It has been established that a person is a natural "host" of 13 types of mycoplasmas, of which the possible causative agents of urethritis can be Mycoplasma (M.) hominis, M. genitalium and Ureaplasma (U.) urealyticum. In addition to these types of mycoplasmas, the urogenital tract is also found M. fermentans, M. primatum, M. pyrum, M. spermatophilum, M. penetrans, M. pneumoniae.

The question of the role of genital mycoplasmas in the etiology of non-gonococcal urethritis (NGU) remains unresolved due to the wide distribution of these microorganisms and their frequent detection in asymptomatic individuals. The opinions of researchers on this issue differ. Some authors tend to attribute mycoplasmas to obligate pathogens that cause urethritis, cervicitis, prostatitis, postpartum endometritis, pyelonephritis, infertility, and various pathologies of pregnancy and fetus. Accordingly, according to these authors, the eradication of mycoplasmas should be sought if they are detected. Others believe that mycoplasmas are conditionally pathogenic flora of the urogenital tract and only under certain conditions can cause infectious and inflammatory diseases of the urogenital organs. Most foreign authors include all mycoplasmas, with the exception of M. genitalium, to opportunistic pathogens. That is why in ICD-10 such a disease as mycoplasmosis, ureaplasmosis or ureaplasma infection is not registered. According to many researchers, from mycoplasmas, without any reservations, only M. genitalium.

Summary data on epidemiology M. genitalium were presented by David Taylor-Robinson (2001) based on an analysis of the works of 19 most respected researchers, according to which these microorganisms were isolated from 10-50% of NGU patients and from 0-17.7% of healthy individuals. Later, N. Dupin et al. (2003) it was shown that the disappearance of these microorganisms from the urethra is accompanied by the resolution of urethritis and, conversely, the recurrence of the disease may be associated with the use of drugs that are not sufficiently active against M. genitalium.

Clinical picture urethritis, in which mycoplasmas are detected, as with chlamydia infection, does not have pathognomonic symptoms. M. genitalium more often found in individuals with chronic urethritis, the likely cause of the recurrence of which it is. L. Mena et al. (2002) showed that patients with M. genitalium-associated urethritis to a lesser extent than patients with gonococcal urethritis, complain of dysuria and discharge, and their discharge is much less likely to be purulent.

Diagnostics. Revealing M. genitalium in the material from the urogenital tract is carried out only by the method of polymerase chain reaction (PCR). The study allows you to very quickly - within a day - to identify the DNA of the pathogen in the scraping from the urogenital tract and determine its species. Culture on selective media is used to identify M.hominis and U. urealyticum.

Treatment

As in most cases of detection of opportunistic flora, a number of factors contributing to the development of infectious and inflammatory processes are distinguished for mycoplasmas. The most important of these are immune disorders, changes in hormonal status, massive colonization, and associations with other bacteria. All these factors, as well as the type of pathogen, the duration of infection, the history of previous treatment, the presence of concomitant pathogenic and opportunistic flora should be taken into account when determining the tactics of managing patients.

Etiotropic treatment of NGU caused by M. genitalium is based on the use of antibacterial drugs different groups. The activity of drugs against any infection is determined by the minimum inhibitory concentration (MIC) in studies in vitro. BMD scores tend to correlate with clinical cure outcomes. Antibiotics with the lowest MICs are considered optimal drugs, but the importance of such parameters as bioavailability, the ability to create high interstitial and intracellular concentrations, treatment tolerability and patient compliance should be remembered.

To select an adequate therapy regimen in specific cases, it is recommended to determine the sensitivity of isolated cultures to various antibiotics in a laboratory. But the problem is that this mainly concerns the identified saprophytic flora. Thus, many authors note the ability of mycoplasmas to quickly acquire resistance to antibacterial drugs during their passage. in vitro. Therefore, it is necessary to test freshly isolated from diseased strains. Another difficulty is that when mycoplasmas are detected, sensitivity to antibiotics in vitro not necessarily correlated with a positive effect in vivo. This may be due to the pharmacokinetics of drugs. These factors must be taken into account when prescribing etiotropic therapy, which in many cases may be part of combination therapy especially in mixed infections.

The European (2001) and American (2006) guidelines for the management of patients with urethritis contain recommendations according to which NGU should be treated according to basic and alternative regimens.

Basic schemes:

• azithromycin - 1.0 g orally, once;
• doxycycline - 100 mg 2 times a day for 7 days.

Alternative schemes:

• erythromycin - 500 mg 4 times a day for 7 days or 500 mg 2 times a day for 14 days;
• ofloxacin - 200 mg 2 times a day, or 400 mg 1 time per day, or 300 mg 2 times a day for 7 days;
• levofloxacin - 500 mg once a day for 7 days;
• tetracycline - 500 mg 4 times a day for 7 days.

From the above schemes, it can be seen that the main antibiotics recommended for the treatment of NGU are tetracyclines, macrolides, and fluoroquinolones.

If we summarize the recommendations set out in the main domestic guidelines (“Federal Guidelines for the Use of Medicines”, “Rational Pharmacotherapy of Skin Diseases and Sexually Transmitted Infections” (ed. by Academician A. A. Kubanova), “Methodological Materials on the Diagnosis and Treatment of the Most Common Sexually Transmitted Infections and Skin Diseases (Protocols of Patient Management), published by TsNIKVI), we can present the following schemes for the etiotropic treatment of NGU, adopted in Russia.

Tetracycline antibiotics

Main drugs:

• doxycycline - 100 mg 2 times a day for at least 7-14 days. The first dose when taking the drug is 200 mg.

Alternative drugs:

• tetracycline - 500 mg 4 times a day for 7-14 days;
• Metacycline - 300 mg 4 times a day for 7-14 days.

Macrolides

Main drugs:

• azithromycin - a single dose of 1.0 g or 250 mg 1 time per day for 6 days. The drug is taken 1 hour before meals or 2 hours after meals;
• josamycin - 500 mg 2 times a day for 7-14 days.

Alternative drugs:

• erythromycin - 500 mg 4 times a day for 7-14 days;
• roxithromycin - 150 mg 2 times a day for 7-14 days;
• clarithromycin - 250 mg 2 times a day for 7-14 days;
• midecamycin - 400 mg 3 times a day for 7-14 days.

Fluoroquinolones

• ofloxacin - 200-300 mg 2 times a day for 7-14 days;
• sparfloxacin - 200 mg once a day for 10 days (double the dose on the first day);
• levofloxacin - 500 mg once a day for 10 days;
• pefloxacin - 600 mg once a day for 7-14 days.

Tetracycline drugs are the most common medicines for the etiotropic treatment of patients with NGU caused by M. genitalium. And although doxycycline has been used in the treatment of various pathologies for several decades, its activity against the main pathogens of NGU remains high (D. Kilic et al., 2004).

That is why, according to all the recommendations mentioned above, the drug of choice in the treatment of NGU is doxycycline. The advantage of its use is rather high efficiency and relatively low cost of treatment. Doxycycline compared to tetracycline has a higher bioavailability, a longer half-life and is better tolerated. In addition, when using doxycycline, unlike other tetracyclines, there is no need to follow a diet designed to take into account the possibility of tetracyclines binding to Ca 2+ ions. The most common side effects when taking tetracycline drugs are nausea, vomiting, diarrhea, and allergic reactions. These reactions are much less pronounced when using doxycycline monohydrate, rather than traditional doxycycline hydrochloride. The neutral reaction of doxycycline monohydrate (Unidox Solutab) excludes the occurrence of esophagitis that occurs with the use of other forms of doxycycline. Doxycycline monohydrate is available in a unique dosage form of Solutab tablets, which can be taken orally as a whole, can be divided into parts or chewed, can be dissolved in water to form a suspension syrup (when dissolved in 20 ml of water) or a suspension solution (when dissolved in 100 ml of water). The bioavailability of doxycycline monohydrate in this form is 95%, which practically corresponds to intravenous infusion. Therefore, a good combination chemical formula(monohydrate) and dosage form(solutab) makes the drug Unidox Solutab safe, and the treatment with its help is highly compliant.

During the period of treatment with drugs of the tetracycline group, patients should avoid insolation due to the possibility of photosensitivity.

This side effect is completely devoid of antibiotics from the macrolide group. All of these guidelines list the macrolide antibiotic azithromycin as the drug of choice for the treatment of NGU. This is facilitated by the unique pharmacokinetic characteristics of azithromycin: a long half-life, a high level of absorption and resistance to an acidic environment, the ability of this antibiotic to be transported by leukocytes to the site of inflammation, a high and prolonged concentration in tissues, and the possibility of penetration into the cell. Due to the fact that a high therapeutic concentration of azithromycin in tissues is achieved after a single dose of a standard dose of an antibiotic and persists in inflammation sites for at least 7 days, with the advent of azithromycin, for the first time, it became possible effective treatment patients with chlamydial infection with a single dose of an antibiotic inside. The original and most famous drug of azithromycin is Sumamed, which is used in Russian Federation since the early 1990s.

The advantages of all modern macrolide antibiotics over the first antibiotic from this group, erythromycin, are higher efficiency, improved pharmacokinetics, good tolerability, and less frequency of administration.

When taking macrolides, there may be side effects from gastrointestinal tract(nausea, vomiting, diarrhea) and liver (increased activity of transaminases, cholestasis, jaundice), as well as allergic reactions.

Josamycin has the most favorable safety profile compared to other macrolides. Frequency side effects when it is taken, it does not exceed 2-4%. The drug does not have hepatotoxicity and almost does not change normal microflora intestines. In our pharmaceutical market, josamycin is still represented by the only drug with the trade name Vilprafen.

It is necessary to pay attention: mycoplasmas can be resistant to "old" macrolides (erythromycin, spiramycin, oleandomycin) and streptogramins, but highly sensitive to the latest macrolides (josamycin, azithromycin, clarithromycin) and lincosamines.

The next group of drugs with high activity against a wide range of NGU pathogens (including M. genitalium), are fluoroquinolones.

Fluoroquinolones such as ofloxacin and sparfloxacin are especially effective in NGU, accompanied by massive colonization of opportunistic saprophytic flora, since this flora is usually sensitive to these antibacterial drugs. Their "leading position" is due to the breadth of the antibacterial spectrum, high bactericidal activity, excellent pharmacokinetic characteristics (absorption rate, high concentrations of the drug in tissues, cells, biological fluids), low toxicity. In the treatment with sparfloxacin, a higher compliance is achieved, since the drug is taken only 1 time per day. According to Yu. N. Perlamutrov et al. (2002), sparfloxacin is highly effective in mycoplasmal and ureaplasma infections. In the Russian pharmaceutical market, sparfloxacin is sold under the trade name Sparflo, and among the generics of ofloxacin, Oflocid has recently become increasingly popular.

Like tetracyclines, fluoroquinolones have a photosensitizing effect. In addition, drugs from the group of fluoroquinolones are contraindicated in patients with impaired liver and kidney function. Of the adverse reactions after taking fluoroquinolones, dyspeptic disorders, nausea, vomiting, dizziness, allergic reactions, tendonitis can be observed.

Thus, based on a review of the literature, in the treatment of patients with urethritis caused by M. genitalium, preference should be given to doxycycline, the latest macrolides and fluoroquinolones. With a recurrent course of infection, the issue of lengthening the time for taking antibiotics and the use of immunotropic drugs is considered.

M. A. Gomberg, doctor of medical sciences, professor
A. M. Solovyov, Candidate of Medical Sciences, Associate Professor
I. N. Aniskova
V. P. Kovalyk, Candidate of Medical Sciences
TsNIKVI, MGMSU, Moscow

Mycoplasmosis is a serious disease that carries the risk of complications without effective and competent treatment. This disease is caused by the microorganism mycoplasma, which can be on the mucous membranes in the human body for a long time. If you suspect this disease, you must definitely consult a doctor to identify mycoplasmosis and treat it in order to avoid serious consequences for the body.

What's this?

The disease is caused by the pathogen Mycoplasma. Such microorganisms are of various types, but only a few of them are dangerous to humans - Mycoplasma Genitalium, Hominis, Pneumonia. It is these pathogens that pose a threat to humans and require treatment. They "settle" on the mucous membranes of the genitourinary system or respiratory tract (depending on the species, they choose different habitats).

Mycoplasmosis is very serious illness, which leads to inflammatory processes of the genitourinary system. It can cause female infertility and changes in the qualitative and quantitative indicators of seminal fluid in men. But this disease is especially dangerous for pregnant women. There is a threat of miscarriage, spontaneous miscarriages, as well as the occurrence of various fetal pathologies (including pneumonia, visual impairment).

Mycoplasmosis is transmitted in most cases sexually, therefore, if an infection is detected, treatment of mycoplasma must be carried out by both partners. The second most common is the vertical route of transmission, that is, from mother to child during pregnancy. The possibility of infection with a microorganism through the personal belongings of the patient is not excluded, although this route of transmission has not yet been proven.

The risk factors for mycoplasmosis should also be noted:

• Reduced level of immunity;
• A history of abortion;
• Postponed surgical interventions;
• Pregnancy and childbirth;
• Diseases of an infectious nature.

Symptoms of the disease

In the vast majority of cases, mycoplasmosis does not manifest itself for a long time, proceeding absolutely asymptomatically, in such cases it can be detected by chance. With an asymptomatic course of the disease, an exacerbation is also possible, the cause of which is stress, surgery (mainly on the pelvic organs), as well as a decrease in immunity.

It is worth noting that the symptoms of mycoplasmosis in men and women are somewhat different.

Symptoms of the disease in women

In women, the infection is manifested by symptoms such as:

• Clear or whitish vaginal discharge;
• The appearance of itching in the genitals;
• From the middle of menstruation to its end, painful sensations may appear;
• Burning sensation when urinating;
• Pain in the lower abdomen;
• Pain during intercourse.

Depending on how mycoplasma has manifested itself, a woman may experience diseases such as urethritis, vaginitis, endometritis, adnexitis and others.

Symptoms of the disease in men

In men, mycoplasma can manifest itself with such signs:

• Clear discharge from the urethra;
• Redness of the mucous membrane around the urethra;
• Burning sensation, toothache and pain during urination;
• Redness of the scrotum;
• Pain in the groin.

The presence of mycoplasma in the body can cause urethritis, orchitis, prostatitis and even infertility in men.

Complications of mycoplasmosis

If mycoplasma is detected, treatment must be carried out in accordance with the doctor's recommendations. Otherwise, various serious complications may occur, including:

• female infertility. It appears as a result of the development of endometritis or inflammatory processes in the fallopian tubes.
• male infertility. Due to damage to the prostate and testicles, significant structural and quantitative changes in sperm parameters are possible, which leads to the impossibility of conception.
• Pathologies of pregnancy, including miscarriages, as well as premature births.
• development of autoimmune diseases.

To avoid such serious complications, it is necessary immediately after the onset of symptoms of the disease to consult a doctor - a gynecologist for women or a urologist for men. Only a specialist will be able to determine how to cure mycoplasmosis, depending on its pathogen and drug sensitivity.

Diagnosis of mycoplasmosis

Modern medicine has several methods for detecting mycoplasma in the human body. In addition to the examination of the doctor and the collection of anamnesis, it is necessary to carry out and laboratory research, which allow you to effectively determine the presence of a microorganism in various human biological fluids.

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One of the very effective methods The definition of mycoplasma is a bacteriological (cultural) study of a smear taken from women from the vagina, and from men from the urethra. This method allows you to determine the presence of infection in the body with a high probability, as well as count the number of microorganisms in ml of the taken biological fluid. A significant disadvantage of the method is its duration - up to 10 days may be required to obtain results.

The PCR method (polymerase chain reaction) is the most effective of all existing ones, since it is able to determine the presence of infection with a probability of up to 96% in the same fluids that are taken for the bacteriological method. This technique detects the presence of mycoplasma DNA, and therefore has such a high sensitivity. This method is the only one that helps to detect the presence of Mycoplasma genitalia, since the culture method will take up to 5 months to identify this type of bacterium.

Serological studies are conducted less frequently, as they have a lower efficiency. ELISA blood test reveals the presence of antibodies to mycoplasma in the patient's blood. But this study can show the presence of antibodies even if the patient has previously met with an infection, but in this moment she is not. So, in the blood of a patient, antibodies can be detected if the patient has a cured mycoplasmosis in the anamnesis.

If, as a result of the examination, mycoplasma was found in a person, it is necessary to begin adequate therapy that can defeat the infection in the patient's body.

How to treat mycoplasma?

If mycoplasmosis is detected, treatment is carried out exclusively with the use of antibacterial medicines- without them, it is impossible to get rid of microorganisms. In some cases, the attending physician may prescribe a whole range of drugs, among which, in addition to antibiotics, there are probiotics, vitamins, and immunostimulating drugs.

"Treatment of mycoplasmosis is carried out with the obligatory intake of antibiotics."

Antibacterial therapy should be carried out exclusively under the supervision of the attending physician, since self-administration of drugs can not only not cure the disease, but also harm the body. Moreover, when prescribing an antibiotic, the doctor relies on test data - the bacteriological method and PCR provide information about which antibacterial agents are effective in each case.

When treating mycoplasmosis with antibiotics, it is important to follow a few simple but extremely important rules. First of all, you should strictly observe all the terms prescribed by the doctor for taking medications, their dosages. It is categorically impossible to change the drugs on your own - this can lead to a lack of effect from the treatment. If side effects occur, you should report them to your doctor. It is strictly forbidden to drink alcoholic beverages during therapy.

Since mycoplasma is sexually transmitted, it is necessary to treat both partners. At the time of treatment, it is recommended to refuse sexual intercourse, even if the partner is also being treated with an antibiotic.

For Mycoplasma Hominis, doctors prescribe metronidazole or clindamycin. A feature of the course of this disease is the possibility of using local drugs.

Popular antibacterial drugs that are used for such a pathogen are:

• Trichopolum. Available in tablets. It allows you to cure not only mycoplasmosis, but also other diseases that often accompany this disease - chlamydia, trichomoniasis and others. An important feature of the drug is the possibility of using it in combination with antibiotics of another series to increase the effectiveness of treatment.
• Metrogyl. This drug is available in both tablets and gels. It shows a fairly high efficiency against mycoplasma. It can also be given to men for external use.

For the treatment of Mycoplasma Genitalium, antibacterial drugs of the tetracycline series and macrolides are prescribed.

Among the antibiotics that are active in this type of pathogen, the following are especially often used:

• Sumamed. It is used in the form of tablets for a course of 3 or 5 days (usually taken 1 tablet a day at the same time). A feature of this agent in the fight against mycoplasma is its ability to accumulate in cells and tissues, since this pathogen is an intracellular microorganism. This makes the drug highly effective.
• Azithromycin. The drug tends to penetrate into the tissues of the genitourinary system and accumulate there, which allows you to effectively eliminate all microorganisms in mycoplasmosis. For the same reason, this antibiotic is also indicated for the treatment of many other diseases of the reproductive system.
• Doxycycline. Usually prescribe its use in capsules, washed down with water, in rare cases can be shown intravenous administration antibiotic. This drug can be used by pregnant and lactating mothers. The standard course of treatment with this drug is 14 days.
• Wilprafen. It is produced in the form of tablets, which must be taken at intervals of 12 hours (twice a day) for at least 10 days (the duration of the course is prescribed by the attending physician). It can be used by children from infancy (a suspension is available for children).
• Amoxiclav. the drug is rapidly absorbed, so it begins to act quickly enough. Especially often it is prescribed to women, since it tends to accumulate in the ovaries and uterus, exerting its effect. For the same reason, it is not prescribed during pregnancy.
• Tetracycline. It can be used in tablets and ointments for external use. It is very effective in mycoplasmosis, as it is very effective in defeating these microorganisms.

Mycoplasma pneumonia requires an integrated approach to the elimination of pathogens. Treatment of atypical pneumonia depends entirely on the results of the diagnosis, the presence of chronic diseases and the general condition of the patient.

• At the first stage, antibacterial drugs are prescribed to destroy the mycoplasma infection. The most commonly used antibiotics are tetracyclines. To determine the most appropriate drug, sputum culture for sensitivity to antibiotics is indicated.
• At the second stage, expectorants are prescribed to patients to thin and accelerate sputum discharge, that is, to improve the drainage function of the bronchi. Also, to eliminate painful symptoms, anti-inflammatory and antihistamines are prescribed.
• To speed up recovery, it is recommended to take general strengthening and fortified preparations. They increase the protective properties of the immune system. Detoxification therapy is recommended, that is, drinking plenty of water to remove the metabolic products of viruses and bacteria. In especially severe cases, specific immunopreparations are prescribed.

To improve the patient's condition, special physiotherapy is prescribed: breathing exercises, vacuum massage, physical education, mustard plasters, compresses. There are also non-traditional methods of treatment using medicinal herbs. An integrated approach to treatment allows you to eliminate the disease without serious complications.

Mycoplasma pneumonia treatment regimens

After the diagnosis, the doctor evaluates the results and draws up a treatment plan. Treatment regimens for mycoplasma pneumonia depend on the neglect and severity of the disease state, the characteristics of the patient's body and the presence of comorbidities.

The disease requires etiotropic treatment. To eliminate mycoplasmosis, antibiotics from the group of macrolides, fluoroquinolones, tetracyclines are used, both for oral and intramuscular administration. The course of treatment averages 10-14 days.

Patients may be prescribed the following drugs:

• Azithromycin 250 mg once a day.
• Clarithromycin 500 mg 1-2 times a day.
• Erythromycin 500 mg 3-4 times a day.
• Levofloxacin 500 mg once a day.
• Doxycycline 100 mg 1-2 times a day.

The treatment regimen for severe atypical inflammation consists of cephalosporin antibiotics and Levofloxacin.

Determination of sensitivity to antibiotics

When choosing drugs to eliminate Mycoplasma pneumoniae, the determination of sensitivity to antibiotics is shown. At the initial stage, bacterial culture is carried out to determine the type of pathogen and its concentration in the body. This method has a high specificity with the ability to study any biological fluid.

For bacteriological culture, sputum, mucus from the nose and throat are used. The collected material is placed in special media for deciphering bacterial cultures. If necessary, microscopy of the obtained material can be carried out with coloring, assessment of the shape, color and density of bacterial colonies.

After the pathogen is established, its sensitivity to antibiotics is determined using intradermal tests, mucus from the nasopharynx, blood, and exudate discharged during coughing. The resulting antibiogram takes into account the resistance of bacteria, that is, resistance to the pathogen. Thanks to this, you can choose the most suitable drug for treatment and its dosage.

Medications

Drug therapy for Mycoplasma pneumonia is carried out from the first days of the disease. Medicines are selected by the doctor, individually for each patient. Treatment consists of taking the following groups of drugs:

Antibiotics

1. Azithromycin

A broad-spectrum antibacterial agent from the group of macrolides. Getting into the foci of inflammation creates high concentrations, providing a bactericidal effect.

• Indications for use: infections of the upper and lower respiratory tract and ENT organs, scarlet fever, infections of the skin and soft tissues, infections of the genitourinary system, Lyme disease.
• Method of application: on the first day of therapy 500 mg, on the second day 250 mg, and from the third to the fifth, 500 mg per day. The course dose, as well as the duration of treatment, is determined by the doctor for each patient individually.
• Side effects: nausea, abdominal pain, vomiting, increased gas formation, increased activity of liver enzymes, allergic skin rashes.
• Contraindications: intolerance to the components of the drug, severe impairment of kidney and liver function, pregnancy and lactation. With extreme caution is prescribed for patients with a history of allergic reactions.

The drug is available in the form of tablets, capsules and syrup in vials.

1. Clarithromycin

Macrolide, a semi-synthetic derivative of erythromycin. Has an extended spectrum antibacterial action, with the creation of maximum concentrations in the lesions.

• Indications for use: pneumonia (including atypical forms), sinusitis, pharyngitis, bronchitis, tonsillitis, folliculitis, streptoderma, erysipelas, dental infections, local and widespread mycobacterial infections.
• Method of application: 250 mg twice a day. In especially severe cases, the dosage may be increased. The drug is taken regardless of food, washed down with water. The duration of therapy is 5-14 days.
• Side effects: pain in the epigastric region, nausea and vomiting, changes in taste sensations, fungal infections mucous membrane oral cavity. Headaches and dizziness, increased anxiety, disorders from the side are also possible. of cardio-vascular system skin allergic reactions.
• Contraindications: hypersensitivity to the components of the drug, the age of patients under 12 years of age, the first trimester of pregnancy and lactation.
• Overdose: nausea, vomiting, diarrhea. Gastric lavage and further symptomatic therapy are recommended for treatment.

The drug is available in tablet form with an enteric coating of 250 and 500 mg.

1. Spiramycin

Macrolide antibiotic with bacteriostatic properties. The destruction of pathogenic microorganisms occurs due to the inhibition of intracellular protein synthesis. The drug is active against Mycoplasma pneumoniae, but is resistant to Pseudomonas, Enterobacteriaceae spiramycin.

• Indications for use: atypical pneumonia (associated with legionella, mycoplasma, chlamydial infection), pharyngitis, bronchitis, toxoplasmosis, skin and soft tissue infections, tonsillitis, arthritis, urethritis, otitis media, diseases of the upper respiratory tract and gynecological infections.
• The method of application and dosage are set individually for each patient. The duration of treatment is 10-14 days, the prophylactic course is 5 days.
• Side effects: skin rashes, ulceration of the gastrointestinal mucosa, nausea and vomiting, diarrhea, transient paresthesia, angioedema, thrombocytopenia. An overdose is manifested by an increase in the above reactions. There is no antidote, treatment is symptomatic.
• Contraindications: hypersensitivity to drug components, pediatric practice, pregnancy and lactation, G6PD deficiency. With special care is prescribed for liver failure and obstruction of the biliary tract.

Available in tablets, 10 capsules per pack.

If the disease is mild, then oral antibacterial drugs are prescribed: tablets, syrups. In complicated cases, intramuscular injections are indicated.

Non-steroidal anti-inflammatory drugs

They are used to eliminate a pronounced intoxication syndrome: fever, chills, fever.

1. Ibuprofen

Pain reliever, antipyretic and anti-inflammatory agent. Its mechanism of action is based on inhibition of prostaglandin biosynthesis through inhibition of the cyclooxygenase enzyme.

• Indications for use: neuralgia, complex therapy of diseases of the upper respiratory tract, traumatic inflammation of soft tissues and the musculoskeletal system, bursitis, sciatica, arthritis, adnexitis, osteoarthritis, dental and headache.
• Method of application: for pain syndrome of moderate intensity take 400 mg 2-3 times a day. The maximum daily dosage should not exceed 2.4 g.
• Side effects: nausea, vomiting, diarrhea, heartburn and other disorders of the gastrointestinal tract. Headaches and sleep disturbances, skin allergic reactions. In rare cases, there are erosive and ulcerative lesions of the gastrointestinal tract, bronchospasm.
• Contraindications: hypersensitivity to the drug, diseases of the optic nerve, severe impairment of kidney / liver function, patients under 6 years of age, hematopoietic disorders, "aspirin" triad. Use during pregnancy and lactation is possible only for medical purposes.
• Overdose: abdominal pain, nausea and vomiting, drowsiness, headaches and tinnitus, acute kidney failure, respiratory arrest, metabolic acidosis, lethargy. For treatment, gastric lavage and further symptomatic therapy are indicated.

Ibuprofen is available as enteric-coated tablets with 200 mg of active ingredient per capsule.

1. Paracetamol

Antipyretic, analgesic and anti-inflammatory agent. Its mechanism of action is based on inhibition of the thermoregulatory center and inhibition of the synthesis of inflammatory mediators and prostaglandins.

• Indications for use: symptomatic therapy of pain syndrome of various origins, conditions with hyperthermic reactions in infectious and inflammatory pathologies.
• The method of application depends on the form of release of the drug. For example, tablets are taken 350-500 mg 3-4 times a day. The maximum daily dosage is 3-4 g. The medicine is taken after meals with a liquid.
• Side effects: nausea, vomiting, pain in the epigastric region, increased drowsiness, renal colic, anemia, leukopenia, skin allergic reactions, muscle weakness.
• Contraindications: intolerance to the components of the drug, renal and hepatic insufficiency. It is prescribed with extreme caution during pregnancy and lactation.
• Overdose: increased drowsiness, pallor skin, nausea, vomiting and dizziness, toxic effects on the liver.

Paracetamol has the following forms of release: enteric-coated tablets, capsules and syrup for oral administration, rectal suppositories.

1. Nimesulide

NSAIDs from the group of sulfonanilides. Used to relieve pain various genesis, arthralgia and myalgia. The analgesic effect develops within 20 minutes. The medicine is taken 100 mg 3-4 times a day. Maximum daily dose- 400 mg.

• Side effects: increased drowsiness, dizziness and headaches, nausea, vomiting, epigastric pain, allergic skin reactions. Also possible pathological changes blood pictures.
• Contraindications: hypersensitivity to the components of the drug, pregnancy and lactation, children under 12 years of age, renal and hepatic insufficiency. With extreme caution, it is prescribed for ulcerative changes in the gastrointestinal tract, heart failure, arterial hypertension.
• Overdose: nausea, vomiting, abdominal pain, gastrointestinal bleeding, acute renal failure, respiratory depression, increased drowsiness, allergic reactions. Symptomatic therapy is indicated for treatment.

Available in the form of a suspension for the preparation of oral solution, tablets and external gel.

To enhance the antipyretic effect, the above NSAIDs are combined with antispasmodics and antihistamines.

Cough preparations

Antitussives affect the focus of inflammation in the lungs. Their mechanism of action is mucolytic, expectorant and muconitic effect. The drugs inhibit the cough reflex, regulate the function of sputum production and metabolism in the epithelial cells that line Airways.

1. Bronchicum

A drug with antispasmodic, anti-inflammatory, expectorant and sputum thinning properties. Effectively eliminates painful paroxysmal cough.

Indications for use: paroxysmal cough, acute and chronic lesions of the upper and lower respiratory tract. The method of application and dosage are individual for each patient. Side effects are manifested in the form of irritation of the gastric mucosa. Available in the form of drops and elixir for oral use.

1. Carbocysteine

Mucolytic agent, liquefies the bronchial secret and accelerates its excretion from the body. Normalizes the chemical and physical characteristics of sputum. It is used for respiratory diseases with the release of a large viscous secret. Patients are prescribed 1-2 capsules 2-3 times a day until the desired therapeutic effect is achieved.

Side effects are manifested by skin allergic reactions and disorders of the gastrointestinal tract. The drug is contraindicated in gastric ulcers and duodenum. It is not prescribed during pregnancy and lactation. Carbocysteine ​​is available in capsule and syrup form in oral vials.

1. Bromhexine

A drug that increases the secretion of secretion by the bronchial glands. Reduces the viscosity of sputum and has a pronounced expectorant effect. It is used for acute and chronic inflammatory diseases of the lungs, bronchi and trachea. It is prescribed for bronchiectasis, bronchography.

Bromhexine is taken 4-8 mg 3-4 times a day. For patients under 2 years of age, the drug is prescribed in the form of a syrup. Side effects are manifested by bouts of nausea and vomiting, various dyspeptic disorders and allergic reactions.

There are no absolute contraindications for taking the medication. It is prescribed with extreme caution in case of hypersensitivity to the drug, gastrointestinal bleeding, early dates pregnancy and peptic ulcer of the stomach. The medicine is available in the form of tablets and syrup.

Bronchodilators

This group of drugs is most often prescribed for the treatment of atypical inflammation. respiratory system in patients childhood and with a predisposition to bronchial hyperreactivity.

1. Berodual

Expands the lumen of the bronchi with the help of active ingredients - ipratropium bromide and fenoterol. The interaction of these components is effective in the bronchodilator therapy of diseases with increased tone of the bronchial muscles.

• Indications for use: complex maintenance therapy and prevention of respiratory failure in pneumonia, bronchitis, bronchopulmonary diseases, bronchial asthma. It is also prescribed in the preparation of the respiratory tract for aerosol administration of drugs.
• The method of application and dosage are individual for each patient, as they depend on the severity of the disease state and other characteristics of the patient's body. To enhance the therapeutic effect, the drug is recommended to be taken with corticosteroids.
• Side effects: temporary impairment of visual perception, tremor of the extremities, dry mouth, palpitations, increased intraocular pressure.
• Contraindications: hypersensitivity to the components of the drug, the first and last trimester of pregnancy. It is forbidden to take with xanthine derivatives and non-cardioselective beta-blockers.

Produced in the form of an aerosol for inhalation and a solution for inhalation in 20 ml vials.

1. Eufillin

Relieves spasms of smooth muscles of the bronchi, relaxing muscle tissues. Reduces system pressure pulmonary artery dilates the heart vessels. It has a moderate diuretic effect and inhibits platelet aggregation.

• Indications for use: bronchial asthma and bronchospasm, hypertension in the pulmonary circulation, cardiac asthma, respiratory disorders. It is prescribed for relief of cerebral vascular crises, improves renal blood flow.
• The method of application depends on the form of release of the drug. For acute attacks bronchial asthma the drug is administered intravenously, in other cases orally or intramuscularly. The dosage is determined by the doctor for each patient separately.
• Side effects: digestive disorders, headaches and dizziness, convulsions, heart palpitations.
• Contraindications: intolerance to components, reduced arterial pressure, tachycardia, epilepsy, coronary insufficiency, cardiac arrhythmias.

Eufillin has several forms of release: powder for solution, tablets for oral administration, ampoules and solution.

1. Fenoterol

Bronchial beta-adrenergic receptor stimulator. Expands the lumen of the bronchi, effectively relieves bronchospasm of various origins, asthma attacks. Increases the frequency and volume of breathing. Therapeutic action persists for 6-8 hours.

• Indications for use: relief of attacks of bronchial asthma, infectious diseases of the lungs with difficulty breathing, emphysema.
• Method of application: adult patients and children over 6 years of age are prescribed single doses of an aerosol of 0.2 mg. If after a single inhalation the asthma attack does not go away, then after 5-7 minutes the inhalation can be repeated.
• Side effects: tremor of the limbs, increased anxiety, palpitations, fatigue, headache and excessive sweating.
• Contraindications: hypersensitivity to the components of the drug, arrhythmia, severe atherosclerosis.

The medicine is intended for inhalation, therefore it is available in 15 ml aerosol cans. Each package contains 300 single doses. There is also a tablet form of release and ampoules for injection.

Antibiotics for Mycoplasma pneumonia

Antibacterial therapy is the main method of eliminating pathogens. Antibiotics for mycoplasma pneumonia are selected by the doctor, individually for each patient. When choosing a drug, the severity of the disease, the presence of chronic pathologies and other features of the patient's body are taken into account.

Consider the main types of antibiotics used to destroy Mycoplasma pneumoniae:

Tetracyclines

1. doksibene

Antimicrobial agent with bacteriostatic properties. Contains the active ingredient - doxycycline. Its mechanism of action is based on the inhibition of protein synthesis in the cells of pathogens. The drug is active against most gram-positive and gram-negative microorganisms.

• Indications for use: infectious diseases caused by viruses and bacteria sensitive to the drug. It is prescribed for atypical forms of pneumonia, typhus, bacterial conjunctivitis, Lyme disease. Effective in otolaryngological, urological, venereological and gynecological practice.
• Method of application: for patients weighing more than 70 kg, 200 mg per day is prescribed at a time or divided into two doses. Patients weighing 50 to 70 kg, 200 mg on the first day of therapy, followed by a dosage of 100 mg per day. For patients less than 50 kg, 4 mg/kg body weight. The course of treatment is 7-14 days.
• Side effects: disorders of the cardiovascular system, decreased visual acuity, leukopenia, leukocytosis, paresthesia, convulsions, increased pressure and excitability. There may also be violations of the urinary system, skin allergic reactions, muscle pain, candidiasis.
• Contraindications: intolerance to the components of the drug, severe violations of the liver and kidneys, patients under 8 years of age, pregnancy and lactation. It is prescribed with extreme caution for arrhythmias, for patients exposed to excessive ultraviolet radiation.
• Overdose: violation of the liver and gastrointestinal tract. There is no specific antidote, gastric lavage and further symptomatic therapy are indicated.

Doxibene is available in the form of capsules for oral administration of 100 and 200 mg of the active ingredient.

1. Doxycycline

Semi-synthetic broad-spectrum antibiotic with bacteriostatic properties. Active against gram-positive microorganisms, aerobic and anaerobic cocci, aerobic and anaerobic spore-forming bacteria, as well as Mycoplasma pneumoniae.

• Indications for use: acute bronchitis, pneumonia, pleurisy, pleural empyema, infections of the gastrointestinal tract and ENT organs, urinary tract. Effective at inflammatory diseases pelvic organs, purulent infections soft tissues. Also used in the prevention of surgical infections.
• Method of application: the drug is taken orally after a meal, washed down with water to reduce irritation of the esophagus. The medicine is taken at 100-200 mg, depending on the severity of the disease. The course of treatment is 10-14 days.
• Side effects: nausea, vomiting, abdominal pain, stool disorders, allergic skin reactions, rashes, excessive sweating, headaches and dizziness.
• Contraindications: intolerance to the components of the drug, the last trimesters of pregnancy and lactation, the age of patients under 9 years. Leukopenia, severe renal failure, porphyria.

The drug is available in the form of capsules for oral administration.

1. minocycline

An antibacterial agent that stops the reproduction of bacteria and has a wide spectrum of action. Active against most pathogens.

• Indications for use: infections of the upper and lower respiratory tract, psittacosis, infectious-allergic disease, inflammation urinary tract, conjunctivitis, trachoma, inflammation of the inguinal lymph nodes, brucellosis, skin and soft tissue infections, meningococcal infection.
• Method of application: the dosage is 200 mg on the first day of treatment and 100 mg thereafter. The duration of treatment is 5-12 days.
• Side effects: appetite and stool disorders, nausea, vomiting, increased activity of liver enzymes, skin allergic reactions, joint and muscle pain.
• Contraindications: hypersensitivity to drugs from the tetracycline group, pregnancy and lactation, patients under 8 years of age.

The medicine has a tablet form of release in packs of 50 and 100 pieces. There is also a suspension for oral administration in 5 ml vials.

Macrolides

1. Azicin

Broad-spectrum antimicrobial agent. Contains the active ingredient - azithromycin. It has high acid resistance. Inhibits the growth and reproduction of pathogenic microorganisms.

• Indications for use: pulmonary mycoplasmosis and other diseases of the respiratory system, infections of soft tissues and skin, urethritis, colpitis, bacterial prostatitis, ulcerative lesions of the gastrointestinal tract, initial stages Lyme disease.
• Method of application: the medicine is taken on an empty stomach, drinking plenty of liquid. In case of infectious pathology of the respiratory tract, 500 mg are prescribed for three days. The total course dose is 1500 mg. For children, the drug is prescribed at a dosage of 10 mg / kg of body weight 1 time per day, the duration of therapy is 3 days.
• Side effects: dizziness and headaches, insomnia, irritability, tremor of the limbs. Tachycardia, neutropenia, gastrointestinal and liver disorders, conjunctivitis, allergic skin reactions.
• Contraindications: intolerance to the components of the drug, patients under 3 years of age, pregnancy and lactation, severe liver dysfunction.
• Overdose: nausea, vomiting, diarrhea, headaches, temporary hearing loss, hepatitis. There is no specific antidote, gastric lavage and enterosorbents are taken.

The medicine has a tablet form of release, 3 capsules in a blister, 1 blister in a package.

1. macrofoam

Macrolide antibiotic to the active substance - midecamycin. Has a wide spectrum of action. After oral administration, it is rapidly and completely absorbed from the gastrointestinal tract, reaching a maximum concentration in 1-2 hours. An increased content of the drug is observed in places of inflammation, in bronchial secretions and skin.

• Indications for use: infections of the respiratory tract, mucous membranes and skin, genitourinary system, diphtheria, whooping cough and other infectious pathologies caused by microorganisms sensitive to the drug.
• The method of application and dosage is calculated individually for each patient. This takes into account the age of the infected and the severity of the disease state. The course of treatment does not exceed 7-12 days.
• Side effects: appetite disorders, nausea and vomiting, allergic skin reactions, increased levels of liver enzymes.
• Contraindications: intolerance to the components of the drug, severe liver failure. The drug is taken during pregnancy when the potential benefit to the mother is higher than the risk to the fetus.
• Overdose: nausea and vomiting. There is no specific antidote. The intake of sorbents is shown to accelerate the excretion of the drug from the body.

Macropen is available in the form of tablets of 400 mg of the active ingredient each and as granules for suspension.

1. Roxithromycin

Semi-synthetic antibacterial agent. It has a wide spectrum of action against most pathogens.

• Indications for use: infections of the upper and lower respiratory tract, including atypical forms. Infections of the skin and soft tissues, urinary tract. Prevention of meningococcal meningitis.
• Method of application: adult patients are prescribed 150 mg twice a day before meals. In especially severe cases, the dosage may be increased.
• Side effects: nausea, vomiting, pain in the abdomen, skin allergic reactions, transient increase in the level of alkaline phosphatase and transaminases.

Contraindications: hypersensitivity to the components of the drug, pregnancy and lactation. It is prescribed with caution for patients with a history of allergic reactions.

Roxithromycin has a tablet form of release with different dosages.

Fluoroquinolones

1. Gatispan

Antibacterial agent with a wide spectrum of action. After oral administration, it is rapidly absorbed from the gastrointestinal tract. Absolute bioavailability is over 96%. The maximum plasma concentration is reached within 2-3 hours after ingestion. Plasma protein binding is about 20%. Excreted as metabolites in urine and feces.

• Indications for use: pneumonia, bronchitis, COPD, cystic fibrosis, lung abscess, sinusitis. Infections of the urinary system, skin and soft tissues, chronic infections of the urinary tract, bones and joints, STDs.
• Method of application: the drug is taken in a dose of 200-400 mg 1 time per day. The course of treatment depends on medical indications, the severity of the disease and the characteristics of the patient's body.
• Side effects: nausea, vomiting, abdominal pain, appetite and stool disorders, flatulence, gastritis, stomatitis, bleeding from the gastrointestinal tract. Sleep disturbances, increased anxiety, headaches and dizziness, muscle cramps. Arterial hypertension, bone pain, bronchospasm, swelling of the face and mucous membranes, allergic reactions.
• Contraindications: patients under 18 years of age, pregnancy and lactation, individual intolerance to the components of the drug.
• Overdose is manifested by more pronounced adverse reactions. To improve the patient's condition, gastric lavage and further symptomatic therapy are recommended.

Gatispan is available as enteric-coated tablets of 200 mg and 400 mg each.

1. Zoflox

A drug with a fluoroquinolone derivative and a bactericidal effect. It has a wide spectrum of action, but is especially active against mycobacteria SARS and beta-lactamase.

• Indications for use: pneumonia, bronchitis, orchitis, sinusitis, urethritis, soft tissue infections and infectious dermatological lesions, pyelonephritis, joint infections. It is used to prevent infectious complications in immunodeficiency states.
• Method of application: tablets are taken orally, and the solution for infusion is intravenously drip. The standard dosage is 200-600 mg / day, the course of treatment is 8-10 days.
• Side effects: skin allergic reactions, various disorders of the gastrointestinal tract and central nervous system, pain in the abdominal region, tremor of the limbs, paresthesia, and more.
• Contraindications: hypersensitivity to the components of the drug, recent traumatic brain injury, history of epilepsy and stroke, inflammation in the central nervous system, pediatric practice, pregnancy and lactation. With special care it is prescribed for violations of cerebral circulation.
• Overdose: symptoms of CNS depression, nausea and vomiting. Treatment is symptomatic, gastric lavage. Hemodialysis is ineffective.

Zoflox is available in tablets and as a solution for infusion.

1. Factive

Broad spectrum antibiotic. It is used for many infectious diseases, including atypical pneumonia.

• Indications for use: diseases caused by microorganisms sensitive to the drug, community-acquired pneumonia, chronic bronchitis, sinusitis in the acute stage.

• Method of application: tablets are taken orally, regardless of food, without chewing. The daily dosage is 320 mg, the course of treatment is 7-10 days. In severe renal impairment, the dose should be reduced to 160 mg.

• Side effects: skin allergic reactions, disorders digestive system, flatulence. In rare cases, the drug causes malignant exudative erythema, appetite disorders, increased activity of liver enzymes. An overdose is manifested by an increase in the above reactions. Treatment is symptomatic.

• Contraindications: Allergy to drug components and other fluoroquinolones. Prolonged QT interval and tendon pathology. The drug is not used in pediatric practice. It is prescribed with extreme caution for patients with epilepsy, with a tendency to convulsions, arrhythmias. It is not prescribed during pregnancy and lactation.

Factive is available in the form of enteric-coated tablets of 160 and 360 mg. active ingredient. One package may contain 5 or 7 tablets of the drug.

Wilprafen

An antibacterial agent from the group of macrolides. Vilprafen has bacteriostatic properties, which are due to the inhibition of protein synthesis by bacteria. Highly active against most intracellular pathogens, including Mycoplasma pneumoniae.

After oral administration, it is well absorbed from the gastrointestinal tract, the maximum concentration in blood plasma is observed 1-2 hours after ingestion. Plasma protein binding is at the level of 15%. The active ingredient, josamycin, penetrates well through biological membranes and accumulates in tissues. Particularly high concentrations are determined in the lungs, saliva, sweat, tears. Absorbed in the liver, excreted in the bile and urine as active metabolites.

• Indications for use: atypical form of pneumonia, pharyngitis, tonsillitis, otitis media, sinusitis, diphtheria, scarlet fever, bronchitis, whooping cough, gingivitis, skin and soft tissue infections, urethritis, gonorrhea, prostatitis. The drug is effective for mycoplasma, ureaplasma, chlamydial and mixed infections of the genitourinary system.
• The method of application and dosage depend on the age of the patient. For patients older than 14 years, 500 mg 2-4 times a day are prescribed. Tablets are recommended to be taken between meals with water. For patients under 14 years of age and infants, the drug is prescribed in the form of a suspension. The daily dosage is 30 mg / kg of body weight for three doses. The course of treatment is 5-10 days.
• Side effects: appetite disorders, nausea, vomiting, dysbacteriosis, violation of the outflow of bile, allergic reactions, hearing impairment, candidiasis. An overdose is manifested by the same symptoms. Treatment is symptomatic.
• Contraindications: individual intolerance to the components of the drug, severe liver dysfunction. The use of an antibiotic during pregnancy and lactation is possible only on medical prescription, taking into account the risks to the fetus.

Vilprafen is available in the form of tablets and oral suspension.

Klacid

Semi-synthetic macrolide antibiotic with the active substance - clarithromycin. It has antibacterial properties, inhibits the synthesis of bacterial proteins. Tablets are a homogeneous crystalline mass. The active ingredient is released during passage through the gastrointestinal tract and has a broad antibacterial effect.

• Indications for use: pneumonia, bronchitis, polysinusitis, pharyngitis, monosinusitis, skin and soft tissue infections, chlamydial infections of the urogenital tract, gastric and duodenal ulcers.
• Method of application: one capsule at a dosage of 500 mg 1-2 times a day. Tablets should be taken with meals, swallowed whole, that is, without breaking or chewing.
• Side effects: ventricular arrhythmia and tachycardia, abdominal pain, diarrhea, vomiting, stomatitis and pancreatitis, oral candidiasis. Headaches and dizziness, increased anxiety, insomnia, noise and ringing in the ears, convulsions, temporary hearing loss and allergic skin reactions may also occur. Treatment is symptomatic.
• Contraindications: hypersensitivity to active ingredients, severe renal failure, porphyria, pregnancy and lactation.
• Overdose: decrease in potassium in the body and a decrease in the level of oxygen in the blood, abdominal pain, nausea and vomiting. For treatment, gastric lavage is indicated with further supportive therapy.

Klacid is available in the form of tablets of 500 mg in a blister of 5, 10 and 14 pieces, 1-2 blisters per pack.

Sumamed

A broad-spectrum antibiotic from the macrolide group. Getting into the focus of inflammation creates high concentrations, providing a bactericidal effect. Sumamed is active against gram-positive cocci, streptococci, gram-negative bacteria, anaerobic microorganisms, including Mycoplasma pneumoniae.

At oral administration it is quickly absorbed from the gastrointestinal tract, as it is resistant to an acidic environment and lipophilic. The maximum plasma concentration is reached after 2-3 hours, bioavailability is 35%. The active components of the preparations are quickly distributed throughout the body, penetrating into the respiratory tract, organs and tissues of the urogenital tract, skin and soft tissues.

The concentration of the active substance in the foci of infection is 25% higher than in healthy tissues.

The main feature of Sumamed is that its bactericidal concentrations remain in the focus of inflammation for 5-7 days, which allows for short courses of treatment.

• Indications for use: pathologies of an infectious nature caused by pathogens sensitive to the drug. The drug is prescribed for infections of the upper respiratory tract and ENT organs, for infections of the lower respiratory tract, SARS, skin and soft tissue infections, urinary tract infections, Lyme disease.
• Method of application: the drug is taken once a day one hour before a meal or 2-3 hours after a meal. With inflammation of the lungs, adult patients are prescribed 500 mg, and for children, 10 mg / kg for 3 days.
• Side effects: nausea, vomiting, stool disorders, increased gas formation, transient increase in liver enzymes, skin rashes. Treatment is symptomatic.
• Contraindications: hypersensitivity to the components of the drug and macrolides. It is prescribed with caution for severe violations of the kidneys and liver, as well as for allergic reactions to the drug in history. The use of Sumamed during pregnancy is possible only for medical purposes, when the potential benefit outweighs the possible risks.
• Overdose: nausea, vomiting, diarrhea, temporary hearing loss. For treatment, gastric lavage and further symptomatic therapy are indicated.

Available in the form of tablets for oral administration of 125, 250 and 500 mg, as well as capsules for oral administration of 250 mg. Children's release form - vials with powder for suspension preparation. Their pharmacies are dispensed by prescription.

vitamins

Atypical pneumonia, like any other disease, requires an integrated approach to treatment. Vitamins are necessary to normalize metabolism and improve the body's tolerance to antibacterial drugs. Useful substances not only contribute to recovery, but also increase the protective properties of the immune system.

Most often, patients are prescribed such vitamins:

• A, C, E - reduce the degree of damage to vascular membranes and improve their condition.
• B1 - reduces the accumulation of metabolic products of pathogens. Normalizes the metabolism of the liver and heart.
• B2 - improves the condition of the mucous membranes internal organs and skin, activates metabolic processes.
• B6 - enhances metabolic processes, regulates the work of the central nervous system.
• B12 - regulates hematopoiesis and metabolic processes, improves the functioning of the central nervous system, liver and other organs.

Multivitamin complexes have a complex effect: Multi-tabs, Vitrum, Neurovitan, Duovit and others. Along with vitamins and minerals, a balanced diet should be followed to improve well-being and prevent infectious processes.

Physiotherapy treatment

To speed up recovery and minimize the risk of developing severe complications of pneumonia, physiotherapy is recommended. Physiotherapy treatment has a desensitizing and bacteriostatic effect, helps to strengthen the immune system.

With mycoplasma pneumonia, the following methods can be prescribed:

• Inductothermy - the lesion is exposed to a high-frequency magnetic field. This enhances microcirculation and lymph flow, reduces bronchospasm, increases metabolism and improves sputum discharge. Physiotherapy helps to relax muscles, stops inflammatory processes.
• UHF electromagnetic field - used in the acute course of inflammation. The electric field reduces tissue swelling and exudation, restores microcirculation.
• Ultraviolet irradiation - has anti-inflammatory properties and promotes the resorption of infiltrates, activates local blood circulation. The action of radiation is directed to the anterior and posterior surface of the chest.
• Electrophoresis - this method is very often combined with the UHF electromagnetic field. The procedure is based on the effect on the body of a drug through which an electric current is passed. It has anti-inflammatory and analgesic properties.
• Decimeter wave treatment - has an anti-inflammatory effect, improves tissue metabolism and increases blood circulation in the lungs. The procedure has pronounced anti-inflammatory properties.
• Magnetotherapy - is prescribed for severe intoxication processes. Removes swelling, improves metabolic processes and capillary circulation.
• Thermal applications - are prescribed to eliminate the residual symptoms of the disease. On the chest apply applications of mud, paraffin and other active ingredients.
• Inhalations are the most affordable, but at the same time effective physiotherapy. The method improves the functioning of upper breathing and has a bacteriostatic effect. The impact on the affected mucous membranes occurs by inhalation of medications.

Physiotherapy treatment is carried out only for medical purposes, as it has certain contraindications: heat body, bleeding, cardiac or pulmonary insufficiency 2-3 degrees, severe disorders of the cardiovascular system, bullous emphysema, neoplasms, blood diseases. Duration of therapy and frequency medical procedures individual for each patient.

Alternative treatment

One of the non-traditional, but quite popular methods of eliminating SARS is folk treatment. Most often, with mycoplasma infection of the respiratory tract, the following recipes are used:

• Dissolve a teaspoon of honey in a glass of warm water and add a couple of drops of lemon juice. Drink the drink 3-4 times a day during the entire course of treatment and after it.
• Pour 2 figs into a glass of milk and simmer for 15-20 minutes. Take ½ cup 2 times a day.
• Take 50 g of walnuts and fill them with 500 ml of red wine. Boil the product over low heat for 20-30 minutes. Take a tablespoon for 2-3 months.
• Finely chop a couple of aloe leaves and mix with a glass of honey. Add 500 ml of warm water to the mixture and boil for 1-2 hours over low heat. The finished medicine should be consumed 1-2 tablespoons 2-3 times a day. The product can be stored in the refrigerator.
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• Pour 1 liter of purified water with 2 parts of St. John's wort, 3 parts of black elderberry and 4 parts of herbaceous elderberry roots. Boil the remedy for 20-30 minutes, strain and consume throughout the day.
• Take equal parts of wintergreen, hogweed and winter-loving. Pour the mixture with 750 ml of boiling water and insist until cool. Strain and take 100 ml 3-4 times a day. The course of treatment is 28 days.
• Blue cornflower has pronounced healing properties. Two tablespoons of dried flowers, pour 500 ml of boiling water, carefully wrap. After cooling, strain and take ½ cup 3-4 times daily.
• healing properties possess herbal inhalations. Mix in equal proportions such herbs: chamomile, St. John's wort, calendula, celandine, needles, eucalyptus. Pour raw materials with boiling water. Inhalations should last 10-20 minutes, procedures should be carried out daily. The infusion can be used to wash the sinuses and gargle.
• It has immunomodulatory properties drug collection from mint, lemon balm, chestnut color and Ivan-tea. Take 5 tablespoons of the mixture and pour 1 liter of boiling water. The tool is better to insist in a thermos. After 2-3 hours, strain and take 150 ml 3-4 times a day.

Before starting herbal treatment, you should consult with your doctor, as some herbal ingredients can cause allergic reactions and other adverse reactions.

Homeopathy

Treatment of atypical pneumonia involves a comprehensive comprehensive approach. Homeopathy refers to alternative methods therapy. To eliminate the infectious process, the following drugs are used:

• Aconite - is prescribed at the initial stage of the disease, can be replaced by Briony or Belladonna.
• Phosphorus, Ipecac - used for sputum with bloody clots.
• Sanguinaria - the secreted exudate has a rusty tint.
• Antimonium Tartaricum - the disease proceeds with moist rales, heavy breathing and poor sputum discharge.
• Veratrum Viride, Camphor - pneumonia with severe cardiovascular insufficiency.
• Iodum, Kalium Yodatum - paroxysmal cough with severe pain in the chest, feverish condition.

If antibiotic therapy is ineffective in eliminating the infection, then homeo-drugs can be prescribed: Sulfur, Arsenicum Albumum, Iodatum and others. All medicines are used only according to the prescription of a homeopath, who selects the dosage and determines the duration of treatment.

Surgery

To eliminate Mycoplasma pneumoniae is indicated drug therapy. Surgery carried out only in the presence of serious complications, such as:

1. Lung abscess - inflammation of the lung tissue with the formation and melting of purulent-necrotic cavities. For treatment, bronchoscopy is performed with aspiration and washing of the cavities with antiseptic solutions. If the lesion is large, then a transthoracic puncture is indicated. In especially severe cases, a resection is performed, that is, the removal of part of the organ.
2. Pleural empyema - accumulation of pus in the anatomical cavities of the lung. Treatment is aimed at removing purulent exudate, straightening the tissues of the organ and reducing signs of intoxication. For this, a thoracostomy is performed, that is, open drainage. Pleurectomy, lung resection, intrapleural thoracoplasty, and bronchopleural fistula closure are also possible.
3. Synpneumonic pleurisy - purulent complication caused by an infectious agent. For treatment, intrapleural administration of antibiotics and lung drainage are indicated. When draining, an underwater valve is installed with which the amount of sputum is noted. The drainage is removed after the process of exudation stops.
4. Pyopneumothorax is a breakthrough of the contents of the lung cavity into pleural cavity. Treatment consists of draining the purulent cavity and eliminating painful symptoms. With tension pneumothorax, emergency decompression is performed, that is, the installation of drainage.
5. Cancer - oncological complications of mycoplasmal pneumonia are extremely rare. Surgical treatment is the main method of therapy, in combination with chemotherapy. The operation is aimed at removing the tumor formation with the affected part of the organ.

» Study of the effectiveness of complex therapy in patients with urogenital chlamydia, mycoplasmosis and ureaplasmosis using Sumamed

Study of the effectiveness of complex therapy in patients with urogenital chlamydia, mycoplasmosis and ureaplasmosis using Sumamed

The positive experience of using complex therapy with the use of the antibiotic of the macrolide group SUMAMED in 129 patients with urogenital chlamydia, mycoplasmosis and ureaplasmosis was shown. High efficiency (91.1-97.0%) and good tolerability of the drug in patients were noted.

INTRODUCTION

Currently, among sexually transmitted diseases, mixed sexual infections caused by chlamydia, ureaplasmas, mycoplasmas, anaerobic opportunistic microorganisms, Trichomonas and viruses are of the greatest interest.

In most countries of the world, there is an increase in these diseases, especially among young people who have just entered the period of sexual activity. The resulting disease can adversely affect both their health and the health of their offspring. Slow progression of symptoms, often complete absence severe symptoms lead to a late visit to the doctor, or to an accidental diagnosis. The features of the course of these diseases include the absence of any specific manifestations and severe clinical symptoms.

The mechanism of pathogenesis of urogenital ureaplasmosis and mycoplasmosis is similar and has not been fully elucidated.

That is why the optimal therapy for chlamydia, ureaplasmosis and mycoplasmosis must meet the following requirements: the antibacterial agent must have the highest degree of penetration into the cell; duration antibiotic therapy should not be less than 3 life cycles microorganism.

3. Depending on the clinical form, localization of lesions, severity of the process, the following ways to increase the effectiveness of antibiotic therapy are used: changing the route of administration and dosage form of the drug; the appointment of agents that increase the permeability of cellular and tissue barriers and enhance the penetration of the drug into the affected organs (enzymes, systemic polyenzymes, vasoactive drugs).

One of the most important factors in treatment is the effect on immune system interferon inducers and non-specific resistance of the body to biogenic stimulants and vitamins. The success of chlamydia treatment also depends on the detection and simultaneous treatment of concomitant urogenital infections (trichomoniasis, gardnerellosis, candidiasis, etc.), examination and simultaneous treatment of all sexual partners. The criterion for the effectiveness of treatment is resolution clinical symptoms diseases and elimination of microorganisms from the body. Control of cure (monitoring studies) is carried out no earlier than 4-6 weeks after the end of antibiotics.

When interpreting the results of all methods for detecting chlamydial antigen, it should be borne in mind that non-viable forms of microorganisms are cytologically indistinguishable from viable ones and can give false-positive results when staining preparations according to Romanovsky-Giemsa, with immunofluorescent, enzyme immunoassay molecular methods of research; the average time for the elimination of "fragments" of microorganisms from cells and tissues is 4-6 weeks; a decrease in the titer of anti-chlamydial antibodies by 4 or more times is considered diagnostic and prognostically significant; in some cases, "immune memory" of previously transferred chlamydia, manifested by low titers of anti-chlamydial antibodies, can persist for a long time (months, years) and does not require active treatment tactics.

The clinical picture of chronic mixed sexual infection is usually characterized by a latent course. The pathological process remains unrecognized for a long time, and belated treatment is often ineffective. That is why, despite the increase in the number of antibacterial drugs that claim to be the most effective remedy in the treatment of chlamydia, mycoplasmosis and ureaplasmosis, the problem of a guaranteed cure for these diseases remains relevant.

The gold standard for the treatment of intracellular infections in the world are macrolide drugs that do not have allergic cross-reactions with antibiotics containing ?-lactam ring, which allows them to be used in people allergic to penicillin, cephalosporins and other drugs. The low toxicity of macrolides allows the use of some of them in diseases of the liver and kidneys in men. Even with prolonged use of macrolides, there are rare cases of intestinal dysbacteriosis.

One such drug for the treatment of urogenital chlamydia, mycoplasmosis and ureaplasmosis is azithromycin.

Pharmacodynamics. Azithromycin is a representative of a new subgroup of macrolide antibiotics - azalides. It binds to the 50S subunit of the 70S ribosome of sensitive microorganisms, inhibiting RNA-dependent protein synthesis, slows down the growth and reproduction of bacteria, and at high concentrations a bactericidal effect is possible.
It has a wide spectrum of antimicrobial activity. Gram-positive coci are sensitive to the drug - Streptococcus pneumoniae, S.pyogenes, S.agalactiae, streptococci of groups C, F and G, S.viridans; Staphylococcus aureus; gram-negative bacteria - Haemophilus influenzae, H.parainfluenzae, Moraxella catarrhalis, Bordatella pertussis, B.parapertussis, Legionella pneumophila, H.ducrei, Campylobacter jejuni, Neisseria gonorrhoeae, Gardnerella vaginalis; some anaerobic microorganisms - Bacteroides bivius, Clostridium perfringens, Peptostreptococcus species, as well as Chlamydia trachomatis, Mycoplasma pneumoniae, Ureaplasma urealyticum, Treponema pallidum, Borrelia burgdoferi. Does not affect gram-positive microorganisms resistant to erythromycin.

Pharmacokinetics. After oral administration, Azithromycin is rapidly absorbed from the alimentary canal. Bioavailability is approximately 37% (first pass effect). The maximum concentration in blood serum is reached after 2.5-3 hours and is 0.4 mg / l when 500 mg of azithromycin is taken orally. The drug penetrates well into the respiratory tract, organs and tissues of the urogenital tract, in particular into the prostate gland, into the skin and soft tissues. The concentration of the drug in tissues and cells is 10-100 times higher than in blood serum. A stable plasma level is reached after 5-7 days. The drug accumulates in large quantities in phagocytes, transporting it to sites of infection and inflammation, where it is gradually released during phagocytosis.

It binds to proteins in inverse proportion to the concentration in the blood (7-50% of the drug). About 35% is metabolized in the liver by demethylation, losing activity. More than 50% of the dose is excreted unchanged in the bile, approximately 4.5% - in the urine for 72 hours.

The plasma half-life is 14-20 hours (in the range of 8-24 hours after taking the drug) and 41 hours (in the range of 24-72 hours). Food intake significantly changes the pharmacokinetics. With age, the parameters of pharmacokinetics do not change in men (65-85 years), in women, Cmax increases by 30-50%.

Dosage and administration. Azithromycin in chronic inflammatory diseases of the genital organs in men and women is taken once a day, one hour before meals or 2 hours after meals, 1 g (4 tablets), and then 500 mg (2 tablets) No. 4 with an interval of 4 days. Total for the course - 3000 mg.

Side effect. Azithromycin rarely causes adverse reactions. Possible complications from the digestive canal (bloating, nausea, vomiting, diarrhea, abdominal pain). In most cases, undesirable effects are mild and do not require discontinuation of the drug. Perhaps a transient, moderate increase in the activity of liver enzymes, neutropenia, rarely - neutrophilia and eosinophilia, cholestatic jaundice, chest pain, palpitations. Sometimes drowsiness, nephritis, vaginitis, candidiasis, desensitization are possible, in children - nervousness, insomnia, conjunctivitis. After 2-3 weeks after stopping treatment, the changed parameters return to normal. Skin reactions (rash) are very rare.

Contraindications. The drug is contraindicated in case of hypersensitivity to macrolide antibiotics; with severe violations of liver function, during pregnancy and lactation (for the duration of treatment, breastfeeding is suspended).

Application features. Due to the peculiarities of the pharmacokinetics of the drug, with the indicated indications for use, there is no need to use the drug for a longer time than indicated in the instructions. For the elderly, there is no need to change the dose. It is not recommended to prescribe the drug during pregnancy and lactation. Azithromycin should be used with caution in patients with severe impairment of the excretory function of the kidneys and liver, with cardiac arrhythmias (ventricular arrhythmias and prolongation of the QT interval are possible). After discontinuation of the drug in some patients, hypersensitivity reactions may persist, which requires specific therapy under the supervision of a physician. With a slight impairment of kidney function (creatinine clearance more than 40 ml / min), there is no need for dose adjustment.

Interaction with other drugs. Antacids slow down the absorption of Azithromycin, so it is necessary to take drugs at least 2 hours apart.
There was no interaction of the drug with theophylline, oral anticoagulants, carbamazepine, phenytoin, triazolam, digoxin, ergotamine, cyclosporine.

MATERIALS AND METHODS

In the clinic of sexopathology and andrology of the Institute of Urology of the Academy of Medical Sciences of Ukraine, 139 patients with chlamydial ureaplasma and mycoplasma infection aged 22 to 43 years with a disease duration of 1 to 10 years were under observation. 63 patients had an acute uncomplicated process with a disease duration of up to 3 months, of which monoinfection was diagnosed in 30 (47.6%) and mixed infection (chlamydia + ureaplasmosis; chlamydia + mycoplasmosis; ureaplasmosis + mycoplasmosis; chlamydia + ureaplasmosis + mycoplasmosis) - in 33 (52.4%). In 66 patients, a chronic complicated genitourinary infection was observed (disease duration from 3 months to 10 years), of which monoinfection was diagnosed in 32 (48.5%) and mixed infection in 34 (51.5%). Laboratory diagnostics chlamydia was carried out using direct immunofluorescence (DIF) and polymerase chain reaction (PCR).

In acute uncomplicated forms of mixed infection, SUMAMED was administered orally once a day, one hour before meals or 2 hours after meals, 1 g (4 tablets), and then 500 mg (2 tablets) No. 4 with an interval of 4 days. Total for the course - 3000 mg.

The treatment of the chronic process, including mixed infections, was carried out by a complex pathogenetic one. As etiotropic agents, SUMAMED was used orally once a day, one hour before meals or 2 hours after meals, 1 g (4 tablets), and then 500 mg (2 tablets) No. 4 with an interval of 4 days. Total for the course - 3000 mg. The total duration of the course of treatment was 20-30 days. In order to correct the immune status and improve the penetration of the antibiotic, immunomodulators were prescribed. Patients also received symptomatic treatment, physiotherapy (endourethral electrical stimulation, laser and magnetotherapy, vibroacoustic therapy), antifungal drugs, vitamins.

RESULTS

As a result of treatment of patients with chlamydia, ureaplasma or mycoplasma monoinfection with acute course on the basis of clinical examination data revealed: recovery in 28 (93.3%) of 30 patients; improvement - in 2 patients (6.7%); no change - 0 (0%). At chronic the course of the disease - recovery - in 30 (90.9%) of 33 patients; improvement - in 2 (6.1%); no change — in 1 (3.0%). In the presence of mixed infection in acute course, the following results were revealed: recovery in 31 (93.9%) of 33 patients; improvement - in 2 (6.1%); no change - 0 (0%). In chronic course - respectively: 30 (88.2%) of 34 patients; 3 (8.8%); 1 (3.0%).

As can be seen from the above data, the results of the treatment of chlamydial-ureaplasma-mycoplasmal infection using complex therapy with the use of SUMAMEDA are very positive. In an acute uncomplicated variant of the course of the process, both in the presence of monoinfection and mixed infection, a positive clinical effect was achieved in almost all cases (complete recovery + improvement) in one course of complex treatment. In a chronic complicated course in the presence of monoinfection, in one course of therapy, a positive clinical effect was achieved in the absolute majority of cases - 97% (recovery + improvement), and in case of mixed infection - in 97%.

Data from a PCR study as a result of treatment of patients with chlamydial, ureaplasma or mycoplasma monoinfection at acute course: recovery in 29 (96.7%) of 30 patients; no change - 1 (3.7%). At chronic the course of the disease - respectively - 32 (97.0%) of 33 patients; and 1 (3.0%). In the presence of mixed infections at acute The course revealed the following results by the PCR method: recovery in 30 (93.8%) of 32 patients; no change - in 2 (6.2%). At chronic course - respectively: 31 (91.1%) of 34 patients; and 3 (8.9%) (Figure 1).

Figure 1. Data from a study of the effectiveness of the treatment of patients with chlamydial ureaplasma and / or mycoplasma infection by the PCR method (recovery in %).

According to the ELISA method (determination of antibodies to chlamydia), the results of the study of the effectiveness of treatment also corresponded to the data of the PCR method. In the presence of monoinfection with acute course: recovery in 28 (93.3%) of 30 patients; decrease in antibody titer - 2 (6.7%); high antibody titers - 0 (0%). At chronic the course of the disease - respectively - 29 (85.4%) of 33 patients; decrease in antibody titer - 2 (5.6%); high antibody titers - 2 (5.6%) (Figure 2).

Figure 2. Data from a study of the effectiveness of treatment of patients with chlamydial ureaplasma and/or mycoplasma monoinfection by the ELISA method (in %).

At the presence of mixed infection at acute the course revealed the following results by the ELISA method: recovery in 30 (93.8%) of 32 patients; decrease in antibody titer - 2 (6.2%); high antibody titers - in 0 (0%). At chronic course - respectively: 29 (85.3%) of 34 patients; decrease in antibody titer - 3 (8.8%); high antibody titers - in 2 (5.9%) (Figure 3).

Figure 3. Data from a study of the effectiveness of treatment of patients with chlamydial ureaplasma and / or mycoplasma mixed infection by the ELISA method (in %).

During the entire course of treatment, the drugs were relatively well tolerated. 7 out of 129 (5.4%) patients had minor side effects in the form of gastric discomfort, headache, sleep disturbances.

CONCLUSIONS

1. Results clinical research complex therapy with the use of SUMAMEDA showed a sufficiently high efficiency in the treatment of patients with both monoinfection and mixed chlamydial-ureaplasma-mycoplasmal infection (91.1-97.0%) after one course of therapy.

2. SUMAMED in complex treatment well tolerated by patients. Only 5.4% of patients had minor side effects.

3. SUMAMED meets all the requirements that apply to modern therapy genitourinary intracellular infections, which allows us to recommend it for complex therapy of intracellular sexually transmitted infections.

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