Description of the drug AZITHROMYCIN for systemic use

Compound

The composition of 1 tablet includes: azithromycin dihydrate (at a concentration equal to 250 or 500 mg of azithromycin ), anhydrous lactose, croscarmellose sodium, anhydrous silicon dioxide in colloidal form, magnesium stearate, corn starch, polacrilin potassium, hypromelose, additives E171 and E172, macrogol 4000.
Capsule composition: 250 or 500 mg of active ingredient, lactose in the form of monohydrate, sodium lauryl sulfate, magnesium stearate.

1 gram of powder contains 15, 30 or 75 mg of azithromycin dihydrate . Auxiliary components: xanthan gum, calcium stearate, silicon dioxide, sodium benzoate, anhydrous sodium carbonate, tartrazine, aspartame , ponceau, flavoring additives “Vanillin” and “Apricot”, refined sugar.

Pharmacodynamics and pharmacokinetics

The semisynthetic antibiotic azithromycin is a synthetically produced derivative of erythromycin , which belongs to the group of macrolide and azalide (it is the first representative of the azalides ).

By binding to the 50S ribosomal subunit, it inhibits protein biosynthesis and inhibits the growth of microbes and suppresses their vital activity. In high concentrations it exhibits a bactericidal effect.

The activity of the drug extends to:

• Gram(+) microorganisms (with the exception of erythromycin microflora) - St. aureus and epidermidis; Str. agalactiae, pneumoniae and pyogenes; streptococci belonging to groups C, F and G;
• Gram(-) microorganisms - pertussis bacillus and parapertussis bacillus , diplococci of the genus Neisseria, Haemophilus influenzae , campylobacteria , bacteria of the genus Legionella , bacteria of the monotypic genus Gardnerella and M. catarrhalis;
• anaerobic microflora (Peptostreptococcus spp., B. bivius, C. perfringens, Peptococcus);
• chlamydia (Chl. trachomatis and pneumoniae);
• mycoparasites of the genus Mycobacterium;
• mycoplasmas (Myc. pneumoniae);
• ureaplasma (Ur. urealyticum);
• spirochetes (causative agents of Lyme disease and spirochete pallidum).

Lipophilic, exhibits stability in acidic environments. After taking the tablet/capsule or suspension, it is quickly absorbed from the gastrointestinal tract.

Bioavailability after taking 0.5 g of the drug is 37%, TCmax is 2-3 hours, the rate of binding to plasma proteins is inversely proportional to the concentration of the substance in the blood and varies from 7 to 50%. T1/2 - 68 hours.

The level of azithromycin in the blood plasma stabilizes after 5-7 days of treatment with the drug.

Easily passing through the blood-parenchymal barriers, the substance enters the tissues, where it is transported to the site of infection by polymorphonuclear leukocytes, phagocytes and macrophages and, in the presence of bacteria, is released at the site of the disease.

Penetrates through plasma membranes, which makes the drug effective against infections caused by intracellular pathogens.

The amount of the substance in tissues and cells is 10-15 times higher than the plasma concentration, the concentration in the pathological focus is 24-34% higher than the concentration in healthy tissues.

After the last administration of the drug, the level necessary to maintain the antibacterial effect is maintained for 5-7 days.

In the liver, azithromycin is demethylated and loses activity. Half of the dose taken is excreted with bile (in its pure form), about 6% of the substance is excreted by the kidneys.

The introduction into clinical practice of a new dosage form of Sumamed (azithromycin) for intravenous administration has significantly expanded the possibilities for effective antibacterial treatment of respiratory infections, and also raised a number of questions about determining the most important indications for its use.

The current practice of using injectable forms is based on the fact that, theoretically, most parenteral drugs are intended for use only in hospital settings, since such treatment must be carried out under close medical supervision. Unfortunately, there are frequent cases of obvious abuse of parenteral administration at the outpatient stage [1]. The main motivating reason for this use of antibiotics is the underestimation by doctors of the capabilities of technologically advanced oral forms of drugs, which are not inferior in pharmacokinetic parameters to many parenteral forms.

In terms of the use of azithromycin, it makes sense to note several fundamentally important points:

• macrolides, as is known, are tissue agents that are delivered by macrophages from the bloodstream, therefore azithromycin, like other representatives of the macrolide class, cannot serve as a means of controlling bacteremia, regardless of the route of administration, since its concentration in the blood very quickly becomes below the optimal for the eradication effect;
• due to the similarity of the pharmacokinetics of oral and parenteral forms, drugs are administered intravenously if the patient for some reason cannot take them orally;
• Parenteral administration of macrolide antibiotics with drugs of other groups in a combination treatment regimen is usually carried out for a limited number of indications.

Azithromycin (Sumamed) has proven high efficiency and good tolerability in cases of bacterial infections of the upper respiratory tract, middle ear cavity, mild lower respiratory tract infections, sexually transmitted diseases, even with the usual, enteral route of administration, including for infection prevention [2–4];

• intravenous administration of azithromycin is part of the so-called stepped antibiotic therapy: the drug is first administered parenterally, and then, as the patient’s condition improves, orally [5]. This approach allows not only to obtain significant pharmacoeconomic advantages, but also prevents the occurrence of iatrogenies caused by excessive damage to the skin and the possibility of infection from the outside.

The main indication for parenteral administration of azithromycin (Sumamed) is currently severe community-acquired pneumonia in hospitalized patients [6]. The criteria for severe pneumonia are well known. Clinical criteria are: acute respiratory failure, arterial hypotension, bilobar or multilobar lung damage, impaired consciousness, extrapulmonary focus of infection. Laboratory criteria should include leukopenia, hypoxemia, acute renal failure, a decrease in hemoglobin less than 100 g/l and hematocrit less than 30%. Along with the classic pathogens of the disease (pneumococcus, bacteria of the Enterobacteriaceae family and, less commonly, staphylococcus), such patients may also encounter intracellular pathogens. Therefore, regimens that combine clarithromycin or azithromycin with beta-lactam antibiotics (amoxicillin/clavulanate, cephalosporins of III–IV generations) have been approved for empirical therapy (Table 1).

Several years ago, the first alarming reports appeared that monotherapy for severe pneumonia, usually accompanied by bacteremia, was inferior in effectiveness to combination treatment [7]. In a retrospective study of 255 patients with severe community-acquired pneumonia, it was found that monotherapy with third-generation cephalosporins and other beta-lactams, as well as respiratory fluoroquinolones, was significantly less effective than combination treatment that included third-generation cephalosporins and macrolides or fluoroquinolones (mortality rate 18.2 and 6). .9%, respectively, p = 0.02, odds ratio – OR = 3.0).

Intragroup analysis showed that the combination of beta-lactam + macrolide was significantly more effective than beta-lactam + quinolone (mortality rate 4.9 and 15.0%, respectively).

Thus, it can be concluded that combination treatment should not include just any combination of drugs, namely a third-generation cephalosporin and a macrolide, since mortality with the addition of a fluoroquinolone remained the same as with the appointment of a cephalosporin as monotherapy.

The above situation was further developed in prospective studies, the results of one of which were published recently [8]. This study is so important for the scientific substantiation of the need for a widespread transition to combination treatment of severe pneumonia that we will dwell on it in more detail. The study involved 1518 patients over the age of 14 years without immunodeficiency conditions, and the etiological diagnosis was not established in 1391 patients (!). The Patients Outcome Research Team (PORT) scale was used as diagnostic criteria [9]. The pattern was an increase in the mortality rate with increasing severity of the disease on the PORT scale - the highest mortality rate was observed with the most severe stage V (Table 2).

From the presented results it is obvious that the most significant differences in the groups appear with increasing severity of pneumonia. The odds ratio, for example, for grade V severity on the PORT scale in the case of pneumonia without an established etiology is 22.4.

Let us pay attention to the data given in table. 2, where the effectiveness of the two modes is compared specifically for pneumococcal invasion.

Macrolide should be considered not only and not so much as a means of “covering” against intracellular pathogens, but also as an antibiotic with a potentiation of the effect against pneumococcus.

The main target of action of azithromycin is the ribosome, while beta-lactams interact with another target: penicillin-binding protein. As a result, a potentiating effect is achieved, which is the key to faster eradication of this pathogen compared to monotherapy, which is especially important in severe cases of the disease [10].

There is another factor for increasing the effectiveness of therapy, based on the multidirectional relationship between the pharmacodynamics/pharmacokinetics of the components of the regimen. As is known, beta-lactams are antibiotics in which the determining factor in the eradication effect is the T/MIC ratio (where T is the time during which concentrations remain 4–5 times higher than the minimum inhibitory concentration), which should be at least 40 % [eleven].

Azithromycin (Sumamed), unlike other macrolides, belongs to the group of antibiotics for which the ratio of the area under the pharmacokinetic curve to the MIC90 is the determining factor in eradication [12]. This is why combining

beta-lactam and azithromycin provide a noticeable synergy of pharmacodynamic/pharmacokinetic interaction on the microbial agent from a clinical and pharmacological point of view.

Azithromycin (Sumamed) is administered intravenously once a day. After intravenous administration, the rate of increase in tissue concentrations, including in lung tissue, is slightly higher than when taking the drug orally. However, azithromycin belongs to drugs with nonlinear pharmacokinetics, i.e. its effectiveness cannot be described as a direct dependence of the eradication effect on the administered dose. The determining factor is the total (cumulative) concentration of azithromycin at the site of infection. When administered intravenously and when taken orally, it is established by the end of the first day. Azithromycin has a long half-life of elimination from tissues, exceeding that of all macrolides [13]. Directly in the lung tissue, intense eradication activity is ensured by the degree of accumulation of the drug in alveolar macrophages in combination with a slow decrease in concentration. You can switch to taking the drug orally after three days of intravenous therapy with azithromycin, provided that clinical and laboratory data improve.

The question of the non-antibiotic effect of azithromycin (Sumamed) is extremely relevant - its effect on the immune system, which manifests itself in the range of usual doses. The drug is detected in inflamed tissues within a few hours after administration and remains there in high eradication concentrations for several days. The effect begins with a suppressive effect on the diapedesis of leukocytes activated by lipopolysaccharide bacteria into the infectious focus. Thus, excess tissue induration, which can lead to subsequent connective tissue replacement, is reduced [14]. Leukocytes move into tissue under the influence of chemotactic factors. Azithromycin, unlike clarithromycin, is able to suppress the production of interleukin-8, as well as the transendothelial migration of neutrophils and monocytes that depends on it, at an early stage [15]. It has the highest degree of penetration into polymorphonuclear neutrophils and lingers in them significantly longer compared to clarithromycin and erythromycin, which enhances the ability for phagocytosis and anti-infective protection [16]. Clarithromycin is apparently removed from monocytes by a kind of “efflux” pump, the reason for which has not yet been established. But it is quite obvious that its effect is less specific than that of azithromycin, and due to the resulting “efflux” it is not as long lasting.

From this point of view, azithromycin (Sumamed), as a longer-acting and selective agent, undoubtedly has a greater chance of affecting inflammation, including chronic or long-term inflammation.

How does this happen? Azithromycin causes degranulation of neutrophils and stimulates the oxidative burst (oxygen consumption necessary for the functions of macrophages) [17]. Evidence of neutrophil degranulation is an increase in the level of lysosomal enzymes in the blood plasma and its decrease in macrophages after taking the first dose of azithromycin. After a standard course of antibiotic therapy, the level of enzymes in the blood remains high for some time, and at the same time, through a feedback mechanism, granules accumulate in neutrophils, which ensures the prolongation of anti-infective protection (Fig. 1).

So, the level of lysosomal enzymes that carry out the lysis of bacteria increases, and at the same time the chemotaxis of macrophages increases - a targeted movement towards infection [18]. In addition, macrolides activate “dormant” leukocytes, i.e., not yet involved in the process of suppressing infectious inflammation, even those that, before exposure to the antibiotic, “did not respond” to activating stimulation by proinflammatory cytokines [19], while the level of anti-inflammatory cytokine increases interleukin-10 and the content of pro-inflammatory interleukin-8 decreases. Thus, there is a significant strengthening of the anti-infective barrier through the involvement of new pools of leukocytes with activation of their functions.

An unconditional distinctive feature of the action of azithromycin (Sumamed) is the stimulation of the “oxidative burst” in macrophages, which indicates energy consumption and effective work on phagocytosis of bacteria.

This “explosion” has a targeted, targeted nature: it should give the phagocytes oxygen to obtain energy. The “explosion” develops quickly and also quickly fades away (Fig. 2), which is important for understanding why the free radicals inevitably formed under its influence cannot have a damaging effect on the host cells, in particular the bronchial epithelium - their effect is short-term, they quickly are destroyed [20]. This so-called early immunomodulation reaction is characteristic only of azithromycin.

Macrolides restore the balance of T-helper cells of various types and support their functions, as described for azithromycin, josamycin and clarithromycin [21, 22]. This is of great importance for regulating the synthesis of pro-inflammatory cytokines, helping to reduce their pressure on host cells and, as a consequence, reducing edema and the formation of congestive lymphocytic induration.

Azithromycin reduces the production of tumor necrosis factor (TNFalpha), which has a stimulating effect on the formation of mucin and supports inflammation of the bronchial epithelium [23].

An extremely important issue is not only the stimulation of immune defense, but also the cessation of immune activation as the infectious process subsides. From this point of view, the capabilities of azithromycin (Sumamed) are unique. After sanitizing the infection, it actually stops the immune “attack” that is already becoming unnecessary. It goes like this. Azithromycin activates apoptosis (biologically programmed death) of neutrophils [24]. This stops the process of local damage and protects host cells from potential involvement in an already unnecessary immune response. It is not yet entirely clear whether this phenomenon applies to all known respiratory pathogens (specificity of action in each individual case is possible), since the effect was obtained on volunteers and in patients with community-acquired pneumonia caused by pneumococcus [25]. For ease of perception, the holistic mechanism of immunomodulation by azithromycin is presented in Fig. 3.

The time window during which antibiotics should be prescribed for pneumonia is constantly narrowing: it is currently believed that the best results are achieved when no more than 8 hours pass from the onset of the disease to the start of antibiotic therapy.

The speed of onset of both the antibacterial and immunomodulatory effects of azithromycin allows us to speak in favor of the unconditional inclusion of this antibiotic in the management of patients with pneumonia in our country.

It is impossible to ignore the issue that has already been raised by us several times [26]. We are talking about the identity of generics with original drugs, which, as is known, in domestic conditions is not always the case. All data on the immunomodulatory effect of azithromycin were obtained exclusively using the original drug and therefore cannot be extrapolated to other drugs containing azithromycin.

Thus, based on the above, the following conclusions can be drawn:

1. Combined antibacterial treatment of severe community-acquired pneumonia, including Sumamed (azithromycin), has significant advantages over beta-lactam monotherapy.
2. The cardinal advantages of therapy with azithromycin (Sumamed) are both a reduction in mortality and a pharmacoeconomically attractive reduction in the length of hospitalization.
3. The optimal presence of Sumamed (azithromycin) in treatment regimens and the total clinical and pharmacological effect of such a combination are determined by:

• control of bacteremia (beta-lactam);
• combined multidirectional pharmacodynamic/pharmacokinetic interaction of the antibacterial components of the regimen when exposed to bacteria;
• optimal immunomodulatory/anti-inflammatory effect (azithromycin).

Indications for use of Azithromycin. What does the drug treat?

Indications for use of Azithromycin:

• infectious diseases of the respiratory and ENT organs ( tonsillitis , pharyngitis , sinusitis , laryngitis , acute chronic bronchitis , pneumonia , otitis media );
• bacterial infections of the urogenital tract that occur without complications ( cervicitis or urethritis );
• soft tissue infections and skin infections (infectious dermatitis , impetigo , beshikha );
• scarlet fever;
• borreliosis in the initial stage;
• diseases of the stomach and duodenum associated with Helicobacter pylori.

Side effects

The most common side effects of Azithromycin: visual disturbances, nausea, vomiting, abdominal discomfort, diarrhea , decreased concentration of blood bicarbonates, lymphocytopenia .

Less than 1% of patients reported: vaginal infections, oral candidiasis , leukopenia , ephosinophilia , vertigo , dizziness, hypoesthesia , syncope , drowsiness, convulsions (other macrolides also been found to provoke convulsions), headache, distortion/loss of taste and sensations of odors, impaired regularity of bowel movements (rare bowel movements), digestive disorders, anorexia , flatulence , gastritis , increased fatigue, increased AST and ALT, creatinine and bilirubin in the blood, urea , K concentration in the blood; vaginitis , arthralgia , skin rashes and itching.

Less than 0.1% of patients experienced: neutrophilia , thrombocytopenia , hemolytic anemia , mental and motor hyperactivity, nervousness, anxiety, aggressiveness, asthenia , lethargy , neurosis, sleep disturbances, insomnia, discoloration of the tongue, constipation, cholestatic jaundice and hepatitis (including altered FPP indicators), angioedema , interstitial nephritis , acute renal failure, exanthema , urticaria , photosensitivity, Lyell's syndrome , polymorphic and malignant exudative erythema , anaphylaxis , angioedema , candidiasis .

In rare cases, palpitations, ventricular arrhythmia or paroxysmal tachycardia of the “pirouette” type, and chest pain are also possible. It has been found that other macrolide antibiotics . hypotension and QT interval prolongation have also been reported

Side effects that occur with an unknown frequency: myasthenia gravis , agitation , fulminant hepatitis , liver failure , necrotizing hepatitis .

In rare cases, macrolides cause hearing loss. Some patients taking Azithromycin experienced hearing loss, ringing in the ears, and deafness.

Most of these cases were recorded during studies in which the drug was used for a long time in high doses. The reports indicate that the problems described are reversible.

Azithromycin, 3 pcs., 500 mg, film-coated tablets

Most of the observed adverse reactions are reversible after completion of the course of treatment or discontinuation of the drug.

Classification of the frequency of side effects (WHO): very often (with a frequency of more than 1/10), often (with a frequency of at least 1/100, but less than 1/10), infrequently (with a frequency of at least 1/1000, but less than 1 /100), rare (with a frequency of at least 1/10,000, but less than 1/1000), very rare (with a frequency of less than 1/10,000), including individual messages.

From the circulatory and lymphatic systems: often - lymphocytopenia, eosinophilia; uncommon - leukopenia, neutropenia; rarely - thrombocytopenia, hemolytic anemia.

From the central nervous system: often - dizziness, headache, paresthesia, impaired perception of taste, anorexia; infrequently - anxiety, nervousness, hyposthesia, insomnia, drowsiness; rarely - agitation, delirium, hallucinations; very rarely - fainting, convulsions, psychomotor hyperactivity, aggression, anosmia, loss of taste, parosmia, exacerbation of myasthenia gravis, perversion of smell.

From the senses: infrequently - hearing impairment, vertigo, visual impairment; unknown frequency - hearing impairment, including deafness and/or tinnitus.

From the respiratory system and JIOP organs: infrequently - shortness of breath, nosebleeds.

From the cardiovascular system: infrequently - a feeling of palpitations, “flushes” of blood to the face; very rarely - decreased blood pressure, arrhythmia, ventricular tachycardia, increased QT interval, arrhythmia.

Infectious diseases: infrequently - rhinitis, respiratory diseases, pharyngitis, pneumonia, candidiasis, including the mucous membrane of the oral cavity and genitals, gastroenteritis.

From the digestive system: very often - nausea, diarrhea, abdominal pain, flatulence (bloating), often - vomiting; uncommon - belching, dysphagia, gastritis, constipation, dryness of the oral mucosa, ulcers of the oral mucosa, increased secretion of the salivary glands; very rarely - discoloration of the tongue, pseudomembranous colitis, pancreatitis.

From the liver and biliary tract: infrequently - hepatitis, hyperbilirubinemia, increased activity of “liver” transaminases; very rarely - cholestatic jaundice, liver failure (in rare cases, fatal, mainly due to liver dysfunction), fulminant hepatitis, liver necrosis.

Allergic reactions: often - itching, rash; uncommon - Stevens-Johnson syndrome, photosensitivity, urticaria; rarely - anaphylactic reactions (including angioedema) in rare cases with fatal outcome, toxic epidermal necrolysis. erythema multiforme.

From the skin and subcutaneous tissues: dry skin, dermatitis, sweating.

From the musculoskeletal system: often - arthralgia; uncommon - osteoarthritis, myalgia, neck pain, back pain.

From the genitourinary system: infrequently - increased residual urea nitrogen and creatinine concentration in the blood plasma, dysuria, pain in the kidneys, metrorrhagia. testicular dysfunction; very rarely - interstitial nephritis, acute renal failure.

Other: often - weakness; uncommon - chest pain, peripheral edema, asthenia (malaise, feeling tired); Uncommon: facial swelling, fever.

Laboratory data: often - an increase in the number of basophils, monocytes, neutrophils, a decrease in the concentration of bicarbonates in the blood plasma; infrequently - increased alkaline phosphatase activity, increased chlorine content, increased glucose concentration, increased bicarbonate concentration in the blood plasma, increased platelet count, increased hematocrit, change in sodium content in the blood plasma, change in the concentration of potassium in the blood plasma.

Any side effect should be reported to your doctor.

Instructions for use of Azithromycin (Method and dosage)

Azithromycin capsules and tablets, instructions for use

The antibiotic is taken 1 time per day, an hour before meals or 2 hours after meals. The missed dose is taken as quickly as possible, and the next dose of medication should be taken 24 hours later.

According to the instructions for use of Azithromycin, for children weighing more than 45 kg and adult patients, the optimal dosage for soft tissue diseases, respiratory diseases and skin diseases is 500 mg 1 time per day. The course lasts 3 days.

For Lipschutz migratory erythema , take 2 tablets of Azithromycin 500 mg on the first day, from days 2 to 5 inclusive - 500 mg/day.

For uncomplicated cervicitis/urethritis, take 1 g of the drug once.

Azithromycin capsules (Astrapharm, Zdorovye, BHFZ and other manufacturers) are taken according to a similar scheme.

Instructions for Azithromycin Forte

For diseases of soft tissues, respiratory organs and skin, the recommended dose per course is 1.5 g (it should be divided into 3 doses with intervals of 24 hours between them).

For the treatment of acne , the drug is taken at a dose of 0.5 g/day for 3 days, followed by 0.5 g/week for the next 9 weeks. (one time). The fourth tablet should be taken on the 8th day of treatment. Subsequent doses are taken at intervals of 7 days.

For uncomplicated cervicitis/urethritis, take 1 g once.

For Lyme disease, the patient is prescribed 1 g on the first day, from days 2 to 5 - 0.5 g. For the full course, the patient takes a total of 3 g of Azithromycin.

For children, the drug is dosed depending on weight. The standard dose is 10 mg/kg/day. The treatment regimen may be as follows:

• 3 doses of 10 mg/kg at intervals of 24 hours;
• 1 dose of 10 mg/kg and 4 doses of 5-10 mg/kg.

At the initial stages of the development of Lyme disease , the first dose of the drug for a child is 20 mg/kg; in the next 4 days, children's Azithromycin Forte is taken at 10 mg/kg.

For pneumonia, treatment begins with intravenous administration of the drug (at least 2 days, 0.5 g/day). Then they switch to taking capsules. The course lasts from 1 to 1.5 weeks. Therapeutic dose - 500 mg/day.

For pelvic diseases , infusion therapy is also indicated at the initial stage of treatment, then the patient should switch to taking 250 mg capsules (2 per day for a week).

The timing of the transition to tablets/capsules is determined depending on the dynamics of laboratory and clinical parameters.

To prepare the suspension, the powder (2 g) is dissolved in 60 ml of water.

To prepare an injection solution, 0.5 g of powder is diluted in 4.8 ml of water for injection.

If the patient is indicated for infusion therapy, 0.5 g of powder must be diluted to a concentration of 1 or 2 mg/ml (500 or 250 ml, respectively) with Ringer's solution, NaCl 0.9% or dextrose 5%. In the first case, the duration of the infusion is 3 hours, in the second - 1 hour.

Treatment regimen for ureaplasmosis

For ureaplasmosis, treatment should be carried out according to the principle of complexity.

A few days before starting Azithromycin, the patient is prescribed immunomodulators. The drug is injected into the muscle 1 r./day. with an interval of 1 day. Injections continue to be given throughout the course of treatment.

Simultaneously with the 2nd dose of the immunomodulator, a bactericidal antibiotic . When it is completed, switch to Azithromycin. During the first 5 days, the drug is taken daily 1.5 hours before breakfast, 1 g.

After this time, take a 5-day break and again, following the recommendations in the instructions for the drug, take 1 g. After another 5 days, Azithromycin is taken for the 3rd and last time. The dose is the same - 1 g.

For 15-16 days, while treatment with Azithromycin continues, the patient should also take 2-3 times a day. take stimulators of the synthesis of your own interferons , as well as antimycotics of the polyene series .

After a course of antibiotics, restorative therapy is indicated using drugs that normalize the function of the gastrointestinal tract and help restore its microflora. Maintenance treatment is continued for 2 weeks or more.

Treatment regimen for chlamydia. Capsules and tablets - why are they effective for chlamydia?

Azithromycin is the drug of choice for chlamydia of the lower genitourinary system, as it is well tolerated by patients, and, in addition, can be used to treat adolescents and during pregnancy .

For this form of infection, it is taken 1 time in a dose of 1 g.

If chlamydial infection , treatment is carried out in short courses, and long intervals are maintained between courses.

The course of treatment is designed for 3 doses. The dose for 1 dose is 1 g. The interval between doses is 7 days, that is, the medicine is taken on days 1, 7 and 14. This regimen has been approved by the Russian Ministry of Health for the treatment of persistent/complicated forms of chlamydia.

How to take Azithromycin for sore throat?

All antibiotics intended for the treatment of sore throat are taken in a ten-day course. Azithromycin is an exception to this rule - it is prescribed for 3-5 days.

Another advantage of the drug is that it is tolerated by patients much better than penicillin drugs ( macrolides are considered the least toxic antibiotics).

Adults and children whose weight exceeds 45 kg are prescribed to take 500 mg/day. If for some reason a dose is missed, the next dose is taken as soon as this circumstance is discovered, and the next dose is taken at 24-hour intervals.

Children aged six months to 12 years are advised to take the suspension. You should take an antibiotic once a day. Treatment lasts at least 3 days, the dose is selected individually.

Reviews of Azithromycin for angina are positive, since even with purulent angina, the patient’s condition improves significantly within 5-6 hours after the first tablet was taken.

Antibiotics for sinusitis. Azithromycin - what are these tablets for for sinusitis?

Azithromycin for sinusitis is used according to one of the following regimens:

• loading dose (500 mg) on ​​the first day, then 500 mg for 3 days;
• loading dose (500 mg) and another 4 days of 250 mg.

Children under 12 years of age are prescribed a suspension. The drug is dosed at the rate of 10 mg per 1 kg of child weight. The medicine is given to the patient 1 time per day. three-day course. In some cases, on the first day it is recommended to give the child 10 mg/kg Azithromycin, and in the next 4 days reduce the dose to 5 mg/kg. The highest dose per course is 30 mg/kg.

Azithromycin for sinusitis , accumulating at the site of the disease, suppresses Gram (+) bacteria, which are the main cause of its development, and effectively relieves inflammation in the sinuses.

Azithromycin is an important drug

As you know, the spread of COVID-19 took the healthcare system by surprise. There is no specific and definite treatment for this disease; it is not for nothing that a dangerous virus has paralyzed the entire world. Traditional antiviral drugs and the well-known antibiotic, azithromycin, turned out to be ineffective in treating it. There is an explanation for this: this is a drug that is not only an antibiotic, but also has a pronounced anti-inflammatory effect, which is why it is included in the coronavirus treatment protocol. Eraliev Sattar Molybekovich, a pulmonologist and member of the European Respiratory Society (ERS), told us more about the drug.

— And why was azithromycin included in the COVID-19 treatment protocol?

— COVID-19 came unexpectedly, so at first doctors tried to use different drugs: antimalarials, drugs to treat HIV (after all, it is also a viral disease). As we know, antibiotics do not work on viruses, but azithromycin, which we know as an antibacterial drug, was included in the initial treatment protocol for COVID-19 because it, like its close relative clarithromycin, also has anti-inflammatory properties.

There is a rare disease - the so-called diffuse panbronchiolitis, when the bronchi continuously secrete a huge amount of mucus, which clogs them, and the person gradually dies. It affects mainly residents of Southeast Asia, and until recently it was considered an incurable disease. Japanese doctors, who first discovered the anti-inflammatory property of azithromycin, used it to treat this disease and obtained excellent results in most patients. Or there is such a pulmonary problem - chronic obstructive pulmonary disease (COPD). Sometimes in some patients this disease cannot be treated with the so-called. basic drugs, according to the decision of the expert council, these patients are prescribed azithromycin for a year. Also, a number of studies have shown that azithromycin still has an immunomodulatory effect, albeit a weak one.

That’s why azithromycin was included in the treatment protocol for COVID-19, but, unfortunately, for Covid it turned out to be ineffective, like all other drugs. But nevertheless, antibiotics, including azithromycin, are indicated for Covid when signs of a secondary bacterial infection appear, which is superimposed on the viral infection. But I want to note that biomarkers of bacterial pneumonia (C-reactive protein, procalcitonin), it turns out, can increase with COVID-19. This is the insidiousness of coronavirus infection, when traditional markers for determining where the virus is, where the bacteria are, have stopped working. Therefore, despite the uncontrolled use of antibiotics, which we, pulmonologists, continue to fight against, it is important to consult a doctor in a timely manner. Only their professional approach to the treatment of Covid patients determines a favorable outcome of treatment.

It is important to note that azithromycin, along with other classes of antibiotics, is the first choice drug in the empirical treatment of bacterial pneumonia. It is used in the initial treatment of atypical pneumonia caused by intracellular pathogens, such as chlamydia and mycoplasma. Because azithromycin, unlike many antibiotics, penetrates into the cell where the causative agent of the disease is “hidden”.

— What contraindications would you highlight for the use of azithromycin?

— This is definitely intolerance to the drug, as well as severe dysfunction of the liver and kidneys, which often remove drugs from the body.

— Is it possible to call azithromycin safer for humans, unlike other antibiotics?

In general, yes. Antibacterial drugs are divided into more and less safe conditionally. However, there are specially approved groups of first-line and second-line antibiotics of choice for the doctor. There are also reserve drugs (usually more toxic) that are used when the antibiotics of choice are ineffective or intolerant, which often happens in severe hospital-acquired infections. Azithromycin and a number of its relatives - macrolide antibiotics - along with amoxicillin are the first-line drugs of choice in the treatment of bacterial pulmonary diseases. But antibiotics of the fluoroquinolone group, although very effective, belong to the second row due to their relative toxicity. They are strictly contraindicated during pregnancy, as they have a teratogenic effect, and for nursing mothers.

Therefore, I would like to emphasize once again how dangerous the uncontrolled use of antibiotics is, in other words, left and right. Unfortunately, since the times of the USSR, antibiotics could be bought freely in pharmacies without a prescription. This is precisely why we have irretrievably lost a number of antibiotics and antibacterial drugs. And now in the post-Soviet space, antibiotic resistance, although it is a global problem, is very acute. The weakness of macrolide antibiotics, which includes azithromycin, is precisely the development of rapid resistance to them, therefore it is extremely important that azithromycin, like all macrolides, is used strictly for its intended purpose.

— Can you tell me more about the side effects of the drug?

— A reaction from the liver and nervous system is possible, although it rarely occurs. In principle, side effects are common to any drug. And this does not always lead to drug withdrawal. If, say, it is mild nausea, then you can continue treatment, keeping the symptoms under control. If this is vomiting, then, of course, we stop the drug. For us, allergic reactions may be a more dangerous manifestation than side effects, and primarily anaphylactic shock. Therefore, before using the drug, it is necessary to conduct a biological test.

Although side effects can also be dangerous for the patient. You've probably heard about the effects of azithromycin on the heart, causing rhythm disturbances. For some reason, our media wrote about this widely. Yes, in 2011 an article by American researchers was published that when using azithromycin, severe arrhythmias can occur, which theoretically can lead to fatal consequences. Subsequent studies conducted in Canada and the Scandinavian countries did not confirm these findings. However, the American Food and Drug Administration (FDA) recommended that azithromycin manufacturers include a warning in the instructions for use: be careful with arrhythmia. But there is no evidence that the medicine causes death, otherwise the drug would have been immediately banned from production.

— Many doctors prescribe probiotics along with antibiotics to prevent dysbiosis. Is it necessary to restore the intestinal microflora after azithromycin?

— When using azithromycin, the intestinal microbiome may be disrupted. To prevent this situation, we prescribe probiotics. Although there is no clear evidence that probiotics protect the intestinal microflora from the harmful effects of antibiotics, they are better than taking antifungal antibiotics. The occurrence of intestinal fungal infection after taking antibiotics has not been described. The most dangerous consequence of a violation of the intestinal microflora is pseudomembranous colitis, when we sometimes lose patients. Thank God, this is a rare complication and, oddly enough, can also be treated with an antibiotic - vancomycin.

— How is azithromycin combined with other drugs?

— Yes, with almost all antibiotics, although caution must be exercised with antibiotics that are also excreted through the liver (bile), like azithromycin. In pulmonology, we have an unofficial gold standard - a combination of azithromycin with cephalosporin antibiotics. By doing this, we achieve coverage of as wide a range of pathogenic microbes as possible, in particular in cases of severe pneumonia. Secondly, when therapy requires combining 2 drugs, we reduce the dose of each, and the manifestation of side effects sometimes depends on the dose of the drug administered. At the same time, we exclude combinations with medications that can provoke arrhythmia.

— What should you pay attention to to find out whether treatment with azithromycin has affected the functioning of the heart?

— Cardiac arrhythmia has its own clinical picture, so we focus on the patient’s complaints. If there is a suspicion that the patient has an arrhythmia, we recommend taking an ECG or Holter monitoring.

— Should the condition of the liver be checked?

- Of course. The best indicator is the level of liver enzymes.

— Can azithromycin be used by pregnant and breastfeeding women and minors?

- It is possible for lactating and pregnant women, but every doctor should take it into account - only when the benefit of the medicine outweighs the risk of side effects. Children are allowed from 12 years old, there is a special dosage that is different from adults. But again, I want to note that children, and adults too, often suffer from acute respiratory viral infections, and, sad to say, many begin to use antibiotics on their own, which is categorically unacceptable. Antibiotics are products that are produced to kill other bacteria, gaining a place in the environment. But a virus is not a bacterium, it is a completely different class of microorganisms, and antibiotics do not work on them!

— Is azithromycin used in the post-Covid period?

- Yes, it applies. Coronavirus leaves a mark after a person recovers, sharply reducing the immunity of many who have recovered. Therefore, in the post-Covid period, there are some acute bacterial infections or exacerbation of chronic infections, in particular of the respiratory tract. This is precisely the indication for the use of azithromycin.

— Is there a significant difference between the original and the generic version of this drug?

— Generics are practically not inferior to the original, this also applies to other antibiotics. In 2016, WHO experts issued a bulletin on the rational use of antibiotics, where they emphasized that generic antibiotics are a solution to the problem for developing countries, since the original drug is not affordable for the general population. A medical problem is the so-called pseudogenerics, which contain a non-optimal dose of the drug. Therefore, any generic antibiotic must have an international quality certificate and a registration certificate confirming the effectiveness, safety and admissibility of use of the drug in the territory of the Republic of Kazakhstan. For example, the domestic company SANTO has these certificates and registration certificates.

In general, all of the above suggests that the state should regulate the medicinal sector. The patient should not take antibiotics unless prescribed by a doctor.

Interaction

Absorption of the drug is reduced in combination with Al3+ and Mg2+-containing antacids, food and ethanol .

The combination of macrolides + Warfarin can provoke an increase in the anticoagulant effect, so patients taking Azithromycin in combination with Warfarin - despite the fact that studies have not shown changes in prothrombin time when taken in usual doses - require careful monitoring of this indicator.

Unlike other macrolides, it does not interact with terfenadine , triazolam , Theophylline , Digoxin , Carbamazepine .

The simultaneous use of terfenadine with various antibiotics provokes prolongation of the QT interval and arrhythmia . Based on this, Azithromycin is used with caution in patients taking this drug.

Macrolides increase plasma concentration and toxicity, and also slow down the excretion of methylprednisolone , Cycloserine , Felodipine , indirect coagulants and drugs subject to microsomal oxidation, however, in the case of the use of Azithromycin (and other azalides), this type of interaction has not been recorded.

The effectiveness of the drug increases in combination with chloramphenicol and tetracycline and decreases in combination with lincosamides .

Azithromycin is pharmaceutically incompatible with Heparin

Azithromycin

Antacids

Antacids do not affect the bioavailability of azithromycin, but reduce the maximum concentration in the blood by 30%, so the drug should be taken at least 1 hour before or 2 hours after taking these drugs and food.

Cetirizine

Concomitant use of azithromycin with cetirizine (20 mg) for 5 days in healthy volunteers did not lead to pharmacokinetic interaction or a significant change in the QT interval.

Didanosine (didezokeyinosine)

The simultaneous use of azithromycin (1200 mg/day) and didanosine (400 mg/day) in 6 HIV-infected patients did not reveal changes in the pharmacokinetic indications of didanosine compared to the placebo group.

Digoxin (P-glycoprotein substrates)

Concomitant use of macrolide antibiotics, including azithromycin, with P-glycoprotein substrates, such as digoxin, leads to increased concentrations of P-glycoprotein substrate in the blood serum. Thus, with the simultaneous use of digoxin and azithromycin, it is necessary to take into account the possibility of increasing the concentration of digoxin in the blood serum.

Zidovudine

Concomitant use of azithromycin (single dose of 1000 mg and multiple doses of 1200 mg or 600 mg) has a minor effect on the pharmacokinetics, including renal excretion of zidovudine or its glucuronide metabolite. However, the use of azithromycin caused an increase in the concentration of phosphorylated zidovudine, a clinically active metabolite in peripheral blood mononuclear cells. The clinical significance of this fact is unclear.

Azithromycin interacts weakly with isoenzymes of the cytochrome P450 system. Azithromycin has not been shown to participate in pharmacokinetic interactions similar to erythromycin and other macrolides. Azithromycin is not an inhibitor or inducer of cytochrome P450 isoenzymes.

Ergot alkaloids

Given the theoretical possibility of ergotism, the simultaneous use of azithromycin with ergot alkaloid derivatives is contraindicated.

Pharmacokinetic studies were conducted on the simultaneous use of azithromycin and drugs whose metabolism occurs with the participation of isoenzymes of the cytochrome P450 system.

Atorvastatin

Concomitant use of atorvastatin (10 mg daily) and azithromycin (500 mg daily) did not cause changes in atorvastatin plasma concentrations (based on an HMC-CoA reductase inhibition assay). However, in the post-marketing period, isolated case reports of rhabdomyolysis have been received in patients receiving concomitant azithromycin and statins.

Carbamazepine

Pharmacokinetic studies involving healthy volunteers did not reveal a significant effect on the plasma concentrations of carbamazepine and its active metabolite in patients receiving concomitant azithromycin.

Cimetidine

In pharmacokinetic studies of the effect of a single dose of cimetidine on the pharmacokinetics of azithromycin, no changes in the pharmacokinetics of azithromycin were detected when cimetidine was used 2 hours before azithromycin.

Indirect anticoagulants (coumarin derivatives)

In pharmacokinetic studies, azithromycin did not affect the anticoagulant effect of a single 15 mg dose of warfarin administered to healthy volunteers. Potentiation of the anticoagulant effect has been reported after simultaneous use of azithromycin and indirect anticoagulants (coumarin derivatives). Although a causal relationship has not been established, the need for frequent monitoring of prothrombin time should be considered when using azithromycin in patients receiving indirect oral anticoagulants (coumarin derivatives).

Cyclosporine

In a pharmacokinetic study involving healthy volunteers who took azithromycin (500 mg/day once) orally for 3 days and then cyclosporine (10 mg/kg/day once), a significant increase in maximum plasma concentration (Cmax) and area under the concentration-time curve (AUC0-5) of cyclosporine. Caution is advised when using these drugs together. If simultaneous use of these drugs is necessary, it is necessary to monitor the concentration of cyclosporine in the blood plasma and adjust the dose accordingly.

Efavirenz

Concomitant use of azithromycin (600 mg/day once) and efavirenz (400 mg/day) daily for 7 days did not cause any clinically significant pharmacokinetic interaction.

Fluconazole

Concomitant use of azithromycin (1200 mg once) did not change the pharmacokinetics of fluconazole (800 mg once). The total exposure and half-life of azithromycin did not change with simultaneous use of fluconazole, however, a decrease in Cmax of azithromycin was noted (by 18%), which had no clinical significance.

Indinavir

Concomitant use of azithromycin (1200 mg once) did not cause a statistically significant effect on the pharmacokinetics of indinavir (800 mg three times a day for 5 days).

Methylprednisolone

Azithromycin does not have a significant effect on the pharmacokinetics of methylprednisolone.

Nelfinavir

The simultaneous use of azithromycin (1200 mg) and nelfinavir (750 mg 3 times a day) causes an increase in the equilibrium concentration of azithromycin in the blood serum. No clinically significant side effects were observed and no dose adjustment of azithromycin was required when used concomitantly with nelfinavir.

Rifabutin

The simultaneous use of azithromycin and rifabutin does not affect the concentration of each drug in the blood serum. Neutropenia has sometimes been observed with simultaneous use of azithromycin and rifabutin. Although neutropenia has been associated with the use of rifabutin, a causal relationship between the use of the combination of azithromycin and rifabutin and neutropenia has not been established.

Sildenafil

When used in healthy volunteers, there was no evidence of the effect of azithromycin (500 mg/day daily for 3 days) on the AUC and Cmax of sildenafil and its main circulating metabolite.

Terfenadine

In pharmacokinetic studies, there was no evidence of interaction between azithromycin and terfenadine. There have been isolated cases reported where the possibility of such an interaction could not be completely excluded, but there was no concrete evidence that such an interaction occurred.

It has been found that the simultaneous use of terfenadine and macrolide antibiotics can cause arrhythmia and prolongation of the QT interval.

Theophylline

No interaction has been detected between azithromycin and theophylline.

Triazolam/midazolam

No significant changes in pharmacokinetic parameters were detected with simultaneous use of azithromycin with triazolam or midazolam in therapeutic doses.

Trimethoprim/sulfamethoxazole

Concomitant use of trimethoprim/sulfamethoxazole with azithromycin did not show a significant effect on the total exposure or renal excretion of trimethoprim or sulfamethoxazole. Azithromycin serum concentrations were consistent with those found in other studies.

special instructions

The Vidal reference book states that since Azithromycin is metabolized in the liver and the substance is excreted primarily in bile, the drug should not be used to treat patients with severely impaired liver function.

Elderly patients do not need to adjust the dose. However, since the electrical conduction of the heart may be impaired in older people, prescribing the drug to them may increase the risk of heart rhythm disturbances and the development of torsades de pointes .

The use of intravenous Azithromycin, according to Wikipedia, is contraindicated in patients under 16 years of age.

Features of the pharmacokinetic profile of the drug

The pharmacokinetic parameters of the drug are largely influenced by food intake, and the extent to which the changes are pronounced also depends on its dosage form.

Thus, food intake helps to reduce the Cmax of azithromycin in capsule form and increases this indicator for the tablet form. In the first case, there is a simultaneous decrease in AUC, in the second, this indicator remains unchanged.

In old age, in women, unlike men of the same age group, pharmacokinetic parameters change, namely, Cmax increases.

In children from 12 months to 5 years, there is a decrease in AUC, Cmax, T1/2.

Azithromycin, tablets coated. captivity. about. 500 mg (Replekpharm), 3 pcs.

From the blood and lymphatic system: infrequently - leukopenia, neutropenia, eosinophilia; very rarely - thrombocytopenia, hemolytic anemia.

From the side of metabolism: infrequently - anorexia.

Allergic reactions: rarely - skin rash, angioedema and anaphylaxis (in rare cases with death), erythema multiforme, drug rash with eosinophilia and systemic manifestations (DRESS syndrome). Some of these reactions that developed during the use of azithromycin acquired a recurrent course and required long-term treatment and observation.

From the skin and subcutaneous tissues: uncommon - skin rash, itching, urticaria, dermatitis, dry skin, sweating; rarely - photosensitivity reaction; frequency unknown - Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme.

From the nervous system: often - headache; infrequently - dizziness, disturbance of taste, paresthesia, drowsiness, insomnia, nervousness; rarely - agitation; frequency unknown - hypoesthesia, anxiety, aggression, fainting, convulsions, psychomotor hyperactivity, loss of smell, perversion of smell, loss of taste, myasthenia gravis, delirium, hallucinations.

From the side of the organ of vision: infrequently - visual impairment.

From the organ of hearing and labyrinthine disorders: infrequently - hearing loss, vertigo; frequency unknown - hearing impairment up to deafness and/or tinnitus.

From the cardiovascular system: infrequently - palpitations, flushing of the face; frequency unknown - decreased blood pressure, increased QT interval on ECG, ari, ventricular tachycardia.

From the respiratory system: infrequently - shortness of breath, nosebleeds.

From the digestive system: very often - diarrhea; often - nausea, vomiting, abdominal pain; uncommon - flatulence, dyspepsia, constipation, gastritis, dysphagia, bloating, dry oral mucosa, belching, ulcers of the oral mucosa, increased secretion of the salivary glands; very rarely - change in tongue color, pancreatitis.

From the liver and biliary tract: infrequently - hepatitis; rarely - impaired liver function, cholestatic jaundice; frequency unknown - liver failure (in rare cases with death, mainly due to severe liver dysfunction), liver necrosis, fulminant hepatitis.

From the musculoskeletal system: uncommon - osteoarthritis, myalgia, back pain, neck pain; frequency unknown - arthralgia.

From the kidneys and urinary tract: infrequently - dysuria, pain in the kidney area; frequency unknown - interstitial nephritis, acute renal failure.

From the genital organs and mammary gland: infrequently - metrorrhagia, dysfunction of the testicles.

Infectious diseases: infrequently - candidiasis (including the mucous membrane of the oral cavity and genitals), pneumonia, pharyngitis, gastroenteritis, respiratory diseases, rhinitis; frequency unknown - pseudomembranous colitis.

Local reactions: often - pain and inflammation at the injection site.

Other: infrequently - asthenia, malaise, feeling of fatigue, facial swelling, chest pain, fever, peripheral edema.

Laboratory data: often - a decrease in the number of lymphocytes, an increase in the number of eosinophils, an increase in the number of basophils, an increase in the number of monocytes, an increase in the number of neutrophils, a decrease in the concentration of bicarbonates in the blood plasma; infrequently - increased activity of AST, ALT, increased concentration of bilirubin in the blood plasma, increased concentration of urea in the blood plasma, increased concentration of creatinine in the blood plasma, change in the potassium content in the blood plasma, increased activity of alkaline phosphatase in the blood plasma, increased chlorine content in the blood plasma, increased blood glucose concentration, increased platelet count, increased hematocrit, increased plasma bicarbonate concentration, change in plasma sodium content.

Azithromycin analogs

Level 4 ATC code matches:
Ecositrin

Azicine

Rovamycin

AzitRus

Safocid

Clarithromycin

Sumamed Forte

Klarbakt

Azitro Sandoz

Sumamed

ZI-Factor

Azitral

Azimed

Azicide

Spiramycin-vero

Zitrolide

Ecomed

Macropen

Klacid SR

Klacid

• Azivok
• Azitral
• Azithromycin-Astrapharm
• AzitRus
• Azithromycin Forte
• Zitrolide
• Tremak-sanovel
• Hemomycin
• Sumamed
• Sumamox
• Sumaclid 1000

Azithromycin for children

The use of tablets and capsules is possible if the child’s body weight exceeds 45 kg. The dosage of Azithromycin for children weighing 45 kg is determined depending on the indications.

Children weighing more than 45 kg are prescribed capsules or tablets at a dosage of 250 mg or 500 mg.

At a young age, the optimal dosage form for children is a suspension.

Bad reviews about the treatment of children with Azithromycin are very rare. A high concentration of the drug at the site of inflammation suppresses the activity of bacteria and prevents the infection from spreading further. The child's respiratory function improves, the temperature decreases, sore throat and weakness decrease.

An important feature of the medicine is that to achieve a therapeutic effect, 3-5 days of treatment are enough, since the drug continues to act for another week after completion of the course.

Azithromycin: indications for use and contraindications

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

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

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

Azithromycin during pregnancy

During pregnancy and breastfeeding, the drug is prescribed when the benefits of treatment for the mother outweigh the potential risks of using Azithromycin for the fetus/child.

Reviews of Azithromycin during pregnancy, compiled by Canadian researchers as part of the Motherisk Program, convincingly prove the safety of using the drug for the treatment of expectant mothers.

In all control groups (women in the 1st group took Azithromycin, in the 2nd group - other antibiotics, in the 3rd group - they were not treated with antimicrobial drugs), the incidence of severe malformations in the fetus did not differ significantly.

Reviews about Azithromycin

Reviews of Azithromycin for chlamydia , sore throat , sinusitis , frontal sinusitis and other diseases that are caused by microbes sensitive to the drug are overwhelmingly good.

The drug is a powerful tool for combating bacterial infection and is well tolerated by patients, and the side effects associated with its use appear infrequently and completely disappear after cessation of treatment.

Reviews from doctors about the drug are also positive. The main advantages of Azithromycin, according to doctors, are that it:

• has anti-inflammatory and immunomodulatory effects;
• characterized by high activity against probable pathogens of infectious respiratory diseases;
• creating high concentrations in tissues, exhibits bactericidal properties against H. pylori, H. influenzae, N. gonorrhoeae, M. catarrhalis S. pyogenes, S. pneumoniae, S. agalactiae, B. pertussis, Campylobacter spp., C. diphtheriae;
• effective against atypical pathogens that reproduce inside cells (in particular, against mycoplasmas and chlamydia );
• can be used during pregnancy ;
• has a dosage form suitable for children.

Azithromycin has a post-antibiotic effect , which allows it to be used in short courses. In addition, under the influence of the drug, even microbes resistant to it become more sensitive to the effects of immune defense factors.

Unlike Erythromycin , which is the basis of macrolide antibiotics, Azithromycin does not decompose in the acidic environment of the stomach and has a lesser effect on gastrointestinal motility.

Adverse reactions during therapy

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

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

Almost 1% of patients experienced the following:

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

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

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

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

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

How much does Azithromycin cost?

In Russian pharmacies, the cost of tablets (250 mg No. 6) is from 50 rubles, the price of Azithromycin in tablets of 500 mg (package No. 3) is about 200 rubles. The price of Azithromycin analogues is approximately the same.

The average price of Azithromycin in Ukraine (250 mg No. 6 tablets) is 30 UAH, 3 antibiotic tablets at a dosage of 500 mg can be bought for 50-70 UAH.

The price of Azithromycin in Belarus is from 15 to 200 thousand rubles (depending on the dosage of the active substance and the number of tablets/capsules in the package). The price of the suspension for children is from 15 to 110 thousand rubles.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

ZdravCity

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Pharmacy Dialogue

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• Azithromycin (caps. 250 mg No. 6)Vertex

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Pharmacy24

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• Azithromycin 500 mg No. 3 capsules TOV Astrapharm, Ukraine

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PaniPharmacy

• Azithromycin-KR por.gr.d/oral.susp.200mg/5ml 25.4g No. 1 Ukraine, Krasnaya Zvezda

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• AZITHROMYCIN capsule Azithromycin capsules 500 mg No. 3 Ukraine, Health LLC

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• AZITHROMYCIN capsule Azithromycin-KR caps. 500 mg No. 3 Ukraine, Red Star OJSC

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• AZITHROMYCIN capsule Azithromycin capsules 0.25g No. 6 Ukraine, Astrapharm LLC

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