Ciprofloxacin is a well-known antibiotic of the fluoroquinolone group, which is actively used for diagnosing a number of acute and chronic pathologies.

Diseases cannot always be cured with just one antibiotic.

Doctors often prescribe combination antibacterial drugs or other drugs are added for treatment to enhance the bactericidal and bacteriostatic effect, as well as to avoid bacterial resistance or side effects.

Ciprofloxacin can easily be combined with other drugs, but patients are most often interested in the specifics of such a combination, because enhanced antibiotic therapy does not benefit the body.

What medications are ciprofloxacin prescribed with?

Ciprofloxacin is a fluoroquinolone antibiotic produced with the aim of expanding its effect on pathogenic bacteria. The drug is suitable for the treatment of many diseases, and its action is varied. Antibiotics are most often not prescribed alone, because the treatment of many pathologies requires individual and combined approach.

Photo 1. Ciprofloxacin, 20 tablets, 500 mg, manufactured by Aliud Pharma.

In an aggressive course of the disease, bacteria acquire sustainability to the active components of the drug, which leads to incomplete recovery and increased relapse. Ciprofloxacin, like a fluoroquinolone, is not a highly effective antibiotic, which justifies the prescription of additional drugs.

Most often it is combined with the following antibiotics and antimicrobial drugs:

Doxycycline;
Levofloxacin;
Metronidazole;
Azithromycin;
Ciftriaxone;
Cephalosporin;
Fluconabosis;
Ibuprofen.

It has been proven that the effectiveness of Ciprofloxacin increases and intensifies with a combination of other antibacterial medicines, but in some cases additional treatment is prescribed as relief of pain symptoms, as well as elimination of side effects.

Compatibility of Ciprofloxacin and Doxycycline

Both drugs are antibiotics, but Doxycycline belongs to the group tetracyclines, that is, it has a completely different chemical composition. These groups of antibacterial drugs have no contraindications for combination.

Due to the combination of Doxycycline and Ciprofloxacin, there is amplifying antibacterial effect, resistance to other antibiotics decreases.

Ciprofloxacin is a drug with a unique chemical formula, which means there is no cross-resistance with drugs of another antibacterial series. It works well with Doxycycline.

The components of both drugs do not block or reduce the pharmacological actions of each other, but only complement (synergy).

Doxycycline itself is a very strong and toxic drug, therefore its simultaneous administration with Ciprofloxacin is a case exceptions rather than rules. This combination is prescribed for the following pathologies:

acute inflammatory pelvic disease among women;
specific urethritis caused by STIs;
infectious complications after operations, abortion;
pneumonia;
tuberculosis;
sepsis;
sinusitis, sinusitis, frontal sinusitis in an acute form.

Most often, Ciprofloxacin + Doxycycline are used in obstetrics and gynecology, but the cases are different. Doxycycline has many dangerous side effects, and the additional intake of other antibiotics will only increase their manifestation. The doctor must be sure to monitor the patient's condition.

Important! Ciprofloxacin + Doxycycline can be taken together only in acute or complicated infections.

Sluggish and chronic pathologies do not imply the combined use of drugs, but a similar option is possible if other treatment is ineffective.

The dosage, as well as the combination of drugs, depends on the doctor's recommendations and the clinical diagnosis.

For acute, severe infections or strong foci of inflammation, Ciprofloxacin and Doxycycline are taken together or combined a week later in order to block resistance.

In cases of ineffectiveness of Ciprofloxacin, Doxycycline is prescribed, which is taken strictly on prescription doctor.

Ciprofloxacin and Levofloxacin: can I take it at the same time

Levofloxacin is a 3rd generation antibiotic fluoroquinolone, belongs to the same drug group as Cifprofloxacin. In clinical practice, such drug combinations can cause cross resistance, that is, the usual resistance of bacteria to the active components of all fluoroquinolones. Their joint purpose doesn't make sense and carries certain risks, but at the same time they are compatible and do not cause any negative manifestations on the part of the body.

The side effects of each antibiotic are dangerous anyway. Levofloxacin is often prescribed after ineffectiveness or intolerance to Ciprofloxacin. They are not taken together, but Cifprofloxacin can be combined with another fluoroquinolone in 7-10 days to reduce resistance.

Photo 2. Levofloxacin, 10 tablets, 250 and 500 mg, manufacturer - Vertex.

Ciprofloxacin + Levofloxacin is theoretically used for any infectious diseases, since they have a wide spectrum of action, but joint administration of drugs leads to the risk of sustainability bacteria.

Ciprofloxacin and Metronidazole: Their Interaction

Metronidazole is not an antibiotic, according to its pharmacological group it is antimicrobial a drug that is intended for auxiliary treatment during antibiotic therapy. Ciprofloxacin and Metronidazole can be taken together or separately, but in the latter case, Metronidazole is prescribed after the end of the appointment Ciprofloxacin to maintain the therapeutic effect.

Ciprofloxacin + Metronidazole are effective against the following pathologies:

protozoal ailments: amebiasis, giardiasis, Trichomonas urethritis / colpitis / vaginitis;
cystitis, summoned STIs;
endocarditis bacterial nature;
meningitis;
pneumonia;
sepsis;
infections caused by Bacteroides spp, Peptostreptococcus spp, Clostridium spp, Peptococcus spp;
organ diseases small pelvis;
skin diseases;
postoperative complications in gynecology / urology.

Reference! Metronidazole is also available under a different trade name. Trichopol, which contains a similar pharmacological composition.

Metronidazole is ineffective when taken alone, so it is always prescribed with other medications or antibiotics. The simultaneous use of drugs is not dangerous, but Metronidazole has many side effects, which usually occur when interacting with other antibiotics. Doctors either reduce the dose of Metronidazole or prescribe it after antibiotic therapy.

How to combine Ciprofloxacin and Azithromycin

Azithromycin - drug antibacterial group, which traditionally refers to macrolides-azalides. There are no contraindications for the combination of Azithromycin with fluoroquinolones, since they are successfully combined in the treatment of a number of specific diseases.

First of all, such pathologies include:

pneumonia;
pleurisy;
COPD;
tuberculosis;
ENT pathology(sinusitis, frontal sinusitis, otitis media, sinusitis).

Ciprofloxacin + Azithromycin is taken together for treatment pulmonary diseases. Their separate use for the above acute pathologies is impractical and ineffective. They combine well and are safe to use, but side effects and individual intolerance are possible.

Ciprofloxacin and Ceftriaxone

Ceftriaxone is an antibiotic belonging to the cephalosporin group, which can be combined with fluoroquinolones, enhancing the bactericidal and bacteriostatic effect. Both antibiotics have a broad spectrum of action, indicating that any bacterial infection is being treated.

In clinical practice, they are combined for the treatment of various pathologies of a bacterial nature, and especially in the case when the patient has resistance to groups of other antibiotics.

They are safe to use and can be consumed at the same time.

Most often, this combination is used for therapy ENT pathology, and infections of the gastrointestinal tract, urogenital tract, skin ailments.

Ciprofloxacin and Cephalosporin: are they taken together

Cephalosporin is an antibacterial agent from the β-lactam group, which is known for the versatility of its pharmacological properties. Ciprofloxacin goes well with cephalosporin, which complements and maintains the bactericidal effect.

In practice, doctors use this combination to treat a wide range of bacterial infections... First of all, it is Gastrointestinal diseases, and urogenital diseases. Both drugs destroy opportunistic bacteria at the cellular level, which, when taken twice, is extremely effective. This combination of drugs allows you to quickly stop the foci of infection.

Most often, drugs are used at the same time, as this helps prevent the growth of bacteria and block resistance. Cephalosporin completely destroys the DNA of bacteria, stopping their division, and Ciprofloxacin consolidates the therapeutic effect.

Ciprofloxacin and Fluconazole

Most antibacterial agents cause side effects, of which the most common are candidiasis(thrush) caused by the pathogenic fungi Candida spp.

Fluconazole is a proven antifungal agent whose pharmacokinetics inhibit the multiplication of Candida spp. And other fungal organisms.

Fluconazole can be taken with any antibiotic to treat fungal infections.

But most often Fluconazole is used after undergoing antibiotic therapy or in the last days of taking Ciprofloxacin to avoid hepatotoxicity and blocking the active components of the antifungal agent.

Important! Simultaneous reception of Ciprofloxacin and Fluconazole obligatory with a significant weakening of immunity after severe conditions (AIDS, radiation therapy).

Ciprofloxacin and Ibuprofen

Ibuprofen is a non-steroidal anti-inflammatory drugs that are designed to relieve pain and lower fever. Often, pathological conditions are accompanied by extremely unpleasant and painful symptoms, which require action.

Ciprofloxacin + Ibuprofen is ideal for both treatment antibacterial infection, and to eliminate concomitant symptoms.

By itself, Ibuprofen has no effect on bacteria, and its pharmacokinetics have no effect on the components of any antibiotic that fights against the cause, not the effect.

This combination of drugs is often prescribed for arthritis, myositis and other musculoskeletal diseases... In terms of side effects and compatibility, these are safe drugs.

What combination of drugs is most suitable for the treatment of tuberculosis

Each combination of drugs has varying degrees of effectiveness and is intended to treat certain diseases. Tuberculosis cannot be stopped with one antibiotic, which requires combination therapy.

Ciprofloxacin, like a fluoroquinolone, is a "reserve" drug for the treatment of tuberculous lesion of the lungs... It has a relatively moderate efficacy, which in practice means the use of Ciprofloxacin only in the case of resistance to the most strong drugs.

The ideal option is the combination of Ciprofloxacin and Doxycycline, as well as Azithromycin. Other combinations of antibiotics will have mild effects.

Important! The ideal combination of antibiotics is their simultaneous use in tableted and injection form (injections).

Ciprofloxacin works well with other antibiotics and antimicrobials. Their double effect enhances bactericidal property and speeds up overall recovery. But Ciprofloxacin does not mix well with others. fluoroquinolones, as well as with some other groups of antibiotics. In other cases, combining drugs is an excellent treatment option, but there is a high likelihood of side effects.

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Azithromycin is an antibiotic used for a wide variety of problems. The drug belongs to the subgroup of macrodidal antibiotics - azalides. Thanks to the use of the drug, harmful bacteria in the human body are suppressed. The agent works both at the intracellular and extracellular levels, suppressing the concentration of any pathogens, except for those that are resistant to erythromycin.

Composition and form of release

Film-coated tablets of blue color, oblong, biconvex; on a cross section - a core from white to white with a yellowish tinge.

Each tablet contains includes such chemical active ingredients as starch glycolate, microcrystalline cellulose, corn starch, sodium benzoate, talc, sodium lauryl sulfate, magnesium stearate.

The composition of the shell includes: polyethylene glycol, propylene glycol, TabcoatPink dye (hydroxypropyl methylcellulose, polyethylene glycol, titanium dioxide, erythrosine E 127 talc).

Indications for the use of Azithromycin

The indications are reduced to the following infectious and inflammatory diseases:

upper respiratory tract infections, infections in the ear, throat, nose. The medicine suppresses infections such as pharyngitis, tonsillitis, sinusitis, otitis media;
infections of the lower respiratory tract and soft tissues, expressed in acne of mild to moderate severity, also in erysipelas, impetigo, and dermatosis;
the primary stage of a disease called Lyme, the medical term for borreliosis, or erythema accompanied by migraine;
infections related to the urinary tract organs, the source of which is urethritis or tsarvicitis.

Contraindications

Contraindications are factors such as:

weak activity of organs such as the kidneys and liver, problems in this area;
The medication is contraindicated in children under the age of 12, and for people whose weight does not reach 45 kg;
It is forbidden to take antibiotics in case of lactation by the mother and breastfeeding;
Contraindications are also the parallel use of ergotamine and dihydroergotamine;
Individual intolerance to the components.

Under certain circumstances, patients should take Azithromycin with extreme caution:

Mild liver and kidney dysfunction;
Arrhythmia;
Parallel administration of drugs such as terfenadine, warfarin, digoxin.

Side effects

The instruction for use warns of the following side effects in patients taking Azithromycin with prolonged or illiterate, not dosed intake:

With regard to the digestive system, side effects can include problems such as nausea, vomiting, diarrhea, sharp pains in the abdominal region, anorexia, constipation, colitis, hepatitis, problems associated with the functioning of the liver;
With manifestations of allergies, side effects are expressed in itching, skin rashes, edema, urticaria, erythema multiforme, anaphalic reaction;
Regarding the cardiovascular system, among the side effects from the use of the drug, one can single out dizziness, pain in the head area, convulsions, a tendency to sleep, asthenia, lack of sleep, manifestation of unjustified aggression, irritability, nervous conditions;
In relation to the senses Azithromycin can cause side effects such as tinnitus, hearing loss, incorrect perception of taste and smell;
With regard to the circulatory and lymphatic systems, side effects when taking the drug are neutropenia, eosinophilia, neutropenia;
In relation to the musculoskeletal system, arthralgia is a side effect;
With regard to the genitourinary system, side effects are acute renal failure and interstitial nephritis;
Also, side effects when taking Azotrimycin medication are problems such as vaginitis and candidiasis.

Instructions for the use of Azithromycin

Method and dosage

For people aged 12 years and older, weighing more than 45 kg is:

for infectious diseases of the upper and lower respiratory tract, a volume of 500 mg once a day for 3 days;
for acne, it is required to take two capsules of 250 mg 1 time per day for 3 days, then the drug must be taken at 250 mg 2 times a week for 9 days. In this case, the dose of the drug in one course reaches 6 mg;
Instructions for use recommend taking the drug for erythema accompanied by migraine; the course consists in 2 capsules of 500 mg on the first day of treatment, from the 2nd to the 5th day it is necessary to take the agent 500 mg every day. In this case, the full dose for the entire course will be 3 mg;
The instruction suggests taking Azithromycin for urinary tract infections, the sources of which are urethritis and cervicitis. In this case, the course includes 2 capsules of 500 mg every day. In this case, the full dose for the entire course in this case will be 2 capsules, drunk at once in one moment;
with kidney dysfunction to moderate severity, the course includes 40 ml / min.

Pharmacokinetics of the drug

The instruction notes that it adapts quickly enough in the gastrointestinal intestinal tract, due to its properties of resistance to acid secreted by the gastrointestinal tract. Immediately after taking 500 grams by the patient, he raises the Cmax level of azithromycin in the blood plasma to the level of 0.4 mg / l, within 2.5 - 2.9 hours. Bioavailability in the case of a 500-gram tablet drunk reaches 37%. Azithromycin perfectly adapts in the respiratory organs, tissues of the urogenital tract, in the skin, and soft tissues... At the same time, during the next 5 - 7 days after use, Azithromycin remains at a decent level. Due to this characteristic of the drug, the courses of treatment are carried out for no more than 3, 5 days.

The drug is excreted from the patient's body in two steps: T1 / 2 is 14-20 hours in the interval from 8 to 24 hours after taking the drug and 41 hours in the interval from 24 to 72 hours, which allows taking the drug once a day, 50% excreted in the bile unchanged, 6% - by the kidneys.

The drug is prescribed once a day, 500 mg. In this case, the remedy can be taken both after meals and before, on an empty stomach or on a full stomach.

During pregnancy and lactation

Pregnant and lactating women can take an antibiotic only on the recommendation of a doctor if the expected benefits outweigh the possible costs.

It is forbidden to take Azithromycin while breastfeeding.

Azithromycin for children

The instructions for use prohibit the administration of the medicine by children under the age of 12 years, and weighing less than 45 kg.

Interaction with other drugs

Azithromycin, in cooperation with antacids, reduces its effect by 30%. Based on the properties, it must be taken one hour before taking antacids, or 2 hours after. In the case of concurrent administration of cyclospirin, it is necessary to monitor the content of this drug in the blood. In the case of concurrent administration of digoxin and Azithromycin, the level of digoxin in the blood should be monitored, since macrolides increase the absorption of digoxin in the intestine.

If it is necessary to take warfarin in parallel with the medication, the prothrombin time should be monitored. Parallel administration of terfenadine and azithromycin can lead to such negative consequences as arrhythmia. Parallel administration of the medication and zidovudine can lead to such a consequence as an increase in the concentration of the active metabolite. It is also undesirable to take the drug simultaneously with macrolides with ergotamines, due to the fact that this connection can lead to an increase in the level of toxins in the body.

Domestic and foreign analogues

The following drugs are analogous: Sumamed; Zitrolide; Z-Factor; Hemomycin; Azitral; Azitrox; Sumamed-Forte; Zitrolide-Forte; Sumamox; AzitRus; AzitRus Forte; Azivok; Zetamax Retard; Zitrocin.

Check out the price of Azithromycin in 2018 and cheap analogs >>> The cost of Azithromycin in different pharmacies can vary significantly. This is due to the use of cheaper components in the drug, and the pricing policy of the pharmacy chain. But what is important is that the difference in price between foreign and Russian counterparts remains practically unchanged.

Source: www.medmoon.ru

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Azithromycin: respiratory specificity and uniqueness

Authors: D.B. Uteshev, Department of Hospital Therapy, Moscow Faculty, Russian State Medical University, I.A. A. V. KRYLOV BUYUKLINSKAYA, Northern State Medical University, Arkhangelsk

Azithromycin is a representative of azalides, a subclass of macrolide antibiotics. Chemically, it differs from macrolides by the presence of a 15-membered lactone ring containing a nitrogen atom. In the arsenal of antibacterial agents intended for the treatment of respiratory infections, azithromycin invariably retains a leading position: depending on the nosological form, it is used as a first-line drug, an alternative agent, or in combination with other antibiotics. This is due to a number of exceptional features of azithromycin, which favorably distinguish it from other antibacterial agents.

Spectrum of antibacterial activity

Azithromycin has a broad spectrum of antibacterial activity that covers most types of bacteria that cause respiratory tract infections. The drug is effective against gram-positive microorganisms, including those producing β-lactamases (streptococci, staphylococci), as well as gram-negative bacteria (enterococci, Escherichia coli, Haemophilus influenzae, Shigella, Salmonella), atypical pathogens (Chlamydia pneumoniae, Legionella pneumophila, Mycoplasma pneumoniae), anaerobes and spirochetes. Azithromycin is 2-4 times less active against staphylococci and streptococci than erythromycin, but it is superior in its effect on Haemophilus influenzae and gram-negative cocci. A positive feature of azithromycin is the low level of microorganism resistance to it.

Features of pharmacokinetics

Azithromycin has unique pharmacokinetic characteristics: first of all, a high degree of accumulation in tissues and inside cells, where its levels are 10-100 times higher than in blood plasma. This property is due to the high lipophilicity of the drug. The maximum concentration of azithromycin is determined in the lung tissue (in comparison with erythromycin, which does not differ in the level in the blood plasma and in the lungs). Due to the accumulation of azithromycin in phagocytes, the drug is distributed to the foci of infectious inflammation. The concentration of azithromycin in the focus of infection is significantly higher than in unaffected tissues.

Metabolic stability is inherent in azithromycin. It acts for a long time (half-life is 2-4 days), with a post-antibiotic effect (maintenance of effective concentrations in the focus of infection for 3-5 days after drug withdrawal) against S.pyogenes, S.pneumoniae, H.influenzae, L.pneumophila... The duration of the postantibiotic effect in relation to H.influenzae and L.pneumophila more azithromycin than clarithromycin. This determines the exceptional feature of the use of azithromycin in the treatment of respiratory tract infections - the effectiveness of 3-5-day courses of treatment.

The drug does not penetrate the blood-brain barrier. Elimination occurs with urine unchanged and with bile. In renal and hepatic insufficiency, the half-life does not change. The drug does not affect the liver microsomal system, therefore, there is no risk of undesirable effects inherent in this interaction.

A new oral dosage form of azithromycin, sustained-release microspheres (S), has been created and introduced into clinical practice in the USA. Office of Control food and US Medicines (FDA) approved the use of ZV azithromycin for the treatment of community-acquired pneumonia and mild / moderate sinusitis in a single dose per course. Compared with the usual dosage form, azithromycin pollutants are absorbed more slowly in the intestine, the maximum plasma concentration is reached after 2.5 hours, and the bioavailability is 82.8%. The use of azithromycin ZV is characterized by a lower incidence of dyspeptic disorders. The combined use of antacid drugs does not significantly affect the parameters of the pharmacokinetics of pollutant azithromycin (maximum plasma concentration, area under the pharmacokinetic curve). The introduction of azithromycin ZV made it possible not only to achieve high efficiency of antibacterial therapy, but also to increase compliance: the drug is prescribed once, has a favorable safety and tolerability profile.

Clinical application

Azithromycin has become justifiably widespread in the treatment of pathology of the respiratory system. This is due to a favorable spectrum of antibacterial activity, a low level of pathogens resistance to it, features of pharmacokinetics (high pulmonary deposition) and good tolerance.

In a comparative study of azithromycin, amoxicillin / clavulanate and the combination of cefuroxime with erythromycin in community-acquired pneumonia, the same clinical efficacy of the compared regimens was established, however, azithromycin was characterized by better tolerance and a lower frequency of adverse effects (12%). In the group of patients receiving cefuroxime in combination with erythromycin, the frequency of undesirable effects was 48% (mainly dyspeptic symptoms). In a pharmacoeconomic comparison of empirical therapy with azithromycin or a combination of cefuroxime with erythromycin in stepwise therapy regimens, the equivalent cost of these regimens was established (while the cost reduction in the azithromycin group was not taken into account due to the lower frequency of undesirable effects, the simplification of the treatment process, and a decrease in staff labor costs).

Azithromycin, along with other macrolide antibiotics, is the drug of choice for the treatment of atypical (mycoplasma, legionella, chlamydial) pneumonia. According to some reports, these intracellular pathogens account for more than 30% of all cases of community-acquired pneumonia, and the verification of these pathogens requires the use of expensive techniques. In this regard, the empirical use of azithromycin in the treatment of community-acquired pneumonia seems to be justified. In severe pneumonia, the empirical appointment of a combination of azithromycin with ceftriaxone is justified.

A new form of azithromycin (sustained-release microspheres) was used in a single dose of 2 g per course for the empirical treatment of community-acquired pneumonia and mild to moderate bacterial sinusitis. A single dose of azithromycin was comparable in effectiveness with the use of levofloxacin or clarithromycin for 7 days for community-acquired pneumonia or levofloxacin for 10 days for sinusitis. The use of the new form of azithromycin has shown high compliance and good tolerance.

It is justified to prescribe azithromycin as a drug of choice and for the treatment of exacerbations of chronic bronchitis, the causative agents of which, as a rule, are S.pneumoniae, M.catarrhalis, H.influenzae... The use of other macrolides is considered inappropriate due to the lack of clinically significant activity against H.influenzae.

Long-term use of azithromycin in low doses in patients with cystic fibrosis with chronic infection Pseudomonas aeruginosa was accompanied by a decrease in the number of exacerbations, a positive effect on pulmonary function, an improvement in nutritional status and good drug tolerance.

Interesting are the data on the organoprotective properties of azithromycin, which may be due to the nonspecific anti-inflammatory activity and antioxidant effect of azithromycin. Thus, in one study, it was demonstrated that azithromycin protects the lungs from damage induced by smoking. Azithromycin inhibits tobacco smoke-induced damage to type II alveolocytes, activation of nuclear factor kB and an increase in tumor necrosis factor a concentration. Such an action is undoubtedly the advantage of this antibiotic in the treatment of bronchopulmonary pathology.

Data on the use of azithromycin for the treatment of infectious processes of other localizations are of independent interest: urogenital chlamydia, syphilis, chronic bacterial prostatitis (in combination with ciprofloxacin), acne, Lyme disease, chronic periodontitis.

Conclusion

Unique pharmacokinetic characteristics (accumulation in tissues, metabolic stability, characteristic exclusively for azithromycin, a long half-life), a wide range of antibacterial activity, including atypical pathogens, the presence of a postantibiotic effect, good tolerance, high compliance, a low level of pathogen resistance, the presence of organoprotective properties (anti-inflammatory and antioxidant activity) - all this gives grounds for the widespread use of azithromycin in respiratory infections. The clinical efficacy of azithromycin in empiric therapy of bronchopulmonary infections (in monotherapy and in combination with β-lactams) on an outpatient basis and in a hospital has been proven in a number of multicenter studies.

Bibliography

1. Chandra R., Liu P., Breen J.D. et al. Clinical pharmacokinetics and gastrointestinal tolerability of a novel extended-release microsphere formulation of azithromycin // Clin. Pharmacokinet. - 2007. - V. 46, No. 3. - P. 247-259.

2. Fernandez-Obregon A., Patton D.L. The role of Chlamydia pneumoniae in the etiology of acne rosacea: response to the use of oral azithromycin // Cutis. - 2007. - V. 79, No. 2. - P. 163-167.

3. Geisler W.M. Management of uncomplicated Chlamydia trachomatis infections in adolescents and adults: evidence reviewed for the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guide-lines // Clin. Infect. Dis. - 2007. - V. 44, Suppl. 3. - R. 77-83.

4. Guillot M., Amiour M., Hachem C. et al. Macrolides, Pseudomonas aeruginosa and cystic fibrosis // Arch. Pediatr. - 2006. - V. 13, Suppl. 1. - P. 48-50.

5. Haggerty C.L., Ness R.B. Newest approaches to treatment of pelvic inflammatory disease: a review of recent randomized clinical trials // Clin. Infect. Dis. - 2007. - V. 44, No. 7. - P. 961-963.

6. Jarraud S., Reyrolle M., Meugnier H. et al. Legionnaires disease // Presse Med. - 2007. - V. 36, No. 2, Pt. 2. - P. 279-287.

7. Magri V., Trinchieri A., Pozzi G. et al. Efficacy of repeated cycles of combination therapy for the eradication of infecting organisms in chronic bacterial prostatitis // Int. J. Antimicrob. Agents. - 2007. - V. 29, No. 5. - P. 549-556.

8. Monsel G., Canestri A., Caumes E. Antibiotherapy for early localized Lyme disease // Med. Mal. Infect. - 2007. - V. 37, No. 7-8. - P. 463-472.

9. Mutak S. Azalides from azithromycin to new azalide derivatives // J. Antibiot. (Tokyo). - 2007. - V. 60, No. 2. - P. 85-122.

10. Sugiyama K, Shirai R, Mukae H et al. Differing effects of clarithromycin and azithromycin on cytokine production by murine dendritic cells // Clin. Exp. Immunol. - 2007. - V. 147, No. 3. - P. 540-546.

11. Swainston Harrison T., Keam S.J. Azithromycin extended release: a review of its use in the treatment of acute bacterial sinusitis and community-acquired pneumonia in the US // Drugs. - 2007. - V. 67, No. 5. - P. 773-792.

12. Tamm M., Todisco T, Feldman C. et al. Clinical and bacteriological outcomes in hospitalized patients with community-acquired pneumonia treated with azithromycin plus ceftriaxone, or ceftriaxone plus clarithromycin or erythromycin: a prospective, randomized, multicenter study // Clin. Microbiol. Infect. - 2007. - V. 13, No. 2. - P. 162-171.

13. Zhang X.R., Duo L.K., Xu P.R. et al. Protection of azithromycin against pulmonary II epithelial cell injuries induced by cigarette smoke extract and relevant mechanisms // Zhongguo Dang Dai Er Ke Za Zhi. - 2007. - V. 9, No. 1. - P. 63-66.

In clinical practice, the use of antimicrobial agents can be empirical (drugs are selected taking into account the spectrum of action for the alleged pathogen) or etiological, based on the results of bacteriological culture for the sensitivity of flora to antibacterial drugs.

Many infectious diseases, such as pneumonia or pyelonephritis, require a combination of antibiotics.

For the competent drawing up of such treatment regimens, it is necessary to clearly understand the types of pharmacological interactions of drugs and know which drugs can be used together, and which are categorically contraindicated.

Also, when compiling complex therapy take into account not only the underlying disease and its causative agent, but also:

the patient's age, pregnancy and lactation period;
clinical contraindications and history of allergic reactions;
kidney and liver function;
chronic diseases and basic medications taken by the patient (antihypertensive therapy, correction diabetes mellitus, anticonvulsants, etc.), prescribed antibiotics (hereinafter referred to as ABP abbreviation) should be well combined with planned therapy.

The result of the pharmacodynamic interaction of drugs can be:

synergism (enhancement of the pharmacological effect);
antagonism (reduction or complete elimination of the drug effect on the body);
reducing the risk of side effects;
increased toxicity;
lack of interaction.

As a rule, pure bactericidal (destroying the pathogen) and bacteriostatic agents (inhibiting the growth and reproduction of pathogenic flora representatives) do not combine with each other. This is primarily due to their mechanism of action. Bactericidal drugs act as efficiently as possible on organisms in the stage of growth and reproduction, therefore, the use of bacteriostatics can cause the development of drug resistance.

It is important to understand that such a division according to the type of action on bacteria is not absolute, and different antibiotics can produce different effects depending on the dose prescribed.

For example, an increase in the daily dose or duration of the use of a bacteriostatic agent leads to its bactericidal effect.

Also, selective action on certain pathogens is possible. As bactericidal antibiotics, penicillins have a bacteriostatic effect against enterococci.

Antibiotic compatibility table by type of action

Bactericidal	Bacteriostatic

The combination of antibiotics with each other, taking into account the dosage and type of action on the flora, allows you to expand the spectrum of action and increase the effectiveness of the therapy. For example, in order to prevent antibacterial resistance in Pseudomonas aeruginosa, it is possible to combine antipseudomonal cephalosporins and carbapenems, or aminoglycosides with fluoroquinolones.

Rational combinations of antibiotics for the treatment of enterococci: the addition of aminoglycosides to penicillins or the use of trimethoprim, in combination with sulfamethoxazole.
The combined drug of the second generation has an extended spectrum of action: combining and Tinidazole ®.
The combination of cephalosporins and metronidazole ® is effective. Tetracyclines are combined with gentamicin to enhance the effect on intracellular pathogens.
Aminoglycosides are combined with rifampicin to enhance the action on serrations (often recurrent upper respiratory tract infections). Also combined with cephalosporins to increase efficacy against enterobacteriaceae.

Antibiotic compatibility with each other: table

Combinations are strictly prohibited
Cephalosporins and Aminoglycosides.	Due to the mutual potentiation of the nephrotoxic effect, it is possible to develop acute renal failure, interstitial nephritis.
Chloramphenicol ® and Sulfonamides.	Pharmacologically incompatible.
, , Aminoglycosides and Furosemide ®.	A sharp increase in the ototoxic effect, up to complete hearing loss.
Fluoroquinolones and nitrofurans.	Antagonists.
Carbapenem ® and other beta-lactams.	Pronounced antagonism.
Cephalosporins and Fluoroquinolones.	Severe leukopenia, pronounced nephrotoxic effect.
It is forbidden to mix and inject in the same solution (syringe):
Penicillins are not mixed with ascorbic acid, B vitamins ®, aminoglycosides.
Cephalosporins (especially ceftriaxone®) are not combined with calcium gluconate.
and hydrocortisone.
Carbenicillin ® with kanamycin ®, gentamycin ®.
Tetracyclines with sulfonamides are not combined with hydrocortisone, calcium salts, soda.
Everything antibacterial drugs, absolutely not compatible with heparin.

Penicillins

Antibiotics of this series are not prescribed simultaneously with allopurinol, in view of the risk of developing an "ampicillin rash".

Additive synergism of antibiotics (summation of the results of action) occurs when administered with macrolides and tetracyclines. Such combinations are highly effective in community-acquired pneumonia. Appointment with aminoglycosides is permissible - separately, since when the drugs are mixed, their inactivation is observed.

When prescribing oral medications, women need to clarify whether they are using oral contraceptives, since penicillins interfere with their action. In order to prevent unwanted pregnancy, it is recommended to use barrier methods of contraception during antibiotic therapy.

Penicillins are not prescribed with sulfonamides in view of a sharp decrease in their bactericidal action.
It is important to remember that their appointment to patients with long-term use of anticoagulants, antiplatelet agents and non-steroidal anti-inflammatory drugs is undesirable in view of the potential for bleeding.

Benzylpenicillin salt is not combined with potassium and potassium-sparing diuretics, in mind high risk hyperkalemia.

Penicillins and fluoroquinolones are compatible

It is possible both a combination of protected or extended-spectrum penicillins for oral administration, with topical administration of fluoroquinolones (drops), and combined systemic use (Levofloxacin® and Augmentin® for pneumonia).

Cephalosporins

Due to the high risk of cross-allergic reactions, the first generation is not prescribed in conjunction with penicillins. It is prescribed with caution in patients with intolerance to beta-lactam antibiotics. history.

The combination with anticoagulants, thrombolytics and antiplatelet agents reduces coagulation, can cause bleeding, usually gastrointestinal as a result of hypoprothrombinemia.
The combined appointment with aminoglycosides and fluoroquinolones leads to a pronounced nephrotoxic effect.

The use of antibes. after taking antacids, it reduces the absorption of the drug.

Carbapenems

Ertapenem ® is categorically incompatible with glucose solution. Also, carbapenems are not prescribed concurrently with other beta-lactam agents due to the pronounced antagonistic interaction.

Aminoglycosides

Due to physical and chemical incompatibility, they are not mixed in the same syringe with beta-lactams and heparin.

The simultaneous use of several aminoglycosides leads to severe nephro- and ototoxicity. Also, these drugs cannot be combined with polymyxin®, amphotericin®, vancomycin®. Not assigned in conjunction with furosemide.

Combined use with muscle relaxants and opioid analgesics can cause neuromuscular blockade and respiratory arrest.

Non-steroidal anti-inflammatory drugs slow the excretion of aminoglycosides due to a slowdown in renal blood flow.

Group of quinolones (fluoroquinolones)

Concomitant use with antacids reduces the degree of absorption and bioavailability of the antibiotic.

They are not prescribed simultaneously with NSAIDs and nitroimidazole derivatives due to the high toxicity for the nervous system and the possible appearance of seizures.

They are antagonists and derivatives of nitrofuran, so this combination is not prescribed.

Ciprofloxacin®, Norfloxacin®, Pefloxacin® are not used in conjunction with sodium bicarbonate, citrates and carbonic anhydrase inhibitors, due to the risk of crystalluria and kidney damage. They also disrupt the metabolism of indirect anticoagulants, and can cause bleeding.
Prescribing to patients receiving glucocorticosteroid therapy significantly increases the likelihood of tendon rupture.

They violate the action of insulin and sugar-reducing tablets, are not prescribed for diabetics.

Macrolides

They are not used in conjunction with antacids, due to a decrease in effectiveness. Prescription with rifampicin ® reduces the concentration of macrolides in the blood. Also not compatible with amphinecol® and lincosamides. Not recommended for use in patients receiving statins.

Sulfonamides

They have a pronounced toxic effect in combination with anticoagulants, antidiabetic and anticonvulsants.

Not prescribed with estrogen-containing contraceptives due to the risk of uterine bleeding.

It is forbidden to combine with drugs that inhibit the function of the bone marrow.

Sulfamethoxazoline / trimethoprim ® (Biseptol ®) and other sulfonamide antibiotics are compatible with polymyxin B ®, gentamicin ® and sisomycin ®, penicillins.

Tetracyclines

They are not prescribed in conjunction with iron preparations. This is due to impaired absorption and assimilation of both drugs.

The combination with vitamin A can cause pseudotumor brain syndrome.
Not combined with indirect anticoagulants and anticonvulsants, tranquilizers.

Interaction of antibiotics with food, alcohol and herbs

The intake of products that increase the secretion of hydrochloric acid in the stomach (juices, tomatoes, tea, coffee) leads to a decrease in the absorption of semisynthetic penicillins and erythromycin ®.

Dairy products with a high calcium content: milk, cheese, cottage cheese, yoghurts, significantly inhibit the absorption of tetracyclines and ciprofloxacin ®.

When using chloramphenicol, metronidazole, cephalosporins, sulfonamides with alcohol, an antabuse-like syndrome (tachycardia, heart pain, flushing of the skin, vomiting, nausea, sharp headache, tinnitus) may develop. This complication is life-threatening and can be fatal.

These drugs should not be combined even with alcoholic herbal tinctures.

The combination of sulfonamides and tetracyclines with St. John's wort can provoke a sharp increase in the sensitivity of the skin to the action of ultraviolet rays (drug photosensitization).

AZITROMYCIN (Zitromax)

. WHAT IS AZITROMYCIN?
... WHY DO PEOPLE WITH HIV TAKE AZITROMYCIN?
... WHAT ABOUT DRUG RESISTANCE?
... HOW TO TAKE AZITROMYCIN?
... WHAT ARE THE SIDE EFFECTS?
... HOW DOES AZITHROMYCIN INTERACT WITH OTHER DRUGS?

WHAT IS AZITROMYCIN?
Azithromycin is an antibiotic drug. In the US, its brand name is Zithromax. It is sold under many other brand names in other countries, including the name Ultreon.

Antibiotics fight infections caused by bacteria. Azithromycin is used to fight opportunistic infections in people with HIV. It is manufactured by Pfizer and McIllert.

WHY DO PEOPLE WITH HIV TAKE AZITROMYCIN?
Azithromycin is used to treat mild to moderate bacterial infections. It works against a variety of bacteria, especially chlamydia, hemophilic bacteria, and streptococcus. These bacteria can infect the skin, nasopharynx, and lungs. In addition, they can be transmitted through sexual activity and cause infections in the genital area.
Many bacteria live in our body and are common in our environment. A healthy immune system can fight and control them. However, HIV infection can weaken the immune system. Infections that develop when immune defenses are compromised are called opportunistic infections. Opportunistic infections can occur in people with advanced HIV infection. For more information on opportunistic infections see Fact Sheet 500.

One of the opportunistic infections in people with HIV is MAC, which stands for the avium mycobacterium complex. For more information on MAC, see Fact Sheet 514. MAC can occur in people with a CD4 cell count of less than 75.
Azithromycin is often used in combination with other antibiotics to treat MAC. It can also be used to prevent MAC infection. If your CD4 cell count is below 75, talk with your healthcare provider about azithromycin prescription.
Azithromycin is also used to treat toxoplasmosis and cryptosporidiosis. Some people are allergic to azithromycin and similar antibiotics. Be sure to tell your doctor if you are allergic to erythromycin or other antibiotics.

WHAT ABOUT DRUG RESISTANCE?
Whenever you are taking medication, be sure to take all of the prescribed doses. Many people stop taking when they start to feel better. This is not very good idea... If the medicine does not kill all bacteria, they may change (mutate) to survive even while you are taking the medicine. When this happens, this drug will stop working. This is called "acquiring resistance" to the drug.

For example, if you take azithromycin to combat MAC and miss too many doses, then the MAC in your body will become resistant to azithromycin. Then you will have to take another medicine or a combination of drugs to fight MAC.

HOW TO TAKE AZITROMYCIN?
Azithromycin can be in capsule and 250 milligram (mg) tablet form. There is also a 600 mg tablet. This medication is also available in powder and liquid form. To fight most infections, the adult dosage is 500 mg on the first day, followed by 250 mg daily for another 4 days.
The dosage for the prevention of MAC infection is 1200 mg or 1250 mg once a week.

Azithromycin tablets can be taken with or without food. Take it with plenty of water. The capsules or liquid form should be taken on an empty stomach, either 1 hour before meals or 2 hours after meals. Please read the instructions carefully.
Do not take azithromycin at the same time as an acid neutralizing agent (antacid) that contains aluminum or magnesium. They will lower the amount of azithromycin in your blood.

WHAT ARE THE SIDE EFFECTS?
Most of the side effects of azithromycin are related to the digestive system. These are diarrhea, nausea and abdominal pain. Some people become very sensitive to sunlight. Some people experience headaches, dizziness or drowsiness, and hearing problems. These side effects occur in a very small number of people who take azithromycin. However, most HIV medications also cause digestive problems. Azithromycin can exacerbate these problems.
Some people have acute allergic reaction for azithromycin. Tell your doctor right away if you have severe diarrhea, fever, severe stomach cramps or pain, swelling in your neck, mouth, arms and legs, or difficulty breathing.
Antibiotics kill the beneficial bacteria that normally live in the digestive system. You can eat yogurt or take acidophilus supplements to help restore these bacteria.

HOW DOES AZITHROMYCIN INTERACT WITH OTHER DRUGS?
Azithromycin is metabolized in the liver. It can interact with other drugs that also travel to the liver. Scientists have not yet explored all possible interactions. Azithromycin likely interacts with some blood thinning medications, heart medications, asthma medications, and other antibiotics. Make sure your doctor is aware of all medications and supplements you are taking.
Your doctor will likely need to monitor you closely if you are taking azithromycin and the protease inhibitor ritonavir.