Azithromycin in angina: dosage, how much and how to take

Such a popular disease as angina is most often associated with penetration of the nasopharynx infection, resulting in the pharynx and tonsils begins inflammation. Most often, the opportunistic microorganisms that are present on the skin and mucous membranes are always the causative agent of the disease, but they only cause the disease when active reproduction occurs under the influence of unfavorable factors that reduce the defenses of the body. When suspected of a bacterial infection, treatment of sore throats is carried out with antibiotics. But are all antibiotics equally effective in this disease, and in what cases can doctors prescribe "Azithromycin" in angina?

Angina and macrolides

Angina is an infectious and inflammatory disease of the mucous membrane of the throat. Because of its popularity in the autumn-winter period, this pathology is not much less than influenza during the epidemic, and people are already so used to such symptoms as redness and sore throat, pain when swallowing and fever, which sometimes just do not pay due attention to the disease, avoiding throat rinses and dissolving antiseptics.

But angina is an infectious disease, and if it's not a rare viral or fungal form of the disease, the inflammation of the tonsils and the sky is caused by bacteria that are very difficult to fight without antibiotics. Usually it all starts with viruses that penetrate the body and try to penetrate into its cells, reducing the defenses. And already against a background of the lowered immunity the conditionally-pathogenic organisms begin to become more active and they speak about the joining of a bacterial infection.

If the body can not independently cope with the actively multiplying and poisoning organism products of its vital activity by microorganisms, then it needs to help to do this. Gargling and taking antiseptics will be an effective treatment only at the very beginning of the disease, and if these methods did not help stop the infection it is necessary to resort to more cardinal measures - the use of potent antimicrobials from the category of antibiotics. These drugs will not only have a local, but also a systemic effect, destroying pathogens that have managed to penetrate the blood and lymphatic cells that make up the tonsils.

Today, there are several different groups of antibiotics, most of which are able to effectively fight streptococcal, pneumococcal and staphylococcal infections. It is the cocci that are considered to be the most frequent pathogens of angina, and the appearance of purulent foci (purulent tonsillitis) on tonsils is usually associated with one of the most dangerous staphylococcus - Staphylococcus aureus or Group A streptococcus. Less often it is a Pseudomonas aeruginosa, E. Coli, Chlamydia, Mycoplasma, fungi and others pathogenic microorganisms.

The development of the disease usually occurs very quickly. Already on the first day of the onset of symptoms, body temperature can reach 39-40 degrees. At the same time to knock down her antipyretics is not so easy. But antibiotics help to normalize the temperature and general condition of the patient in a short time.

But how correctly to make an appointment of antibiotics, after all for revealing of the originator of illness it is necessary certain time, and to accept medical measures it is necessary as soon as possible? To help come the antibiotics of a wide spectrum of action. And the doctor's task is to select the drug that will be active against any possible pathogens of angina.

Most often, doctors pay attention to drugs penicillin and cephalosporin series, as well as antibiotics from the group of macrolides. If the above drugs are intolerant, they turn to tetracyclines (mainly "Dixycycline"). The use of fluoroquinolones and aminoglycosides is justified only in severe cases of purulent sore throat and its complications.

What else besides the spectrum of antimicrobial activity is the doctor guided by the choice of the drug? Of course, the safety of drugs for the human body. And the most safe because of their minimal toxicity and rarer allergic reactions compared with penicillins and cephalosporins are antibiotics from the macrolide group. Not for nothing because these drugs are most often prescribed for the treatment of angina paediatricians.

"Azithromycin" - one of the representatives of the above group of antibiotics, which has 15 hydrogen atoms at the base of the macrocyclic lactone ring. The spectrum of the drug, covering most of the possible pathogens of angina, including H. Influenzae, considered the causative agent of influenza, allows using it to treat sore throats. A low toxicity of the active substance allows us to answer the question of whether it is possible to use Azithromycin in angina, positively.

Despite the fact that the group of macrolides consists of several dozen names of preparations on the basis of various active substances, most often for the treatment of sore throat appoint drugs whose active substances are erythromycin, azithromycin and josamycin. These substances have a spectrum of action as close as possible to penicillins, which are the drugs of choice for angina (in the absence of allergic reactions).

Treatment of sore throat "Azithromycin", "Summamed", "Azitrox" and other macrolides based on azithromycin allows avoiding dangerous reactions caused by penicillins and cephalosporins with hypersensitivity to these antibiotics. In addition, therapy with such drugs does not entail a violation of the functions of the nervous system, kidneys and hearing organs, characteristic of more toxic drugs (fluoroquinolones, aminoglycosides, nirofurans and some new varieties of antibiotics).

[1], [2]

Indications Azithromycin in tonsillitis

We will not go into details of treating angina with various antibiotics from the macrolide group. Today our goal will be to find out in what cases the doctor can prescribe the drug "Azithromycin" and its analog "Azitrox 500" with angina, and whether the reddening of the throat is the reason for the appointment of this macrolide.

Redness (congestion) of the mucous throat, perspiration in it, pain while swallowing water or food, a small increase in palatine tonsils, a rise in temperature to 38-39 degrees is all symptoms of catarrhal cough, the culprit of which is considered to be viruses. To combat viruses, it is inappropriate to use antibiotics, which, moreover, can only exacerbate the situation, disrupting the intestinal microflora and thereby inflicting a serious blow to immunity. In this case, much more benefit will bring peace and immunostimulating agents that improve the functioning of the immune system.

If during the first two days it is not possible to defeat the disease by immunity, the body is weakened. This gives the soil for the reproduction of bacterial infection, and they speak of the purulent form of angina. "Azithromycin" with purulent sore throat is prescribed when the following symptoms appear, indicating an organism's intoxication with the products of the vital activity of microorganisms (this phenomenon is possible only with a large number of bacteria):

• increase in body temperature to 39-40 degrees,
• severe weakness and drowsiness,
• the appearance of pain in the heart and joints, muscle pain and muscle weakness,
• fast fatiguability,
• appearance in the sky, palatine arches and tonsils purulent plaque whitish or grayish color,
• in blood tests, leukocytosis and high levels of ESR are observed,
• urine tests can show the presence of protein and individual red blood cells.

The appearance on the mucous throat and tongue of whitish foci, filled with purulent contents, and unusual light films indicates the attachment of a bacterial infection. In this case, the lack of appropriate treatment may threaten the further spread of the infectious process to the organs of hearing (otitis), the kidneys (glomerulofefritis), nasal passages (sinusitis), accessory or maxillary sinus (sinusitis).

To prevent this, doctors prescribe broad-spectrum antibiotics, for example, "Azithromycin." A wide range of antibacterial activity helps the drug to fight not only a single pathogen, but also several types of bacteria simultaneously, because with angina, analyzes often reveal a mixed microflora.

Catarrhal angina, which does not require antibiotic treatment, can easily turn into a purulent form, especially if we take into account the fact that at the first signs of the disease we are not too quick to try on bed rest and do not often treat the throat with antiseptics. Usually, such measures are resorted to when the disease is actually actually knocked down, passing into a purulent form, and depending on the direction of the purulent-inflammatory process, doctors diagnose lacunar or follicular angina.

With lacunar angina purulent foci can be seen on the surface of the lacunae of the tonsils and on the palatine arch, they are easily removed by a match with a bandage wrapped around it. With follicular angina, there is a strong increase in the tonsils themselves and the purulent process is localized directly to the lymphoid tissue (festering follicles). At the same time, the whitish-yellow purulent foci have small dimensions (like a pinhead) and are scattered over hypertrophied tonsils.

"Azithromycin" can be prescribed both in follicular and lacunar angina, because in both cases it is a bacterial infection, the spread of which must be prevented. With a purulent form of angina, this drug is prescribed more often to others, considering it the gold standard for the treatment of this disease, because for a short course of antibiotic treatment the symptoms go away completely. In this case, the therapeutic course of treatment with azithromycin-based drugs is usually almost half that of other antibiotics. Relief patient already feels on the first-second day of taking the medicine.

[3], [4], [5], [6], [7]

Release form

The drug "Azithromycin", which, as we found out, is widely used in angina, for the convenience of use is available in various forms and dosages. Most forms of the drug are intended for oral administration.

So the preparation having the name conformable with the active substance "Azithromycin" is available in the form of capsules and tablets.

Tablets, depending on the dosage of the active substance, are called "Azithromycin 125", "Azithromycin 250" and "Azithromycin 500". This suggests that they contain respectively 125, 250 and 500 mg of azithromycin, respectively. Packaging the drug with a dosage of 125 and 250 mg contains 1 blister of 6 tablets, in the package of the drug with a dosage of 500 mg is only 3 tablets, which are usually sufficient for a 3-day course of treatment.

"Azithromycin" is also available in the form of capsules, the shell of which protects the stomach from the irritating effect of the drug. Capsules can have a dosage of 250 and 500 mg. In the package, they also contain respectively 6 and 3 pieces.

There is also information about a form of release, such as lyophilate for the preparation of an infusion solution in vials manufactured in India, called "Azithromycin-J". But this form for treatment of sore throat is not applied. It is intended for the treatment of severe cases of community-acquired pneumonia and complicated infectious pathologies of pelvic organs.

In pharmacies you can also find complete analogues of the domestic "Azithromycin". Therefore, in case of angina, we replace our antibiotic, if it is not available, with imported preparations such as Azitrox Turkey, Sumamed Israel, Azivok India, etc., which can differ only in auxiliary substances. The truth about the safety of such a replacement should be consulted with a doctor and when buying the drug, make sure that the dosage of the medicine coincides with the prescribed dosage.

So the drug "Azitrox" can be found in pharmacies in the form of capsules with a dosage of 250 and 500 mg of azithromycin, respectively, 6 and 3 pieces per pack, and also in the form of powder for the preparation of a suspension with a dosage of 100 and 200 mg of azithromycin per 5 ml of the prepared solution. Suspension, like capsules, is also designed for internal reception.

The medicine with the name "Azivok" is in the form of capsules 250 mg (6 capsules per package).

The drug "Sumamed", which is especially liked by pediatricians, is issued in the form of:

• tablets with a film sheath 125 and 500 mg of azithromycin (6 and 3 in the package, respectively),
• capsules with a dosage of 250 mg (6 pieces per pack),
• powder for the preparation of the oral suspension in vials (dosage of 100 and 200 mg of azithromycin per 5 ml of the prepared solution),
• powder for the preparation of an infusion solution in a vial (it is not used for the treatment of angina, it is indicated for severe infections of the genitourinary system and community-acquired pneumonia with complicated course).

As you can see, the difficulties with purchasing a medicine based on the antibiotic azithromycin prescribed by a doctor should not arise. In addition, the cost of the drug (especially domestic) is considered quite affordable. In this case, usually the case is limited to the acquisition of only 1 package of antibiotic for the treatment of purulent angina.

[8]

Pharmacodynamics

According to the general opinion of doctors and most patients, azithromycin is considered one of the best antibiotics in angina. If the preference was previously given to penicillin drugs, and if there was no desired effect, the patients were transferred to cephalosporin antibiotics, now therapists and pediatricians are increasingly inclined to prescribe antimicrobial agents from the macrolide group.

But why exactly azithromycin? This substance was synthesized after erythromycin and some other macrolides, and during the test it was revealed that it is more resistant to the destructive effect of digestive enzymes, which makes it possible to effectively treat using the oral forms of the drug. In addition, the concentrations that the drug creates in diseased tissues are significantly higher than those needed to combat the pathogens of angina. So, the medicine helps not only to effectively destroy the pathogenic bacteria, but also protects the body from complications for some time after taking the antibiotic.

Pharmacodynamics of the drug is similar to the mechanism of action of other macrolides. In normal concentrations, the drug has a bacteriostatic effect, i.e. Does not kill bacteria, but negatively affects the synthesis of protein in their cells, which leads to a halt in the growth and multiplication of microorganisms. Under the influence of an antibiotic, microbes become inactive, so they are no longer capable of damaging the human body.

If the dose of the drug is increased, it will show already bactericidal effect, i.e. Destroy bacteria like penicillins and cephalosporins, while not causing severe allergic reactions characteristic of the above group of antibiotics.

The drug is considered an active fighter with streptococcal infection, while it is able to destroy group A streptococcus (the main pathogens of angina), CF and G, the causative agents of pneumonia, staphylococcal infection (golden and epidermal staphylococcus).

In addition to gram-positive cocks, which are considered to be specific pathogens of angina, the drug acts on gram-negative bacteria: hemophilic rod, moraxell, bordetell, legionella, gardnerell, non-serial. Some anaerobes turn out to be sensitive to it: bacteroides, clostridia, peptococci and peptostreptococci. Azithromycin effectively fights other types of pathogens: chlamydia, ure- and mycoplasma, mycobacteria, spirochetes, etc.

Some of the above-described bacteria and parasites can also be found in the locus of the disease or be a nonspecific pathogens called "angina" (in medical terminology, the disease is called acute tonsillitis). So mycoplasmas, chlamydias and some other pathogens can cause the transition of angina into a chronic form. They are considered atypical pathogens of severe pneumonia.

Insensitive to azithromycin are those microorganisms that are resistant to its erythromycin precursor. Nevertheless, there are not so many such bacteria, and among them, not more than 6% of the causative agents of angina. Thus, the ineffectiveness of the drug in the treatment of sore throats comes only from individual complaints, the number of which is noticeably less than for other drugs with other active substances from the discharge of antibiotics.

A high percentage of effectiveness against various pathogens is especially important in circumstances where there is no time to wait for the results of bacteriological tests and urgent effective treatment is needed to prevent complications. And complications with angina are very likely and dangerous: otitis media, abscess formation and phlegmon, rheumatism, inflammatory kidney pathology, meningitis, pneumonia, appendicitis, sepsis (and this is not a complete list).

[9], [10], [11]

Pharmacokinetics

With oral administration, azithromycin easily penetrates into the blood, and from there to various tissues of the body, creating an optimal concentration in the throat and inflamed tonsils, where the bulk of the causative agents of the disease is noted. The drug shows resistance to the acidic environment of the stomach and is not destroyed by hydrochloric acid. The active substance has a similarity with organic compounds, therefore it is easily absorbed in the lumen of the gastrointestinal tract.

Eating significantly slows the absorption of the drug in the digestive system, so taking tablets, capsules and suspensions is recommended to be done outside the meal with an hourly interval. If the reception is done correctly, the maximum concentration of the active substance in the blood plasma can be expected after 2.5-3 hours. With the flow of blood, the antibiotic will quickly spread through the soft tissues of the body, where it will begin active work, creating a concentration several dozen times higher than in the plasma itself. In the affected area (inflamed tissue with purulent exudate), the amount of the drug exceeds its concentration in healthy tissues by more than 25%.

Macrolide binds weakly to blood proteins, which allows it to create large concentrations in the soft tissues of the throat, lymphoid tissue of the tonsils, the airways. This is also facilitated by a long half-life of the drug, which is just under 3 days.

Azithromycin is able to accumulate in the blood and tissues of the body, acquiring a stable concentration after 5-7 days, i.e. Even after the end of the course of treatment, the medicine will show an antibacterial effect in the body within a week. In this regard, it became possible to reduce the course of antibiotic therapy in angina to 3-5 days instead of 7-10 recommended for other antibiotics.

Antibiotic azithromycin in angina and other infectious and inflammatory pathologies of different localization (and indications for the use of the drug are not limited to purulent inflammation in the throat) easily penetrates into the tissues and cells of the body without exerting a destructive effect on them. But it is able to destroy the intracellular parasites that have got into the body, providing therapeutic effect both on the surface of the mucous throat and inside the lymphoid tissue where the pathogens accumulate.

More than half of the active substance remains unchanged together with bile through the intestine, and only a small part (about 6%) gets into the urine, without exerting toxic effects on the kidneys.

The drug is considered safe enough, because even high doses of azithromycin can not cause serious complications and health problems. This makes it possible, if necessary, to increase the dose of the antibiotic without fear of consequences.

Antibiotic therapy is not only an effective fight against bacteria and parasites, but also a blow to the human immune system. Such a struggle often ends with the development of secondary infections against a background of weakened immunity. So treatment of angina can result in the development or exacerbation of candidiasis (fungal infection). Typically, this outcome is expected if long-term use of antibiotics is required.

In the case of short-term treatment with azithromycin, candidiasis can develop only in isolated cases (usually it is an exacerbation of an already existing disease). But it is possible to combine treatment with antifungal agents.

[12], [13]

Dosing and administration

No matter how safe the antibiotic from the macrolide group appears to be, it remains a potent substance, which can only be taken at the doctor's prescription. There are various treatment regimens for angina "Azithromycin", designed for a 3-5-day course of treatment. In severe cases, the drug can be continued for 6 or 7 days, but only if it is the doctor's appointment.

Most often, doctors do not resort to an extension of the therapeutic course, but to an increase in the dosage of the drug in order to achieve the bactericidal effect necessary for rapid and complete destruction of pathogens. As we have already said, the product package has 3 or 6 tablets (capsules). And this is not accidental, because it is designed for 3 or 5-day treatment.

How often can you take azithromine in a sore throat? Take the pill only once a day and preferably at the same time. Reception of tablets, capsules or oral suspension should be delineated in time with food intake. So take the drug manufacturers recommend 1 hour before meals. If this is not possible, you can take the drug 2 hours after eating.

When asked how to drink Azithromycin in angina, it can be answered that it is better to do this in the morning or afternoon, so that there is an opportunity to assess the presence or absence of an inadequate response to the medicine on the part of the body and in case of which to take the necessary measures.

Most often, "Azithromycin" in angina in adults is prescribed according to this scheme: on the first day of treatment the patient takes 1 tablet (capsule) 500 mg or 2 250 mg, on the second and subsequent days the dosage remains constant-250 mg once a day.

Another popular regimen, recommended if it is necessary to reduce the course of treatment, is a daily intake for 3 days of the same dose of the drug - 500 mg.

As you can see, the course of "Azithromin" in angina depends on the treatment scheme chosen by the doctor. Usually it is 3 or 5 days.

Some patients are worried about whether Azithromycin can be taken for more than 3 days, is it dangerous for the body? But we have already said that the duration of the course of treatment depends on the therapeutic regimen and the daily dosage of the drug. A 3-day course of treatment implies taking 500 mg of azithromycin once a day. If this dose is reduced by half, then the course of treatment will be twice as much.

Speaking about the duration of the treatment course, the doctor looks at the patient's condition and, if necessary, increases it. Concerning azithromycin, there is nothing to worry about. So, Lyme disease is recommended to be treated within 5 days, while the course dose will be not 1.5, but 3 g, which is considered quite acceptable. And in order to combat helikobakter pylori, which causes gastritis and gastric ulcer, the drug during a 3-day course of treatment is taken in a daily dose of 1 g, which in the end will again be 3 g per course.

With angina, the standard course dose of the drug is 1.5 grams of azithromycin. In severe cases, on the first day, a shock dose of 1 g can be prescribed, and in the following two days the usual high dose is 500 mg. This excess of the exchange rate does not entail an increase in the toxic effect of the drug on the body, but may cause a violation of its microflora. Therefore, along with the antibiotic is recommended to take probiotics, restoring the composition of the internal environment of the body.

[19], [20],

Application for children

The child's organism differs markedly from the adult. It is more gentle, because not all vital systems for kids are still working at the proper level, so the toxic effects of drugs can be especially destructive for them. The violation of the work of various organs in turn imposes a terrible imprint on the development of the child.

The weakness of the immune system and the narrowness of the nasal passages in childhood, which makes it possible to breathe through the mouth with the slightest rhinitis, leads to the fact that children are much more likely than their parents to suffer from cold infections of the infectious plan. If viruses and bacteria get into the body, weak immunity can not slow down their reproduction, which means that they need help with drugs that can do it.

Antibiotics are just such potent drugs. True, their influence on the body is not always limited only by the destruction of pathogens. They destroy the microflora of the body and have a toxic effect on various organs and systems.

Macrolides in terms of toxicity are considered a more gentle option for antibiotics, so when angina in children doctors often prescribe "Azithromycin", "Sumamed" and other drugs of this group. Nevertheless, they are not recommended for treating babies for up to six months. In the instruction there are indications that the drug can not be administered to children whose body weight is less than 5 kg.

In reality, "not recommended" does not mean it is forbidden, and "Azithromycin" in serious situations appoint babies of any month of life, determining for them a safe dosage in each specific case.

Children with half a year and up to 3 years of age, pediatricians are prescribed a dosage form in the form of a suspension, and the recommended daily dose is calculated as 5 mg of azithromycin per kilogram of the baby's weight, i.e. Year-old baby with a weight of about 10 kg for treatment of angina will be enough 50 mg azithromycin per day. If 5 ml of the suspension is 100 mg of active ingredient, then it is about 2.5 ml / kg, etc. Depending on the dosage of the drug. The course of treatment will be at least 3 days.

If necessary, the dosage of the drug for children 1-3 years old the doctor can double; for every kilogram of body weight of a small patient, it will be necessary to take not 5, but 10 mg of azithromycin. For our one-year-old baby weighing about 10 kg, this will be 100 mg (or 5 ml of a suspension containing 100 mg of active ingredient for every 5 ml of the final solution). Usually, this dosage is prescribed on the first day of taking the antibiotic, and then the baby takes all the same 5 mg per kg. With a three-day course of treatment, the child takes the drug at a dosage of 10 mg per kg for 3 days.

Children older than 3 years on the first day of antibiotic therapy receive 15 mg of azithromycin per kg, and then adhere to a dose of 10 mg per kilogram of body weight. But in some cases, the initial dose is not changed and continue treatment for 3 days.

Form release in the form of a suspension have several drugs with the active substance azithromycin. In the instructions to the preparations there is information about the preparation of the prepared solution. Depending on the amount of powder in the vial, the necessary volume of chilled boiled water is added to it with a syringe and the composition is shaken carefully. So, in a bottle of "Azithromycin" containing 20 g of powder (the powder can contain 300, 600 or 1,5 thousand mg of active substance), add 60 ml of water to the mark on the vial. 

Forms of release in the form of tablets and capsules with a dosage of 250 and 500 mg are calculated for adult patients, whose weight is more than 45 kg. Tablets 125 mg azithromycin can be used in the treatment of children and adolescents who can swallow this form.

As an adult patient, children should only take an antibiotic once a day.

These are all general recommendations, but when prescribing treatment to a child, the pediatrician takes into account such factors as the weight of the baby, the congenital and acquired diseases, the general condition, so the dosage of the drug and the duration of the course of treatment will be individual.

[21], [22]

Use Azithromycin in tonsillitis during pregnancy

The drug is not prohibited for use in the treatment of angina in expectant mothers, as there is no evidence of its adverse effects on the health of the mother and fetus or the course of pregnancy. Nevertheless, doctors prescribe antibiotic "Azithromycin" in angina only if there is a real danger to the health and life of a pregnant woman, which significantly exceeds the risk for an unborn baby.

This caution is important in the appointment of pregnant women with any drugs, and even more potent drugs, which primarily include antibiotics. For the same reason, and also because of the good penetrating properties of azithromycin, which allow it to penetrate into breast milk, the drug is not recommended for breastfeeding. If there is a need for antibiotic therapy, for this period it is better to give up breastfeeding from the baby.

Contraindications

The wide prevalence of the antibiotic "Azithromycin" and its analogs in angina is not accidental, because in addition to high efficiency, the drug has a minimum number of restrictions in the application. And this fact in turn confirms the safety of the drug, which does not harm even those patients who, in addition to sore throats, have other serious health problems.

Contraindications to the use of antibiotics from the group of macrolides are limited to hypersensitivity to the components of the drug, i.e. The drug is not suitable for people whose body rejects its active ingredient or ancillary components. Intolerance to even one of the components of the medicine is considered a contraindication to the use of the whole drug. However, if it is not an active substance, there is the possibility of changing the form of release of the drug to another, in which the allergen is absent.

Do not prescribe the drug in the event that previously the patient experienced hypersensitivity reactions to other drugs from the group of macrolides, regardless of the active substance.

Caution should also be exercised in prescribing patients who have already had an allergic reaction in their history. In this case, it is important to monitor their condition and pay attention to any unusual symptoms (the appearance of a runny nose, a rash on the body, sneezing, itching, increased swelling of the pharynx and larynx, etc.).

Since the drug is metabolized in the liver and some of it is excreted by the kidneys, with diseases of these vital organs, it may be necessary to adjust the dose and control the patient's condition. The same can be said about people with heart rhythm disturbances, because they are capable of ventricular arrhythmias and prolongation of the QT interval.

The intake of the drug "Azithromycin" and its analogs in some people can cause dizziness and drowsiness. Such patients need either to prescribe the drug with another active substance or to limit their activity to safe work. Driving vehicles and performing potentially dangerous jobs with the appearance of the described effects from taking azithromycin is unsafe.

[14], [15]

Side effects Azithromycin in tonsillitis

The drug "Azithromycin" for purulent sore throat is often prescribed not only because it effectively fights with various pathogens of this dangerous with its complications of the disease. Good results in this regard are shown not only by macrolides, but also by antibiotics from other groups. For example, the strongest drugs in purulent processes are not even macrolides, but fluoroquinolones. Nevertheless, guided by the notion of the safety of the medicinal product used, doctors prefer to prescribe in the angina drugs with sufficient efficiency and a minimum amount of side effects caused by the toxic effects of drugs on the patient's body.

"Azithromycin" is just such a drug. To say that he has no side effects at all. To say that he has no side effects at all. Some unpleasant symptoms sometimes appear in patients, because each organism is individual and in addition to sore throat can have other health disorders that can eventually give an unusual picture of the disease after taking the medication. But the positive point is that side effects of the drug are very rare, and most patients do not experience discomfort during antibiotic treatment.

And yet it is better to know what symptoms can be encountered during therapy with "Azithromycin":

• Possible reactions on the part of the gastrointestinal tract are: nausea, rarely vomiting, diarrhea and increased gas formation, an increase in the concentration of hepatic enzymes, usually associated with the already existing pathologies of the digestive system. In rare cases, there was cholestatic jaundice, symptoms of anorexia, digestive disorders, inflammation of the intestinal mucosa associated with taking medications.
• The central nervous system to administer the drug can respond with headaches and dizziness, changes in taste, cramps in the limbs. Significantly less often after taking an antibiotic, drowsiness or vice versa is a nervous excitement that disrupts the process of falling asleep, an anxious feeling, an unusual weakness, twitching of the limbs.
• The reaction of the immune system in the form of allergic manifestations is rare. Most often, it is cutaneous and itchy on the body, less often - Quincke's edema and eosinophilia. In some cases, skin reactions such as increased sensitivity to sunlight (UV radiation), development of erythema multiforme, or toxic epidermal necrolysis have also been noted.
• People with a weak heart can complain of chest pain, palpitation and arrhythmia, tachycardia.
• Women sometimes have a pathology like vaginitis, i.e. Inflammation of the vaginal walls caused by a violation of the microflora, which is provoked by antibiotic therapy (any antibiotics act not selectively, so along with the pathogenic microflora destroy and useful).
• After taking Azithromycin, individual, leuko-, thrombocyto-and neutropenia (a decrease in blood levels of white blood cells, platelets or neutrophils) may be noted in individual patient analyzes. Reduction of leukocytes and neutrophils is fraught with increased susceptibility of the organism to infections, and thrombocytopenia has such consequences as increased bleeding and difficulties with stopping bleeding.
• Other unpleasant symptoms may include increased potassium levels in the body (hyperkalemia), joint pain (arthralgia), temporary worsening of hearing (extremely rare and against the background of existing disorders), development of fungal pathologies (candidiasis occurs less frequently than with other antibiotics), inflammation kidneys (nephritis).

Let us clarify again that possible side effects are described. But they appear rarely enough and are reversible. In addition, it is not always possible to say with certainty what causes the symptom: directly taking an antibiotic or is one of the manifestations of the disease.

[16], [17], [18]

Storage conditions

The storage conditions for tablets, capsules and powder for suspension are common for antibiotics. The temperature in the room where the medicine is stored should not exceed 25 degrees. Preparations should be protected from sunlight and moisture. Like any antibiotic, azithromycin should not fall into the hands of children who may use the medicine for other purposes.

[23], [24], [25], [26]

Special instructions

Despite the fact that "Azithromycin" in angina can be prescribed in high dosages, a single dose is limited to 1000 mg (2 tablets or 500 mg capsules). If this dose is exceeded, the patient may have symptoms such as nausea, vomiting, loose stools, temporarily stagnant. The appearance of such symptoms after taking high doses of antibiotic indicates an overdose of the drug.

Symptoms of an overdose of azithromycin do not pose a threat to life and for their elimination, symptomatic therapy is sufficient: gastric lavage, sorbents and antiemetics. Hearing restoration occurs on its own, when part of the drug leaves the body.

Another important point that should be remembered for both doctors and patients is the drug interaction and reaction to the intake of food.

As we have already noted, food intake negatively affects the absorption of the drug, so the medicine should be taken on a loose stomach. But not only food can slow down and significantly reduce the absorption of azithromycin in the digestive tract. Such properties are also possessed by antacids, which reduce the acidity of the stomach and create a protective film on its walls. Preparations of such a plan and azithromycin should be taken at intervals of 2 hours.

The instructions do not contain information on the interaction of azithromycin with alcohol, but there is an unspoken rule during antibiotic therapy not to consume alcoholic beverages. And this rule applies to all antimicrobial agents, since it is believed that ethanol reduces the absorption of oral antibiotics.

We have so far mentioned the effect of antacids on the metabolism of azithromycin, and now consider its interaction with other drugs. It is believed that the use of therapeutic doses of the drug has no significant effect on the absorption, distribution and excretion of such drugs as otorvastine, carbamazepine, cetirizine, didanosine, indinavir, medazolam, triazolam, fluconazole, theophylline. Nevertheless, simultaneous treatment with these drugs should be carried out under the supervision of a doctor.

Antifungal drug "Fluconazole" slightly affects the pharmacokinetics of azithromycin, so their joint use is not prohibited. The same goes for other antifungal agents, which can help to restrain the reproduction of fungal microflora during antibiotic therapy.

Joint therapy with the above medicines does not require correction of the prescribed doses of azithromycin.

If antibiotic therapy is prescribed to a patient with cardiovascular diseases requiring regular intake of cardiac glycosides, one should know that azithromycin is capable of increasing the concentration in the blood of digoxin. In this case, an adjustment of the dose of the latter is required.

Ergotamine and dihydroergotamine with simultaneous administration with erythromycin can cause spasm of the vessels of the extremities and seizures in them, as well as a violation of the sensitivity of the body. This is due to increased toxicity of the above drugs.

An increase in the concentration of azithromycin in the blood can cause terfenadine, hexobarbital, phenytoin, cyclosporine. In this case, if necessary, adjust the dose of azithromycin. When treating azithromycin and cyclosporine, you need to monitor the blood content of both drugs. There is a risk of increased toxicity and side effects of cyclosporine.

Conducting joint therapy with warfarin requires monitoring prothrombin time.

Studies of the interaction of azithromycin with statins did not show a change in the pharmacokinetic properties of the drugs. Nevertheless, subsequently, individual cases of development of extreme myopathy in combination with renal insufficiency (rhabdomyolysis) were recorded.

Terfenadine is undesirable to combine with any macrolides, including azithromycin, since there is a risk of arrhythmia and prolongation of the QT interval. With the simultaneous administration of azithromycin and disopyramide, the patient was found to have ventricular fibrillation, but one episode about the dangers of such interaction is illogical.

Rifabutin increases the risk of leukemia and neutropenia, therefore regular monitoring of the blood condition is required, because these disorders indicate a strong decrease in the protective functions of the body and the lack of strength to fight the disease. Against this background, the addition of superinfections is not ruled out.

[27], [28], [29], [30]

Shelf life

The use of any medication requires a patient to control the expiration date. Especially dangerous delay, when it comes to potent drugs for their discharge of antibiotics. So the form of release of drugs for oral administration with the active substance azithromycin can be stored no more than 2-3 years from the date of release. For capsules and tablets, "Azithromycin" is 2 years, for the same forms of the drug "Sumamed" - 3 years.

Powder for the preparation of the suspension can be stored for no more than 2 years. Ready suspension "Azithromycin" should be used for 3 days, keeping it in a cold place.

[31], [32], [33], [34]

Drug analogues

"Azithromycin" is considered a drug that shows sufficient effectiveness in angina in most cases. But the organism of each person is individual, and not always proven effectiveness of the drug is a guarantee of cure for a particular patient.

As, however, it is difficult to predict in advance which pathogen became the cause of the disease. Antibiotics of a wide spectrum of action doctors appoint usually even before reception of results of the bacteriological analysis or instead of them. And if the pathogen appears to be insensitive to the antibiotic or during the course of the illness some non-specific infection will join, the result of the treatment will be negative.

But after all, leaving the disease without further treatment and giving it the opportunity to give complications to different organs is unacceptable. Therefore, the question arises, how to replace azithromycin, if it does not help with angina? If there is no "Azithromycin" drug in the pharmacy, you can buy its analogues: "Sumamed". "Azitrox", "Azivok", etc., but it is unlikely that this will affect the result of antibiotic therapy, because the active substance of the drugs is the same. In this case, it makes sense to prescribe a drug with another active substance that will help to defeat the stable pathogen

It must be said that with angina in children and adults, almost as often as azithromycin, drugs based on amoxicillin are prescribed. Amoxicillin is an antibiotic of the penicillin series, able to cope with a number of specific and atypical pathogens of angina. The active substance with this name we find in the preparations "Amoxicillin", "Augmentin", "Amoxiclav". The last two drugs are very popular, since their action is intensified by clavuonic acid, which makes the antibiotic resistant to the destructive effect of enzymes produced in the organism of penicillin-resistant bacteria.

But what kind of drug in this case is better: "Amoxiclav" or "Azithromycin"? It must be said that both drugs are equally effective in angina and are of low toxicity. But the patient's medical history is influenced by the choice of medicine. If previously the patient had hypersensitivity reactions to amoxicillin or clavuonic acid, or if taking Amoxiclav in connection with another pathology caused negative reactions from the liver and other organs, it is clear that the choice will fall on the safer Azithromycin or its analogues. The same applies to the presence in the patient's history of an individual sensitivity to any other drug from the penicillin or cephalosporin series.

If the above described reactions were not noted, everything will depend on the physician's preferences. And if there is no effect from taking "Azithromycin", the drug can be replaced with "Amoxiclav", "Augmentin", etc. Or vice versa. In the absence of positive dynamics during the administration of penicillins, preparations of cephalosporin series are prescribed (for example, "Ceftriaxone"), which is usually administered intramuscularly and acts quite quickly. In severe cases of complicated angina, a doctor may resort to fluoroquinolones, but the toxic effect of the drug is less dangerous for a person's life than a severe purulent process, which turns into sepsis.

[35], [36]

Reviews about the drug

About macrolides and directly the drug "Azithromycin", so often prescribed for angina, you can write a lot of good, but any theoretical information will be of high value, if it is confirmed by practical results. It is clear that the doctors' sympathy for the drug is not accidental. If the effectiveness of the drug in treating angina was low, it would hardly be prescribed so often.

To say that doctors help pharmacies, in this case it is not necessary, because the cost of a domestic drug with the name "Azithromycin" is low, and doctors rarely insist on buying more expensive import analogues. In addition, there are more expensive drugs, the sale of which would be more beneficial to distributors.

And the people themselves say that 35-40 UAH. For packaging an antibiotic that can restore health to them without harming the body, this is a purely symbolic price. Even if we take into account the fact that the suspension costs the buyer 4 times more expensive, it does not confuse the parents of small children, who are often treated with this form of the drug. After all, caring parents are primarily concerned about the safety of the medicine for their child's health. And as the reviews show, the side effects of the drug are rare.

Usually, problems occur in those people who already have inflammatory diseases of the stomach and intestines. All the same, "Azithromycin", like other drugs, can have irritating effects on the stomach and intestines, especially if one takes into account that oral solutions (tablets, capsules and suspension) are actually taken on an empty stomach so that the food does not interfere with the absorption of the active substance.

Patients with gastritis and stomach ulcers should pay attention to the form of the preparation in the form of capsules that dissolve directly in the intestine (where the drug is absorbed) without irritating the inflamed walls of the stomach. Yes, and drink the medicine you need a lot of water.

But the rapid effect of taking the drug is a positive feature of the medicine, which is emphasized by almost everyone: both former patients and parents of small children who had had an angina. In many reviews, one can find the phrase that the drug actually saved from fever and heat, which could not be cured with the help of other medications.

When asked what day "Azithromycin" starts to work, most people find it difficult to answer, because many of them felt noticeable relief during the first day of treatment with the drug. However, there are also those who felt the effect of treatment only after 3-5 days, required for the course of treatment. Nevertheless, about a 10-day course of treatment say units, most managed to defeat the disease in the prescribed instructions to the drug timing.

Negative reviews of antibiotics are usually associated with the characteristics of the patient's body and the stability of the identified strains of pathogens. The benefit of such reviews is very small.

Promises made by the drug manufacturers are confirmed by reviews of people who have experienced the effect of an antibiotic on themselves or their relatives, this indicates the high effectiveness of the drug "Azithromycin" in angina. Nevertheless, the drug belongs to the category of potent agents and it is not necessary to use it for the treatment of acute tonsillitis or any other pathology without the appointment of a doctor. Antibacterial drugs are designed to combat bacterial infection, if the fact of its presence is established or there is a high risk of infection. If the doctor believes that the cure is possible without antibiotics, then there is no need for their reception, no matter how safe they may seem.