Antibiotics for the treatment of osteoarthritis and arthritis of the joints: rheumatoid, reactive, and infectious arthritis

Arthritis is an inflammation of the intra-articular tissue. The symptoms of the disease are visually manifested by reddening of the skin and significant swelling in the projection of the inflammation site. There is an increase in local temperature in the area of the affected joint. The functions of large and small joints are impaired, active and passive movements are limited and accompanied by severe pain. According to the duration and course, arthritis is divided into acute and chronic. According to the generally accepted International Systematization of Diseases, 2 main groups of pathological conditions of articular tissue are distinguished depending on the causes that provoke them - inflammatory and infectious. Therapeutic measures for infectious arthritis are carried out in combination with antibacterial drugs. Antibiotics are not recommended during the treatment of destructive lesions of articular tissue of autoimmune inflammatory genesis.

Operating principle

Antibiotics suppress and destroy pathogenic bacteria that have entered the human body or significantly inhibit their reproduction. Antibiotics that are active against gram-positive and gram-negative strains of pathogens are called broad-spectrum antibiotics. Drugs that are active against a certain type of bacteria belong to the group of narrow-spectrum antibiotics.

The rate of bacterial growth suppression and destruction depends on the concentration of the antibiotic pharmacological preparation. The action of antibiotics can be synergistic, antagonistic or indifferent. For the treatment of arthritis caused by a bacterial pathogen, combinations of two or more preparations that enhance each other's action can be used.

Before starting to use an antimicrobial agent, it is mandatory to analyze the sensitivity of the pathological flora to different types of antimicrobial drugs. After completing the tests, the most active drug is selected and biological tests are carried out to determine the patient's tolerance to this drug.

The effect of destroying a bacterial infection depends on the dosage, duration of exposure and regularity of taking the antibiotic.

Indications antibiotics for arthritis

In case of arthritis of infectious genesis, antibiotics must be present in the complex treatment. Their prescription is justified in the following situations:

• A protracted disease in which, due to inflammatory reactions in the joint tissue, the patient experiences severe pain and limited functionality of the joint during active and passive movements;
• Exacerbation of chronic diseases of the nasopharynx (tonsillitis, sinusitis, etc.) during which the manifestations of arthritis become more pronounced;
• Infectious joint lesions with corresponding symptoms;
• Immunodeficiency states complicated by pathology of cartilage tissue;
• Gastrointestinal diseases.

Many experts are of the opinion that antibacterial drugs are not the only panacea for infectious pathological joint lesions and cause negative general and local reactions of the body. The main function of antibiotics is to combat pathological bacterial infection. There must be good reasons for prescribing and using antibacterial drugs. Self-medication with antibiotics is strictly prohibited, because only a doctor determines the characteristics of the course of the disease and prescribes the necessary medication.

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Release form

Antimicrobial drugs prescribed for the treatment of arthritis have the following pharmacological forms:

• Solution. The medicine is a liquid obtained by dissolving one or more solid active ingredients. It is used for injection, oral or external use. Penicillins, macrolides, etc. are produced in powder form for obtaining solutions. There are solutions in ampoules that are immediately ready for use.
• Tablets. A solid, strictly dosed form of medicine containing compressed active components, which include one or more substances.
• Ointments and liniments. An ointment is a soft, flexible form. A liniment is a type of ointment that has a more liquid consistency. Antimicrobial ointment-like forms are used externally. They are applied to skin areas with massage movements or prescribed by a doctor in the form of dressings on open post-traumatic lesions, as well as in the postoperative period for patients with arthropathies.
• Suppositories. These are medications that are solid at room temperature and melt under body temperature. They are used rectally.
• Drops. Presented as colloidal or homogeneous solutions. Dosage is carried out by drops.
• Suspension. Medicines that are a suspension of several ingredients, in which the solid components are in an undissolved state and are evenly distributed in the form of non-settling particles in the liquid.
• Aerosols. Medicines in the form of aerosol sprays in cans. Medicinal substances under the influence of compressed or liquefied gas when pressing on the can are evenly distributed over the treated surface.

Names

Treatment for each type of arthritis should be comprehensive, strictly individually selected and depending on the cause of the disease. For example, arthritis caused by a systemic disease is treated with cytostatics, and arthritis caused by an infection is treated with antibiotics. For the treatment of arthritis of infectious genesis, doctors use the following means, taking into account the patient's age:

• Newborn patients are prescribed - Oxacillin, Cefotaxime, Cefazolin, Aminoglycoside, Amoxicillin, Clavulanate, Ampicillin, Sulbactam.
• children under 6 years of age - Oxacillin, Ceftriaxone, Cefotaxime, Aminoglycoside;
• adults and children over 6 years old - Oxacillin, Cefazolin, Aminoglycoside, Amoxicillin, Clavulanate;
• in case of introduction of sexually transmitted bacteria, regardless of the age of the patient - Ceftriaxone, Cefotaxime, Fluoroquinolones.

When the arthritis symptom complex is relieved, the therapy continues for another 2 weeks. In the case of chronic infectious lesions of joint tissues, it is necessary to exclude the presence of the tuberculosis pathogen and mycotic infection.

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Antibiotics for Rheumatoid Arthritis

Rheumatoid arthritis (polyarthritis rheumatoidea) is a lesion of the joint tissue caused by beta-hemolytic streptococcus and accompanied by destructive inflammatory processes. If degenerative changes are actively progressing, it means that pathological bacterial flora is present in the body. Doctors rarely recommend antimicrobial drugs for rheumatoid arthritis. The therapeutic measures they prescribe are aimed at relieving pain, reducing swelling and local inflammation. Destruction of the bacterial pathogen, which is the main cause of the pathological condition of the joints, helps to stop the development of destructive intra-articular changes. Therapy for rheumatoid arthritis with antimicrobial drugs is appropriate and plays an important role in the treatment of the disease.

The grounds for prescribing antibiotics are:

• prevention of rheumatoid arthritis caused by acute or chronic infectious diseases (tonsillitis, flu, tonsillitis, etc.).
• protracted infectious and inflammatory processes accompanied by painful sensations in the joints;
• activation of chronic diseases (sinusitis, sinusitis, bronchitis, pyelonephritis and others), which may lead to the development of rheumatoid arthritis. The development of infection contributes to the appearance of negative manifestations from the joints;
• rheumatoid arthritis, with active long-term exposure to pathological factors, can be complicated by the occurrence of suppuration of the intra-articular fluid and osteomyelitis manifestations. The main signs of aggravation of the process are increased pain during movement and the occurrence of pain in a passive state, increasing hyperemia and swelling of the skin in the area of joint inflammation, general hyperthermia;
• immunodeficiency caused by drug therapy. This negative phenomenon accompanies the intake of many pharmaceuticals used in rheumatoid arthritis. This situation requires the prescription of antimicrobial drugs for therapy or for the prophylactic purpose of complications;
• a functional gastrointestinal disorder caused by suppression of local immunity when taking medications used to treat arthritis.

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Antibiotics for arthritis and arthrosis

Antimicrobial therapy is actively used to treat certain groups of joint diseases. This pathology includes septic arthritis, which is accompanied by the penetration of the pathogen into the intra-articular fluid. In the case of arthritis and arthrosis caused by a bacterial infection, the use of antibiotics is justified and mandatory.

When patients seek help from a doctor, most already have pronounced symptoms of arthritis: severe pain and limited full movement. Therefore, the main task of the specialist is to quickly establish a diagnosis and prescribe effective drug therapy. If there is a bacterial infection in the body, it is necessary to take into account the hematogenous route of introduction of the pathogen from the main focus into the joint tissues. The selection of the most effective antibiotic is carried out depending on the type of infection strain:

• the pathogen entered the joint with the bloodstream, due to urogenital diseases. In this case, tetracycline drugs (Tetracycline, Metacycline, Doxycycline) are needed, as well as drugs containing fluoroquinolone (Ofloxacin, Lovefloxacin) or macrolides (Azithromycin, Erythromycin, Sumamed);
• a patient with joint inflammation and severe symptoms of upper respiratory tract infection is prescribed drugs from the penicillin group (Carbenicillin, Acocicillin, Ampicillin), cephalosporins (Cefazolin, Cephalexin, Cefotaxime) or macrolides;
• In case of intestinal infection complicated by arthritis, medications containing fluoroxyquinolones (Lomefloxacin, Ofloxacin) are prescribed. These are broad-spectrum drugs that destroy the functioning of microorganism DNA.

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Antibiotics for reactive arthritis

Reactive arthropathy is a disease that is difficult to treat with medication. If the pathology is not advanced, then, by seeking medical help in time, you can slow down the process and avoid serious complications. The most common causative agents of the disease are chlamydia, shigella and salmonella. To rid the body of these pathogens, adequate and serious treatment with antibacterial drugs is necessary. The minimum course of antibiotic therapy lasts 1 week. According to numerous studies, the greatest effect of treatment is observed when using Azithromycin and Doxycycline. If the patient does not tolerate these drugs, the doctor prescribes Ofloxacin, Roxithromycin, Clarithromycin. Previously, such infections were treated with drugs from the macrolide group (Erythromycin). These are relatively inexpensive and effective antimicrobial agents, but their use causes many side effects from the gastrointestinal tract, which is why doctors prescribe the drugs listed above.

Unfortunately, treatment of chlamydial infection is a long and not always successful process. In order to determine the presence of infection in the patient's body and the effectiveness of the treatment measures, the doctor prescribes laboratory tests before and after the course of therapy. If the treatment fails to eliminate the chlamydial infection, another antibiotic must be prescribed.

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Antibiotics for arthritis of the foot

Arthritis of the foot is a fairly common joint problem these days. The pathology affects both the elderly and the young. The causes of foot arthritis are:

• rheumatoid arthritis;
• gout;
• osteoarthritis;
• reactive arthritis;
• lower limb injuries.

When arthritis symptoms appear, the joints of the foot must be treated as soon as possible, otherwise complications can be serious, up to the loss of motor function. It is dangerous to treat arthritis of the foot on your own; a consultation with an experienced doctor is necessary. The specialist begins the examination with an examination of the patient, a thorough collection of anamnesis, prescribes laboratory and instrumental examinations, then draws up a treatment plan, which includes:

• suppression of the autoimmune inflammatory process with non-steroidal drugs;
• removal and neutralization of uric acid;
• prescribing antibiotics (if the disease has worsened due to the introduction of pathogenic bacterial strains);
• gentle load on inflamed joints of the foot.

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Antibiotics for infectious arthritis

Infectious arthritis occurs when the body is affected by a mycotic, viral or bacterial infection that enters the joint tissue with the bloodstream. The pathogen enters the joint during surgeries, injuries, etc. The appearance of the provoking factor is associated with the patient's age. Infectious arthritis in newborns is caused by gonococcal infection, which is transmitted from a sick mother to a child. Infectious arthritis can affect children's joints after various manipulations without careful adherence to the rules of asepsis and antisepsis, for example, when inserting an intravenous catheter. The cause of this disease in the pediatric age group is very often staphylococcal infection or Pfeiffer's bacillus. In adult patients and adolescents, infectious damage to joint tissue is in most cases caused by streptococci, less often by staphylococci. Elderly patients suffer from infectious arthritis, which develops when Pseudomonas aeruginosa or salmonella enter the joint.

Infectious arthritis therapy should be performed in a hospital and use a combination of medication and physical therapy for several weeks. If the patient's condition is moderate, a course of treatment begins with the use of antibiotics administered intravenously. The course of therapy lasts 2 weeks, and then the patient takes oral antibiotics for a long time.

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Antibiotics for purulent arthritis

Purulent inflammation of the joints in the acute stage requires emergency treatment, otherwise the joint is destroyed. The success of the treatment of purulent arthritis depends entirely on the timely administration of effective antibiotics. Therapy begins with broad-spectrum antibacterial drugs, which are administered by injection at the beginning of treatment. Determining the causative agent of purulent arthritis allows the doctor to adjust the prescription and use stronger drugs. The following antimicrobial agents are standardly used to inhibit the growth of bacterial microflora in the joints:

• Ampicillin is a semi-synthetic penicillin active against both gram-positive and gram-negative bacteria, excluding Pseudomonas aeruginosa. It is produced in tablet form, powder required for the preparation of injection solutions. Adults are administered 500 mg at a time, the daily dosage is 2-3 g. Injections are administered at equal time intervals. The daily dosage for children is 100-400 mg / kg of body weight.
• Amoxicillin belongs to the same series of antimicrobial agents as ampicillin. It has a similar clinical effect and has similar antibacterial activity. It is possible to use the pharmaceutical drug in tablet form for less advanced pathological processes in purulent arthrosis. For adult patients and children over 10 years old, a single dose of 250-500 mg is recommended. For children aged 5 to 10 years, a single dose of 250 mg is indicated, 2-5 years - 125 mg.

Due to the fact that some microorganisms that provoke acute purulent processes in joint tissue synthesize penicillinase, which neutralizes the action of antibiotics of the penicillin group, combined preparations of antimicrobial agents with clavulanic acid, which destroys penicillinase, are used to increase efficiency.

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Antibiotics for gouty arthritis

Gout is a systemic disease that occurs when uric acid metabolism is disrupted. Increased levels of uric acid (7,9-Dihydro-1H-purine-2,6,8(3H)-trione) in the bloodstream lead to the appearance of uric acid salts in various tissues, which manifests itself in recurring acute arthritis and the formation of tophi (gouty nodes). The basis of therapy and diet for gout is monitoring the content of 7,9-Dihydro-1H-purine-2,6,8(3H)-trione acid in the body. A consultation with a rheumatologist is necessary for the treatment of gout. In this situation, a specialist prescribes drugs that reduce the content of uric acid and accelerate its elimination from the body. The goals of drug treatment of gouty manifestations:

• reducing the concentration of uric acid in the patient's body;
• reduction of manifestations of the inflammatory process;
• relief of pain.

Antibiotics are not used in classical therapy of gout. They are necessary if a bacterial infection occurs, which has entered the body during exacerbation of ENT diseases, the occurrence of acute intestinal infections, surgical interventions, open injuries.

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Pharmacodynamics

The pharmacodynamics section studies the mechanisms of the drug's effect on the body (pharmacological effect, duration and strength of the active ingredient's effect). Antibiotics, entering the infection site with the bloodstream, affect microorganisms in different ways. Some destroy the structure of bacteria, others block their reproduction. In pharmacology, antibacterial agents are classified:

• Bactericidal - destroy microorganisms (Penicillin, Cephalosporin);
• Bacteriostatic - block the proliferation of bacteria (Tetracycline, Erythromycin).
• Among antimicrobial drugs, there is a group of broad-spectrum antibiotics that are active against several types of bacteria.

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Pharmacokinetics

The concept of pharmacokinetics combines absorption, distribution, metabolic changes and excretion of active ingredients of the drug. The chain of pharmacokinetic transformations of antibiotics begins from the moment the components of the drug enter the bloodstream until its complete disintegration and excretion from the bloodstream.

The active effect of antibiotics in arthritis depends on the following factors:

• doses of active ingredient;
• duration of drug use;
• regularity of taking the medicinal form;
• the speed of its metabolic breakdown in the body;
• rates of elimination from the bloodstream.

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Dosing and administration

In the complex treatment of arthritis with antibiotics, it is necessary to additionally use antiphlogistic, analgesic and restorative medications. The duration of therapy can be several months, but this does not apply to antimicrobial agents. Antibiotics are prescribed in courses of treatment, in a dosage and regimen strictly determined by the doctor. If the cause of reactive arthritis was angina, then the treatment regimen contains antimicrobial drugs combined with antirheumatic drugs to eliminate the source of infection:

• Azithromycin must be taken once in tablets for 7 days.
• Doxycycline in capsules - 1 capsule twice a day. The treatment cycle is 7 days.
• If it is not possible to eliminate the source of infection, another combination of antimicrobial agents is used.

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Use antibiotics for arthritis during pregnancy

Doctors recommend that women who have undergone a course of treatment with antibiotics or other medications refrain from planning a pregnancy for up to 3 months. During this period, the components of the drugs will be completely eliminated from the body's tissues, the immune system will recover and the gestation period will pass without any particular problems. If taking antibiotics could not be avoided, and pregnancy has occurred, you should consult a geneticist, because some antimicrobial agents affect the formation of the fetus, i.e. have a teratogenic effect. During the first 2 weeks, the embryo has no connection with the mother's circulatory system and the risk of disruption of its development from taking antibiotics is minimal. When treating arthritis in the gestation period, taking antimicrobial drugs is not recommended. In the 1st trimester of pregnancy, it is advisable not to use antibiotics in any dosage forms for the treatment of arthritis, because the formation of the main systems and organs of the fetus occurs.

If there is a need to take antibacterial drugs for urgent treatment of arthritis in the first trimester of gestation, it is advisable to refuse a course of antibiotic therapy and prefer less toxic drugs. The decision to prescribe certain pharmaceuticals for the course of treatment of inflammatory phenomena in the joint tissue is made by the doctor.

Taking antimicrobial agents does not mean that the newborn will necessarily have health problems after birth. To monitor the correct development of the fetus, the doctor will recommend undergoing the necessary laboratory and hardware examinations.

Sometimes an infection caused by microorganisms poses a much greater danger to the proper development of the child in the womb than taking antimicrobial agents with possible negative consequences. The possibility of a completely normal pregnancy with a competent approach to therapy is not excluded.

Contraindications

The modern pharmaceutical industry annually increases the number and range of antibiotics. Each group of antibiotics has its own contraindications for use. Important criteria for selecting an antibacterial agent are vital history, information on taking pharmaceuticals and a number of complaints presented by the patient. The main contraindications to prescribing antibiotics for arthritis are:

• pregnancy period (1st trimester);
• allergic reactions and individual intolerance;
• kidney, liver, and gastrointestinal diseases.

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Side effects antibiotics for arthritis

Patients should not self-medicate. Antimicrobial agents are not the main component of the drug therapy cycle for arthritis. Their incorrect use will harm the body. Antibiotics have a depressing effect on natural immunity, reduce the body's resistance to pathogenic strains of bacteria, and cause negative effects on various organs and systems. Antibiotics suppress beneficial intestinal microflora.

If a doctor has prescribed antibiotics for the treatment of arthritis, it is necessary to strictly follow the specialist's instructions. Refusal to take antimicrobial agents leads to negative dynamics of the inflammatory process, development of complications and an unfavorable prognosis and outcome. Antibiotics of any group have a general effect on the body, so negative side effects are inevitable. Many medications have analogues or substitutes that differ in the strength of action and activity of the main substance. Patients may have intolerance or hypersensitivity to the ingredients of the drugs, which must also be taken into account by the doctor when choosing and prescribing a medicine:

• Azithromycin is more effective than Erythromycin, but its negative impact on the digestive system leads to the refusal to use the drug. If Erythromycin is indicated, then probiotics should be used additionally.
• Clarithromycin and Roxithromycin are quickly eliminated from the body and have fewer side effects.
• During pregnancy, it is advisable to completely stop taking antibiotics, especially in the 1st and 2nd trimesters.
• Some medications have a negative impact on the processes of hematopoiesis, blood circulation and provoke pathologies of nerve fibers.

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Overdose

If antibiotics are taken incorrectly or not taken in the prescribed dosage for arthritis, negative consequences may occur, which are divided into groups: causing toxic damage, affecting the gastrointestinal tract, liver, kidneys, provoking neurological and autoimmune reactions, leading to impaired hemostasis, and having a teratogenic effect.

When accidentally taking a large dose of an antimicrobial agent for the treatment of arthritis, the most common outcome is poisoning of the body with toxic substances:

• Overdose of penicillin and cephasporin drugs is expressed by attacks of nausea and vomiting, diarrhea. When large doses of penicillin group drugs are administered intravenously, epileptic seizures may occur, negative changes in the ECG are observed.
• The consequences of an overdose of tetracycline drugs are rare, but they are dangerous for young children. With prolonged use, rashes and angioedema appear.
• Overdose of fluoroquinolones has a detrimental effect on the cardiovascular system, causing kidney dysfunction and toxic liver damage.
• Macrolide antibiotics are considered the safest drugs and are well tolerated by patients. No cases of nephro- and hematotoxicity have been recorded when using pharmaceuticals, and no negative effects on the nervous system have been noted. Overdose may cause antibiotic-associated diarrhea and allergic reactions.

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Interactions with other drugs

Pharmaceutical interaction of one or more drugs is caused by physical and chemical reactions. Antimicrobial agents of the penicillin series and aminoglycosides inactivate each other when administered in the same syringe. These drugs should be administered into different areas of the body at intervals of 60 minutes. Penicillin is inactivated by solutions of heparin, glucose, vitamins of groups B and C. The pharmacodynamic effect of antibiotics used to treat arthritis is expressed by the enhancement or suppression of the effect of several drugs used. For example, penicillin drugs and aminoglycosides when used together give a synergistic effect in eliminating staphylococcal infection. With the synchronous use of fluoroquinolones and NSAIDs, the risk of CNS excitation and seizures increases. The simultaneous use of macrolides with theofenadine entails an increase in the toxic effect on the heart muscle, leads to ventricular fibrillation, ventricular tachycardia and the risk of death. Oral contraceptives in combination with Erythromycin lead to hepatic cholestasis and increase the risk of jaundice.

The physiological effect of antibiotics and other drugs is expressed in independent action on different organs and tissues of the body. When anticoagulants, thrombolytic agents and cephalosporins are used together, the risk of bleeding increases. Broad-spectrum antibiotics significantly suppress beneficial intestinal microflora when taken for a long time.

Antacids, iron preparations, create insoluble chemical complexes with tetracyclines, oral cephalosporins, macrolides, fluoroquinolones, reducing their effect. In this case, patients are recommended to take the listed antimicrobial agents 1-3 hours before or after taking antacids. When drinking alcohol against the background of intravenous administration of Erythromycin, alcohol absorption increases.

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Storage conditions

Antibiotics used to treat arthritis should be stored according to the requirements specified in the manufacturer's instructions. Most tablet forms of antimicrobials are stored at room temperature, protected from sunlight. The storage location of antimicrobials should be inaccessible to children and animals. Ampoules are stored at a temperature not exceeding 30 degrees without access to light. The prepared suspension is stored in the refrigerator.

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Shelf life

Antibiotics have different expiration dates. The date of manufacture and the date of final sale are indicated on the factory packaging, as well as on the ampoule, blister or bottle. Antibiotics used to treat arthritis should not be used after the expiration date.

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