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The antibiotic has no effect on pneumonia. Antibiotics for pneumonia

In recent years, experts have called pneumonia one of the most dangerous diseases of the respiratory system. The only effective treatment is antibiotics. Only these drugs help to quickly eliminate the causes of pneumonia and get rid of the symptoms. In order for treatment to be effective, you need to know which medications are most effective.

Taking and choosing antibiotics

Pneumonia develops against the background of the activity of pathogenic microorganisms that have entered the human body. It is impossible to cope with them without the use of antibiotics in 85% of cases.

Several groups of antibiotics have been developed: depending on the severity of the disease, they can be used individually or as part of a comprehensive treatment program. If the initially chosen drug does not bring the desired result, the doctor prescribes medications from a different group.

Long-term use of antibiotics often leads to intestinal problems. In this regard, doctors recommend taking medications after a course of therapy aimed at restoring the natural microflora in the intestines. In this case, treating pneumonia with antibiotics will not harm the patient's health.

Blood, urine and sputum tests help select the right antibiotics for the treatment of pneumonia in adults. With their help, the doctor determines which bacteria caused the disease. Based on this, the selection of drugs is made.

After the causative agent of pneumonia has been identified in the laboratory, additional testing is carried out to determine its sensitivity to medications. Such an analysis will help determine the group to which the antibiotic should belong.

The method is quite accurate, but the result will have to wait. As a rule, the study takes from 2 to 5 days. In some cases, such delay can be dangerous.

Which pulmonary antibiotic will be effective depends on the patient’s health status. If the disease has reached a severe stage, then the use of the latest generation of drugs will be required. They have a wider spectrum of action.

Penicillin group drugs

Penicillin was one of the first antibiotics used to treat pneumonia. But if previously they were of natural origin, the drugs used today are most often semi-synthetic.

Natural medicines include benzylpenicillin. It is effective against pneumococcal pneumonia.

Among semisynthetic drugs, Oxacillin and Cloxacillin are popular. The best results are shown in the fight against staphylococcus. Broad-spectrum drugs are considered advanced. These include Ampiox and Amoxicillin. They quickly penetrate the body's cells and successfully fight gram-negative bacteria.

This antibiotic therapy is used for mild pneumonia. It is prescribed for infection with staphylococci and streptococci. Taking penicillin drugs can provoke an allergic reaction, diarrhea, colitis and dyspepsia.

Treatment of pneumonia with cephalosporins

Antibiotics for pneumonia, belonging to the group of cephalosporins, are quite effective. They have a wide spectrum of action and successfully fight pathogens. There are four generations of such medications:

First generation. It includes Cefapirin and Cefazolin. This antibacterial therapy is effective for pneumonia caused by cocci.
Second generation. This group includes Cefuroxime and Cefradine. They successfully fight Haemophilus influenzae and Escherichia coli, as well as gonococci and Klebsiella.
Third generation. Its representatives were Cefotaxime and Ceftazidime. They cope well with all bacteria except cocci. Such drugs are used to treat severe pneumonia.
Fourth generation. This group includes Cefpirome. It has a wide spectrum of action, but does not have the desired effect on enterococci.

The only drawback of using such antibiotics for pneumonia is the likelihood of an allergic reaction. Allergy to cephalosporins is observed in 10% of patients.

Macrolides

Pneumonia is successfully treated with macrolide antibiotics. Some time ago they were considered ineffective. This happened due to the inability of specialists to use them correctly.

Many doctors simply did not follow the grading program during therapy. Due to this, bacteria began to develop resistance.

But later this omission was corrected. Modern antibiotics for pneumonia show excellent results in the treatment of pneumonia. They cope best with legionella, chlamydia and cocci.

Among the most popular drugs in this group are:

Ziomycin.
Rovamycin.

The disease can be cured fairly quickly with these medications. They are quickly absorbed into the tissues and cells of the body. Eating somewhat slows down this process.

Allergic reactions to macrolides are extremely rare. They are not recommended for use in patients suffering from liver dysfunction.

Fluoroquinolones

Medicines of this group are quickly absorbed into the cells of the body. Contraindications to their use include pregnancy and individual intolerance.

Tetracyclines

The treatment of pneumonia in adults begins with the use of antibiotics of the tetracycline group until the pathogen is identified. This is especially true if the disease progresses quickly and there is no time to wait for test results. The attending physician may prescribe these medications for infection with chlamydia and mycoplasma.

Recently, it has been noted that tetracyclines have become less effective than drugs from other groups. This is due to the fact that microorganisms have developed immunity to them.

This antibiotic for pneumonia has a significant drawback: the ability to accumulate in the bones and tissues of the body. This leads to slow intoxication. Over time, teeth can decay. In this regard, the use of such medications is contraindicated for children, women during pregnancy and lactation, as well as for patients with impaired renal function.

Among the most popular drugs in this group are Tetracycline and Doxycycline.

List of the best antibiotics for pneumonia

If you ask your doctor how to treat pneumonia, his answer will be clear - take antibiotics. The key to successful therapy will be the selection of an effective drug and its correct use. All modern products are available in tablets or injections. Among them, the following can be particularly highlighted:

Contraindications and possible side effects

Antibiotic treatment is an integral part of therapy for pneumonia. But taking some medications can negatively affect the patient's health.

Among the main contraindications are the following:

Allergic reactions.
Liver failure.
Kidney diseases.
Pregnancy.
Childhood.

In these cases, the doctor selects the medication especially carefully. The patient's health status and the results of all tests are taken into account.

Long-term use of antibiotics often provokes side effects. Diarrhea, attacks of nausea, dizziness, skin rash, swelling, insomnia, and panic attacks may occur.

If you begin to notice such symptoms, immediately consult your doctor. Most likely, you will need to make adjustments to the chosen treatment regimen. Your doctor will tell you which antibiotics are best for pneumonia. The choice of a specific drug is made exclusively by the attending physician based on the patient’s tests.

It is important to remember that uncontrolled use of antibiotics can lead to negative health consequences. It is necessary to strictly follow the dosages prescribed by the specialist.

A hundred years ago, people died from many diseases that are successfully treated by doctors today. Dangerous diseases with a high risk of death included nephritis, tonsillitis, meningitis, and pneumonia. The situation began to change with the discovery of the capabilities of active microorganisms - antimicrobial agents, called “antibiotics”. The most effective antibiotics for pneumonia have also been identified.

There are many varieties of pneumonia and they depend on the pathogen that provokes the inflammatory process in the pulmonary system. Therefore, antibiotics for pneumonia are selected depending on many factors and symptoms accompanying the course of inflammation.

The progression of the inflammatory process in the respiratory system and separately in the lungs is indicated by general symptoms and signs. The patient's condition deteriorates sharply: coughing, accompanied by chest pain and symptoms of fever.

The patient usually requires urgent hospitalization. In severe cases of the disease, the patient is hospitalized in the intensive care unit and, accordingly, receives urgent drug antiviral therapy. Since in such cases there may be no time left for laboratory determination of the pathogen, doctors use the so-called “gold standard” of antimicrobial therapy for an emergency response:

antimicrobial drugs of a number of macrolides: Azithromycin, Clarithromycin;
antibiotics for pneumonia of the fluoroquinol series: Ciprofloxacin, Levofloxacin;

To increase the effectiveness of antimicrobial drugs, specialists use an effective treatment regimen: in the first days, an antibiotic for pneumonia is administered to the patient intravenously using the jet method or intramuscularly. Over the next few days, treatment is carried out with tablet forms of the drug.

Treatment depending on the type of disease

The most effective antimicrobial drug for the treatment of pneumonia is selected using laboratory tests. A bacteriological culture of sputum is taken from the patient and in this way the causative agent of the disease is determined.

Treatment of pneumonia with antibiotics is adjusted in accordance with the etymology of the inflammatory process.

Prescribing antibiotics for the treatment of pneumonia should be done by a qualified specialist. Self-medication for this complex disease can aggravate the pulmonary degenerative process and lead to serious complications and consequences for the patient. The attending doctor determines which antibiotics to use as a therapeutic effect and adjusts the dosage regimen, following certain rules for prescribing antibiotics for pneumonia.

Features of rapid response in complex pneumonia

In each specific case of an inflammatory disease in the respiratory system, the doctor is faced with the need to choose the right medicine. Broad-spectrum antibiotics are known for the treatment of pneumonia; in cases of “hurricane” development of the disease, doctors resort to them. The advantage of such antimicrobial drugs is that they can act on a wide range of pathogens.

The enhanced formula of penicillin with clavulanic acid (Amoxiclav) effectively affects most microorganisms that cause inflammation.
Macrolides (Rulid, Rovamycin) are prescribed as a broad-spectrum antimicrobial drug for pneumonia.
To quickly respond to symptoms of pneumonia, patients are prescribed treatment with antibiotics of a number of first-generation cephalosporins (Cefazolin, Cephalexin).

As a rule, rapid therapy for pneumonia with antibiotics in adults and children is carried out in a hospital setting under the supervision of a physician. If after a three-day period the patient does not improve, the temperature drops to low-grade and does not drop below 37, the prescribed antibiotics for pneumonia are canceled and the doctor makes a complete correction of the treatment regimen, based on the prepared diagnostic picture of the course of the disease.

Features of prescribing antimicrobial therapy

Considering the fact that viruses and bacteria that can provoke complex diseases in humans constantly mutate and adapt to antimicrobial strains, becoming insensitive to them, doctors often prefer to treat pneumonia in adults using not one medicine, but two at once with different active ingredients . To correctly combine medications, doctors make prescriptions following the following scheme:

An analytical culture of sputum is done to determine the pathogen that provokes the inflammatory process in the lungs;
a test is taken to determine the sensitivity of the pathogen to a certain number of antimicrobial agents;
The sensitivity of the patient to the antibiotic and the absence of an allergic response to the activity of this strain of microorganisms are also checked;
determines the degree of likelihood of complications and side effects in a patient from an antimicrobial drug that is planned to treat pneumonia.

In addition, the doctor takes into account the compatibility of the groups of drugs prescribed to him. It is known that cephalosporins and fluoroquinolones “get along well with each other.” When prescribing certain groups of drugs, the anthropometric data of the patient should be taken into account, so the doctor may conduct an additional examination to calculate the dosage of the drug.

Outpatient treatment regimen for severe pneumonia

Despite the fact that pneumonia is treated mainly in a hospital setting, sometimes the doctor is forced to make a decision about setting up a hospital at home due to accompanying diseases and pathologies in the patient. In a home hospital, both severe forms of pneumonia and mild inflammatory pathologies of the pulmonary system are treated.

Severe forms of pneumonia in a home hospital are treated using the following drugs:

Adult patients are prescribed aminopenicillins: amoxicillin with clavulanic acid. To treat young children, this antimicrobial drug is used in combination with aminoglycosides. The drug can be used in tablet form: drink strictly according to the regimen prescribed by the doctor.
The best treatment option for severe inflammatory pulmonary disease is intravenous administration of an antimicrobial drug with aminoglycosides. Augmentin is used as an antibiotic for injection treatment. Intravenous injections must be given by a qualified physician, therefore, when organizing a home hospital for the treatment of pneumonia, a visiting nurse is assigned to the patient, monitoring the patient’s condition and quickly making a decision on urgent hospitalization if signs of deterioration appear.
In severe and advanced forms of pneumonia, combinations of aminoglycosides with carboxypenicillins or the latest generation cephalosporins are also possible. At the same time, experts say that such treatment is best carried out under the constant supervision of doctors and in a hospital setting.
Taking antihistamines is recommended in cases where the patient has a history of a tendency to allergic reactions. To prevent an allergic response from the body, experts recommend taking antihistamine medications in combination with active antimicrobial agents.

It is impossible to cure complicated pneumonia on your own, without the help and supervision of doctors: you can only transfer the pathology to the chronic stage or provoke serious pathological irreversible processes in the lungs. The final decision on how to treat severe pneumonia should be made by the doctor, both in inpatient and outpatient settings.

Outpatient treatment of mild inflammation

The human body, in most cases, reacts negatively to the activity of antibiotics, causing complications and associated pathological processes. Therefore, for uncomplicated forms of pneumonia, specialists prefer to prescribe to their patients only one antimicrobial drug, selected according to a specific pathogen.

A good effect was recorded in the treatment of mild pneumonia with Amoxiclav. This drug is not used for more than a week; it is believed that during this period it will actively destroy pathogens and relieve inflammatory manifestations.
Treatment with Sumamed is carried out for the same period. This antibiotic is a broad-spectrum drug, which is why it often turns out to be a panacea for mild pneumonia.
Amoxil, Clarithromycin, Fluconazole also cope well with bacterial pneumonia. The dosage, schedule and duration of taking these medications is also determined by the doctor, based on the medical history.

The key to successful treatment of pneumonia with antibiotics is considered to be strict adherence to the recommendations of the attending physician. Antibiotics for pneumonia are a strong and effective tool in the fight against bacteria and microorganisms, but this tool must be operated by skilled hands. We should also not forget that different names of drugs do not always indicate different active substances, so independent replacement of the antibiotic also threatens to aggravate the pathological process in the lungs and deteriorate the general condition of the patient.

Content

Pneumonia or pneumonia is a dangerous disease in which inflammation of the lung tissue occurs. The process leads to an imbalance of oxygen metabolism in the body, which in its advanced form sharply increases the risk of developing blood poisoning and other life-threatening conditions. Pneumonia is caused by pathogenic microbes. This reason necessitates the need for drug therapy that can kill the infection.

What are antibiotics for pneumonia in adults

A fundamental part of the fight against pneumonia is antibiotics, which can destroy the pathogen and suppress its ability to reproduce. Otherwise, the disease can cause irreparable damage to the body in the form of complications and even cause death. The duration of treatment depends on the stage of advanced pneumonia and the patient’s immunity. The extracellular form of the pathogen can be killed in 7 days, the intracellular form in 14, and it can take 50 days to treat a lung abscess.

General principles of appointment

Antibiotics are the main means of treatment aimed at eliminating the cause of the disease, which is the presence of pathogenic microflora. The main principle of treatment with them is the correct selection of the form, which determines the method and the factor of continuity of drug delivery into the blood and sputum. Injections are considered a good method, since the antibiotic is delivered directly to the location of the pathogens, which minimizes the impact on the gastrointestinal tract.

However, oral administration is more accessible. Rules for using antibacterial agents:

After diagnosis, you should immediately start taking medications;
First-line antibiotics are those that belong to the penicillin group;
if the disease is severe, then a more effective drug is added to the existing drug (if the pathogen is identified);
in initially severe cases, therapy with two drugs begins immediately - it is recommended to use penicillin with erythromycin, monomycin or streptomycin, as well as tetracycline with oleandomycin and monomycin;
It is not recommended to use more than two drugs simultaneously on an outpatient basis;
It is not recommended to use small doses so that microbes do not develop resistance;
long-term use of antibiotics (more than 6-10 days) leads to the development of dysbiosis, which necessitates the use of probiotics;
if treatment requires taking medications for more than three weeks, then it is necessary to provide a 7-day break and further use of drugs of the nitrofuran series or sulfonamides;
It is important to complete the course even if the negative symptoms disappear.

What antibiotics to take for pneumonia

More often, doctors prescribe antibiotics for pneumonia in adults from the following effective drug groups:

Penicillins: Carbenicillin, Augmentin, Amoxiclav, Ampicillin, Piperacillin.
Cephalosporins: Ceftriaxone, Cephalexin, Cefuroxime.
Macrolides: Clarithromycin, Erythromycin, Azithromycin.
Aminoglycosides: Streptomycin, Gentamicin, Tobramycin.
Fluoroquinolones: Ciprofloxacin, Ofloxacin.

Each of these groups differs from the others in the breadth of its range of applications, duration and strength of exposure, and side effects. To compare drugs, see the table:

	Name of drugs	Features of application
Cephalosporins	Cefotaxime, Ceftriaxone	They treat uncomplicated pneumonia caused by strepto- and pneumococci, enterobacteria, but are powerless against Klebsiella and Escherichia coli. The appointment of this group occurs with proven sensitivity of microbes to the drug, with contraindications to macrolides.
Macrolides	Erythromycin, Azithromycin, Clarithromycin, Midecamycin	First-line drugs in the presence of contraindications to the penicillin group. They successfully treat atypical pneumonia and pneumonia associated with acute respiratory infections. Medicines affect mycoplasmas, chlamydia, legionella, hemophilus influenzae, but practically do not kill staphylococci and streptococci.
Semi-synthetic penicillins	Oxacillin, Amoxiclav, Ampicillin, Flemoklav	Prescribed for proven sensitivity to microorganisms - Haemophilus influenzae, pneumococci. The drugs are used to treat mild pneumonia caused by viruses and bacteria.
Carbapenems	Meropenem, Imipenem	They act on bacteria resistant to cephalosporins, eliminate complex forms of diseases and sepsis.
Fluoroquinolones (quinolones, fluoroquinols)	Levofloxacin, Moxifloxacin, Sparfloxacin	Affects pneumococci.
Monobactams	Aztreons	The agents are similar in action to penicillins and cephalosporins and have an excellent effect on gram-negative microorganisms.

When prescribing antibiotics for the treatment of pneumonia in adults, doctors should pay attention to the compatibility of the drugs. For example, you cannot simultaneously take medications of the same group or combine Neomycin with Monomycin and Streptomycin. At the initial stage, before obtaining the results of a bacteriological study, broad-spectrum drugs are used; they are taken as continuous therapy for three days. Then the pulmonologist may decide to change the medication.

In severe cases, a combination of Levofloxacin and Tavanic, Ceftriaxone and Fortum, Sumamed and Fortum is recommended for adults. If patients are under 60 years of age and have mild pneumonia, then they take Tavanic or Avelox for five days, Doxycycline for up to two weeks, Amoxiclav, Augmentin for 14 days. Antibacterial agents should not be prescribed independently, especially for older people.

Community-acquired form

Treatment of community-acquired pneumonia in adults is carried out using macrolides. Sometimes drugs based on clavulanic acid, sulbactam, penicillins, cephalosporins of 2-3 generations are prescribed in combination with macrolides. In severe cases, carbapenems are indicated. Description of several drugs:

Amoxicillin – capsules and suspension based on the component of the same name from the group of semi-synthetic penicillins. Principle of action: inhibition of flora cell wall synthesis. Use is contraindicated in case of intolerance to the components and high severity infectious mononucleosis. Dosage: 500 mg three times a day.
Levofloxacin is a tablet based on levofloxacin hemihydrate, which blocks DNA synthesis of microbial cells and disrupts their cytoplasmic and cellular membrane barriers. They are contraindicated in case of tendon damage, under the age of 18, during pregnancy and lactation. Dosage: 500 mg 1-2 times/day for 7-14 days.
Imipenem is a beta-lactam carbapenem available in the form of an injection solution. It is used in the form of droppers or intramuscular injections. Dosage: 1-1.5 g per day in two doses. The duration of the droppers is 20-40 minutes. Contraindications: pregnancy, age up to three months for intravenous and up to 12 years for intramuscular injection, severe renal failure.

Aspiration

Antibacterial agents for the treatment of aspiration-type pneumonia should include clavulanic acid, amoxicillin, and vancomycin-based aminoglycosides. In severe cases, third generation cephalosporins are indicated in combination with aminoglycosides and metronidazole. Description of medications:

Augmentin is a tablet based on amoxicillin and clavulanic acid trihydrate in potassium salt format. It belongs to the group of penicillins and inhibits beta-lactamases. Dosage: 1 tablet 875 +125 mg twice a day or tablet 500 + 125 mg three times a day. For children, the suspension format is indicated (the tablet dissolves in water). Contraindications: jaundice.
Moxifloxacin is an antimicrobial solution and tablets from the fluoroquinolone group. Contains moxifloxacin hydrochloride, contraindicated during pregnancy, breastfeeding, and under the age of 18 years. Dosage method: once a day intravenously 250 ml over an hour or orally 400 mg/day for a course of 10 days.
Metronidazole is a solution for infusion or tablets based on the component of the same name. The 5-nitroimidazole derivative inhibits the synthesis of bacterial nucleic acids. Contraindications: leukopenia, impaired coordination, epilepsy, liver failure. Dosage: 1.5 g/day in three divided doses as a weekly course in tablet form.

Nosocomial

Pneumonia of the nosomial type is treated with the use of 3-4 generation cephalosporins, Augmentin. In severe cases, the use of carboxypenicillins in combination with aminoglycosides, 3rd generation cephalosporins or 4th generation in combination with aminoglycosides is indicated. Popular drugs:

Ampicillin - tablets and capsules contain ampicillin trihydrate, which inhibits bacterial cell wall synthesis. Contraindicated for mononucleosis, lymphocytic leukemia, liver dysfunction. It is indicated to use 250-500 mg 4 times a day orally or 250-500 mg every 4-6 hours intramuscularly or intravenously.
Ceftriaxone powder for injection contains ceftriaxone disodium salt. Inhibits the synthesis of the cell membrane of microorganisms. Contraindicated for use in the first three months of pregnancy. Average daily dose: 1-2 g once a day or 0.5-1 g every 12 hours. It is used intramuscularly and intravenously in the hospital.
Tavanic – tablets and solution for infusion based on levofloxacin. They belong to the group of fluoroquinolones and have a broad antimicrobial effect. Contraindicated for epilepsy, tendon disorders, lactation, pregnancy, under 18 years of age, and heart disease. Directions for use: 250-500 mg tablets 1-2 times a day or in the early stages intravenously 250-500 mg 1-2 times a day.

Mycoplasma

This form of the disease is atypical and is manifested by nasal congestion, myalgia, sore throat, headache, paroxysmal cough, and general weakness. The disease is treated for at least 14 days; intravenous solutions are used during the first 48-72 hours. Drugs from the macrolide group are used:

Clarithromycin is a semisynthetic macrolide in the form of tablets based on clarithromycin. Suppresses protein synthesis of the bacterial ribosome, leading to the death of the pathogen. Contraindicated during pregnancy, lactation, under 12 years of age, in combination with ergot preparations. Dosage: 250 mg twice a day for a week.
Sumamed is a solution for infusion, tablets, capsules and powder for oral administration from the group of macrolides-azalides. Suppress protein synthesis by bacteria and have a bactericidal effect. Contraindications: liver and kidney dysfunction. Directions for use: once a day, 500 mg once a day for three days.
Rovamycin is a tablet based on spiramycin and belongs to the group of macrolides. They act bacteriostatically, disrupting protein synthesis inside the cell. Contraindicated during lactation. Dosage: 2-3 tablets in 2-3 divided doses/day

Treatment of pneumonia caused by Klebsiella

The disease caused by Klebsiella (microorganisms found in the human intestines) develops against the background of impaired immunity and leads to the development of a pulmonary infection. At the initial stage in adults, aminoglycosides and 3rd generation cephalosporins are used for 14-21 days. Medicines used:

Amikacin - powder for the preparation of a solution administered intravenously and intramuscularly, contains amikacin sulfate. A semi-synthetic antibiotic-aminoglycoside acts bactericidal, destroying the cytoplasmic barrier of the cell. Contraindicated in severe chronic renal failure, acoustic neuritis, pregnancy. Dosage: 5 mg/kg body weight every 8 hours. For uncomplicated infections, administration of 250 mg every 12 hours is indicated.
Gentamicin is an aminoglycoside in the form of an injection solution containing gentamicin sulfate. Disturbs the synthesis of protein in the cell membrane of microorganisms. Contraindicated in case of hypersensitivity to the components. Directions for use: 1-1.7 mg/kg body weight 2-4 times/day intravenously or intramuscularly. The course of treatment lasts 7-10 days.
Cefalotin is a first-generation cephalosporin antibiotic that acts by destroying the cell walls of bacteria. Solution for parenteral administration based on cephalothin. Contraindications: hypersensitivity to ingredients, beta-lactam antibiotics. Dosage: intravenously or intramuscularly 0.5-2 g every 6 hours. For complications, administration of 2 g every 4 hours is indicated.

For congestive pneumonia

Antibiotics for congestive lung inflammation are prescribed from the group of cephalosporins, sometimes macrolides are prescribed. Congestive pneumonia in adults is a secondary inflammation of the lungs that occurs due to stagnation in the pulmonary circulation. At risk of its development are patients with atherosclerosis, hypertension, ischemia, pulmonary emphysema, and somatic diseases. Medicines are used for 14-21 days:

Cifran is an antimicrobial tablet from the group of fluoroquinolones based on ciprofloxacin monohydrate hydrochloride and tinidazole. Penetrates through the bacterial wall, acting bactericidal. Contraindications: pregnancy, lactation, age under 12 years. Dosage: 500-750 mg every 12 hours before meals.
Cefazolin is a powder for the preparation of parenteral solution. Contains the sodium salt of cefazolin, a first-generation semi-synthetic cephalosporin antibiotic. The drug has a bactericidal effect and is contraindicated during pregnancy and under 1 month of age. Directions for use: intramuscularly or intravenously 0.25-1 g every 8-12 hours. In severe cases, administration of 0.5-1 g every 6-8 hours is indicated.
Targocid is a lyophilized powder for the preparation of injections that contains teicoplanin, which has antimicrobial and bactericidal effects. Blocks cell wall synthesis and inhibits bacterial growth and reproduction. Contraindications: hypersensitivity to beta-lactam antibiotics. Dosage: intramuscularly or intravenously on the first day, 400 mg, then 200 mg once a day.

Antibiotics in tablets

The most popular format for taking medications is tablets. They should be taken during or after meals, washed down with water. Popular drugs:

Erythromycin is a macrolide antibiotic containing erythromycin. It disrupts the formation of peptide bonds between bacterial amino acids, causing their death. Contraindicated in cases of hearing loss, lactation, and under 14 years of age. Dosage: 0.25-0.5 g every 4-6 hours.
Moxifloxacin is a bactericidal tablet from the group of fluoroquinolones based on moxifloxacin hydrochloride. They block enzymes responsible for the reproduction of bacterial DNA. Contraindications: age under 18 years, pregnancy, lactation. Directions for use: 400 mg once a day for 10 days.

IV

In the first days of exacerbation of pneumonia in adults, doctors advise administering antimicrobial agents parenterally (intravenous drip or stream), and after relief, transfer the patient to tablets. Popular solutions for droppers are:

Amoxiclav - contains potassium clavulanate and amoxicillin trihydrate, available in powder format for the preparation of an intravenous solution. The combination of active substances of the drug provides bactericidal activity. Contraindications for taking the solution include jaundice and liver dysfunction. Dosage: 30 mg/kg in two doses over a course of 5-14 days.
Meropenem is an antibacterial agent from the carbapenem group, has a bactericidal effect by inhibiting the synthesis of bacterial cell walls. Contraindicated in case of hypersensitivity to beta-lactams, under the age of three months. Dosage: 500 mg every 8 hours (intravenous bolus for 5 minutes or intravenous infusion for 15-30 minutes).

Strong antibacterial agents

For severe pneumonia in adults, doctors prescribe strong antimicrobial agents to patients. The most popular include:

Avelox - tablets based on moxifloxacin hydrochloride, belong to the group of fluoroquinolones, have a bactericidal effect. Contraindications: severe diarrhea. Dosage: 400 mg once a day for 10 days.
Ospamox is a powder for preparing a suspension based on amoxicillin. It belongs to the group of penicillins and has a rapid effect. Contraindicated in infectious mononucleosis and individual lymphocytic leukemia. Dosage: 1.5-2 g/day in 3-4 doses over a course of 2-5 days.

New generation

The latest generation of antibiotics for pneumonia in adults is distinguished by broad activity, a minimum of side effects, a quick effect, and maximum safety. Popular medications:

Furazolidone - antimicrobial tablets from the nitrofuran group contain the destructive furazolidone, which suppresses the Krebs cycle in bacteria - this leads to their death by suppressing the respiratory process. Contraindications: age under 3 years. Dosage: orally after meals, tablets with a concentration of 110-150 mg 4 times a day for a course of 5-10 days. During treatment, monitoring of vital signs is necessary.
Remedia - tablets based on levofloxacin hemihydrate from the fluoroquinolone group, block the DNA of microbial cells. Contraindications: epilepsy, history of tendon damage, pregnancy, lactation, allergic reactions. Take 500 mg 1-2 times/day for 2 weeks.

Treatment regimen

When prescribing therapeutic therapy, the belonging of pathogens to one or another classification series is taken into account. The general principle is that the antibiotic must be effective against staphylococcus, pneumococcus, and Haemophilus influenzae. When prescribing a treatment regimen for children, the group of aminopenicillins (ampicillin, amoxicillin) is taken as a basis.

If there is a suspicion that the cause of the inflammatory process is bacterial strains that produce betalactamases, then inhibitor-protected penicillins (drugs with a complex of clavulanic acid and amoxicillin) are used as treatment. Augmentin is acceptable for use in both adults and children. If patients (children and adults) used ampicillin or amoxicillin for treatment, then Augmentin, Amoxiclav, Flemoclav, Claforan are often prescribed.

Antibiotics for pneumonia for adults from the macrolide group (spiramycin, azithromycin, lincomycin and clarithromycin) are prescribed when a patient is allergic to cephalosporins and penicillins, when atypical pneumonia is diagnosed (mycoplasma, chlamydia, legionella). In addition, doxycycline (a new generation drug) has good effectiveness for the treatment of atypical pneumonia. Long-term bronchopneumonia is successfully treated with beta-lactam antibiotics (cephalosporins and penicillins)

Price

You can purchase antibiotics for pneumonia in adults with a prescription from a doctor. You should not prescribe them on your own, only after outpatient tests. You can order medications from a pharmacy catalog or buy them inexpensively in an online store. The cost of the most popular drugs in Moscow pharmacies is shown in the table:

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Antibiotics for pneumonia are the main component of the treatment process. Inflammation of the lungs begins acutely, with fever, severe cough with brown or yellowish sputum, chest pain when coughing and breathing.

Antibiotics for pneumonia in children

Antibiotics for pneumonia in children begin to be administered immediately after confirmation of the diagnosis. Children are subject to mandatory hospitalization for therapy or, in case of a complex course, in intensive care if:

The child is less than two months old, regardless of the severity and location of the inflammatory process in the lungs.
A child under three years old, diagnosed with lobar pneumonia.
A child under five years of age is diagnosed with damage to more than one lobe of the lung.
Children with a history of encephalopathy.
A child under one year old with a history of confirmed intrauterine infection.
Children with congenital defects of the heart muscle and circulatory system.
Children with chronic diseases of the respiratory system, cardiovascular system, kidneys, diabetes mellitus and malignant blood diseases.
Children from families registered with social services.
Children from orphanages, from families with insufficient social and living conditions.
Hospitalization of children is indicated if medical recommendations and treatment at home are not followed.
Children with severe pneumonia.

For mild bacterial pneumonia, the administration of antibiotics from the penicillin group, both natural and synthetic, is indicated. Natural antibiotics: benzylpenicillin, phenoxymethylpenicillin, etc. Semi-synthetic penicillins are usually divided into isoxozolylpenicillins (oxacillin), aminopenicillins (ampicillin, amoxicillin), carboxypenicillins (carbenicillin, ticarcillin), ureidopenicillins (azlocillin, piperacillin).

The described antibiotic treatment regimen for pneumonia in children is prescribed until the results of a bacterial analysis are obtained and the pathogen is identified. After identifying the pathogen, further treatment is prescribed by the doctor strictly individually.

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Names of antibiotics for pneumonia

The names of antibiotics for pneumonia indicate which group a particular drug belongs to: ampicillin - oxacillin, ampiox, piperacillin, carbenicillin, ticarcillin, cephalosporins - claforan, cephobid, etc. For the treatment of pneumonia in modern medicine, both synthetic and semi-synthetic ones are used. and natural antibiotics. Some types of antibiotics act selectively, only on a certain type of bacteria, and some on a fairly wide range of pathogens. It is with broad-spectrum antibiotics that it is customary to begin antibacterial treatment of pneumonia.

Rules for prescribing antibiotics for pneumonia:

A broad-spectrum antibacterial drug is prescribed, based on the course of the disease and the color of expectorated sputum.

Conduct a BAC analysis of sputum to identify the pathogen, test the sensitivity of the pathogen to antibiotics.
Prescribe an antibacterial therapy regimen based on the test results. At the same time, take into account the severity of the disease, effectiveness, the likelihood of complications and allergies, possible contraindications, the rate of absorption of the drug into the blood, and the time of elimination from the body. Most often, two antibacterial drugs are prescribed, for example, an antibiotic of the cephalosporin and fluoroquinolone group.

Hospital-acquired pneumonia is treated with amoxicillin, ceftazidime, and if ineffective - with ticarcillin, cefotaxime. A combination of antibiotics is also possible, especially in severe conditions, mixed infections, and weak immunity. In such cases, the following is prescribed:

Cefuroxime and gentamicin.
Amoxicillin and gentamicin.
Lincomycin and amoxicillin.
Cephalosporin and lincomycin.
Cephalosporin and metronidazole.

For community-acquired pneumonia, azithromycin, benzylpenicillin, fluoroquinolone are prescribed, for severe conditions - cefotaxime, clarithromycin. Combinations of the listed antibiotics are possible.

You should not change the line of antibiotic treatment on your own, as this can lead to the development of resistance of microorganisms to certain groups of drugs, resulting in the ineffectiveness of antibacterial therapy.

A course of antibiotics for pneumonia

A course of antibiotics for pneumonia is prescribed by the attending physician, based on the patient’s age, the severity of the disease, the nature of the pathogen and the body’s response to antibacterial therapy.

For severe community-acquired pneumonia, the following treatment is prescribed:

Aminopenicillins – amoxicillin/clavulanate. Children at an early age are prescribed with aminoglycosides.
Possible treatment options:
- Ticarcillin antibiotics
- Cephalosporins II–IV generations.
- Fluoroquinolones

For aspiration bacterial pneumonia, the following antibiotics are prescribed:

Amoxicillin or clavulanate (Augmentin) intravenously + aminoglycoside.
Possible treatment options, purpose:
- Metronidazole + cephalosporins III p.
- Metronidazole + cephalosporins III + aminoglycosides.
- Lincosamides + cephalosporins III.
- Carbapenem + vancomycin.

For nosocomial pneumonia, the following antibiotics are prescribed:

For mild pneumonia, protected aminopenicillins (Augmentin) are prescribed.
Possible options for the treatment regimen are the appointment of cephalosporins II-III p.
In severe cases, combination treatment is required:
- inhibitor-protected carboxypenicillins (ticarcillin/clavulanate) and aminoglycosides;
- III cephalosporins, IV cephalosporins with aminoglycosides.

Treatment of pneumonia is a long and serious process, and attempts to self-medicate with antibiotics can not only lead to complications, but also cause the impossibility of correct antibacterial therapy due to the low sensitivity of the pathogen to the drug.

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Treatment of pneumonia caused by Klebsiella with antibiotics

When Clibsiella pneumonia is detected in sputum, treatment with antibiotics is the main method of pathogenic therapy. Klebsiella is a pathogenic microorganism that is normally found in the human intestine, and with high concentrations and decreased immunity it can cause pulmonary infections. Approximately 1% of cases of bacterial pneumonia are caused by Klebsiella spp. Most often, such cases are recorded in men over 40, patients with alcoholism, diabetes mellitus, and chronic bronchopulmonary diseases.

The clinical course of pneumonia caused by Klibsiella is similar to pneumococcal pneumonia; often the source of inflammation is localized in the right upper lobe of the lung and can spread to other lobes. Cyanosis, shortness of breath, jaundice, vomiting, and diarrhea develop. Pneumonia is often complicated by abscess and empyema of the lung, the reason being that Klibsiella causes tissue destruction. In community-acquired pneumonia, Klebsiella, Serratia and Enterobacter are found in sputum.

Klebsiella, Serratia and Enterobacter have varying degrees of sensitivity to antibiotics, so treatment begins with the administration of aminoglycosides and 3rd generation cephalosporins, mezlocillin; amikacin is effective against the Serratia strain.

With proper and timely treatment, pneumonia caused by Klibsiella is completely cured in 2-3 weeks without complications.

Treatment of severe pneumonia caused by Klibsiella is prescribed with aminoglycosides (tombramycin, gentamicin from 3 to 5 mg/kg per day) or amikacin 15 mg/kg per day with cephalothin, cephapirin, from 4 to 12 g per day. Treatment of severe pneumonia caused by Klibsiella is prescribed with aminoglycosides (tombramycin, gentamicin from 3 to 5 mg/kg per day) or amikacin 15 mg/kg per day with cephalothin, cephapirin, from 4 to 12 g per day.

Antibiotic treatment of mycoplasma pneumonia

If mycoplasma pneumonia is detected in sputum, treatment is directed towards combating a specific pathogen. Once in the body, mycoplasma penetrates the mucous membrane of the upper respiratory tract, where releasing a special secretion first causes severe inflammation, and then the destruction of intercellular membranes and epithelial tissues begins, which ends in necrotic degeneration of the tissue.

In the pulmonary vesicles, mycoplasmas multiply rapidly, the alveoli enlarge, and damage to the interalveolar septa is possible. Mycoplasma pneumonia develops slowly, the onset of the disease is similar to a cold, then the temperature rises to 39-40 degrees, and a severe cough begins. The temperature lasts for about 5 days, then drops sharply, fixing at around 37-37.6 degrees and lasts for a long time. The X-ray image clearly shows darkened lesions and degeneration in the connective tissue septa.

The difficulty in treating mycoplasma pneumonia is that the pathogen is located inside neutrophils, and this makes penicillins, cephalosporins and aminoglycosides ineffective. First of all, macrolides are prescribed: azithromycin (sumamed), spiromshchin (rovamycin), clarithromycin, used orally 2 times a day, no more than 2 weeks, with shorter courses a relapse is possible.

Antibiotics for congestive pneumonia

Antibiotics for congestive pneumonia are prescribed for a course of at least 2 weeks. Congestive pneumonia develops with prolonged bed rest, in elderly, weakened people, as well as a complication after complex operations. The course of congestive pneumonia is slow, asymptomatic, there is no chills, fever, or cough. The patient may only be bothered by shortness of breath and weakness, drowsiness, and later coughing appears.

Congestive pneumonia can be treated at home, but following all the instructions, and only under the supervision of a doctor, so most often the patient is hospitalized in a hospital. If a bacterial infection is also detected in the sputum (congestive pneumonia is not always bacterial in nature), then antibiotics are prescribed - cefazolin, tsifran or protected penicillin. The course of treatment is 2-3 weeks.

For congestive pneumonia developing against the background of heart failure, additional glycosides and diuretic drug complexes are prescribed, along with antibacterial, bronchodilator, and expectorant drugs. In addition, physical therapy and a diet rich in vitamins are indicated. For aspiration pneumonia, bronchoscopy is mandatory.

In general, with a timely diagnosis and antibacterial therapy, high-quality prevention and maintenance of the patient’s body, complications with congestive pneumonia do not develop, and recovery occurs in 3-4 weeks.

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Combination of antibiotics for pneumonia

A combination of antibiotics for pneumonia is introduced by the doctor into the treatment regimen under certain conditions that aggravate the clinical picture of the disease. In the clinic, the use of two or more antibiotics is not approved, due to the high load on the body - the liver and kidneys of a weakened person are not able to cope with so many toxins. Therefore, in practice, it is more acceptable to treat pneumonia with one antibiotic, the effect of which on pathogenic flora is very high.

Combinations of antibiotics for pneumonia are acceptable when:

Severe pneumonia, with secondary pneumonia.
Mixed infection.
Infections with suppressed immunity (cancer, lymphogranulomatosis, use of cytostatics).
Danger or development of resistance to the selected antibiotic.

In such cases, a treatment regimen is developed based on the administration of antibiotics that act on gram-positive and gram-negative microorganisms - penicillins + aminoglycosides or cephalosporins + aminoglycosides.

You should not self-medicate, since only a doctor can prescribe the required dosage of the drug, and with insufficient doses of the antibiotic, microorganisms will simply develop resistance to the drug, and with too high a dose, cirrhosis of the liver, impaired renal function, dysbacteriosis, and severe anemia may develop. In addition, some antibiotics for pneumonia, when combined, simply reduce each other’s effectiveness (for example, antibiotics + bacteriostatic drugs).

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The best antibiotic for pneumonia

The best antibiotic for pneumonia is the one to which the bacteria are most sensitive. To do this, special laboratory tests are carried out - they do a bacteriological culture of sputum to determine the pathogen and then test for sensitivity to antibiotics.

The main direction in the treatment of pneumonia is antibacterial therapy. Until the causative agent of the disease is identified, broad-spectrum antibiotics are prescribed. For community-acquired pneumonia, the following are prescribed: penicillin with clavulanic acid (amoxiclav, etc.), macrolides (rulid, rovamycin, etc.), 1st generation cephalosporins (kefzone, cefazolin, zufalexin, etc.).

For hospital-acquired pneumonia, the following are prescribed: penicillin and clavulanic acid, 3rd generation cephalosporins (claforan, cephobid, fortum, etc.), fluoroquinolones (peflacin, tsiprobay, taravid, etc.), aminoglycosides (gentamicin), carbapenems (thienam).

The full complex of therapy consists not only of a combination of antibiotics (2-3 types), but is also aimed at restoring bronchial drainage (administration of aminophylline, berodual), diluting and removing sputum from the bronchi. Anti-inflammatory, absorbable drugs, vitamins and components that stimulate the immune system are also administered - fresh frozen plasma intravenously, anti-staphylococcal and anti-influenza immunoglobulin, interferon, etc.

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Modern antibiotics for pneumonia

Modern antibiotics for pneumonia are prescribed according to a special scheme:

If gram-positive cocci predominate, penicillin or 1st and 2nd generation cephalosporins - cefazolin, cefuroxime, cefoxin - are prescribed intravenously and intramuscularly.
If gram-negative bacteria predominate, 3rd generation cephalosporins are prescribed - cefotaxime, ceftriaxone, ceftazidime.
For atypical pneumonia, macrolides are prescribed - azithromycin, midecamycin, as well as 3rd generation cephalosporins - ceftriaxone, ceftazidime, etc.
If gram-positive cocci, methicillin-resistant staphylococci or enterococci predominate, 4th generation cephalosporins - cefipin, carbapinems - thienam, meronem, etc. are prescribed.
If multiresistant gram-negative bacteria predominate, 3rd generation cephalosporins are prescribed - cefotaxime, ceftriaxone, ceftazidime, and aminoglycosides are additionally prescribed.
If fungal infection predominates, 3rd generation cephalosporins plus fluconazole are prescribed.
When intracellular organisms predominate - mycoplasma, legionella, etc., macrolides are prescribed - azithromycin, clarithromycin, roxithromycin, etc.
For anaerobic infection, inhibitor-protected penicillins are prescribed - lincomycin, clindamycin, metronidazole, etc.
For penumocystis pneumonia, cotrimoxazole and macrolides are prescribed.
For cytomegalovirus pneumonia, ganciclovir, acyclovir, and cytotect are prescribed.

Pneumonia is one of the most dangerous infectious diseases of the respiratory tract (airways), which is characterized by damage to the lower respiratory tract (alveoli) and lung parenchyma. The main principle of its treatment (as with bronchitis) is antibiotic therapy - that is, treatment aimed at eliminating the pathogen (that is, defeating the microorganism that led to pneumonia).

Without the use of antibiotics for pneumonia, it is almost impossible to cure a patient, since the rare immune system can cope with pneumonia on its own. All other approaches and techniques (treatment with probiotics, expectorants, detoxification therapy, antipyretic drugs, and everything else) are purely auxiliary, as with bronchitis. It is important to understand that using only antibiotic therapy, pneumonia can be cured, although with side effects that are very unpleasant, not without it. Without an antibiotic, pneumonia is incurable, unlike bronchitis, and there is a high probability of death, especially in a child.

It is not for nothing that before Fleming invented penicillin, pneumonia was one of the most common causes of death. It is fair to say that the invention of antibiotics is a new word in medicine, bringing it to a qualitatively new level. No homeopathic or Ayurvedic medicine can compare with the effectiveness of antibiotics, despite all the promotion that some pharmaceutical companies do.

So, into what groups are antibiotics classified for pneumonia and bronchitis, which of them are used in the treatment of pneumonia? This question is ambiguous, since, by and large, representatives of absolutely all pharmacological groups are applicable in the treatment of pneumonia. However, in the absolute, overwhelming majority of cases, the following groups of antibiotics for pneumonia are used:

These include penicillins, cephalosporins and carbapenems. The most proven representatives of these subgroups are the following:

Broad-spectrum cephalosporins. There are four generations of broad-spectrum cephalosporins.
Penicillins (unprotected and protected forms, which are characterized by resistance to the action of beta-lactamases - enzymes secreted for the purpose of protection by bacteria) - ospamox, augmentin, amoxiclav, sulbactam, ampicillin.

Broad-spectrum carbapenems – meronem, imipenem.

Macrolide group

Broad-spectrum antibiotics for pneumonia and bronchitis, produced exclusively in oral form. Well-proven antibiotics for pneumonia, long known in the domestic and foreign pharmaceutical markets. It should be noted that for some time there has been an increase in the resistance of microorganisms to these antibiotics due to incorrect diagnosis and non-compliance with the gradation of therapy, however, today the most modern forms of macrolides work well. The most famous and effective representatives today are azithromycin (Ziomycin, Sumamed, Azitsin-Darnitsa, Ormax, Azitro-Sandoz), clarithromycin (Klacid), rovamycin (Roxilide).

Fluoroquinolones

This is a group of broad-spectrum antibiotics for pneumonia and bronchitis, which has its own niche of use. It is used mainly as a reserve drug, in the presence of contraindications to all other groups. The most commonly used subgroup is the third generation respiratory fluoroquinolones, the best known representative is levofloxacin (Tigeron, Eleflox); Fourth generation fluoroquinolones, Ozerlik, are also used. Ciprofloxacin has proven itself to be the drug of choice in the treatment of all kinds of intestinal infections, although it can also help effectively cope and cure pneumonia.

A group of antibiotics for pneumonia and bronchitis - Aminoglycosides. They are considered reserve drugs. As a rule, amikacin or gentamicin is used against pneumonia. Incredibly effective drugs, but cause severe side effects.

Glycopeptides

A group of antibiotics for pneumonia and bronchitis - Glycopeptides. Vancomycin is a powerful antibiotic, used against pneumonia only in the intensive care unit.

In which clinical case is it better to prescribe which antibiotic?

There are several specific rules according to which antibiotics are prescribed for pneumonia, bronchitis and other infectious diseases:

Patient management tactics in each individual case

These are all the general rules and algorithms for treating pneumonia and bronchitis with antibiotics (and, in fact, like all other infectious diseases). However, in practice it is often necessary to deviate from these generally accepted standards and choose other antibiotics for pneumonia, especially if you have to treat it at home.

First, let's look at outpatient (polyclinic) practice. A patient comes to the consultation with complaints of an increase in temperature to febrile levels, a severe cough with the release of a large amount of sputum. Auscultation reveals an abundance of moist rales in the lower parts of the lungs; percussion - dullness of sound over one of the areas. Plus – classic symptoms in the form of intoxication, catarrhal manifestations. Yes, this patient does not yet have a plain X-ray of the chest organs, no, and for the next week there will be no sputum culture to determine the sensitivity of microorganisms to antibiotics; even a general analysis of urine and blood is not ready. However, he needs to start empirical therapy with broad-spectrum antibacterial drugs right now. Even if suddenly the diagnosis of pneumonia is not confirmed and there is ordinary bronchitis, you will still need to use an antibiotic. So the tactics of conducting will not change.

Which antibiotic is best for pneumonia? Good question. We must start solely from what characteristics the patient has and where we will treat him. An important note - only a mild form of pneumonia in the most responsible adult patient can be treated on an outpatient basis, that is, at home. All other cases should be sent to the hospital.

In the case of treatment at home, it would be best to use Augmentin 1000 mg at the rate of one tablet three times a day, with an interval of eight hours, for a course of seven days. If the patient has the opportunity to do intramuscular injections at home, it is better to prescribe ceftriaxone intramuscularly, one gram twice a day with an interval of twelve hours (again, a slight deviation from the standards of treatment, but in this case it is justified, since augmentin loses its effectiveness with each during the day). If an atypical etiology is suspected, you can prescribe a macrolide - azithromycin or clarithromycin, one tablet once a day, for a course of three to five days, depending on the severity of the condition. It is also possible to prescribe fluoroquinolones (for example, if the patient is allergic to beta-lactams) - then it will be possible to take levofloxacin 500 mg against pneumonia, drink one tablet once a day, a course of five days, regardless of , at home or in the hospital.

In the case of inpatient treatment of pneumonia or bronchitis, it is immediately necessary to use injectable forms of antibiotics for pneumonia in adults. If there is ordinary, community-acquired pneumonia, you can completely get by with antibiotics for pneumonia in adults, such as ceftriaxone, zinacef or cefoperazone. If there is a suspicion of a hospital infection (the same Pseudomonas aeruginosa), cefepime is recommended.

And if methicillin-resistant staphylococcus (MRSA) is cultured, it is necessary to use the most powerful antibiotics - aminoglycosides, carbapenems or glycopeptides. Today, the most powerful antibiotic therapy regimen is the combination of tienam + vancomycin + amikacin - it covers all microorganisms currently known to science.
Regarding the use of antibiotics in children, the difference lies in the dosages and the fact that many groups of antibacterial drugs are not applicable in childhood. Fighting pneumonia at home is also too risky. In children, only penicillins, cephalosporins and macrolides can be used. All other groups - exclusively for health reasons and in cases where the expected benefit outweighs the possible risk.

Conclusions

Antibiotic therapy is a serious direction in therapy, and therefore it is still not worth treating pneumonia at home. If only because you will have to give injections intravenously, intramuscularly - and this can cause an infection.