The corresponding, effective, timely therapy for any IMP leads to a significantly higher incidence of symptomatic and bacteriological treatment and better pre -infection prevention. Unfortunately, treatment can lead to antibiotic resistance to pathogens and commentary bacteria and have adverse effects on the intestinal and vaginal flora, so it is very important to consult a doctor immediately and choose it properly.
The American Society of Infectious Diseases Specialists (IDSA) in collaboration with the European Society of Microbiology and Infectious Diseases (ESCMID) published clinical recommendations for treatment with acute uncomplicated cystitis and pyelonephritis in 2011. This document has become an invaluable reference to the IMP service. This guide discusses important factors when choosing optimal treatment:
As for sensitivity, two important facts are noted in this guide:
In this way, the recommendations are periodically reviewed due to constantly developing resistance, the development of new instruments and conducting studies showing the superiority and ineffectiveness of drugs. According to and recommendations and studies, they are best met with the requirements for medicines for the treatment of uncomplicated cystitis, the following substances:
The following selection criteria were used: pharmacokinetics, interaction, likelihood of hitting (the likelihood of microorganism being sensitive to antibiotics), the development of resistance, specific use for IPS, efficiency, side effects, dose frequency, duration of treatment, costs.
The study includes the following medicines: amoxicillin (with or without clavulanic acid), nitrofurantine, sulfamethizole, trimoprim, co-trimoxazole, ciprofloxacin, norfloxacin, offxacin and phosphomycin trometamol.
Characteristic of the first line of treatment of infections of the lower urinary tract
Table 1. First row to treat cystitis
Substance Dose The duration of treatment Phosphomycin trometamol 3 g single dose Single dose (once) Nitrofurantine 50-100 mg four times a day 5-7 days
Phosphomycin trometamol Phosphomycin was discovered in 1969 as a representative of the new class of phosphone antibiotics.
Active substance: phosphomycin. Release Form: Granules for the preparation of the solution, in packs 1 or 2 packs, a dose of phosphomycin 3 g/bag, 2 g/bag.
It refers to the clinical and farm groups to the Waro -Antiseptics, antibiotics (phosphonic acid derivative).
Spectrum Phosphomycin has bactericidal activity of a wide range of action in connection with:
Staphylococci (Staphylococcus spp. ); Enterococci (Enterococcus spp. ); Haemophilus spp; Most intestinal gram-negative bacteria, including 95, 5% E. coli, producing β-lactamases of the extended spectrum (BLRS); E. Coli strains producing metal-β-lactamase sensitive to phosphomycin; CITROBACTER SPP. ; Enterobacter spp. ; Klebsiella spp. , Klebsiella pneumoniae; Morganella morganii; Proteus mirabilis; Pseudomonas spp. ; Serratia spp. The peculiarity of the drug Trometamol phosphomycin is prescribed exclusively for the treatment of acute uncomplicated cystitis in the form of a single dose of 3 g and is not prescribed for pyelonephritis. It is best absorbed if you take it before eating. It reaches high urine concentration and maintains a high level for more than 24 hours. In several studies, the clinical and microbiological efficacy of phosphomycin has been compared with other first row antimicrobial agents with uncomplicated cystitis. The clinical effectiveness of one dose (3 g) of phosphomycin is 91% (treatment occurs in 91% of patients). The indicator is comparable to nitrofurantoin (93%), trime-sulfamethoxazole (93%) and fluoroquinolones (90%) in acute uncomplicated cystitis.
Advantages of phosphomycin treatment The microbiological level of treatment of phosphomycin (80%) is more than that of comparable antibiotics with 88-94%. However, a recent meta -analysis of 27 studies does not reveal the differences in effectiveness between phosphomycin and other antibiotics for the treatment of cystitis and discovered the following facts:
Phosphomycin causes significantly less side effects, which is most important -including in pregnant women. An additional advantage is to treat multi -resistant microorganisms. Several studies by In vitro show that phosphomycin is active in connection with vanzico resistant Staphylococcus aureus and Gram-negative sticks that produce BLR. Effective in the treatment of IMP caused by K. pneumoniae. Enterobacteriaceae producing carbapenema (in doses of 3 g, repeat every 48-72 hours). It has a minimal side effect on the body. This is shown by the high incidence of E. coli in regions with frequent use of phosphomycin with uncomplicated cystitis in women; Convenience of one dose mode. Testification acute cystitis (bacterial origin); exacerbation of recurrent cystitis (bacterial origin); urethritis (bacterial non -specific); Bacteriuria of pregnant women asymptomatic; IMP after operations; IMP prevention. Dose and method of administration
Treatment of simple acute cystitis Repeated/Heavy forms of IMP IMP prevention Adults - 3, 0 g (1 pack) once
Children (5 years old) - 2, 0 g once
Adults - 3, 0 g twice, the second intake after 24 hours First technique: 3, 0 g 3 hours before surgery/diagnostic procedure
Second trick: 3, 0 g 24 hours after the primary
Recommendations for use Follow all label instructions. Phosphomycin is usually prescribed only in one dose. Do not take large/smaller quantities or more if not prescribed by a doctor. It can be used at the same time/after meals. Phosphomycin is a powder medicine, before being used, should be diluted with water. Do not take dry powder without adding water. Dissolve a 1/2 cup of cold water, stir and drink immediately. You can add a little more water to the same glass, carefully shake and drink immediately to provide a full dose. Do not mix with hot water. It's a good idea to take it overnight. There will be a longer interruption between urination, which will ensure a longer presence of the drug in the bladder and a more effective effect. Store at room temperature away from moisture and heat in the original package. Other instructions:
Symptoms cannot completely pass immediately after 2-3 days; It is necessary to contact a urologist if the symptoms do not disappear within 3 days after treatment, fever or other new complaints will occur; Before administering the patient, it is recommended that you consult a doctor to make sure that phosphomycin is a suitable antibiotic for treatment. In addition, urine analysis may be necessary before and after taking this medicine. Contraindications:
Children under 5 years; allergic reactions to components; Severe renal failure. Common side effects:
nausea, stomach upset, mild diarrhea; headache, dizziness; Itching or vaginal discharge (rarely). Interaction Co -administration with meteclapraramide is not recommended to avoid weakening of phosphomycin action.
Thus, the convenience of single dose mode, in vitro activity in connection with resistant gram -negative sticks that cause both simple and immature, uncomplicated cystitis. , And the minimum tendency to lateral damage is made by phosphomycin a useful choice in the treatment of infections of the lower MVP (cystitis, urethritis).
Nitrofurantine Active substance: nitrofurantine. Release form: tablets, dose 100 mg, 50 mg.
It applies according to the clinical and farmological groups to the uramantiseptics, antimicrobials.
Nitrofurantine associated with the synthetic nitrofuran group is originally represented in the form of a microcrystalline form. In 1967, the form of macrocrystalline with improved gastrointestinal tolerance was offered.
There are currently two main types of nitrofurantine: macrocrystalline form and a mixture of microcrystalline and macrocrystalline forms (25 mg macrocrystals plus 75 mg monohydrate). Mixed species in the patented dual delivery system are not registered in the Russian Federation and are not in circulation.
The mechanism of action The mechanisms of bacterial activity of nitrofurantine include several places:
Inhibition of ribosomal radiation; damage to bacterial DNA; Intervention in the CREB cycle. Nitrofurantine is active in connection with:
More than 90% of the intestinal strains causing IMP; Enterococcus, including vancromycin resistant; Klebsiella spp. ; Proteus spp. ; Staphylococci (gold and saprophytic) are usually susceptible. The drug resistance is rare, probably due to many areas of the drug. However, Proteus, Serratia and Pseudomonas have a natural resistance to nitrofurantoin.
Nitrofurantine can also be an additional option for oral antimicrobial treatment of acute uncomplicated cystic caused by bacteria producing BLR.
Pharmacokinetics. Ingestion improves when eating. The concentrations of nitrofurantine in the serum are low or not defined in standard doses, the prostate content is not detected. It is excreted mainly with urine, where the concentration of the drug (50 to 250 mg/ml) easily exceeds 32 mg/ml MPC.
Nitrofurantine should not be prescribed to patients with pronounced renal failure (creatinine clearance<60 m/min), but studies have monitored high drug efficiency in patients with creatinine clearance of 60-30 ml/min.
Safe for use in pregnant women and children.
Indications: Cystitis (bacterial origin) treatment and prevention.
Dose. It is prescribed by a urologist separately on the basis of the severity of the condition, duration and severity of the symptoms.
The usual dose for adults with cystitis:
50 to 100 mg orally 4 times a day for 1 week or at least 3 days after reaching the sterility of urine. The usual adult dose to prevent cystitis: 50 to 100 mg orally once a day before bedtime. Children's dose for the treatment of cystitis: 1 month and more adult: 5-7 mg/kg/day (up to 400 mg/day) oral at 4 doses. The usual baby dose to prevent cystitis: 1 month and older: 1 to 2 mg/kg/day (up to 100 mg/day) oral at 1-2 doses. Most experts agree with the recommendation of a 5-day drug for the treatment of acute uncomplicated cystitis. Studies show the incidence of early clinical treatment with nitrofurantoin from 79% to 95% and the incidence of microbiological cure from 79 to 92%. In the aggregate of the clinical efficacy study, they show the general equivalence between nitrofurantoin prescribed for 5 or 7 days, and trimeters-sulfamethoxazole (grains), ciprofloxacin and one dose of trometamol phosphomycin (monural). However, the speed of microbiological treatment is constantly demonstrating a slightly more beneficial effect on comparing medication.
Patients' recommendations You need to follow all the doctor's prescriptions and instructions in the medicine instructions. Do not use in large or smaller quantities or longer than recommended. It is better to take nitrofuranine with food (bioavailability is increased). It is recommended to monitor administration throughout the prescribed period. Symptoms may go earlier, but treatment cannot be discontinued until the infection is completely eliminated. Doses can increase the risk of more developing the infection resistant to antibiotics, and the risk of relapse. Nitrofurantine does not cure viral infections, such as colds or flu. Side effect Common side effects:
headache, dizziness; gas formation, stomach disorder; Mild diarrhea; Itching or vaginal discharge. Much rarely are they:
watery or bloody diarrhea; Sudden pain or discomfort in the chest, whistling breathing, dry cough; difficulty breathing; fever, chills, body pain, fatigue, unexplained weight loss; numbness, tingling or pain in the arms or legs; Liver problems - nausea, upper stomach pain, itching, feeling of fatigue, loss of appetite, dark urine, stools with clay, jaundice (yellowing of the skin or eye); Lupid -like syndrome - joint pain or fever swelling, swollen glands, muscle pain, chest pain, vomiting, unusual thoughts or behavior, sweaty rashes. Serious side effects can be more likely in the elderly, long -term patients or weakened people.
Contraindications:
serious disorders of excretory renal function; renal damage; Oliguria; Glucose-6-phosphate dehydrogenase; pregnancy; age up to 1 month; allergic reactions to components; XN II-III stages; cirrhosis; chronic hepatitis; Acute porphyria; Lactation. Pregnancy The category of the drug in relation to pregnancy: IN (according to FDA - US Health Agency). This medicine is thought to not harm an unborn child in the early stages of pregnancy. In the last 2-4 weeks, pregnancy is contraindicated.
Nitrofurantine is able to penetrate the breast milk, during lactation is not prescribed.
Special instructions The risk of peripheral neuropathy is increased in the presence of anemia, diabetes mellitus, severe MES, disorder of electrolyte balance, lack of vitamins in Group B. Nitrofurantine is not used to treat prostatitis, lesions of the cortical substance of the kidneys, purulent paranephritis. In pyelonephritis, they are not prescribed due to ineffectiveness. Nitrofurantine can produce unusual results with a certain laboratory glucose (sugar) in the urine. Interaction With fluoroquinolones it is incompatible. Magnesium -based antacids of trilacic, Nastex acid while taking the antimicrobial activity of nitrofurantine. Channel secretion, which blocks the secretion of the channel, is not prescribed as they increase the toxicity of nitrofurantine (blood content increases), decreases bactericidal properties (the content of the urine decreases). Nitrofurantine is considered a therapeutic drug in the first row in acute uncomplicated cystitis due to:
the effectiveness of a 5-day course; Little risk of side effects and damage to the normal flora of a person; minimum bacteria resistance; Effectiveness comparable to other antimicrobial drugs.