Systemic antibiotics in the treatment of bacterial infections of the skin and soft tissues: focus on macrolides

Antibiotics are substances of biological or semi-synthetic origin. They are used in medical practice to combat pathogenic microbes and viruses. Before the advent of these medications, typhoid fever, dysentery, pneumonia, and tuberculosis had the status of incurable diseases. Today, treatment of infectious diseases is possible with the use of 1-6 generations of antibiotics.

At this moment, the pharmacological industry produces more than 2000 varieties of drugs of this type. Doctors have described the effects of about 600 positions, and about 120-160 drugs are used in medical practice.

Important! For any disease, it is recommended to take antibiotics after consulting a doctor. Otherwise, antibiotic resistance may develop (decreased sensitivity of pathogenic microorganisms to antibacterial agents).

How to choose an antibiotic

To choose the right antibiotic, you need to consider many factors. Only then will the treatment be effective and safe. So, what should you pay attention to?

• it is necessary to determine which bacteria caused the inflammation;
• choose the most suitable form of antibiotic so that it quickly reaches the site of inflammation;
• take into account the condition of the liver and kidneys;
• remember possible chronic diseases and age to avoid side effects;
• An important factor is the presence of pregnancy or breastfeeding.

If you start taking an antibiotic, also consider the following points:

• look at the dynamics of treatment after 48 hours (is the treatment effective);
• control antibiotic resistance;
• pay attention to side effects (both clinical manifestations and laboratory tests);
• Be sure to follow the course of treatment prescribed by the doctor.

When are oral antibiotics prescribed for acne?

Taking systemic medications is justified when the affected area is large, when a lot of acne* appears on the back, arms, décolleté, and face. Oral antibacterial agents may also be prescribed if the clinical picture is dominated by inflammatory pustules, and therapy with exclusively topical agents does not give the desired effect.

For moderate and severe acne, complex treatment with topical and systemic drugs is prescribed18. They have two main requirements - rapid absorption, intensive accumulation in the sebaceous glands.

Systemic antibacterial drugs are taken for at least a month. During this time, serious side effects may develop:

• dysbiosis of the vagina and intestines;
• gastrointestinal ulcer;
• onycholysis;
• hyperpigmentation of nails and skin;

Due to interactions with other drugs, the properties of antibiotics may change, so it is important that the treatment is prescribed by a doctor. Before prescribing systemic medications, the doctor determines the causes of acne. For example, in case of hormonal imbalances and improper functioning of the sweat and sebaceous glands, oral antibacterial drugs are ineffective.

List of the most effective antibiotics

Our rating includes the best antibiotics, since we took into account the recommendations of doctors and reviews of those who took these drugs. We divided antibiotics into groups: broad-spectrum, antibiotics for sore throat, cough and bronchitis, antibiotics for sinusitis and drugs used in gynecology.

The best antibiotics for coughs, bronchitis and sore throats

Most antibiotics have a broad spectrum of action and affect several types of bacteria at once. But for more effective treatment of cough, bronchitis or sore throat, it is better to choose drugs intended for the upper respiratory tract.

Sources

• Weinberger KR., Kulick ER., Boehme AK., Sun S., Dominici F., Wellenius GA. Association Between Hurricane Sandy and Emergency Department Visits In New York City By Age and Cause. // Am J Epidemiol - 2022 - Vol - NNULL - p.; PMID:33910231
• Miller JE., Carter KW., de Klerk N., Burgner DP. The familial risk of infection-related hospitalization in children: A population-based sibling study. // PLoS One - 2022 - Vol16 - N4 - p.e0250181; PMID:33909680
• Herbosa CM., Bhat TS., Semenov YR., Rosman IS., Musiek AC. Diagnostic concordance of clinical diagnosis, tissue culture, and histopathology testing for skin and soft tissue infections: A single-center retrospective study. // Int J Womens Dermatol - 2020 - Vol6 - N5 - p.395-398; PMID:33898706
• Sari MK., Satria CD., Arguni E. Predictors of Infection in Children with Systemic Lupus Erythematosus: A Single Center Study in Indonesia. // Glob Pediatr Health - 2022 - Vol8 - NNULL - p.2333794X211005609; PMID:33889678
• Jones SU., Chua KH., Chew CH., Yeo CC., Abdullah FH., Othman N., Kee BP., Puah SM. spa diversity of methicillin-resistant and -susceptible Staphylococcus aureus in clinical strains from Malaysia: a high prevalence of invasive European spa-type t032. // PeerJ - 2022 - Vol9 - NNULL - p.e11195; PMID:33889447
• Chan ED., Cota-Gomez A., Podell B. Adding Another Piece to the Puzzle of Why NTM Infections Are Relatively Uncommon despite Their Ubiquitous Nature. // mBio - 2022 - Vol12 - N2 - p.; PMID:33879587
• Urie R., McBride M., Ghosh D., Fattahi A., Nitiyanandan R., Popovich J., Heys JJ., Kilbourne J., Haydel SE., Rege K. Antimicrobial laser-activated sealants for combating surgical site infections. // Biomater Sci - 2022 - Vol - NNULL - p.; PMID:33876069
• Scott MM., Liang SY. Infections in Older Adults. // Emerg Med Clin North Am - 2022 - Vol39 - N2 - p.379-394; PMID:33863466
• Lipový B., Mager R., Raška F., Hanslianová M., Blažek J., Křemečková H., Suchánek I., Hladík M. Vibrio vulnificus-Induced Necrotizing Fasciitis Complicated by Multidrug-Resistant Acinetobacter baumannii Infection: Efficacy of Chemical Necrectomy Using 40% Benzoic Acid. // Int J Low Extreme Wounds - 2022 - Vol - NNULL - p.15347346211004305; PMID:33856245
• Monecke S., Müller E., Braun SD., Armengol-Porta M., Bes M., Boswihi S., El-Ashker M., Engelmann I., Gawlik D., Gwida M., Hotzel H., Nassar R ., Reissig A., Ruppelt-Lorz A., Senok A., Somily AM., Udo EE., Ehricht R. Characterization of S. aureus/MRSA CC1153 and review of mobile genetic elements carrying the fusidic acid resistance gene fusC. // Sci Rep - 2022 - Vol11 - N1 - p.8128; PMID:33854075

Azithromycin

One of the most inexpensive semi-synthetic antibiotics, which is often prescribed for bacterial infections against the background of colds. The active ingredient of the drug is azithromycin dihydrate. Azithromycin is usually taken for laryngitis, bronchitis and pneumonia. This antibiotic has a whole list of side effects and contraindications (like most antibiotics). Azithromycin is contraindicated in children under 16 years of age, as well as adults with liver or kidney failure, or arrhythmia.

Azithromycin

CJSC VERTEX, Russia; Obolenskoye (OBL Pharm), Russia; OZON, Russia; OJSC Pharmstandard-Leksredstva, Russia; Zentiva, Czech Republic; AKRIKHIN, Russia; ProMed, Russia; JSC Dalkhimfarm, Russia

Azithromycin is a broad-spectrum antibiotic.
Azalide antibiotic, a representative of a new subgroup of macrolide antibiotics. When high concentrations are created at the site of inflammation, it has a bactericidal effect. from 68

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Macropen

Most often, Macropen is prescribed for stomatitis, bronchitis, pneumonia and other infections. In addition, your doctor may recommend this antibiotic to treat diphtheria and whooping cough. The active ingredient of the product is midecamycin. Macropen has a small list of contraindications, it is very effective, and has virtually no side effects. In addition to tablets, you can also buy Macropen in the form of a suspension (for small children). You need to take this antibiotic three times a day, one tablet; there are 16 tablets in a package.

Macropen

KRKA (KRKA), Slovenia

Infectious and inflammatory diseases caused by microorganisms sensitive to the drug: - respiratory tract infections: tonsillopharyngitis, acute otitis media, sinusitis, exacerbation of chronic bronchitis, community-acquired pneumonia (including those caused by atypical pathogens Mycoplasma spp., Chlamydia spp., Legionella spp. and Ureaplasma urealyticum);
— infections of the genitourinary system caused by Mycoplasma spp., Chlamydia spp., Legionella spp. and Ureaplasma urealyticum; - infections of the skin and subcutaneous tissue; — treatment of enteritis caused by Campylobacter spp.; - treatment and prevention of diphtheria and whooping cough. from 213

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Rules for taking antibiotics

Addressing the problem of antibiotic resistance

One of the most pressing problems is antibiotic resistance. To reduce the risk of its development, it is necessary to adhere to the following rules for the use of antibiotics18:

• the duration of use should not be more than 8 weeks;
• it is necessary to avoid the combined use of topical and oral antibacterial agents without external use of benzoyl peroxide;
• It is required, if possible, to limit the use of antibacterial drugs in terms of frequency of prescription and duration of use;
• Systemic and topical antibiotics should not be used in maintenance or monotherapy.

Sumamed

Broad-spectrum antibiotic with the active substance azithromycin. “Sumamed” is indicated for infections caused by bronchitis, purulent tonsillitis (even in the most difficult cases), and otitis media. “Sumamed” acts as quickly as possible, and the course of treatment lasts three days (one tablet per day). Improvement in the condition of ARVI occurs already on the second day of treatment with this antibiotic. Sumamed does not have such a large list of side effects and contraindications as cheaper antibiotics. Many doctors choose this particular drug for its effectiveness and safety. "Sumamed" can be taken by children from three years of age (available in the form of a suspension).

Sumamed

Pliva Hrvatska, Croatia

Infectious and inflammatory diseases caused by microorganisms sensitive to the drug: - infections of the upper respiratory tract and ENT organs (pharyngitis/tonsillitis, sinusitis, otitis media);
— lower respiratory tract infections (acute bronchitis, exacerbation of chronic bronchitis, pneumonia, including those caused by atypical pathogens); - infections of the skin and soft tissues (erysipelas, impetigo, secondary infected dermatoses; - initial stage of Lyme disease (borreliosis) - erythema migrans; - genitourinary tract infections (urethritis, cervicitis) caused by Chlamydia trachomatis. from 150

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Fluimucil – IT antibiotic

One of the best antibiotics for coughs, which can be used both as injections and inhalations. The active ingredient is thiamphenicol glycinate acetylcysteinate. “Fluimucil – antibiotic IT” is prescribed in the form of inhalations and rinses for diseases of the upper respiratory tract and ENT organs such as wet cough, bronchitis, exudative otitis media, sinusitis, laryngotracheitis, and sinusitis. The drug successfully combines an antibiotic and a mucolytic, so Fluimucil not only destroys bacteria, but also helps to clear sputum better (for example, with bronchitis). It is important not to confuse this antibiotic with the drug of the same name in the form of soluble tablets and granules that are taken orally.

Fluimucil-Antibiotic IT

Zambon, Italy

Diseases of the upper respiratory tract and ENT organs: exudative otitis media, sinusitis, laryngotracheitis;
diseases of the lower respiratory tract: acute and chronic bronchitis, prolonged pneumonia, lung abscess, emphysema, bronchiectasis, cystic fibrosis, bronchiolitis, whooping cough; prevention and treatment of bronchopulmonary complications after thoracic surgery (bronchopneumonia, atelectasis); prevention and treatment of obstructive and infectious complications of tracheostomy, preparation for bronchoscopy, bronchoaspiration; with concomitant nonspecific forms of respiratory infections to improve drainage, including cavernous lesions, with mycobacterial infections. from 46

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The best antibiotics for sinusitis

In the treatment of sinusitis, antibiotics are usually used, often in combination with other medications. Such drugs come in the form of tablets, solutions, for topical use and injections. We have compiled a list of the most effective antibiotics prescribed by doctors for sinusitis.

Principles for choosing antimicrobial drugs

Self-medication with antibiotics is strictly prohibited, since uncontrolled use of potent drugs can weaken the body and worsen the body's defense reactions. The drugs are selected exclusively by the doctor, taking into account the form of the disease and the patient’s condition.

Indications for prescribing antibiotics for the treatment of infectious diseases are the following:

• Development of bacterial microflora in the respiratory tract. This is indicated by sputum with a green or yellow tint, which comes out with a cough.
• Maintaining body temperature above 38.5°C for more than 4 days.
• Severe weakness and the appearance of severe fatigue with minimal exertion.
• The presence of purulent mucus in the stool.

Before a certain type of antibiotic is prescribed, a bacteriological culture must be carried out. To do this, take a swab from the nasopharynx and trachea, as well as mucus from the stool. Samples are placed in a nutrient medium to determine the type of microorganism. After this, a group of antibiotics is selected that destroy certain bacteria.

To ensure that the chosen antibiotic does not provoke a deterioration in the general condition, the following general tests are performed:

• Blood. During the test, the number of main components is determined. When using antimicrobial drugs, a decrease in their levels may occur, so it is important to exclude the possibility of critical indicators.
• Urine. Testing allows you to determine the condition of the urinary system and prevent possible inflammatory processes due to increased stress on the organs when removing the antibiotic from the body.

Also carried out:

• Biochemical blood test to exclude exacerbations of existing pathologies when using potent antimicrobial drugs.
• CT scan of the chest to assess the extent of damage to the lung tissue and select the dosage of the antibiotic.

Vilprafen Solutab

The active ingredient of this drug is josamycin. "Vilprafen Solutab" is prescribed for many infectious diseases, in particular for otitis, bronchitis, sore throat, pneumonia, dental inflammatory processes, furunculosis and diseases of the genitourinary system. The advantage of this antibiotic is that it can be taken during pregnancy and breastfeeding. "Vilprafen Solutab" is one of the safest antibiotics. Contraindications include only severe liver damage and intolerance to the components of the drug. Vilprafen Solutab has practically no side effects. The only disadvantage of this antibiotic is its high cost.

Vilprafen Solutab

Yamanouchi Europe, Netherlands

Treatment of infectious and inflammatory diseases caused by microorganisms sensitive to josamycin: infections of the upper respiratory tract and ENT organs (including pharyngitis, tonsillitis, paratonsillitis, otitis media, sinusitis, laryngitis);
diphtheria (in addition to treatment with diphtheria antitoxin); scarlet fever (with hypersensitivity to penicillin); lower respiratory tract infections (including acute bronchitis, bronchopneumonia, pneumonia, including atypical form, whooping cough, psittacosis); oral infections (including gingivitis and periodontal disease); infections of the skin and soft tissues (including pyoderma, boils, anthrax, erysipelas / with hypersensitivity to penicillin /, acne, lymphangitis, lymphadenitis); infections of the urinary tract and genital organs (including urethritis, prostatitis, gonorrhea; with increased sensitivity to penicillin - syphilis, lymphogranuloma venereum); chlamydial, mycoplasma (including ureaplasma) and mixed infections of the urinary tract and genital organs. from 45

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Etiology of bacterial skin infections

The most common causative agents of skin infections are staphylococci and streptococci:

EcoClav

The active ingredients of this drug are amoxicillin and clavulanic acid, which supports the action of the antibiotic, making it even more effective. "EcoClav" is a broad-spectrum antibiotic, but it is often prescribed specifically for bronchitis and sore throat, regardless of the pathogen that caused these diseases. EcoClav is also indicated for skin infections and osteomyelitis. Contraindications include age under 12 years, intolerance to the active substances of the drug, severe liver and kidney damage. EcoClav can be taken during pregnancy and breastfeeding, which indicates its safety compared to other antibiotics.

Ecoclave

ABVA RUS, Russia

Infectious and inflammatory diseases caused by pathogens sensitive to the drug: lower respiratory tract infections (bronchitis, pneumonia);
infections of the ENT organs (sinusitis, tonsillitis, otitis media); infections of the genitourinary system and pelvic organs (pyelonephritis, pyelitis, cystitis, urethritis, bacterial prostatitis, cervicitis, salpingitis, salpingoophoritis, endometritis, bacterial vaginitis, septic abortion, chancroid, gonorrhea); infections of the skin and soft tissues (erysipelas, impetigo, secondary infected dermatoses, abscess, cellulitis, wound infection); infections of bones and joints (osteomyelitis). from 111

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Systemic antibiotics in the treatment of bacterial infections of the skin and soft tissues: focus on macrolides

Bacterial infections of the skin, causing purulent inflammation, were identified as a group of infectious dermatoses by the French scientist H. Leloir in 1891 under the name pyodermatitis (pyon - pus, derma - skin). Abroad, pyoderma is usually classified as a broad group of skin and soft tissue infections (SSTI), which includes, in addition to infections of the skin and its adnexal structures, infections of the subcutaneous fatty tissue and underlying tissues. In economically developed countries, SSTIs account for 1/3 of all infectious diseases. According to domestic studies, pustular skin infections account for 30–40% of all dermatological pathology in people of working age; in military personnel this figure reaches 60%. In pediatric dermatological practice, this pathology is one of the most common and accounts for 30 to 50% of all cases of visits to the doctor [1–3]. Etiology The main source of SSTIs are microorganisms that contaminate and colonize the surface of the skin. Gram-positive cocci S. aureus and S. Pyogenes, capable of penetrating into the thickness of the epidermis in the presence of its damage, undoubtedly play a leading role in the etiology of pustular skin infections. Moreover, S. aureus is the most common pathogen; infections caused by S. pyogenes, as well as a mixed infection involving both microorganisms, are somewhat less common. According to the results of foreign multicenter studies, in addition to S. aureus, S. pyogenes, Corynebacterium diphtheriae, P. aeruginosa, Enterobacteriaceae, Streptococcus spp. may be involved in the development of SSTI. The type of infection is of great importance in determining the etiological role of the suspected pathogen (Table 1). Unlike primary pyodermas, secondary ones, like most necrotizing SSTI infections, have a polymicrobial etiology. The virulence of the microorganism and the degree of bacterial contamination play an important role in the development of infection. It has been shown that the probability of developing an infection is directly proportional to the degree of bacterial contamination and virulence of the microorganism and inversely proportional to the strength of the body's protective reaction. The likelihood of colonization increases in the presence of skin diseases of allergic origin. Thus, in patients with atopic dermatitis, colonization of the affected areas with S. aureus is detected in 90% of cases [3]. Pathogenesis In the occurrence of one or another form of pyoderma, an important role is played by: the type of pathogen, its virulence, the state of the macroorganism, as well as various endogenous and exogenous predisposing factors that reduce the barrier and protective functions of the skin. The virulence of staphylococci and streptococci is determined by a number of pathogenic toxins and enzymes they secrete (coagulase, leukocidin, streptokinase, hyaluronidase streptolysin, hemolysins, etc.), which facilitate the penetration of pathogens into the skin, lead to damage and stratification of all layers of the epidermis, cause hemolysis and necrotization of the dermis and underlying tissues, disrupting their normal metabolism [4,5]. In the occurrence and development of SSTIs, the reactivity of the body and its mechanisms of resistance to microbial aggression are of great importance. The insufficiency of the immunocompetent system in this case is, as a rule, of a secondary (acquired) nature. It can form in the premorbid period as a result of previous or concomitant severe diseases. Diseases of the endocrine system (obesity, diabetes, insufficient activity of the pituitary-adrenal system, thyroid, gonads) contribute to a decrease in the body's anti-infective defense mechanisms. More than half of patients (52%) with chronic pyoderma abuse carbohydrates (usually easily digestible), which creates a constant overload of the insular apparatus of the pancreas and can contribute to carbohydrate metabolism disorders of varying degrees, the accumulation of carbohydrates in tissues, which are a favorable breeding ground for pyococci. A significant role is also assigned to the seborrheic skin condition. Due to an increase in the amount of sebum and changes in its chemical composition, a decrease in the sterilization properties of the skin and activation of pyogenic cocci occurs [6]. Of no small importance in the development of pustular skin diseases are chronic infectious diseases of various organs and tissues: periodontal disease, caries, gingivitis, tonsillitis, pharyngitis, infections of the urogenital tract, dysbacteriosis, intestinal intoxications, which reduce the general and local antibacterial resistance of the body and contribute to the development of subsequent specific sensitization in patients , which aggravates the course of the infectious process. A significant role in the development of chronic pyoderma is played by diseases of the central and autonomic nervous system, mental or physical overstrain, “debilitating diseases” - alcoholism, fasting, malnutrition (lack of proteins, vitamins, mineral salts, hypovitaminosis, especially A and C. Vitamin A is involved in In the process of keratin formation, vitamin C regulates the permeability of the vascular wall and is a synergist of corticosteroids). A major role in the development of pyoderma is played by various immunodeficiency conditions that arise as a result of congenital or acquired immunodeficiency (HIV infection, use of glucocorticosteroids, cytostatics and immunosuppressants). Defects in cellular antibacterial defense in the form of inhibition of the phagocytic activity of neutrophils, impaired chemotaxis, as well as a decrease in opsonic factors of blood serum and immunoglobulins contribute to chronic infection and frequent relapses [7]. Violations of the T-cell immune system are of major importance in the pathogenesis of SSTIs. The basis for disorders of specific mechanisms of immunological reactivity is a decrease in the number of T-lymphocytes in the peripheral blood, a decrease in the number of CD3 and CD4 cells and a change in their relationship with monocytes, which leads to a weakening of the T-cell immune response. Insufficiency of the patient’s immune system (immunological imbalance) and antigenic mimicry of the pathogen often lead to chronic infection and the formation of bacterial carriage, and irrational use of antibiotics leads to pathogen resistance [8]. Unfavorable environmental influences that violate the integrity of the skin and create an “entry gate” for infection are of significant importance in the development of bacterial skin infections. These primarily include the influence of high or low temperature, high humidity, leading to maceration of the skin, increased pollution and microtraumatization by occupational factors (oils, cement, coal dust). The entry point for infection occurs due to household microtraumas (cuts, injections), scratching and itchy dermatoses. Violation of the skin barrier in the form of dryness and thinning of the stratum corneum contributes to the penetration of microorganisms into the deep layers of the skin and underlying tissues, which leads to the development of the pyodermic process. Clinical types of SSTIs SSTIs are a fairly numerous and clinically heterogeneous group of diseases that lead to lesions of varying depth, prevalence and severity. A common symptom characteristic of all is the presence of local purulent inflammation, which in severe cases is accompanied by the development of a systemic inflammatory reaction. Clinical forms depend on the type of etiological factor, anatomical localization, association with skin appendages, depth and area of ​​the lesion, and duration of the process. In domestic dermatology, the classification of primary pyoderma was adopted, proposed by J. Jadasson back in 1934 and built on an etiological principle. It includes: staphyloderma, mainly affecting the skin around the appendages (sebaceous follicles, sweat glands); streptoderma, affecting smooth skin mainly around natural openings and mixed strepto-staphylococcal infections. In each of the three groups, depending on the depth of the lesion, superficial and deep forms are distinguished. In addition, pustular skin diseases are divided into primary, occurring on unchanged skin, and secondary, developing as complications against the background of an existing dermatosis, usually itchy (scabies, eczema, atopic dermatitis). According to the duration of the course, acute and chronic pyoderma are distinguished. Staphylococcal pyoderma is usually associated with skin appendages (hair follicles, apocrine glands). They are characterized by the formation of a deep pustule, in the center of which a cavity is formed, filled with purulent exudate. Along the periphery there is a zone of erythematous-edematous inflammatory skin. The suppurative process ends with the formation of a scar (Fig. 1). Streptococcal pyoderma most often develops on smooth skin, around natural openings (oral cavity, nose) and begins with the formation of phlyctena - a superficially located bubble with a flabby folded tire, inside which contains serous-purulent contents. The thin walls of the phlyctena quickly open, and the contents pour out onto the surface of the skin, drying out into honey-yellow layered crusts. The process tends to spread along the periphery as a result of autoinuculation (Fig. 2). Staphyloderma more often affects men, streptoderma – women and children [3,4]. In foreign literature, from a practical point of view, all SSTIs are divided into three main groups: primary pyoderma, overwhelmingly caused by S. aureus and pyogenic b-hemolytic streptococci (mainly group A), and developing on unchanged skin (folliculitis, impetigo, erysipelas) ; secondary pyoderma developing against the background of skin damage or concomitant somatic pathology (for example, bedsores, diabetic foot ulcers, infections after animal bites, postoperative wound and post-traumatic infections), as well as against the background of dermatoses accompanied by itching and scratching (allergic dermatitis, psoriasis, scabies and etc.); necrotizing infections, representing the most severe form of SSTI (cellulitis of polymicrobial etiology - synergistic cellulitis, necrotizing fasciitis, myonecrosis - gas gangrene) (Fig. 3). With this pathology, determining the depth and extent of the lesion is the priority of the surgeon, because Only with surgical treatment can the true extent of the infection be most accurately determined. The initial management of these patients is the same. It consists of early surgical intervention and the appointment of adequate antimicrobial therapy [9]. Treatment of SSTIs Treatment of patients with bacterial skin infections should be comprehensive (etiotropic and pathogenetic) and carried out after a thorough anamnestic, clinical and laboratory examination of the patient. It is necessary to identify and treat concomitant diseases, examine for foci of focal infection, and in the case of a long-term persistent process, study the immunostatus. The main and only method of etiotropic treatment of patients with SSTIs are antibiotics. In acute superficial non-common processes (impetigo, folliculitis, paronychia), therapy may be limited to the local use of antibiotics and antiseptics. In all other cases, systemic antibiotic therapy is required. Indications for systemic antibiotic therapy are deep forms of pyoderma: boils (especially localized on the face and neck), carbuncle, hidradenitis, erysipelas, cellulite. The listed forms of bacterial skin infections have a long, often chronic, recurrent course, a high prevalence of the process and are often accompanied by symptoms of general intoxication in the form of fever, headache, weakness, as well as the development of regional complications (lymphadenitis, lymphangitis). Antibiotics are used as an etiotropic agent in the treatment of bacterial dermatosis – Lyme disease. They are the drugs of choice for the treatment of acne vulgaris. In dermatovenerological practice, antibiotics are widely used both for the treatment of infectious dermatoses and diseases caused by sexually transmitted infections (STIs) [4]. Before prescribing an antibacterial drug, it is advisable to culture the pus to determine the sensitivity of the isolated microorganism to various antibiotics and, based on the results of the study, prescribe the appropriate drug. However, this is not always feasible, especially if complications of infection threaten or develop. As an analysis of modern literature and our own clinical experience shows, today the following groups of antibiotics are most often used in the treatment of bacterial skin infections: 1. β-lactams: a) natural penicillin, its durant forms and semi-synthetic penicillins; b) cephalosporins (1st–4th generation). 2. Macrolides. 3. Tetracyclines. 4. Fluoroquinolones. In recent years, penicillin and its durant drugs have rarely been used in the treatment of SSTIs, since the overwhelming number of pyococcal strains have acquired the ability to produce the enzyme b-lactamase (penicillinase), which suppresses the antibacterial activity of penicillin. In addition, β-lactams are drugs that have a high incidence of allergic reactions. Tetracyclines and aminoglycosides are currently used much less frequently. This is due to the large number of strains of microorganisms resistant to these antibiotics (which implies their low therapeutic activity), as well as the presence of severe side effects. It should be remembered that tetracyclines are contraindicated in pregnancy, children and patients with liver failure. Fluoroquinolones are prescribed mainly for the treatment of sexually transmitted diseases, due to the high sensitivity of urogenital infections to them, and for pyoderma they are used only when other groups of antibiotics are ineffective. However, in diseases of the central nervous system, in pregnant women, as well as in pediatrics, the range of their use is limited - they are prescribed mainly for health reasons. It is also necessary not to forget about the photosensitizing effect of fluoroquinolones and the associated precautions, especially in spring and summer [10]. Modern medical practice imposes certain requirements on the choice of antibiotic. First of all, the drug must have a wide spectrum of antimicrobial action and minimally expressed antibiotic resistance to microbial agents, have no severe side effects, have a minimal risk of allergic reactions, be convenient to use for the patient (availability of an oral form, a convenient dosage regimen) and affordable. In addition, it is very important that the antibiotic does not have clinically significant interactions with other drugs. Today, antibiotics – macrolides – fully meet these requirements. Classification and mechanisms of pharmacotherapeutic action of macrolides Macrolides have been widely used in clinical practice for more than 50 years. The first natural antibiotic of this group, erythromycin (a metabolite of Streptomyces erythreus), was obtained back in 1952. Macrolides can be classified by chemical structure and origin. The basis of the chemical structure of this class of antibiotics is the macrocyclic lactone ring. Depending on the number of carbon atoms in the ring, macrolides are divided into 14-, 15- and 16-membered (Table 2). Among macrolides, there are 3 generations: a) first generation: erythromycin, oleandomycin; b) second generation: spiramycin, roxithromycin, josamycin, clarithromycin, etc.; c) third generation: azithromycin (Azitral). The antibacterial effect of macrolides is based on disruption of the synthesis of ribosomal proteins of the microbial cell and thereby inhibiting the process of pathogen reproduction. They mainly have a bacteriostatic effect, which makes it advisable to prescribe them in the acute phase of inflammation. Macrolides belong to “tissue antibiotics”, i.e. when distributed in the body, they accumulate predominantly not in the bloodstream, but in those organs and tissues where there is inflammation, thereby creating high concentrations of the drug. Well distributed in the body, macrolides are able to overcome histohematological barriers (with the exception of the blood-brain barrier), significantly superior to β-lactam antibiotics. However, widespread (and often unjustified) use quickly led to the emergence of a high percentage of erythromycin-resistant strains of pathogens, especially staphylococci. This, in turn, has significantly reduced the use of erythromycin in clinical practice [11]. Interest in macrolides arose again in the early 80s of the 20th century, after the emergence of new generations of antibiotics of this group - azalides (in particular, azithromycin). Azithromycin was synthesized in 1983 from erythromycin. The drug in its pharmacokinetic properties surpassed all the indicators of its predecessor and became the first representative of the new group of antibiotics - azalids. The uniqueness of azithromycin is based on its exceptional pharmacokinetics. Azithromycin is stable in an acidic environment, due to which it is well absorbed after oral administration. Simultaneous intake with food reduces the absorption by 50%, so the drug is taken 1 hour before or 2 hours after eating. The lipophilicity of the azithromycin molecule provides, in addition to a high level of absorption in the intestines, also an excellent penetration of the drug into the tissue. The rapid penetration of azithromycin from the blood in the tissue is also ensured by a low level of binding of azithromycin with blood proteins, which makes it possible to achieve a rapid therapeutic effect in infections that affect the cells and tissue. A high concentration of the drug in the area of ​​lesion, 10-100 times higher than the concentration in the bloodstream, allows you to actively affect the pathogenic focus, thereby providing a quick clinical effect and an early recovery. Современные макролиды (в частности, азитромицин) проявляют наибольщую эффективность в отношении таких возбудителей, как S. pyogenus, S. aureus, S. pneumoniae, некоторых грамотрицательных микроорганизмов (гонококи), а также внутриклеточных возбудителей (в частности, Chlamidia trachomatis и Ureaplasma urealyticum) What causes their high demand in dermatovenerological practice [12]. The second -generation macrolides are important for antibacterial activity of the second -generation macrolides. Due to their ability to penetrate neutrophils and create high concentrations in them, many macrolides positively modify the functions of these cells, influencing, in particular, chemotaxis, the activity of phagocytosis and killing. Along with the antimicrobial effect, these antibiotics have moderate anti -inflammatory activity. Activating the cells of the macrophage row, they are able to penetrate them and during the migration of phagocytic cells into the focus of inflammation to go there with them. The uniqueness of these drugs also lies in the fact that they have a pronounced plain effect, that is, they retain high concentrations in the focus of inflammation for 5-7 days after the abolition. This sanogenetic effect made it possible to develop short treatment courses not exceeding 3-5 days, and a convenient dosage regimen (1 time per day). This, in turn, ensures the compliance of treatment and improves the quality of life of the patient. The most pronounced postbiotic effect in azithromycin is, which allows you to create an antibiotic concentration in the foci of infection, which is many times higher than the IPC in relation to active pathogens in the treatment of both acute and chronic infections. Recently, evidence of the immunomodulating action of azithromycin in an experiment on healthy volunteers has been obtained. The first phase of the immunomodulating effect is to degenerate neutrophils and oxidant explosion, which contributed to the activation of protective mechanisms. Upon reaching the eradication of pathogens, it was noted to reduce IL -8 products and the stimulation of neutrophil apoptosis, which minimized the severity of the inflammatory reaction [13]. Macrolides, both natural and semi -synthetic, compared to other antibiotics have a minimal effect on the normal microflora of the human body and do not cause dysbiosis. Therefore, azithromycin is considered not only as a highly effective, but also the safest antibiotic with a minimum number of contraindications to the appointment. Unwanted reactions when taking it as a whole are extremely rare and do not exceed 5%. The most common side effects are symptoms from the gastrointestinal tract (nausea, severity in the epigastric region), which are usually expressed moderately, do not require the cancellation of the drug and quickly pass when taking drugs after eating [11]. The clinical efficiency of azithromycin as comparative studies indicate, with IKMT among antibiotics used in outpatient practice, the most effective macrolides of the new generation, primarily 15- and 16 -member (azithromycin, josamycin, roxyromycin). The 20 -year positive experience in the use of azithromycin in domestic dermatovenerological practice has already been accumulated. In dermatology, it is the basic therapy of staphylococcal and streptococcus lesions of the skin and soft tissues (boil, impetigo, cellulite), and in venereological practice - in the treatment of SPPPs. Unlike most macrolides, azithromycin does not have clinically significant interactions with other drugs. It is not associated with the enzymes of the Cytochrome R450 complex, as a result of which it does not show a reaction of drug interaction with drugs metabolizing along this path. This property is important, since in real clinical practice, most patients who occur IKMT have background or related diseases, about which they receive appropriate treatment. It must also be emphasized that, along with good tolerance and lack of pronounced adverse reactions of macrolides (azithromycin), have another unconditional advantage compared to other groups of antibiotics - this is that it can be prescribed for pregnant women and children [14]. Currently, one of the most commonly used drugs in clinical practice is the Azitral (azithromycin) drug, produced by pharmaceutical. Azitral (azithromycin) is similar to the original azithromycin - the first representative of the Azalids subgroup from the group of macrolide antibiotics used in the treatment of IKMT and urogenital infections. Studies have shown that the clinical effectiveness of the drug prescribed in a single dose of 500 mg for 3 days is comparable to the effectiveness of most widely used antibacterial agents. This allows you to reduce the usual course of antibiotic therapy by 2-3 times, and the unique pharmacokinetic profile of Azitral provides one -time daily intake and high compliance of therapy [15]. Due to the features of pharmacokinetics and a kind of antimicrobial spectrum covering the main pathogens of the genitourinary tract infections, azithromycin is the first choice in the therapy of combined IPPPs, including chronic complicated urogenital chlamydia and in non -understanding women, and an alternative tool for the treatment of this disease during the period of pregnancy. With a single use of 1 g of azithromycin (azitral), its concentration in the tissue of the prostate and uterus exceeds the IPC for C. trachomatis (0.125 μg/ml) by 42.5 times, and in the cervical canal - 12 times, which is the therapeutic concentration for the treatment of this infection. Moreover, even after 2 weeks, the therapeutic concentration of azithromycin in the prostate tissue exceeds the MPC for C. trachomatis by 13.6 times. The authors proved that it was with such a technique in tissues where C. trachomatis is vegetated that a high therapeutic concentration of the drug is supported during 6–8 development cycles. The data obtained indicate the high efficiency of pulse - therapy with Azitral (1 g 1 time per week, a course dose of 3 g). In the complex treatment of chronic chlamydial urethropostatitis and mycouraplasmic and wardenelle infection associated with it. It is important to note that the drug Azitral is well tolerated by patients, is available in price and therefore can be widely used in therapy of complicated urogenital chlamydia and VZ [16,17]. The study of the effectiveness, safety and tolerance of azithromycin in 30 children from 6 months to 3 years with staphylococcal infections of various localization of ENT organs and skin showed that asytromycin (Azitral) is not inferior in effectiveness with anti -staphylococcal penicillins. Along with high efficiency, characterized by quick and persistent reverse dynamics of the main clinical symptoms and local inflammatory changes in 100% of cases, good tolerance of the drug and the lack of side effects in all children were noted. A wide range of antimicrobial activity, features of pharmacokinetics, a low percentage of unwanted phenomena and a number of advantages over other macrolides determine the priority of using the drug for various skin infectious processes (impetigo, furunculosis, folliculitis, cellulite, paronichia) in children. The effectiveness of azithromycin in pediatric practice, proved by clinical trials, allows you to recommend it as an alternative to b -lactam antibiotics, and in children with burdened allergoannesis - as a drug of choice [18,19]. One of the most important pharmacoeconomic indicators that determine the choice of antibiotic is the ratio of cost/efficiency. It is determined how the ratio of the cost of drug treatment (for oral drugs is equal to the cost of a course dose) to the share of successfully treated patients. It should be noted that Azitral among the existing drugs of azithromycin shows the optimal price/quality ratio [20]. It is known that the inefficiency of antibiotic therapy is largely determined by a decrease in sensitivity to the drug used. Currently, there is no clinically significant resistance to azithromycin. According to antibiotic resistance monitoring, resistance to azithromycin and other macrolides of the latest generation among the pathogens of IKMT does not exceed 2-10%. The sensitivity of S. Pyogenes is allocated in Russia to the antibiotic of azithromycin is 92%. As shown in a number of studies, the clinical effectiveness of azithromycin is higher than that of tetracyclines and B - lactam antibiotics. Comparative clinical and microbiological study of effectiveness in deep staphyloderma of the 5 -day course of azithromycin and 10 -day taking cephalexin showed higher therapeutic activity of macrolide. The eradication of the pathogen when using azithromycin was noted in 94%, with cephalexin in 90% of cases, clinical cure - respectively, in 56 and 53% of cases. At the same time, the frequency of adverse reactions, as a rule, does not require the abolition of the drug, does not exceed 5%, which is much lower than erythromycin (up to 14%) or oral forms of B - lactams [21,22]. Thus, azithromycin has a wide spectrum of antimicrobial action, high bacteriostatic activity in relation to sensitive infections for it, high bioavailability with selective effects in the focus of inflammation, it has low toxic, has a minimum of side effects and a convenient regime of administration. Consequently, the drug meets the modern requirements of rational antibiotic therapy and can be recommended for effective use in dermatovenerological practice.

References 1. Jones ME, Karlowsky JA, Draghi DC, Thornsberry C., Sahm DF, Nathwani D. Epidemiology and antibiotic susceptibility of bacteria causing skin and soft tissue infections in the USA and Europe: a guide to appropriate antimicrobial treatment. Int J Antimicrob Agent 2003; 22:406–19. 2. N.N. Murashkin, M.N. Gluzmina, L.S. Galustyan. Pustular skin lesions in the practice of a pediatric dermatologist: a fresh look at an old problem. RZHKVB: Scientific and practical journal, 2008, No. 4, p. 67–71. 3. Belkova Yu.A. Pyoderma in outpatient practice. Diseases and pathogens. Clinical microbiology and antimicrobial chemotherapy: No. 3, volume 7, p. 255–270, 2005. 4. T.A. Belousova, M.V. Goryachkina. Bacterial skin infections: the problem of choosing the optimal antibiotic. RMJ 2005, volume 13, no. 16, p. 1086–1089. 5. Takha T.V., Nazhmutdinova D.K. Rational choice of antibiotic therapy for pyoderma. RMJ 2008, volume 16, no. 8, p. 552–555. 6. Novoselov V.S., Plieva L.R. Pyoderma. RMJ 2004, volume 12, no. 5, p. 327–335. 7. Masyukova S.A., Gladko V.V., Ustinov M.V., Vladimirova E.V., Tarasenko G.N., Sorokina E.V. Bacterial skin infections and their significance in the clinical practice of a dermatologist. Consilium medicum 2004, volume 6, no. 3, p. 180–185. 8. T. File. Diagnosis and antimicrobial therapy of skin and soft tissue infections. Ohio, USA. Clinical microbiology and antimicrobial chemotherapy: No. 2, volume 5, p. 119–125, 2003 9. Shlyapnikov S.A., Fedorova V.V. The use of macrolides for surgical infections of the skin and soft tissues. GRM, 2004.–t.12, no. 4, pp.204–207 10. Guchev I.A., Sidorenko S.V., Frantsuzov V.N. Rational antimicrobial chemotherapy for skin and soft tissue infections. Antibiotics and chemotherapy. 2003, v. 48, 10, pp. 25–31 11. Parsad D., Pandhi R., Dogras S. A guide to selection and appropriate use of macrolides in skin infection Am J Clin Dermatol 2003; 4:389–97 12. Yakovlev S.V., Ukhtin S.A. Azithromycin: basic properties, optimization of application regimens based on pharmacokinetic and parameters. Antibiotics and chemotherapy. 2003 vol. 48, no. 2. - With. 22–27 13. Turovsky A.B., Kolbanova I.G. Macrolides in the treatment of respiratory tract infections from the position of an ENT doctor: pros and cons Consilium medicum, 2010, No. 4, vol. 12, p. 11 -14. 14. Prokhorovich E.A. Azithromycin. From clinical pharmacology to clinical practice. RMJ 2006, volume 14, no. 7, p. 567–572 15. Berdnikova N.G. Current aspects of the use of azithromycin (Azitral) in the treatment of community-acquired pneumonia in adults. RMJ 2006, volume 14, no. 22, p. 1625–1628. 16. Khryanin A.A., Reshetnikov O.V. Macrolides in the treatment of chlamydial infection in pregnant women (efficacy, safety, cost-effectiveness). RMJ 2008, volume 16, no. 1, p. 23–27. 17. Serov V.N., Dubnitskaya L.V., Tyutyunnik V.L. Inflammatory diseases of the pelvic organs: diagnostic criteria and principles of treatment. RMJ 2011, volume 19, no. 1, p. 46–50. 18. Talashova S.V. Some aspects of the use of antibacterial drugs in pediatrics using the example of macrolides. RMJ 2009, volume 17, no. 7, p. 464–466 19. Mazankova L.N., Ilyina N.O. The place of azalides in pediatric practice. RMJ 2008, volume 16, no. 3, p. 121–125. 20. Solovyov A.M., Pozdnyakov O.L., Tereshchenko A.V. Why is azithromycin considered the drug of choice for the treatment of urogenital chlamydial infection. RMJ 2006, volume 14, no. 15, p. 1160–1164. 21. Gurov A.V., Izotova G.N., Yushkina M.A. Possibilities of using the drug Azitral in the treatment of purulent-inflammatory diseases of the ENT organs. RMJ 2011, volume 19, no. 6, p. 405. 22. Klani R. Double-blind, double-dummy comparison of azithromycin and cephalexin in the treatmen of skin and skin structure infection. Eur.J. Clin. Microbiol. Infect.Dis. 1999, Oct. 10 (10) – p.880–84

Isofra

This is perhaps the best antibiotic for treating sinusitis. The active ingredient of the product is framycetin sulfate. You can buy Isofra in the form of a nasal spray for topical use. The drug is often prescribed for long-term rhinitis, sinusitis and nasopharyngitis. Isofra spray is suitable for both adults and children, because it is as safe as possible, it has almost no contraindications, and it can be combined with other medications. Possible side effects include only an allergy to the components of the drug and a slight disruption of the microflora of the nasopharynx (if the spray is used for a long time). Despite its safety, Isofra should be prescribed exclusively by a doctor, because it is an antibiotic. It is prohibited to use the drug for allergic rhinitis.

Isofra

Laboratories Bouchard-Recordati, France

As part of combination therapy for infectious and inflammatory diseases of the upper respiratory tract, including: - rhinitis;
- rhinopharyngitis; - sinusitis (in the absence of damage to the septum). Prevention and treatment of inflammatory processes after surgery. from 220

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Polydexa with phenylephrine

Typically, Polydex spray is prescribed for prolonged runny nose with purulent discharge. Active ingredients of the drug: dexamethasone, neomycin, polymyxin B, phenylephrine (vasoconstrictor). "Polydex with phenylephrine" is indicated for bacterial sinusitis and rhinitis. The spray not only destroys bacteria, but also relieves inflammation, improving nasal breathing. After just three to five days, the positive effect of using Polydex is noticeable. Contraindications include pregnancy, breastfeeding, children under 2.5 years of age, and kidney problems. Because of these contraindications, doctors often prescribe safer analogues of this antibiotic.

Polydexa with phenylephrine

Laboratories Bouchard-Recordati, France

Inflammatory and infectious diseases of the nasal cavity, pharynx, paranasal sinuses: - acute and chronic rhinitis;
- acute and chronic nasopharyngitis; - sinusitis. from 265

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Read also: Top 7 effective remedies for a runny nose The best nasal drops and sprays that quickly and effectively help cure a runny nose.

The best antibiotics for gynecological diseases

Many women face inflammatory diseases that require special treatment. Among such diseases: adnexitis, oophoritis, STDs, salpingoophoritis, cervicitis, bacterial vaginosis, etc. Gynecologists have antibiotics in their arsenal that are prescribed to treat specifically “female” problems.

Spectrum of action

There are antibacterial agents:

Cefotaxime

This antibiotic is often prescribed for inflammatory and infectious diseases in gynecology. You can buy Cefotaxime in almost any pharmacy; it is inexpensive and effective. This is a third generation cephalosporin antibiotic whose active ingredient is cefotaxime sodium. This antibiotic is often prescribed to prevent infections after gynecological operations. Cefotaxime should be prescribed exclusively by a doctor; it must be administered intramuscularly or intravenously. It is often indicated in cases where tablets are ineffective. Contraindications include hypersensitivity to active substances, serious liver and kidney diseases.

Cefotaxime

CJSC FF "Lekko", Russia; MJ Biopharm, India; Sintez OJSC, Russia; Belmedpreparaty, Belarus; Deco, Russia; OJSC Borisov Plant of Medical Preparations (Borimed), Belarus; Kraspharma, Russia; PJSC "Biokhimik", Russia; Protek-SVM, Russia

Antibiotic, third generation cephalosporin.
Used for: Severe infectious and inflammatory diseases caused by microorganisms sensitive to cefotaxime, incl. peritonitis, sepsis, abdominal and pelvic infections, infections of the lower respiratory tract, urinary tract, infections of bones and joints, skin and soft tissues, infected wounds and burns, gonorrhea, meningitis, Lyme disease. Prevention of infections after surgery. from 19

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Tsiprolet

This antibiotic is prescribed not only in gynecology, but also in other areas of medicine. The active ingredient is ciprofloxacin hydrochloride monohydrate. “Tsiprolet” is inexpensive, but it is convenient to take, the positive effect is visible fairly quickly, and the drug almost does not disturb the intestinal microflora. The antibiotic is suitable for the treatment of inflammation of the pelvic organs and any “female” inflammatory processes. Contraindications include pregnancy, breastfeeding, allergies to the components of the drug, and the drug is also contraindicated in children and adolescents.

Tsiprolet

Dr. Reddy's Laboratories, India

Tsiprolet eye drops are an aqueous solution of ciprofloxacin for topical use in ophthalmology.
The drug belongs to antimicrobial drugs from the fluoroquinolone group, exhibits a bactericidal effect against most gram-negative and gram-positive bacteria, and is used to treat bacterial eye diseases (conjunctivitis, keratitis), including those caused by microorganisms resistant to other groups of antibiotics. from 45

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By composition

Antibacterial drugs are divided into 6 groups:

• Penicillins are the first antimicrobial drugs, obtained back in 1928 from a biological substance (Penicillium fungi). For a long time they remained the most popular medicine for the treatment of infectious diseases.
• Cephalosporins belong to the group of the most powerful antimicrobial agents with a wide range of applications. They completely destroy pathogenic flora and are well tolerated by humans.
• Macrolides are the name of a group of narrow-range antimicrobial agents. They do not destroy the diseased cell, but only stop its growth. This category includes the following drugs: erythromycin, spiramycin, azithromycin.
• Tetracyclines are good drugs for the treatment of infectious diseases of the respiratory and urinary tract.
• Fluoroquinolones are antimicrobial agents with a wide range of effects. Completely destroy pathogenic microorganisms. You can find 1st-2nd generation medications on sale. Doctors usually prescribe them to combat Pseudomonas aeruginosa.
• Aminoglycosides are antimicrobial drugs with a wide range of applications. Popular drugs in this group - streptomycin (therapy of tuberculosis, plague) and gentamicin - are used as ointments, eye drops, and injections for ophthalmic infections.

Generations of drugs. Advanced antimicrobial drugs already have six generations. For example, penicillin was the first drug of natural origin, while the third or sixth generation is an already improved version, which includes the strongest inhibitors. The relationship is direct: the newer the generation, the more effective the effect of drugs on pathogenic microflora.

By method of administration. Oral – taken by mouth. These are various syrups, tablets, soluble capsules, suspensions. Parenteral - administered intravenously or intramuscularly. They work faster than oral medications. Rectal medications are injected into the rectum.

Important! Taking antibiotics is allowed only after consulting a doctor, otherwise antibiotic resistance will develop.

Tetracycline

Everyone has probably heard about this antibiotic, because it has the widest possible spectrum of action. You can buy Tetracycline in any form. The active substance of the drug is tetracycline hydrochloride. Typically, "Tetracycline" is prescribed in tablets (for bronchitis, pharyngitis, tonsillitis, eczema, prostatitis, infections of the gastrointestinal tract and soft tissues. Thanks to its universal action, this antibiotic quickly defeats the infection. "Tetracycline" ointment is used externally for eye infections. But The drug has a large list of contraindications and side effects, which are important to read in the instructions.

Tetracycline

Belmedpreparaty, Belarus

Infectious and inflammatory diseases caused by microorganisms sensitive to tetracycline, incl.
pneumonia, bronchitis, pleural empyema, tonsillitis, cholecystitis, pyelonephritis, intestinal infections, endocarditis, endometritis, prostatitis, syphilis, gonorrhea, brucellosis, rickettsiosis, purulent soft tissue infections, osteomyelitis; trachoma, conjunctivitis, blepharitis; blackheads Prevention of postoperative infections. from 23

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Classification of antibiotics

All antibacterial agents can be divided into 5 categories according to their characteristics and range of application. Let's take a closer look at this classification:

Mechanism of action:

• Bactericidal - the active substances of the drugs completely destroy bacteria and viruses. After taking such strong drugs, all pathogenic microflora in the human body dies.
• Bacteriostatic – inhibits the growth or spread of viruses. Thus, the cells remain “alive” without forming pathogenic flora.

Amoxicillin

Another popular antibiotic, which is considered universal and at the same time as safe as possible. The active ingredient of the drug is amoxicillin trihydrate. Amoxicillin is inexpensive but effective. The drug is prescribed for many diseases caused by bacteria (from otitis media and tonsillitis to meningitis, Lyme disease and sepsis). You can buy Amoxicillin in any form: tablets, suspension, injections. Due to the fact that this antibiotic has practically no contraindications and side effects, it can be used by children from one month old, pregnant and lactating women.

Amoxicillin

Sintez OJSC, Russia; ABVA RUS, Russia

For use as monotherapy and in combination with clavulanic acid: infectious and inflammatory diseases caused by sensitive microorganisms, incl.
bronchitis, pneumonia, tonsillitis, pyelonephritis, urethritis, gastrointestinal infections, gynecological infections, infectious diseases of the skin and soft tissues, listeriosis, leptospirosis, gonorrhea. For use in combination with metronidazole: chronic gastritis in the acute phase, peptic ulcer of the stomach and duodenum in the acute phase, associated with Helicobacter pylori. from 45

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Read also The most effective probiotics for the intestines: top 5 How to choose a probiotic and for what problems it is prescribed.

*This article is for informational purposes only and is not an advertisement or purchase guide. Information is provided for reference purposes. Self-medication is unacceptable. Before purchasing any drug or if there are signs of illness, you must consult a doctor.