is also the lack of effect from traditional starting antibacterial therapy carried out with antibiotics of the penicillin or cephalosporin group [8, 13, 15, 16].

Radiographs of mycoplasma lesions of the bronchi show characteristic signs of bronchitis. A feature of the X-ray picture of mycoplasma pneumonia is bilateral interstitial changes, sometimes combined with mediastinal lymphadenopathy. With timely and adequate etiotropic therapy, mycoplasma pneumonia quite quickly regresses clinically, but the radiological picture persists for 4–6 weeks [16, 17].

Laboratory diagnostics play a decisive role in identifying mycoplasma infection. For reliable etiological identification, it is necessary to conduct a serological study (enzyme immunoassay of paired blood serum samples) in combination with methods based on identifying the DNA of a microorganism using a polymerase chain reaction [4, 5, 8, 15, 17].

Treatment of mycoplasma infection DP

Antibacterial therapy occupies a central place in the treatment of respiratory mycoplasmosis. However, if the infection is limited to the upper respiratory tract, you can not resort to antibiotics, limiting yourself to only symptomatic drugs: antitussive drugs in the presence of a dry obsessive cough, expectorants for coughs with difficult to separate sputum, local vasoconstrictors for rhinitis, antiseptics for gargling, physiotherapeutic procedures during the convalescence period . Antibacterial drugs are indicated primarily for patients with risk factors for a complicated course: immunodeficiency states, sickle cell anemia, Down syndrome. Antibiotics are also necessary in cases of severe infection, accompanied by severe symptoms of intoxication, respiratory failure, high fever, significant leukocytosis and a neutrophil shift to the left in the presence of purulent sputum. Mycoplasma pneumonia is an absolute indication for antibacterial therapy [3, 8, 15-17].

The duration of antibacterial therapy for mycoplasma pneumonia does not have any distinctive features and is determined by generally accepted criteria. In mild cases of the disease, antibiotic therapy can be completed once stable normalization of body temperature is achieved within 48–72 hours; with this approach it usually lasts no more than 7–10 days. In case of severe pneumonia, the presence of complications, or extrapulmonary foci of infection, the duration of use of antibacterial agents is determined individually [18].

Extrapulmonary manifestations of respiratory mycoplasmosis, such as polymorphic erythema, myelitis, encephalitis, hemolytic anemia, are an indication for the prescription of drugs from the group of corticosteroid hormones. In the presence of bronchial obstructive syndrome, bronchodilator drugs are indicated [17].

The role of macrolides in the treatment of respiratory mycoplasmosis

The microbiological characteristics of M. pneumoniae explain the lack of effect of standard therapy with β-lactam antibiotics acting on the bacterial cell wall and lead to the need to use drugs that can penetrate the affected cells, accumulate in them and block intracellular protein synthesis. Of the entire arsenal of antimicrobial agents, macrolides, tetracyclines and fluoroquinolones have such properties. Nevertheless, macrolides are the drug of choice because they have a number of positive properties that distinguish them from other antibiotics. These are features of the spectrum of action, successful pharmacokinetic and pharmacodynamic characteristics, and a favorable safety profile. Macrolides are the safest group of antibacterial drugs. Unlike tetracyclines and fluoroquinolones, they can be prescribed to children, pregnant and lactating women. The use of fluoroquinolones by children is possible only for health reasons. Tetracyclines are prescribed to children over 8 years of age; in terms of antimycoplasma activity, they are significantly inferior to other classes of antibiotics [15, 17–19].

At the same time, macrolides have high eradication activity against M. pneumoniae. Their spectrum of antibacterial activity includes other pathogens, often found in association with mycoplasmas - S. pneumoniae, including penicillin-resistant strains, H. influenzae, C. pneumoniae, M. catarrhalis [19]. The advantages of macrolides include a small frequency of use, the possibility of shorter courses of treatment, and a rare occurrence of adverse reactions. When using macrolides, the risk of adverse effects on kidney function, hematopoiesis, cartilage tissue, and the central nervous system is minimal. Severe toxic-allergic syndromes, anaphylactic reactions and antibiotic-associated diarrhea, characteristic of other classes of antimicrobial drugs, are extremely rare when treated with macrolide antibiotics [20].

The immunomodulatory properties of macrolides are known. A positive effect of drugs on the immune system is observed in roxithromycin, clarithromycin and azithromycin [21].

Roxithromycin is an effective macrolide in the treatment of mycoplasma infections of DP

Currently, for the treatment of infections of the upper and lower DP, incl. mycoplasma etiology, the macrolide antibiotic roxithromycin has been successfully used [22]. This drug is a semi-synthetic derivative of natural erythromycin and belongs to the 14-membered macrolides. Modification of the lactone ring of the macrolide led to the emergence of advantages for roxithromycin compared to erythromycin, in particular to the expansion of the spectrum of antibacterial activity due to gram-negative flora (H. influenzae, Neisseria spp., M. catarrhalis) and improvement of pharmacokinetics [23].

Roxithromycin, like all macrolides, has a bacteriostatic effect by disrupting protein synthesis by the microbial cell by binding the drug molecule to the 50S ribosomal subunit. At the same time, roxithromycin is able to create higher intracellular concentrations compared to erythromycin, which ensures greater activity of the drug against intracellular bacteria - mycoplasmas. Compared with other macrolides, in particular azithromycin and clarithromycin, roxithromycin is not inferior to them in terms of antimycoplasma activity [24].

The effectiveness of roxithromycin against other bacteria, often combined with M. pneumoniae, is also noteworthy. Roxithromycin is highly active against S. pneumoniae, M. catarrhalis, C. pneumoniae, Legionella spp. In terms of activity against these pathogens, roxithromycin does not differ from azithromycin and clarithromycin [25]. Despite the fact that in vitro roxithromycin exhibits relatively low activity against H. influenzae, the clinical effectiveness of the antibiotic in patients with respiratory tract infections caused by this microorganism, according to a meta-analysis of controlled studies, is about 80% [26].

According to some authors, roxithromycin has anti-inflammatory activity. It is believed that this may be related to its ability to inhibit cytokine production and antioxidant properties [27]. According to experimental studies, roxithromycin is superior to clarithromycin and azithromycin in terms of the severity of its anti-inflammatory effect [28]. Compared with erythromycin, roxithromycin has higher bioavailability when taken orally. It is more resistant to the action of gastric acid and is absorbed faster and more completely in the gastrointestinal tract. Food, as a rule, does not affect the complete absorption of roxithromycin, but may reduce its rate [29].

The standard daily dose of roxithromycin is 300 mg. Moreover, according to a randomized study that included 1588 patients with various infections, the effectiveness of the antibiotic is equally high regardless of whether it was prescribed as a single dose of 300 mg or in two doses of 150 mg [30]. Due to improved absorption and distribution parameters, roxithromycin has higher concentrations in tissues and body fluids compared to other macrolides. High concentrations of the drug, exceeding MIC90 for sensitive microorganisms, are created in the tonsils, paranasal sinuses, lungs, as well as in other organs and environments [31].

Roxithromycin is able to significantly penetrate into cells, especially into neutrophilic leukocytes and monocytes, stimulating their phagocytic activity. The ratio of the antibiotic concentration in the cytoplasm of neutrophils to the concentration in the extracellular fluid for roxithromycin is 21.9, and for erythromycin it is about 6.6 [32].

An important advantage of roxithromycin is its good tolerability. Adverse reactions develop in only 3–4% of patients, and 75–80% of these cases are mild dyspeptic symptoms [33]. Roxithromycin inhibits the cytochrome P450 system to a lesser extent than erythromycin. This is of important clinical significance, since this drug has a low likelihood of interaction with drugs metabolized in the liver with the participation of microsomal enzymes. Studies have not revealed clinically significant interactions of this antibiotic with theophylline, warfarin, oral contraceptives and carbamazepine [34].

Today, the Russian pharmaceutical market offers several trade names of the drug roxithromycin. It should be remembered that the effectiveness and safety of pharmacotherapy are largely determined by the quality of drug production. One of the highest quality generics of roxithromycin is the German drug Esparoxy, which is bioequivalent to the original drug and is widely used in Europe. It is necessary to note the favorable pharmacoeconomic characteristics of this drug. With Western European quality, the cost of Esparoxi is lower than that of the original drug and other generics, so it can treat various types of DP infections, incl. mycoplasma etiology is effective, safe and economically justified.