Treatment of streptococcal infection with antibiotics and without antibiotics

The use of antibacterial drugs will be most effective when the drug therapy is purposeful, that is, etiotropic: if the pathogen is streptococci, antibiotics from streptococci should be used.

To do this, a bacteriological study is necessary - to isolate and identify a specific bacterium, confirming its belonging to the genus Gram-positive bacteria Streptococcus spp.

What antibiotics kill streptococcus?

Effective against streptococci can be drugs of bactericidal action that can not only overcome the factors of their virulence - enzymes-antigens, cytotoxins (leading to β-hemolysis), surface adhesive proteins that allow streptococci to resist phagocytosis - but also provide eradication of the pathogen in vivo. And in order for an antibiotic to eradicate bacteria, it must penetrate through their outer membranes and affect the vulnerable structures of the microorganism cells.

The main names of antibacterial drugs, which are considered the best antibiotics from streptococcus:

Antibiotics from hemolytic streptococcus or antibiotics against streptococcus group A - beta-hemolytic streptococcus group A strain Streptococcus pyogenes - include antibiotics from streptococcus in the throat (as the strain causes streptococcal pharyngitis and tonsillitis): β-lactam carbapenems - Imipenem (other trade names - Imipenem with cilastatin, Tienam, Cilaspen), Meropenem (Mepenam, Merobocid, Inemplus, Doriprex, Synerpene); antibiotics of the group of lincosamides Klindamycin (Klindachin, Klimitsin, Klinimitsin, Dalatsin); Amoxiclav (Amoxil, A-Clave-Farmex, Augmentin, Flemoclav Solutab).

Antibiotics from streptococcus pneumonia - the colonizing nasopharynx of the commensal bacterium Streptococcus pneumoniae, often called pneumococcus include all of the above drugs, as well as cephalosporin antibiotics of the fourth generation by Cephira (Keiten) or Cefepime.

Inflammation of the inner shell of the heart is most often a consequence of the pathogenic effect of green streptococcus - the alpha-hemolytic type of Streptococcus viridans. If it enters the heart with blood, it can cause subacute bacterial endocarditis (especially in people with damaged heart valves). Treatment of green streptococcus with antibiotics is carried out with the help of Vancomycin (trade names - Vankocin, Vanmixan, Vankorus) - a glycopeptide antibiotic.

The sensitivity of streptococci to antibiotics is a factor of successful treatment

Before proceeding to the description of individual antibacterial agents used in streptococcal infections, it should be emphasized that the most important factor in the effectiveness of treatment is the sensitivity of streptococci to antibiotics, which determines the ability of drugs to destroy bacteria.

Often the effectiveness of antibiotic therapy is so small that the question arises - why did not the antibiotic kill streptococcus? These bacteria - in particular, Streptococcus pneumoniae - have shown a significant increase in resistance over the last two decades, that is, resistance to antibacterial drugs: tetracycline and its derivatives do not act on them; almost a third of their strains can not be influenced by erythromycin and penicillin; resistance to some drugs of the macrolide group was developed. And fluoroquinolones are initially less effective in streptococcal infections.

The researchers attribute the decrease in the sensitivity of streptococci to antibiotics with the transformation of individual strains as a result of genetic exchange between them, as well as with mutations and increased natural selection, somehow provoked by the same antibiotics.

And it's not just about the self-medication censured by doctors. A medication prescribed by a doctor may also be impotent before a streptococcal infection, since in most cases an antibacterial drug is prescribed without revealing a particular causative agent, so to speak, empirically.

In addition, the antibiotic does not have time to kill streptococcus, if the patient before the time stops taking the drug, shortening the duration of treatment.

Useful information also in the material -  Antibiotic resistance

Indications of the antibiotics from streptococci

Strains, serotypes and groups of  streptococci are  very numerous, as are the inflammatory diseases caused by them, which spread from the pharyngeal mucosa to the membranes of the brain and heart.

The list of indications for the use of antibacterial agents includes: peritonitis, sepsis, septicemia and bacteremia (including neonatal); meningitis; scarlet fever; impetigo and face; streptoderma; lymphadenitis; sinusitis and acute otitis media; pneumococcal pharyngitis, tonsillitis, bronchitis, tracheitis, pleurisy, bronchopneumonia and pneumonia (including nosocomial); endocarditis. Effective in infectious inflammation of soft and bony tissues (abscesses, phlegmon, fasciitis, osteomyelitis) and lesions of the joints of streptococcal origin with rheumatic fever in acute form.

These antibiotics are used in the treatment of pyelonephritis and acute glomerulonephritis; inflammation of the urino-genital organs; intra-abdominal infection; postpartum infectious inflammation, etc.

Read also -  Streptococcal infection

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

Release form

The form of release of antibiotics Imipenem, Meropenem, Tsefpir and Vancomycin is a sterile powder in vials intended for the preparation of a solution that is administered parenterally.

Amoxiclav is available in three forms: tablets for oral use (125, 250, 500 mg), powder for the preparation of ingested suspension and powder for the preparation of solution for injection.

A Clindamycin is in the form of capsules, granules (for the preparation of syrup), a solution in ampoules and 2% cream.

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

Pharmacodynamics

Beta-lactam antibiotics Imipenem and Meropenem, related to carbapenems (a class of organic compounds known as thienamycins), penetrate into bacterial cells and interfere with the synthesis of vital components of their cell walls, which leads to the destruction and death of bacteria. From penicillins, these substances are somewhat different in structure; In addition, the composition of Imipenem is sodium cilastatin, which inhibits its hydrolysis by renal dehydropeptidase, which prolongs the effect of the drug and increases its effectiveness.

A similar principle of action has Amoxiclav, a combined preparation with aminopenicillin amoxicillin and clavulanic acid, which is a specific inhibitor of β-lactamases.

Pharmacodynamics of clindamycin is based on binding to the 50 S subunit of ribosomes of bacterial cells and inhibition of protein synthesis and growth of the RNA complex.

Cephalosporin antibiotic of the fourth generation by Cephir also disrupts the production of heteropolymeric peptidoglycans (mureins) in the framework of bacterial walls, leading to destruction of peptidoglycan chains and bacterial lysis. A mechanism of action of Vancomycin lies both in inhibiting the synthesis of mureins, and in disturbing the synthesis of RNA bacteria Streptococcus spp. The advantage of this antibiotic is that, having no β-lactam ring in its structure, it is not exposed to the protective enzymes of bacteria - β-lactamases.

[9], [10], [11], [12], [13], [14], [15], [16], [17]

Pharmacokinetics

Meropenem penetrates into tissues and biological fluids, but binding to plasma proteins does not exceed 2%. It is cleaved to form one inactive metabolite. Two thirds of the drug is eliminated in its original form; with iv introduction half-life is 60 minutes, with an injection / im - about an hour and a half. It is excreted from the body by the kidneys in an average of 12 hours.

In the pharmacokinetic characteristic of Clindamycin, its 90% bioavailability and a high degree of binding to blood albumin are noted (up to 93%). After oral administration, the maximum concentration of the drug in the blood is reached after about 60 minutes, after the introduction into the vein - after 180 minutes. Biotransformation occurs in the liver, some metabolites are therapeutically active. Excretion from the body lasts about four days (through the kidneys and intestines).

Cephpir is administered by infusion, and although the drug binds to plasma proteins by less than 10%, within 12 hours the therapeutic concentration in the tissues is retained and the bioavailability is 90%. This drug in the body is not split and excreted by the kidneys.

After oral administration of Amoxiclav into the blood, amoxicillin and clavulanic acid enter approximately an hour later, and are withdrawn twice as long; binding to blood proteins is 20-30%. In this case, the accumulation of the drug is noted in the sinuses of the upper jaw, lungs, pleural and spinal liquids, in the middle ear, abdominal cavity and pelvic organs. Amoxicillin almost does not split and is excreted by the kidneys; metabolites of clavulanic acid are excreted through the lungs, kidneys and intestines.

The pharmacokinetics of Vancomycin is characterized by binding to plasma proteins at a level of 55% and penetration into all body fluids and through the placenta. Biotransformation of the drug is negligible, and the half-life is an average of five hours. Two-thirds of the substance is excreted by the kidneys.

[18], [19], [20], [21], [22], [23], [24],

Dosing and administration

The way of application of preparations depends on their form of release: tablets are taken orally, solutions for injection are administered parenterally.

Imipenem can be injected into the vein (slowly, for 30-40 minutes) and into the muscle, but intravenous administration is practiced more often. A single dose of adults is 0.25-0.5 g (depending on the disease), the number of injections - three to four during the day. Doses for children are determined by body weight - 15 mg per kilogram. The maximum daily intake for adults is 4 g, for children - 2 g.

Meropenem is injected into a vein - jet or drip: every 8 hours for 0.5-1 g (with meningitis - 2 grams). For children under 12 years of age, the dosage is 10-12 mg per kilogram of body weight.

Encapsulated Clindamycin is taken orally - 150-450 mg four times a day for ten days. For children, syrup is more suitable: up to a year - half a teaspoon three times a day, after a year - a teaspoon. Injections of Clindamycin - intravenous drip and intramuscular - are prescribed in a daily dose of 120 to 480 mg, (divided into three injections); the duration of parenteral use is 4-5 days with the transition to taking capsules before the end of the course of treatment, the total duration of which is 10-14 days. Clindamycin in the form of a vaginal cream is used once a day for a week.

Antibiotic from streptococcuses Cefpirom is administered only intravenously, and the dose depends on the pathology caused streptococcus - 1-2 g twice daily (after 12 hours); the maximum allowable dose is 4 g per day.

Amoxiclav for adults and children over 12 years of age is administered intravenously four times a day for 1.2 g; children under 12 years of age - 30 mg per kilogram of body weight. The course of treatment is 14 days with a possible transition (according to the state) to the taking of tablets. Amoxiclav tablets are taken at a meal of 125-250 mg or 500 mg two to three times a day for 5-14 days.

A single dose of Vancomycin, which requires very slow intravenous administration, is 500 mg for adults (every six hours). For children, the dose is calculated: for each kilogram of the weight of the child - 10 mg.

[31], [32], [33]

Use of the antibiotics from streptococci during pregnancy

The safety of the use of antibiotics-carbapenems (Imipenem and Meropenem) by pregnant manufacturers is not established, therefore their use during pregnancy is allowed only a significant advantage of benefit for the future mother over the potential negative impact on the fetus.

The same principle applies to pregnant and lactating Clindamycin and Amoxiclav.

In pregnancy, it is prohibited to use Cephir. The ban on the use of Vancomycin concerns the first trimester of pregnancy, and at later dates, use is allowed only in extreme cases - in the presence of a life threat.

Contraindications

Basic contraindications for use:

Imipenem and Meropenem - the presence of allergies and hypersensitivity to drugs, a child of up to three months;

Clindamycin - inflammation of the intestine, insufficiency of the liver or kidneys, children's age up to a year;

Tsefpirom - penicillin intolerance, pregnancy and lactation, the age of patients younger than 12 years;

Amoxiclav - hypersensitivity to penicillin and its derivatives, bile stasis, hepatitis;

Vancomycin - hearing impairment and cochlear neuritis, kidney failure, first trimester of gestation, lactation period.

[25], [26], [27]

Side effects of the antibiotics from streptococci

The most likely side effects of Imipenem, Meropenem and Cephyrom include:  

Soreness at the injection site, nausea, vomiting, diarrhea, skin rashes with itching and flushing, a decrease in the level of leukocytes and an increase in urea in the blood. There may also be hyperthermia, headache, breathing and heart rhythm disturbances, convulsions, intestinal microflora disorders.

In addition to those already listed, the side effects of Clindamycin may be manifested as a taste of metal in the mouth, hepatitis and cholestatic jaundice, increased levels of bilirubin in the blood, pain in the epigastric region.

The use of Amoxiclav may be accompanied by nausea, vomiting and diarrhea, acute inflammation of the intestine (pseudomembranous colitis) due to activation of opportunistic infection - clostridia, as well as exudative erythema of the skin and development of toxic necroticisation of the epidermis.

Similar side effects may manifest in the treatment of green streptococcus antibiotics-glycopeptides (Vancomycin). In addition, this antibiotic can adversely affect hearing.

[28], [29], [30]

Overdose

In official instructions to the preparations Imipenem and Meropenem indicated that their overdose is unlikely.

Exceeding the dose of the remaining antibiotics considered in this review is manifested by an increase in their side effects, which are treated symptomatically.

[34], [35], [36], [37], [38], [39], [40]

Interactions with other drugs

These antibiotics from streptococci exhibit the following drug interactions:

Imipenem and Meropenem should not be used concomitantly with drugs that can damage the liver or worsen its kidney function.

Clindamycin differs incompatibility with the antibiotics of the aminoglycoside group, hypnotics and sedatives, calcium gluconate and magnesium sulfate, as well as with vitamins B6, B9, B12.

The activity of the drug with Cefpirum potentiates the simultaneous use of antibiotics of other groups (aminoglycosides, fluoroquinolones, etc.). Also, its combination with antitumor agents, immunosuppressors, drugs for the treatment of tuberculosis, diuretics of the loop type should be avoided.

Amoxiclav reduces blood coagulability and the reliability of hormonal contraceptives.

[41], [42], [43], [44]

Storage conditions

Sealed vials of preparations Imipenem, Meropenem, Cephpira should be stored in a dark place at t <+ 25 ° C; prepared solutions - at t <+ 5 ° C (no more than two days).

Vancomycin - at t <+ 10 ° C.

[45], [46], [47], [48], [49], [50], [51], [52]

Shelf life

The shelf-life of the products is indicated on their packaging.

[53], [54], [55], [56], [57], [58]

Treatment of streptococcus without antibiotics

As doctors say, treatment of streptococcus without antibiotics is impossible, because strengthening immunity with vitamin infusions of wild rose berries or decoctions of echinacea, cranberry juice or tea with ginger can reduce the inflammatory reaction, but does not kill its cause - bacteria.

Garlic, honey, goat milk, gargling with the infusion of eucalyptus leaves, propolis or turmeric solution are aids from streptococcus in the throat. And septicemia, meningitis, scarlet fever or acute glomerulonephritis can cure only antibiotics from streptococci.