Azithromycin for sore throat: dosage, how much and how to take

Such a popular disease as tonsillitis is most often associated with the penetration of infection into the nasopharynx, as a result of which an inflammatory process begins in the area of the pharynx and tonsils. Most often, the causative agent of the disease is opportunistic microorganisms, which are present on the skin and mucous membranes of a person almost always, but cause the disease only with active reproduction under the influence of unfavorable factors that reduce the body's defenses. If a bacterial infection is suspected, tonsillitis is treated with antibiotics. But are all antibiotics equally effective for this disease, and in what case can doctors prescribe Azithromycin for tonsillitis?

Angina and macrolides

Angina is an infectious and inflammatory disease of the mucous membrane of the throat. In its popularity in the autumn-winter period, this pathology is not much inferior to the flu during an epidemic, and people have become so accustomed to symptoms such as redness and irritation in the throat, pain when swallowing and fever that sometimes they simply do not pay due attention to the disease, getting by with gargling and resorption of antiseptics.

But tonsillitis is an infectious disease, and if we are not talking about a rare viral or fungal form of the disease, inflammation of the tonsils and palate is caused by bacteria, which are very difficult to fight without antibiotics. Usually, everything starts with viruses that penetrate the body and try to penetrate its cells, reducing the body's defenses. And already against the background of reduced immunity, opportunistic organisms begin to activate and we are talking about the addition of a bacterial infection.

If the body cannot cope with microorganisms that are actively multiplying and poisoning the body with their waste products, then it needs help to do so. Gargling and taking antiseptics will be effective treatment only at the very beginning of the disease, and if these methods do not help stop the infection, you need to resort to more drastic measures - taking potent antimicrobial drugs from the antibiotic category. These drugs will have not only 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 combat streptococcal, pneumococcal and staphylococcal infections. It is cocci that are considered the most common causative agents of angina, and the appearance of purulent foci on the tonsils (purulent angina) is usually associated with one of the most dangerous staphylococci - Staphylococcus aureus or group A streptococci. Less often, we are talking about Pseudomonas aeruginosa and Escherichia coli, chlamydia, mycoplasma, fungi and other pathogenic microorganisms.

The disease usually develops very quickly. Already in the first day of symptoms, the body temperature can reach 39-40 degrees. At the same time, it is not so easy to bring it down with antipyretic drugs. But antibiotics help to normalize the temperature and the general condition of the patient in a short time.

But how to prescribe antibiotics correctly, because it takes a certain amount of time to identify the pathogen, and treatment measures need to be taken as early as possible? Broad-spectrum antibiotics come to the rescue. 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 penicillin and cephalosporin drugs, as well as antibiotics from the macrolide group. In case of intolerance to the above-mentioned drugs, they turn to tetracyclines (mainly "Doxycycline"). The use of fluoroquinolones and aminoglycosides is justified only in severe cases of purulent tonsillitis and its complications.

What else besides the spectrum of antimicrobial activity does a doctor use when choosing a drug? Of course, the safety of the drug for the human body. And the safest antibiotics due to their minimal toxicity and rarer allergic reactions compared to penicillins and cephalosporins are considered to be macrolide antibiotics. It is not for nothing that these drugs are most often prescribed by pediatricians for the treatment of tonsillitis.

"Azithromycin" is one of the representatives of the above-mentioned group of antibiotics, which has 15 hydrogen atoms in the basis of the macrocyclic lactone ring. The spectrum of action of the drug, covering most possible causative agents of angina, including H.influenzae, considered the causative agent of influenza, allows it to be used to treat angina. And the low toxicity of the active substance allows us to answer the question of whether "Azithromycin" can be used for angina, positively.

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

Treatment of angina with Azithromycin, Summamed, Azitrox and other azithromycin-based macrolides allows avoiding dangerous reactions caused by penicillins and cephalosporins in case of hypersensitivity to these antibiotics. In addition, therapy with such drugs does not entail dysfunctions of the nervous system, kidneys and hearing organs, which are typical for more toxic drugs (fluoroquinolones, aminoglycosides, nirofurans and some new types of antibiotics).

[ 1 ], [ 2 ]

Indications Azithromycin for tonsillitis.

We will not go into details of treating angina with various antibiotics from the macrolide group. Today our goal will be to understand in which cases a doctor can prescribe the drug "Azithromycin" and its analogue "Azitrox 500" for angina, and whether a reddened throat is a reason to prescribe this macrolide.

Redness (hyperemia) of the throat mucosa, a sore throat, pain when swallowing water or food, a slight increase in the tonsils, a rise in temperature to 38-39 degrees - these are all symptoms of catarrhal tonsillitis, the culprit of which is considered to be viruses. To combat viruses, it is inappropriate to use antibiotics, which, moreover, can only aggravate the situation, disrupting the intestinal microflora and thereby causing a serious blow to the immune system. In this case, much more benefit will be brought by rest and immunostimulants that improve the functioning of the immune system.

If the immune system fails to defeat the disease within the first two days, the body weakens. This provides grounds for the proliferation of bacterial infection, and we speak of a purulent form of tonsillitis. "Azithromycin" for purulent tonsillitis is prescribed when the following symptoms appear, indicating intoxication of the body with the waste products 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,
• rapid fatigue,
• the appearance of a purulent coating of a whitish or grayish color on the palate, palatine arches and tonsils,
• blood tests show leukocytosis and high ESR levels,
• Urine tests may show the presence of protein and individual red blood cells.

The appearance of whitish lesions filled with purulent contents and unusual light films on the mucous membrane of the throat and tongue indicates the addition of a bacterial infection. In this case, the absence of appropriate treatment may threaten further spread of the infectious process to the organs of hearing (otitis), kidneys (glomeruloferritis), nasal passages (sinusitis), paranasal or maxillary sinuses (sinusitis).

To prevent this from happening, doctors prescribe broad-spectrum antibiotics, such as Azithromycin. A wide range of antibacterial activity helps the drug fight not only a single pathogen, but also several types of bacteria at the same time, since tests for tonsillitis often reveal mixed microflora.

Catarrhal tonsillitis, which does not require antibiotic treatment, can quite easily turn into a purulent form, especially considering the fact that at the first signs of the disease we are not in a hurry to try on bed rest and do not often enough treat the throat with antiseptics. Usually, such measures are resorted to when the disease has already actually knocked you off your feet, turning into a purulent form, and depending on the direction of the spread of the purulent-inflammatory process, doctors diagnose lacunar or follicular tonsillitis.

In lacunar tonsillitis, purulent foci can be seen on the surface of the lacunae of the tonsils and on the palatine arches; they are easily removed with a match with a bandage wound around it. In follicular tonsillitis, the tonsils themselves greatly enlarge and the purulent process is localized directly on the lymphoid tissue (follicles become suppurated). In this case, the whitish-yellow purulent foci are small in size (like a pinhead) and are scattered across the hypertrophied tonsils.

"Azithromycin" can be prescribed for both follicular and lacunar tonsillitis, because in both cases we are talking about a bacterial infection, the spread of which must be prevented. In the case of purulent tonsillitis, this drug is prescribed more often than others, considering it the gold standard for treating this disease, because after a short course of taking the antibiotic, the symptoms of the disease disappear completely. At the same time, the therapeutic course of treatment with drugs based on azithromycin is usually almost 2 times shorter than that of other antibiotics. The patient feels relief already on the first or second day of taking the drug.

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

Release form

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

Thus, the drug, which has a name similar to the active substance “Azithromycin”, is produced in the form of capsules and tablets.

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

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

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

In pharmacies, you can also find complete analogues of the domestic "Azithromycin". Therefore, in case of sore throat, you can replace our antibiotic, if it is not available, with such imported drugs as "Azitrox" Turkey, "Sumamed" Israel, "Azivok" India, etc., which may differ only in auxiliary substances. However, you need to consult a doctor about the safety of such a replacement and when buying a drug, make sure that the dosage of the drug matches the prescribed one.

Thus, the drug "Azitrox" can be found in pharmacies in the form of capsules with a dosage of 250 and 500 mg of azithromycin, 6 and 3 pieces per package, respectively, 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 finished solution. The suspension, like the capsules, is also intended for internal use.

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

The drug "Sumamed", which is especially loved by pediatricians, is available in the form of:

• film-coated tablets of 125 and 500 mg azithromycin (6 and 3 pieces per package, respectively),
• capsules with a dosage of 250 mg (6 pieces per package),
• powder for the preparation of oral suspension in vials (dosage 100 and 200 mg azithromycin per 5 ml of finished solution),
• powder for the preparation of an infusion solution in a bottle (not used to treat tonsillitis, indicated for severe infections of the genitourinary system and community-acquired pneumonia with complicated course).

As we can see, there should be no difficulties in purchasing a medicine based on the antibiotic azithromycin prescribed by a doctor. In addition, the cost of the drug (especially domestic) is considered quite affordable. In this case, the matter is usually limited to purchasing only 1 package of antibiotic for the treatment of purulent tonsillitis.

[ 8 ]

Pharmacodynamics

According to the general opinion of doctors and most patients, azithromycin is considered one of the best antibiotics for sore throat. If previously preference was given to penicillin drugs, and in the absence of the desired effect, patients were transferred to cephalosporin antibiotics, now therapists and pediatricians are increasingly inclined to prescribe antimicrobial agents from the macrolide group.

But why azithromycin? This substance was synthesized later than erythromycin and some other macrolides, and during the testing process it was revealed that it is more resistant to the destructive effects of digestive enzymes, which makes it possible to effectively treat with the use of 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. This means that the drug not only helps effectively destroy pathogenic bacteria, but also protects the body from complications for some time after taking the antibiotic.

The pharmacodynamics of the drug are similar to the mechanism of action of other macrolides. In normal concentrations, the drug has a bacteriostatic effect, i.e. it does not kill bacteria, but negatively affects the synthesis of protein in their cells, which leads to a cessation of growth and reproduction of microorganisms. Under the influence of the antibiotic, microbes become inactive, so they are no longer able to harm the human body.

If the dose of the drug is increased, it will already show a bactericidal effect, i.e. destroy bacteria, like penicillins and cephalosporins, without causing severe allergic reactions characteristic of the above-mentioned group of antibiotics.

The drug is considered an active fighter against streptococcal infection, and it is capable of destroying group A streptococci (the main causative agents of tonsillitis), CF and G, causative agents of pneumonia, staphylococcal infection (golden and epidermal staphylococcus).

In addition to gram-positive bacteria, which are considered specific causative agents of angina, the drug affects gram-negative bacteria: Haemophilus influenzae, Moraxella, Bordetella, Legionella, Gardnerella, Neseria. Some anaerobes are also sensitive to it: bacteroides, clostridia, peptococci and peptostreptococci. Azithromycin effectively fights other types of pathogens: chlamydia, urea- and mycoplasma, mycobacteria, spirochetes, etc.

Some of the above-described bacteria and parasites can also be found in the focus of the disease or be non-specific pathogens of the disease called "tonsillitis" (in medical terminology, the disease is called acute tonsillitis). Thus, mycoplasmas, chlamydia and some other pathogens can cause the transition of tonsillitis to a chronic form. They are also considered atypical pathogens of severe forms of pneumonia.

Microorganisms that are resistant to its predecessor erythromycin are considered insensitive to azithromycin. However, there are not so many such bacteria, and among them there are no more than 6% of causative agents of angina. Thus, only isolated complaints are received about the ineffectiveness of the drug in the treatment of angina, the number of which is significantly less than in relation to other drugs with other active substances from the antibiotic category.

A high percentage of effectiveness against all possible pathogens is especially important in conditions where there is no time to wait for the results of bacteriological tests and urgent effective treatment is required to prevent complications. And complications with angina are very likely and dangerous: otitis, formation of abscesses and phlegmon, rheumatism, inflammatory pathologies of the kidneys, meningitis, pneumonia, appendicitis, sepsis (and this is not a complete list).

[ 9 ], [ 10 ], [ 11 ]

Pharmacokinetics

When taken orally, azithromycin easily penetrates the blood, and from there into various tissues of the body, creating an optimal concentration in the throat and inflamed tonsils, where the accumulation of the main part of pathogens is noted. The drug exhibits resistance to the acidic environment of the stomach and is not destroyed by hydrochloric acid. The active substance is similar to organic compounds, so it is easily absorbed in the lumen of the gastrointestinal tract.

Eating noticeably slows down the absorption of the drug in the digestive system, so it is recommended to take tablets, capsules and suspensions outside of meals at one-hour intervals. If taken correctly, the maximum concentration of the active substance in the blood plasma can be expected after 2.5-3 hours. With the blood flow, the antibiotic will quickly spread through the soft tissues of the body, where it will begin to work actively, creating a concentration several dozen times higher than in the plasma itself. At the same time, in the affected area (inflamed tissues with purulent exudate), the amount of the drug exceeds its concentration in healthy tissues by more than 25%.

The macrolide weakly binds to blood proteins, which allows it to create high concentrations in the soft tissues of the throat, lymphoid tissue of the tonsils, and respiratory tract. This is also facilitated by the long half-life of the drug, which is slightly less than 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 drug will exhibit an antibacterial effect in the body for a week. In this regard, it became possible to reduce the course of antibiotic therapy for sore throat to 3-5 days instead of 7-10 recommended for other antibiotics.

The antibiotic azithromycin for tonsillitis and other infectious and inflammatory pathologies of various localizations (and the indications for the use of the drug are not limited to purulent inflammation in the throat) easily penetrates the tissues and cells of the body without having a destructive effect on them. But it is able to destroy intracellular parasites that have entered the body, having a therapeutic effect both on the surface of the throat mucosa and inside the lymphoid tissue, where pathogens accumulate.

More than half of the active substance is excreted unchanged along with bile through the intestines, and only a small part (about 6%) enters the urine, without having a toxic effect on the kidneys.

The drug is considered to be quite safe, because even high doses of azithromycin are not capable of causing 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 fight often ends with the development of secondary infections against the background of weakened immunity. Thus, the treatment of angina can end with the development or exacerbation of candidiasis (fungal infection). Usually, such an outcome is expected when long-term use of antibiotics is necessary.

In case of short-term treatment with azithromycin, candidiasis may develop only in isolated cases (usually we are talking about an exacerbation of an existing disease). However, there is a possibility of combined treatment together with antifungal agents.

[ 12 ], [ 13 ]

Dosing and administration

No matter how safe the macrolide antibiotic may seem, it remains a potent substance that can only be taken as prescribed by a doctor. There are various treatment regimens for sore throat with Azithromycin, designed for a 3-5-day course of treatment. In severe cases, therapy with the drug can be continued for 6 or 7 days, but only if prescribed by a doctor.

Most often, doctors resort not to extending the therapeutic course, but to increasing the dosage of the drug in order to achieve the bactericidal effect necessary for the rapid and complete destruction of pathogens. As we have already said, the drug package contains 3 or 6 tablets (capsules). And this is no accident, because it is designed for a 3 or 5-day course of treatment.

How often can you take azithromycin for sore throat? You need to take the tablets only once a day and preferably at the same time. Taking tablets, capsules or oral suspension should be separated by time from eating. So the manufacturers recommend taking the drug 1 hour before eating. If this is not possible, the drug can be taken 2 hours after eating.

To the question of how to take Azithromycin for sore throat, one can answer that it is better to do this in the morning or during the day, so that it is possible to assess the presence or absence of an inadequate reaction to the drug on the part of the body and, if necessary, take the necessary measures.

Most often, Azithromycin for tonsillitis in adults is prescribed according to the following scheme: on the first day of treatment, the patient takes 1 tablet (capsule) of 500 mg or 2 of 250 mg, on the second and subsequent days the dosage remains constant - 250 mg 1 time per day.

Another popular regimen, recommended if it is necessary to shorten the course of treatment, is daily administration of the same dose of the drug – 500 mg – for 3 days.

As we can see, the course of "Azithromycin" for angina depends on the treatment regimen chosen by the doctor. Usually it is 3 or 5 days.

Some patients are concerned about whether it is possible to take Azithromycin 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 involves taking 500 mg of azithromycin once a day. If this dose is halved, then the course of treatment will be twice as long.

Speaking about the duration of the course of treatment, the doctor looks at the patient's condition and increases it if necessary. There is nothing to worry about with azithromycin. Thus, Lyme disease is recommended to be treated for 5 days, and the course dose will be not 1.5, but 3 g, which is considered quite acceptable. And in order to combat Helicobacter pylori, which causes gastritis and stomach ulcers, the drug is taken in a daily dose of 1 g during a 3-day course of treatment, which will ultimately amount to 3 g per course.

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

[ 19 ], [ 20 ]

Application for children

A child's body is noticeably different from an adult's. It is more delicate, because not all vital systems in babies are yet functioning at the proper level, so the toxic effect of drugs can be especially destructive for them. The disruption of various organs in turn leaves its terrible mark on the child's development.

The weakness of the immune system and the narrowness of the nasal passages in childhood, which forces them to breathe through the mouth at the slightest runny nose, leads to the fact that children suffer from infectious colds much more often than their parents. When viruses and bacteria enter the body, the weak immune system cannot slow down their reproduction, which means that help from drugs that can do this is required.

Antibiotics are just such potent drugs. However, their effect on the body is not always limited to the destruction of pathogens. They destroy the body's microflora and have a toxic effect on various organs and systems.

Macrolides are considered a more gentle version of antibiotics in terms of toxicity, so for sore throat in children, doctors often prescribe Azithromycin, Sumamed and other drugs of this group. However, they are not recommended for the treatment of babies under six months. The instructions indicate that the drug cannot be prescribed to children whose body weight is less than 5 kg.

In reality, “not recommended” does not mean prohibited, and “Azithromycin” is prescribed to infants of any month of life in serious situations, determining a safe dosage for them in each specific case.

For children from six months to 3 years old, pediatricians prescribe a medicinal form in the form of a suspension, and the recommended daily dose is calculated as 5 mg of azithromycin for each kilogram of the baby's weight, i.e. for a one-year-old baby weighing about 10 kg, 50 mg of azithromycin per day will be enough to treat tonsillitis. If there are 100 mg of the active substance per 5 ml of suspension, then we are talking 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 doctor can double the dosage of the drug for children aged 1-3 years, i.e. for each kilogram of the little patient's body weight, 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 suspension containing 100 mg of the active substance for every 5 ml of the finished solution). Usually, such a dosage is prescribed on the first day of taking the antibiotic, and then the child takes 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 all 3 days.

Children over 3 years of age are given 15 mg of azithromycin per kg on the first day of antibiotic therapy, and then a dose of 10 mg per kilogram of body weight is maintained. But in some cases, the initial dose is not changed and treatment is continued for 3 days.

Several drugs with the active ingredient azithromycin are available in suspension form. The instructions for the drugs contain information on how to prepare a ready-made solution. Depending on the amount of powder in the bottle, add the required volume of cooled boiled water with a syringe and shake the composition thoroughly. Thus, 60 ml of water is added to a bottle of Azithromycin containing 20 g of powder (the powder may contain 300, 600 or 1.5 thousand mg of the active ingredient) up to the mark on the bottle.

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

Like adult patients, children only need to take the antibiotic once a day.

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

[ 21 ], [ 22 ]

Use Azithromycin for tonsillitis. during pregnancy

The drug is not prohibited for use in the treatment of sore throat in expectant mothers, since there is no evidence of its negative impact on the health of the mother and fetus or the course of pregnancy. However, doctors prescribe the antibiotic "Azithromycin" for sore throat only if there is a real danger to the health and life of the pregnant woman, which significantly exceeds the risk to the unborn baby.

Such caution is important when prescribing any medications to pregnant women, especially potent drugs, which primarily include antibiotics. For the same reason, as well as due to the good penetrating properties of azithromycin, allowing it to penetrate into breast milk, the drug is not recommended for breastfeeding. If there is a need for antibiotic therapy, it is better to stop breastfeeding the baby during this period.

Contraindications

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

Contraindications to the use of an antibiotic from the macrolide group are limited to hypersensitivity to the components of the drug, i.e. the drug is not suitable for those people whose body rejects its active substance or auxiliary components. Intolerance to even one of the components of the drug is considered a contraindication to the use of the entire drug. However, if we are not talking about the active substance, it is possible to replace the drug release form with another one in which the allergen is absent.

The drug is also not prescribed if the patient has previously experienced hypersensitivity reactions to other drugs from the macrolide group, regardless of the active substance.

Caution in prescribing the drug should also be exercised by patients who have a history of allergic reactions. In this case, it is important to monitor their condition and pay attention to any unusual symptoms (runny nose, 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 through the kidneys, in diseases of these vital organs, it may be necessary to adjust the dose and monitor the patient's condition. The same can be said for people with heart rhythm disorders, since they may have ventricular arrhythmias and prolongation of the QT interval.

Taking the drug "Azithromycin" and its analogues may cause dizziness and drowsiness in some people. Such patients should either be prescribed a drug with a different active substance or limit their activities to safe types of work. Driving a vehicle and performing potentially dangerous work when the described effects from taking azithromycin appear is unsafe.

[ 14 ], [ 15 ]

Side effects Azithromycin for tonsillitis.

The drug "Azithromycin" for purulent tonsillitis is often prescribed not only because it effectively fights various pathogens of this disease, which is dangerous for its complications. Not only macrolides, but also antibiotics of other groups show good results in this regard. For example, the most powerful drugs for purulent processes are considered not even macrolides, but fluoroquinolones. Nevertheless, guided by such a concept as the safety of the drug used, doctors prefer to prescribe drugs for tonsillitis with sufficient effectiveness and a minimum number of side effects caused by the toxic effect of drugs on the patient's body.

"Azithromycin" is just such a drug. It is impossible to say that it has no side effects at all. It is impossible to say that it has no side effects at all. Some unpleasant symptoms sometimes still appear in patients, because each organism is individual and in addition to tonsillitis may have other health problems, which can ultimately give an unusual picture of the disease after taking the drug. But the positive point is the fact that side effects of the drug occur very rarely, and most patients do not experience discomfort during treatment with the antibiotic.

However, it is better to familiarize yourself with the symptoms that you may encounter during Azithromycin therapy:

• Possible reactions from the gastrointestinal tract are: nausea, less often vomiting, diarrhea and increased gas formation, increased concentration of liver enzymes, usually associated with existing pathologies of the digestive system. In rare cases, cholestatic jaundice, symptoms of anorexia, digestive disorders, inflammation of the intestinal mucosa associated with taking medications occurred.
• The central nervous system may react to the administration of the drug with headaches and dizziness, changes in taste sensations, and cramps in the limbs. Much less frequently, after taking the antibiotic, drowsiness or, on the contrary, nervous excitement that disrupts the process of falling asleep, an anxious feeling, unusual weakness, and twitching of the limbs are observed.
• The immune system's reaction in the form of allergic manifestations is rare. Most often, it is skin rash and itching on the body, less often - Quincke's edema and eosinophilia. In some cases, skin reactions such as increased sensitivity to sunlight (UV radiation), the development of erythema multiforme or toxic epidermal necrolysis were also noted.
• People with a weak heart may complain of chest pain, palpitations and arrhythmia, tachycardia.
• Women sometimes experience a pathology known as vaginitis, i.e. inflammation of the vaginal walls caused by a disturbance in the microflora, which is provoked by antibiotic therapy (any antibiotics do not act selectively, therefore, along with the pathogenic microflora, they also destroy the beneficial one).
• After taking Azithromycin, leuko-, thrombocyto- and neutropenia (a decrease in the level of leukocytes, thrombocytes or neutrophils in the blood) may be noted in the analyses of individual patients. A decrease in leukocytes and neutrophils is fraught with an increase in the body's susceptibility to infections, and thrombocytopenia has consequences such as increased bleeding and difficulty stopping bleeding.
• Other unpleasant symptoms may include increased potassium levels in the body (hyperkalemia), joint pain (arthralgia), temporary hearing loss (extremely rare and against the background of existing disorders), development of fungal pathologies (candidiasis occurs less frequently than with treatment with other antibiotics), and kidney inflammation (nephritis).

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

[ 16 ], [ 17 ], [ 18 ]

Storage conditions

Storage conditions for tablets, capsules and powder for suspension are typical for antibiotics. The temperature in the room where the medicine is stored should not exceed 25 degrees. The drugs 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" for sore throat can be prescribed in high doses, a single dose is limited to 1000 mg (2 tablets or capsules of 500 mg). If this dose is exceeded, the patient may experience symptoms such as nausea, vomiting, loose stools, and a temporary noticeable decrease in stamina. The appearance of such symptoms after taking high doses of the antibiotic indicates an overdose of the drug.

Symptoms of azithromycin overdose are not life-threatening and symptomatic therapy is sufficient to eliminate them: gastric lavage, intake of sorbents and antiemetics. Hearing is restored on its own when part of the drug leaves the body.

Another important point that both doctors and patients need to remember is drug interactions and reactions to food intake.

As we have already noted, food intake negatively affects the absorption of the drug, so the medicine should be taken on an empty stomach. But not only food can slow down and significantly reduce the absorption of azithromycin in the gastrointestinal tract. Antacids, which reduce the acidity of the stomach and create a protective film on its walls, also have such properties. Drugs of this type and azithromycin should be taken at intervals of 2 hours.

The instructions do not contain information about the interaction of azithromycin with alcohol, but there is an unspoken rule not to drink alcohol during antibiotic therapy. And this rule applies to all antimicrobial agents, since ethanol is believed to reduce the absorption of oral antibiotics.

We have so far mentioned the effect of antacids on the metabolism of azithromycin, and now we will consider its interaction with other drugs. It is believed that the use of therapeutic doses of the drug does not have a significant effect on the absorption, distribution and excretion of drugs such as otorvastine, carbamazepine, cetirizine, didanosine, indinavir, medazolam, triazolam, fluconazole, theophylline. However, simultaneous treatment with these drugs should be carried out under the supervision of a doctor.

The antifungal drug Fluconazole has little effect on the pharmacokinetics of azithromycin, so their combined use is not prohibited. The same applies to other antifungal agents that can help to restrain the proliferation of fungal microflora during antibiotic therapy.

Concomitant therapy with the above-mentioned drugs does not require adjustment of the prescribed doses of azithromycin.

If antibiotic therapy is prescribed to a patient with cardiovascular diseases that require regular intake of cardiac glycosides, it is important to know that azithromycin can increase the concentration of digoxin in the blood. In this case, the dose of the latter will need to be adjusted.

Ergotamine and dihydroergotamine, when taken simultaneously with erythromycin, can cause spasm of the vessels of the extremities and cramps in them, as well as a violation of the sensitivity of the body. This is caused by an increase in the toxicity of the above-mentioned drugs.

Terfenadine, hexobarbital, phenytoin, and cyclosporine may increase the concentration of azithromycin in the blood. In this case, the dose of azithromycin is adjusted if necessary. When treating with azithromycin and cyclosporine, the blood levels of both drugs must be monitored. There is a risk of increased toxicity and side effects of cyclosporine.

Concomitant therapy with warfarin requires monitoring of prothrombin time.

Studies of the interaction of azithromycin with statins have not shown changes in the pharmacokinetic properties of the drugs. However, individual cases of extreme myopathy in combination with renal failure (rhabdomyolysis) were subsequently registered.

Terfenadine should not be combined with any macrolides, including azithromycin, because of the risk of arrhythmia and prolongation of the QT interval. When taking azithromycin and disopyramide simultaneously, a patient developed ventricular fibrillation, but it is illogical to draw conclusions about the danger of such an interaction based on one episode.

Rifabutin increases the risk of developing leuko- and neutropenia, so regular monitoring of the blood condition is required, because these disorders indicate a strong decrease in the body's protective functions and a lack of strength to fight the disease. Against this background, the addition of superinfections is not excluded.

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

Shelf life

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

The powder for the suspension can be stored for no more than 2 years. The prepared suspension "Azithromycin" should be used within 3 days, storing it in a cool place.

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

Analogues of the drug

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

As, incidentally, it is difficult to predict in advance what pathogen caused the disease. Doctors usually prescribe broad-spectrum antibiotics before receiving the results of bacteriological analysis or instead of them. And if the pathogen turns out to be insensitive to the antibiotic or some non-specific infection joins in the course of the disease, the treatment result will be negative.

But leaving the disease without further treatment and allowing it to cause complications in various organs is unacceptable. Therefore, the question arises, what to replace azithromycin with if it does not help with angina? If there is no drug "Azithromycin" in the pharmacy, you can buy its analogues: "Sumamed". "Azitrox", "Azivok", etc., but this is unlikely to 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 a different active substance that will help defeat a resistant pathogen.

It should be said that for tonsillitis in children and adults, almost as often as azithromycin, amoxicillin-based drugs are prescribed. Amoxicillin is an antibiotic of the penicillin series, capable of coping with many specific and atypical pathogens of tonsillitis. We find the active substance with this name in the drugs "Amoxicillin", "Augmentin", "Amoxiclav". The last two drugs are especially popular, since their action is enhanced by clavulanic acid, which makes the antibiotic resistant to the destructive action of enzymes produced in the body of penicillin-resistant bacteria.

But which drug is better in this case: Amoxiclav or Azithromycin? It must be said that both drugs are equally effective for sore throat and are low-toxic. But the doctor's choice of drug is influenced by the patient's medical history. If the patient previously had hypersensitivity reactions to amoxicillin or clavulanic acid, or taking Amoxiclav due to 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 medical history of individual sensitivity to any other drug from the penicillin or cephalosporin series.

If the above-described reactions were not observed, everything will depend on the doctor'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, cephalosporin drugs are prescribed (for example, "Ceftriaxone"), which is usually administered intramuscularly and acts quite quickly. In severe cases of complicated tonsillitis, the doctor can also resort to fluoroquinolones, but the toxic effect of the drug is less dangerous to human life than a severe purulent process that turns into sepsis.

[ 35 ], [ 36 ]

Reviews of the drug

Much good can be written about macrolides and the drug "Azithromycin" itself, so often prescribed for sore throat, but any theoretical information will be of great value if it is confirmed by practical results. It is clear that doctors' sympathy for the drug is not accidental. If the drug's effectiveness in treating sore throat were low, it would hardly be prescribed so often.

It is not possible to say that doctors are helping out pharmacies in this case, because the cost of the domestic drug called "Azithromycin" is low, and doctors rarely insist on buying more expensive imported analogues. In addition, there are more expensive drugs, the sale of which would be more profitable for distributors.

And people themselves say that 35-40 UAH for a package of antibiotics that can restore their health without harming the body is a purely symbolic price. Even if we take into account the fact that the suspension will cost the buyer 4 times more, it does not bother parents of small children, who are most often treated with this form of the drug. After all, caring parents are primarily concerned about the safety of the drug for the health of their child. And as reviews show, side effects of the drug are rare.

Usually, problems occur in those people who already have inflammatory diseases of the stomach and intestines. Still, "Azithromycin", like other drugs, can have an irritating effect on the stomach and intestines, especially if you consider that oral agents (tablets, capsules and suspension) have to be taken practically on an empty stomach so that 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 drug in capsules, which dissolve directly in the intestine (where the medicine is absorbed), without irritating the inflamed walls of the stomach. And the medicine should be washed down with plenty 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 have had tonsillitis. In many reviews, you can find the phrase that the drug actually saved from fever and heat, which could not be relieved with other drugs.

When asked on 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. True, there are those who felt the effect of the treatment only after 3-5 days, which is required for the course of treatment. Nevertheless, only a few people talk about a 10-day course of treatment, most managed to defeat the disease within the timeframes specified in the instructions for the drug.

Negative reviews of the antibiotic are usually related to the characteristics of the patient's body and the resistance of the identified strains of pathogens. Fortunately, there are very few such reviews.

The promises of the drug manufacturers are confirmed by reviews of people who have experienced the effect of the antibiotic on themselves or their relatives, this indicates the high effectiveness of the drug "Azithromycin" for sore throat. However, the drug belongs to the category of potent drugs and should not be used to treat acute tonsillitis or any other pathology without a doctor's prescription. Antibacterial drugs are designed to combat bacterial infection if the fact of its presence has been established or there is a high risk of infection. If the doctor believes that recovery is possible without antibiotics, then there is no need to take them, no matter how safe they may seem.