Antibiotics for pharyngitis

Pharyngitis is an inflammatory process of the mucosa of the pharynx, which can be caused by both bacterial and viral infection. Do I need to take antibiotics with pharyngitis? After all, there is an opinion that pharyngitis can pass by itself for 15-20 days and without treatment.

The treatment of pharyngitis with antibiotics is in fact not always practiced. Often, the disease occurs when exposed to viruses, which, as is known, antibiotics do not work. For this reason, antibacterial agents are prescribed by the doctor only if there is a threat of appearance or with the development of an infectious complication.

Unfortunately, it is very difficult to determine the nature of pharyngitis at once and accurately, and even more so to forecast the pathology for the near future: signs of bacterial and viral infection in inflammatory lesions of the pharynx are almost identical. However, despite this, experts are slow to prescribe antibiotics for pharyngitis, because the irrational use of such medications can adversely affect the composition of the microflora, both the intestine and the respiratory tract itself. Therefore, the appointment of antibacterial drugs must necessarily be determined by clear indications.

[1], [2], [3], [4], [5]

Indications for use of antibiotics for pharyngitis

For preventive purposes, to prevent the development of complications of bacterial etiology, indications for the use of antibiotics for pharyngitis are:

• the development of bacterial angina, or exacerbation of the chronic form of tonsillitis;
• facts that indicate the risk of developing pneumonia;
• inflammatory disease of the bronchi (especially obstructive form);
• purulent otitis media;
• the spread of infection in the nasal sinuses;
• febrile conditions, lasting more than 2 days, or earlier, at the discretion of the doctor;
• subfebrile temperature, which persists for more than 5-6 days;
• a prolonged course of pharyngitis (more than a month).

Form of issue

Inflammatory pharyngeal disease often occurs due to a cold or acute rhinitis, and also is combined with them. For this reason, with pharyngitis, antibiotics of systemic and local action can be prescribed - in the form of rinses, inhalations and irrigation.

For irrigation of the pharynx, combined agents in aerosol packages are usually used.

Some antibacterial solutions are used to lubricate the pharyngeal mucosa, or to treat individual granules on the posterior wall of the pharynx and lateral pharyngeal ridges.

For systemic treatment, antibiotics can be used in the form of intramuscular injections, as well as in the form of tablets and capsules for oral administration.

In rare cases, an antibiotic is used in a powdered form, which the affected areas of the mucosa are sprinkled with an insufflator.

[6], [7], [8], [9]

Pharmacodynamics of antibiotics with pharyngitis

The clinical effect of antibiotics in pharyngitis is mainly determined by its spread in the body, the ability to penetrate the area of pathological lesion. The effect may worsen in cases of violations of the liver and kidneys.

What happens to the drug when it enters the body? Usually this is due to the peculiarities of metabolism, as well as the ability to bind to serum proteins.

The optimal degree of absorbability of the drug is also considered a guarantee of successful therapeutic effect. In addition, antibacterial drugs are exposed to enzymes inside the body, which contributes to the formation of unnecessary or even toxic substances.

At the first stage, the active ingredient of the antibiotic dissolves and releases: it acquires access to absorption. The interaction of the antibacterial drug with other drugs, with food residues and gastric juice enzymes leads to changes and some loss of antibiotic activity. The connection of food elements with medications is carried out, as a rule, in the digestive system, with the formation of insoluble or slightly soluble compounds with a poor degree of adsorption.

Tetracycline drugs usually form a bond with calcium (a component of dairy products). Under the influence of food elements, the absorption of tetracycline, penicillin antibiotics, as well as erythromycin, rifampicin and some other drugs is somewhat impaired.

Pharmacokinetics of antibiotics with pharyngitis

After getting the antibiotic, the processes of absorption, distribution, metabolism and elimination of the drug take place in the body. At all these stages, the active substance acts on the pathogen in varying degrees, beginning with the detection of the antibiotic in the blood and until the drug is completely released.

With intramuscular injection of an antibacterial agent, a faster contact with pathogenic microorganisms is observed, as well as an early entry of the drug into the infectious focus. The rate at which the drug enters the bloodstream depends directly on the solubility characteristics of the preparation in aqueous and fatty environments.

Sometimes the greatest effect can be achieved by injecting antibiotics directly into the pharynx, using sprays and aerosol injections.

The effect of an antibiotic on bacteria can last for several hours, and for several days, depending on the prolonged action of a particular drug.

Antibiotics for pharyngitis in adults

The purpose of prescribing antibiotics for pharyngitis in adults is not only to eliminate signs of infection and improve the patient's condition, but also to prevent the development of early and subsequent complications.

The administration of antibiotics can be justified only if the pharyngitis is clearly or allegedly bacterial. Unfounded antibiotic therapy will contribute to the formation of resistance (addiction) to drugs, in addition, there may be undesirable side effects.

Antibiotic therapy can be started before the results of bacteriological analysis are obtained, based on the clinical picture and epidemiology, which indicate the bacterial origin of the disease.

Antibiotics for acute pharyngitis are usually prescribed from the penicillin series. Oral cephalosporins (cefazolinum, ceftriaxone) can be used less often. In patients with an allergic reaction to β-lactams, macrolide (erythromycin, azithromycin) and lincosamide antibiotics (lincomycin, clindamycin) should be used. We will talk about the recommended preparations, dosages and administration regimen below.

When using antibiotics in the treatment of acute inflammatory process in the pharynx, it is necessary to take into account such factors:

• for the destruction of pathogenic bacteria it is necessary to undergo a ten-day course of antibiotic therapy (the exception is azithromycin, used for five days);
• the earlier antibacterial drugs are prescribed, the easier and faster the organism will cope with the disease;
• Sometimes after antibiotic therapy, a repeated bacteriological analysis may be necessary.

Antibiotics for chronic pharyngitis are appointed during the period of exacerbation of the disease. If antibiotics have already been used to treat pharyngitis, the doctor has to prescribe stronger preparations of a wide range of effects.

The transition of the acute form of the disease into a chronic one can be due to several reasons:

• incorrectly selected drug for the treatment of acute pharyngitis;
• violation by the patient of prescriptions of the doctor (premature cancellation of the drug, deliberate decrease in daily dosage, skipping of the drug);
• presence of concomitant foci of infection.

In order to prevent the development of a chronic form of the disease, you must follow certain rules:

• Do not neglect bacteriological analysis;
• if the local therapy is ineffective, do not delay with the prescription of systemic drugs;
• Do not shorten or abolish the drug ahead of time with an improvement in the patient's condition.

[14], [15], [16]

Antibiotics for pharyngitis in children

Irrigation of the pharynx and throat in children with pharyngitis can be carried out by solutions or aerosols with antibacterial agents of topical application - for treatment use miramistin, orasept, hexoral.

In the treatment of the inflammatory process of the pharynx, antibiotics of local action are often used. Drugs are selected depending on the age and the spectrum of action, taking into account also the possibility of allergies and side effects.

Antibiotics of systemic exposure (for oral administration) are used in case of a risk of complications, however, in the usual course of pharyngitis, it is better not to use them.

In cases where pharyngitis occurs against the background of sore throats, there are no contraindications for prescribing antibiotics. Children older than 3 years are prescribed antibacterial candies: falimint or strepsils.

If the bacterial nature of pharyngitis is proven (streptococcus, staphylococcus, hemophilic rod), then the doctor will prescribe an antibiotic, given the sensitivity of the microorganisms. Remember that antibiotic therapy is prescribed only by a specialist and only with a complicated course of the disease.

With great care should be taken to use antibacterial sprays in infants up to 2 years of age. Unexpected for the child, the injection of the drug is capable of provoking a spasmodic reflex of the larynx, causing suffocation. For this reason, the solution should be injected on the side surfaces of the cheeks, but not directly into the neck. After using the aerosol, the child should not be allowed to drink and eat for 1-2 hours.

[17], [18], [19], [20], [21]

Antibiotics for pharyngitis and laryngitis

Pharyngitis often occurs in conjunction with laryngitis: this happens when the inflammatory process affects not only the pharynx, but also the larynx.

The question of the expediency of prescribing antibiotics in such a situation should be decided by the doctor. First, it depends on the etiology and course of the disease. Secondly, in the early stages of the disease can be successfully treated with conventional methods. This is, first of all, the peace of the vocal cords, gargling, taking hot foot basins, carrying out inhalations, putting compresses on the neck area, applying physiotherapy procedures.

If such treatment turns out to be ineffective, and the process drags on, only then can we talk about the possibility of using antibiotic therapy. It is advisable to use antibiotics of the penicillin group, and if they are ineffective, semi-synthetic penicillin preparations (oxacillin, ospen, ampicillin, augmentin).

Simultaneously with antibiotics, antitussives can be prescribed to ensure that the infection does not sink to the lower parts, for example, to the bronchi.

To reduce the negative effects of antibiotics on the intestinal microflora, with antibiotic therapy should additionally take capsules or sachets with bifidobacteria and lactobacilli, use fresh sour-milk products.

[22], [23], [24], [25]

Names of antibiotics for pharyngitis

The most frequent helpers in the treatment of a complicated course of pharyngitis are the following antibiotics:

• penicillins (amoxicillin, benzylpenicillin, phenoxymethylpenicillin);
• cephalosporin preparations (cefadroxil, ceftriaxone);
• macrolide antibiotics (erythromycin, spiramycin, azithromycin, roxithromycin, clarithromycin, midecamycin);
• Lincosamides (lincomycin, clindamycin).

Method of administration and dose of antibiotics against pharyngitis

With local treatment of pharyngitis, drugs that affect microorganisms that inhabit the mucous membrane of the pharynx are used. For example, it is rational to use fyuzafyunzhin-aerosol: it has antimicrobial and anti-inflammatory activity, blocks the spread of infection in the lower respiratory organs, and also promotes rapid healing of irritated tissue surfaces.

Systemic use of antibiotics can be carried out according to different schemes and combinations of drugs. As a rule, the following antibiotics can be prescribed in the appropriate dosages:

• Benzathine penicillin - 2.4 million units. In / m once. This drug can be prescribed in cases where there is a doubt that the patient adhered to the recommended regimen of antibiotic treatment, as well as under adverse domestic and social conditions, or with streptococcal epidemics;
• amoxicillin - 5 mg three times a day;
• cefadroxil - 5 mg twice a day;
• phenoxymethylpenicillin - 5 mg three times a day for 60 minutes before meals (recommended for use in children's practice after adjusting the dose according to age);
• azithromycin - 5 mg once in the first day of treatment, then 0.25 g once a day for 60 minutes before meals. The course of treatment is 4 days;
• clarithromycin - 0.25 g twice daily;
• midekamycin - 4 mg three times a day for 60 minutes before meals;
• roxithromycin - 0.15 g twice a day for 10 days;
• erythromycin - 5 mg three times per day (erythromycin can have the maximum amount of adverse events);
• clindamycin - 0.15 g four times a day for 10 days;
• cefuroxime 0.25 g twice daily, immediately after ingestion, for 10 days.

It is recommended to use the selected antibiotic for several days after the disappearance of the clinical signs of pharyngitis: temperature stabilization, relief of soreness of the throat, restoration of the normal state of the lymph nodes.

Use during pregnancy

In acute and chronic pharyngitis, the course of which is not accompanied by critical changes in the state of health of a pregnant patient, it is often sufficient to carry out symptomatic therapy: warm milk with honey, steam inhalation procedures, rinses and compresses. Recall that an uncomplicated course of pharyngitis does not need the appointment of systemic antibiotics. Sometimes, at the physician's discretion, local antibiotic therapy can be used, which reveals a minimal amount of side effects and harm to the fetus and pregnancy in general.

The appointment of antibiotics for pharyngitis during pregnancy can only be performed by a medical specialist after conducting a woman's examination and assessing the potential risk to the future mother and baby.

Contraindications to the use of antibiotics with pharyngitis

Before using antibiotics, read some of the contraindications for use:

• hypersensitivity to antibiotics or to a specific group of antibacterial agents;
• period of pregnancy (especially the first trimester);
• the period of breastfeeding (you can stop breastfeeding during the forced intake of antibiotics);
• the phenomenon of renal-hepatic insufficiency.

Each drug may have its own additional list of contraindications, so read the instructions carefully before use.

[10], [11], [12], [13]

Side effects of antibiotics with pharyngitis

The use of antibiotics is often accompanied by the appearance of undesirable side effects. Such manifestations in each drug may differ significantly, but more often the following effects can be observed:

• development of an allergic reaction: allergic dermatitis, runny nose, conjunctival eye inflammation, angioedema, anaphylaxis;
• dyspeptic phenomena: pain in the stomach, attacks of nausea and vomiting, development of dysbiosis, flatulence, indigestion, enterocolitis;
• anemia, a drop in the number of platelets and leukocytes in the blood;
• pain in the joints, the appearance of pinpoint hemorrhages;
• feverish conditions;
• development of fungal diseases, thrush, mycoses;
• when administered intramuscularly - the appearance of infiltration and soreness at the injection site;
• with topical application - reddening of mucous membranes, reflex spasm of the larynx, suffocation.

Overdose

With prolonged use of antibiotic therapy in large doses, changes in the blood picture can be observed (signs of leukopenia, neutropenia, thrombocytopenia, hemolytic anemia).

The treatment of this condition is symptomatic, hemodialysis and peritoneal dialysis with an overdose of antibiotics usually does not bring any effect.

Interactions with other drugs

The degree of interaction of antibiotics with pharyngitis with other drugs depends on the mechanism of action and composition of the drug.

In patients with a tendency to allergic reactions to penicillin preparations, there may be a cross-allergic sensitivity to cephalosporin antibiotics.

Semisynthetic penicillins can enhance the effectiveness of anticoagulants of direct and indirect action, as well as fibrinolytic agents and antiplatelet agents.

With the simultaneous administration of antibiotics and non-steroidal anti-inflammatory drugs, the possibility of developing side effects increases.

Preparations of the tetracycline series and macrolide antibiotics reduce the bactericidal effect of penicillins.

Storage conditions

Tableted and powdered forms of antibacterial drugs are stored in a place protected from direct sunlight at a temperature of up to 25 ° C, outside the children's access zone. Shelf life - up to 2 years.

Aerosols and solutions of antibacterial drugs should be stored in dry, dark places at temperatures from +8 to +15 ° C. Shelf life - from 1 to 2 years.

Before applying antibiotics for pharyngitis, it is necessary to consult with the doctor, since this article is offered only for general information on the topic. In order to get more information, contact your doctor and carefully read the instructions for the specific antibiotic.

The best antibiotic for pharyngitis

The choice of antibiotic for pharyngitis in adults and children should be determined by the characteristics and severity of the disease.

Streptococcal, pneumococcal and anaerobic infection presupposes, as a rule, the use of natural penicillins (benzylpenicillin, etc.).

For the suppression of streptococcal infection of group A and pneumococci, the action of semisynthetic penicillins of a wide range of effects is used. Usually this is an ampicillin or carbenicillin.

Ampicillin is active against gram-negative bacteria, certain types of proteas and E. Coli. This drug is used in children's and adult practice in tonsillitis, infectious pathologies of the respiratory system, inflammatory process in the ear, etc.

Carbenicillin acts on a bacterial flora similar to ampicillin. He is active in relation to the Pseudomonas aeruginosa and all types of proteas.

With infection caused by staphylococcus, it is preferable to treat with semi-synthetic penicillin-resistant antibiotics - oxacillin, dicloxacillin.

Dicloxacillin is several times more active than oxacillin, so it is prescribed in smaller doses for an equivalent course of the disease.

More complex cases, when there is no effect from the above drugs, require the appointment of complex antibiotics.

More often than others, a cephalosporin group of antibiotics is currently prescribed. They include cefazolinum, ceftriaxone. In latitude and the way they affect bacteria, they are close to semisynthetic penicillins.

At moderate pathologies that require the appointment of antibiotics, macrolides (erythromycin, oleandomycin) can be used.

Tetracycline drugs, very common earlier, have now lost their positions and are no longer considered to be the main choice. They can be prescribed in a resistant microflora to the effects of other antibiotics, or in case of hypersensitivity to the penicillin group. In addition, tetracycline antibiotics are not prescribed until 8 years of age, as well as during pregnancy and feeding.

Semisynthetic tetracyclines (morphocycline, metacycline) have some advantage over conventional tetracyclines: they can be administered in smaller dosages, so side effects are less pronounced when used.

Long-term use of antibiotics can provoke the development of fungal diseases. For this reason, against the background of antibiotic therapy (especially tetracyclines) it is necessary to prescribe antifungal drugs.