Antibiotics for chlamydia in women and men

The most common sexually transmitted infection caused by tiny microorganisms – chlamydia, is difficult to treat. In the vast majority of cases, its course is asymptomatic, patients come to the doctor's attention already having an advanced form of the disease. The consequences of chlamydia are impressive. These are not only inflammatory processes of the genitourinary organs and, as a result, reproductive dysfunction in both sexes, but also serious diseases of the eyes, joints, lymph nodes. Antibiotics for chlamydia are prescribed to destroy the pathogen and eliminate the inflammatory process, as well as prevent dangerous complications. They must be taken in strict accordance with medical recommendations. The choice of drug depends on the form and stage of the disease.

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Indications antibiotics for chlamydia

Infectious and inflammatory diseases of the genitourinary organs: non-gonococcal urethritis in both sexes; cervicitis, salpingitis, endometritis in women, prostatitis and orchiepididymitis in men, combined lesions of the genitourinary organs, eyes and joints (Reiter's syndrome).

Antibiotics are prescribed to individuals with positive laboratory test results for chlamydia, their sexual partners, and newborns from mothers with chlamydia.

Three groups of antibacterial drugs are used to eradicate chlamydia: tetracyclines (usually prescribed for acute forms of the disease without complications to people who have not previously undergone a course of antichlamydial therapy); macrolides (drugs of choice for pregnant and lactating women); fluoroquinolones (antibiotics for chronic chlamydia or for patients with resistant forms); combinations of two antibacterial drugs are often used.

The drugs of these groups are able to penetrate into the cell and disrupt the life cycle of chlamydia. Drugs that have a destructive effect on cell walls and have a low ability to penetrate into the cell (penicillin, cephalosporin, nitroimidazole groups) are useless in the fight against these microorganisms.

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Release form

Oral antibiotics are usually prescribed to treat chlamydia. The drugs come in various forms: tablets, capsules, powders for suspension, syrups.

Since the main contingent of patients are young adults, the preferred form of treatment is taking tablets (capsules).

In cases of resistant complicated forms of chlamydia, a course of intravenous injections may be prescribed in a hospital.

Names of drugs for chlamydia

Chlamydia is almost always treated with macrolides. The pathogen is very sensitive to drugs of this group, in addition, these are natural antibiotics, more effective than tetracycline drugs. An antibiotic with the active substance is usually prescribed:

• Azithromycin (the drug of the same name, Azitral, Azitrox, ZI-Factor, Sumazid and others);
• Josamycin (the drug of the same name, Vilprafen, Vilprafen Solutab).

Other macrolides are also used as second-line drugs (for patients with intolerance to preferred drugs): Erythromycin, Clarithromycin, Rovamycin.

Patients with mild forms of chlamydia without complications are prescribed Doxycycline (Vibramycin, Doxibene, Supracycline, Unidox Solutab and other synonyms).

Fluoroquinolones (Ofloxacin, L-floxacin, Lomefloxacin, Ciprofloxacin, Norfloxacin) are prescribed to patients in case of chronic forms of the disease, when the infection does not respond to treatment with first-line drugs.

In practice, combined forms of infection are much more common than monoinfection. In these cases, the drug is selected in such a way that it is active against all infectious agents found in the patient.

Doxycycline, Azithromycin, Josamycin and fluoroquinolones, belonging to the third and fourth generations, are active not only against chlamydia but also against gonococci, although many pathogens are currently showing resistance to tetracycline drugs. Therefore, the drugs of choice are macrolides, fluoroquinolones are used in extreme cases. Antibiotics for gonorrhea and chlamydia are the main drugs for eradication of infectious agents.

The antibiotics mentioned above are effective against ureaplasma and chlamydia; mycoplasma is also sensitive to them.

Unfortunately, one antibiotic for trichomoniasis and chlamydia will not be able to cope with this mixed infection. In this case, antiparasitic agents (5-nitroimidazole derivatives) are introduced into the therapeutic regimen - Tinidazole, Ornidazole, Metronidazole. The antibiotic of choice should not belong to the fluoroquinolone group, since such a combination increases the toxicity of both drugs.

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Pharmacodynamics

Chlamydia are intracellular microorganisms, so all drugs prescribed for their eradication have the ability to penetrate into the cell.

Semi-synthetic macrolide Azithromycin is the drug of choice for the treatment of chlamydia. This is due to several reasons: firstly, the ability to cure the infection with a single dose (it is easy to follow all the rules); secondly, it is active against many combined infectious agents, in particular, ureaplasma and gonococci, although it is not a first-line drug for the treatment of gonorrhea. It has a bacteriostatic effect in therapeutic doses, like all representatives of this group, penetrating the cell wall and binding to a fragmentary section of the bacterial ribosome, preventing the normal synthesis of its protein, inhibiting the transfer of peptides from the acceptor site to the donor site. In addition to bacteriostatic, antibiotics of this group have the ability to somewhat stimulate immunity and suppress the activity of proinflammatory mediators.

Erythromycin is the first antibiotic of this class, considered the least toxic, has a natural origin. It is considered an alternative, used in the treatment of pregnant women, adolescents and newborns. The spectrum of action is similar to the previous one, however, many microorganisms have already acquired resistance to this drug and its effectiveness is considered lower than that of later macrolides.

Josamycin, a representative of the same class of antibiotics, has a natural origin and is more active than the previous two. Unlike others, it practically does not suppress the beneficial microflora of the gastrointestinal tract. Resistance to it develops less often than to other representatives of this group.

Of the macrolides, Clarithromycin and Roxithromycin can also be used as alternative drugs in the treatment of chlamydia.

The tetracycline antibiotic Doxycycline is also prescribed quite often for chlamydia. Since many pathogens have already developed resistance to drugs of this series, it is recommended for use in primary patients with uncomplicated disease. It has a pharmacological effect, inhibiting the production of proteins in bacterial cells, interfering with the process of transmitting its genetic code. It has a wide range of activity, in particular, to chlamydia and gonococci. Its disadvantage is also the widespread resistance of pathogens to tetracycline antibiotics.

Fluorinated quinolones are considered reserve drugs and are used in cases where the previous ones are not effective. They exhibit a bactericidal effect - they inhibit the enzymatic activity of two microbial topoisomerases of the second type at once, which are necessary for the vital activity of bacteria - the process of realizing their genetic information (DNA biosynthesis). For the eradication of chlamydia, second-generation drugs Norfloxacin, Ofloxacin or Ciprofloxacin can be prescribed, which also exhibit antigonococcal activity. Ureaplasma, in most cases, is insensitive to these drugs. If the mixed infection includes this pathogen, then Levofloxacin or Sparfloxacin, which belong to the third generation of this group of antibiotics, are used.

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Pharmacokinetics

Azithromycin is absorbed from the gastrointestinal tract at a good rate, since this drug is characterized by acid-resistant properties and affinity for fats. The highest plasma concentration is determined after a period of 2.5 to 3 hours. About 37% of the administered dose enters the bloodstream unchanged. It is well distributed in all tissues. All antibiotics of this group are characterized by high tissue, not plasma, concentrations, which is due to low affinity for proteins, as well as the ability to penetrate the cells of pathogenic microorganisms and accumulate in lysosomes. Azithromycin is transported to the sites of infection by phagocytes, where it is released during their activity. A higher concentration of the drug is determined in infected tissues compared to healthy tissues, comparable to the degree of inflammatory edema. The function of phagocytes is not impaired. The therapeutic concentration of the drug is maintained at the sites of localization of the inflammatory process for five to seven days from the moment of its last administration. It is this ability that allows Azithromycin to be taken once or in short courses. Elimination from serum is prolonged and two-stage, which explains its administration once a day.

The rate of absorption of Erythromycin in the digestive tract is determined by the characteristics of the patient's body. The highest plasma concentration is recorded two hours after taking the drug, binds to plasma albumins from 70 to 90% of the dose taken. Distribution occurs mainly in tissues and body fluids, can be absorbed by 30-65%. Low toxicity, overcomes the placental barrier and is determined in breast milk.

It is broken down in the liver, the metabolic products are excreted almost entirely with bile, an insignificant part is excreted unchanged through the urinary tract. Normally functioning kidneys ensure the excretion of half of the taken dose of erythromycin within two hours after administration.

Josamycin is almost completely absorbed from the digestive tract at a good rate. Unlike other macrolides, its bioavailability does not depend on food intake. The highest serum concentration is determined after an hour, about 15% of the active substance taken binds to plasma albumins. It is well distributed in tissues, crosses the placenta and is detected in breast milk. It is broken down in the liver. Metabolites slowly leave the body through the biliary tract, less than 15% - through the urinary organs.

Doxycycline is absorbed quickly, regardless of the presence of food in the gastrointestinal tract, and its elimination is slow. The therapeutic concentration in the blood serum is determined for 18 or more hours after administration, the connection with plasma albumins is approximately 90%. The active substance is quickly distributed in liquid substances and tissues of the body. Elimination occurs through the gastrointestinal tract (about 60%), with urine - the rest. The half-life is from 12 hours to a day.

Fluorinated quinolones are well, quickly and widely distributed in tissues and organs of various systems, creating significant concentrations of the active substance. Except for Norfloxacin, which is maximally concentrated in the intestines, urinary tract and prostate gland, where the infection is most often localized in male patients.

The highest level of tissue saturation of various localizations is observed during therapy with Ofloxacin, Levofloxacin, Lomefloxacin, Sparfloxacin.

Among antibiotics, they have an average ability to penetrate cell membranes into the cell.

The rate of biotransformation and elimination depends on the physicochemical properties of the active substance. In general, drugs of this group are characterized by rapid absorption and distribution. Pefloxacin is most actively metabolized, ofloxacin, levofloxacin, the least, the bioavailability of which is almost 100%. The bioavailability of ciprofloxacin is also high, at 70-80%.

Fluctuations in the half-dose elimination period for fluorinated quinolones range widely from three to four hours for Norfloxacin to 18 to 20 hours for Sparfloxacin. Most of the drug is excreted via the urinary tract, and three to 28% (depending on the drug) via the intestines.

Renal dysfunction in the patient prolongs the half-life of all drugs in this group, especially ofloxacin and levofloxacin. In cases of severe renal dysfunction, the dose of any fluorinated quinolone must be adjusted.

Antibiotics for chlamydia in men are prescribed individually depending on the form and stage of the disease, localization of the infection, presence of complications and combined infections. When choosing a drug, the patient's tolerance of a certain group of antibacterial agents, the need to combine them with the intake of any other drugs if the patient has chronic diseases, the sensitivity of infectious agents to certain drugs are also taken into account.

Doctors are guided by the same principles when choosing antibiotics for chlamydia in women. A special category of patients are expectant mothers.

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Dosing and administration

The most commonly prescribed course of antibiotics for chlamydia is:

A single dose of Azithromycin at a dosage of 1000 mg (two tablets of 500 mg) one hour before meals or a seven-day course of Doxycycline at 100 mg (one capsule) every 12 hours, with plenty of water.

Second-line drugs are taken for a week:

Erythromycin - 500 mg every six hours, one hour before meals, with plenty of water;

Josamycin – 750 mg every eight hours;

Spiramycin - 3 million units every eight hours;

Ofloxacin - 300 mg every twelve hours;

Ciprofloxacin – every twelve hours, 500-750 mg in complicated cases.

Pregnant women are prescribed standard treatment regimens with Erythromycin, Josamycin, and Spiramycin.

During treatment, it is necessary to maintain a sufficient water regime (at least 1.5 liters of water per day).

The course of treatment is mandatory for both partners. In complicated cases, two antibiotics of different pharmacological groups can be used, for example, Azithromycin or Doxycycline in combination with Ciprofloxacin.

An indicator of the effectiveness of treatment is considered to be a negative result of the polymerase chain reaction of smears of the urogenital tract one and a half to two months after the end of treatment.

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Use antibiotics for chlamydia during pregnancy

Doxycycline and antibiotics belonging to the fluoroquinolone group are not prescribed to women who are carrying a child.

The tetracycline antibiotic Doxycycline can cause abnormalities in the formation of bone tissue in the fetus.

Fluoroquinolones are classified as toxic antibiotics, however, there is no reliable data on the teratogenicity of these drugs. However, in studies on laboratory animals, their offspring developed arthropathies, in addition, there are reports of isolated cases of hydrocephalus, intracranial hypertension in newborns whose mothers took drugs of this group during pregnancy.

Macrolide antibiotics, although they penetrate the placental barrier, are considered non-teratogenic and low-toxic. Therefore, a drug for the treatment of chlamydia in pregnant women is chosen from this group. The safest of them is Erythromycin, however, Vilprafen (Josamycin) and Spiramycin, natural sixteen-membered macrolides, are considered more effective. Azithromycin is prescribed only for vital indications. The effect of other drugs in this group on the fetus has been little studied, so they are not recommended for use in the treatment of pregnant women. Clarithromycin, according to some data, can have a negative effect.

Contraindications

A common contraindication for the use of all antibiotics is a known allergic reaction to the drug.

Fluoroquinolones and Doxycycline are contraindicated in pregnant and lactating women.

Doxycycline is not prescribed to children from birth to seven years of age, as well as to patients with severe liver pathologies.

Fluorinated quinolones are not used in pediatrics and for the treatment of patients with congenital enzymatic deficiency of glucose-6-phosphate dehydrogenase, epileptics and individuals with pathological changes in tendons after a course of drugs in this group.

Second-line macrolide antibiotics (Clarithromycin, Midecamycin, Roxithromycin) are not used to treat expectant mothers and breastfeeding patients. Josamycin and Spiramycin, which can be used to treat chlamydia during pregnancy, are not prescribed during lactation.

Severe dysfunction of the liver and biliary tract is a contraindication to the use of any macrolides.

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Side effects antibiotics for chlamydia

Antibiotics cause all sorts of allergic reactions, from itchy skin rashes and swelling to severe asthma and anaphylaxis.

General effects of antibiotics include disorders of the digestive organs - dyspeptic phenomena, abdominal discomfort, loss of appetite, stomatitis, colitis, intestinal microflora disorders, in addition, fluoroquinolones can also cause intestinal perforation and hemorrhage, as well as various liver disorders, jaundice, moderate cholestasis. This is where the list of side effects of macrolide antibiotics ends.

Doxycycline and fluoroquinolones can cause changes in the blood count: a decrease in the level of red blood cells, platelets, neutrophils, hemoglobin; pancytopenia, eosinophilia; the use of the latter can cause the appearance of pinpoint or larger hematomas, nosebleeds.

These drugs can provoke the development of superinfection, reinfection, mycoses, the emergence of bacterial strains resistant to them, and photosensitivity phenomena.

Doxycycline causes permanent discoloration of tooth enamel.

The longest list of side effects is associated with fluorinated quinolones. In addition to those already mentioned, these drugs can cause:

• metabolic and exchange disorders;
• mental disorders manifested in an overexcited state, insomnia and nightmares, paranoid and depressive disorders, phobias, disorientation in space, suicide attempts, etc.;
• disorders of the central and peripheral nervous system;
• visual disorders (photophobia, diplopia, conjunctivitis, nystagmus);
• hearing and motor coordination disorders;
• disturbances in the functioning of the heart, including cardiac arrest and cardiogenic shock, thrombosis of cerebral vessels;
• disruption of the respiratory system, even to the point of respiratory arrest;
• pain in muscles, joints, tendons, damage and rupture of their tissue, and during the first two days of taking the drug; muscle weakness;
• all kinds of disorders of the urinary system, candidiasis, formation of kidney stones;
• in patients with hereditary porphyria - exacerbation of the disease;
• in addition – asthenic syndrome, back pain, hyperthermia, fever, weight loss, taste and smell perversions.

Overdose

Exceeding the dose of macrolides manifests itself in symptoms of digestive system disorders (diarrhea, nausea, abdominal pain, and sometimes vomiting).

Overdose of Doxycycline or fluorinated quinolones manifests itself as a neurotoxic reaction - dizziness, nausea, vomiting, convulsions, loss of consciousness, headache.

Treatment: gastric lavage, administration of activated charcoal.

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Interactions with other drugs

This factor must be taken into account in order to achieve maximum effectiveness from drug treatment and neutralize the negative effects that arise.

Basically, the mutual influence of macrolide antibiotics with various drugs is associated with the inhibition of the cytochrome P-450 system by these drugs. The ability to suppress this system increases in the specified group of antibacterial agents in the following sequence: Spiramycin → Azithromycin → Roxithromycin → Josamycin → Erythromycin → Clarithromycin.

With the corresponding intensity, representatives of the specified pharmacological class slow down the biological transformation and increase the serum density of indirect anticoagulants, theophylline, finlepsin, valproates, disopyramide derivatives, ergot-based drugs, cyclosporine, respectively, increasing the likelihood of development and the strength of side effects of the listed drugs. Therefore, it may be necessary to change their dosage regimen.

It is not advisable to use macrolide antibiotics (with the exception of Spiramycin) simultaneously with fexofenadine, cisapride, and astemizole, since this combination significantly increases the risk of severe arrhythmias caused by prolongation of the QT interval.

Antibiotics of this series help improve the absorption of oral digoxin, as they reduce its inactivation in the intestine.

Antacid medications reduce the absorption of macrolide antibacterial agents in the digestive tract, and Azithromycin is particularly susceptible to this effect.

The anti-tuberculosis antibiotic Rifampicin accelerates the process of biotransformation of macrolides by the liver and, accordingly, reduces their plasma concentration.

Combined use with lincosamide antibiotics is not recommended, since competition between them is likely (they have a similar effect).

Drinking alcohol during treatment with any antibiotics is unacceptable, but it should be taken into account that Erythromycin, especially its intravenous injections, increases the risk of acute alcohol intoxication.

The absorption of Doxycycline is reduced by antacids and laxatives containing magnesium salts, antacids containing aluminum and calcium salts, medicinal and vitamin preparations containing iron, sodium bicarbonate, cholestyramine and colestipol, therefore, when they are prescribed in combination, the intake is spaced out over time, with an interval of at least three hours.

Since the drug disrupts the intestinal microbiocenosis, thrombocytopenia occurs and a change in the dose of indirect anticoagulants is required.

Simultaneous administration with penicillin and cephalosporin drugs, as well as others whose mechanism of action is based on disruption of the synthesis of the bacterial cell membrane, is inappropriate, since it neutralizes the effect of the latter.

Increases the risk of unwanted pregnancy when combined with estrogen-containing contraceptives.

Substances that activate the process of microsomal oxidation (ethyl alcohol, barbiturates, rifampicin, finlepsin, phenytoin, etc.) increase the rate of breakdown of Doxycycline and decrease its serum concentration.

Combination with methoxyflurane is fraught with the risk of developing acute renal failure and even death of the patient.

Taking vitamin A while taking Doxycycline may cause an increase in intracranial pressure.

The simultaneous inclusion in the regimen of taking fluorinated quinolones with medications that contain bismuth, zinc, iron, and magnesium ions is absorbed significantly worse due to the creation of non-absorbable chelate compounds with them.

Ciprofloxacin, Norfloxacin and Pefloxacin reduce the excretion of methyl xanthine derivatives (theobromine, paraxanthine, caffeine) and increase the likelihood of mutual toxic effects.

The neurotoxic effect of fluorinated quinolones increases with combined use with non-steroidal anti-inflammatory drugs, as well as nitroimidazole derivatives.

Incompatible with nitrofuran-based medications.

Ciprofloxacin and Norfloxacin have the ability to disrupt the process of biotransformation of indirect anticoagulants in the liver, as a result of which the likelihood of blood thinning and hemorrhagic phenomena increases (it may be necessary to adjust the dose of the antithrombotic drug).

Fluoroquinolones are not prescribed in the same regimen with cardiac drugs that prolong the QT interval due to the high risk of cardiac arrhythmia.

Combined use with glucocorticoid hormones is dangerous due to the high probability of tendon injuries; elderly patients are at increased risk.

The use of Ciprofloxacin, Norfloxacin and Pefloxacin in combination with medications that alkalize urine (sodium bicarbonate, citrates, carbonic anhydrase inhibitors) increases the likelihood of stone formation and the nephrotoxic effect of such a combination of medications.

When taking azlocillin or cimetidine, due to a decrease in tubular secretion, the rate of elimination of fluoroquinolone antibiotics from the body decreases and their plasma concentration increases.

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Information for patients

It is necessary to observe the storage conditions of the drug and the expiration date indicated on the package. Never use drugs whose expiration date has expired or whose appearance has changed (color, smell, etc.).

Currently, macrolides are positioned as the most effective antibiotics for chlamydia. They have the highest ability among other antibacterial drugs to penetrate into the cell and affect the pathogens that have settled there. They are effective, microbes have not yet lost sensitivity to them. Low toxicity of macrolide antibiotics is also a positive factor in favor of their use. However, there is no single approach to all patients and cannot be, since the choice of treatment regimen is influenced by many factors - from individual tolerance to the degree of neglect of the disease and the patient's health.

Treatment, as practice shows, is not always effective. And the question often arises, why do chlamydia symptoms not go away after antibiotics? There are many reasons for this. First of all, the irresponsibility of the patient himself. Not everyone strictly follows medical prescriptions, adheres to the regimen for the entire course of treatment. And also withstands its duration and does not stop treatment without control tests.

In addition, both partners must be treated. Chlamydia can be transmitted countless times, especially if there is a source of infection nearby.

During the course of treatment, it is necessary to abstain from sex. If you took Azithromycin once, then you still need to make sure that you are cured after a week. It is recommended to undergo a control examination after three months or later to make sure that the pathogen has been destroyed.

If symptoms return, you should definitely see a doctor. Re-infection can lead to serious complications.

The question often arises: how to cure chlamydia without antibiotics? The official answer: eradication of chlamydia without antibiotics is not yet possible. Science does not stand still, however, such treatment is a task for the future. True, several options for treating chlamydia with herbs and dietary supplements are described on the Internet. No one is prohibited from trying alternative methods, you just need to take into account that by delaying the process, you risk complicating the course of the disease, and then it will be much more difficult to get rid of it.