Antibiotics for pharyngitis

Pharyngitis is an inflammatory process of the mucous surface of the pharynx, which can be caused by both bacterial and viral infections. Do you need to take antibiotics for pharyngitis? After all, there is an opinion that pharyngitis can go away on its own within 15-20 days and without treatment.

Treatment of pharyngitis with antibiotics is not always practiced. Often the disease occurs when exposed to viruses, which, as is known, antibiotics do not work on. For this reason, antibacterial agents are prescribed by a doctor only when there is a threat of an infectious complication or when it develops.

Unfortunately, it is quite difficult for a doctor to immediately and accurately determine the nature of pharyngitis, and even more so to predict the prognosis of the pathology in the near future: the signs of bacterial and viral infections in inflammatory lesions of the pharynx are almost the same. However, despite this, specialists are in no hurry to prescribe antibiotics for pharyngitis, because the irrational use of such medications can negatively affect the composition of the microflora, both the intestines and the respiratory tract. Therefore, the appointment of antibacterial drugs must be determined by clear indications.

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Indications for the use of antibiotics for pharyngitis

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

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

Release form

Inflammatory disease of the pharynx often occurs as a result of a cold or acute rhinitis, and is also combined with them. For this reason, systemic and local antibiotics can be prescribed for pharyngitis - in the form of gargles, inhalations and irrigation.

For irrigation of the throat, combination products in aerosol packages are usually used.

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

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

In rare cases, an antibiotic is used in powder form, which is sprinkled on the affected areas of the mucous membrane using an insufflator.

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Pharmacodynamics of antibiotics in pharyngitis

The clinical effect of antibiotics in pharyngitis is mainly determined by its spread in the body, the ability to penetrate into the area of pathological damage. The effect may worsen with liver and kidney dysfunction.

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

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

At the first stage, the active component of the antibiotic is dissolved and released: it becomes available for absorption. The interaction of the antibacterial drug with other drugs, food residues and gastric enzymes leads to changes and some loss of activity of the antibiotic. The combination of food elements with drugs is usually carried out in the digestive system, with the formation of insoluble or poorly 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 in pharyngitis

After the antibiotic enters the body, the processes of absorption, distribution, metabolism and excretion of the drug occur in turn. At all these stages, the active substance affects the pathogen to varying degrees, starting with the detection of the antibiotic in the blood and until the complete release of the drug.

When an antibacterial agent is administered intramuscularly, there is a faster contact with pathogenic microorganisms, as well as a faster penetration of the drug into the infectious focus. The speed with which the drug enters the blood directly depends on the solubility characteristics of the drug in aqueous and fatty environments.

Sometimes the greatest effect can be achieved by administering antibiotics directly into the throat area, using sprays and aerosol injections.

The effect of an antibiotic on bacteria can last from several hours to several days, depending on the duration of 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.

Prescribing antibiotics can only be justified if the pharyngitis is obviously or presumably bacterial in origin. Unreasonable antibiotic therapy will contribute to the development of resistance (addiction) to the drugs, and undesirable side effects may also occur.

Antibiotic therapy may be initiated before the results of bacteriological analysis are available, based on clinical and epidemiological data that indicate a bacterial origin of the disease.

Antibiotics for acute pharyngitis are usually prescribed from the penicillin series. Less commonly, oral cephalosporins (cefazolin, ceftriaxone) can be used. In patients with an allergic reaction to β-lactams, it is necessary to use macrolide (erythromycin, azithromycin) and lincosamide antibiotics (lincomycin, clindamycin). We will discuss the recommended drugs, dosages and regimen below.

When using antibiotics to treat acute inflammation in the throat, the following factors should be taken into account:

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

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

The transition from an acute form of the disease to a chronic one can be caused by several reasons:

• incorrectly selected drug for the treatment of acute pharyngitis;
• violation of the doctor's orders by the patient (premature discontinuation of the drug, intentional reduction of the daily dosage, skipping a dose of the drug);
• the presence of concomitant foci of infection.

In order to prevent the development of a chronic form of the disease, it is necessary to follow certain rules:

• do not neglect to carry out bacteriological analysis;
• if local therapy is ineffective, do not delay in prescribing systemic drugs;
• Do not reduce or discontinue the drug prematurely if the patient's condition improves.

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Antibiotics for pharyngitis in children

Irrigation of the pharynx and throat in children with pharyngitis can be carried out with solutions or aerosols with local antibacterial agents - miramistin, orasept, and hexoral are used for treatment.

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

Systemic antibiotics (for oral administration) are used when there is a risk of complications, but it is better not to use them in the normal course of pharyngitis.

In cases where pharyngitis occurs against the background of tonsillitis, there are no contraindications for prescribing antibiotics. Children over 3 years old are prescribed antibacterial lozenges: Falimint or Strepsils.

If the bacterial nature of pharyngitis is proven (streptococcus, staphylococcus, hemophilus bacillus are detected), then the doctor will definitely prescribe an antibiotic, taking into account the sensitivity of the microorganisms. Remember that antibiotic therapy is prescribed only by a specialist and only in case of complicated course of the disease.

Antibacterial sprays should be used with great caution in children under 2 years of age. An unexpected injection of a drug for a child can provoke a spasmodic reflex of the larynx, causing suffocation. For this reason, the solution should be injected onto the side surfaces of the cheeks, but not directly into the neck. After using the aerosol, the child should not be allowed to drink or eat for 1-2 hours.

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Antibiotics for pharyngitis and laryngitis

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

The question of whether it is appropriate to prescribe antibiotics in such a situation should be decided by a doctor. Firstly, it depends on the etiology and course of the disease. Secondly, in the early stages the disease can be successfully treated with conventional methods. This is, first of all, resting the vocal cords, gargling, taking hot foot baths, inhalations, applying compresses to the neck area, and using physiotherapy procedures.

If such treatment is 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 drugs (oxacillin, ospen, ampicillin, augmentin).

Along with antibiotics, cough suppressants may be prescribed to prevent the infection from spreading to the lower parts, such as the bronchi.

To reduce the negative impact of antibiotics on the intestinal microflora, when treating with antibacterial drugs, you should additionally take capsules or sachets with bifidobacteria and lactobacilli, and consume fresh fermented milk products.

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Names of antibiotics for pharyngitis

The most common aids in the treatment of complicated pharyngitis are the following antibiotics:

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

Method of administration and dosage of antibiotics for pharyngitis

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

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

• benzathine penicillin - 2.4 million units intramuscularly once. This drug can be prescribed in cases where there are doubts that the patient has followed the recommended antibiotic treatment regimen, as well as in negative household and social conditions, or during streptococcal epidemics;
• amoxicillin - 5 mg three times a day;
• cefadroxil - 5 mg twice a day;
• phenoxymethylpenicillin - 5 mg three times a day 60 minutes before meals (recommended for use in pediatric practice after specifying the dose depending on age);
• azithromycin - 5 mg once on the first day of treatment, then 0.25 g once a day 60 minutes before meals. The course of treatment is 4 days;
• clarithromycin – 0.25 g twice a day;
• midecamycin – 4 mg three times a day 60 minutes before meals;
• roxithromycin – 0.15 g twice a day for 10 days;
• erythromycin - 5 mg three times a day (erythromycin can cause the maximum number of side effects);
• clindamycin – 0.15 g four times a day for 10 days;
• cefuroxime – 0.25 g twice a day immediately after meals, for 10 days.

It is recommended to use the selected antibiotic for several days after the disappearance of clinical signs of pharyngitis: stabilization of temperature, relief of sore 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 well-being of the pregnant patient, symptomatic therapy is often sufficient: warm milk with honey, steam inhalation procedures, gargles and compresses. Let us recall that uncomplicated pharyngitis does not require the prescription of systemic antibiotics. Sometimes, at the discretion of the doctor, local antibiotic therapy can be used, which reveals a minimal number of side effects and harm to the fetus and pregnancy as a whole.

Only a medical specialist can prescribe the use of antibiotics for pharyngitis during pregnancy after examining the woman and assessing the potential risk to the expectant mother and baby.

Contraindications to the use of antibiotics for pharyngitis

Before using antibiotics, please read some contraindications for use:

• hypersensitivity to antibiotics or to a specific group of antibacterial agents;
• pregnancy period (especially the first trimester);
• breastfeeding period (you can stop breastfeeding for the period of forced antibiotic use);
• phenomena of renal and hepatic insufficiency.

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

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Side effects of antibiotics for pharyngitis

The use of antibiotics is often accompanied by the appearance of unwanted side effects. Such manifestations for each drug can vary significantly, but the following effects can be observed most often:

• development of an allergic reaction: allergic dermatitis, rhinitis, inflammation of the conjunctiva of the eye, angioedema, anaphylaxis;
• dyspeptic phenomena: pain in the stomach, attacks of nausea and vomiting, development of dysbacteriosis, flatulence, indigestion, enterocolitis;
• anemia, a decrease in the number of platelets and leukocytes in the blood;
• joint pain, appearance of pinpoint hemorrhages;
• febrile conditions;
• development of fungal diseases, thrush, mycoses;
• with intramuscular injection - the appearance of infiltrate and pain at the injection site;
• when applied locally – redness of the mucous membranes, reflex spasm of the larynx, asthma attack.

Overdose

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

Treatment of this condition is symptomatic; hemodialysis and peritoneal dialysis in case of antibiotic overdose are usually ineffective.

Interactions with other drugs

The degree of interaction of antibiotics for 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 drugs, cross-allergic sensitivity to cephalosporin antibiotics may be observed.

Semi-synthetic penicillins can enhance the effectiveness of direct and indirect anticoagulants, as well as fibrinolytic agents and antiplatelet agents.

When antibiotics and non-steroidal anti-inflammatory drugs are taken simultaneously, the risk of developing side effects increases.

Tetracycline drugs and macrolide antibiotics reduce the bactericidal effect of penicillins.

Storage conditions

Tablet and powder forms of antibacterial drugs are stored in a place protected from direct sunlight at a temperature of up to 25 °C, out of reach of children. Shelf life is up to 2 years.

Aerosols and solutions of antibacterial preparations are recommended to be stored in dry, dark places at a temperature of +8 to +15 °C. Shelf life is from 1 to 2 years.

Before using antibiotics for pharyngitis, it is necessary to consult a doctor, since this article is offered only to obtain general information on the topic. In order to obtain more complete information, consult a doctor and carefully read the instructions for a 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 infections usually require the use of natural penicillins (benzylpenicillin, etc.).

To suppress group A streptococcal infection and pneumococci, broad-spectrum semisynthetic penicillins are used. Usually, this is the prescription of ampicillin or carbenicillin.

Ampicillin is active against gram-negative bacteria, some types of Proteus and E. coli. This drug is used in pediatric and adult practice for tonsillitis, infectious pathologies of the respiratory system, inflammatory process in the ear, etc.

Carbenicillin acts on bacterial flora similarly to ampicillin. It is active against Pseudomonas aeruginosa and all types of Proteus.

For infections caused by staphylococcus, treatment with semi-synthetic penicillinase-resistant antibiotics is preferable - oxacillin, dicloxacillin.

Dicloxacillin is several times more active than oxacillin, so it is prescribed in smaller doses for equivalent disease progression.

More complex cases, when the above medications have no effect, require the prescription of complex antibiotics.

The cephalosporin group of antibiotics is currently prescribed most often. These include cefazolin and ceftriaxone. In terms of the breadth and method of action on bacteria, they are close to semi-synthetic penicillins.

For moderate pathologies requiring antibiotics, macrolides (erythromycin, oleandomycin) can be used.

Tetracycline drugs, which were very common earlier, have now lost their positions and are no longer considered the first choice. They can be prescribed for microflora resistant to other antibiotics, or for hypersensitivity to the penicillin group. In addition, tetracycline antibiotics are not prescribed to children under 8 years of age, as well as during pregnancy and breastfeeding.

Semi-synthetic tetracyclines (morphocycline, metacycline) have a certain advantage over conventional tetracyclines: they can be prescribed in smaller doses, so the side effects when using them are less pronounced.

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