Any Imp appropriate, effective, timely therapy leads to significantly higher frequency of symptomatic and bacteriological cure and better prevention of recreation. Unfortunately, treatment can lead to antibiotic resistance to pathogens and commentary bacteria and can have a detrimental effect on the intestinal and vaginal flora, so it is very important to consult a doctor immediately and choose correctly.
Clinical recommendations for the treatment of acute non -complicated cystitis
The company of American infectious disease (IDSA), in cooperation with the European Society of Microbiological and Infectious Diseases (Escmid), has published clinical recommendations for the treatment of acute, non -complicated cystitis and pyelonephritis. This document has become an invaluable reference in the IM office. This manual discusses important factors for selecting optimal treatment:
- the nature of the resistance of the uropathogens;
- Sensitivity of urepatogenic bacteria with antimicrobial drugs;
- The possibility of side effects of antimicrobial drugs.
As for sensitivity, we find two important facts in this leadership:
- Uropatogens antibiotics have increased in recent years;
- The nature of the resistance shows that they show significant geographical variability between countries and even regions.
Thus, recommendations regularly review the continuously developing resistance, the development of new tools and the demonstration of the superiority and efficiency of drugs. Recommendations and research show that the requirements for drug treatment for complex cystitis are best met, as follows:
- phosphomicin;
- Nitrofurantin.
The following selection criteria were applied: pharmacokinetics, interaction, probability of impact (the likelihood of microorganism sensitive to antibiotics), resistance, specific use, efficiency, side effects, dosage frequency, duration of treatment, cost.
The study included the following drugs: amoxicillin (with or without chlavulanic acid), nitrofurantin, sulfametizole, trimtoprim, co-trimoxazole, ciprofloxacin, norfloxacin, offloxacin and phosphomicine.
Characterization of the first line of the first treatment of lower urinary tract infections
Table 1. First line to treat cystitis
Material Dosage Duration of treatment Phosphomicin trometamol 3 g single dose A single dose (once) Nitrofurantin 50-100 mg four times a day 5-7 days Phosphomicin trometamol
Fosfomicin was opened in 1969 as a representative of the new class of phosphon antibiotics.
Active material: phosphomicin. Expenditure form: granules for the solution of the solution, 1 or 2 packs, dosing of 3 g/bag of foszkin, 2 g/bag.
This refers to the clinical and pharmacological group to uroantizeptics, antibiotics (derivatives of phosphonic acid).
Spectrum
Bactericidal activity of phosphomycin has a widespread effect on the following:
- Staphylococci (Staphylococcus spp. );
- Enterococci (Enterococcus spp. );
- Haemophilus spp;
- Most guts are gram-negative bacteria, including E. coli 95, 5%, and produces β-lactamases in the extended spectrum (BLRS);
- E. coli strains that produce metal-β-lactamase for phosphomicin;
- Citrobacter spp. ;
- Enterobacter spp. ;
- Klebsiella spp. , Klebsiella pneumoniae;
- Morganella Morganani;
- Proteus mirabilis;
- Pseudomonas spp. ;
- Serratia spp.
The peculiarity of the medicine
- Trometamol phosomicin is prescribed only for the treatment of acute non -complicated cystitis, in a single dose of 3 g and is not prescribed for pyelonephritis.
- It is best absorbed when you take it before meals.
- It reaches high concentration in the urine and retains the high level for more than 24 hours.
Numerous studies compared the clinical and microbiological efficiency of phosphomicin with the first row of other antimicrobial agents, uncomplicated cystitis. Clinical efficiency of a dose (3 g) of phosphomicine is 91% (the cure occurs in 91% of patients). The indicator is comparable to nitrofurantoin (93%), trimethrometoxazole (93%) and fluoroquinolones (90%) in acute dirty cystitis.
The benefits of treatment with phospicin
The microbiological level of the cure for the cure (80%) is 88-94%lower than that of comparable antibiotics. However, recent meta -analysis of 27 studies did not discover the differences in the efficiency of phosphomicin and other antibiotics to treat cystitis and discovered the following facts:
- Phosphomycin causes significantly fewer harmful reactions, which is most important, including pregnant women.
- Another advantage is the treatment of multi -resistant microorganisms. Many in vitro studies have shown that phosphomicin is active in the Staphylococcus aureus with Vancico and Gram-negative sticks that produce BLRs.
- Effective in the treatment of Imp, which is K. pneumoniae. Enterobacteriaceae, which produces carbapenemase (dose of 3 g, repeats every 48-72 hours).
- It has minimal side effects on the body. This is indicated by the high frequency of E. coli's sensitivity in regions in which phosphomicine is often used in complex cystitis in women;
- The comfort of the only portion of mode.
Indications
- acute cystitis (bacterial origin);
- Aggravation of recurrent cystitis (origin of bacteria);
- urethra (bacterial gender -specific);
- Pregnant women bacteriuria are asymptomatic;
- Imp after operations;
- Imp.
Dosage and method of application
Treatment of simple acute cystitis Return/heavy forms of Imp Imp prevention Adults - 3, 0 g (1 pack) once Kids (from the age of 5) - once 2, 0 g
Adults - 3, 0 g twice, second bet after 24 hours First Technique: 3, 0 g 3 hours before surgery/diagnostic procedure Second trick: 3, 0 g 24 hours after primary
Recommendations
- Follow all instructions for the label.
- Phosphomicine is usually prescribed in only one portion.
- Do not take large/smaller quantities or longer if your doctor does not prescribe it.
- Can be used simultaneously/after a meal.
- Phosphomycin is a powder medicine before you need to be used with water. Do not take dry dust without adding water.
- Dissolve a bag of 1/2 cup of cold water, mix immediately and drink. You can add a little more water to the same glass, shake it gently and drink it immediately to ensure the entire dose.
- Do not mix with hot water.
- It's good to take it overnight. There will be a longer break between urination, which will ensure the longer presence of the drug in the bladder and a more effective effect.
- Store at room temperature from moisture and heating in the original packaging.
Other instructions:
- Symptoms cannot pass immediately after 2-3 days;
- The urologist should be acted if the symptoms do not disappear within 3 days of treatment, fever or other new complaints appear;
- Before applying the patient, it is advisable to seek medical attention to ensure that phosphomicin is adequate for treatment. In addition, urine analysis may be required before and after taking the medicine.
Contraindications:
- Children under 5 years of age;
- allergic reactions to the ingredients;
- Serious kidney failure.
General side effects:
- nausea, stomach disorder, mild diarrhea;
- headache, dizziness;
- Itching or vaginal discharge (rarely).
Drug
Concomitant intake with meteklopramide is not recommended to avoid weakening the effect of phosphomicin.
ThusTo And the minimal tendency of side damage makes it a useful choice to treat lower MVP (cystitis, uretritis) infections.
Nitrofurantin
Active material: nitrofurantin. Expenditure form: tablet, 100 mg dose, 50 mg.
According to the clinical and pharmacological group, it applies to uroantizeptics and antimicrobials.
Nitrofurantin related to a group of synthetic nitrofurans was originally presented in a microcrystalline form. In 1967, the macrocrystalline form became available with improved gastrointestinal tolerance.
Currently, there are two main types of nitrofurantin: macrocrystalline form and a mixture of microcrystalline and macrocrystalline forms (25 mg macrocrystals plus 75 mg monohydrate). The mixed species of the patented dual transport system has not been registered in the Russian Federation and is not in circulation.
The mechanism of action
Mechanisms of bacterial activity of nitrofurantin include more space:
- Inhibition of ribosomal broadcasting;
- damage to bacterial DNA;
- Intervention in the CREB cycle.
Nitrofurantin is active in connection with:
- More than 90% of the intestinal strains causing IMP;
- Enterococcus, including resistance against vancromycin;
- Klebsiella spp. ;
- Proteus spp. ;
- Stilaccus (gold and saprophy) is generally sensitive.
Resistance to the drug is rare, probably due to several areas of the drug. However, Proteus, Serratia and Pseudomonas have natural resistance to nitrofurantoin.
Nitrofurantino may be an additional option for the oral antimicrobial treatment of acute, non -complicated cystitis caused by BLR producing bacteria.
Pharmacokinetics. Absorption is improving at meals. In the serum, the concentration of nitrofurantin is low or not determined in standard doses, and the contents of the prostate gland are not detected. It is primarily emptied from urine, where the concentration of the drug (50-250 mg/ml) easily exceeds 32 mg/ml MPC.
Nitrofurantin should not be allowed for patients with high renal failure (Creatinine Clearness<60 m/min), but the tests observed the high efficiency of the drug in 60-30 ml/min Creatinine Clearance.
Safe for use in pregnant women and children.
Goods: Cystitis (origin of bacteria) treatment and prevention.
Dosage. The urologist prescribes individually based on the severity, duration and severity of the state.
For adults with the usual dose of cystitis:
- Up to 50-100 mg orally orally four times a day for 1 week or at least 3 days after reaching urine sterility. The usual dose of adults to prevent cystitis:
- 50-100 mg orally once a day before bedtime. Dosage of children to treat cystitis:
- 1 month and older: 5-7 mg/kg/day (up to 400 mg daily) in 4 portions orally. Dose of usual children to prevent cystitis:
- 1 month and older: 1-2 mg/kg/day (up to 100 mg daily) by mouth 1-2 bets.
Most experts agree with the recommendation of the drug's 5 -day course to treat acute, uncomplicated cystitis. Studies showed the frequency of early clinical cure for nitrofurantoin from 79% to 95% and the frequency of microbiological healing to 79-92%. The overall equation of clinical efficiency tests indicates the general equivalence between nitrofurantoin, 5 or 7 days of nitrofurantoin and trimetrome sulfametoxazole (beads), cyprofloxacin and the only dose of trimetamol phospomicine (monal). However, the speed of microbiological cure has constantly detected a slightly more beneficial effect on comparative drugs.
Recommendations to patients
- All prescriptions and instructions for your doctor should be followed in the drug instructions.
- Do not use large or smaller quantities or longer than recommended.
- It is better to take nitrofurantin with food (rise in bioavailability).
- We recommend that you observe the reception throughout the prescribed period. Symptoms may disappear before, but treatment cannot be stopped until the infection is completely eliminated. Doses increase the risk of further development of antibiotics and the risk of relapse.
- Nitrofurantin does not treat viral infections, such as cold or flu.
Side effect
General side effects:
- headache, dizziness;
- Gas formation, stomach disorder;
- light diarrhea;
- Itching or vaginal discharge.
They are much less likely to be found:
- wet or bloody diarrhea;
- Sudden pain or discomfort in the chest, beep breathing, dry cough;
- difficulty breathing;
- fever, chills, pain in the body, fatigue, inexplicable weight loss;
- numbness, tingling or pain in hands or feet;
- Liver problems - nausea, pain in the upper part of the stomach, itching, feeling of fatigue, loss of appetite, dark urine, clay stools, jaundice (skin or eye yellow);
- Lupid syndrome - joint pain or edema fever, swollen glands, muscle pain, chest pain, vomiting, unusual thoughts or behavior, spotted rashes.
Severe side effects may be more likely in elderly, long -term patients or weakened people.
Contraindications:
- severe disorders of the kidney emptying function;
- kidney failure;
- Oliguria;
- glucose-6-phosphate-dehydrogenase error;
- pregnancy;
- age up to 1 month;
- allergic reactions to the ingredients;
- XN II-IIi sections;
- cirrhosis;
- chronic hepatitis;
- Acute porphiria;
- breast-feeding.
Application during pregnancy
The category of medicine compared to pregnancy: in (FDA - according to the United States Health Agency). It is believed that this medicine is not harmful to the birth of a child in early pregnancy. Contraindicated in the last 2-4 weeks of pregnancy.
Nitrofurantin is able to penetrate breast milk and are not prescribed during breastfeeding.
Special instructions
- The risk of peripheral neuropathy in the presence of anemia, diabetes mellitus, severe week, violation of electrolyte balance, lack of vitamins B.
- Nitrofurantin is not used to treat prostatitis, kidney cortical injuries, and to treat messy paanephritis. In the case of pyelonephritis, they are not prescribed due to efficiency.
- Nitrofurantin can provide unusual results for the laboratory glucose (sugar) in the urine.
Drug
- Not compatible with fluoroquinolons.
- Antacids are based on the magnesium of nastyx acid while taking antimicrobial activity of nitrofurantin.
- Channel secretion blocking channel secretion is not prescribed as they increase the toxicity of nitrofurantin (increasing the blood content), reducing bactericidal properties (reduced urine content).
Nitrofurantin is considered to be the therapeutic drug of the first row in acute unusual cystitis:
- efficiency of a five -day course;
- a minor risk of damage to the side effects and the normal flora of the human;
- Minimal resistance of bacteria;
- Efficiency comparable to other antimicrobial drugs.