Clarithromycin and vilprafen comparison. Vilprafen - cheaper analogues (list with prices), comparison of effectiveness

Stop, stop, stop. All antibiotics effective against mycoplasma are available in tablet form. If there were effective injections, they would definitely be prescribed to patients, but there are no such injections.

Indications for antibiotics

Antibiotics for ureaplasma in men are prescribed if the microorganism has caused:

  • urethritis (inflammatory lesion of the urethra);
  • prostatitis (inflammation of the prostate gland);
  • orchitis (inflammation of the testicles);
  • epididymitis (damage to the epididymis).

In women, ureaplasma can cause:

  • urethritis;
  • vaginitis (inflammatory process in the vagina);
  • cervicitis (inflammatory lesion of the cervix);
  • endometritis (damage to the uterus);
  • adnexitis (inflammatory lesion of the ovaries).

Endometritis and adnexitis develop rarely, as a rule, against the background of immunodeficiency states.

In the future, inflammation of the uterus and ovaries increases the risk of ectopic pregnancy or infertility.

The most effective drugs

The table below shows indicators of sensitivity and resistance of ureaplasmas to certain types of antibiotics according to research data. Detailed tables and links to the source are at the end of the article.

Thus, the best drugs for the treatment of ureaplasmosis are Macropen And Doxycycline.

Josamycin (the only one approved during pregnancy) is taken 500 mg 3 times a day for 10 days;

Standard treatment regimens:

  • Doxycycline(“Unidox Solutab”, “Vibramycin”, “Doxal”) 100 mg, 1 tablet, twice a day for 2 weeks;
  • Erythromycin 400 mg, 2 tablets, four times daily for 7 days;
  • Josamycin(“Vilprafen”, “Vilprafen Solutab”) 500 mg 3 times a day, between meals, 10 days;
  • Azithromycin(“Sumamed”, “Azitral”) - 250 mg once a day for 6 days.
  • Clarithromycin– take 500 mg twice a day;
  • Ofloxacin– take 200 mg twice a day;
  • Spiramycin– take 3,000,000 IU 2-3 times a day.

Doxycycline for ureaplasma

Doxycycline is the drug of choice for the treatment of ureaplasmosis. Due to improved pharmacokinetic properties, doxycycline is better tolerated than tetracycline and is much less likely to cause undesirable effects from use. The main complaints after taking the product are related to disorders of the gastrointestinal tract. In order to prevent the occurrence of abdominal pain or nausea after taking capsules, it is recommended to use the antibiotic during meals.

Doxycycline for ureaplasma is taken 1 capsule (100 milligrams) 2 times a day. The course of treatment ranges from seven to 14 days.

The drug is not prescribed:

  • during pregnancy (tetracycline drugs are included in the group of drugs that are strictly contraindicated for use during this period);
  • during breastfeeding;
  • up to eight years;
  • in the presence of individual intolerance to tetracycline drugs;
  • with severe kidney and liver dysfunction.

Undesirable effects from use may be associated with disruption of the gastrointestinal tract, thrush, intestinal dysbiosis, allergies and photosensitivity.

Azithromycin for ureaplasma - treatment regimen

Among macrolide antibiotics, clarithromycin, azithromycin, josamycin, midecamycin and erythromycin can be used to treat ureaplasmosis.

Clarithromycin for ureaplasma is considered the most effective drug after doxycycline. Josamycin (Vilprafen) is the antibiotic of choice for the treatment of ureaplasmosis in pregnant women.

Azithromycin for ureaplasma is somewhat inferior in effectiveness to clarithromycin, but less often causes gastrointestinal disorders.

Azithromycin can be used in 1 capsule containing 0.25 grams of antibiotic, once a day for six days, or in a single dose of 1 gram.

Sumamed for ureaplasma is often prescribed when a single dose of 1 gram of the drug is necessary. The cost of 1 tablet of Sumamed (pharmaceutical company Pliva Hrvatska d.o.o.) is 620 rubles.

Sumamed. Azithromycin is taken one hour before meals or two hours after. Contraindications to the use of the drug are:

  • individual intolerance to macrolide agents;
  • severe arrhythmias and taking antiarrhythmics;
  • violation of the QT interval;
  • severe kidney and liver dysfunction;
  • age up to 12 years (for capsules 250 milligrams; for young children it is necessary to use a suspension or, from three years old - tablets of 125 milligrams).

Azithromycin is generally well tolerated and rarely causes side effects from treatment.

Vilprafen for ureaplasma

Vilprafen (trade name josamycin) is produced by the Dutch company Astellas. The cost of packaging is 10 tablets. 0.5 grams is 340 rubles.

Vilprafen should be taken 1 tablet (0.5 grams) three times a day. The course of treatment ranges from seven to 14 days.

The medicine is contraindicated in the presence of individual intolerance to macrolide antibiotics and severe liver failure. Josamycin is used with caution in renal failure.

Josamycin is the drug of choice for the treatment of ureaplasma, as well as chlamydial infection in pregnant women. Taking an antibiotic is possible only after consultation with your doctor.

Vilprafen is generally well tolerated by patients and causes virtually no side effects from treatment. The undesirable effect of the antibiotic can be manifested by disruption of the gastrointestinal tract, allergies, dysbacteriosis or thrush.

Clarithromycin for ureaplasma

Clarithromycin preparations for ureaplasmosis should be taken 0.25 grams twice a day. The prolonged form of SR (Klacid SR) is taken once a day at a dose of 0.5 grams. The duration of treatment is determined by the attending physician and ranges from 7 to 14 days.

Clarithromycin preparations are not used in the first trimester, for porphyria, severe renal and hepatic dysfunction, and individual intolerance. Tablets are contraindicated up to 12 years of age (a suspension is used from six months).

Macropen

The drug must be taken before meals. Three times a day, one tablet. Macropen therapy usually lasts from 7 to 10 days.

This drug belongs to the group of macrolides. The main active ingredient is midecamycin. The drug Macropen is quickly absorbed into the gastrointestinal tract. It begins to act after 1–2 hours. Macropen is excreted mainly by the liver.

The drug Macropen has side effects, these include:

  • decreased appetite;
  • nausea and vomiting;
  • allergic reactions on the skin.

And the contraindications are:

  • drug intolerance;
  • liver failure in severe form.

Drug sensitivity tables

Summary table of antibiotic susceptibility of human mycoplasmas (Review of publications Antimicrob. Agents Chemother. 1992-2003* indicates the minimum inhibitory concentration MIC (µg/ml)

< 1 означает высокая чувствительность, эффективный препарат.

1-10 average sensitivity.

32 and above – low sensitivity, the drug is ineffective.

Antibiotic Ureaplasma.sp doxycycline (+) Ureaplasma.spdoxycycline (-)
Gentamicin < 1 < 1
Clindamycin >64 >64
Lincomycin >64 >64
Erythromycin 0.12-1 0.12-1
Rulid 0.06-0.5 0.06-0.5
Clarithromycin 0.015-0.03 0.015-0.06
Azithromycin 0.06-0.25 0.12-0.5
Josamycin 0.03-0.12 0.03-0.12
Rovamycin 4-32 8-32
Maxaquin 0.5-4 0.5-4
Tavanik 0.5-1 0.5-1
Avelox 0,25 0.25-1.0
Sparfloxacin 0.12-0.25 0.06-0.25
Oflaxacin 1-2 1-2
Doxycycline 0.06-0.5 >64

Another study - Journal of Antimicrobial Chemotherapy 2008 62(1): 122-125Incidence and antimicrobial susceptibilities of genital mycoplasmas in outpatient women with clinical vaginitis in Athens, GreeceNektaria Kechagia, Sotiris Bersimis and Stylianos Chatzipanagiotou

Here, the higher the value, the higher the efficiency.

Vilprafen Solutab is the trade name of the macrolide antibiotic josamycin, which is used primarily for the treatment of bacterial pathologies of the ENT organs. Over time, it was also discovered that this drug has a much broader effect, which led to a significant expansion of indications for use.

Characteristics of Vilprafen

Vilprafen Solutab has a good bacteriostatic effect due to its ability to inhibit the functioning of the 50S ribosomal subunit of microbes. This leads to the inability of further reproduction of pathogenic bacteria, as well as a decrease in their resistance to the body’s immune response.

It acts on staphylococci, streptococci, neisseria, pneumococci, corynebacteria, mycoplasma, chlamydia, treponema and rickettsia.

The pharmacological features of josamycin are special. The drug molecules are well absorbed when taken orally. Vilprafen Solutab is not used for intramuscular or intravenous administration. Antibiotic particles accumulate precisely in inflamed tissues, where their concentration can exceed the amount of the drug in the blood several times. Vilprafen is excreted from the body mainly by the kidneys in an unchanged state, which makes it possible to use it for infections of the genitourinary system.

Vilprafen Solutab is prescribed for the following conditions:


When using Vilprafen, side effects are rarely observed. Sometimes allergic reactions of varying severity occur (however, much less frequently than when prescribing beta-lactam antibiotics).

Cases of transient increases in the concentration of bilirubin and liver enzymes in the peripheral blood, the development of toxic hepatitis, hearing loss, general fatigue and the appearance of edema of the lower extremities have been described.

The drug has a fairly small list of contraindications, which includes individual intolerance to the components of the drug, impaired renal function, pregnancy and lactation in women.

Also, neonatologists do not recommend prescribing Vilprafen during the newborn period of a child.

Vilprafen Solutab is prescribed to adults 500-1000 mg 2-3 times a day, depending on the severity of the pathology. For children, the antibiotic dosage must be individually calculated based on their age and body weight. Their usual daily dose is 50 mg/kg. The duration of treatment is from 5 to 14 days.

Vilprafen's analogs

Azithromycin, like Vilprafen analogue, is an antibacterial agent from the group of macrolide antibiotics. The drug is a representative of the azalide subclass, which introduces several features into the pharmacological characteristics of the antibiotic.

The drug has a bacteriostatic effect, like josamycin. The mechanism of action of these medications is also identical. However, the spectrum of sensitivity to azithromycin is somewhat narrower. This antibiotic has a more pronounced ability to accumulate in inflamed tissues of the body, in which its therapeutic concentration remains for up to 72 hours. This allows you to reduce the frequency of administration and course of antibiotic treatment.

As with other analogues of Vilprafen, the indications for prescribing azithromycin are almost identical. Azithromycin, as one of the safest and most effective antibiotics, is today included in treatment protocols for all antibacterial pathologies of the respiratory system and ENT organs.

It is given preference in cases of ineffectiveness of penicillins, or the presence of hypersensitivity to beta-lactam drugs (in addition to penicillins, this also includes cephalosporins, monobactams, carbapenems).

Azithromycin is also included in combination therapy for peptic ulcers to eradicate Helicobacter pylori infection.

Azithromycin should not be prescribed for the following conditions:

  • individual intolerance to the drug;
  • liver failure;
  • the presence of a congenital tendency to cardiac tachyarrhythmias.

During pregnancy, azithromycin is prescribed in cases where it cannot be replaced with a drug with a safer profile. In case of renal failure, it is necessary to carefully select the dosage of the drug based on glomerular filtration rates. It is advisable to monitor the concentration of the antibiotic in the blood plasma.

Azithromycin is prescribed to adults 500 mg once a day. Most pathologies require a 3-day course of therapy, but it can be continued if necessary. For children, a special form of antibiotic has been developed in the form of syrup, which also simplifies the dosage of the drug.

If we are talking about analogues of Vilprafen, then it is necessary to talk about Klacida. This drug also belongs to the group of macrolide antibiotics. Its active ingredient is clarithromycin. Like other representatives of this class of medications, Klacid has a bacteriostatic effect. But unlike josamycin, this drug does not have an effective effect on pathogens of urogenital infections.

However, Klacid inhibits almost the entire spectrum of mycoplasma and Helicobacter infections.

In the body, clarithromycin accumulates in affected tissues, but is eliminated much faster than azithromycin. At the same time, the drug shows the greatest effectiveness at neutral acidity. Therefore, to treat Helicobacter pylori infection, it must be combined with drugs that would reduce the production of gastric juice (proton pump inhibitors are most suitable).

In modern recommendations, clarithromycin is of greatest importance as a treatment for mycobacterial, legionella and Helicobacter pathologies. It is also used for bacterial infectious processes of the respiratory system and ENT organs.

Klacid is contraindicated for use if the patient has the following conditions:

  • allergies to macrolide drugs;
  • ventricular tachyarrhythmias or a high risk of their development;
  • hypokalemia;
  • liver failure;
  • simultaneous use of ticagrelor after myocardial infarction;
  • use of colchicine.

The most common side effects that occur when taking Klacid are:

  • transient increase in the concentration of bilirubin and liver enzymes in the blood plasma;
  • allergic reactions of varying severity;
  • the addition of a secondary bacterial, viral or fungal infection;
  • development of cardiac tachyarrhythmia;
  • inhibition of hematopoiesis (with clinical symptoms of anemia, internal or external hemorrhages, secondary infections);
  • toxic effect on the central nervous system (headache, dizziness, parasthesia);
  • functional disorders of the digestive system (nausea, vomiting, feeling of heaviness in the abdomen, decreased appetite, diarrhea).

It is not recommended to use the drug during lactation and pregnancy.

The course of treatment depends on the etiology of the bacterial process. For Helicobacter pylori infection, the course of treatment lasts at least 14 days, for most diseases of the respiratory system - 3-7, and for mycobacterial infection - from 10 days.

Amoxicillin is an antibacterial agent belonging to the group of synthetic penicillins. Unlike penicillin, this drug has a pronounced bactericidal effect. Its molecules are capable of disrupting the integrity of the cell membranes of pathogenic pathogens, which leads to their death and lysis.

The drug has an active effect on staphylococci, streptococci, pneumococci, corynebacteria, Haemophilus influenzae, clostridia, listeria, salmonella, shigella, Escherichia coli, Proteus, Klebsiella, Moraxella. This allows the antibiotic to be used for a wide range of bacterial infections of the respiratory and digestive systems.

When taken orally, the drug is partially absorbed. The therapeutic concentration of amoxicillin is maintained for 3-4 hours after administration. This determines the frequency of antibiotic use 3 times per day.

Amoxicillin is used for bacterial pathologies of the respiratory system (tracheitis, bronchitis, community-acquired pneumonia), ENT organs (otitis, sinusitis, pharyngitis, tonsillitis), intestinal infections (salmonellosis, shigellosis), cholecystitis, urethritis, cystitis and for the prevention of complications after surgical interventions. .

When prescribing amoxicillin, allergic reactions (rash with severe itching, dyspeptic disorders, Quincke's edema or anaphylactic shock) occur more often than with other analogues. Therefore, before prescribing, it is imperative to check with the patient whether he has previously had hypersensitivity reactions to beta-lactam antibiotics (penicillins, cephalosporins, monobactams and carbapenems).

In addition, the following side effects occur:

  • sleep disturbance;
  • headache and dizziness;
  • dyspeptic disorders;
  • toxic hepatitis and jaundice of the skin;
  • inhibition of hematopoiesis.

Despite the presence of these side effects, amoxicillin is considered a safer antibacterial drug than macrolides.

It is allowed to be used as a substitute for Vilprafen during pregnancy. However, it also has its drawback - many strains of bacteria have developed resistance to its action. What is best in each specific situation should be decided by a qualified doctor.

Amoxicillin is prescribed in the form of tablets for adults and syrup for children under 6 years of age.

Vilprafen is an antibacterial drug from the macrolide group. It has a bacteriostatic effect due to inhibition of protein synthesis by bacteria. The drug is highly active against a large number of intracellular microorganisms and gram-positive aerobic bacteria. The antibiotic has no analogues that are cheaper in terms of the active substance, but with the permission of a doctor it can be replaced with drugs that are similar in indications and pharmacological effects.

In addition to the antibiotic Vilprafen, there is the drug Vilprafen Solutab; in terms of active substance, pharmacological action and indications, they are absolutely identical, the only difference is in the release form and dosage.

Vilprafen

The active ingredient of the drug is josamycin, release form: tablets, suspension, dispersible tablets (dissolving in the oral cavity).

The antibiotic, according to the instructions, is allowed during pregnancy and lactation strictly as prescribed.

Side effects: rarely - nausea, lack of appetite, vomiting, heartburn, dysbacteriosis, diarrhea; in some cases - increased activity of liver transaminases, jaundice and impaired bile outflow, urticaria, hearing impairment, candidiasis.

Contraindications: severe liver dysfunction, intolerance to the drug components. Not compatible with alcohol.

Analogues

Doxycycline (Doxal, Doxycycline Hydrochloride, Doxycycline-Acos, Doxycycline-Ferein)

Available in the form of capsules, lyophilisate; active ingredient – ​​doxycycline hydrochloride.

A broad-spectrum tetracycline antibiotic is indicated for many infectious and inflammatory diseases.

Capsules for adults and children over 12 years of age (weighing more than 45 kilograms) are prescribed in an average daily dose of 200 milligrams on the first day, then 100 milligrams per day. Depending on the severity of the disease, the maximum daily dose for adults is 300-600 milligrams for 5 days.

Side effects: dizziness, anorexia, blurred vision, constipation, nausea, rash, dermatitis, urticaria, myalgia, liver dysfunction.

Contraindications: lactose intolerance, lactase deficiency, hypersensitivity to the drug, porphyria, severe renal and/or liver failure, age up to 12 years (for capsules), up to 8 years (for lyophilisate).

Clarithromycin (Klacid, Klabax OD, Clarexid, Claricin, Ecositrin, Fromilid UNO, Fromilid)

Available in tablets, capsules; active ingredient – ​​clarithromycin.

A broad-spectrum antibiotic used in the treatment of infectious and inflammatory diseases: infections of the upper and lower respiratory tract, ENT organs, skin and soft tissues, odontogenic and mycobacterial infections.

Adults and children over 12 years of age are prescribed a single dose of 0.25-1 grams, divided into 2 doses; children under 12 years old – 7.5-15 milligrams/kilogram/day in 2 divided doses. Maximum daily doses: for children – 1 gram, adults – 2 grams.

Side effects: diarrhea, nausea, vomiting, abdominal pain, dyspepsia, gastritis, stomatitis, skin rash, urticaria, dermatitis, insomnia, headache, drowsiness, hypersensitivity, intense sweating, deafness, anorexia, asthma.

Contraindications: severe renal failure, 1st trimester of pregnancy, lactation period, history of jaundice, simultaneous use of the drug with cisapride, astemizole, pimozide, hypersensitivity to the active substance of the drug and other macrolides.

Metronidazole (Metronidazole Nycomed, Trichopolum, Flagyl, Klion)

Available in the form of tablets, suppositories, solution, gel; active ingredient – ​​metronidazole.

The drug is used for the treatment of infectious diseases of the intestinal (including amoebic liver abscess, dysentery) and genital area (chlamydia, bacterial vaginosis) in adults, children, also during pregnancy and lactation.

The doctor prescribes the dosage regimen individually depending on the disease and the severity of its course, as well as the age of the patient. The tablets should be taken orally during or after meals, without chewing and with water or milk. The average duration of use is 10 days. In case of severe disease, the dose may be increased, and women are also additionally prescribed Metronidazole in the form of suppositories (for example, for trichomoniasis).

Side effects: nausea, diarrhea, anorexia, constipation, dry mouth, dizziness, weakness, headache, depression, irritability, cystitis, candidiasis, urticaria, skin hyperemia, nasal congestion.

Contraindications: leukopenia, hypersensitivity, organic damage to the central nervous system, lactation period, pregnancy (1st trimester), liver failure.

Roxithromycin (Roxide, Rowenal, Brilid, Roximizan, Elrox, Rulid, Xitrocin, Roxibel)

Available in the form of tablets, capsules; active ingredient – ​​roxithromycin.

A semi-synthetic macrolide has a bacteriostatic effect. It is prescribed for infectious lesions of the upper and lower respiratory tract, bacterial infections of the ENT organs, and urinary system. The medicine is also used for diphtheria, scarlet fever, whooping cough, erythematous rashes, and periodonitis.

Tablets and capsules should be taken before meals with water. For adults and children over 12 years of age (weighing more than 40 kilograms), the standard dosage is 150 milligrams twice a day or 300 milligrams once. If necessary, the doctor can adjust the dose.

Side effects: vomiting, nausea, diarrhea, pancreatitis, headache, rash, temporary hearing loss, impaired sense of smell, bronchospasm, candidiasis.

Contraindications: pregnancy, hypersensitivity to the components of the drug, porphyria, lactation, age under 12 years. With caution in case of renal and/or liver failure, in patients over 65 years of age.

Spiramycin-Vero (Rovamycin, Spiramisar)

Available in tablet form; active ingredient – ​​spiramycin.

The antibiotic has a bacteriostatic effect and is indicated for toxoplasmosis, acute bronchitis, exacerbation of chronic bronchitis, community-acquired pneumonia, sinusitis, rhinitis, tonsillitis, urethritis and other infectious and inflammatory diseases.

Adults and children over 18 years of age are prescribed 1 tablet twice a day for 5-7 days. The maximum daily dose is 3 tablets. The medicine should be taken before meals with a sufficient amount of liquid.

Side effects: paresthesia, prolonged QT interval, acute hemolysis, thrombocytopenia, Quincke's edema, itching, rash, nausea, diarrhea, vomiting, cholestatic hepatitis.

Contraindications: pregnancy, breastfeeding, age under 18 years, hypersensitivity, glucose-6-phosphate dehydrogenase deficiency.

Sumamed (Azithromycin, Azithromycin-OBL, Azilide, Zitrolide, Azitrox, Hemomycin)

Available in the form of capsules, powder, tablets, lyophilisate; active ingredient – ​​azithromycin dihydrate.

Macrolide antibiotics are prescribed for infectious and inflammatory diseases caused by drug-sensitive microorganisms: infections of the upper and lower respiratory tract, skin and soft tissues, genitourinary tract, etc.

Capsules and tablets are taken orally 1 hour before or 2 hours after meals without chewing. Adults and children over 12 years of age are prescribed 500 milligrams once every 24 hours for 3-5 days, depending on the nature of the disease. For children from 3 to 12 years of age, the medicine is prescribed at the rate of 10 milligrams per kilogram of weight once a day for 3 days. Children from 6 months to 3 years are prescribed a suspension of 2.5-5 milliliters once a day.

Side effects: candidiasis, leukopenia, anorexia, headache, drowsiness or insomnia, anxiety, irritability, blurred vision.

Contraindications: impaired renal and/or liver function, age up to 12 years with a weight of less than 45 kilograms (for tablets and capsules 500 milligrams), age up to 3 years (for tablets 125 milligrams), age up to six months (for powder), hypersensitivity, simultaneous reception with dihydroergotamine and ergotamine. Use caution during pregnancy and lactation.

Flemoxin Solutab (Amoxicillin, Amoxicillin Sandoz, Amosin, Ecobol)

Available in the form of dispersible tablets; active ingredient – ​​amoxicillin.

An antibiotic of the penicillin group with a wide spectrum of antimicrobial activity. Indications: bacterial infections of the respiratory system (pneumonia, tonsillitis, sinusitis, pharyngitis, acute inflammation of the middle ear), genitourinary system (pyelitis, urethritis, pyelonephritis, endometritis, cervicitis), skin and soft tissues (erysipelas, impetigo, secondary infected dermatoses), organs of the digestive system and abdominal infections (dysentery, cholecystitis, typhoid fever).

The tablets can be swallowed whole or pre-dissolved in water. The doctor prescribes the dosage individually depending on the course of the disease, the age of the patient and the sensitivity of the pathogen to the drug.

Side effects: rarely - vomiting, nausea, dysbacteriosis, stomatitis, crystalluria, leukopenia, eosinophilia, anxiety, insomnia, headache, convulsions, difficulty breathing, skin rashes and others.

Contraindications: intolerance to the components of the drug; it should be taken with caution in case of lymphocytic leukemia, infectious mononucleosis, gastrointestinal diseases, pregnancy, lactation, allergic reactions.

Ceftriaxone (Rocephin, Azaran, Cefaxone, Ceftriaxone Kabi)

Available in powder form for the preparation of solution for injection; The active ingredient is ceftriaxone.

An antibiotic of the cephalosporin group, like Vilprafen, is indicated for the treatment of many infections: meningitis, sepsis, skin and soft tissues, ENT organs, etc. The medicine is administered intravenously or intramuscularly.

Adults and children over 12 years of age are prescribed 1-2 grams once a day; newborns depending on body weight.

Side effects: rash, bronchospasm, fever, nausea, diarrhea, vomiting, flatulence, stomatitis, leukopenia, renal dysfunction, phlebitis, etc.

Contraindications: hypersensitivity, with caution during pregnancy, colitis, enteritis, premature and newborn children with jaundice.

Tsifran (Tsiprolet, Ciprofloxacin, Tsiprinol, Tsiprobay)

Available in the form of tablets and solution; active ingredient – ​​ciprofloxacin hydrochloride.

Indications for the use of fluoroquinolone antibiotics are infectious and inflammatory diseases, including pathologies of the respiratory tract, pelvic and abdominal organs, bones, skin, joints; infections of ENT organs, treatment of postoperative infections. For local use: subacute and acute conjunctivitis, blepharitis, keratitis, meibomitis and so on.

Doses are prescribed individually. The duration of treatment is from 7-10 days to 4 weeks. The course of treatment is 1-2 weeks.

Side effects: dizziness, sleep disturbance, nausea, vomiting, abdominal pain, crystalluria, dysuria, tachycardia, neutropenia, Quincke's edema, urticaria and others.

Contraindications: age under 18 years, pregnancy, lactation, hypersensitivity to the components of the drug.

Erespal (Erispirus, Epistat, Codestim, Eladon)

Available in the form of tablets, syrup; active ingredient – ​​fenspiride hydrochloride.

A medicine with antibronchoconstrictor and anti-inflammatory activity is used for diseases of the lower and upper respiratory tract: laryngitis, rhinopharyngitis, tracheobronchitis, bronchial asthma, bronchitis, respiratory phenomena (hoarseness, cough, sore throat), whooping cough, measles, influenza, sinusitis and otitis media of various origins.

For adults and children over 18 years of age, Erespal is prescribed 1 tablet 2-3 times a day. The maximum daily dose is 240 milligrams. Children are recommended to take the drug in syrup form per kilogram of body weight.

Side effects: nausea, diarrhea, dysbacteriosis, moderate tachycardia, drowsiness, abdominal pain, urticaria, rash, increased fatigue.

Contraindications: age under 18 years (for tablets), age under 2 years (for syrup), hypersensitivity.

Unidox Solutab (Xedocin)

Available in tablet form; active ingredient – ​​doxycycline monohydrate.

Analogue of Vilprafen Solutab. A broad-spectrum antibacterial drug of the tetracycline group is used for the treatment of infectious and inflammatory diseases: infections of the respiratory tract, ENT organs, sexually transmitted infections, genitourinary system, gastrointestinal tract, etc.

The tablets are taken with meals, after dissolving in a small amount of liquid (20 milliliters). The average duration of treatment is 5-10 days. Dosages are prescribed by the doctor based on the patient’s age and weight, and the severity of the disease.

Side effects: anorexia, dysphagia, esophageal ulcer, dermatitis, urticaria, anaphylactic reactions, pericarditis, neutropenia, vestibular disorders, candidiasis, etc.

Contraindications: pregnancy, breastfeeding, porphyria, severe renal and/or liver dysfunction, age under 8 years, hypersensitivity.

MACROLIDES

Macrolide antibiotics are divided into several groups depending on the method of preparation and the number of carbon atoms in the macrocyclic lactone ring, which is their structural basis (Table 7).

Table 7. Classification of macrolides
General properties
  • Mainly bacteriostatic effect.
  • Activity against gram-positive cocci (streptococci, staphylococci) and intracellular pathogens (mycoplasma, chlamydia, legionella).
  • High concentrations in tissues (5-10-100 times higher than plasma concentrations).
  • Low toxicity.
  • No cross-allergy with β-lactams.
  • 14-membered macrolides interact with theophylline, carbamazepine, cyclosporine, cisapride, etc.

ERYTHROMYCIN

The first natural macrolide. One of the safest antibiotics in terms of the development of serious adverse reactions.

Activity spectrum
Pharmacokinetics

It is not completely absorbed into the gastrointestinal tract. Bioavailability varies from 30 to 65%, and is significantly reduced in the presence of food. Penetrates well into bronchial secretions and bile. Does not pass through the BBB or GOB well. It is excreted primarily through the gastrointestinal tract. T 1/2 - 1.5-2.5 hours.

Adverse reactions
  • Dyspeptic and dyspeptic symptoms (in 20-30% of patients) are caused by stimulation of gastrointestinal motility (prokinetic, motilin-like effect).
  • Pyloric stenosis in newborns (therefore, it is preferable for them to be prescribed 16-membered macrolides - spiramycin, midecamycin).
  • Allergic reactions.
Drug interactions

When administered simultaneously with theophylline, carbamazepine, cyclosporine, bromocriptine, disopyramide, erythromycin increases their concentration in the blood due to inhibition of metabolism in the liver. It should not be used in combination with cisapride due to the risk of developing severe cardiac arrhythmias.

The bioavailability of digoxin while taking erythromycin may increase due to a decrease in inactivation of digoxin by intestinal microflora.

Indications
  • Streptococcal infections (GABHS) in patients allergic to penicillins (tonsillopharyngitis, scarlet fever, prevention of rheumatic fever).
  • Community-acquired pneumonia.
  • Diphtheria.
  • Whooping cough.
  • Orodental infections (periodontitis, etc.).
  • Campylobacteriosis.
  • Chlamydial infection.
  • Mycoplasma infection.
  • Legionellosis.
Dosage
Adults

Orally - 0.25-0.5 g every 6 hours 1 hour before meals; for streptococcal tonsillopharyngitis, 0.25 g every 8-12 hours for 10 days; for the prevention of rheumatic fever, 0.25 g every 12 hours. Intravenous drip, 0.5-1.0 g every 6 hours.

Children

Orally - 40-50 mg/kg/day in 4 divided doses 1 hour before meals.

Intravenous drip - 30 mg/kg/day in 2-4 injections.

Release forms

Tablets of 0.1 g, 0.2 g, 0.25 g and 0.5 g; suspension; ointment 10 thousand units/g; bottles of 0.05 g, 0.1 g and 0.2 g of erythromycin phosphate in powder form for the preparation of a solution for infusion.

OLEANDOMYCIN

Outdated drug. The antimicrobial spectrum is close to, but less active. Worse tolerated.

ROXYTHROMYCIN

Rulid, Roxithromycin Lek

Differences from erythromycin:
  • more stable bioavailability (50%), practically independent of food;
  • higher concentrations in blood and tissues;
  • longer T 1/2 - 10-12 hours;
  • better tolerability;
Indications
  • Orodental infections.
  • Skin and soft tissue infections.
  • Chlamydial infection.
  • Mycoplasma infection.
Dosage
Adults

Orally - 0.15 g every 12 hours or 0.3 g every 24 hours 15 minutes before meals.

Children

Orally - 5-8 mg/kg/day in 2 divided doses 15 minutes before meals.

Release forms

Tablets of 0.05 g, 0.1 g and 0.15 g.

CLARITHROMYCIN

Klacid, Fromilid

Semi-synthetic 14-membered macrolide. The spectrum of activity is close to .

Differences from erythromycin:
  • has an active metabolite - 14-hydroxy-clarithromycin, due to which increased activity against H.influenzae;
  • the most active of all macrolides against H. pylori;
  • acts on atypical mycobacteria ( M.avium etc.), causing opportunistic infections in AIDS;
  • high acid resistance and bioavailability (50-55%), independent of food;
  • longer T 1/2 (3-7 hours);
  • better tolerability;
  • Not prescribed for children under 6 months, pregnant or breastfeeding women.
Indications
  • Infections of the upper respiratory tract with allergies to penicillins (streptococcal tonsillopharyngitis, acute sinusitis).
  • Infections of the respiratory tract (exacerbation of chronic bronchitis, community-acquired pneumonia).
  • Orodental infections.
  • Eradication H. pylori(in combination with other antibiotics and antisecretory drugs).
  • Skin and soft tissue infections.
  • Chlamydial infection.
  • Mycoplasma infection.
  • Atypical mycobacteriosis in AIDS (treatment and prevention).
Dosage
Adults

Orally 0.25-0.5 g every 12 hours; 0.5 g once daily with or without food (if using extended-release tablets); intravenous drip - 0.5 g every 12 hours.

Children over 6 months

Orally - 15 mg/kg/day in 2 divided doses (no more than 250 mg per day) regardless of food.

Release forms

Tablets of 0.25 g and 0.5 g; tablets with delayed release, 0.5 g ("Klacid SR"); powder for suspension 125 mg/5 ml; bottles of 0.5 g of powder for preparing a solution for infusion.

AZITHROMYCIN

Sumamed

A semi-synthetic 15-membered macrolide, part of the azalide subclass.

Differences from erythromycin:
  • more active in relation to N. influenzae, N.gonorrhoeae And H. pylori;
  • bioavailability (about 40%) is less dependent on food;
  • higher concentrations in tissues (the highest among macrolides);
  • has a significantly longer half-life (up to 55 hours), which makes it possible to prescribe the drug once a day, use short courses (1-3-5 days) while maintaining the therapeutic effect for 5-7 days after discontinuation;
  • better tolerability;
  • drug interactions are less likely.
Indications
  • Infections of the upper respiratory tract with allergies to penicillins (streptococcal tonsillopharyngitis, acute sinusitis).
  • Infections of the respiratory tract (exacerbation of chronic bronchitis, community-acquired pneumonia).
  • Orodental infections.
  • Skin and soft tissue infections.
  • Chlamydial infection.
  • Mycoplasma infection.
  • Prevention of atypical mycobacteriosis in AIDS.
Dosage
Adults

Orally - 0.5 g/day for 3 days or on the 1st day - 0.5 g, in the next 4 days 0.25 g, 1 time per day; for acute chlamydial urethritis and cervicitis - 1.0 g once. Take 1 hour before meals.

Children

10 mg/kg for 3 days or on the 1st day - 10 mg/kg, in the next 4 days - 5 mg/kg, 1 time per day.

Release forms

Capsules 0.25 g; tablets of 0.125 g and 0.5 g; syrup 100 mg/5 ml and 200 mg/5 ml; powder for preparing a suspension.

SPIRAMYCIN

Rovamycin

Natural 16-membered macrolide.

Differences from erythromycin:
  • active against some pneumococci and GABHS resistant to 14- and 15-membered macrolides;
  • acts on toxoplasma and cryptosporidium;
  • bioavailability (30-40%) does not depend on food;
  • higher concentrations in tissues;
  • better tolerated;

Like erythromycin, it can be used in pregnant women.

Indications
  • Infections of the respiratory tract (exacerbation of chronic bronchitis, community-acquired pneumonia).
  • Orodental infections.
  • Skin and soft tissue infections.
  • Chlamydial infection.
  • Mycoplasma infection.
  • Toxoplasmosis.
  • Cryptosporidiosis.
Dosage
Adults

Orally, 2-3 million IU (3 million IU = 1 g of spiramycin) every 8-12 hours, regardless of food; intravenous drip - 4.5-9 million IU/day in 3 administrations.

Children

Inside - body weight< 10 кг: 2-4 пакетика по 375 тыс МЕ/сут в 2 приёма; 10-20 кг: 2-4 пакетика по 750 тыс МЕ/сут в 2 приёма; >20 kg: 1.5 million IU/10 kg/day in 2 divided doses. Prescribed regardless of food.

Release forms

Tablets of 1.5 million IU and 3 million IU; granules for preparing a suspension in bags; bottles of 1.5 million IU of powder for preparing a solution for infusion.

MIDECAMICIN, MIDECAMICIN ACETATE

Macropen

Midecamycin is a natural 16-membered macrolide, midecamycin acetate is its semi-synthetic derivative, which has slightly greater antimicrobial activity in vitro and improved pharmacokinetics.

Differences from erythromycin:
  • act on a number of staphylococci, pneumococci and GABHS, resistant to 14- and 15-membered macrolides;
  • better absorbed from the gastrointestinal tract (especially midecamycin acetate);
  • create higher tissue concentrations (especially midecamycin acetate);
  • better tolerated;
  • clinically significant drug interactions have not been established.
Indications
  • Infections of the upper respiratory tract due to allergies to penicillins (streptococcal tonsillopharyngitis).
  • Infections of the respiratory tract (exacerbation of chronic bronchitis, community-acquired pneumonia).
  • Skin and soft tissue infections.
  • Chlamydial infection.
  • Mycoplasma infection.
Dosage
Adults

Orally - 0.4 g every 8 hours 1 hour before meals.

Children

Inside - body weight< 30 кг: 20-40 мг/кг/сут в 3 приёма, при тяжелых инфекциях 50 мг/кг/сут в 2-3 приёма, масса тела >30 kg: as in adults, prescribed 1 hour before meals.

Release forms

Tablets of 0.4 g midecamycin; powder for preparing a suspension of 0.175 g midecamycin acetate/5 ml.

JOSAMICIN

Vilprafen

Differences from erythromycin:
  • less active against most erythromycin-sensitive microorganisms;
  • acts on a number of staphylococci, pneumococci and GABHS, resistant to 14- and 15-membered macrolides;
  • more acid-resistant, bioavailability does not depend on food;
  • less likely to cause adverse reactions from the gastrointestinal tract, and can sometimes cause hypotension.
Indications
  • Infections of the upper respiratory tract due to allergies to penicillins (streptococcal tonsillopharyngitis).
  • Infections of the respiratory tract (exacerbation of chronic bronchitis, community-acquired pneumonia).
  • Skin and soft tissue infections.
  • Chlamydial infection.

"Vilprafen" has different dosage forms. You can find on sale containing 500 mg of josamycin, a suspension (10 ml contains 300 mg of josamycin) and water-soluble tablets (one piece contains 1 g of active substance). A doctor or pharmacy pharmacist can recommend a suitable form of the drug. The question of whether Vilprafen can be used with another drug from the same pharmacological group must be decided by the attending physician. Antibiotics of the macrolide group are "Erythromycin", "Clarithromycin" ("Binoklar", "Clabax", "Clareksid", "Claricin", "Klatsid", "Fromilid"), "Azithromycin" ("Azivok", "Sumamed", " Azilide", "Zitrolide", "Sumazid", "Hemomycin"), "Roxithromycin" ("Brilid", "Rovenal", "Roxide", "Roximizan", "Roxithromycin"), "Elrox", "Spiramycin" ("Rovamycin "), "Midecamycin", "Macropen".

The mechanism of action of these drugs is based on the suppression of protein synthesis in the cells of pathogens. As a rule, they inhibit the vital activity of bacteria (have a bacteriostatic effect); in large doses they can act bactericidal (kill bacteria). These exhibit an active effect against staphylococci, streptococci, pneumococci, chladymias, mycoplasmas, ureaplasmas, legionella, pathogens of whooping cough, and diphtheria. These also have immunomodulatory and anti-inflammatory properties. Erythromycin is considered the first macrolide; currently, most infectious agents have developed resistance to it. Azithromycin exhibits the highest activity against Haemophilus influenzae; Larithromycin and Vilprafen are the most active against ureaplasma, mycoplasma, and chlamydia. "Midecamycin" is effective against many pathogens, including intracellular ones.

Possible side effects of macrolide antibiotics

Side effects of macrolides depend on the drug and its dose. Patients may experience gastrointestinal disturbances (nausea, vomiting, abdominal pain). When taking Erythromycin, these phenomena are caused by the fact that this substance binds to motilin receptors and promotes increased motor skills. Azithromycin and Clarithromycin are better tolerated, but they can also cause gastrointestinal disorders.

Ototoxic and hepatotoxic effects of macrolide antibiotics are less common. Erythromycin often exhibits a hepatotoxic effect in the form of cholestatic jaundice. The ototoxic effect (reversible hearing impairment) when taking these drugs orally is observed quite rarely, however, when Erythromycin was administered intravenously, hearing impairment was detected in 20% of patients. In rare cases, allergic reactions on the skin occur when taking macrolides.