Clinical and pharmacological features of azithromycin as the basis for the effectiveness of short courses of antibacterial therapy

Azithromycin: indications for use and contraindications

The manufacturer's instructions for the drug indicate the following pathologies for which the drug is sufficiently effective:

inflammatory processes in the respiratory tract, with the formation of sinusitis, tonsillitis, pharyngitis, laryngitis, otitis media, pneumonia or exacerbation of chronic bronchitis;
damage to the genitourinary tract without secondary complications - urethritis, cervicitis;
infection of the dermis and soft tissues - infectious superficial pyoderma, erysipelas, dermatitis;
initial borreliosis, scarlet fever, gastrointestinal pathologies associated with Helicobacter pylori.

The medication is not prescribed for complex diseases of the kidneys, liver, or allergic reactions to macrolides. The suspension is not used for babies weighing no more than 5 kg, and tablets and capsules - less than 45 kg.

Playing blind

Most outpatient doctors immediately prescribe medications without properly examining the patient. The worst thing is that the doctor, in the absence of information, cannot adequately formulate his own indications for hospitalization.

“It often happens that people come to the hospital, literally breaking all the laws, doing tests on their own in a commercial laboratory, deceiving their doctor, deceiving the laboratory, saying that he is not sick with Covid, and self-propelled - on foot, in personal transport, in a taxi - arrives to the hospital in serious or moderate condition.”

Adverse reactions during therapy

Frequent clinical signs of the occurrence of a non-standard effect on treatment include:

problems with visual acuity;
attacks of vomiting with nausea;
discomfort in the abdominal area;
insufficient lymphocyte content;
disturbance of acid-base balance in the blood.

Almost 1% of patients experienced the following:

vaginal infections, oral candidiasis;
vestibular dysfunction, constant drowsiness;
convulsive syndrome, insufficient presence of leukocytes in the blood;
cephalgia, loss of sensitivity of receptors responsible for taste and smell;
constipation, digestive problems, active gas formation;
gastroduodenitis, rapid loss of strength;
vaginitis, dermatological rashes, obsessive itching.

Adverse reactions to Azithromycin in 0.1% of those undergoing treatment were:

increased neutrophil content, decreased platelet count;
anemia of hemolytic origin;
increased activity, unreasonable excitement;
anxiety, outbursts of aggression;
asthenic syndrome, tingling sensation, ants moving across the skin;
lethargy, neuroses, insomnia;
discoloration of the skin in a yellow tint, symptoms of hepatitis;
Quincke's edema, nettle fever, severe photosensitivity;
exudative erythema – polymorphic, malignant course;
anaphylactic shock, fungal infection.

Occasionally, an acceleration of the heart rate, ventricular arrhythmia, and pain in the chest space are recorded. Similar symptoms can be provoked by other macrolides. Antibiotics can cause a decrease in blood pressure and increase the QT interval.

Sometimes a decrease in hearing acuity, asthenic bulbar palsy, motor restlessness, liver dysfunction, hepatitis with necrotic complications are recorded. In most cases, adverse reactions occurred in patients taking Azithromycin in high dosages for a long period. Studies have shown that the resulting consequences are reversible.

Useless antibiotics

One of the common mistakes is prescribing antibiotics. But antibiotics have no effect on the coronavirus itself.

Back in the spring, research was carried out “in a hurry” and a regimen was developed - a combination of azithromycin and hydroxychloroquine. In laboratory conditions, hydroxychloroquine showed a positive effect, and the antibiotic azithromycin was used as a “courier” of hydroxychloroquine inside the cell.

In practice, this combination did not work. It did not improve the outcome of the disease, and people died just as often as those who did not receive these drugs. Moreover, this combination does not shorten the length of hospitalization and does not shorten the stay of the virus in the body.

Signs of secondary bacterial pneumonia

With secondary bacterial pneumonia, a clinical blood test will show an increase in the level of leukocytes, neutrophils, including their immature forms.

The patient may develop purulent sputum, colored - green, rusty, streaked with blood. Sputum may become more abundant.

Another sign of the development of secondary bacterial pneumonia is an increase in body temperature to 38.5 degrees or higher in the later stages - 12-14 days of Covid disease.

After 2 weeks of coronavirus infection in the body and the development of covid pneumonia, changes occur in the lung tissues that are most convenient for the addition of bacteria and the development of bacterial pneumonia.

“Changes in the lungs after covid pneumonia persist for about 8 weeks after recovery. This does not mean that post-Covid pneumonia needs to be treated somehow. Saturation should be restored to your normal by the end of the infection.”

Disservice

Azithromycin itself did not initially work and was simply a conduit for hydroxychloroquine. Even without reference to the coronavirus, Russian people are accustomed to treating any infection with antibiotics. And, what is absurd, outpatient doctors continue to use the azithromycin monotherapy regimen in the treatment of coronavirus infection.

Pneumonia caused by different causes (viruses or bacteria) affects the lung tissue in different ways, and for this reason, treatment tactics will differ.

There are 4 lines of antibacterial drugs on the World Health Organization (WHO) list that should be used in certain situations. The notorious azithromycin is included in the second line and is used for specific indications.

In addition, there is a list of antibiotics that are not recommended for use in certain combinations, because they have very pronounced side effects.

Now the most common combination of coronavirus treatment at the prehospital stage is a combination of azithromycin and levofloxacin. This particular combination is not recommended by WHO. It is prohibited by clinical pharmacologists, including in Russia.

Photo: Anton Vergun/TASS

Principles of treatment

A person becomes infected with a viral infection through the mucous membranes of the eyes and nasopharynx. The incubation period lasts about a week. At this time, symptoms may occur in the form of aches and malaise. During the acute phase, the temperature rises, headaches, cough, runny nose, chills, and nausea appear. The severe phase of the disease causes severe shortness of breath, pain in the abdomen and chest. To prevent serious complications, it is important to quickly and correctly select treatment.

There is currently no vaccine for coronavirus. The course of treatment is based on the use of antiviral medications and antibiotics. The patient is prescribed a potent drug. An antiviral substance will not be able to cope with the virus on its own, so additional painkillers, antipyretics and sorbent medications are taken.

Antibiotics are prescribed for a complicated form of the disease, when opportunistic microflora multiply.

Note!

The description of the drug Azithromycin on this page is a simplified author’s version of the apteka911 website, created on the basis of the instructions for use.
Before purchasing or using the drug, you should consult your doctor and read the manufacturer's original instructions (attached to each package of the drug). Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide to prescribe the drug, as well as determine the dose and methods of its use.

Features of use

There are several principles for the use of drugs from the group of antibiotics that require mandatory compliance. Violations of them can lead to serious consequences. The drug should always be prescribed by an otolaryngologist, and if not, then by a therapist.

1. At the initial visit, if it is not possible to wait for the results of the smear, a broad-spectrum drug is prescribed for treatment, effective against the main pathogens of the identified pathology. After the results of the study are received, the treatment regimen will be edited if necessary.

2. If there is no result, the drug must be replaced. In such a situation, a second smear may be necessary, since failure of treatment most likely means that a mistake was made in choosing the medicine. If the patient does not comply with the dosage regimen, then the lack of effect from the antibiotic is associated with the development of a drug-resistant form of the pathogen.

3. Minimum course duration is 7 days. Be sure to complete the treatment completely. Even if it seems that the medicine is no longer needed, you should definitely continue taking it. Otherwise, if the patient does not complete the course, it will cause the appearance of a particularly persistent pathogen, against which antibiotics from this category will be useless in the future.

4. When choosing a drug, it is necessary to study the patient’s chart in order to determine which antibiotic drugs have already been administered recently. In this case, you need to choose a different remedy, since the previous one may no longer be effective enough. It is highly undesirable to use the same drug several times in one year. This is allowed only if there is no other way out;

Also, the patient must inform the attending physician about what medications he is taking, since not all drugs can be combined with antibiotics. In this case, therapy is based on a special plan if it is not possible to stop the medication.

Therapy of despair

The new virus has misled the entire global medical community, researchers and experts. What can we say about the paramedics and doctors who come to our home when called. Patients with Covid are prescribed azithromycin, arbidol, hydroxychloroquine, and other useless, unnecessary or dangerous drugs.

Indeed, it happens that doctors do not know what to prescribe, and they prescribe at least something for the sake of prescribing, to reassure the patient and give him hope that he will recover. Do not forget that they follow the guidelines approved by the Ministry of Health, the schemes of which are used only in Russia.

Photo: Alexander Demyanchuk/TASS

“I started to get the impression that outpatient doctors weren’t just doing this to prescribe. They want to reassure not only the patient, but also to overcome their fear of this infection and their fear of complications that may arise suddenly. It feels like they are trying to use everything, but as a therapy for despair. Thus, they delay the moment of what they believe are complications, and they also gain time for themselves, giving themselves the opportunity to reduce their vigilance towards this patient. So the doctor shifts responsibility to those who created these clinical recommendations.”

There are also those who have not read clinical studies or studied the opinions of the world medical community. Prescriptions by such doctors occur out of ignorance.

University

→ Home → University → University in the media → Does a sore throat need to be treated with antibiotics?

Sore throat, chronic tonsillitis - thousands of people are familiar with these diagnoses. Is it possible to get rid of a sore throat forever? How long should you take antibiotics? Is it possible to prevent this disease?

Assistant of the Department of Infectious Diseases of the Belarusian State Medical University, Candidate of Medical Sciences Nikita Solovey answered these and other questions from Komsomolskaya Pravda readers on a direct line

— I have chronic tonsillitis. For the last year, my sore throats have gone away without fever, but with stomatitis. Maybe some kind of prevention can be done?

— How does stomatitis manifest itself?

- Very painful ulcers appear in the mouth.

- Perhaps this problem is not related to your chronic tonsillitis. Stomatitis can be caused by other causes; you need to be examined by specialists who deal with the mucous membranes of the oral cavity, for example, dentists.

— And I also have constant traffic jams.

- If you do not have a fever or severe sore throat, topical medications with anti-inflammatory and antimicrobial effects may be effective, for example, evidence of effectiveness in studies has been obtained for nanocolloidal silver, extracts of certain algae and herbs. These remedies can also be useful for stomatitis.

— Why does chronic tonsillitis occur in general? Is this all due to reduced immunity?

- No, this is a feature of inflammation of the tonsils, which develops in response to the influence of certain microorganisms, often with not entirely correct treatment of repeated episodes of sore throat.

— If sore throats occur two or three times a year, is this an indication for tonsil removal?

— To date, research results show that in adults, removal of tonsils often does not lead to a reduction in the number of recurrent inflammations of the oropharynx. In fact, the final decision on indications is made by otolaryngologists during long-term observation of the patient.

Antibiotics must be taken for at least 10 days

— My son is already in the 8th grade, and since the 5th grade he has been tormented by sore throats. Now they are literally every two weeks, he practically does not go to school. Sore throat manifests itself only with a high temperature, up to 38 degrees. He was already in the hospital. Constantly takes antibiotics. The analysis showed that he had staphylococcus. What should we do?

— Recurrent tonsillitis is a common situation. It is extremely important to adequately treat each exacerbation with the correct course of antibiotics. It is not necessary to use injections; today, most antibiotics are highly effective when taken orally. It is important to carry out 10-day courses of antibacterial therapy. Otherwise, you get a clinical effect - the sore throat goes away, the temperature drops, but the pathogen on the tonsils remains.

— Is it possible to undergo any other examination besides the smear that revealed staphylococcus?

“Unfortunately, most studies do not show the real picture, since we can only examine the microflora from the surface of the tonsils. And in patients with chronic tonsillitis, as studies show, deep in the tonsils there may be a completely different microflora. Therefore, it is more important to adequately treat each episode of exacerbation.

- I'm already desperate. Taking antibiotics so often is also harmful.

— Even frequent use of antibiotics used in modern outpatient practice does not have any long-term consequences. It's a delusion. They can of course have side effects during treatment, just like any other medicine. But those drugs that are approved in our time do not have serious long-term consequences.

- I am 40 years old. The throat is constantly inflamed. Maybe I should have my tonsils removed? My doctor says that problems with the heart and joints may begin.

- At your age, removing your tonsils will not do any good. Problems with the heart and joints can be caused by frequently recurring tonsillitis caused by streptococcus pyogenes. This pathogen is more typical for children and adolescents and is rarely found in older people. In the case of chronic pharyngitis, during exacerbations, drugs with local antimicrobial and anti-inflammatory effects, for example, containing nanocolloidal silver or medicinal plant extracts, can be used.

A virus can also cause a sore throat

— Is it possible to do without antibiotics for a sore throat?

— It all depends on what kind of sore throat the patient develops. There are sore throats that are caused by bacterial pathogens, most often streptococcus pyogenes. But there are sore throats that are caused by respiratory viruses, and then antibacterial therapy is not needed. There are symptoms that practically exclude the bacterial nature of a sore throat: if, in addition to complaints of sore throat, plaque on the tonsils, and fever, there is also conjunctivitis, or a cough, or diarrhea, or a rash. This most likely indicates the viral nature of the disease and requires the use of only agents with a local anti-inflammatory effect.

— I had my tonsils removed when I was a child. And now, as I understand it, doctors are in no hurry to prescribe such an operation.

— First, you always need to adequately treat a sore throat. If this is not done, an acute, frequently recurring process can become chronic.

— I heard that tonsils are not completely removed, but only trimmed.

— There is no scientific evidence of the effectiveness of this procedure. We must understand that by removing the tonsils, we prevent frequent relapses of sore throat, but we open the path of infection to the upper respiratory tract. The tonsils are a barrier organ of the immune system. Recent studies show that the rate of recurrence of acute respiratory viral infections in children whose tonsils were removed is two and a half times higher than in those children who were not operated on. Therefore, tonsils should be removed when there is a real threat of the formation of acute rheumatic fever with consequences in the form of damage to the heart and joints, or when tonsillitis often recurs and ongoing antibacterial therapy becomes ineffective. In addition, not all patients are predisposed to rheumatic complications. Therefore, if we generalize the world experience, there are no clear instructions under which it is definitely necessary to remove tonsils. Everything is decided individually.

Do exercises and don't get too cold

— I am 46 years old, and I have had chronic tonsillitis since childhood. Maybe you can recommend some drug that needs to be taken constantly?

— How does your tonsillitis manifest itself?

— There are seasonal exacerbations, when the throat gets sore and congestion appears.

— Is the temperature rising?

- Not anymore.

— If an exacerbation occurs with a high fever and severe sore throat, it is important to be treated with a 10-day course of oral antibiotics. This course cannot be shortened, even if the patient begins to feel well. Together with the antibiotic, you can use local agents with antimicrobial action. In case of erased exacerbations, it is permissible to use only local remedies.

— Are there methods for preventing or preventing angina?

— Of the methods that have proven effectiveness in treating frequent sore throats, the only effective one is the long-term use of antibiotics with prolonged action. Injections of such antibiotics are given to the patient once a month for a long time. But such prevention is prescribed for very serious reasons, when a person has more than six sore throats per year or there is a threat of rheumatic complications.

In other cases, you just need to carry out general preventive measures: observe a rational work and rest schedule, eat right, develop physically, take multivitamins.

— Does hypothermia affect the occurrence of sore throat?

- Certainly. Hypothermia can lead to an acute or exacerbation of a chronic process. Tonsillitis pathogens live in our oral cavity anyway, but often they cannot realize their pathogenic potential until some predisposing factor occurs. And hypothermia is just that.

— Do rinsing with herbs help?

- Perhaps only at the very initial stage and with viral sore throats. If a real bacterial sore throat has developed, you cannot do without antibiotics. Komsomolskaya Pravda , November 24, 2015

Release forms, analogues and dosages of azithromycin

The medicine is available in the form of capsules of 250 and 500 mg of azithromycin, which are prescribed to adults. Analogues of the active substance - Sumamed, Azimed, Azitro Sandoz are presented on the territory of Ukraine in the form of tablets coated with a protective coating and contain 125, 250, 500 and 1000 mg of the active substance.

In what cases is it advisable to prescribe azithromycin?

Azithromycin is prescribed to adults for the treatment of sore throat - 500 mg orally once a day. Course – 3 days.
The antibiotic is used in the complex therapy of sinusitis - 500 mg twice a day for 3 days.
Azithromycin for mild pneumonia and bronchitis is prescribed to adults - 500 mg once for 3-5 days.

The drug is used in pediatric practice.

In pharmacies it is presented in the form of analogues:

Sumamed - prescribed for a child from six months to 3 years.
Sumamed-forte - used in children whose weight exceeds 15 kg.

The dosage form is available in the form of a powder, which, when diluted, forms a suspension and contains 100 and 200 mg of azithromycin per 5 ml. The package contains a measuring spoon, which makes dosing and administration easier.

The drug is diluted with boiled water at room temperature, in accordance with the instructions for use. The resulting solution has a fruity taste and does not make it difficult for a child to swallow.