Antibiotics for chlamydia in women and men

The most common venereal infection caused by the smallest microorganisms - chlamydia, is difficult to treat. In the overwhelming majority of cases, its course is asymptomatic, patients fall into the doctor's field of vision, already having a neglected form of the disease. The consequences of chlamydia are impressive. It is not only the inflammatory processes of the genitourinary organs and, as a consequence, the violation of reproductive function in people of both sexes, but also serious diseases of the eyes, joints, lymph nodes. Antibiotics for chlamydia are appointed to destroy the pathogen and eliminate the inflammatory process, as well as to prevent dangerous complications. They must be taken in strict accordance with medical recommendations. The choice of the drug depends on the form and stage of the disease.

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

Indications Antibiotics for chlamydia

Infectious and inflammatory diseases of the genito-urinary organs: non-gonococcal urethritis in persons of both sexes; cervicitis, salpingitis, endometritis in women, prostatitis and orchoepidymitis in men, combined urinary tract, eye and joint damage (Reiter's syndrome).

Antibiotics are prescribed to persons with positive laboratory results for the presence of chlamydia, their sexual partners, newborns from mothers with chlamydia.

For the eradication of chlamydia antibacterial drugs of three groups are used: tetracycline (usually prescribed in acute form of the disease without complications to persons who have not previously undergone anti-Chlamydia therapy); macrolides (drugs of choice for pregnant and lactating women); fluoroquinolones (antibiotics for chronic chlamydia or for patients with resistant forms), combinations of two antibacterial drugs are often used.

Preparations of these groups are able to penetrate into the cell and disrupt the life cycle of chlamydia. Medications that destroy cell walls and have a low penetration ability (penicillin, cephalosporin, nitroimidazole groups) in the fight against these microorganisms are useless.

[4], [5], [6], [7], [8]

Release form

For the treatment of chlamydia, oral administration of antibiotics is usually prescribed. Preparations are available in various forms: tablets, capsules, powders for the preparation of suspension, syrups.

Since the main contingent of patients are adult young patients, the preferred form of treatment is the taking of tablets (capsules).

With resistant complicated forms of chlamydia, a course of intravenous injections in a hospital can be prescribed.

Names of drugs from chlamydia

Chlamydia is almost always treated with macrolides. To drugs of this group the pathogen is very sensitive, in addition, it is natural antibiotics, more effective than tetracycline drugs. In general, an antibiotic with an active ingredient is prescribed:

• Azithromycin (eponymous drug, Azitral, Azitrox, ZI-Factor, Sumazid and others);
• Josamycin (eponymous drug, Wilprafen, Wilprafen Solutab).

As preparations of the second stage (for patients with intolerance of preferred drugs), other macrolides are also used: Erythromycin, Clarithromycin, Rovamycin.

Patients with mild forms of chlamydia without complications are prescribed Doxycycline (Vibramycin, Doxibene, Supracycline, Unidox solute and other synonyms).

Fluoroquinolones (Ofloxacin, L-floxacin, Lomefloxacin, Ciprofloxacin, Norfloxacin) are prescribed to patients in the case of chronic forms of the disease, when the infection is not amenable to treatment with drugs of the first order.

In practice, combined forms of infection are more common than monoinfection. In these cases, the drug is selected in such a way that it is active against all infectious agents found in the patient.

Doxycycline, Azithromycin, Josamycin and fluoroquinolones belonging to the third and fourth generation are active in addition to chlamydia also to gonococci, although many pathogens are now resistant to tetracycline drugs. Therefore, the drugs of choice - macrolides, fluoroquinolones are used in extreme cases. Antibiotics for gonorrhea and chlamydia are the main drugs for the eradication of infectious agents.

The above mentioned antibiotics are effective in ureaplasma and chlamydia, mycoplasma is also sensitive to them.

Unfortunately, one antibiotic for trichomoniasis and chlamydia can not cope with this mixed infection. In this case, antiparasitic agents (derivatives of 5-nitroimidazole) - Tinidazole, Ornidazole, Metronidazole - are introduced into the therapeutic scheme. The antibiotic of choice should not belong to the group of fluoroquinolones, because in such a combination the toxicity of both drugs increases.

[9], [10], [11], [12], [13]

Pharmacodynamics

Chlamydia are intracellular microorganisms, so all drugs prescribed for their eradication have the ability to penetrate inside the cell.

Semisynthetic macrolide  Azithromycin  is the preferred drug for the treatment of chlamydia. This is due to several reasons, firstly, the ability to cure the infection with a single dose (it is easy to follow all the rules); secondly, it is active against many combined infectious agents, in particular ureaplasma and gonococci, although it is not a first-line drug for the treatment of gonorrhea . It has bacteriostatic action in therapeutic doses, like all representatives of this group, penetrating through the cell wall and binding to the fragmentary part of the bacterial ribosome, prevents the normal synthesis of its protein, inhibiting the transfer of peptides from the acceptor site to the donor. In addition to bacteriostatic, antibiotics of this group have the ability to stimulate immunity somewhat and inhibit the activity of proinflammatory mediators.

Erythromycin  - the first antibiotic of this class, is considered the most non-toxic, has a natural origin. It is considered an alternative, used in the treatment of pregnant women, adolescents and newborns. The spectrum of action is similar to the previous one, however, many microorganisms have already acquired resistance to this drug and its effectiveness is considered to be lower than that of the later macrolides.

Josamycin, a  representative of the same class of antibiotics, has a natural origin and a higher activity than the previous two. In contrast to others, practically does not depress the useful microflora of the gastrointestinal tract. Resistance to it develops less often than to other representatives of this group.

From macrolides in the treatment of chlamydia as alternative drugs, Clarithromycin  and  Roxithromycin can also be used  .

Tetracycline antibiotic  Doxycycline  is also prescribed quite often in chlamydia. Since to the drugs of this series many pathogens have already developed resistance, it is recommended to use in primary patients with uncomplicated disease. Has a pharmacological effect, inhibiting the production of proteins in bacterial cells, interfering with the transfer of its genetic code. Has a wide range of activities, in particular, to chlamydia and gonococci. Its disadvantage is also the widespread resistance of pathogens to antibiotics of the tetracycline series.

Fluorinated quinolones are considered reserve drugs and are used in cases where the previous ones are not effective. They show bactericidal action - they inhibit the enzymatic activity of two microbial topoisomerases of the second type, which are necessary for the vital activity of bacteria - the process of realizing their genetic information (DNA biosynthesis). For the eradication of chlamydia, second-generation drugs such as Norfloxacin,  Ofloxacin,  or  Ciprofloxacin may also be prescribed , which  also exhibit anti -  nococcal activity. Ureaplasma, in most cases, is insensitive to these drugs. If the mixed infection includes this pathogen, then  Levofloxacin  or  Sparfloxacin,  belonging to the third generation of this group of antibiotics, are used.

[14], [15], [16], [17],

Pharmacokinetics

Azithromycin is  absorbed from the gastrointestinal canal at a good rate, because this drug is acid-resistant and has an affinity for fats. The greatest plasma concentration is determined after a period of 2.5 to three hours. In the blood stream, approximately 37% of the dose administered is unchanged. Well distributed in all tissues. For all antibiotics of this group, a high tissue, rather than plasma, concentration is characteristic, which is due to low affinity for proteins, as well as the ability to penetrate cells of pathogenic microorganisms and accumulate in lysosomes. Azithromycin is transported to the foci of infection by phagocyte cells, where during their activity, its release occurs. A higher concentration of the drug in infected tissues is found compared with healthy ones, comparable with the degree of inflammatory edema. The function of the phagocyte cells is not disturbed. The therapeutic concentration of the drug remains in the localization of the inflammatory process within five to seven days from the moment of its last administration. It is this ability that allows you to take Azithromycin once or in short courses. Elimination from whey is long and two-stage, which explains its purpose once a day.

The rate of absorption of  Erythromycin  in the digestive channel is determined by the characteristics of the patient's body. The highest plasma concentration is recorded after two hours from the administration of the drug, binds with plasma albumin from 70 to 90% of the dose. Distribution occurs mainly in the tissues and fluids of the body, can be absorbed by 30-65%. Malotoxic, overcomes the placental barrier and is determined in breast milk.

Splits in the liver, metabolic products are excreted almost completely with bile, a small part - unchanged through the urinary tract. Normally working kidneys provide deducing half of the accepted dose of erythromycin already in two hours after reception.

Josamycin is  almost completely absorbed from the digestive tract at a good rate. Unlike other macrolides, its bioavailability does not depend on food intake. The highest serum concentration is determined after an hour, about 15% of the active substance is bound with plasma albumins. It is well distributed in tissues, overcomes the placenta and is determined in breast milk. It is split in the liver. Metabolites slowly leave the body through the biliary tract, less than 15% - through the organs of urination.

Doxycycline is  absorbed quickly, regardless of the presence of food in the gastrointestinal tract, and its elimination is slow. The therapeutic concentration in the blood serum is determined within 18 hours and more after administration, the association with plasma albumins is approximately 90%. The active substance is quickly distributed in liquid substances and tissues of the body. Elimination occurs through the gastrointestinal tract (about 60%), with urine - the rest. The half-life is 12 hours to 24 hours.

Fluorinated quinolones are  well, rapidly and ubiquitously distributed in the tissues and organs of various systems, creating significant concentrations of the active substance. In addition to Norfloxacin, the most concentrated in the intestines, urinary tract and prostate gland, where infection is most often localized in male patients.

The highest level of tissue saturation of various localizations is observed with the therapy of Ofloxacin, Levofloxacin, Lomefloxacin, Sparfloxacin.

They have an average ability among antibiotics to penetrate the cell walls inside the cell.

The rate of biotransformation and elimination depends on the physicochemical properties of the active substance. In general, the drugs of this group are characterized by rapid absorption and distribution. The most actively metabolized Pefloxacin, the least - Ofloxacin, Levofloxacin, bioavailability of which is almost one hundred percent. The bioavailability of ciprofloxacin is also high, at a level of 70-80%.

Fluctuations in the elimination of half of the dose taken in fluorinated quinolones constitute a wide time range from three to four hours in Norfloxacin to 18-20 hours in Sparfloxacin. The most part is excreted through the urinary organs, and from three to 28% (depending on the drug) - the intestine.

Renal dysfunction in the patient lengthens the half-life interval for all drugs in this group, especially in Ofloxacin and Levofloxacin. In cases of severe renal dysfunction, the dose of any fluorinated quinolone needs to be adjusted.

Antibiotics for chlamydia in men are prescribed individually depending on the form and stage of the disease, the localization of infection, the presence of complications and associated infections. When choosing a drug, the patient's tolerance to a certain group of antibacterial agents is also taken into account, the need to combine them with the intake of any other drugs in the presence of chronic diseases in the patient, the sensitivity of infectious agents to certain medicines.

The same principles guide doctors, when they select antibiotics for chlamydia in women. A special category of patients are future mothers.

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

Dosing and administration

The most frequently prescribed course of antibiotics for chlamydia is:

A single dose of Azithromycin 1000 mg (two 500 mg tablets) an hour before meals or a seven-day course of Doxycycline 100 mg (one capsule) every 12 hours, with plenty of water.

Preparations of the second line are taken during the week:

Erythromycin - every six hours for 500 mg an hour before meals with plenty of water;

Josamycin - every eight hours for 750 mg;

Spiramycin - every eight hours for 3 million units;

Ofloxacin - every twelve hours for 300 mg;

Ciprofloxacin - every twelve hours for 500-750 mg in complicated cases.

Pregnant women are prescribed the usual therapy with Erythromycin, Josamycin, Spiramycin.

During treatment it is necessary to observe a sufficient water regime (not less than 1.5 liters of water per day).

The course of treatment is mandatory for both partners. In complicated cases, two antibiotics of different pharmacological groups can be used, for example, Azithromycin or Doxycycline in combination with Ciprofloxacin.

The indicator of treatment effectiveness is a negative result of the polymerase chain reaction of the urogenital tract smears one and a half to two months after the end of treatment.

[27], [28],

Use Antibiotics for chlamydia during pregnancy

Doxycycline and antibiotics belonging to the group of fluoroquinolones, women bearing a baby, are not prescribed.

Antibiotic of the tetracycline group Doxycycline can provoke anomalies in the formation of bone tissue in the fetus.

Fluoroquinolones are classified as toxic antibiotics, however, there is no reliable data on the teratogenicity of these medicines. There, however, in studies on laboratory animals, arthropathies developed in their offspring, and there are also reports of single cases of hydrocephalus, intracranial hypertension in newborns whose mothers took drugs of this group during gestation.

Macrolide antibiotics though penetrate the placental barrier, but are not considered teratogenic and low-toxic. Therefore, the drug for the treatment of chlamydia in pregnant women is selected from this group. The safest of these is Erythromycin, however, Wilprafen (Josamycin) and Spiramycin are the most effective natural hexyl macrolides. Azithromycin is prescribed only for vital indications. The effect of other drugs in this group on the fetus has been studied little, so they are not recommended for use in the treatment of pregnant women. Clarithromycin, according to some sources, may have a negative effect.

Contraindications

Common to all antibiotics is a known allergic reaction to the drug.

Fluoroquinolones and Doxycycline are contraindicated in pregnant and lactating women.

Doxycycline is not prescribed for children from birth until the full seven years, and also for patients with severe liver diseases.

Fluorinated quinolones are not used in pediatrics and for the treatment of patients with congenital enzymatic deficiency of glucose-6-phosphate dehydrogenase, epileptics and individuals with pathological changes in tendons after the course of drugs of this group.

Macrolide antibiotics of the second stage (Clarithromycin, Midekamycin, Roxithromycin) are not used for treatment of expectant mothers and breast-feeding patients. Josamycin and Spiramycin, which can be used to treat chlamydia during pregnancy, are not prescribed during lactation.

The prohibition to use any macrolides is severe dysfunction of the liver and bile ducts.

[24], [25], [26]

Side effects Antibiotics for chlamydia

Antibiotics cause allergic reactions from itchy skin rashes and swelling to severe bronchial asthma and anaphylaxis.

The general actions of antibiotics include disorders of the digestive organs - dyspepsia, abdominal discomfort, lack of appetite, stomatitis, colitis, intestinal microflora disorder, in addition, fluoroquinolones can still cause perforation and intestinal hemorrhage, as well as various liver disorders, jaundice, mild cholestasis. On this list of side effects of macrolide antibiotics ends.

Doxycillin and fluoroquinolones can cause changes in the blood formula: a decrease in the level of erythrocytes, platelets, neutrophils, hemoglobin; pancytopenia, eosinophilia; the use of the latter can cause the appearance of point or larger hematomas, nasal bleeding.

These drugs can provoke the development of superinfection, reinfection, mycoses, the emergence of resistant strains of bacteria, the phenomenon of photosensitization.

Doxycillin causes a persistent discoloration of tooth enamel.

The longest list of side effects is fluorinated quinolones. In addition to those already mentioned, these drugs can cause:

• metabolic and metabolic disorders;
• mental disorders manifested in an overexcited state, insomnia and nightmares, paranoid and depressive disorders, phobias, disorientation in space, attempts at suicide and others;
• disorders of the central and peripheral nervous system;
• visual disorders (photophobia, diplopia, conjunctivitis, nystagmus);
• hearing impairment and coordination of movements;
• disruption of the heart until its stop and cardiogenic shock, thrombosis of cerebral vessels;
• upset respiratory organs;
• pain in muscles, joints, tendons, lesions and ruptures of their tissues, and during the first two days of taking the drug; muscle weakness;
• all kinds of disorders of the urinary tract, candidiasis, kidney stones;
• in patients with hereditary porphyria - exacerbation of the disease;
• in addition - asthenic syndrome, back pain, hyperthermia, fever, weight loss, distortion of taste and perception of odors.

Overdose

Exceeding the dose of macrolides is symptomatic of a digestive system disorder (diarrhea, nausea, abdominal pain, and sometimes vomiting).

Overdosage Doxycycline or fluorinated quinolones manifests as a neurotoxic reaction - dizziness, nausea, vomiting, convulsions, loss of consciousness, headache.

Treatment: gastric lavage, reception of activated charcoal.

[29],

Interactions with other drugs

This factor must be taken into account in order to achieve maximum effectiveness from drug treatment and neutralize the resulting negative effects.

In general, the mutual influence of  macrolide  antibiotics with various drugs is associated with inhibition of the cytochrome P-450 system by these drugs. The ability to inhibit this system increases in this group of antibacterial agents in this order: Spiramycin → Azithromycin → Roxithromycin → Josamycin → Erythromycin → Clarithromycin.

With appropriate intensity, representatives of this pharmacological class slow down the biological transformation and increase the serum density of indirect anticoagulants, theophylline, finlepsin, valproate, derivatives of disopyramide, ergot medicaments, cyclosporine, respectively, increasing the likelihood of development and the strength of the side effects of these drugs. Therefore, the dosage regimen may need to be changed.

It is undesirable to simultaneously use macrolide antibiotics (except Spiramycin) with fexofenadine, cisapride, astemizole, since this combination significantly increases the risk of severe arrhythmias caused by prolongation of the QT interval.

Antibiotics of this series contribute to the improvement of digestion of oral digoxin, since it reduces its inactivation in the intestine.

Antacid medicines reduce the absorption of macrolide antibacterial agents in the digestive canal, in particular, this effect is susceptible to Azithromycin.

Anti-tuberculosis antibiotic Rifampicin accelerates the process of biotransformation of macrolides by the liver and, accordingly, reduces their plasma concentration.

Combined use with lincosamide antibiotics is not recommended, since competition is likely to occur between them (they have a similar effect).

The use of alcohol during treatment with any antibiotics is unacceptable, but it should be noted that Erythromycin, especially its intravenous injections, increases the risk of acute alcohol intoxication.

Absorption of  Doxycycline  reduces drugs-antacids and laxatives, which contain magnesium salts, antacids containing salts of aluminum and calcium, medicinal and vitamin products containing iron, sodium bicarbonate, cholestyramine and colestipol, so when combined, the appointment is diluted in time, making interval of at least three hours.

Tact as a drug disrupts intestinal microbiocenosis, thrombocytopenia and requires a change in the dose of indirect anticoagulants.

Simultaneous reception with preparations of penicillin and cephalosporin series, as well as others, whose mechanism of action is based on the violation of the synthesis of bacterial cells, is inappropriate, since it neutralizes the effect of the latter.

Increases the risk of unwanted pregnancy in combination with taking estrogen-containing contraceptives.

Substances that activate the process of microsomal oxidation (ethyl alcohol, barbiturates, rifampicin, finlepsin, phenytoin and others) increase the rate of Doxycycline cleavage and lower its serum concentration.

The combination with methoxyflurane is fraught with the risk of developing acute renal failure and even the death of the patient.

Taking vitamin A on a background of therapy with Doxycycline may cause an increase in intracranial pressure.

Simultaneous inclusion in the scheme of reception of  fluorinated quinolones  with medicines, which contain ions of bismuth, zinc, iron, and magnesium, are absorbed significantly worse due to the creation of nonabsorbable chelate compounds with them.

Ciprofloxacin, Norfloxacin and Pefloxacin reduce the excretion of methyl xanthine derivatives (theobromine, paraxanthin, caffeine) and increase the likelihood of mutual toxic effects.

The neurotoxic effect of fluorinated quinolones increases with combined use with non-steroidal anti-inflammatory agents, as well as derivatives of nitroimidazole.

Not compatible with drugs based on nitrofuran.

Ciprofloxacin and Norfloxacin have the ability to disrupt the biotransformation process in the liver of indirect anticoagulants, which increases the likelihood of blood thinning and hemorrhagic phenomena (it may be necessary to adjust the dose of the antithrombotic drug).

Fluoroquinolones are not given in the same regimen with cardiac means that increase the QT interval, because of the high likelihood of heart rhythm disturbances.

Combined use with glucocorticoid hormones is a dangerously high probability of injuries of tendons, in the group of high risk - patients of advanced age.

The use of ciprofloxacin, Norfloxacin and pefloxacin on the background of taking drugs with the effect of alkalinization of urine (sodium bicarbonate, citrates, inhibitors of carbonic anhydrase), increases the likelihood of the formation of concrements and nephrotoxic effects of such a combination of medications.

Against the background of taking azlocillin or cimetidine due to a decrease in tubular secretion, the rate of elimination of the fluoroquinolone antibiotics from the body decreases and their plasma concentration increases.

[30], [31]

Information for patients

It is necessary to observe the storage conditions of the product and the expiration date, which are indicated on the package. Do not use medicines whose expiration date has expired or the appearance of the product has changed (color, odor, etc.).

Currently, as the most effective antibiotics in chlamydia, macrolides are positioned. They have the highest ability among other antibacterial drugs to penetrate into the cell and to work on the pathogens that have settled there. They are effective, microbes have not yet lost sensitivity to them. The low toxicity of antibiotics in the macrolide group is also a positive factor in favor of their use. However, a single approach to all patients does not exist and can not be, since many factors influence the choice of the treatment regimen - from individual tolerance to the degree of neglect of the disease and the state of the patient's health.

Treatment, as practice shows, is not always effective. And often the question arises, why do not the symptoms of chlamydia after antibiotics pass? There are many reasons for this. First of all, the irresponsibility of the patient. Far from all strictly comply with medical prescriptions, adhere to the regime of admission during the entire treatment course. And also maintain its duration and do not stop treatment without control tests.

In addition, both partners must be treated. Chlamydia can be infected countless times, especially if the source of the infection is nearby.

During the course of treatment it is necessary to abstain from sex. If you took Azithromycin once, then in a week you need to make sure of your cure. It is recommended to undergo a follow-up check three months or later to make sure that the pathogen is destroyed.

If the symptoms return, it is necessary to consult a doctor. Repeated infection is fraught with serious complications.

Often the question arises: how to cure chlamydia without antibiotics? The official answer is that eradication of chlamydia without antibiotics is not yet possible. Science does not stand still, however, such treatment is the task of the future. However, on the Internet several variants of treatment of a clamidiosis with herbs and bioadditives are painted. Trying alternative methods is not prohibited to anyone, just need to take into account that, by delaying the process, you risk complicating the course of the disease, and then getting rid of it will be much more difficult.