Emergency care: antibiotics for sexually transmitted diseases in men and women. The use of azithromycin for the prevention and treatment of pelvic inflammatory diseases and urogenital chlamydia Does azithromycin treat all STDs

To date, scientists have identified 14 types of ureaplasma, but only 2 of them are considered the causative agents of ureaplasmosis. They make up a group called by physicians ureaplasma ssp. These are the following types of ureaplasma: urealyticum (Ureaplasma urealyticum) and parvum (Ureaplasma parvum).

The second is more pathogenic, and the disease caused by it proceeds in a more acute form. Men are diagnosed less frequently than women. The pathogenic activity of the bacteria leads to various disorders of the organs of the genitourinary system, including infertility, urolithiasis disease and others.

What is ureaplasma parvum, what are the symptoms of its spread and how to treat ureaplasmosis?

Bacteria Features

Ureaplasma parvum is part of the opportunistic flora of the genital mucosa of women and men, the bacterium can be freely present in the body healthy person without causing harm to him in the normal state of immunity.

With a decrease in the immune response, general or local, the number of the pathogenic microorganism begins to grow exponentially, which naturally leads to the manifestation of its pathogenic nature.

Bacteria of the genus Ureaplasma are able to break down urea, and one of the products of this process is ammonia. Its excess leads to damage to the cells of the mucous membrane and the formation of erosion or ulcers on its surface.

Inflammatory processes resulting from this most often affect the vagina, fallopian tubes, cervix in women, seminal ducts, and epididymis in men. The urethra is affected in both sexes.

One of the dangers of infection with ureaplasma parvum bacteria is the blurring of symptoms and its similarity with manifestations of other infectious diseases of the genitourinary system.

If representatives of other STIs were present in the microflora of the genital organs, a decrease in local immunity, pushed by chlamydia, can provoke the activation of their pathogenic properties.

Ways of infection

The pathogen is spread in the following ways:

  1. Sexual way. In this case, parvum ureaplasma enters a healthy body during unprotected sexual contact from infected partner. Infection occurs even if the latter is exclusively a carrier, that is, its immunity successfully suppresses the pathogenic activity of the bacterium. This is especially common among people who are promiscuous. sexual life. Infection can occur during any type of sex: traditional, oral or anal.
  2. vertical path. Thus, the conditionally pathogenic flora is transmitted from mother to child in the prenatal period or directly during childbirth, when the newborn passes through the birth canal.
  3. Contact household. Such cases are possible when visiting public places such as baths, saunas, swimming pools, public toilets. The likelihood of infection directly depends on the degree of compliance with the rules of personal hygiene.
  4. Organ transplantation. This is the least common mode of transmission, but it does happen. Such cases are possible when untested biological material is used for transplantation.

Infectionists have the term "contagiousness". It means the ability of an infection to be transmitted from an infected organism to a healthy one. Ureaplasmosis and ureaplasma parvum, in particular, are highly contagious.

The probability of transmission of infection by one of these methods is almost 100%. Men are most often carriers, since the bacterium in their bodies does not lead to active inflammation, the disease proceeds in an asymptomatic form.

According to statistics, the definition of ureaplasmosis in men occurs in most cases by chance, with regular examination or suspicion of another infection.

Symptoms and consequences

The pathogenic activity of Ureaplasma parvum is characterized by the development of inflammation in the area of ​​​​localization of the bacterium. It can be acute or chronic, which most often occurs with a long course of the disease.

Depending on the location of the focus of inflammation, signs of ureaplasmosis in women may include the following conditions:

  • multiple vaginal discharge having a mucous structure, mixed with pus, and sometimes blood;
  • uterine bleeding not related to the menstrual cycle;
  • burning sensation and itching in the perineum;
  • difficulty urinating (dysuria);
  • increased urine production (polyuria);
  • pain and other manifestations of discomfort in the lower abdomen;
  • discomfort, sometimes pain, during sex;
  • fever, excessive sweating and signs of intoxication of the body (nausea, skin allergic reactions, etc.);
  • redness and swelling of the tissues of the vagina and urethra.

In men, the manifestations of the infection are less pronounced and include:

  • meager discharge from the urethra, having a transparent structure;
  • itching and burning sensation, sometimes during sex;
  • pain of varying severity when emptying the bladder (depending on the extent of the spread of the pathogen).

One of the main dangers of ureaplasmosis is its asymptomatic course on early stages development of pathology. This incubation period for ureaplasma can range from 2 weeks to several months, and in some cases even years.

In the absence of adequate treatment, the activity of the infectious agent can lead to serious consequences, in some cases irreversible. This is especially true for women who are pregnant or about to conceive.

When carrying a child, the body's immune response decreases naturally. This is a necessary measure for the normal development of the fetus. Such conditions are also ideal for Ureaplasma parvum.

How to treat ureaplasmosis: drugs, their action and use

The activity of pathogenic microorganisms during pregnancy can lead to malformations in the fetus. The risk of miscarriage increases sharply early dates and premature births in late.

Tests for the presence of ureaplasmosis are a mandatory procedure for every woman in position.

And outside of pregnancy, the danger of infection with Ureaplasma parvum is difficult to overestimate, especially without adequate treatment. Inflammatory processes in the uterus or ovaries can lead to the impossibility of conception in the future.

On the male body, the effect of ureaplasmosis is no less destructive. The main purpose of ureaplasma is the sperm production organs and seminal ducts. The result is a decrease in semen production and an increase in its viscosity.

This can cause infertility, as well as the fact that sperm under the influence of pathological effects become less mobile.

Consequence of development inflammatory processes in the area of ​​the prostate becomes prostatitis and its characteristic features.

Diagnostics

The most informative and reliable diagnostic methods for detecting Ureaplasma are:

  1. ELISA. In the course of a blood test with enzyme-linked immunosorbent assay (ELISA), specific antibodies that appear when infected with ureaplasma are looked for in the sample. When they are detected, we can talk about the presence of a pathogenic bacterium in the body. The disadvantage of the method is the impossibility exact definition time of infection. Some antibodies can persist for a long time, therefore, the analysis is not always informative.
  2. PCR. With the help of PCR analysis (polymerase chain reaction), it is possible to determine with a high degree of probability whether infectious agents are present in the body. The accuracy of the technique is evidenced by the fact that the result can be obtained even in the presence of only one pathogenic bacterium in the sample. False-positive or false-negative results are possible only if the rules for preparing for the sampling procedure are not followed.
  3. Cultural sowing or bakposev. As a result of this study, it is possible to determine not only the presence of a representative of the pathogenic flora in the sample, but also the degree of its resistance to one or another type of antibiotics. Samples of secretions and mucous from the vagina, urethra, seminal fluid, urine and blood are used as the test material. The only disadvantage of this diagnostic method is the duration of the procedures - the result can be obtained only after a few days.

Being a representative of the opportunistic flora, the presence of Ureaplasma in the body does not always mean the presence of pathogenic changes. To clarify this nuance, the analyzes indicate a quantitative characteristic of the content of bacteria in the sample.

If their number exceeds 104 per 1 g of material, we can speak with full confidence about ureaplasmosis in the active phase. This becomes the reason for the appointment of treatment.

Is it necessary to treat ureaplasma parvum if the test results are below this limit?

If the number of pathogens is close to this mark, and there are no clinical manifestations of the disease, the use of antibiotics is not recommended. In such cases, immunostimulating therapy is prescribed.

Treatment

Within its framework, antibacterial drugs (antibiotics) are prescribed, vitamin complexes, anti-inflammatory drugs (preference is given to non-steroidal ones), adaptogens and immunostimulants.

Among the most frequently appointed medicines includes:

Ureaplasma is also treated with the help of physiotherapeutic procedures, but they act as auxiliary methods of treatment.

A speedy recovery and the absence of relapses in the future can only be achieved by following all the recommendations and prescriptions of the doctor regarding the treatment regimen.

Otherwise, the repetition of the development of pathology cannot be avoided. In such situations, it is necessary to revise the course of treatment, replacing the antibiotic with a more powerful one. Since the probability of development of resistance by bacteria ureaplasma parvum to the previous one is almost absolute.

Prevention

Among the preventive rules that help avoid infection with ureaplasmosis include:

  • strict adherence to the principles of hygiene;
  • the use of barrier protection, especially during sexual contact with an unfamiliar partner;
  • orderly sex life;
  • use of antiseptics after unprotected intercourse.

The disease is always easier to prevent than to treat it later. That is why prevention is so important.

Outcome

Ureaplasma parvum is a dangerous and insidious bacterium. Being part of the conditionally pathogenic flora, it may not manifest itself for a long time after infection. But with changes in the immune picture, its pathogenic component is sharply activated.

Considering the consequences that a prolonged course of the disease can lead to, you need to contact a specialized specialist at the first symptoms.

Only timely diagnosis and adequate treatment can save the patient from the disease and possible problems in the future.

About the unfriendly union of Trichomonas and Chlamydia

Among the most common sexually transmitted diseases, trichomoniasis and chlamydia occupy a leading position. The clinical manifestations of these pathologies are largely similar, and the methods of diagnosis and treatment are not very different.

The main danger of chlamydia and trichomoniasis is that they negatively affect the human reproductive system, so you should know the methods of prevention to avoid infection.

Relationship between trichomoniasis and chlamydia

Symptoms of both pathologies are more pronounced in women, in men they often occur in a latent form, without any special signs, which makes timely treatment difficult.

Are trichomoniasis and chlamydia the same thing? Both infections can develop at the same time, since chlamydia and Trichomonas often live simultaneously in the human body.

Symptoms of trichomoniasis

Manifestations of pathology

Signs of trichomoniasis in women Signs of trichomoniasis in men

Pulling pain in the lower abdomen, sometimes in the anal region, pain during urination, swelling of the external genital organs.

Fever, profuse discharge with impurities of pus, blood with a pungent odor.

Disruptions in the menstrual cycle.

In advanced forms of the disease, cystitis and pyelonephritis develop.

On examination, the doctor can see many small hemorrhages on the cervix.

Itching, discomfort in the genital area, groin, pain can radiate to the back, leg, discomfort during intercourse, urination.

Inflammation of the foreskin

copious discharge from the urethra, most often in the morning.

With a weakened immune system, the temperature rises, with prolonged infection, discharge from the urethra appears, the quality of sperm deteriorates, and there are problems with potency.

Signs of chlamydia

Symptoms of chlamydia

Combined infection treatment

If unpleasant symptoms appear, it is necessary to visit a gynecologist, urologist or venereologist. Diagnosis of diseases that are sexually transmitted includes taking a smear from the vagina, urethra, cervical, urethra, PCR, clinical blood and urine tests.

Based on the results obtained, the doctor selects drugs that can destroy all types of pathogenic microorganisms.

If treatment is not started in a timely manner, then in men, against the background of sexual infections, urethritis, prostatitis develop, sexual desire decreases, and infertility is possible.

The inflammatory process covers the testicles, seminal vesicles. In women, trichomoniasis and chlamydia can cause adhesions, inability to conceive. Pathogenic microorganisms can cause miscarriage or premature birth during pregnancy.

How to expel chlamydia?

For the treatment of chlamydia, antibacterial drugs are used, so that the therapy is effective, it is necessary to first do tests for the sensitivity of microorganisms to the active substance of the drug.

The drug of choice in the treatment of chlamydia is often Doxycycline from the tetracycline group. Despite the long-term use of this medicine, pathogenic microorganisms have not developed immunity to it. Reception schedule - on the first day, 200 mg in the morning and evening, then 100 mg twice a day.

Well helps to cope with chlamydia Azithromycin (Sumamed) - on the first day you need to take 500 mg of medication in the morning and evening, then 500 mg once a day every other day for a week.

How to treat chlamydia:

  • macrolides - Clarithromycin, Fromilid, 500 mg twice a day for 7 days;
  • rifamycins - Rifampicin;
  • fluoroquinols - Ciprofloxacin, Tsiprobay, Ofloxacin;
  • antimycotic drugs - Flucostat, 50 mg once a day for a week;
  • suppositories - Hexicon, Vagilak, administered anally or vaginally;
  • means for restoring microflora - Linex, Hilak-forte;
  • local preparations - Erythromycin, Tetracycline ointment.

The average duration of therapy for chlamydia is 1-2 weeks. Additionally, immunomodulators, vitamin complexes are prescribed.

In the treatment of chlamydia in pregnant women, Erythromycin is used - 500 mg every 6 hours for a week, or 250 mg four times a day for 2 weeks. The same drug is also used to treat children - the dosage is 50 mg / kg. Reception should be continued for 10-14 days.

In chronic chlamydia, before starting antibiotic therapy, a course of injections of Polyoxidonium is preliminarily administered or Interferon is prescribed to strengthen the patient's immunity.

Reliable ways to get rid of Trichomonas

The main drug for the treatment of trichomoniasis is Metronidazole and its derivatives. The medicine is released in the form of tablets and vaginal suppositories, which allows you to effectively treat the infection in women and men. The duration of treatment is 7-14 days.

Tinidazole, Ornidazole, Macmirror, antibiotics from the tetracycline group are used as additional drugs.

Is it possible to treat venereal diseases with folk remedies?

Alternative medicine methods will not help get rid of chlamydia and Trichomonas, but they can enhance the therapeutic effect of drugs, speed up the healing process.

One of the effective methods of combating genital infections is douching with garlic tincture. It should be poured with 500 ml of alcohol 50 minced garlic, sent to a dark place for 14 days, shaken daily.

Strain the resulting tincture, dilute with water in a ratio of 1:10 before the procedure. For one session, 300 ml of solution will be required.

Juice therapy also helps a lot - add 60 ml of beetroot and cranberry juice to 120 ml of blackcurrant juice. Drink a drink in the morning and evening after meals for a month. This method of treatment helps to strengthen the immune system, is effective in chronic infections.

Prevention of STDs

To avoid infection with sexually transmitted diseases, you must be careful about choosing a sexual partner, use barrier contraceptives, do not use other people's underwear, washcloths, towels.

The story of a qualified specialist about the treatment of combined STIs:

Strict observance of the rules of personal hygiene is the main rule for preventing various sexual infections.

Prevention of sexually transmitted diseases consists in regular visits to the doctor, partners should pass all the necessary tests at the stage of pregnancy planning in order to avoid miscarriage, premature birth, infection of the fetus.

Trichomoniasis and chlamydia are dangerous sexually transmitted diseases that negatively affect the functioning of the genitourinary and reproductive systems. Can diseases be cured forever?

Alternative opinion. Visiting Dr. Komarovsky, obstetrician-gynecologist Sergey Baksheev talks about commercial diagnoses in gynecology, among which he names chlamydia:

With timely diagnosis and proper therapy, it is possible to get rid of pathologies without consequences and complications in 2 weeks. If you start the infectious process, then it will turn into a chronic form, it will take a long and not always successful treatment.

Somehow at the beginning of this spring, on the eve of the March holidays, I had a romantic adventure with a pleasant night continuation. But not really counting on such a scenario as a sin, I did not have antiseptics with me for post-exposure prophylaxis of infections, mainly transmitted sexually. The review is dedicated to how much I later regretted it, and how it all ended. I will make a reservation in advance that the sex was protected, in a condom, but oral contact was without an elastic band.

A couple of days after that, I felt slight tickling in the urethra to which I did not attach much importance. However, the next day the tickling turned into itching or even burning that worsens with urination. Particularly embarrassing was that at work I had to conduct important interviews that day - and I could not concentrate on interviewing candidates: intimate discomfort was very distracting. I strenuously drove myself away from thinking about a possible STI and tried not to remember what we were taught at school about venereal diseases. But when I noticed light yellowish discharge in the toilet, there was no doubt left: after all it's a tripper.

In order not to engage in self-diagnosis, on the same day after work, I hastily ran (because I had to catch a plane in the evening) to a private medical center. The dermatovenereologist did not like me very much, because I only wanted to take a smear and that he would just give me a prescription for one antibiotic. This approach categorically did not suit him, since he earns the main money not on a smear, but on injection treatment of gonorrhea in the very center - and this service is worth 3500 rub. I wanted to take pills. But their appointment by a doctor is also an additional service. We even almost got into a fight about my resistance to making money from him.

In general, he took a smear from me and sent me to think about the option of how I would still be treated. After 20 minutes, the result was ready, disappointing - there was gonococcus in the smear.

I took the results, thanked him for the diagnosis, apologized for his eccentric behavior (because he was in a hurry to the plane). The doctor eventually relented and said the therapy regimen in words: Cefixime 400 mg once and Azithromycin 1000 mg once. I immediately rushed to Rigla's pharmacy, where all this joy was sold to me without a prescription.


In general, if the doctor had not told me, I myself would not have taken Azithromycin for gonorrhea, limiting myself to only one antibiotic - Cefixime, since only it is indicated (from tablets) in the National Guidelines for the Management of Patients with Sexually Transmitted Infections of the Russian Society of Dermatovenereologists and Cosmetologists:

Treatment of gonococcal infection of the lower urinary tract, gonococcal pharyngitis and gonococcal infection of the anorectal region:

■ ceftriaxone 250 mg once intramuscularly or

■ cefixime 400 mg orally once or

■ spectinomycin 2.0 g once

But the doctor said that now there are many resistant forms, and cefixime must be taken in combination with azithromycin. Although the indications are gonorrhea, azithromycin does not have

Indications Infectious and inflammatory diseases caused by microorganisms sensitive to azithromycin:

infections of the upper respiratory tract and ENT organs (pharyngitis, tonsillitis, sinusitis, otitis media);

infections of the lower respiratory tract (acute bronchitis, exacerbation of chronic bronchitis);

community-acquired pneumonia, incl. caused by atypical pathogens (see section "Special Instructions");

infections of the skin and soft tissues (acne vulgaris of moderate severity, erysipelas, impetigo, secondarily infected dermatoses);

the initial stage of Lyme disease (borreliosis) - migratory erythema (erythema migrans);

urinary tract infections caused by Chlamydia trachomatis (urethritis, cervicitis).

But on the other hand, there is chlamydia in the testimonies, for which I did not take tests. In total, I agreed with the doctor that it was superfluous Azithromycin will not be, especially the reception - single.

Azithromycin by Vertex is available in a fashionable design, packaging - No. 3- designed for a three-day intake for respiratory tract infections (he took this course before himself with sinusitis). Price - 116 rubles.


I only needed 2 tablets of 0.5 g each. Therefore, I still have one tablet left (neither here nor there).


The next day I still had purulent discharge which passed by the evening. And completely all the symptoms disappeared on the second day. That's why azithromycin in combination with another antibiotic successfully coped with acute gonorrhea.

I had such an unpleasant but successful experience in the treatment of gonococcal infection. In order not to repeat this experience to anyone, I strongly recommend that you protect yourself during classic sex, and after unprotected oral sex, use antiseptics: cheap Chlorhexidine or popular Miramistin or powerful Octenisept. True, they hardly affect viruses ..

I also offer you a review of how tablets from the same manufacturer. you can get rid of nail fungus without removing them.

The azithromycin treatment regimen for chlamydia for women and men is selected individually by a dermatovenereologist, based on general condition patient health, test results and many other factors that play a role in the successful treatment of this disease. In addition, the sooner the patient visits the doctor, the more successful the treatment will be.

In this article, we will talk about in general terms chlamydia, such as the signs of this disease and how to diagnose it, as well as consider the available treatment regimens with azithromycin and get acquainted with the side effects and contraindications to the use of this drug.

Chlamydia is a sexually transmitted sexually transmitted infection (read more), the causative agent of which is Chlamydia trachomatis. The highest prevalence of infection is observed among people aged 20-40 years, as well as in regions with a low socio-economic standard of living. Infection can occur with any kind of unprotected sexual contact and women are more susceptible to this disease.

Chlamydia can occur in an acute or chronic form, as well as be asymptomatic. In addition, this disease has a number of serious complications arising from the lack of treatment or improperly selected drug therapy (including self-medication).

Depending on gender and form, the disease proceeds in the following ways:

acute form Chronic form
There is a slight increase in body temperature, increased fatigue and general weakness. There are discharges from the urethra of a glassy, ​​watery or mucopurulent nature, especially after a night's sleep. In the process of urination, a man may feel a burning sensation and itching, observe a cloudy first portion of urine. Often there is swelling and redness of the external opening of the urethra, bloody issues during ejaculation or urination. Pain is present in the lower back and groin.Symptoms in the chronic form occur at the stage of exacerbation. During the period of remission, slight pulling pains in the groin and lower back, a rare occurrence of itching and burning during urination are possible.
In women, subfebrile temperature, weakness and a feeling of fatigue occur. Chlamydia in female body can cause inflammation of the urethra, appendages, uterus and fallopian tubes, endometrium, etc. The disease is accompanied by pulling pains in the lower abdomen and lower back, pain during urination, burning, itching and a feeling of excessive moisture in the genital area. In addition, urination becomes more frequent, the menstrual cycle is disturbed, mucopurulent discharge with an unpleasant odor occurs.In more than 20% of cases, the chronic form is asymptomatic. In other cases, periods of exacerbation are accompanied by symptoms of varying severity.

In order to diagnose a disease, there is a large number of effective methods. When choosing a research method, the doctor takes into account its specific purpose: it is necessary to establish the presence of a pathogen, or also the phase of the disease.

The most commonly used types of analyzes are:

  • cultural method;
  • ELISA;
  • REEF;
  • PCR;
  • general smear;
  • express test (mini-test).

The price of these is quite diverse, the lowest cost is microscopic analysis (general smear), but, accordingly, the least informative. PCR and ELISA analysis are the most effective, their rates reach 100% and 90%, respectively.

Therapy with azithromycin

Before proceeding to treatment with the drug, the doctor must conduct a survey and examination of the patient, which should include an analysis for sensitivity to antibiotics.

Azithromycin is successful, since the drug tends to get inside the affected cells and accumulate there, which increases the effectiveness of the fight against the pathogen. This tool belongs to the group of macrolides and has the ability to expand antimicrobial properties and be resistant to acids.

The standard instruction for the use of azithromycin is as follows:

  1. In the initial stage of the disease, it is recommended to use 1 tablet of the drug 1 time per day, 2 hours before meals.
  2. Sluggish chlamydia is treated with the use of an antibiotic in this way: on the first day - 1 g, on days 2 and 3, 500 mg each, from 4 to 7 days of therapy, 250 mg each.

In other cases, alternative treatment regimens are possible:

  1. How to take azithromycin for chlamydia in men or women if the degree of prescription of the disease is not established and there are no concomitant complications? In this case, take 1 g of the drug on the 3rd, 5th and 7th day of treatment, or 1 g per week for two weeks.
  2. How to take azithromycin for chlamydia in women or men in case of complicated chronic infection? It is recommended to use azithromycin 500 mg per day once a week for 3 months. Or an alternative treatment regimen, which takes azithromycin 1 g on the 1st, 7th and 14th day of the course.

Note! An important role in the treatment of chlamydia with azithromycin is played by the patient's compliance with the doctor's recommendations. According to various sources, about 60-90% of patients independently change the regimen of taking the drug or stop taking it. The consequence of such actions is the persistence of the pathogen, increasing its resistance to antibiotics, as well as relapses of the disease.

Contraindications and side effects

Despite the fact that the instruction for azithromycin claims a slight likelihood of side effects, they still take place and can be manifested by such conditions:

  • diarrhea against the background of activation of motor receptors of the gastrointestinal tract;
  • increased transient activity of liver enzymes;
  • skin allergic reactions;
  • dizziness, drowsiness, headache;
  • tinnitus;
  • change in taste sensations;
  • temporary hearing loss
  • chest pains, disruption of the cardiovascular system.

In cases where the antibiotic is prescribed with antimicrobials, it is possible to increase the side effects of azithromycin.

The drug is not prescribed for:

  • hypersensitivity to macrolides;
  • severe disorders in the work of the kidneys and / or liver;
  • severe allergic reactions.

During pregnancy, the use of an antibiotic is allowed only if necessary, which exceeds the risk, the same applies to the period of breastfeeding. With caution, it is prescribed to patients with arrhythmia, as well as with the simultaneous use of warfarin or digoxin.

From the photos and videos in this article, we were able to learn not only about the characteristic features of this disease, but also about the main treatment regimens with an antibiotic from a number of macrolides - azithromycin, while familiarizing ourselves with contraindications and side effects this medication.

Frequently asked questions to the doctor

Alternative paths

Good evening. Tell me, if azithromycin is not suitable for the treatment of chlamydia, can a specialist prescribe me a drug from any other group of antibiotics?

Hello. Of course, for patients who cannot take azithromycin, there are a number of alternative drugs. This can be tetracycline at a dosage of 500 mg, lomefloxacin 600 mg, roxithromycin 150 mg or ciprofloxacin 0.5 g each. The duration of the course of treatment and the frequency of administration in such cases is determined by the attending physician.

Macrolide antibiotics are popular among the population, especially for the treatment of respiratory diseases. However, the number of sensitive microbes to these drugs is much wider. "Azithromycin" is widely used in obstetric-gynecological, urological practice. Ease of administration and high efficiency are the main advantages of the drug.

Composition and principle of action

"Azithromycin" belongs to the group of azalides, the composition contains the active ingredient of the same name. It has high bioavailability, when it enters the body, it reaches maximum concentrations in the blood after three hours. The following microorganisms fall into the spectrum of action of "Azithromycin":

  • streptococci, staphylococci- "responsible" for all purulent inflammatory processes;
  • bordetella, legionella- cause respiratory tract infections;
  • campylobacter, helicobacter- cause diseases of the gastrointestinal tract;
  • gonococci - cause gonorrhea;
  • gardnerella- provoke bacterial vaginosis;
  • STIs - sexually transmitted infections: chlamydia, mycoplasma and ureaplasma, trichomonas;
  • bacterioids are anaerobic bacteria.

"Azithromycin" is distributed throughout the body. But its highest concentrations are observed in the following tissues:

  • Airways;
  • genitals;
  • urinary system;
  • skin and underlying tissues.

Therefore, most often the drug is prescribed for the treatment of diseases associated with damage to these organs and tissues. An important feature of "Azithromycin" is its ability to intracellular accumulation. Some pathogenic microorganisms spend the main part of their life cycle inside cellular structures, where not all drugs can "get". This unique property microbes leads to their chronic persistence (permanent "residence") in the body. "Azithromycin" penetrates into lysosomes (cell elements) and phagocytes, which accumulate in the focus of inflammation, destroying pathogens there.

When to use

How to take azithromycin for adults and how much does it work? It is optimal to prescribe a medicine after determining the sensitivity to it and only according to indications. Independent uncontrolled intake leads to the emergence of resistance of pathogens. What does the drug help? The use of Azithromycin tablets 500 mg is justified in the following cases:

  • respiratory infections- bronchitis, pneumonia;
  • inflammation of the ENT organs- sinusitis (frontitis, sinusitis), otitis media, pharyngitis, tonsillitis (tonsillitis);
  • inflammation of the skin and lymph nodes- impetigo, erysipelas, secondary infection in the presence of a focus nearby;
  • genital infections- chlamydia, ureaplasmosis, mycoplasmosis, trichomoniasis, gonorrhea, syphilis;
  • diseases of the gastrointestinal tract - if they are associated with infection with Helicobacter pylori;
  • infections urinary tract - cystitis, urethritis, pyelonephritis, and prostatitis;
  • other ailments - scarlet fever, borreliosis, whooping cough, bacterial intestinal infections.

In obstetrics and gynecology

In gynecological and obstetric practice, in addition to the treatment of STIs with Azithromycin, the drug is used in the following cases:

  • for the prevention of complications after abortion, curettage;
  • after performing hysteroscopy, laparoscopy;
  • in the treatment of bartholinitis and inflammation of the cyst of the Bartholin gland;
  • for the treatment of adnexitis.

Indications for the use of "Azithromycin" for pregnant women:

  • with polyhydramnios and oligohydramnios;
  • with fetal growth retardation;
  • with suspicion of intrauterine infection;
  • with premature outflow of water;
  • with hydrocephalus in a child according to the results of ultrasound.

After childbirth, the drug can be prescribed to prevent purulent-septic complications, if additional manipulations were performed. For example, curettage of the uterus, manual separation of the placenta. Also, an antibiotic is prescribed after a cesarean section, with postpartum endometritis, with lactational mastitis.

When not to prescribe

Usually the drug is well tolerated and practically does not entail side effects. But contraindications for admission are the following conditions:

  • allergic reactions to macrolides;
  • chronic renal failure;
  • serious violations of the liver;
  • established arrhythmias.

Use during pregnancy and lactation is acceptable, taking into account the possible risk. When taking Azithromycin breast-feeding should stop for a while.

Instructions and method for the use of "Azithromycin"

In each clinical situation, the regimen of "Azithromycin" and the necessary combinations with other drugs are determined by the doctor. Standard appointment options are presented in the table.

Table - Dosage of "Azithromycin" for various pathologies


The drug is produced in the form of capsules of 250 mg and 500 mg, as well as in the form of tablets of 125, 500 mg. There is a children's form - powder for the preparation of a suspension of "Azithromycin".

The drug is taken orally one hour before meals or two hours after. Washed down with a small amount of clean non-carbonated water. You can not combine the reception with antacids, since the effectiveness of "Azithromycin" is reduced. If a tablet/capsule is accidentally missed, it should be taken as soon as possible. The next portion of the medicine should be taken no earlier than a day later.

Side effect

In 3-5% of cases of taking the drug, adverse reactions develop. Usually it is a slight nausea, abdominal pain, diarrhea, loss of appetite, bloating. Less commonly, the following side effects occur:

  • increased heart rate;
  • chest pain;
  • headache, drowsiness, anxiety;
  • vaginal candidiasis;
  • violation of the kidneys;
  • allergic reactions.

In case of overdose, nausea, vomiting, diarrhea occur, and a temporary decrease or loss of hearing is possible. Treatment in this case is symptomatic and aimed at removing the drug from the intestines and blood.

special instructions

Caution must be exercised when combined with other drugs. Most bright examples interactions are presented in the table.

Table - Interaction with drugs


Alcohol and any food also slow down the absorption of Azithromycin.

Analogues

"Azithromycin" has a large number of analogues with the same active ingredient and dosages, it can be both injections and tablets. According to doctors, the following suitable drugs can be distinguished:

  • "Azikar";
  • "Sumamed";
  • "Zitrolid";
  • "Hemomycin";
  • "Ecomed";
  • "Sumametsin".

Comparable in terms of spectrum of action are also drugs from the group of macrolides Josamycin, Erythromycin, Clarithromycin.

"Azithromycin" is a popular and effective drug for the treatment of infectious diseases of the skin, subcutaneous tissue, genitourinary infections, inflammation of the upper respiratory tract and respiratory tract. Reviews of "Azithromycin" in capsules and tablets indicate a small number of complications of admission and simple schemes.

Azithromycin is a representative of the 15-membered macrolides. Like all macrolides, it has a bacteriostatic effect, disrupting the process of protein synthesis in target microorganisms by stopping the processes of translocation and transpeptidation. However, under certain conditions, when creating higher intracellular concentrations, azithromycin can exhibit a bactericidal effect on some microorganisms.
Azithromycin (Zitrocin and others) is active against a large number of gram-positive and gram-negative microorganisms, including intracellular pathogens.
The highest activity of azithromycin as a representative of the macrolide class was noted against gram-positive pathogens, in particular Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae (except for methicillin-resistant strains). Azithromycin is not active against enterococci (like all macrolides).
With regard to gram-negative microorganisms, azithromycin has the highest activity among its class of drugs against Haemophilus influenzae, including strains that produce b-lactamase. It is moderately active against Salmonella spp., Shigella spp., Yersinia enterocolitica, Campylobacter jejuni, Helicobacter pylori.
Most importantly, azithromycin is highly active against "atypical" and intracellular pathogens, as well as STI pathogens. The drug acts on Legionella pneumophila, Mycoplasma pneumoniae, Mycoplasma hominis, Chlamydophila pneumoniae, C. trachomatis, Neisseria gonorrhoeae, Haemophilus ducreyi, Ureaplasma urealyticum, Treponema pallidum.
IN Lately it became known about the clinically proven activity of this drug against certain types of pathogens of malaria, toxoplasmosis, whooping cough, Lyme disease and the Mycobacterium avium complex.
In addition to the direct antibacterial action, azithromycin, like all macrolides, has an effect on the system of nonspecific anti-infective protection. Of great clinical importance is the interaction of the antibiotic with phagocytes, as a result of which the activity of free radical oxidation and the release of anti-inflammatory cytokines decrease, chemotaxis, phagocytosis and killing are activated. In addition, macrolides have membrane stabilizing activity, improve mucociliary clearance and reduce mucus secretion. Azithromycin has the highest degree of penetration into polymorphonuclear leukocytes among macrolides and stays in them much longer, which increases the ability to phagocytosis and anti-infective protection to a greater extent. The high anti-inflammatory, immunomodulatory and mucoregulatory action of azithromycin has been proven by experimental and clinical studies.
One of the main mechanisms of immunomodulatory action is a change in the virulence factors of pathogens. Antibiotics that inhibit protein synthesis cause a change in the cell membrane, characterized by a decrease in the expression of proteins with antiphagocytic functions (M-protein), which increases the fixation of the C3 component on the bacterial wall, reduces the need for opsonins, and improves phagocytosis. On the other hand, phagocytes also influence the activity of antibacterial drugs. They secrete substances that have a bactericidal effect and increase cell permeability. As a result, synergism with the drug is observed and the bactericidal effect of lysozyme, which destroys microorganisms, is enhanced even at low pH values.
Any chemotherapeutic agent has side effects in its application. However, macrolides are rightfully considered the safest antibacterial drugs. When taking azithromycin, cases of vaginitis and nephritis, headache, dizziness and drowsiness, adverse events from gastrointestinal tract, fatigue, paresthesia, allergic manifestations in the form of angioedema, skin rash, urticaria. In 64% of cases, these phenomena were in mild and in 30% - moderate forms, and their frequency did not exceed 1%. When using this drug in pregnant women, no risk of fetal harm is expected and there is no evidence of its toxic effect on the fetus in studies in animals.
The resistance of microorganisms to azithromycin is mainly (>90%) determined by two mechanisms: active removal of the drug from the microbial cell and modification of the target of its action, and the second mechanism usually gives a high level of resistance. In Russia, the problem of resistance to macrolides, and in particular to azithromycin, does not yet pose serious problems and amounts to only 5-6% (the dominant mechanism of resistance is the active release of the antibiotic from the microbial cell, much less often - ribosome methylation).
Azithromycin (Zitrocin and others) has one of the highest tissue affinity among antibacterial drugs. The maximum accumulation of the drug, especially with the development of microbial inflammation, is noted, in addition to the lung tissue and mucosa, the organs of the female reproductive system, the mucosa of the gastrointestinal tract, as well as in the prostate gland and urethra.
The concentration of azithromycin in monocytes, macrophages, fibroblasts and polymorphonuclear leukocytes is tens and hundreds of times higher than the serum concentration. The created high tissue concentrations, significantly exceeding the MIC of sensitive microorganisms, determine the pharmacodynamic advantages of macrolides. In addition, the accumulation of macrolides in the lysosomes of phagocytic cells, with the effective fusion of phagosomes and lysosomes, forms therapeutic concentrations in phagolysosomes and cytoplasm - the habitat of Chlamydia spp., Legionella spp., Mycoplasma spp., The role of which in the development of infections of the lower parts of the urogenital tract - urethritis and prostatitis - in last years much more than the role of typical bacteria: E. coli and other enterobacteria, staphylococcus, enterococcus.
From this it follows that on present stage in urological practice, azithromycin is used mainly for the treatment of sexually transmitted diseases.
One of the most problematic urogenital infections is chlamydia. The urogenital area is affected by C. trachomatis D.K. serotypes.
The danger of this infection is an asymptomatic course, late diagnosis, the consequence of which are complications, the main of which in both women and men is infertility. Specialists pay special attention to the treatment of chlamydia and its complicated forms. At present, the greatest difficulty is presented by the so-called persistent forms of chlamydia, which, in all likelihood, stopped their development at the stage of elementary bodies for unknown reasons. A similar condition is often observed after the treatment, when the clinical symptoms have passed, but, according to laboratory tests, chlamydia is still detected.
Difficulties in the treatment of chlamydia and other STDs are associated not only with the peculiarities of the biology of pathogens, but also with the fact that not all antibacterial drugs penetrate well into the inflamed tissue and secretion of the prostate gland, which is explained by the barrier function of the prostatic epithelium, an increase in the pH of the secretion of the gland and local microcirculation disorders. The data obtained as a result of clinical trials indicate that azithromycin is a drug with good tissue pharmacokinetics, it is high degree accumulates in the tissue and secretion of the prostate gland and persists there for a long time. In addition, for antibacterial drugs, not only the level of the drug in the blood and tissues is important, but to a greater extent the ratio of tissue concentrations and MIC values ​​\u200b\u200b(minimum inhibitory concentrations) for the infectious agent. It was shown that the concentration of azithromycin in secret and prostate tissue exceed the MIC values ​​for C. trachomatis, Ureapl. urealyticum, N. gonorrhoeae and 24 hours after ingestion, when the maximum level of the drug in the gland tissue is noted, and after 72 hours, when the concentration of the drug in secret and tissue becomes the same.
The data obtained allow us to conclude that, due to the unique tissue pharmacokinetics, azithromycin can be prescribed for urogenital STIs in short courses or with long intervals between doses (for chlamydial infection, this interval is 7 days). So, since 2000, there has been a method for treating complicated forms (prostatitis, total urethritis, epididymitis) of urogenital chlamydial infection with azithromycin 1.0 g once on days 1-7-14 of treatment (3.0 g per course), so called pulse therapy. In these forms of diseases, in more than 90% of cases, along with chlamydia, patients also have other microorganisms (U. urealyticum, M. genitalium, Trichom. vaginalis, N. gonorrhoeae). Observations show that with this treatment regimen, relapses even after two years are observed only in 1.2% of men and 2.5% of women.
This effect cannot be achieved using any of the currently known macrolides or tetracyclines used in the treatment of chlamydia. The proposed course of fractional therapy of 1.0 g with an interval of 1 week is able to "block" from 6 to 8 life cycles C. trachomatis (one cycle - 48-72 hours).
Currently, the treatment of various forms of complicated chlamydia using pulse therapy is carried out not only in Russia, but also abroad. And in our country, this scheme was included in the “Federal Guidelines for Physicians” (formular system), 2002.
In especially severe cases of the disease, in addition to the oral form of azithromycin, a form for intravenous administration.
Conducted clinical studies have shown that azithromycin is currently the drug of choice for the treatment of urogenital chlamydia in non-pregnant women and an alternative treatment for this disease during pregnancy. It also plays an important role in the prevention of pelvic inflammatory disease. It seems promising to include azithromycin in the treatment regimens for inflammatory diseases of the pelvic organs in connection with the registration in Russia of the dosage form of the drug for intravenous administration. This drug is active against the main causative agents of the disease, ensures the rapid creation of a therapeutic concentration in the focus of inflammation, and also has an immunomodulatory effect that increases the nonspecific immunological reactivity of the body. The presence of azithromycin dosage forms for oral and parenteral administration allows the use of stepwise therapy, which, in turn, helps to reduce economic costs and improve the quality of life of patients during the treatment period.
Unfortunately, there are already the first reports indicating the emergence of single strains of chlamydia resistant to azithromycin. This is a rather formidable sign, indicating the beginning of the process of adaptability of chlamydia to one of the main antibiotics of choice, which in the future is fraught with an increase in the incidence and new complications.
The data from scientific studies were supported by data from clinical studies, and later from the clinical use of azithromycin in gonococcal infections. They show that the activity of this drug against gonococci is quite high, and the number of strains resistant to this drug is no more than 3% (and, for example, to ciprofloxacin - about 35%).
There is evidence of the possibility of using azithromycin for the treatment of early syphilis - in studies, this drug was slightly more effective than benzathine benzylpenicillin (97.7% vs. 95%) during treatment, 3 and 6 months after completion of therapy.
Azithromycin has long been used to treat chancroid (an infection caused by Haemophilus ducreyi), non-gonococcal urethritis, and granuloma inguina (donovanosis caused by Calymmatobacterium granulomatis).
At the moment, azithromycin (Zitrocin and others) continues to be a unique drug for a number of infectious diseases, especially for urogenital infections.
The problem of resistance of both gram-positive and gram-negative clinical strains of the main pathogens to azithromycin in Russia is not yet relevant and does not require a quick solution. A good tolerability profile allows the use of this drug in a wide range of patients.
In recent years, it has become possible to use azithromycin for stepwise therapy, primarily for complicated inflammatory diseases of the pelvic organs, due to the appearance of a form for intravenous use.
Azithromycin is one of the few antibiotics that, due to its low toxicity and the absence of serious side effects, is approved for use in children from an early age, as well as during pregnancy.
Insufficient attention in the appointment of azithromycin is paid to its immunomodulatory properties, but, most likely, over time, these non-antibiotic features of it will find their full clinical use.
Summarizing all of the above, it must be emphasized that azithromycin not only has not exhausted its practical potential, but continues to be one of the most important and promising drugs in modern antibacterial therapy both in outpatient and inpatient settings. And the creation of new generic drugs based on azithromycin, which deepen its immunomodulatory properties, opens up new broad horizons for its application, including in the field of urological practice.

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