Antibiotics: spectrum of action, reception, treatment after antibiotics - Causes, symptoms and treatment. MF.

No medicine saves as many lives as antibiotics.

Therefore, we have the right to call the creation of antibiotics the greatest event, and their creators - great. Alexander Fleming in 1928 was accidentally discovered penicillin. A wide production of penicillin was discovered only in 1943.

What is an antibiotic?

Antibiotics are substances of either biological or semi-synthetic origin that are capable of having a negative effect( to depress vital activity or cause complete death) of various pathogens( more often bacteria, less often protozoa, etc.).

The main natural producers of antibiotics are mold fungi - penicillium, cephalosporium and others( penicillin, cephalosporin);actinomycetes( tetracycline, streptomycin), some bacteria( gramicidin), higher plants( phytoncides).

There are two main mechanisms for the action of antibiotics:

1) The bactericide is a complete inhibition of the growth of bacteria by acting on the vital cellular structures of microorganisms, hence causing irreversible death. They are called bactericidal, they destroy microbes. Thus, for example, penicillin, cephalexin, gentamicin can act. The effect of the bactericidal drug will come faster.

2) The bacteriostatic mechanism is an obstacle to bacterial growth, the growth of microbial colonies is inhibited, and the body itself, more precisely, the cells of the immune system - leukocytes, has a disastrous effect on them. This is the action of erythromycin, tetracycline, and levomycetin. If you can not withstand the full course of treatment and early stop taking a bacteriostatic antibiotic, the symptoms will return.

What are the antibiotics?

I. By mechanism of action:
- Bactericidal antibiotics( group of penicillin, streptomycin, cephalosporins, aminoglycosides, polymyxin, gramicidin, rifampicin, ristomycin)
- Bacteriostatic antibiotics( macrolides, tetracycline, levomycetin, linkomycin)

II. According to the spectrum of action:
- The broad spectrum of action of ( prescribed with an unknown pathogen, has a wide range of antibacterial effects on many pathogens, but there is a small probability of death of representatives of normal microflora of various body systems).Examples: ampicillin, cephalosporins, aminoglycosides, tetracycline, levomycetin, macrolides, carbapenems.
- Narrow spectrum of action :
1) With the predominant effect on gr + bacteria and cocci - staphylococci, streptococci( penicillins, cephalosporins I-II generation, lincomycin, fusidine, vancomycin);
2) With a predominant effect on gr-bacteria, for example, Escherichia coli and others( third generation cephalosporins, aminoglycosides, aztreonam, polymyxins).
* - gram + or gram-differ in color according to Gram and microscopy( gram + are painted in violet, and gram-in reddish).
- Other narrow-spectrum antibiotics:
1) Anti-tuberculosis( streptomycin, rifampicin, florimycin)
2) Antifungal( nystatin, levorin, amfortericin B, batrafen)
3) Against the simplest( monomycin)
4) Antitumor( actinomycins)

III. By Generations: There are antibiotics 1, 2, 3, 4 generations.
For example, cephalosporins that are divided into 1, 2, 3, 4 generation drugs:
- 1st generation: cephalexin, cephrine, cephalothin;
- 2nd generation: cefamezin, cefazolin( kefzol), cefamandol( mandol);
- 3rd generation: cefotaxime( klaforan), cefuroxime( ketocef), ceftriaxone( longachef), cefuroxime axetil( zinnate), ceftazidime( fortum);
- 4th generation: cefepime, cefpir( cephyr, kaiten) and others.

A newer generation of antibiotics differs from the previous one with a broader spectrum of action on microorganisms, greater safety for the human body( ie, a lower incidence of adverse reactions), a more convenient technique( if a first-generation drug needs to be administered 4 times a day, then 3 and 4 generations -only 1-2 times a day), are considered more "reliable"( higher efficacy in bacterial foci, and, accordingly, early onset of the therapeutic effect).Also, modern drugs of recent generations have oral forms( tablets, syrups) with a single dose during the day, which is convenient for most people.

How antibiotics can be injected into the body?

1) Through the mouth or by mouth ( tablets, capsules, drops, syrups).It is worth noting that a number of drugs in the stomach are poorly absorbed or simply destroyed( penicillin, aminoglycosides, carbapines).
2) In the internal environment of the body or parenterally ( intramuscularly, intravenously, into the spinal canal)
3) Directly in the rectum or rectally ( in enemas)
The onset of the effect on oral antibiotics( oral) is expected longer thanwith parenteral administration. Accordingly, with severe disease, parenteral administration is given an unconditional preference.

After taking the antibiotic appears in the blood, and then in a specific organ. There is a favorite localization of certain drugs in certain organs and systems. Accordingly, with this or that disease, drugs are prescribed with this antibiotic in mind. For example, with pathology in the bone tissue is assigned lincomycin, hearing organs - semisynthetic penicillins, etc. Azithromycin has a unique ability to be distributed: in case of pneumonia it accumulates in the lung tissue and in pyelonephritis in the kidneys.

Antibiotics are excreted from the body in several ways: with urine unchanged, all water-soluble antibiotics are excreted( example: penicillins, cephalosporins);with urine in modified form( example: tetracyclines, aminoglycosides);with urine and bile( example: tetracycline, rifampicin, levomycetin, erythromycin).

Reminder for the patient before taking the antibiotic

Before you are prescribed an antibiotic, inform the doctor:
- About the presence of your side effects of medications in the past.
- On the development in the past of allergic reactions to medications.
- On the admission of another treatment and compatibility of already prescribed drugs with the required medications now.
- About the presence of pregnancy or the need for breastfeeding.

You need to know( ask the doctor or find in the instructions for the drug):
- What is the dose of the drug and the frequency of reception during the day?
- Is special nutrition required during treatment?
- The course of treatment( how long should I take an antibiotic)?
- Possible side effects of the drug.
- For oral administration - the connection between taking the medicine and eating.
- Is prophylaxis of side effects( for example, intestinal dysbiosis, for the prevention of which probiotics are prescribed)?

When it is necessary to consult with a doctor when treating with antibiotics:
- If there are signs of an allergic reaction( skin rash, itchy skin, shortness of breath, swelling of the throat, etc.).
- If there is no improvement within 3 days of administration, but on the contrary, new symptoms have joined.

Features of antibiotic administration:

When taken orally, the timing of drug intake is important( antibiotics can bind to food components in the digestive tract and then form insoluble and slightly soluble compounds that are poorly absorbed into the total blood flow, respectively, the effect of the drug will be poor).

An important condition is the creation of an average therapeutic concentration of antibiotic in the blood, that is, sufficient concentration to achieve the desired result. That is why it is important to observe all doses and the frequency of reception during the day, prescribed by a doctor.

At present, the problem of antibiotic resistance of microorganisms is acute( the resistance of microorganisms to the action of antibacterial drugs).The causes of antibiotic resistance can be self-medication without the involvement of a doctor;interruption of the course of treatment( this certainly affects the lack of a full-fledged effect and "trains" the microbe);prescribing antibiotics for viral infections( this group of drugs does not affect the intracellular microorganisms that are viruses, so the incorrect antibiotic treatment of viral diseases only causes more pronounced immunodeficiency).

Another important problem is the development of adverse reactions in antibiotic therapy( digestive disorders, dysbiosis, individual intolerance and others).

The solution of these problems is possible with rational antibiotic therapy( the competent use of the drug for a specific disease, taking into account its favorite concentration in a specific organ and system, as well as the professional appointment of a therapeutic dose and a sufficient course of treatment).New antibacterial drugs are being created.

General rules for the administration of antibiotics:

1) Any antibiotic should only be prescribed by a doctor!

2) Categorically it is not recommended self-medication with antibiotics for viral infections( usually motivating it by preventing complications).You can aggravate the course of a viral infection. To think about admission is necessary only if the fever persists for more than 3 days or exacerbation of a chronic bacterial focus. Obvious evidence will be determined only by a doctor!

3) Carefully observe the prescribed course of antibiotic treatment prescribed by the attending physician. In no case should you stop taking the reception after you feel better. The disease will definitely return.

4) Do not adjust the dosage of the drug during treatment. In small doses, antibiotics are dangerous and affect the formation of resistance of bacteria. For example, if it seems to you, then 2 tablets 4 times a day - somehow too much, it's better to take 1 tablet 3 times a day, then it is likely that soon one injection will be required 4 times a day, since the pills will cease to function.

5) Take antibiotics should be, washing down with a 0.5-1 glass of water. Do not try to experiment and drink it with tea, juice, and even more so with milk. You will drink them "for nothing".Milk and dairy products should be taken no earlier than 4 hours after taking the antibiotic or completely abandon them during the course of therapy.

6) Observe a certain frequency and turn of taking the drug and food( different preparations are taken in different ways: before, during, after meals).

7) Strictly observe the specific time of taking the antibiotic. If once a day, then at the same time, if 2 times a day, then strictly after 12 hours, if 3 times - then after 8 hours, if 4 times - after 6 hours and so on. This is important for creating a certain concentration of the drug in the body. If you suddenly missed the time of admission, then take the drug as soon as possible.

8) Taking an antibiotic requires a significant reduction in physical activity and total refusal to engage in sports.

9) There are certain interactions of some drugs with each other. For example, the effect of hormonal contraceptives is reduced when taking antibiotics. Reception of antacids( maalox, renni, almagel and others), as well as enterosorbents( activated charcoal, white coal, enterosgel, polyphepam and others) can affect the absorption of antibiotic, therefore, simultaneous administration of these drugs is not recommended.

10) Do not drink alcohol( alcohol) during the course of treatment with antibiotics.

The possibility of antibiotic use in pregnant and lactating

Safe for indications( ie, the presence of obvious benefit with minimal harm): penicillins, cephalosporins throughout the period of pregnancy and feeding( however, the child may develop intestinal dysbacteriosis).After the 12th week of pregnancy, it is possible to prescribe drugs from the macrolide group. Contraindicated in pregnancy aminoglycosides, tetracyclines, levomycetin, rifampicin, fluoroquinolones.

The need for antibiotic treatment in children

According to statistics, antibiotics in Russia receive up to 70-85% of children with purely viral infections, that is, antibiotics have not been shown to these children. At the same time, it is known that antibacterial drugs provoke the development of bronchial asthma in children! In fact, only 5-10% of children with ARVI should be prescribed antibiotics, and only if complications occur in the form of a bacterial focus. According to statistics, only 2.5% of children who are not treated with antibiotics are diagnosed with complications, and the complications treated by them are registered twice as often.

A doctor and only a doctor reveals the testimony of a sick child for prescribing antibiotics: they may have an exacerbation of chronic bronchitis, chronic otitis, sinusitis and sinusitis, developing pneumonia and the like. Also, do not hesitate to prescribe antibiotics for mycobacterial infection( tuberculosis), where specific antibacterial drugs are key in the treatment regimen.

Side effects of antibiotics:

1. Allergic reactions( anaphylactic shock, allergic dermatosis, Quincke's edema, asthmatic bronchitis)
2. Toxic effect on the liver( tetracyclines, rifampicin, erythromycin, sulfonamides)
3. Toxic effect on the hematopoietic system( levomycetin, rifampicin, streptomycin)
4Toxic effect on the digestive system( tetracycline, erythromycin)
5. Complex toxic - auditory nerve neuritis, optic nerve damage, vestibular disorders, possible development of polyneuritis, toxickidney expressions( aminoglycosides)
6. The reaction Jarisch-Geytsgeymera( endotoxic shock) - arises when assigning a bactericidal antibiotic which leads to "endotoxin shock" as a result of a massive destruction of the bacteria. It develops more often with the following infections( meningococcemia, typhoid fever, leptospirosis, etc.).
7. Dysbacteriosis of the intestine - imbalance of normal intestinal flora.

Antibiotics in addition to pathogenic microbes kill both representatives of normal microflora, and opportunistic microorganisms with which your immune system was already "familiar" and restrained their growth. After treatment with antibiotics, the organism is actively populated with new microorganisms, the recognition of which the immune system needs time, besides, those microbes are activated on which the antibiotic used does not work. Hence the symptoms of a decrease in immunity with antibiotic therapy.

Recommendations for patients after the course of antibiotic therapy:

After any treatment with antibiotics, recovery is necessary. This is due, above all, to the inevitable side effects of drugs of any degree of severity.

1. To observe a sparing diet with avoidance of acute, roast, salted and frequent( 5 times a day) reception in small portions for 14 days.
2. For the purpose of correcting digestive disorders, enzyme preparations( creon, mikrazim, hermital, pancitrat for 10 thousand IU or 1 capsule 3 times a day for 10-14 days) are recommended.
3. Probiotics are recommended for the correction of intestinal dysbiosis( violations of the ratio of representatives of normal flora).
- Bactisubtil 1 caps 3 r / day for 7-10 days,
- Bifiform 1 tab 2 r / day for 10 days,
- Linnex1 capsule 2-3 r / day 7-10 days,
- Bifidumbacterin forte 5-10doses 2 r / d 10 days,
- Acipol for 1 capsule 3-4 r / day 10-14 days.
4. After taking hepatotoxic drugs( for example, tetracycline, erythromycin, sulfonamides, rifampicin) it is recommended to take hepatoprotectors on a plant basis: hepatrin, ovesol( 1 capsule or tablets 2-3 times a day), carp( 2 tablets 3 times a day) for 14-21 days.
5. After the course of antibiotics, it is recommended that plant immunomodulators( immunal, Echinacea solutions) be taken and hypothermia should be avoided.

The doctor infektsionist Bykova N.I.