Top 20 Antibiotics

*Overview of the best according to the editors of Healthy Food Near Me. About selection criteria. This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.

This article is intended for people without a medical background, solely for the purpose of broadening their horizons. It is very good if, after reading this material, the reader will understand how much you need to know in order to correctly prescribe any antibiotic and cure the patient. The purpose of publishing this material, among other things, can be considered the assimilation of the simple fact that in no case should antibiotics be used for self-treatment, without a doctor’s prescription, and without accurate diagnostic measures.

Yes, indeed, recently in the Russian Federation, antibiotics are sold only by prescription, and this is justified. The wide availability of antibiotics, which were previously purchased without any restrictions, and used, including incorrectly, led to a wide “acquaintance” of numerous populations of pathogenic and opportunistic microorganisms with them, with the rapid formation of resistance.

This is all the more relevant because “antimicrobials” is the largest group of all drugs, and the vast majority are antibiotics. In the 30st century, more than XNUMX groups of antimicrobial drugs are known, and the number of original drugs alone, excluding their commercial copies and trade names of various companies, exceeds a couple of hundred items.

The difference between antibiotics and other drugs

A number of special properties of antibiotics can be identified that distinguish them from other drugs. Here are the important points:

1. drugs from the group of antibiotics do not affect human organs and tissues in any way, and their effect extends exclusively to alien cells, and most often these are bacteria. No antiviral antibiotics;

2. a gradual decrease in the activity of drugs, as microorganisms “learn” to fight antibiotics.

Therefore, the pharmaceutical industry and scientific laboratories must constantly look for ways to improve and invent new drugs. Compared to blood pressure medications, anticonvulsants, local anesthetics, or vitamins (i.e., those drugs that affect human cells, organs, and tissues), their effect on the body does not change. The same Capoten will equally help in 20 years. With antibiotics, everything is far from the same: there is an infectious process, like the interaction of two or more organisms with all the ensuing, and sometimes unpredictable consequences.

About microbial resistance

Microbes defend themselves against antibiotics in a variety of ways. Here are the most famous methods of their “tricks” to scientists:

1. microbes modify and change those structures that are affected by antibiotics, and the drug loses the ability to find a target-point of application;

2. microorganisms begin to synthesize enzymes that destroy antibiotics. This is the mechanism of beta-lactamase resistance;

3. microbes have learned to very quickly remove the drug from their cells, this explains the resistance of Pseudomonas aeruginosa to fluoroquinolones and even carbapenems;

microbes modify their cell wall, or other outer structure of the cell, making it more durable and inaccessible to antibiotics. That is why Pseudomonas aeruginosa tolerates high dosages of aminoglycosides, and ordinary fungi, or Candida albicans, may be insensitive to the effects of triazoles.

How do antibiotics work?

There are two ways to harm the vital activity of microbes: by exerting a bactericidal and bacteriostatic effect. Bactericidal antibiotics literally destroy microbial cells and cause their death. The second principle of action of antibiotics is bacteriostatic: the drug stops the reproduction of a harmful microbe.

It would seem that bactericidal antibiotics are much more useful, and the bacteriostatic effect is not needed at all. What is the use of the fact that microbes, not multiplying, will remain in the body of the patient? The benefits of this are enormous, and the use of bacteriostatic antibiotics can literally save a patient’s life. For example, with meningococcal infection in its generalized form, that is, with meningococcemia, when there are a huge number of pathogens in the blood, only Levomycetin or similar bacteriostatic drugs should be used to stop the reproduction of microbes.

If you immediately apply bactericidal antibiotics that will kill all the microbes in the blood, then there will be a massive decay of them, and the release of antigens, and all the toxins that were contained in the microbes, directly into the bloodstream. The body may not withstand this, an infectious-toxic shock will develop, with a high variant of death. Therefore, bacteriostatic antibiotics in some cases are the only chance to survive. On the other hand, if patients have a severe decrease in immunity, then they require the appointment of bactericidal antibiotics, especially in the chronic course of the disease.

Also in the last century, such obsolete concepts as “broad” or “narrow spectrum” antibiotics were used. But now microbes are so familiar with antibiotics that these concepts have become irrelevant, and on this basis it is hardly possible to prescribe empirical treatment when the causative agent is still unknown. Why is it so? The fact is that microbial associations (when several types of microbes participate in an attack on the human body at once) are still not so common. This requires low immunity, and certain conditions. In most cases, doctors are dealing with one type of pathogen, and there is absolutely no need for an excessive breadth of the spectrum of action. This is literally “shooting sparrows with a cannon” when you can safely destroy your own microflora of the gastrointestinal tract, and this will be a side effect of such breadth and guaranteed effectiveness.

It is necessary to identify the pathogen as early as possible in order to transfer the presumptive, that is, empirical antibiotic therapy, into rational therapy, that is, to prescribe the drug that is guaranteed to cure the person, with the identified pathogen.

Finally, the concept of “broad-spectrum antibiotics” has lost its relevance due to the development of microbial resistance. All this is said here to ensure that the appointment of an antibiotic is carried out by a doctor, and preferably, after identifying the pathogen and determining the sensitivity of the isolated culture to antibiotics. If at first you still have to use antibiotics of the “broad spectrum” blindly, before the results of the tests arrive: PCR or bakposev, then this period should be as short as possible. We turn to the list of effective and popular antibiotics that exist in 2020 in Russia.

Rating of the best antibiotics

We will adhere to the presentation of the material from a chemical point of view, considering the structure of antibiotic molecules. Another approach could be taken: not to consider penicillins, cephalosporins or carbapenems, but to consider antibiotics for the treatment of bronchopulmonary diseases, urological infections, or infections of the skin and soft tissues.

The second approach is much more understandable to the common man, but it is extremely tempting to try to prescribe the drug “to oneself” in the presence of various seemingly similar symptoms, as well as any leftover antibiotics in the medicine cabinet. Therefore, we will not look for easy ways, but consider a list of 20 effective antimicrobials from the group of antibiotics that are popular in 2020.

First comes a description of a group of drugs with common properties, then the international non-proprietary name, or INN, and then the first, or original, first released drug from this group. Most studies on efficacy and safety have been accumulated on the original drug. It then lists the brand names of generics, or commercial copies of the original drug, which are always cheaper and more readily available.

However, when choosing a medicine, even as prescribed by a doctor, you should never purchase the cheapest, domestic counterparts. Savings on health can lead to insufficient efficiency, the formation of resistance of pathogens. In the end, you will have to turn to a more expensive drug, but having already spent money on a cheap one. The list of antibiotics provides a price range for the best representatives of each remedy, which is relevant for June 2020 for pharmacies of all forms of ownership in the Russian Federation.

The description of drugs is not an invitation to purchase and advertising, especially since there are no more antibiotics in the free sale in the Russian Federation. The information is for informational purposes only, and all these medicines are references in national and international recommendations and treatment protocols for various infectious diseases.

Penicillin group: Benzylpenicillin-sodium

Rating: 4.9

The most famous, first created antimicrobials are a group of penicillins. The first representatives are natural compounds that are produced either by mold or other microorganisms to protect themselves from each other. And the very first antibiotic obtained by man is benzylpenicillin. At one time, he made a splash, and, perhaps, not even a single most modern and powerful antibiotic can be compared with him in terms of the effectiveness of the action that he showed in the forties.

Simple penicillin, developed by Fleming and penicillin-crustosin, developed under the leadership of Yermolyeva in the USSR, caught all microbes “by surprise”. Now there are a lot of penicillins, but the simplest benzylpenicillin still has not lost its capabilities. More than 60 years have passed since its inception, but it is still relevant.

You can buy one bottle of benzylpenicillin in the form of a powder for injections extremely cheaply: for 6 rubles 50 kopecks. Such a bottle will contain 1 million units, and it is produced by the domestic company Biosintez. There are no tablets with benzylpenicillin, because it is destroyed in the gastrointestinal tract. The medicine perfectly helps with diseases caused by group A beta-hemolytic streptococcus.

These are scarlet fever, acute rheumatic fever, tonsillopharyngitis and erysipelas. It is used in the treatment of meningitis, bacterial endocarditis, but in combination with other antibiotics. Pathogens of borreliosis, leptospirosis, syphilis and even anthrax are sensitive to it. Benzylpenicillin still treats gas gangrene and tetanus, as well as actinomycosis. For adults, it is prescribed for severe infections up to 12 million units per day, intramuscularly or intravenously every 6 hours. With tonsillopharyngitis, 500 thousand units every 12 hours for 10 days are quite enough.

Advantages and disadvantages

The advantage is a powerful bactericidal effect, low cost and low toxicity. The disadvantage can be considered resistance to it of staphylococci, gonococci and pneumococci, as well as a rather high development of allergic side effects. This is a rash, Quincke’s edema, eosinophilia.

Piperacillin/Tazobactam (Tazocin)

Rating: 4.8

Tazocin is a highly active and modern representative of combined penicillins, consisting of two antibiotics: piperacillin and tazobactam. Their ratio is 4 g and 500 mg in powder form to create an intravenous solution. 12 such bottles in a package will be very expensive: their average cost is 8500 rubles. Tazocin is produced in Italy.

Components: piperacillin is a highly effective medicine for Pseudomonas aeruginosa, and tazobactam is an antibiotic that is well protected against beta-lactamase. The drug is very active against staphylococci, other cocci, against enterobacteria, Klebsiella.

Tazocin should be administered only intravenously, so it is used exclusively in a hospital, in seriously ill patients. It is indicated for severe infections of the skin and soft tissues, including diabetic foot, sepsis, severe infections of the abdominal cavity and small pelvis, as well as nosocomial pneumonia.

Adults and children over 12 years of age are prescribed, on average, 3 g of Tazocin every 8 hours intravenously by drip for 30 minutes. Accordingly, one bottle is required three times a day, and in adults 1 package worth 8500 rubles. ends in 4 days.

Advantages and disadvantages

The advantage is high activity, Tazocin can be considered a standard, but at the same time, the drug exhibits undesirable neurotoxic reactions, with the possible development of seizures and tremors, reduces the concentration of sodium and potassium in the blood, which is dangerous in patients with cardiovascular insufficiency, and disrupts platelet aggregation. But if a competent doctor takes into account the possibility of these side effects, then there is practically no alternative to Tazobactam.

Second Generation Oral Cephalosporins: Cefuroxime (Zinnat, Axosef)

Rating: 4.8

Leaving the group of penicillins, we turn to cephalosporins. There are 4 generations of them, and we will consider the most modern of them, namely the third and fourth generations. All cephalosporins act bactericidal, but do not act on enterococci and listeria. However, they can be destroyed by microbial beta-lactamases.

Zinnat can be considered one of the most effective medicines. It is taken orally and comes in the form of granules for suspension. The cost of a 50 ml bottle is, on average, 250-300 rubles, produced by the well-known company Glaxo Wellcom. This derivative of cefuroxime is a prodrug. Zinnat works well for infections caused by gram-positive cocci and gram-negative rods. It is best absorbed with food and excreted in the urine.

Zinnat is effective in streptococcal tonsillitis and pharyngitis, in acute sinusitis, sinusitis, acute otitis media. It is prescribed for bacterial infections of the lower respiratory tract, urinary tract, and infections of the skin, joints, and soft tissues. The so-called “step” therapy is very good: intramuscular administration of cefuroxime, and then the use of Zinnat inside. For adults, a dosage of 0,25-0,5 g is calculated after 12 hours with meals, for children there is a special dosage per kilogram of weight, which is prescribed by a doctor.

Advantages and disadvantages

All cephalosporins work well together with aminoglycosides, and their popularity is associated with good tolerability. However, there may be common adverse reactions: these are allergic urticaria, eosinophilia, and allergies, the frequency of which depends on generations: much more side effects develop on first and second generation cephalosporins than on the third and fourth. It is undesirable to take alcohol during treatment with cephalosporins, since a teturam-like effect may develop. Certain advantages of Zinnat are in low cost, and the ability to use drugs inside, because most cephalosporins are designed for intramuscular and intravenous injections.

Ceftriaxone (Rocefin, Lendacin, Forcef, Ceftriabol)

Rating: 4.8

The following drug also belongs to cephalosporins, and is sold in the form of a powder for intramuscular and intravenous injections at an average price of 500 rubles per 1 bottle weighing 1 g of antibiotic. It is produced by the Swiss company Hoffmann La Roche. Among all cephalosporins, Rocephin has the longest half-life, and therefore can be administered once a day. An exception is made only for severe meningitis, when twice a day administration is necessary.

Rocephin is used for severe infections of the upper respiratory tract, in ENT practice, for otitis media and sinusitis, for various forms of community-acquired and hospital-acquired pneumonia, for urinary tract infections. Together with anaerobic preparations, it is prescribed for the treatment of severe infections of the gastrointestinal tract and pelvic organs, and in severe acute intestinal infections, such as bacterial dysentery or salmonellosis. It is active in bacterial endocarditis, sepsis, gonococcal infections, Lyme disease, and severe infections of the skin, soft tissues, and joints. Adults need from one to 2 vials per day for one injection, and for acute gonorrhea, one quarter of the vial is enough, that is, 250 mg intramuscularly just once.

Advantages and disadvantages

With intramuscular injection, the injection is quite painful, so it must be diluted with lidocaine. A rather high cost of treatment will be considered a disadvantage, for example, with severe meningitis, four such bottles per day are needed, that is, 2000 rubles. It cannot be used for infections of the biliary tract, since the medicine falls out in the form of salts, and it is forbidden to take it in newborns. However, among third-generation cephalosporins, Rocephin still has not lost its significance, and is considered the drug of choice for many infectious lesions.

Cefepime (Maxipim, Maksicef, Movizar, Cnpim, Cefomax)

Rating: 4.8

Maximim is a modern 4th generation cephalosporin produced by the British company Bristol-Myers Squibb. One package of 1000 mg of lyophilisate for the preparation of a solution for parenteral administration can be found in pharmacies at a price of 240 rubles. Maximim is highly effective for the treatment of streptococcal, including pneumococcal diseases, treats staphylococcal pathology.

Unfortunately, enterococci are resistant to it. If diseases are caused by gram-negative cocci or rods, then the drug can quickly help. These are acute gonorrhea, bacterial meningitis, various enterobacteria, Klebsiella resistant to third-generation cephalosporins.

As in the previous case, Maximim is prescribed for sepsis, infections of soft tissues, joints and skin, together with metronidazole – for the treatment of pelvic infections and severe purulent lesions of the gastrointestinal tract, with complicated urinary tract infections, and community-acquired pneumonia caused by resistant flora . Adults should be prescribed one or 2 g every 12 hours, and in the case of a life-threatening infection, the dose is 2 g every 8 hours, that is, 6 g per day.

Advantages and disadvantages

This drug is quite resistant, especially to the action of beta-lactamases, the drug is more active than 3rd generation cephalosporins, especially against gram-positive cocci. The drug, even the original one, is quite cheap: the price of one bottle does not exceed 300 rubles, which is significantly inferior in price, for example, to Tazotsin.

Carbapenem: meropenem (Meronem)

Rating: 4.8

This group includes meropenem and imipenem. They can be prescribed if the use of 3rd or 4th generation cephalosporins has failed, and microbes have high resistance even to these cephalosporins. They are usually non-spore-forming anaerobes. Drugs from the group of carbapenems act on many gram-negative microbes, but these drugs are quite expensive. The original Meronem manufactured by Astrazeneca, UK, will cost about one thousand rubles per 1 g bottle, and a package of 10 bottles can be purchased for both 8500 rubles and 18500 rubles, depending on the pharmacy chain. Therefore, a targeted search is urgently needed in order not to lose extra and big money.

Of the two drugs, meropenem is more active than imipenem. It treats diseases caused by gram-negative flora better, but at the same time it is less active in case of infection with staphylococci and streptococci, so it is imperative to find out which microorganism caused the infection. Meronem is prescribed exclusively for severe infections caused by microbial associations and resistant strains. These are various types of abscesses and gangrene of the lung, acute complicated forms of pyelonephritis, nosocomial pneumonia, sepsis, bacterial meningitis, as well as various types of neutropenic fever. Adults are administered Meronem intravenously by drip or jet, but not less than five minutes, and by drip – in 20-30 minutes. The drug is administered every 8 hours, 1 g, and for meningitis, 2 g.

Advantages and disadvantages

This drug is not capable of causing convulsions, therefore it is well prescribed for various types of bacterial, purulent meningitis. A distinctive feature of Meronem should be considered the absence of intramuscular administration: it is administered intravenously, drip or jet. The drug is currently considered a reserve medicine, since it is quite expensive, and there are practically no domestic generics. This medicine is only for severe patients who are in intensive care units, purulent surgery, and the like. The drug is considered highly effective, but it is desirable to use it with a verified flora, after crops, so that the effectiveness is greatest, and the diagnosis is known before the start of treatment.

Monobactam: Aztreonam (Azactam)

Rating: 4.7

The monobactam group is represented by a single drug: aztreonam. This is also an expensive remedy, and you can hardly find it in pharmacies, you need an individual order on the Internet. One vial for injection of aztreonam weighing 1000 mg, manufactured by Sanofi, will cost about 8500 rubles. It is a strong but “narrow” antibiotic: it destroys gram-negative flora, but is useless against staphylococci and bacteroids, which destroy it by secreting beta-lactamase.

Azaktam is prescribed in case of severe gonococcal and meningococcal infections, with salmonellosis, microbial dysentery, proteus and citrobacter infections. It should not be prescribed for gram-positive flora. The drug is indicated for various pneumonias, including against the background of cystic fibrosis, with severe urinary tract infections, and in combination with metronidazole and other antianaerobic drugs, aztreonam is indicated for the treatment of infections of the pelvic organs and the gastrointestinal tract. It is prescribed for sepsis, infections of the skin, bones, joints and soft tissues. It is prescribed to adults intravenously at 1 g every 6-8 hours, and if the patient has a severe Pseudomonas aeruginosa infection, then up to 12 g per day, respectively, each day of treatment will cost about one hundred thousand rubles.

Advantages and disadvantages

If the diagnosis is accurately made, and the disease is caused by gram-negative flora resistant to other drugs, and the patient’s condition is severe, then aztreonam will be extremely effective. However, its absence in pharmacies and the need to order the product on the Internet, as well as its very high cost, can be considered a significant disadvantage.

Aminoglycosides: Amikacin

Rating: 4.7

Let’s go back to inexpensive antibiotics. Aminoglycosides are active against gram-negative flora, act quickly and almost do not cause allergies, but still much more toxic than beta-lactam antibiotics. There are several generations of aminoglycosides, but we will consider only one of the most modern and inexpensive drugs. Amikacin is available in the form of a powder, from which a solution is prepared for intramuscular and intravenous administration. One bottle contains 1000 mg of the product, and you can buy this bottle for no more than 80 rubles, produced by the domestic company Sintez.

Amikacin acts on gram-negative flora: rods, and cocci. However, it also acts on gram-positive microbes that have a cell wall. These are staphylococci, which can be highly sensitive to Amikacin. They treat meningococcal and gonococcal infections, in some cases it is prescribed for tuberculosis. Anaerobic flora is insensitive to Amikacin. It is widely prescribed for the treatment of nosocomial gram-negative pneumonia, urinary tract infections, sepsis, and tuberculosis, for which it is a second-line drug. For both adults and children, Amikacin is prescribed at a dosage of 15-20 mg per kilogram of body weight for one or two injections.

Advantages and disadvantages

Amikacin can be considered the most modern of the aminoglycosides, but still resistance often develops to it, even in gram-negative flora. A certain plus can be considered the ubiquity of Amikacin in a variety of pharmacies, and its low cost.

4th generation fluoroquinolones: Moxifloxacin (Avelox, Moxiflox, Vigamox, Moflaxia, Rotomox, Floxepol, Hynemox)

Rating: 4.7

Turning to fluoroquinolones, it should be clarified that some do not consider these drugs to be antibiotics. But since it is extremely difficult to draw a reasonable line between antibiotics and antimicrobials, fluoroquinolones should be included in the list, and specifically, the most effective drugs of the latest generation. This can be considered the German drug Avelox, aka moxifloxacin. Only 5 tablets in a package of 400 mg each will cost an average of 600 rubles, and a minimum of 520 rubles. Accordingly, each tablet will pull about 100 rubles.

What can cure Avelox? He has a “zest”: he works well against those anaerobes that do not form spores. And this means that he independently remarkably treats infections of the gastrointestinal tract, pelvic organs, even without the use of other drugs. The drug works remarkably well against pneumococci, including resistant strains. This antibiotic is indicated for infections of the upper and lower respiratory tract, for acute sinusitis, exacerbation of chronic bronchitis and community-acquired pneumonia, for infections of the skin and soft tissues. Avelox should be taken once a day, regardless of the meal, and the duration of the course is determined by the doctor.

Advantages and disadvantages

Avelox Kuchin is convenient to take, And even at a price of 100 rubles. for a pill, this can not be considered too high a price, because this is the price of a daily intake. The medicine really helps to cope alone with many infections, and at the same time we are talking about taking pills, and not at all about intravenous infusions. But, all fluoroquinolones have a negative effect on cartilage, and they should not be prescribed to children. Quite rarely, adults can develop inflammation of the tendons, and with intense physical activity, they can be torn, for example, an Achilles tendon rupture. The antibiotic can cause sun exposure photodermatitis, and lengthen a certain cardiac interval on the ECG, which will lead to the development of ventricular arrhythmias.

Tetracyclines: Doxycycline (Unidox Solutab, Vibramycin)

Rating: 4.6

Tetracyclines are a long-known group, and one of the most modern, but long-used representatives can be considered Doxycycline in the face of Unidox Solutab. 20 dispersible tablets of 100 mg of doxycycline can be purchased at a price of 570 to 650 rubles, manufactured by Astellas Pharma. Half the size of the package, in 10 tablets, can be purchased at prices ranging from 290 to 330 rubles. also made in the Netherlands.

It is active against gram-positive rods and cocci, gram-negative cocci and rods, anaerobes, mycoplasmas, actinomycetes and chlamydia, spirochetes and even some protozoa. The drug is very widely used for dental infections, sinusitis, bronchitis with yersiniosis, for Helicobacter pylori infection eradication schemes. As a reserve antibiotic, it is indicated for syphilis, pelvic infections, and especially dangerous infections, such as plague, together with the old streptomycin, and cholera. It is indispensable for leptospirosis, brucellosis and anthrax. The drug should be administered orally at 200 mg every 12 hours, and for children – 5 mg per kilogram of body weight per day.

Advantages and disadvantages

Doxycycline is a pronounced bacteriostatic that inhibits the reproduction of microorganisms, but at the same time, unwanted reactions often develop. The drug inhibits protein metabolism, in high doses the antibiotic increases plasma nitrogen, leads to the development of inflammation of the esophagus and disrupts the normal microflora of the intestine and vagina. In large doses, it can be hepatotoxic, up to necrosis of the liver tissue, especially with rapid intravenous administration, and also cause an increase in intracranial pressure. If expired doxycycline is used, then the development of a nephrotoxic effect is very likely.

Macrolides: midecamycin (Macropen)

Rating: 4.6

The next group of antibiotics are macrolides, among which the tablet preparation Macropen, or midecamycin, should be especially noted. It is produced by Krka from Slovenia, and 16 tablets of 400 mg each will cost an average of 300 rubles. It is predominantly bacteriostatic. However, its activity is most powerful against gram-positive cocci, and most importantly – intracellular pathogens. This allows you to treat chlamydia, legionella infection and mycoplasmas. Also, the drug accumulates in tissues, which leads to its concentration 100 times higher than in blood plasma. The drug has a low toxicity, which allows it to be widely used in practice.

Macropen is indicated for infections of the upper respiratory tract in conditions of allergy to penicillin antibiotics, as well as for exacerbation of chronic bronchitis and various forms of community-acquired pneumonia, for infections of soft tissues and skin. Adults need to take it 1 tablet 3 times a day, that is, after eight hours one hour before meals, and children – at special dosages.

Advantages and disadvantages

The drug has much more advantages than disadvantages. There is a tablet form, convenient intake, low toxicity, bacteriostatic effect that improves its safety profile, as well as the fight against chlamydia and mycoplasma infection, where interstitial concentration is important to achieve a rapid effect. The disadvantages include the existence of cross-allergy with beta-lactam antibiotics, therefore, with each joint appointment of Macropen with drugs in this group, caution is necessary.

Lincosamines: clindamycin (Dalacin C, Klimycin)

Rating: 4.5

The next group is represented by clindamycin. Good Clindamycin can be purchased as an INN-generic of Serbian production, Hemofarm. 16 capsules of 150 mg will cost within 160 rubles. The drug is used to treat staphylococcal and streptococcal infections, primarily pneumococci. However, if a patient has a pneumococcus that is resistant to penicillin, then there is a high probability that clindamycin will also fail to cure the patient. Clindamycin is a semi-synthetic derivative of the older antibiotic lincomycin. Clindamycin is much more active, and in high doses even acts on Toxoplasma.

The drug is prescribed for streptococcal tonsillitis and various infections of the lower respiratory tract, intra-abdominal infectious processes and pathology of the pelvic organs. Clindamycin is also used in sepsis, but if mixed flora is suspected, concomitant administration with other antibiotics is necessary. Clindamycin is indicated for necrotizing fasciitis, a tropical malaria that is not treated with chloroquine. It is applied topically as a cream and gel for bacterial vaginosis and severe acne. Clindamycin adults should be given 300 or 450 mg every 6 hours. It is possible to use intravaginally in the form of a cream, as well as parenterally, for example, intravenously or intramuscularly.

Advantages and disadvantages

Clindamycin is a classic bacteriostatic but should not be used in empirical therapy when the causative agent is unknown. It helps only if the disease is caused by gram-positive cocci, or non-spore-forming anaerobic microorganisms. The great advantage of clindamycin is the selective high accumulation in bone tissue and joints, but poor penetration through the blood-brain barrier, which limits the treatment of encephalitis and meningitis. The medicine can cause a relatively common side effect such as diarrhea.

Glycopeptides: Vancomycin (Vanmixan, Edicin, Vancocin, Vancorus)

Rating: 4.5

Another powerful, but relatively infrequently prescribed antibiotic is vancomycin at a dose of 1 g in a vial. It is produced by the domestic enterprise Kraspharma, with an average price of 200 rubles. for one vial. Vancomycin, like teicoplanin (the second antibiotic of this group), are considered classic bacteriostatics with a narrow focus. The main reason why it is used is for the treatment of enterococcal infections, as well as in the presence of methicillin-resistant strains of various microorganisms. Most often, these are various staphylococci, streptococci aerobes and clostridia.

The antibiotic must be administered intravenously, since intramuscular administration causes tissue necrosis and very severe pain. The drug penetrates well through the blood-brain barrier only in meningitis, when the meninges lose their protective function. In case of other diseases of the central nervous system, with intact membranes, the drug is not used. It is necessary to prescribe the medicine strictly intravenously, one vial of 1000 mg every 12 hours, diluted in 5% glucose solution or saline. It is necessary to drip for at least 1 hour, that is, only a slow introduction is required.

Advantages and disadvantages

The drug is indicated for severe systemic infections, for example, with pneumococcal pneumonia resistant to penicillin. Also, the antibiotic is used as a means of pre- and postoperative prophylaxis, if the hospital flora resistant to methicillin “lives” in this hospital.

A relative disadvantage is the requirement for slow intravenous administration and the categorical rejection of intramuscular injections, as well as the development of side effects. This is phlebitis, or inflammation of the venous wall at the site of infusion, tinnitus, especially in the elderly, as well as nephrotoxicity, which is much more pronounced if the drug is combined with aminoglycosides, a decrease in neutrophils in the blood plasma. If the drug is administered intravenously too quickly, then patients experience nausea, blood pressure drops, the neck and skin turn red with the development of unpleasant symptoms associated with a sharp release of histamine from mast cells.

14. Linezolid: Zyvox (Rowlin, Selezolid)

Rating: 4.5

Linezolid, or Zyvox, is a representative of a completely new group of antibiotics. This is a synthetic drug, a classic bacteriostatic with a narrow spectrum of activity. The main application is high efficiency on gram-positive cocci, which no other antibiotic “takes”, including methicillin-resistant strains, penicillin-resistant pneumococci, and vancomycin-resistant enterococci.

It is important that there is both an intravenous form and a tablet form that allows stepwise therapy, but the price of this drug is quite biting. A package of 10 tablets of 600 mg of Zyvox will cost, on average, 10000 rubles, 1000 rubles each. for a pill. A solution for infusion, packaged in 100 ml packages containing 0,2 g, in the amount of 10 pieces, will cost 7000 rubles. Produces Zyvox in tablets Norwegian company Fresenius Kabi. Tablets are licensed by the Russian Federation. The main indications for administration can be considered resistant staphylococcal and pneumococcal infections, infections of the skin and soft tissues, as well as resistant enterococcal processes. Adults should prescribe the drug orally or intravenously at 0,6 g every 12 hours.

Advantages and disadvantages

The disadvantage can be considered a very high price, as well as the complete resistance to it of any kind of gram-negative flora, so the drug should be prescribed only after the isolation of a pure culture, and confirmation by PCR. The drug is generally very well tolerated, side effects revealed a slight headache, a moderate effect on the blood in the form of mild anemia, increased liver transaminases, taste disturbance and dyspepsia. An obvious plus is the availability of both parenteral form and tablets for stepwise treatment.

Chloramphenicol: (Levomycetin)

Rating: 4.5

Now we will consider the antibiotics of individual groups that contain one representative each. And again we will return to cheap and widespread means, to chloramphenicol. This antibiotic is a direct antipode to the previous one: 20 tablets of 500 mg each will not cost more than 100 rubles, Dalchimpharm produces it. Levomycetin acts both as a bactericidal antibiotic and as a bacteriostatic. It kills pneumococci, meningococci and Haemophilus influenzae, and other flora does not multiply against its background.

The drug is used in the absence of more modern antibiotics, on a limited scale, since many pathogens have become resistant to levomycetin, and also due to the possibility of developing severe side effects. You can prescribe a medicine for streptococcal and staphylococcal infections, uncomplicated gonorrhea, diseases caused by Escherichia coli, salmonellosis, bacterial dysentery, brucellosis, yersiniosis are treated quite well. However, cultures should be done again, as more than 90% of Shigella can be resistant to chloramphenicol.

Indications include brain abscess, bacterial meningitis, generalized salmonellosis, gas gangrene, and typhoid fever. However, in any case, it is desirable to use Levomycetin as a reserve antibiotic. The dosage of chloramphenicol both orally and intramuscularly is, on average, 60 mg per kilogram of body weight per day, divided into 4 doses.

Advantages and disadvantages

The advantages of levomycetin are its cheapness, and the disadvantages are the development of resistance, a harmful effect on the blood, for example, with the development of anemia. If aplastic anemia occurs, the outcome is almost always guaranteed death. But this complication is quite rare: one case in 30-40 thousand patients. But the insidiousness of this complication is that it can develop even 2 months after the abolition of chloramphenicol, and even after a single dose of it, and even local application: No. anointed and died. The drug can affect the optic nerve, it is hepatotoxic, therefore, when prescribing it, it is advisable to conduct a blood test every three days, and be sure to pay attention to the number of platelets and reticulocytes.

Fusidic Acid (Fusidine)

Rating: 4.5

Fusidin is a special antibiotic that is produced by a special fungus. It is used topically, in the form of a cream and ointment, as well as in the form of eye drops, the same Fucitalmic. For example, a cream can be purchased for 500 rubles. Danish production, in the amount of 15 g 2% concentration. Fusidin is a bacteriostatic antibiotic that acts mainly on staphylococci, and even penicillin- and methicillin-resistant strains cease to multiply. But it does not act on streptococci, and resistance to this drug quickly develops. Adults need to give it 500 mg, or 1 g 3 times a day after 8 hours, one hour before meals. Intravenous drip drip slowly, 500 mg every 8 hours.

Advantages and disadvantages

It is very good to prescribe this medicine in short courses for staphylococcal infections, when there is either an allergy to beta-lactam antibiotics, or resistance has already developed. In this case, Fuzidin can be combined with rifampicin, erythromycin. Fusidin is an excellent treatment for pseudomembranous colitis, but it is best kept as a reserve drug. Of the minuses, a harmful effect on the liver can be noted, up to the development of jaundice, especially with prolonged use. Frequent use of droppers can cause phlebitis.

Rifampicin (Rimactan)

Rating: 4.4

Speaking of various antibiotics, one cannot do without rifampicin. This is a dark orange powder for solutions, for injection. 10 ampoules of 150 mg are produced in Belarus, and, on average, costs 400 rubles. for packing. Rifampicin is used to treat tuberculosis, leprosy, and diseases caused by other mycobacteria. The drug affects gram-positive and gram-negative cocci, gonococci and meningococci.

The drug does not affect the anaerobic flora, and tuberculosis is still considered the main purpose when rifampicin is prescribed together with isoniazid. But recently it has been used in HIV-infected patients along with azithromycin and clarithromycin for the treatment of atypical mycobacteriosis. It is prescribed with erythromycin for the treatment of legionellosis, and for the treatment of severe staphylococcal methicillin-resistant infections, together with vancomycin or fluoroquinolones.

Rifampicin should be prescribed to adults at 500 mg per day in two divided doses, with a staphylococcal infection, the dosage is the same, orally or intravenously.

Advantages and disadvantages

Rifampicin is considered a classic drug in the good sense of the word, but can cause dyspepsia, abdominal discomfort, and also stains urine, saliva, and even tears orange and red. But still, the main side effects are a harmful effect on the blood and the liver, up to the development of hepatitis and hemolytic anemia. Patients quite often develop a flu-like syndrome during use, with joint pain, muscle pain and fever.

Mupirocin (Bonderm, Bactroban)

Rating: 4.4

An antibiotic such as mupirocin works great depending on the concentration as a bactericidal drug or a bacteriostatic antibiotic. It is intended for local treatment, as a skin remedy. It is highly active against staphylococci, which may be resistant to other drugs: macrolides, penicillin, or methicillin. Mupirocin does not affect the normal microflora of the skin. So, a package of ointment weighing 15 g produced by the Croatian company Belupo can be bought for 400 rubles. Mupirocin destroys gram-positive cocci and gram-negative rods, but it is desirable to take an analysis, since it does not affect gram-positive rods, anaerobic flora, most known enterobacteria and enterococci. The medicine is applied to the skin 2-3 times a day. There is also a form of nasal ointment, which lubricates the mucous membrane of the vestibule of the nose.

Advantages and disadvantages

The drug, when used correctly according to the indications, is very good, but locally it can cause a rash, burning and itching. This medicine remarkably treats furunculosis, infected eczema and infected abrasions and wounds, trophic ulcers and abrasions. But you can not use skin ointment to lubricate the nasal mucosa. In patients with renal insufficiency, there may be a nephrotoxic effect, since propylene glycol is included in the ointment base.

Spectinomycin (Kirin)

Rating: 4.4

Spectinomycin is another modern antibiotic that is produced in Cyprus, and one bottle of 2 g costs 300 rubles. It must be used against the causative agent of gonorrhea when the patient is allergic to other antibiotics. Kirin can also be used for gonorrhea if the pathogen is resistant to penicillin, including its prolonged forms: bicillin 3 and 5. It is also prescribed for gonorrheal cervicitis and proctitis. With regard to gonococcal pharyngitis, the drug should not be used, since its concentration in saliva is neither bactericidal nor bacteriostatic. It should be administered once intramuscularly, in case of disseminated gonococcal infection – one vial twice a day for 3 days.

Advantages and disadvantages

The advantage of the drug is its narrow “specialization” and very high efficiency, and the disadvantage is its low prevalence in pharmacies. But if there are sufficient indications for its use, and we are dealing with an uncomplicated gonococcal infection, then after a single injection you can really forget about gonorrhea.

Fosfomycin Trometamol (Monural)

Rating: 4.4

Finally, it was decided to consider Monural, or fosfomycin, as the last antibiotic from modern and popular remedies. This is an antibiotic of the middle price class, and granules for preparing a solution for oral administration will cost an average of 800 rubles. for 6 g of the drug, packaged in two sachets of 3 g each. They are produced by the Swiss company Zambon. This medicine is a bactericidal antibiotic that is prescribed for gram-negative flora: it is Escherichia coli, Proteus, in some cases, gram-positive cocci, for example, staphylococci. You can not prescribe this antibiotic in the presence of anaerobic infection, enterococcal and streptococcal flora. Monural is prescribed in case of acute recurrent cystitis, as well as in the isolation of bacteria in pregnant women. It is prescribed for adults with acute cystitis – one sachet per 3 g, and for recurrent cystitis, repeat the sachet in a day.

Advantages and disadvantages

The advantages of the drug are a very high activity on the principle of “accepted and forgotten”: one sachet is enough for treatment. But in the event that the doctor incorrectly identified the pathogen, and they turned out to be, for example, enterococci, then the drug will be ineffective. The accuracy of the diagnosis is very important here. The medicine can rarely cause dizziness and diarrhea. Also, its not very wide distribution in the pharmacy network can serve as a minus.

Conclusion

After reading the article, it became clear to everyone that it is advisable not to use modern antibiotics “anyhow”, before the analysis came: ELISA, PCR or bacteriological test results, preferably with antibiotic susceptibility testing. Yes, you can’t hesitate, and an experienced doctor on the first, second, third day will prescribe an antibiotic empirically, even before a known pathogen. Therefore, the main principle that runs through the entire text is the correct definition of the pathogen, and the earliest possible start of rational antibiotic therapy, taking into account contraindications, as well as the level of immunity and allergies in the patient.

Be sure to take into account violations of the liver and kidneys, as well as comorbidities: diabetes mellitus, endocrine disorders and the age of the patient. Only in this case will it be possible to use antibiotics, or their combinations, as quickly and effectively as possible.

Attention! This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.