Sinusitis

Do azithromycin tablets help with pneumonia. Azithromycin in the treatment of lower respiratory tract infections

Scientific Center for Expertise and State Control of Medicines, Moscow

Clinical use of azithromycin (indications for use and treatment regimens)

The main indications for the use of azithromycin and the regimen for its use are presented in table. 4.

Among macrolides, azithromycin is the most commonly prescribed antibiotic for the treatment of infections of the upper and lower respiratory tract, infections of the skin and skin structures, sexually transmitted diseases, and diseases of the gastrointestinal tract.

Its role is especially great in community-acquired pneumonia, otitis media, sinusitis, the leading pathogens of which (Streptococcus spp., H.influenzae, M.catarrhalis, as well as atypical pathogens - Chlamydia, Legionella spp.) are highly sensitive to this antibiotic.

The problem of choosing optimal antibiotics and treatment regimens for community-acquired pneumonia remains relevant, despite the introduction into clinical practice of new generations of cephalosporins, new dosage forms of broad-spectrum penicillins, new fluoroquinolones, etc. Its severity is due to the highest frequency of visits to the population for pneumonia among outpatients patients with a high mortality rate (from 10 to 40%) when seeing a doctor late; diagnostic difficulties in home treatment conditions; changes in the structure and properties of pathogens, damage to immune defense systems.

Initial therapy for community-acquired pneumonia is almost always empirical due to the need for immediate initiation of treatment, especially in severe cases of the disease in the absence of data on its causative agent.

According to the recommendations of the American Thoracic Society, the Infectious Diseases Society of the United States, and the Canadian Consensus Group on Community-Acquired Infections, the use of azithromycin for community-acquired pneumonia, including in the form for intravenous administration (in severe cases), is considered the most appropriate. For initial treatment of hospitalized patients, it is recommended to prescribe beta-lactam antibiotics in combination with macrolides, taking into account in vitro data. The basis for the recommendation of azithromycin is the spectrum of action of the drug, covering the supposed typical and atypical pathogens of pneumonia. This is especially important from the point of view of varying data on the composition of its pathogens. Thus, when analyzing the results of 16 studies, the frequency of isolation of S. pneumoniae as the causative agent of pneumonia ranged from 1 to 76%. H. influenzae among the etiological agents ranked second in frequency of isolation (5-22%). Intracellular pathogens accounted for about 25%, and it was noted that hospitalization was required for only 5% of patients. Severe pneumonia was noted in the presence of risk factors such as old age, the presence of concomitant diseases, and the development of septic shock. Taking into account these data, the choice and prescription of azithromycin for community-acquired pneumonia is the most appropriate, due to its greatest activity against H. influenzae and M. catarrhalis among the compared drugs (Table 5).

Currently, a huge amount of experimental and clinical material has been accumulated that characterizes the current significance of azithromycin in the treatment of lower respiratory tract infections (pneumonia, acute and exacerbation of chronic bronchitis, diffuse panbronchiolitis, etc.). Many aspects of this problem are discussed in the review, especially from the point of view of the effectiveness of azithromycin in comparison with other modern antibiotics, optimization of treatment regimens with azithromycin, pharmacoeconomics of the drug in comparison with other regimens of antibacterial therapy for pneumonia, etc.

Azithromycin is not recommended for use in oral form for hospital-acquired pneumonia, which is due to the absence in its spectrum of the most severe pathogens of hospital-acquired pneumonia, such as Klebsiella spp. , Pseudomonas aeruginosa and other types of microbes of the Citro-Enterobacter-Serratia group, etc. At the same time, the main pathogens of community-acquired pneumonia are S. pneumoniae, H. influenzae, M.catarrhalis, as well as nosocomial pathogens such as C. pneumoniae, M. pneumoniae, L.pneumophila, are characterized by high sensitivity to azithromycin.

Azithromycin treatment regimens for pneumonia have been well established in recent years. As a result of multicenter clinical trials in large treatment centers on a large number of patients, a higher or similar effectiveness of short courses of therapy with azithromycin (3-5 days) was convincingly shown in comparison with the results of treatment with erythromycin for days or daily courses of treatment with other antibiotics - amoxicillin, amoxicillin / clavulanic acid , cefuroxime, cefaclor, etc.

With a treatment regimen of azithromycin orally, 500 mg on the 1st day once and 250 mg once a day from the 2nd to the 5th day, the treatment effect was 30% for clinical indicators and 70-80% for bacteriological indicators for pneumonia, caused by sensitive strains of pneumococci, moraxella, hemophilus influenzae.

The effectiveness of azithromycin (a 3-day course of treatment of 500 mg once daily orally) for community-acquired pneumonia was assessed in an open, non-comparative study in 66 patients. Microbiologically, 40 patients were examined and Legionella pneumophila, S.pneumoniae were isolated; a patient with repeated isolation of H. influenzae was excluded from the study. Based on the results of the study, it was concluded that the prescribed course of therapy was highly effective (clinical effect in 97% of cases, including cases of pneumococcal bacteremia in 6 patients). In patients with bacteremia, eradication of the pathogen from the blood was achieved within 48 hours, complete cure on the 14th day, adverse reactions in 6% of cases. There is also evidence of excellent results in the treatment of acute bronchitis, community-acquired pneumonia caused by azithromycin-sensitive strains of traditional bacterial pathogens, as well as chlamydial and legionella pneumonia. The drug was used according to the usual regimens: adults 500 mg on the first day and 250 mg in the next 4 days or a 3-day course of 500 mg once a day once and a daily dose of 5-10 mg/kg for children.

In comparative studies of azithromycin with erythromycin, roxithromycin, cefaclor and cefuroxime (all drugs were used according to typical treatment regimens for upper respiratory tract infections), the obvious advantages of azithromycin (5-day course of treatment) over other drugs were shown: effectiveness in more than 90% of cases clinical and more than 70% - in terms of bacteriological indicators, as well as in terms of tolerability and compliance. However, it is noted that these data relate to the use of azithromycin orally for community-acquired infections; There are no systematic data on the possibilities and effectiveness of treatment of severe forms of pneumonia in conditions of bacteremia and generalization of infection.

In connection with the emergence in the last decade of the problem of resistance to benzylpenicillin S.pneumoniae, the question arises of clarifying approaches to the selection of antibiotics for the treatment of community-acquired pneumonia caused by resistant strains. A feature of pneumococci resistant to benzylpenicillin (BP-R S.pneumoniae) is their cross-resistance to antibiotics of other groups, including macrolides (erythromycin and new semisynthetic ones - azithromycin, clarithromycin, etc.). The frequency of isolation of BP-R pneumococci varies among countries, regions, and hospitals and correlates with the frequency of isolation of macrolide-resistant strains. Thus, data are provided on the isolation of 17% of erythromycin-resistant pneumococci among BP-sensitive ones, 22% among strains with intermediate BP-R and 33% among BP-R. Taking this fact into account, it is obvious that there is a need for constant monitoring of the sensitivity of pneumococci not only to benzylpenicillin and macrolides, but also to antibiotics of other groups, since this resistance is multiple in nature, and control over its spread can serve as a certain guarantee of the effectiveness of antibacterial therapy for pneumococcal pneumonia.

In countries with a low detection rate of BP-R pneumococci, azithromycin and betalactams may retain their importance as first-line antibiotics for community-acquired pneumonia. In severe cases, combinations of betalactam antibiotics are prescribed parenterally in combination with erythromycin. Azithromycin or other macrolides are prescribed for suspected “atypical” pneumonia with simultaneous differential diagnosis between “typical” and “atypical” pneumonia, including subsequent laboratory confirmation.

In countries with a high rate of isolation of resistant pneumococci, azithromycin, like other macrolides, cannot be prescribed as first-line drugs. They are also not prescribed for patients with a high risk of developing infections caused by gram-negative microorganisms, weakened patients, with severe concomitant diseases, alcoholism, drug addiction, etc.

Assessing the effectiveness of azithromycin with an analysis of the causes of failure based on determining the etiology of the disease, antibiotic sensitivity, drug doses, duration of treatment courses, and the presence of risk factors in the patient will make it possible to clarify the therapeutic capabilities of azithromycin in various forms of pneumonia and the advisability of its use in certain clinical situations.

Azithromycin in the fight against pneumonia

Azithromycin is an antibiotic drug with quite powerful bactericidal properties. It copes well with both gram-positive bacteria and streptococci, as well as anaerobic microorganisms. Azithromycin is available in capsules. It is also worth noting that this drug is absorbed quite quickly and easily from the gastrointestinal tract.

Cervicitis, bronchitis, erysipelas, dermatoses, gonorrhea, infectious diseases of the urinary system– all this is also subject to azithromycin.

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azithromycin for pneumonia

Questions and answers on: azithromycin for pneumonia

I went to my phthisiatrician that same day and the commission decided that!! I came to her and said give me a certificate, the child cannot be examined properly without it!! She says that at the commission we finally decided that there were improvements, but insignificant, it was still pneumonia! She looked at me, there was no cough, and she tested sputum again that day. She prescribed Azithromycin to come to her for 10 days; the child does not need to be examined yet.

I took the pills and came to see her on the 9th day. I donated blood, macular examination, and had an x-ray done! I’m sitting here waiting for a description! And so I go to her, she says that after all, we are diagnosing you with infiltrative tuberculosis, MBT (-). Trial treatment for 2 months until this macrota comes! It is treated at home, go every day to get pills. What does it have to do with I was surprised to receive pills not from them, but from my own clinic. I was still surprised, I said something like this: Why is it in your dispensary? And where are the healthy people!! She says that no one will let you into the tuberculosis dispensary!! There are sick people there! But it’s like yours is just starting, and you’re not contagious. I’ll soon take the child to the nursery! I don’t have any certificates on hand, I just wrote on a piece of paper that I should give it to the nursery! They didn’t register me, they said that it’s a trial treatment, it all depends on the sputum that will come in 2 months!

I have a lot of questions: Please tell me something. Help with a word. I’m crying, I feel bad. I’m all at a loss

1) Can a diagnosis be made only on the basis of an x-ray? If all tests are normal, there is no cough, the Diaskin test is negative, the sputum is negative!

I'm just really worried. Can you simply make a diagnosis based on X-rays?! And even get the pills in your clinic!! There are a lot of contradictions with such a disease!

1. First rise in temp. up to 39 C was at the beginning of January 2016, they shot down the special ones. help, 2nd day 38.4, 3rd and 4th - dropped to normal.

3. In the next two weeks after discharge, I froze.

4. The third rise in temperature: 03/02/2016 to 39 and even to 40.5 (single). Laboratory tests were done: Chlamydia - negative, Toxoplasma - negative, Hepatitis A, B, C - negative, ECHO of the heart - no additional structures were found on the valves, deflection of the anterior wall by 4 mm, ultrasound of the abdominal organs - enlarged liver and spleen (splenomegaly), which is observed throughout the entire treatment period, Antinuclear bodies (ANA-9) - all negative, MRI naked. brain - no pathology was detected, ultrasound of the thyroid gland - no pathology was detected, analysis of bone marrow punctunate - leukemoid reaction of the neutrophil type, HIV - negative, increased Aspartaminotransphenase 46.6, Alanine aminotransphenase - 97.9, Gammaglutamyltransphenase - 215, Total cholesterol - 6.91 (yes) laboratory tests of Eurolab), Anti-CCP - 28, 31 (by March 29 - already 42, 69), Herpes type 6 was detected (5 copies of DNA), treated for 10 days with cymevene - twice 500 ml / day, not in the subsequent analysis discovered. S-RB - 102, Antistreptolysin 03/09, and 03/29. An MRI of the knee joints was done - initial degenerative changes. Due to hypotremia, Solumedrol was introduced for 7 days at a dose of 165 mg/day, stopped for a day, due to which acute knee pain and a rise in temperature appeared, introduced at a dose of 80 mg/day, and is now taking Metypred 32 mg per day. When trying to reduce it to 24 mg/day, the temperature rose to 38.2, but returned to 32 mg/day. MRI of the knees. sust. - initial degenerative-dystrophic changes. Rheumat. factor - 2.57 03.13.2016 and 2.03.2016. AT to double-stranded DNA - 1.00. Analysis for Ferritin dated March 29, C-reactive protein - 9.3, Procalcitonin

Use of Azithromycin for pneumonia and colds

With the arrival of cold weather, the body begins to freeze very much. So I got sick! I stood at the bus stop, waited a long time for the minibus, got very cold, and lo! Temperature 39, weakness, severe cough, after which the throat and lungs hurt greatly. I called an ambulance. The doctor prescribed Azithromycin for pneumonia (yes, that’s what I was diagnosed with)

Indications for use

Azithromycin is prescribed if there is an infection in the respiratory tract, as well as in the nasopharynx. This drug is also used for inflammatory infectious processes of the skin, as well as for diseases of the urinary and reproductive system with the Chlamydia virus.

It is worth noting that today Azithromycin occupies the first position among effective and popular antimicrobial drugs. It has a positive effect on the bronchial system and very quickly leads the body to recovery.

Azithromycin is a new product in the pharmacological world, which is sold at the most affordable prices. Azithromycin is your assistant in the fight against the hated cough.

Experts prescribe Azithromycin to people with pneumonia as an excellent antimicrobial agent that will quickly bring the body out of such a critical condition.

Everyone knows that pneumonia is a serious disease that requires treatment only with antibiotics. In this case, azithromycin will help, since it is considered a powerful broad-spectrum antibiotic. It eliminates gram-positive bacteria and anaerobic microorganisms.

It is produced only in capsules. It is very quickly absorbed into the gastrointestinal tract, and from there it enters the bloodstream and spreads throughout the body.

Contraindications

There are also some contraindications to the use of this drug. It should not be prescribed to children under 12 years of age, as well as to people with kidney and liver failure.

It is also prohibited to prescribe this drug to pregnant and lactating women, as well as to those who may have allergic reactions to the components of this medicine.

Side effects

Experts warn that Azithromycin should be taken strictly as directed by a specialist doctor, as it has many side effects.

They are observed from the central nervous, circulatory systems, sensory organs, as well as the gastrointestinal tract. If symptoms of a drug overdose appear, it is imperative to cleanse the stomach by lavage and call an ambulance!

You also need to be very careful when using it with other medications, since it is not compatible with anything.

How to take Azithromycin

The usual dose of the drug prescribed by doctors is 1 mg. It should be taken once a day and preferably an hour or two after meals.

The dosage depends on the disease, weight and age of the patient. It should be noted that you need to take the drug very seriously and if you forget to take the next dose on time, you do not need to wait for the next dose, but take it as soon as you remember. Take the following medication doses on a regular schedule, as prescribed by your specialist doctor.

Since Azithromycin is a drug of the antibiotic group, it is necessary to take antifungal therapy along with it. During treatment with this drug, you should stop driving a car and also not engage in activities that require maximum concentration.

My results and results

This drug helped me get back on my feet very quickly. Azithromycin eliminated all the coughing and thereby helped me get rid of pain in the chest area. After the first use, the body temperature stabilized and weakness disappeared.

I am very grateful to Azithromycin that I got back on my feet so quickly. I recommend it to everyone!

Azithromycin in the treatment of community-acquired pneumonia

Community-acquired pneumonia (synonyms: home, outpatient) is an acute disease that arose in a community setting, accompanied by symptoms of lower respiratory tract infection (fever, cough, chest pain, shortness of breath) and “fresh” focally infiltrative changes in the lungs in the absence of obvious diagnostic alternatives.

Community-acquired pneumonia (CAP) can be divided into 3 groups:

1. Pneumonia that does not require hospitalization. This group of patients is the largest, accounting for up to 80% of all patients with pneumonia; these patients have mild pneumonia and can receive therapy on an outpatient basis; mortality does not exceed 1-5%.

2. Pneumonia requiring hospitalization of patients in a hospital. This group makes up about 20% of all pneumonias; patients have underlying chronic diseases and severe clinical symptoms; the risk of mortality in hospitalized patients reaches 12%.

3. Pneumonia requiring hospitalization of patients in intensive care units. Such patients are defined as patients with severe community-acquired pneumonia. The mortality rate for severe pneumonia is about 40%.

The reasons for the development of an inflammatory reaction in the respiratory parts of the lungs can be either a decrease in the effectiveness of the body’s defense mechanisms, or a massive dose of microorganisms and/or their increased virulence. Aspiration of the contents of the oropharynx is the main route of infection of the respiratory parts of the lungs, and therefore the main pathogenetic mechanism for the development of pneumonia. Under normal conditions, a number of microorganisms (eg, Streptococcus pneumoniae) can colonize the oropharynx, but the lower respiratory tract remains sterile. In cases of damage to the “self-cleaning” mechanisms of the tracheobronchial tree, for example, during a viral respiratory infection, favorable conditions are created for the development of pneumonia. In some cases, an independent pathogenetic factor may be the massive dose of microorganisms or the penetration into the respiratory parts of the lungs of even single highly virulent microorganisms that are resistant to the action of the body’s defense mechanisms, which also leads to the development of pneumonia.

The etiology of CAP is directly related to the normal microflora colonizing the upper respiratory tract. Of the numerous microorganisms, only a few that have increased virulence are capable of causing an inflammatory reaction when they enter the lower respiratory tract.

Such typical pathogens of community-acquired CAP are: Streptococcus pneumoniae, Haemophilus influenzae.

Atypical microorganisms have a certain significance in the etiology of community-acquired CAP, although it is difficult to accurately determine their etiological significance: Chlamydophila (Chlamydia) pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila.

Typical but rare pathogens of CAP include: Staphylococcus aureus, Klebsiella pneumoniae, and less commonly, other enterobacteriaceae.

Streptococcus pneumoniae is the most common causative agent of CAP in people of all age groups. Due to the difficulty of identifying the pathogen, initial therapy for CAP in the vast majority of cases is empirical. The choice of drugs is based on data on the frequency of occurrence of certain pathogens in different age groups, the local level of antibiotic resistance, the clinical picture of the disease and epidemiological information.

The initial choice of an antimicrobial drug is made empirically (i.e., before receiving the results of a microbiological study), since:

In at least half of the cases, the responsible microorganism cannot be identified even using the most modern research methods, and existing microbiological methods are rather nonspecific and insensitive;

Any delay in etiotropic treatment of pneumonia is accompanied by an increased risk of complications and mortality of pneumonia, while timely and correctly selected empirical therapy can improve the outcome of the disease;

Assessing the clinical picture, radiological changes, concomitant diseases, risk factors and severity of pneumonia in most cases allows you to make the right decision on the choice of adequate therapy.

At the same time, it is necessary to strive to clarify the etiological diagnosis, especially in patients with severe pneumonia, since such an approach may have an impact on the outcome of the disease. In addition, the advantages of targeted therapy include a reduction in the number of drugs prescribed, a reduction in the cost of treatment, a reduction in the number of side effects of therapy, and a decrease in the potential for the selection of resistant strains of microorganisms.

The choice of initial therapy depends on the severity of the disease, site of therapy, clinical and epidemiological factors. Since it is often difficult to immediately determine the type of causative agent of CAP, macrolides, which have a wide spectrum of antimicrobial action, are widely used drugs.

As an analysis of foreign data shows, macrolides are effective in 80-90% of patients with CAP. This is determined by their adequate spectrum of activity, including most potential pathogens, incl. mycoplasma, chlamydia and legionella, as well as favorable pharmacokinetic properties that lead to the creation of high concentrations in the lungs. An important factor determining the empirical choice of macrolides is the low level of resistance of a number of microorganisms to them. For example, mycoplasmas exhibit constant sensitivity to antibiotics of this group; the development of resistance to them has not been described. In Russia, the level of macrolide resistance of the most common causative agent of CAP, S. Pneumoniae, is less than 5%. Moreover, in a number of microorganisms, sensitivity to macrolides was restored after a period of decreased intensity of their use.

The advantages of macrolides also include low toxicity and good tolerability, including low allergenic potential. The frequency of hypersensitivity reactions when used does not exceed 0.5%, which is significantly lower than that during treatment with penicillins (up to 10%) and cephalosporins (up to 4%), and therefore macrolides are considered the drug of choice in patients with allergies to 3-lactam antibiotics .

North American guidelines for the treatment of CAP consider macrolides as first-line drugs. Their effectiveness and safety are confirmed by the results of a meta-analysis of clinical studies.

It has been suggested that macrolides not only have a therapeutic effect, but also help prevent carriage of atypical pathogens, which can lead to a decrease in the frequency of recurrent cases of PFS and a decrease in morbidity.

The above factors determine the widespread use of macrolides in adults and children for lower respiratory tract infections, starting in 1952, when the first representative of this pharmacological group, erythromycin, appeared on the international pharmaceutical market. In subsequent years, new antibiotics from the macrolide group were developed, differing from erythromycin primarily in improved pharmacokinetic properties and better tolerability.

The most widely used among modern macrolides is azithromycin. More than 20 years of experience in the use of azithromycin in clinical practice indicates its truly worldwide recognition. During this time, the drug has proven itself in the treatment of various infectious diseases, and primarily bronchopulmonary infections. According to the results of a study by the European Society of Antimicrobial Chemotherapy (ESAC), conducted in 2009, in most European countries, macrolides rank second in terms of consumption among antibiotics used in outpatient practice, second only to penicillins. Azithromycin and clarithromycin are among the “top five” most actively sold antimicrobial drugs in the world. Consumption of azithromycin reaches colossal volumes and continues to increase steadily. In 1999, azithromycin was the most prescribed macrolide drug in the world (IMS Drug Monitor, 1999), with sales exceeding US$1 billion in 2002.

compared to others

Azithromycin (Zitrocin) is a semisynthetic antibiotic from the group of 15-membered macrolides or azalides. This chemical structure determines its improved pharmacokinetics, primarily significantly increased acid resistance (300 times compared to erythromycin), better absorption from the gastrointestinal tract and more reliable bioavailability. The features of azithromycin that distinguish it from other macrolides are its very long half-life (up to 79 hours) and the ability to create higher concentrations in tissues. Azithromycin is superior to other macrolides in its ability to accumulate intracellularly. It is actively captured by phagocytes and delivered to foci of infectious inflammation, where its concentrations are 24-36% higher than those in healthy tissues. The ability of azithromycin to penetrate phagocytes is 10 times higher than that of erythromycin.

Due to its high lipophilicity, azithromycin (Zitrocin) is well distributed throughout the body, reaching levels in various organs and tissues that far exceed the minimum inhibitory concentrations (MIC) for the main pathogens of the corresponding localization. Intracellular concentrations of the drug are several times higher than those in the blood plasma. The highest concentrations are created in the tonsils, adenoids, middle ear exudate, bronchial mucosa and bronchial secretions, as well as in the epithelium of the alveoli. A high level of the drug in the bronchi and lungs is maintained for several days after its discontinuation. The spectrum of action of azithromycin is wider than that of erythromycin, due to microorganisms such as Borrelia burg-dorferi, Helicobacter pylori, the intracellular complex of Mycobacterium avium, Cryptosporidium spp. and Toxoplasma gondii. The activity of azithromycin against gram-positive microorganisms is comparable to that of erythromycin, but it is superior to erythromycin in its activity against gram-negative microorganisms in vitro. In particular, azithromycin is 2-8 times more active than erythromycin against H. influenza, including 3-lactamase-producing strains, which occur in approximately 20-40% of cases. Azithromycin is superior to erythromycin in activity against Legionella spp., H. ducreyi, Campylobacter spp. and some other microorganisms. The drug acts on all major pathogens of lower respiratory tract infections, including S. pneumoniae, H. influenzae, M. catarrhalis, M. pneumoniae and C. pneumoniae. According to Japanese authors, azithromycin remains active against pneumococci resistant to other macrolides.

Azithromycin (Zitrocin) has a post-antibiotic effect, incl. against such pathogens of community-acquired pneumonia as S. pneumoniae and H. influenzae.

The advantage of azithromycin over other macrolides, as well as most antibiotics of other groups, is a once-daily dose and a short course of treatment, which is convenient for both children and their parents. A convenient regimen of administration, in turn, increases the accuracy of following therapeutic recommendations.

The advantages of azithromycin include high safety and good tolerability, due to both a favorable adverse reaction profile and a low potential for clinically significant drug interactions. According to the results of meta-analyses, the rate of discontinuation of azithromycin due to adverse reactions is 0.7% for lower respiratory tract infections and 0.8% for upper respiratory tract infections. The discontinuation rate of comparison antibiotics according to the results of these meta-analyses was for amoxicillin/clavulanate - 2.3-4%, cefaclor - 1.3-2.8%, erythromycin -1.9-2.2%, clarithromycin - 0.9 -1%. In clinical studies, azithromycin rarely caused serious adverse reactions, the cause-and-effect relationship of which with the drug has not been fully established.

The ability of macrolides to enter into drug interactions is mainly determined by their effect on enzymes of the cytochrome P450 system in the liver. According to the degree of inhibition of cytochrome P450, they are arranged in the following order: clarithromycin > erythromycin > roxithromycin > azithromycin > spiramycin. Thus, with regard to drug interactions, azithromycin (Zitrocin) is safer than most other macrolides. Unlike erythromycin and clarithromycin, it does not interact clinically with cyclosporine, cisapride, pimozide, disopyramide, astemizole, carbamazepine, midazolam, digoxin, statins and warfarin.

Azithromycin (Zitrocin) is recommended to be taken before meals, since under the influence of food its bioavailability, according to some data, may decrease. However, 3 studies showed that food did not affect the bioavailability of azithromycin in dosage forms such as 250 mg tablets, 1000 mg powders and 500 mg pediatric suspension. The results of these studies indicate that taking azithromycin (Zitrocin) does not need to be tied to meals, which makes the use of the drug even easier.

Thus, the main properties of azithromycin, which allow it to maintain a strong position in the treatment of not only community-acquired pneumonia, but also other respiratory tract infections, come down to the following:

High activity against the main pathogens of lower respiratory tract infections (S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, Enterobactericae);

Activity against intracellular atypical pathogens;

Low resistance of S. pneumoniae and H. influenzae to azithromycin;

High concentration in various bronchopulmonary structures;

Presence of post-antibiotic effect;

No clinically significant interactions with other drugs;

Convenient dosing regimen;

Availability of the drug in various dosage forms.

In the modern extensive arsenal of antibacterial drugs intended for the treatment of bronchopulmonary infections, azithromycin continues to occupy an important place.

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Azithromycin in the treatment of community-acquired pneumonia

Department of Therapy and Occupational Diseases MMA named after. I.M. Sechenov, Moscow State University. M.V. Lomonosova

In recent years, it would seem that everything that can be said has already been said about community-acquired pneumonia, but attention to this problem has not weakened, as reflected in the constant flow of publications and recommendations on the diagnosis and treatment of pneumonia. Such interest is quite understandable. On the one hand, community-acquired pneumonia remains one of the most common infectious diseases, and on the other hand, the changing epidemiological situation forces us to reconsider existing approaches to treatment and re-evaluate the role of certain antibacterial drugs. Currently, there is a clearly defined list of antibiotics that are considered possible throughout the world to be used for empirical treatment of community-acquired pneumonia. One of them is azithromycin (Sumamed), which appears in all recommendations devoted to this disease. The choice of this azalide antibiotic is determined by the spectrum of action, which includes the main causative agents of community-acquired pneumonia, pharmacokinetics/pharmacodynamics features that make shortened courses of treatment possible, and a variety of release forms that allow the drug to be prescribed in any situation. What is the place of azithromycin in modern therapy for community-acquired pneumonia?

Results of controlled clinical studies

The effectiveness of azithromycin in the treatment of community-acquired pneumonia has been proven in numerous controlled studies. Over 10 years, 29 such studies were published in a total of 5901 patients, including 762 children. 12 studies included patients with various infections, 8 with exacerbation of chronic bronchitis and 9 with pneumonia. Macrolides (erythromycin, clarithromycin, roxithromycin, dirithromycin) were used as comparison drugs in 8 studies, penicillins (co-amoxiclav, amoxicillin, benzylpenicillin) in 13, cephalosporins (cefaclor, cefuroxime axetil, ceftibuten) in 4 and fluoroquinolones (moxifloxacin) in 1 Most often (in 9 studies) azithromycin was compared with co-amoxiclav. The effectiveness of both 3-day and 5-day courses of azithromycin therapy was high and in most studies was comparable to that of 10-day courses of treatment with comparator drugs. In 5 studies, azithromycin was superior to comparators (co-amoxiclav, erythromycin, benzylpenicillin and ceftibuten). It should be noted that a small but statistically significant superiority of azithromycin over co-amoxiclav was noted in two large studies in 759 patients with exacerbation of chronic bronchitis (clinical effectiveness 89.7 and 80.2%, respectively, p = 0.0003) and 481 patients with lower respiratory tract infections (95.0 and 87.1%, p=0.0025). Tolerability of therapy in the study and control groups was generally comparable, although in 4 studies azithromycin caused adverse reactions less frequently than co-amoxiclav or cefuroxime. The difference was mainly due to a lower incidence of gastrointestinal disorders.

Empirical therapy for pneumonia in outpatient settings

The etiology of community-acquired pneumonia depends on many factors and may vary significantly between studies. Its main causative agent remains Streptococcus pneumoniae. In modern conditions, the role of atypical microorganisms, including M. pneumoniae, C. pneumoniae, L. pneumophila, is growing in the etiology of community-acquired pneumonia. Much less often, pneumonia is caused by N. influenzae, as well as S. aureus, Klebsiella and other enterobacteria. Often, mixed or co-infection is detected in patients. In recent years, the main concern among specialists has been the spread of penicillin-resistant strains of pneumococcus, which often show resistance to several classes of antibacterial drugs, i.e. are multiresistant. In some countries, the proportion of such strains reaches 40-60%. However, for Russia this problem is apparently not relevant yet. According to monitoring of the resistance of clinical strains of S. pneumoniae in the multicenter Russian study PeGAS, the proportion of resistant strains remains low. Only 6-9% of pneumococcal strains were resistant to macrolides, including azithromycin.

When should azithromycin be prescribed? Any antibiotic intended for empirical treatment of community-acquired pneumonia must have activity against S. pneumoniae. It is also desirable that it act on atypical pathogens. Macrolide antibiotics meet these requirements, therefore, in all recommendations they are considered the means of choice in the treatment of community-acquired pneumonia of mild to moderate severity that does not require hospitalization. The advantage of azithromycin over most other macrolides is its activity against H. influenzae, which further expands the indications for its use. The range of drugs that are active against pneumococcus and atypical pathogens is not so wide. In addition to macrolides, these include respiratory fluoroquinolones (levofloxacin, moxifloxacin) and tetracyclines. There is no reason yet for wider use of the former in routine clinical practice (including due to high cost), while the use of tetracyclines is hampered by the spread of resistant strains of pneumococcus. The advantages of azithromycin over amoxicillin and other beta-lactams are especially obvious if there is a high likelihood of atypical pneumonia (gradual onset, symptoms of upper respiratory tract damage, nonproductive cough, headache, etc.). Mycoplasma pneumoniae is the main causative agent of pneumonia in school-age children, so macrolides should always be preferred in such cases, especially if they are available in the form of a suspension. In pediatric practice, macrolides essentially have no competitors, since fluoroquinolones cannot be prescribed to children. When treating pneumonia in young children, the possibility of prescribing azithromycin once a day and a short course of therapy (3-5 days) is of particular importance.

All recommendations highlight situations when the usual spectrum of pneumonia pathogens changes and, accordingly, there is a need to modify approaches to empirical therapy. The draft domestic recommendations for the diagnosis and treatment of community-acquired pneumonia (2005) propose dividing adult patients into two groups depending on age (younger or older than 60 years) and the presence of a number of unfavorable prognostic factors:

chronic obstructive pulmonary disease (COPD);
diabetes mellitus;
congestive heart failure;
chronic renal failure;
cirrhosis;
alcoholism, drug addiction;
body weight deficiency.

In elderly patients with these risk factors, the etiological role of H. influenzae and other gram-negative bacteria increases. Accordingly, in this case it is better to use amoxicillin/clavulanate or respiratory fluoroquinolones. It should be noted, however, that the issue of the etiology of community-acquired pneumonia in older people is complex. For example, in a Finnish study, in 48% of 345 patients over the age of 60 years, the cause of pneumonia was S. pneumoniae, in 12% - C. pneumoniae, in 10% - M. pneumoniae, and only 4% - H. influenzae. This spectrum of pathogens “ideally” corresponds to the spectrum of activity of azithromycin. The results of controlled studies did not confirm the benefits of co-amoxiclav over azithromycin in patients with exacerbation of COPD (see above). R. Panpanich et al. conducted a meta-analysis of comparative studies of azithromycin and amoxicillin (amoxicillin/clavulanate) in more than 2500 patients with acute bronchitis, pneumonia and exacerbation of chronic bronchitis. In general, no significant differences between these drugs were found in clinical and microbiological effectiveness, although in some studies azithromycin had certain advantages. In addition, its use was associated with a lower incidence of adverse effects (relative risk 0.75).

American guidelines list azithromycin as the drug of choice in the treatment of community-acquired pneumonia in patients with concomitant diseases (COPD, diabetes mellitus, renal or heart failure, or malignant tumor) who have not received antibiotics. If patients have recently undergone antibiotic therapy, then macrolides should be combined with beta-lactams. The possibility of combination therapy is also indicated in domestic recommendations.

Empirical therapy for pneumonia in hospitalized patients

In accordance with modern concepts, a significant number of patients with community-acquired pneumonia can receive antibacterial drugs orally and, accordingly, do not require hospital treatment. In this regard, it is very important to correctly identify patients who should be hospitalized. The most important signs for resolving this issue are signs of the severity of pneumonia, for example, high fever (>40°C), tachypnea, arterial hypotension, severe tachycardia, disturbances of consciousness, damage to more than one lobe of the lung, the presence of decay cavities, pleural effusion, etc. Reasons for hospitalization may include old age, serious concomitant diseases, the impossibility of organizing treatment at home, the ineffectiveness of previous antibacterial therapy, or the wishes of the patient or his relatives. Particular attention is paid to patients whose severity of condition dictates the need for emergency hospitalization in the intensive care unit (rapid progression of infiltrative changes in the lungs, septic shock, acute renal failure, etc.). To objectively assess the condition of patients and prognosis, it has been proposed to use various scales (for example, Pneumonia Outcomes Research Team - PORT), but they are rarely used in routine practice.

The group of hospitalized patients with community-acquired pneumonia is heterogeneous. Among them, there may be a fairly significant proportion of patients with non-severe pneumonia (this can be facilitated by simplified hospitalization in departmental medical institutions). Consequently, in many cases, approaches to the treatment of pneumonia in outpatient and hospitalized patients are the same and involve oral use of antibiotics, including azithromycin, although doctors still usually prefer their parenteral administration. When choosing parenteral antibiotics for the treatment of more severe pneumonia, the possible etiological role of gram-negative pathogens (H. influenzae, Enterobacteriaceae) should be taken into account; therefore, inhibitor-protected penicillins and cephalosporins of the second-third generation (ceftriaxone, cefotaxime, etc.) are usually considered the drugs of choice. However, pneumonia can also be caused by atypical pathogens in hospitalized patients. For example, the role of Legionella pneumophila in the development of severe pneumonia requiring ICU admission is well known. To completely cover the spectrum of the most likely pathogens of pneumonia, macrolides should always be included in combination therapy. This point of view is reflected both in the draft domestic recommendations (Table 1) and in the American recommendations for the treatment of pneumonia. The choice of route of use of a macrolide antibiotic depends on the severity of the patient's condition. In more severe cases, intravenous administration of azithromycin is preferable.

Ampicillin IV, IM ± macrolide orally 1;

Co-amoxiclav IV ± macrolide orally 1;

Cefuroxime IV, IM ± macrolide orally 1;

Cefotaxime IV, IM ± macrolide orally 1;

Ceftriaxone IV, IM ± macrolide orally 1

Azithromycin IV 3

Cefotaxime IV + macrolide IV

Ceftriaxone IV + macrolide IV

2 If an infection caused by P. aeruginosa is suspected, the drugs of choice are ceftazidime, cefepime, cefoperazone/sulbactam, ticarcillin/clavulanate, piperacillin/tazobactam, carbapenems (meropenem, imipenem), ciprofloxacin. If aspiration is suspected - amoxicillin/clavulanate, cefoperazone/sulbactam, ticarcillin/clavulanate, piperacillin/tazobactam, carbapenems (meropenem, imipenem).

3 In the absence of risk factors for antibiotic-resistant S. pneumoniae, Gram-negative enterobacteria, or Pseudomonas infections

Combination therapy is supported by reports that it is associated with an improved prognosis and a shorter length of hospital stay. R.Brown et al. retrospectively analyzed the effect of initial therapy on 30-day mortality, hospital costs, and length of stay in near-patients hospitalized for pneumonia. Depending on the therapy, they were divided into the following groups: monotherapy with ceftriaxone, other cephalosporins, fluoroquinolones, macrolides or penicillins or combination therapy with these drugs and macrolides. The addition of macrolides in all groups led to a decrease in mortality compared to that with monotherapy with antibiotics of the same groups from 5-8 to<3% (р>0.05). Treatment with ceftriaxone in combination with a macrolide was also associated with a reduction in length of hospitalization and total costs (p<0,0001). У пациентов молодого и пожилого возраста результаты исследования оказались в целом сходными, хотя у молодых людей летальность была ниже.

It cannot be excluded that the choice of macrolide antibiotic may influence the results of combination therapy. F. Sanchez et al. compared the effectiveness of treatment with ceftriaxone in combination with azithromycin (3 days) or clarithromycin (10 days) in 896 elderly patients with community-acquired pneumonia. The two groups of patients were comparable in severity of pneumonia and frequency of bacteremia. In the azithromycin group, a decrease in the duration of hospitalization was found (7.4 versus 9.4 days in the clarithromycin group; p<0,01) и летальности (3,6 и 7,2%; р<0,05). По мнению авторов, полученные данные необходимо подтвердить в дополнительных исследованиях.

Possible mechanisms for the beneficial effect of combination therapy on the prognosis of the disease: 1) expansion of the spectrum of action against pathogens of pneumonia; 2) anti-inflammatory activity of macrolides; 3) possible advantages of using two agents that act on one pathogen; 4) coinfection caused by atypical pathogens. The third mechanism can be confirmed by the results of the use of beta-lactams in combination with macrolides in a 10-year study in 409 patients with pneumococcal pneumonia accompanied by bacteremia. In multivariate regression analysis, the authors identified 4 independent factors that were associated with death: shock (p<0,0001), возраст 65 лет и старше (р=0,02), устойчивость к пенициллину и эритромицину (р=0,04) и отсутствие макролида в составе стартовой антибиотикотерапии (р=0,03). Привлекательной выглядит и гипотеза о противовоспалительных и иммуномодулирующих свойствах макролидных антибиотиков, которые подтверждены в многочисленных исследованиях in vitro и in vivo . Установлено, что азитромицин оказывает двухфазное действие при инфекционных заболеваниях. В острую фазу он усиливает защитные механизмы организма и подавляет рост возбудителей, а в более поздние сроки индуцирует апоптоз нейтрофилов и других воспалительных клеток, ограничивая воспаление.

In a hospital, treatment of pneumonia (regardless of severity) almost always begins with parenteral administration of antibiotics. A rational approach to reducing costs and length of patient stay in the hospital is step therapy, which involves switching to oral use of an antibacterial drug after body temperature normalizes and other symptoms of pneumonia disappear. Ideally, stepwise therapy uses the same antibiotic, available in different forms. Although most hospitalized patients with community-acquired pneumonia are recommended for combination antibacterial therapy, in some cases stepwise monotherapy with azithromycin is also possible (500 mg once daily intravenously for 2-5 days, and then 500 mg once daily orally; total course duration 7 -10 days). Domestic experts consider it justified in patients with non-severe pneumonia who do not have risk factors for infection with antibiotic-resistant S. pneumoniae (age over 65 years, therapy with beta-lactams for the last 3 months, chronic alcoholism, immunodeficiency conditions, including therapy with systemic glucocorticoids), enterobacteria (concomitant cardiovascular and bronchopulmonary diseases) and P. aeruginosa (“structural” lung diseases, for example, bronchiectasis, systemic therapy with glucocorticoids, broad-spectrum antibiotics for more than 7 days in the last month, exhaustion). The American Thoracic Society guidelines (2001) indicate that azithromycin monotherapy is possible in hospitalized young and middle-aged patients with mild community-acquired pneumonia in the absence of serious cardiovascular and bronchopulmonary diseases, renal or hepatic insufficiency, impaired immune system and risk factors for the discovery of resistant pathogens (previous antibiotic therapy for 3 months, hospital stay for the next 14 days, etc.).

The effectiveness of azithromycin monotherapy in hospitalized patients with community-acquired pneumonia has been confirmed in a number of clinical studies. R. Feldman et al. compared the results of azithromycin (n=221) and antibiotics recommended (n=129) and not recommended (n=92) by the American Thoracic Society in patients with mild to moderate pneumonia who were not immunosuppressed or had metastatic cancer. Clinical outcomes were not significantly different in the three groups, but the average length of hospitalization in the azithromycin group was significantly lower (4.35 days) than in the other two groups (5.73 and 6.21 days, respectively; p = 0.002 and p<0,001). Сходные результаты были получены в другом исследовании у 92 госпитализированных больных внебольничной пневмонией, у которых сравнивали эффективность монотерапии азитромицином и другими парентеральными антибиотиками . У больных, получавших азитромицин, средняя длительность пребывания в стационаре была в два раза короче, чем в группе сравнения (4,6 и 9,7 дня соответственно; р=0,0001). В открытом рандомизированном исследовании у 202 госпитализированных больных внебольничной пневмонией сравнивали эффективность ступенчатой монотерапии азитромицином и цефуроксимом/эритромицином . По клинической эффективности две схемы не отличались (выздоровление или улучшение у 77 и 74% больных соответственно), хотя средняя длительность терапии в группе азитромицина была достоверно короче (р<0,05).

Based on an analysis of antibiotic resistance of pneumococci, the results of clinical studies and existing recommendations, the following conclusions can be drawn regarding the role of azithromycin in the treatment of community-acquired pneumonia:

Considering the high activity of Sumamed against the main pathogens of respiratory tract infections, especially pneumococcus and Haemophilus influenzae, and the growing role of atypical pathogens in the etiology of community-acquired pneumonia, azithromycin remains the drug of choice in patients with mild to moderate pneumonia that does not require hospitalization (3-5 day course );
in patients with severe community-acquired pneumonia, the drug is the drug of choice in combination with beta-lactam antibiotics;
the appearance of the intravenous form of Sumamed expands the therapeutic capabilities of the doctor thanks to the use of modern treatment technology - step therapy;
Sumamed's unique biphasic immunomodulatory/anti-inflammatory properties modify the immune response, increasing the body's innate ability to defend against infections and promoting the resolution of inflammation, including chronic and long-term inflammation.

S.V. Moiseev
Department of Therapy and Occupational Diseases MMA named after. I.M. Sechenov, Moscow State University. M.V. Lomonosova

Results of controlled clinical studies

The effectiveness of azithromycin in the treatment of community-acquired pneumonia has been proven in numerous controlled studies. Over 10 years (1991-2001), 29 such studies were published in a total of 5901 patients, including 762 children. 12 studies included patients with various infections, 8 with exacerbation of chronic bronchitis and 9 with pneumonia. Macrolides (erythromycin, clarithromycin, roxithromycin, dirithromycin) were used as comparison drugs in 8 studies, penicillins (co-amoxiclav, amoxicillin, benzylpenicillin) in 13, cephalosporins (cefaclor, cefuroxime axetil, ceftibuten) in 4 and fluoroquinolones (moxifloxacin) in 1 Most often (in 9 studies) azithromycin was compared with co-amoxiclav. The effectiveness of both 3-day and 5-day courses of azithromycin therapy was high and in most studies was comparable to that of 10-day courses of treatment with comparator drugs. In 5 studies, azithromycin was superior to comparators (co-amoxiclav, erythromycin, benzylpenicillin and ceftibuten). It should be noted that a small but statistically significant superiority of azithromycin over co-amoxiclav was noted in two large studies in 759 patients with exacerbation of chronic bronchitis (clinical effectiveness 89.7 and 80.2%, respectively, p = 0.0003) and 481 patients with lower respiratory tract infections (95.0 and 87.1%, p=0.0025). Tolerability of therapy in the study and control groups was generally comparable, although in 4 studies azithromycin caused adverse reactions less frequently than co-amoxiclav or cefuroxime. The difference was mainly due to a lower incidence of gastrointestinal disorders.

Empirical therapy for pneumonia in outpatient settings

The etiology of community-acquired pneumonia depends on many factors and may vary significantly between studies. Its main causative agent remains Streptococcus pneumoniae. In modern conditions, the role of atypical microorganisms, including M. pneumoniae, C. pneumoniae, L. pneumophila. Pneumonia is caused much less frequently N. influenzae, and also S. aureus, Klebsiella and other enterobacteria. Often, mixed or co-infection is detected in patients. In recent years, the main concern among specialists has been the spread of penicillin-resistant strains of pneumococcus, which often show resistance to several classes of antibacterial drugs, i.e. are multiresistant. In some countries, the proportion of such strains reaches 40-60%. However, for Russia this problem is apparently not relevant yet. According to monitoring the resistance of clinical strains S. pneumoniae in the multicenter Russian study of PeGAS, the proportion of resistant strains remains low. Only 6-9% of pneumococcal strains were resistant to macrolides, including azithromycin.

When should azithromycin be prescribed? Any antibiotic intended for empirical treatment of community-acquired pneumonia must have activity against S. pneumoniae. It is also desirable that it act on atypical pathogens. Macrolide antibiotics meet these requirements, therefore, in all recommendations they are considered the means of choice in the treatment of community-acquired pneumonia of mild to moderate severity that does not require hospitalization. The advantage of azithromycin over most other macrolides is its activity against N. influenzae, which further expands the indications for its use. The range of drugs that are active against pneumococcus and atypical pathogens is not so wide. In addition to macrolides, these include respiratory fluoroquinolones (levofloxacin, moxifloxacin) and tetracyclines. There is no reason yet for wider use of the former in routine clinical practice (including due to high cost), while the use of tetracyclines is hampered by the spread of resistant strains of pneumococcus. The advantages of azithromycin over amoxicillin and other beta-lactams are especially obvious if there is a high likelihood of atypical pneumonia (gradual onset, symptoms of upper respiratory tract damage, nonproductive cough, headache, etc.). Mycoplasma pneumoniae is the main causative agent of pneumonia in school-age children, so in such cases macrolides should always be preferred, especially if they are available in the form of a suspension. In pediatric practice, macrolides essentially have no competitors, since fluoroquinolones cannot be prescribed to children. When treating pneumonia in young children, the possibility of prescribing azithromycin once a day and a short course of therapy (3-5 days) is of particular importance.

chronic obstructive pulmonary disease (COPD);
diabetes mellitus;
congestive heart failure;
chronic renal failure;
cirrhosis;
alcoholism, drug addiction;
body weight deficiency.

In elderly patients with these risk factors, the etiological role increases N. influenzae and other gram-negative bacteria. Accordingly, in this case it is better to use amoxicillin/clavulanate or respiratory fluoroquinolones. It should be noted, however, that the issue of the etiology of community-acquired pneumonia in older people is complex. For example, in a Finnish study, in 48% of 345 patients over the age of 60 years, the cause of pneumonia was S. pneumoniae 12% - S. pneumoniae, 10% - M. pneumoniae and only 4% - N. influenzae. This spectrum of pathogens “ideally” corresponds to the spectrum of activity of azithromycin. The results of controlled studies did not confirm the benefits of co-amoxiclav over azithromycin in patients with exacerbation of COPD (see above). R. Panpanich et al. conducted a meta-analysis of comparative studies of azithromycin and amoxicillin (amoxicillin/clavulanate) in more than 2500 patients with acute bronchitis, pneumonia and exacerbation of chronic bronchitis. In general, no significant differences between these drugs were found in clinical and microbiological effectiveness, although in some studies azithromycin had certain advantages. In addition, its use was associated with a lower incidence of adverse effects (relative risk 0.75).

Empirical therapy for pneumonia in hospitalized patients

The group of hospitalized patients with community-acquired pneumonia is heterogeneous. Among them, there may be a fairly significant proportion of patients with non-severe pneumonia (this can be facilitated by simplified hospitalization in departmental medical institutions). Consequently, in many cases, approaches to the treatment of pneumonia in outpatient and hospitalized patients are the same and involve oral use of antibiotics, including azithromycin, although doctors still usually prefer their parenteral administration. When choosing parenteral antibiotics for the treatment of more severe pneumonia, the possible etiological role of gram-negative pathogens should be taken into account (H. influenzae, Enterobacteriaceae), therefore, inhibitor-protected penicillins and cephalosporins of the II-III generation (ceftriaxone, cefotaxime, etc.) are usually considered the drugs of choice. However, pneumonia can also be caused by atypical pathogens in hospitalized patients. For example, the well-known role Legionella pneumophila in the development of severe pneumonia requiring hospitalization in the ICU. To completely cover the spectrum of the most likely pathogens of pneumonia, macrolides should always be included in combination therapy. This point of view is reflected both in the draft domestic recommendations (Table 1) and in the American recommendations for the treatment of pneumonia. The choice of route of use of a macrolide antibiotic depends on the severity of the patient's condition. In more severe cases, intravenous administration of azithromycin is preferable.

Use of Azithromycin for pneumonia and colds

Indications for use

It is worth noting that today Azithromycin occupies the first position among effective and popular antimicrobial drugs. It has a positive effect on the bronchial system and very quickly leads the body to recovery.

Azithromycin is a new product in the pharmacological world, which is sold at the most affordable prices. Azithromycin is your assistant in the fight against the hated cough.

Experts prescribe Azithromycin to people with pneumonia as an excellent antimicrobial agent that will quickly bring the body out of such a critical condition.

It is produced only in capsules. It is very quickly absorbed into the gastrointestinal tract, and from there it enters the bloodstream and spreads throughout the body.

Contraindications

There are also some contraindications to the use of this drug. It should not be prescribed to children under 12 years of age, as well as to people with kidney and liver failure.

It is also prohibited to prescribe this drug to pregnant and lactating women, as well as to those who may have allergic reactions to the components of this medicine.

Side effects

Experts warn that Azithromycin should be taken strictly as directed by a specialist doctor, as it has many side effects.

You also need to be very careful when using it with other medications, since it is not compatible with anything.

How to take Azithromycin

The usual dose of the drug prescribed by doctors is 1 mg. It should be taken once a day and preferably an hour or two after meals.

The dosage depends on the disease, weight and age of the patient. It should be noted that you need to take the drug very seriously and if you forget to take the next dose on time, you do not need to wait for the next dose, but take it as soon as you remember. Take the following medication doses on a regular schedule, as prescribed by your specialist doctor.

My results and results

I am very grateful to Azithromycin that I got back on my feet so quickly. I recommend it to everyone!

Treatment of pneumonia with Azithromycin

Pneumonia is the most common cause of infection-related death worldwide. Every year, millions of people suffer from this dangerous disease, so the correct selection of antibacterial drugs remains relevant. The choice of medication for the treatment of pneumonia is based on many factors. It is necessary to take into account the sensitivity of the pathogen, the pharmacokinetics of the drug, contraindications and possible side effects. An important role in the choice of medication is played by the method of application and frequency of treatment. Azithromycin for pneumonia often becomes the drug of choice #1, since this antibiotic has a detrimental effect on many pathogenic microorganisms, and it only needs to be taken once a day.

The principle of choosing an antibiotic for lung pathologies

Experts select antibiotics for the treatment of lower respiratory tract infections based on data on the most common causative agents of these pathologies. This approach is due to the fact that not all clinics have the opportunity to quickly culture sputum and determine which microorganism caused the disease. In some cases, pneumonia causes a nonproductive cough, making it very difficult to take sputum samples.

The choice of antibiotic is often complicated by the fact that the doctor is not able to constantly monitor the course of the disease and, if necessary, promptly adjust treatment. Different antibiotics have different pharmacological effects and penetrate differently into different tissues and fluids in the body. Thus, only a few types of antibiotics penetrate well into cells - macrolides, tetracyclines and sulfonamides.

If the pathogen is sensitive to an antibacterial drug, but the drug reaches the site of inflammation in insufficient concentration, then there will be no effect from such treatment. But you need to understand that with this method there is no improvement in the patient’s condition, but microbes become resistant to the antibiotic.

A very important aspect when choosing antibiotics is the safety of the drug. In home treatment settings, the choice is most often given to oral medications. Doctors try to select medications whose frequency of administration is minimal, but whose effectiveness is high.

In pediatric practice, when choosing antibacterial drugs, preference is given to syrups and suspensions with a broad-spectrum active substance.

What pathogens cause pneumonia?

Colds in children and adults often develop into obstructive bronchitis, and in the absence of proper treatment and the addition of bacterial microflora, they can develop into pneumonia.

The most common causative agent of pneumonia remains pneumococcus; less commonly, the disease is provoked by mycoplasmas, chlamydia and Haemophilus influenzae. In young people, the disease is most often caused by a single pathogen. In old people, in the presence of concomitant diseases, the disease is provoked by a mixed microflora, where both gram-positive and gram-negative bacteria are present.

Lobar pneumonia in all cases is caused by streptococcus. Staphylococcal pneumonia is less common, mainly in the elderly, in people with bad habits, as well as in patients who have been on hemodialysis for a long time or have had the flu.

Quite often it is not possible to determine the pathogen. In this case, antibacterial drugs are prescribed by trial. Recently, the number of pneumonias caused by atypical pathogens has increased.

Azithromycin gives good results for pneumonia in adults and children. It is generally well tolerated by patients of all age groups and rarely produces side effects.

Azithromycin belongs to the group of macrolides. This antibacterial drug is often prescribed for intolerance to antibiotics from the penicillin group.

General description of Azithromycin

Azithromycin is available in capsules with different dosages of the active substance. The drug belongs to the group of macrolides. It has pronounced activity against gram-positive, gram-negative, anaerobic and intracellular pathogens.

The shelf life of the drug is 2 years. It must be stored in a cool place, at a temperature no higher than 25 degrees.

Use for pneumonia

The instructions for use of Azithromycin for pneumonia indicate that the drug must be taken in the following dosages:

Children over 12 years of age and adults drink 1 capsule, which contains 500 mg of the active substance, 1 time per day. The duration of treatment is most often 3 days.
Children from 6 to 12 years old take 1 capsule, which contains 250 mg of the active substance, just once a day.
For children under 6 years of age, it is advisable to prescribe a suspension. The dosage is calculated by the attending physician individually, depending on the age of the small patient.

The instructions for the drug say that the interval between antibiotic doses should be about a day. In this case, a constantly high concentration of the drug is maintained in the blood.

Features of treatment with Azithromycin

Azithromycin for pneumonia is used with great caution in patients with chronic liver diseases, as hepatitis and severe liver failure may develop.. If there are signs of liver dysfunction, which are manifested by jaundice, darkening of urine and a tendency to bleed, then therapy with the antibacterial drug is stopped and the patient is examined.

If the patient has moderate renal dysfunction, treatment of pneumonia with Azithromycin should be carried out under the supervision of a physician.

If an antibacterial drug is used for treatment for more than 3 days, pseudomembranous colitis may develop. This condition may be accompanied by dyspeptic disorders, including severe diarrhea.

When treated with macrolide antibiotics, the risk of developing cardiac arrhythmia increases. This must be taken into account when treating people with heart pathologies.

Features of the treatment of pneumonia in children

When treating pneumonia in children, it is necessary to select the correct dosage form of the drug. To treat children under 6 years of age, you should take a suspension, since it is very difficult for a child to swallow the entire capsule, and if you pour the powder out of the capsule, the baby will not want to swallow it because the taste is too bitter.

For severe lower respiratory tract infections, the dosage is calculated by the attending physician, who also determines the duration of therapy. In most cases, the course of treatment lasts three days, but for severe pneumonia, a weekly course may be recommended. The child should take the medicine at the same time every day. This ensures a constantly high concentration of the antimicrobial agent in the blood.

Treatment should not be interrupted when the patient's condition improves. If you do not take the full course of antibiotics, a superinfection may develop that is difficult to treat.

Azithromycin is a broad-spectrum, long-acting antibiotic. After taking the last capsule, the therapeutic concentration of the active substance in the blood remains for three days. Thanks to this property, this macrolide becomes the drug of choice for the treatment of pneumonia.

How many days should Azithromycin be taken for pneumonia?

The drug Azithromycin for pneumonia in adults often becomes the main medication in therapy. The choice of medication for pneumonia depends on many factors.

Azithromycin has a detrimental effect on most harmful bacteria, so it is often prescribed for pneumonia. The specialist selects an antibiotic to eliminate the infection, based on test results, medical knowledge about the most common types of pathogens and the effectiveness of modern medicine. It is not always possible to take a bacterial culture test of the discharge and determine the type of causative agent of the disease. And the use of the drug Azithromycin helps to overcome community-acquired pneumonia.

Action of the medicine

The positive effects of Azithromycin in pneumonia have been repeatedly proven over many years by clinical studies. In various tests, drugs from the macrolide group were used to eliminate the infectious process. The drug Azithromycin has been compared to the effects of many drugs. In most studies of the treatment of pneumonia, Azithromycin showed the best therapeutic results.

The superiority of Azithromycin over other drugs is determined by its pharmacological properties.

In the human body, Azithromycin:

suppresses pathogens of pneumonia;
has a pronounced anti-inflammatory effect;
affects anaerobic types of bacteria;
eliminates chills and normalizes temperature;
reduces cough;
strengthens the immune system.

Pneumonia is often an exacerbation of obstructive bronchitis. During the inflammatory process, bacterial flora attaches, and the pathology affects the lung tissue. The main causative agent of pneumonia is pneumococcal bacteria. They penetrate the body's blood and cause the destruction of lung cells. The disease can also be provoked by chlamydia, mycoplasma, and hemophilus influenzae.

In the absence of proper treatment, the infection develops further and can even lead to death. It is advisable to treat pneumonia with Azithromycin in various forms of the disease under the supervision of a physician. The drug copes well with infectious agents with mixed microflora in the lower lung tissues. Therapy with the antibiotic Azithromycin is carried out according to the instructions supplied with the packaging by the manufacturer.

If it is impossible to determine the exact causative agent of the disease, the selection of medicine for pneumonia is carried out by trial method. The antibacterial drug Azithromycin has proven itself in the treatment of pneumonia. It is well tolerated by patients of all ages and is less likely to cause side effects than other medications.

Azithromycin in pneumonia has a pronounced effect on the production of polynucleotides and inhibits the inflammatory process in the body. It actively fights pneumonia and eliminates its symptoms. The effect of the drug in pneumonia is aimed at improving well-being and reducing the symptoms of the disease. The drug reduces active compounds that affect the cellular parts of the immune system. It reduces the effects of nitric oxide, which prevents damage to organic cells. The medicine also increases the synthesis of cytokines, which actively fight the inflammatory process in the lung tissues.

Application

The dosage of Azithromycin for pneumonia is 500 mg per day. Take the medicine one tablet once a day. The tablet is swallowed whole; it is not recommended to chew it. Take the product with 1 glass of clean water. Take the medicine 1 hour before meals or 2 hours after.

The drug is intended for systemic use and is a powerful antimicrobial agent. For pneumonia, Azithromycin is taken for 3-5 days, the duration of the course is regulated by the doctor. If necessary, the dose can be reduced to 250 mg per day.

Adverse reactions

In some cases, when taking Azithromycin to eliminate pneumonia, some side effects may develop.

May be observed:

flatulence and abdominal pain;
digestive and stool disorders;
various types of colitis;
jaundice;
vomiting or nausea;
nervous excitement;
dizziness;
skin rash and itching;
arthralgia;
neutropenia.

If any adverse reactions occur, you should inform your doctor. It is possible that the doctor will reduce the recommended dose of the drug for an adult or include another drug in the treatment.

Treatment of childhood pneumonia

For pneumonia in children, Azithromycin has a pronounced anti-inflammatory effect and helps the child cope with the disease more quickly. A child's body can react quite violently to the medicine. However, with a properly selected dosage, pneumonia therapy occurs without complications.

Azithromycin:

helps to liquefy mucus accumulated in the lungs;
exhibits optimal activity against pathogenic agents;
improves the condition of the alveolar epithelium;
maintains fluid balance in lung tissues;
reduces the amount of bronchial secretion;
restores the mucous membrane of the respiratory tract.

In terms of its effectiveness, treatment with Azithromycin for pneumonia is not inferior to therapy with other antibacterial drugs. Medical studies have proven that the elimination of pneumonia with Azithromycin for 5 days in patients aged 7-16 years has a very powerful therapeutic result and does not differ from treatment with drugs such as Amoxicillin, Erythromycin, Sumamed. In preschool children, the course of treatment with Azithromycin for pneumonia occurs mainly without adverse reactions.

Azithromycin has a high degree of safety and is a fairly effective macrolide. It is metabolized in the liver structures, does not contribute to organ damage and interacts well with other medications. Medicinal components are excreted unchanged from the body by bile and kidneys.

The overall incidence of adverse events when using macrolide in pediatric patients is approximately 10%. Whereas other drugs show a significantly higher percentage. Possible withdrawal of this drug due to the development of adverse events did not exceed 0.6% for pneumonia. These research results are included in the appropriate protocols.

Considering the low level of resistance of pathogenic microbes to Azithromycin, this drug is considered by doctors to be a priority drug for pneumonia in children. It is clinically recommended to treat community-acquired pneumonia with Azithromycin in weak and premature children. According to medical observations, atypical pneumonia of mixed type prevails in children over 5 years of age. Azithromycin is an effective drug in its treatment.

Indications for use

Azithromycin is a new product in the pharmacological world, which is sold at the most affordable prices. Azithromycin is your assistant in the fight against the hated cough.

Experts prescribe Azithromycin to people with pneumonia as an excellent antimicrobial agent that will quickly bring the body out of such a critical condition.

It is produced only in capsules. It is very quickly absorbed into the gastrointestinal tract, and from there it enters the bloodstream and spreads throughout the body.

Contraindications

There are also some contraindications to the use of this drug. It should not be prescribed to children under 12 years of age, as well as to people with kidney and liver failure.

It is also prohibited to prescribe this drug to pregnant and lactating women, as well as to those who may have allergic reactions to the components of this medicine.

Side effects

Experts warn that Azithromycin should be taken strictly as directed by a specialist doctor, as it has many side effects.

You also need to be very careful when using it with other medications, since it is not compatible with anything.

How to take Azithromycin

The usual dose of the drug prescribed by doctors is 1 mg. It should be taken once a day and preferably an hour or two after meals.

My results and results

I am very grateful to Azithromycin that I got back on my feet so quickly. I recommend it to everyone!

Before purchasing the antibiotic Azithromycin, you must carefully read the instructions for use, methods of use and dosage, as well as other useful information on the drug Azithromycin. On the website “Encyclopedia of Diseases” you will find all the necessary information: instructions for proper use, recommended dosage, contraindications, as well as reviews from patients who have already used this drug.

Azithromycin - composition and release form

Release form: Capsules. Pills.

The drug is produced in the form of convex oval tablets of a white shade, with a dosage of 500, 250 or 125 mg. There are 3 or 6 tablets in a cardboard box.

1 tablet contains: azithromycin (in dihydrate form) 125 mg, 250 mg, 500 mg.

1 capsule contains: azithromycin (in dihydrate form) 500 mg, 250 mg.

Packing: 3, 6, 9, 10, 12, 15, 18, 20, 24, 30, 36, 40, 50, 60 or 100 pcs.

Azithromycin - Pharmacological action

Azithromycin is an antibiotic agent with a wide range of applications, which belongs to the class of macrolides with bactericidal effects.

Azithromycin is a fairly popular antibiotic with a wide range of uses. Numerous positive reviews about the drug confirm its effectiveness against various infectious pathologies caused by chlamydia, sore throat, sinusitis, etc.

Azithromycin is the first representative of a new subgroup of macrolide antibiotics - azalides. When high concentrations are created at the site of inflammation, it has a bactericidal effect.

Gram-positive cocci are sensitive to Azithromycin: Streptococcus pneumoniae, Str.pyogenes, Str.agalactiae, streptococci of groups CF and G, Staphylococcus aureus, S.viridans; gram-negative bacteria: Haemophilus influenzae, Moraxella catarrhalis, Bordetella pertussis, B.parapertussis, Legionella pneumophila, H.ducrei, Campylobacter jejuni, Neisseria gonorrhoeae and Gardnerella vaginalis; some anaerobic microorganisms: Bacteroides bivius, Clostridium perfringens, Peptostreptococcus spp; as well as Clamydia trachomatis, Mycoplasma pneumoniae, Ureaplasma urealyticum, Treponema pallidum, Borrelia burgdoferi. Azithromycin is inactive against gram-positive bacteria resistant to erythromycin.

The drug effectively eliminates bacterial infections, is relatively easy to tolerate, and rarely has negative consequences, which, as a rule, stop after therapy.

Azithromycin is a derivative of erythromycin, but has less negative effects on the gastrointestinal tract.

Azithromycin belongs to the broad-spectrum bactericidal antibiotic agents and has antimicrobial properties. The drug is able to inhibit the production of proteins in microbial bodies, suppress peptide translocase, and inhibit the development and reproduction of microbes.

The drug destroys gram-positive and gram-negative microbes, anaerobic bacteria that can become resistant to the effects of the drug.

When taken orally, the product dissolves well and is quickly distributed throughout the body, passing through the cell structure, weakening the pathogens inside the cells.

The half-life is 35-50 hours, from tissues - more than 50 hours.

The therapeutic effect of the drug can last up to 1 week.

50% of Azithromycin is excreted by the intestinal system, 6% by the renal system.

Azithromycin - Indications for use

Azithromycin is prescribed by a doctor for infections and inflammatory pathologies caused by bacteria sensitive to the drug. The indications are:

Infectious processes of the ENT organs and upper respiratory systems: sinusitis, pharyngitis, sinusitis, otitis media;

Diseases of the lower respiratory tract: pneumonia caused by atypical bacteria, bronchitis in the acute and chronic stages;

Infections of the skin and tissues, infectious dermatosis, erysipelas, acne, impetigo, boils;

Borreliosis in the early stage of an infectious-allergic nature;

Infectious diseases of the urogenital tract caused by chlamydia trachomatis: inflammation of the cervix, urethritis.

Azithromycin - Method of administration and dosage

Azithromycin is prescribed to adults and children over 12 years of age weighing over 45 kg, once a day 60 minutes before or 2 hours after meals.

The drug is most effective for:

For pathologies of the respiratory system and skin, the drug is taken in a course of 1500 mg, 500 mg at a time. Duration of treatment - 3 days.

For Lyme disease at an early stage, the drug is consumed once a day for 5 days. The dosage is: on the first day - 1000 mg, from days 2 to 5 - 500 mg daily. The dose for the entire course of therapy should not exceed 3 g.

For acne, the treatment regimen is as follows: 1st, 2nd and 3rd day - 500 mg, 8th day - 500 mg, then 500 mg 1 time per week for 9 weeks. Weekly doses are taken strictly at 7-day intervals.

For infections of the urogenital tract caused by chlamydia trachomatis, the drug is taken once, in the amount of 1000 mg.

For stomach or duodenal ulcers caused by Helicobacter pylori, Azithromycin is prescribed 1 g (4 capsules of 250 mg) per day for 3 days as part of combination therapy.

Children use the drug depending on their weight: 10 mg per 1 kg of weight, 1 time per day, duration of therapy is 3 days. The dosage for the entire course is 30 mg/kg.

For patients with moderate stage renal dysfunction, no special dose adjustment is required.

Azithromycin - Contraindications

The drug is prohibited for use:

With increased sensitivity to antibiotics of the macrolide group;

For pathologies of the liver and kidneys;

Children under 12 years of age and weighing less than 45 kg;

During breastfeeding.

Azithromycin is also not taken together with ergotamine and dihydroergotamine.

Azithromycin during pregnancy and lactation

The drug can be used during pregnancy only if the probable benefit to the woman outweighs the possible risk of negative manifestations in the fetus. The decision must be made by the attending physician.

When breastfeeding, it is necessary to suspend lactation for the duration of drug therapy.

Azithromycin - Side effects

From the hematopoietic and lymphatic system: a decrease in the number of platelets, accompanied by increased bleeding, agranulocytosis.

From the side of the central nervous system: headache, dizziness, convulsive syndrome, increased drowsiness, sleep disturbance, feeling of numbness, tingling, goosebumps, asthenic syndrome, increased excitability, anxiety, conflict.

From the peripheral system: hearing loss, feeling of deafness, sensation of tinnitus, changes in taste, decreased sensitivity to odors.

From the heart and blood vessels: rapid heartbeat, interruptions in heart function, tachycardia.

On the part of digestion: nausea, diarrhea, gag reflexes, discoloration of the tongue, colic, bloating, impaired digestion of food, liver failure, loss of appetite, constipation, inflammation of the large intestine, jaundice, hepatitis, death of liver tissue. Rarely fatal.

Allergic manifestations - angioedema, urticaria, excessive skin sensitivity to ultraviolet radiation, anaphylactic reactions, malignant exudative erythema, itching, rash, Lyell's syndrome.

From the musculoskeletal organs: joint pain.

From the urogenital tract - inflammatory pathologies of the kidneys, failure of the kidneys and metabolism.

Azithromycin - Drug interactions

Antacids (aluminum and magnesium), ethanol and food slow down and reduce absorption. When warfarin and azithromycin were co-administered (in usual doses), no changes in prothrombin time were detected, however, given that the interaction of macrolides and warfarin may enhance the anticoagulation effect, patients need careful monitoring of prothrombin time. Digoxin: increased digoxin concentrations. Ergotamine and dihydroergotamine: increased toxic effects (vasospasm, dysesthesia). Triazolam: decreased clearance and increased pharmacological action of triazolan. Slows down the elimination and increases the plasma concentration and toxicity of cycloserine, indirect anticoagulants, methylprednisolone, felodipine, as well as drugs subject to microsomal oxidation (carbamazepine, terfenadine, cyclosporine, hexobarbital, ergot alkaloids, valproic acid, disopyramide, bromocriptine phenytoin, phenytoin, oral hypoglycemic ical means , theophylline and other xanthine derivatives) - due to inhibition of microsomal oxidation in hepatocytes by azithromycin). Lincosamines weaken the effectiveness, tetracycline and chloramphenicol enhance it. Pharmaceutically incompatible with heparin.

Azithromycin - Special instructions

If a dose is missed, the missed dose should be taken as soon as possible, and subsequent doses should be taken at intervals of 24 hours. A break of 2 hours should be observed when using antacids simultaneously.

The safety of administration (iv, as well as in the form of capsules and tablets) of azithromycin in children and adolescents under 16 years of age has not been definitively established (use in the form of an oral suspension in children 6 months and older is possible).

After discontinuation of treatment, hypersensitivity reactions may persist in some patients, which requires specific therapy under medical supervision.

Azithromycin - Analogs

To date, there are no cheaper analogues of Azithromycin. We can only say that there is a more expensive drug, such as Sumamed, which has exactly the same composition, but only the price is several times higher.

When turning to a pharmacy, many patients are faced with the fact that pharmacists try to sell Sumamed, even if they ask for Azithromycin, justifying this with the best effect. In fact, these are two absolutely identical drugs, just produced in different countries.

Azithromycin - Reviews

Among the positive aspects regarding the antibiotic Azithromycin, according to consumers, are: affordable price; ease of use, since the number of capsules in the package is just designed for the full course of treatment; fast action: already on the second day after starting treatment, patients notice an improvement in their condition.

Not all patients agree that Azithromycin is an almost universal drug, since in some cases it did not help. But one thing should be noted: all doctors say that if a course of antibiotic treatment has been started, they must be taken to the end. And if the course was interrupted, then the next time after prescribing the same drug there will be no effect, because the bacteria have already become resistant to it.

Before starting treatment with the drug, you need to consult with your doctor so that he can issue a prescription. Because today most pharmacies do not sell it without a prescription due to the fact that some patients take the drug for other purposes.

Storage period and conditions

The shelf life of the drug is 24 months.

Azithromycin should be stored in a dry, dark place, at a temperature not exceeding 25°C. Keep away from children.

The drug is purchased at a pharmacy with a prescription.

We would like to draw special attention to the fact that the description of the antibiotic Azithromycin is presented for informational purposes only! To obtain more accurate and detailed information about the drug Azithromycin, we ask you to refer exclusively to the manufacturer’s annotation! Do not self-medicate under any circumstances! You should definitely consult a doctor before starting to use the drug!

Use of Azithromycin for pneumonia and colds

Indications for use

Azithromycin is a new product in the pharmacological world, which is sold at the most affordable prices. Azithromycin is your assistant in the fight against the hated cough.

Experts prescribe Azithromycin to people with pneumonia as an excellent antimicrobial agent that will quickly bring the body out of such a critical condition.

It is produced only in capsules. It is very quickly absorbed into the gastrointestinal tract, and from there it enters the bloodstream and spreads throughout the body.

Contraindications

There are also some contraindications to the use of this drug. It should not be prescribed to children under 12 years of age, as well as to people with kidney and liver failure.

It is also prohibited to prescribe this drug to pregnant and lactating women, as well as to those who may have allergic reactions to the components of this medicine.

Side effects

Experts warn that Azithromycin should be taken strictly as directed by a specialist doctor, as it has many side effects.

You also need to be very careful when using it with other medications, since it is not compatible with anything.

How to take Azithromycin

The usual dose of the drug prescribed by doctors is 1 mg. It should be taken once a day and preferably an hour or two after meals.

My results and results

I am very grateful to Azithromycin that I got back on my feet so quickly. I recommend it to everyone!

Treatment of pneumonia with Azithromycin

The principle of choosing an antibiotic for lung pathologies

In pediatric practice, when choosing antibacterial drugs, preference is given to syrups and suspensions with a broad-spectrum active substance.

What pathogens cause pneumonia?

Colds in children and adults often develop into obstructive bronchitis, and in the absence of proper treatment and the addition of bacterial microflora, they can develop into pneumonia.

Quite often it is not possible to determine the pathogen. In this case, antibacterial drugs are prescribed by trial. Recently, the number of pneumonias caused by atypical pathogens has increased.

Azithromycin gives good results for pneumonia in adults and children. It is generally well tolerated by patients of all age groups and rarely produces side effects.

Azithromycin belongs to the group of macrolides. This antibacterial drug is often prescribed for intolerance to antibiotics from the penicillin group.

General description of Azithromycin

The shelf life of the drug is 2 years. It must be stored in a cool place, at a temperature no higher than 25 degrees.

Use for pneumonia

The instructions for use of Azithromycin for pneumonia indicate that the drug must be taken in the following dosages:

Children over 12 years of age and adults drink 1 capsule, which contains 500 mg of the active substance, 1 time per day. The duration of treatment is most often 3 days.
Children from 6 to 12 years old take 1 capsule, which contains 250 mg of the active substance, just once a day.
For children under 6 years of age, it is advisable to prescribe a suspension. The dosage is calculated by the attending physician individually, depending on the age of the small patient.

The instructions for the drug say that the interval between antibiotic doses should be about a day. In this case, a constantly high concentration of the drug is maintained in the blood.

Features of treatment with Azithromycin

If the patient has moderate renal dysfunction, treatment of pneumonia with Azithromycin should be carried out under the supervision of a physician.

If an antibacterial drug is used for treatment for more than 3 days, pseudomembranous colitis may develop. This condition may be accompanied by dyspeptic disorders, including severe diarrhea.

When treated with macrolide antibiotics, the risk of developing cardiac arrhythmia increases. This must be taken into account when treating people with heart pathologies.

Features of the treatment of pneumonia in children

Treatment should not be interrupted when the patient's condition improves. If you do not take the full course of antibiotics, a superinfection may develop that is difficult to treat.

For quotation: Nonikov V.E., Konstantinova T.D., Makarova O.V., Evdokimova S.A. Azithromycin in the treatment of lower respiratory tract infections // Breast Cancer. 2008. No. 22. S. 1482

The epidemiological situation in recent years is characterized by the increased etiological significance of pathogens such as mycoplasma and chlamydia, widespread sensitization of the population to penicillin derivatives and sulfonamides, and a significant increase in the resistance of many microorganisms to the most commonly used antibiotics. To a large extent, the increase in resistance was a consequence of many years of routine use of co-trimoxazole and semi-synthetic tetracyclines in outpatient practice. In recent years, fluoroquinolones have become increasingly used in clinics, resulting in the formation of strains resistant to these drugs.

The first of the macrolides, erythromycin, was created in 1952, but drugs of this series were rarely used until the dramatic outbreak of Legionella pneumonia (80s of the twentieth century), accompanied by a 30% mortality rate. It was quickly established that macrolides are the optimal drugs for the treatment of infections caused by intracellular infectious agents (legionella, mycoplasma, chlamydia), and this led to the widespread use of this group of antibiotics. A number of new drugs for oral and parenteral use have been created, differing in terms of pharmacokinetics and pharmacodynamics.
The basis of the chemical structure of macrolides is the macrocyclic lactone ring. Depending on the number of carbon atoms in the lactone ring, 14-membered (erythromycin, clarithromycin, roxithromycin), 15-membered (azithromycin) and 16-membered (josamycin, midecamycin, spiramycin) macrolides are distinguished.
Azithromycin belongs to the azalide subclass because one carbon atom in its ring is replaced by a nitrogen atom. The structural features of individual drugs determine differences in pharmacokinetic characteristics, tolerability, the possibility of drug interactions, as well as some features of antimicrobial activity. Azithromycin is characterized by unique cellular kinetics, rapid and intense penetration into cells and interstitial tissues, high levels of distribution of the antibiotic in tissues and relatively low levels in the blood.
Azithromycin well suppresses (Table 1) gram-positive (pneumococci, streptococci, staphylococci) and gram-negative (moraxella, Haemophilus influenzae) microorganisms and intracellular agents (chlamydia, mycoplasma, legionella, ureaplasma). Other macrolides (except clarithromycin) are less active against Haemophilus influenzae. Considering that in the etiological structure of community-acquired pneumonia, the leading positions are occupied by pneumococci, Haemophilus influenzae, mycoplasma, chlamydia, and exacerbations of chronic bronchitis (chronic obstructive pulmonary disease), as a rule, are caused by pneumococci, Haemophilus influenzae, moraxella (less often - mycoplasma and chlamydia), It is becoming clear that azithromycin is often the antibiotic of choice for treating pulmonary patients.
In Western and Southern Europe, the widespread use of macrolides has led to an increase (up to 30%) in pneumococcal resistance to them. The corresponding resistance rates in our country, according to various estimates, do not exceed 4-8%. The characteristics of azithromycin are determined not only by the spectrum of action, but also by the creation of high concentrations in the pulmonary parenchyma and alveolar macrophages. A comparison of the concentrations created in different biological media shows that the concentrations of azithromycin in the lung parenchyma are 8-10 times higher, and in alveolar macrophages 800 times higher than in blood serum. Thus, this drug should be highly effective in the treatment of pulmonary pathology.
Azithromycin remains at the site of infection for 4-5 days or more, depending on the dose and tissue structure. Due to the release of the antibiotic from phagocytes during their destruction, the concentration at the site of infection quickly increases. High intracellular penetration and accumulation in cells and infected tissues determines the effectiveness of azithromycin, which exceeds the effect of other antibiotics, in infections caused by intracellular pathogens, including pathogens of dangerous infectious diseases (brucellosis, tularemia, etc.).
A feature of the pharmacodynamics of macrolides is a long-term post-antibiotic effect, due to which, when the antibiotic is used in minimal inhibitory concentrations, the effect of the antibiotic continues after its withdrawal. For azithromycin, a post-antibiotic effect lasting up to 90 hours is considered proven, and this allows reducing the duration of antibacterial treatment.
Allergic sensitization to macrolides is relatively rare. Among the side effects, gastrointestinal manifestations predominate and, perhaps, some of them are due to the ability of macrolides to enhance intestinal motility. Side effects are more common when using erythromycin. Toxic and allergic side effects when using azithromycin are rare.
Azithromycin is approved for medical use in our country in several dosage forms: capsules 0.25 g, tablets 0.5 g, powder for suspension 2.0 g, powder for injection 0.5 g. Thus, the antibiotic can be used orally, intravenously and in step therapy mode. The drug has a convenient dosage regimen (administered once a day). Given the long-term post-antibiotic effect of azithromycin, this antibiotic was (and is) often used in short 3-5 day courses. The dosage form is a powder for the preparation of a suspension (2.0 g of azithromycin) which involves treatment with a single dose of an antibiotic.
Features of pharmacokinetics allow the use of azithromycin once a day. Naturally, drugs used once or twice a day have greater compliance and are readily used by patients. There are various regimens for oral administration of azithromycin. The most common dosage for the treatment of pulmonary diseases is 500 mg on the first day of treatment and 250 mg every 24 hours for the next 4 days. With this regimen, the duration of treatment for pneumonia is 5 days. The treatment period for pneumonia caused by common bacterial agents (pneumococci, streptococci, Haemophilus influenzae, etc.) can be reduced to three days if the daily dose is 500 mg. The duration of treatment for pneumonia caused by mycoplasma and chlamydia is 14 days, and for legionella pneumonia - 21 days.
Our own experience of using azithromycin for 15 years is based on the treatment of more than 1,500 patients with pneumonia with this antibiotic, and all described oral therapy regimens, step-down therapy, and treatment with azithromycin in combination with b-lactam antibiotics were used with high efficiency.
According to the Department of Pulmonology of the Central Clinical Hospital in 1984, macrolides (only erythromycin was used) accounted for only 9% of the antibiotics used. In 2004, the frequency of their use tripled (27.3%), second only to b-lactam antibiotics. Five oral drugs were used, of which azithromycin was used most often (80%). The significant frequency of prescription of macrolides is explained by the rise in the incidence of chlamydial and mycoplasma infections, as well as the widespread use of combinations of macrolides with b-lactam antibiotics when the etiological deciphering is impossible.
According to microbiological studies of sputum, pneumococcus still dominates as the leading etiological agent of respiratory infections (52.1%). In addition to pneumococcus, cultures of viridans streptococcus and Haemophilus influenzae were isolated from sputum. Gram-negative microorganisms and staphylococci were rarely detected. In recent years, the frequency of mycoplasma and chlamydial infections has increased significantly, and intracellular agents are often the cause of epidemic outbreaks in families and groups.
Indications for the use of azithromycin are upper respiratory tract infections (tonsillopharyngitis, acute otitis media, sinusitis), as well as bronchitis and community-acquired pneumonia. The so-called atypical pneumonias are caused by intracellular agents such as viruses, mycoplasma (50% of all cases), chlamydia, and legionella. Azithromycin is the best antibiotic to treat most of them. Brief differences between atypical pneumonias are given in Table 2. The infection is often transmitted from person to person (in recent years, several family and work-related outbreaks of mycoplasma and chlamydial pneumonia have been observed). Etiological diagnosis is possible by identifying specific IgM antibodies in the blood serum or seroconversion (when studying paired sera).
A study of the clinical manifestations of mycoplasma pneumonia showed that a prodromal period in the form of malaise and respiratory syndrome, manifested by nasopharyngitis, tracheobronchitis, and less commonly otitis, is characteristic. The development of pneumonia is rapid, sometimes gradual with the onset of fever or low-grade fever. Chills and shortness of breath are not typical. Cough, often nonproductive or producing mucous sputum, is the dominant symptom. In 30-50% of patients, a paroxysmal, nonproductive, painful, whooping cough of low timbre is typical, sometimes accompanied by difficulty in inhaling. These cough paroxysms are often caused by the development of the phenomenon of tracheobronchial dyskinesia, in which the mobility of the pars membranacea of the trachea and large bronchi increases significantly. On auscultation, dry and/or local moist rales are heard. There is no crepitus or signs of compaction of the lung tissue. Pleural effusion rarely develops. Extrapulmonary symptoms are common: myalgia (usually pain in the muscles of the back and thighs), profuse sweating, muscle weakness, arthralgia, lesions of the skin and mucous membranes, gastrointestinal disorders, headaches, and sometimes insomnia.
X-ray examination reveals typical pneumonic infiltration of the pulmonary parenchyma (usually focal and multifocal in nature), however, in 20-25% of patients only interstitial changes are detected, and occasionally no pathology is noted on standard radiographs (especially those performed in a hard mode). Therefore, in cases where clinically pneumonia is beyond doubt, and the results of radiography are not conclusive, computed x-ray tomography can be used, which provides confirmation of the diagnosis due to viewing the image in various modes and the absence of hidden zones for the method.
The phenomenon of tracheobronchial dyskinesia is revealed when performing forced expiratory pulmonary tests. Characteristic is the appearance of additional “steps” on the spirographic curve. More accurately, the presence of this syndrome can be proven by fluoroscopy of the trachea with a cough test.
The leukocyte formula of peripheral blood is usually not changed. Slight leukocytosis or leukopenia is possible. Occasionally, unmotivated anemia is noted. Blood cultures are sterile, and sputum cultures are uninformative.
Mycoplasma pneumonia is characterized by dissociation of some clinical signs: high fever in combination with a normal leukocyte count and mucous sputum; low-grade fever with heavy sweats and severe asthenia. Thus, mycoplasma pneumonia has certain clinical features, the comparison of which with the epidemiological situation allows one to make the right decision on the choice of antibacterial drug.
With chlamydial infection, the development of pneumonia is often preceded by a respiratory syndrome in the form of malaise and pharyngitis, occurring with a dry cough at normal or subfebrile body temperature. The development of pneumonia is subacute with the appearance of chills and fever. The cough quickly becomes productive with the release of purulent sputum. During auscultation, crepitus is heard in the early stages; local moist rales are a more stable sign. In lobar pneumonia, shortening of percussion sound, bronchial breathing, and increased bronchophony are determined. Chlamydial pneumonia can be complicated by pleurisy, which is manifested by characteristic pleural pain and pleural friction noise. With pleural effusion, dullness is determined by percussion, and when auscultated, a sharp weakening of breathing is detected. Some patients tolerate high fever relatively easily. A whooping cough-like course of chlamydial pneumonia has been described in children, which is associated with the frequent development of tracheobronchial dyskinesia, which is also a characteristic symptom of pulmonary chlamydia in adults. Of the extrapulmonary manifestations, sinusitis is more common (5%), and myocarditis and endocarditis are much less common. Radiographic findings are extremely variable. Infiltrative changes in the volume of one or more lobes are detected; often the infiltration is interstitial in nature. In typical cases, the leukocyte formula is not changed, but leukocytosis with a neutrophil shift is often observed

Patient Kh., 15 years old, was hospitalized in the pulmonology department on the 7th day of illness. There is an outbreak of acute respiratory infection at school. In the class, 5 out of 25 students were diagnosed with pneumonia. The patient was diagnosed with pneumonia on the 2nd day of illness. Therapy with amoxicillin/clavulanate 2.0 g/day was started. Treatment for 5 days without effect. Fever persisted all days up to 38-38.5°C. On admission the condition was of moderate severity. Body temperature 38.5°C. Clinical and radiological data are consistent with right-sided lower lobe pneumonia. The blood test showed moderate leukocytosis without a neutrophilic shift in the leukocyte formula. Oral azithromycin 500 mg/day was prescribed. A few hours after the first dose of antibiotic, the body temperature returned to normal. During examination, high titers of antibodies to chlamydia of the IgM class were detected in the blood serum. Azithromycin was used for 12 days. The outcome is recovery.
In this clinical observation, the basis for correct clinical assessment and selection of an effective antibiotic (azithromycin) was the characteristic epidemiological history and the lack of effect from 5-day therapy with an enhanced b-lactam antibiotic at an effective dose.
In addition to monotherapy with azithromycin, this antibiotic is often prescribed in combination with b-lactam drugs. If a patient is hospitalized for moderate or severe pneumonia, de-escalation tactics are often practiced, involving the use of a combination of antibiotics for initial therapy, usually a combination of a b-lactam drug (aminopenicillins, cephalosporins, carbapenems) with a macrolide, which is prescribed based on the possibility of legionella or chlamydial infections. infections. Subsequently, after the diagnosis is clarified, one of the drugs is discontinued.

Several years ago, on the 4th day of illness, patient N., 42 years old, was hospitalized in our department. Upon admission, the condition was serious: body temperature 39.0°C, unstable hemodynamics, respiratory rate - 36 per minute. Clinically and radiologically - bilateral multilobar (infiltration of 3 lobes) pneumonia. Leukocytosis 22.0 with a band shift of 30%. Antibacterial therapy was prescribed: meropenem 4.0 g/day. intravenously in combination with azithromycin 500 mg/day. orally. Pressor amines and intravenous glucocorticosteroids were used, and oxygen therapy was used. Hemodynamic parameters were stabilized within 4 hours and further use of steroids and pressor amines was discontinued. Etiologically, pneumonia was deciphered as Legionella (antibodies to Legionella were detected in the blood serum at a titer of 1:1024). The duration of treatment with azithromycin is 18 days, meropenem is 4 days (the drug was discontinued after the diagnosis of legionellosis was established). Oxygen therapy was used for 7 days. The outcome is recovery.
It can be reasonably assumed that the outcome of the disease in the observed patient would have been questionable if empirical antibacterial therapy had been carried out only with meropenem, and azithromycin had been prescribed only after the Legionella nature of the pneumonia had been established.
This observation prompted us to carry out de-escalation antibacterial therapy (b-lactam antibiotic + macrolide) in almost half of the patients with pneumonia and in all cases of treatment of severe pneumonia.
For severe pneumonia, antibiotics are used intravenously. When used intravenously, azithromycin is dosed at 500 mg every 24 hours.
The costs of antibacterial therapy must be taken into account, which can be quite significant. In recent years, so-called step therapy has been successfully used. When using azithromycin using this method, treatment begins with intravenous antibiotic use of 500 mg every 24 hours. Upon achieving a clinical effect (usually after 2-3 days), when antibacterial therapy has provided an improvement in the patient’s condition, accompanied by a decrease or normalization of body temperature, a decrease in leukocytosis, it is possible to switch to oral administration of azithromycin (if good absorption is expected) at 0.25-0. 5/24 hours. While this technique is highly effective, it is less expensive not only due to the difference in prices for parenteral and tablet drugs, but also due to the reduced consumption of syringes, droppers, and sterile solutions. This therapy is easier to tolerate by patients and is less likely to be accompanied by side effects.
Intravenous and stepwise administration of azithromycin is usually used in the treatment of severe pneumonia. When treating other bronchopulmonary infections, as a rule, you can limit yourself to oral therapy.
The data presented and our own long-term experience indicate that azithromycin currently occupies one of the main positions in the treatment of bronchopulmonary infections.

Literature
1. Practical guide to anti-infective chemotherapy (Ed. L.S. Strachunsky, Yu.B. Belousov, S.N. Kozlov) // Smolensk, MAKMAH, 2007. - 464 p.
2. Nonikov V.E. Atypical pneumonia: the rebirth of macrolides //New Medical Journal.-1995.-No. 1.-p.5-7
3. Nonikov V.E. Tactics of antibacterial chemotherapy of pneumonia //RMZh.-1997.-Vol. 5.-No. 24,- p.1568-1578
4. Nonikov V.E. Antibiotics-macrolides in pulmonological practice // Atmosphere: pulmonology and allergology.-2004.- No. 2 (13).- p.24-26
5. Bartlett J. Pocket Book of Infectious Diseases Therapy //Lippincott Williams & Wilkins.-2005-6.- 349p.
6. Zackom H. Pulmonary Differential Diagnosis //W.B.Saunders.- 2000.- 885 p

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