Antibiotics for the treatment of joint arthrosis and arthritis: rheumatoid, reactive, infectious

Arthritis is an inflammation of the intraarticular tissue. The symptomatology of the disease is visually manifested by reddening of the skin and considerable swelling in the projection of the focus of inflammation. There is an increase in local temperature in the area of the affected joint. The functions of large and small articulations are violated, active and passive movements are limited and accompanied by severe pain. In terms of duration and course, arthritis is divided into acute and chronic. According to the generally accepted International Systematization of Diseases, two main groups of the pathological condition of the joint tissue are identified, depending on the causes of their provoking - inflammatory and infectious. Therapeutic measures of infectious arthritis are carried out in complex with the use of antibacterial medications. During the treatment of destructive lesions of the joint tissue of autoimmune inflammatory genesis, antibiotics are not recommended.

Principle of operation

Antibiotic drugs suppress and destroy, penetrating into the human body, pathogenic bacteria or greatly inhibit their reproduction. Antibiotics that are active against gram-positive and gram-negative strains of pathogens are called broad-spectrum antibiotics. Drugs active against a specific type of bacteria belong to the group of antibiotics of a narrow spectrum of action.

The rate of inhibition of bacterial growth and their destruction depends on the concentration of the antibiotic pharmacological preparation. The action of antibiotics can be synergistic, antagonistic or indifferent. For the therapy of arthritis caused by a bacterial pathogen, combinations of two or more drugs can be used that enhance the effect of each other.

Before the introduction of an antimicrobial agent, an analysis is necessary for the sensitivity of the pathological flora to different types of antimicrobial drugs. After the completion of the tests, the most active drug is selected and biological tests are conducted to determine whether the medication is tolerable by the patient.

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

Indications of the antibiotics for arthritis

For arthritis of infectious genesis, antibiotics must necessarily be present in complex treatment. Their appointment is justified in the following situations:

• A protracted disease in which, due to inflammatory reactions in the patient's articular tissue, the strong pain sensations and the limited functionality of the joint are disturbed by active and passive movements;
• Exacerbation of chronic diseases of the nasopharynx (tonsillitis, sinusitis, etc.) during which the manifestations of arthritis become brighter;
• Infectious lesions of joints with the corresponding symptoms;
• Immunodeficiency conditions complicated by pathology of cartilaginous tissue;
• Diseases of the gastrointestinal tract.

Many experts are of the opinion that antibacterial drugs are not the only panacea for infectious pathological articular lesions and cause negative general and local body reactions. The main function of antibiotics is the fight against pathological bacterial infection. It is necessary to have good reasons for prescribing and using antibacterial drugs. Self-medication with antibiotics is strictly prohibited, because only the doctor determines the features of the course of the disease and prescribes the necessary medication.

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

Release form

Antimicrobials prescribed in the treatment of arthritis have the following pharmacological forms of release:

• Solution. A medicament is a liquid obtained by dissolving one or more solid active ingredients. Used for injection, oral or external use. Penicillins, macrolides, etc., are released in the form of a powder to produce solutions. There are solutions in ampoules immediately ready for use.
• Pills. A solid, strictly dosage form of the drug containing compressed active components, in which one or more substances are included.
• Ointments and liniments. Ointment is a plastic soft form. Liniment - a kind of ointment, which has a more liquid consistency. Antimicrobial ointment forms are applied externally. They are applied to the skin by massage movements or appointed by the physician in the form of bandages to open posttraumatic foci, and also in the postoperative period to patients with arthropathies.
• Suppositories. These are medications that are in a solid state under room conditions, melting under the influence of body temperature. Are applied rectally.
• Drops. Presented by colloidal or homogeneous solutions. Dosage is carried out by drops.
• Suspension. Medications are a slurry of several ingredients in which the solid constituents are in an undissolved state and evenly distributed as non-sedimenting particles in the liquid.
• Aerosols. Medications in the form of aerosol sprays in cans. Medicinal substances under the influence of compressed or liquefied gas when pressed on the balloon are evenly distributed over the surface to be treated.

Titles

Treatment for each type of arthritis should be comprehensive, strictly tailored and depending on the cause that caused the disease. For example, arthritis caused by a systemic disease is treated with cytostatics, and the resulting infection is caused by antibiotics. For the treatment of arthritis of infectious genesis, doctors use the following tools, given 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 - Oksacillin, Cefazolin, Aminoglycoside, Amoxicillin, Clavulanate;
• when introducing sexually transmitted bacteria, regardless of the age of the patient - Ceftriaxone, Cefotaxime, Fluoroquinolones.

When cupping the symptom-complex of arthritis, therapy continues for another 2 weeks. In the chronic form of the infectious defeat of the joint tissues, it is required to exclude the presence of the causative agent of tuberculosis and mycotic infection.

[5], [6], [7], [8]

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 the degenerative changes actively progress, then the pathological bacterial flora is present in the body. Doctors, with rheumatoid arthritis, rarely recommend antimicrobial medications. The therapeutic measures prescribed by them 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, contributes to the cessation of the development of destructive intraarticular changes. The therapy of rheumatoid arthritis with antimicrobial medications 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, influenza, tonsillitis, etc.).
• protracted infectious and inflammatory processes, accompanied by painful sensations in the region of the joints;
• activation of chronic diseases (sinusitis, sinusitis, bronchitis, pyelonephritis and others), in which the development of rheumatoid arthritis is possible. The development of infection contributes to the appearance of negative manifestations on the part of the joints;
• rheumatoid arthritis, with an active long-term exposure to pathological factors, can be complicated by the appearance of suppuration of the intra-articular fluid and osteomyelitis. The main signs of the aggravation of the process are an increase in painful sensations during movement and the appearance of soreness in the passive state, an increase in hyperemia and swelling of the skin in the area of joint inflammation, a general hyperthermia;
• immunodeficiency caused by therapy with pharmacological drugs. This negative phenomenon accompanies reception of many pharmaceuticals used in rheumatoid arthritis. This situation requires the appointment of antimicrobial agents for therapy or with the prophylactic goal of complications;
• functional gastrointestinal disorder, provoked by oppression of local immunity with the use of medications used to treat arthritis.

[9], [10], [11], [12]

Antibiotics for arthritis and arthrosis

For the treatment of certain groups of joint diseases, antimicrobial therapy is actively used. This pathology includes septic arthritis, which is accompanied by penetration of the pathogen into the intraarticular fluid. When arthritis and arthrosis caused by bacterial infection occur, the use of antibiotics is justified and compulsory.

When patients turn to a doctor for help, the majority already has a pronounced symptomatology of arthritis: severe pain and limited full-fledged movements. Therefore, the main task of a specialist in a short time to establish a diagnosis and prescribe an effective medication. If there is a bacterial infection in the body, it is necessary to take into account the hematogenous path of introduction of the pathogen from the main focus into the joint tissues. Selection of the most effective antibiotic is carried out depending on the type of strain of infection:

• the pathological pathogen got into the joint with the blood flow, due to urogenital diseases. In this case, preparations of the tetracycline series (Tetracyclin, Metacyclin, Doxycycline), as well as agents containing Fluoroquinolone (Ofloxacin, Lovefloxacin) or macrolides (Azithromycin, Erythromycin, Sumamed) are necessary;
• Patients with inflammation of the joints and severe symptoms of upper respiratory infection are prescribed penicillin group preparations (Carbenicillin, Akosicillin, Ampicillin), cephalosporin series (Cefazolin, Cephalexin, Cefotaxime) or macrolides;
• In the case of an intestinal infection complicated by arthritis, medicines are prescribed, which contain fluoroxyquinolones (Lomefloxacin, Ofloxacin). These are broad-spectrum drugs that destroy the functioning of microorganism DNA.

[13], [14], [15]

Antibiotics for reactive arthritis

Reactive arthropathy is a disease that is difficult to medicate. If the pathology is not started, then, by applying for medical help on time, you can slow down the process and avoid formidable complications. Provocators of the disease are more often chlamydia, shigella and salmonella. To relieve the body of these pathogens requires adequate and serious treatment with antibacterial drugs. The duration of the minimal course of antibiotic therapy lasts 1 week. According to numerous studies, the greatest effect of treatment is observed with the use of 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 when they are used there are many side reactions from the gastrointestinal tract, in connection with which the doctors prescribe the drugs listed above.

Unfortunately, the treatment of chlamydial infection is a long and not always successful process. 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 as a result of the treatment failed to eliminate the chlamydial infection, the appointment of another antibiotic is necessary.

[16], [17], [18], [19]

Antibiotics for arthritis of the foot

Arthritis of the foot in our time is a common problem with joints. Pathology affects both older people and young people. The causes of arthritis of the foot are:

• rheumatoid arthritis;
• gout;
• osteoarthritis;
• reactive arthritis;
• trauma of the lower extremities.

Joints of the foot when symptoms of arthritis appear must necessarily be treated as soon as possible, otherwise complications can be severe, up to loss of motor function. Arthritis of the foot is dangerous to treat independently, it is necessary to consult an experienced doctor. The specialist starts the examination with a patient's examination, a careful history, appoints laboratory and instrumental examinations, then makes up a treatment regimen that includes:

• arresting the process of autoimmune inflammation with nonsteroidal agents;
• excretion and neutralization of uric acid;
• administration of antibiotics (if the disease is aggravated by the introduction of strains of pathological bacteria);
• gentle pressure on the inflamed joints of the foot.

[20], [21], [22], [23]

Antibiotics for infectious arthritis

Infectious arthritis occurs against the background of an organism's damage by a mycotic, viral or bacterial infection that enters the joint tissue together with the blood flow. The causative agent penetrates into the joint during surgical operations, injuries, etc. The appearance of a provoking factor is associated with the age of the patient. Infectious arthritis in newborns is caused by gonococcal infection, which is transmitted from a sick mother to a child. Children's joints infectious arthritis can be affected after carrying out various manipulations without carefully observing the rules of aseptic and antiseptic, for example, with the introduction of an intravenous catheter. The cause of this disease in the children's age group is often staphylococcal infection or Pfyfer's wand. In adult patients and adolescents, infectious involvement of the articular tissue in most cases is caused by streptococci, less often by staphylococci. Older patients suffer from infectious arthritis, which develops when they get into the joint of Pseudomonas aeruginosa or salmonella.

Therapy of infectious arthritis should be performed in a hospital and a combination of medicamental and physiotherapeutic treatment should be used within a few weeks. If the patient's state of moderate severity begins treatment with the use of antibiotics, which are administered intravenously. The course of therapy lasts 2 weeks, and then the patient takes oral antibiotics for a long time.

[24], [25], [26],

Antibiotics for Purulent Arthritis

Purulent inflammation of the joints in the acute stage requires emergency treatment, otherwise the joint is destroyed. The success of treatment for purulent arthritis depends entirely on the timely administration of effective antibiotics. Therapy starts with antibacterial drugs of a wide spectrum of action, which are injected at the beginning of the treatment. Determining the pathogen of purulent arthritis enables the doctor to adjust the appointments and apply stronger drugs. To inhibit the growth of bacterial microflora in joints, the following antimicrobial agents are routinely used:

• Ampicillin - semi-synthetic penicillin is active against bacteria of both gram-positive and gram-negative, excluding the Pseudomonas aeruginosa. It is produced in tablet form, the powder necessary for the preparation of injection solutions. Adults inject 500 mg once a day, the daily dosage is 2-3 g. Injections are administered at equal time intervals. Children's daily dosage is 100-400 mg / kg body weight.
• Amoxicillin belongs to the same series of antimicrobial agents as ampicillin. Has a similar clinical effect and has a similar antibacterial activity. It is possible to use pharmaceutical preparation in tablet form with less neglected pathological processes with purulent arthrosis. For adults and children over 10 years of age, a one-time dosage of 250-500 mg is recommended. To children of the age category from 5 to 10 years, a single dose is indicated in a dose of 250 mg, 2-5 years, 125 mg.

Due to the fact that some microorganisms provoking acute purulent processes in articular tissue synthesize penicillinase neutralizing the action of antibiotics of the penicillin group, to increase the effectiveness, use combined antimicrobial agents with clavulanic acid that destroys penicillinase.

[27], [28], [29]

Antibiotics for gouty arthritis

Gout (podagra) is a systemic disease that occurs when uric acid metabolism is impaired. An increase in the amount of uric acid (7,9-Dihydro-1H-purine-2,6,8 (3H) -trione) in the blood stream leads to the appearance of uric acid salts in different tissues, manifested by repeated acute arthritis and the formation of tophi (gouty nodes). The basis of therapy and diet for gout is the control of the content of 7.9-Dihydro-1H-purine-2,6,8 (3H) -trione acids in the body. For gout therapy, consultation with a rheumatologist is necessary. In this situation, the specialist prescribes drugs that reduce the content of uric acid and accelerate its excretion from the body. The purposes of treatment of medications with gouty manifestations:

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

Antibiotics in classical gout therapy are not applied. They are necessary if there is a joining of a bacterial infection that has been introduced into the body during an exacerbation of diseases of the ENT organs, the onset of OCD, surgical interventions, open trauma.

[30], [31], [32]

Pharmacodynamics

Section pharmacodynamics studies the mechanisms of the effect of the drug on the body (the pharmacy effect, the duration and strength of the effect of the active ingredient). Antibiotics, getting into the focus of infection with a blood stream, affect the 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 reproduction of bacteria (Tetracycline, Erythromycin).
• Among antimicrobials there is a group of broad-spectrum antibiotics that are active against several types of bacteria.

[33], [34], [35], [36],

Pharmacokinetics

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

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

• doses of the active ingredient;
• duration of drug use;
• regularity of taking the dosage form;
• the rapidity of its metabolic cleavage in the body;
• the rate of elimination from the bloodstream.

[37], [38], [39], [40]

Dosing and administration

When complex treatment of arthritis with antibiotics, antiflogistic, analgesic and restorative medications should be used additionally. The duration of therapy may be several months, but this does not apply to antimicrobial agents. Antibiotics are prescribed by treatment courses, in a strictly prescribed dosage and mode of admission. If the cause of reactive arthritis was angina, then the therapy scheme contains antimicrobials, combined with antirheumatic drugs to eliminate the focus of infection:

• Azithromycin should be taken once in tablets for 7 days.
• Doxycycline in capsules - 1 capsule twice a day. The treatment cycle is 7 days.
• If the foci of infection can not be eliminated, another combination of antimicrobial agents is used.

[48], [49], [50], [51]

Use of the antibiotics for arthritis during pregnancy

Women who have been treated with antibiotics or other drugs, doctors recommend to refrain from planning pregnancy for up to 3 months. During this period, the components of the drugs will be finally removed from the body tissues, the immune system will be restored and the gestational period will pass without any problems. If the antibiotic can not be avoided and the pregnancy has come, you should get a genetic consultation, because some antimicrobial agents affect the formation of the fetus, ie. Have a teratogenic effect. During the first 2 weeks, the embryo has no connection with the mother's circulatory system and the risk of disrupting its development from taking antibiotics is minimal. In the treatment of arthritis in the gestational period, the use of antimicrobials is not recommended. In the first trimester of pregnancy, it is advisable not to use antibiotics in any dosage forms for the therapy of arthritis, because the basic systems and organs in the fetus are formed.

If there is a need to take antibacterial drugs for urgent treatment of arthritis in 1 trimester of gestation, it is desirable to abandon the course of antibiotic therapy and prefer less toxic drugs. The decision on the appointment of certain pharmaceuticals for the cycle of treatment of inflammatory phenomena in the joint tissue is decided by the doctor.

Taking antimicrobial means does not mean that a newborn will always have health problems after birth. To control the correct development of the fetus, the doctor will recommend passing the necessary laboratory and hardware examinations.

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

Contraindications

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

• pregnancy period (1 term);
• allergic manifestations and individual intolerance;
• diseases of the kidneys, liver, gastrointestinal tract.

[41], [42], [43], [44], [45], [46]

Side effects of the antibiotics for arthritis

Patients should not self-medicate. In arthritis, antimicrobial agents are not the main component in the medication therapy cycle. Wrong application of them will harm the body. Antibiotics have a depressing effect on natural immunity, reduce the body's resistance to pathogenic strains of bacteria, cause negative phenomena on the part of various organs and systems. Antibiotic drugs suppress beneficial intestinal microflora.

If a doctor has prescribed antibiotics for the treatment of arthritis, then it is necessary to follow the prescriptions of the specialist clearly. Refusal to take antimicrobial agents, leads to a negative dynamics of the inflammatory process, the development of complications and unfavorable prognosis and outcome. Antibiotics of any group have a general effect on the body, so negative side effects are unavoidable. Many medications have analogues or substitutes, which differ in strength of action and activity of the basic substance. Patients may experience intolerance or hypersensitivity to the ingredients of the drugs, which also need to be considered by the doctor when choosing and prescribing the medication:

• Azithromycin is more effective than Erythromycin, but its negative effect on the digestive system leads to a withdrawal from the use of the drug. If the reception of Erythromycin is indicated, probiotics should be used additionally.
• Clarithromycin and Roxithromycin are rapidly evacuated from the body and have fewer side effects.
• During pregnancy it is desirable to completely stop taking antibiotics especially in 1 and 2 trimesters.
• Some drugs have a negative effect on the processes of hemopoiesis, blood circulation and provoke pathologies of nerve fibers.

[47]

Overdose

If the dosage of antibiotics prescribed by the doctor is incorrectly accepted or the doctor dosages antibiotics, there may be negative consequences in the treatment of arthritis, which are divided into groups: those causing toxic damage, affecting the gastrointestinal tract, liver, kidneys, provoking neurological and autoimmune reactions, leading to a disruption of the function of hemostasis and having a teratogenic effect.

When you randomly take a large dose of an antimicrobial for the treatment of arthritis, most often poisoning the body with toxic substances:

• Overdose of drugs penicillin and cephasporin series is expressed by attacks of nausea and vomiting, diarrhea. With the introduction of intravenously high doses of penicillin group preparations, epileptic seizures may occur, and negative changes in the ECG are observed.
• The consequences of overdose with tetracycline drugs are rare, but they are dangerous for young children. With prolonged admission, rashes appear, angioedema.
• An overdose of fluoroquinolones adversely affects the CCC, provoking kidney dysfunction and toxic liver damage.
• Antibiotics of the macrolide group are considered the safest drugs and are well tolerated by patients. When using pharmaceuticals, there were no cases of nephro- and hematotoxicity, no negative effects on the nervous system. When an overdose may appear antibiotic-associated diarrhea, allergic reactions.

[52], [53], [54], [55], [56], [57]

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, when administered in the same syringe, inactivate each other. These drugs must be injected into different areas of the body with an interval 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 enhancing or suppressing the effect of several drugs used. For example, preparations of the penicillin group and aminoglycosides, when used together, have a synergistic effect on the elimination of staphylococcal infection. In the synchronous use of fluoroquinolones and NSAIDs, the risk of CNS excitation and the appearance of seizures increases. Simultaneous use of macrolides with theofenadine results in 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 medicinal products is expressed in an independent effect on various organs and tissues of the body. With the combined use of anticoagulants, thrombolytic agents with cephalosporins, the risk of bleeding increases. Antibiotics of a wide spectrum of action at long reception considerably suppress a useful microflora of an intestine.

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 alcohol is used against the background of intravenous administration of Erythromycin, alcohol absorption is increased.

[58], [59], [60], [61]

Storage conditions

Antibiotics used to treat arthritis should be stored according to the requirements specified in the manufacturer's instructions. Most tableted forms of antimicrobial agents are stored at room temperature, creating protection from sunlight. The storage of antimicrobial agents should be inaccessible to children and animals. Ampoules are stored at a temperature of no higher than 30 degrees without access to light. The prepared suspension is stored in the refrigerator.

[62], [63], [64], [65], [66]

Shelf life

Antibiotics have different shelf life. Date of manufacture and date of final sale is indicated on the original packaging, as well as on the ampoule, blister or bottle. Antibiotics used to treat arthritis should not be used after the expiration date.

[67], [68], [69]