The corresponding, effective and timely therapy of any IMP leads to the frequency of symptoms and bacteria significantly higher and better prevention. Unfortunately, treatment can lead to antibiotics for pathogens and bacteria to comment and have side effects on intestinal and vaginal flora, so it is very important to immediately consult a doctor and choose it correctly.
Clinical recommendations for the treatment of uncomplicated cystitisThe American Association of Infectious Diseases (IDSA) cooperates with the European Microbiology and Infectious Disease Association (ESCMID) published clinical recommendations for non -acute bladder inflammation and pyelonephritis in 2011. This document has become an invaluable reference in the IMP office. This guide discusses important factors in optimal treatment:
The nature of Uropathogen resistance;
The sensitivity of urepatogen bacteria for antibacterial drugs;
Side effects of antibacterial drugs.
For sensitivity, two important facts are recorded in this leadership:
Uropathogen stability for antibiotics has increased in recent years;
The nature of the resistance shows a significant geographical change among countries and even regions.
Therefore, the recommendations for the amendments due to continuous development of drug resistance, the development of new tools and conducts research shows the superiority and inefficiency of the drug. According to and recommendations and research, they are best met with drug requirements to treat uncomplicated cystitis, the following substances:
phosphomicin;
Nitrofurantin.
The following selection criteria have been used: pharmacokinetics, interaction, probability of beating (probability of microorganisms that are sensitive to antibiotics), resistance to resistance, specific use for IMPS, efficiency, side effects, dose frequency, treatment time, cost.
Research includes the following drugs: Amoxicillin (with or without clavulanic acid), nitrofurantin, sulfametizol, trimtoprime, co-trimoxazole, ciprofloxacin, norfloxacin, offloxacin and phosphomicin trometamol.
Characteristics of the first infection treatment line of the lower urinary tractTable 1. The first line to treat cystitis
Matter
Dosage
Treatment time
Phosfomicin trometamol
3 g a single dose
A single dose (one time)
Nitrofurantin
50-100 mg four times a day
5-7 days
Phosfomicin trometamolPhosfomycin was opened in 1969 as a representative of the new phosphone antibiotic.
Activity: Phosphomicin. Release sample: particles to prepare solution, in packaging 1 or 2 packs, phosphomicin dose 3 g/bag, 2 g/bag.
It refers to the clinical and farm for uroantisptic, antibiotics (derivatives of phosphonic acid).
Spectrum of actionPhosfomycin has the bactericidal activity of a broad -action spectrum related to:
Staphylococci (Staphylococcus spp. );
Enterococci (Enterococcus spp. );
Haemophilus spp;
Most gram-negative bacteria, including 95, 5% E. Coli, created the expansion spectrum (BLRS);
E. coli strains produce metal-lactamase sensitive to phosphomicin;
Citrobacter spp. ;
Entobacter spp. ;
Klebsiella spp. , Klebsiella Pneumoniae;
Morganella Morganii;
Proteus Mirabilis;
Pseudomonas spp. ;
Serratia spp.
The peculiarity of the drugTrometamol phosphomicin is exclusively prescribed to treat non -acute cystitis in the form of a 3 g dose and is not prescribed Pyelonephr inflammation.
It is best absorbed if you use it before eating.
Achieving high concentrations in urine and holding high for more than 24 hours.
In some studies, the clinical effect and microorganisms of phosphomicin with other anti -bacterial drugs of the first row with uncomplicated cystitis are compared. The clinical effect of a dose (3 g) phosphomicin is 91% (healing occurs in 91% of patients). The indicators are equivalent to nitrofurantoine (93%), trimetrome-sulfametoxazole (93%) and fluoroquinolones (90%) in non-acute bladder inflammation.
Advantages of phosphomicin treatmentThe microbiological level of phosphomicin treatment (80%) is lower than the antibiotic equivalent to 8844%steel. However, a recent general analysis of 27 studies does not show the difference in effectiveness between phosphomicin and other antibiotics to treat cystitis and detect the following events:
Phosfomycin causes significantly less adverse reactions, which is the most important - including in pregnant women.
An additional benefit is to treat multi -variable microorganisms. A number of studies in vitro have shown that phosphomicin acts related to staphylococcus aureus against vancico and negative sticks that produce BLR.
Effective in IMP treatment caused by K. Pneumoniae. Enterobacteriaceae produces carbapenemase (at a dose of 3 g, repeat every 48 hours 72).
It has minimal side effects on the body. This is indicated by the high frequency of the sensitivity of E. coli in areas that often use phosphomicin with uncomplicated cystitis in women;
Convenience of a single dose mode.
AssignAcute cystitis (bacterial origin);
worsen recurrent cystitis (bacterial origin);
Urethritis (nonspecific bacteria);
The bacteria of pregnant women have no symptoms;
IMP after operation;
Prevent IMP.
Dosage and application method
Treatment of simple acute cystitis
The recurrent/heavy IMP forms of IMP
IMP prevention
Adults - 3. 0 g (1 pack) onceChildren (from 5 years old) - 2, 0 g once
Adults - 3. 0 g twice, the second reception after 24 hours
First technique: 3. 0 g 3 hours before performing/diagnosticSecond trick: 3. 0 g 24 hours after the main itself
Recommendation for useFollow all instructions on the label.
Phosfomycin is usually only prescribed in one dose.
Do not receive large/smaller or longer quantities if it is not prescribed by the doctor.
It can be used simultaneously/after eating.
Phosfomycin is a powder medicine, before use, it must be diluted with water. Do not take dry powder without adding water.
Dissolve a bag of 1/2 cup of cold water, mix and drink immediately. You can add a little water to the same glass, shake carefully and drink immediately to ensure a complete dosage.
Do not mix with hot water.
It is good to bring it overnight. There will be longer breaking between urination, ensuring longer presence of the drug in the bladder and more effective.
Store at room temperature away from moisture and heat in the original packaging.
Other instructions:
Symptoms cannot be completely overcome immediately, after 2-3 days;
It is necessary to contact the urinary doctor if the symptoms do not disappear within 3 days after treatment, fever or other new complaints will appear;
Before applying the patient, consult a doctor to ensure that phosphomicin is an appropriate antibiotic for treatment. In addition, urine analysis may be required before and after this medication.
Contraindications:
Children under 5 years old;
allergic reactions to components;
Severe renal failure.
Common side effects:
Nausea, stomach disorders, mild diarrhea;
Headache, dizziness;
Itching or vaginal discharge (rarely).
Drug interactionMeteclopramide should not be used at the same time to avoid weakening the effects of phosphomicin.
Therefore, the convenience of a single dose regime, in vitro activity is related to drug -resistant gram sticks that cause both simple and unpromaled, uncomplicated cystitis.Then And the minimum tendency to damage makes phosphomicin a useful option in the treatment of lower MVP infections (cystitis, urethritis).
Nitrofurantin Activity: Nitrofurantin. Form of release: Vien, dose of 100 mg, 50 mg.
It mentioned in clinical and farm groups with Uroantisptics, anti -bacteria.
Nitrofurantin, related to the synthetic nitrofurans group, is originally presented in the form of a crystal form. In 1967, the form of macrocstalline crystals with improved gastrointestinal intolerance is available.
Currently, there are two main types of nitrofurantin: macrocryallline and mixture of micro -crystal and crystal macrocrytalline crystals (25 mg of macrocrystal plus 75 mg of monohydrate). Mixed species in the patented dual distribution system are not registered and not circulated in the Russian Federation.
Mechanism of actionNitrofurantin's mechanisms of bacteria include a number of locations:
inhibit ribosome broadcasting;
damage to bacterial DNA;
Intervene in the CREBS cycle.
Nitrofurantin is related to:
More than 90% of intestinal strains cause IMP;
Enterococcus, including resistance to vancromicin;
Klebsiella spp. ;
Proteus spp. ;
Staphylococci (gold and saprophytic) are often easily affected.
Anti -drug is very rare, probably due to many areas of the drug. However, Proteus, Serratia and Pseudomonas are natural resistance to nitrofurantine.
Nitrofurantino can also be an additional option for the oral antibacterial treatment of uncomplicated cystitis caused by bacteria to BLR.
Pharmacokinetics. The absorption improves when eating. The concentration of nitrofurantin in the serum is low or not determined in the standard doses, the content of the prostate is not detected. It is excreted mainly with urine, in which the concentration of the drug (from 50 to 250 mg/ml) easily exceeds 32 mg/ml MPC.
Nitrofurantin should not be prescribed for patients with significant kidney failure (creatinine clearance<60 m/min), but observation studies found the effect of the drug in patients with creatinine clearance of 60-30 ml/minute.
Safe for use in pregnant women and children.
Assign: Inflammation (bacterial origin) for treatment and prevention.
Dosage. It is prescribed by a personal urinary doctor based on the severity of the state, time and severity of symptoms.
The usual dose for adults with cystitis:
From 50 to 100 mg 4 times a day for a week or at least 3 days after aseptic urine reaches. The usual dose for adults to prevent cystitis:
From 50 to 100 mg once a day before going to bed. The dosage of children to treat cystitis:
1 month of age: 5 matches 7 mg/kg/day (up to 400 mg/day) oral in 4 doses. The usual dosage of children to prevent cystitis:
1 month or more: From 1 to 2 mg/kg/day (up to 100 mg/day) by mouth 1-2 times of reception.
Most experts agree with the recommendation of the 5 -day process of the drug to treat unprovative cystitis. Studies show that the frequency of early clinical healing with nitrofurantine is from 79% to 95% and the frequency of microbiological treatment from 79 to 92%. In the synthesis of clinical effectiveness, they indicate the common equivalent between nitrofurantoin, prescribed for 5 or 7 days and trimetrode-sulfametoxazole (particle), cyprofloxacin and a dose of phosphomycin trometamol (single). However, the rate of microbiological treatment has continuously proved a slightly more favorable effect on the comparative drugs.
Recommendation for patientsIt is necessary to follow all the prescriptions and instructions of the doctor in the instructions for the drug.
Do not use in large or smaller or longer quantities or proposed.
It is better to use nitrofurantin with food (bioavailability).
Should observe the reception in the entire prescribed time. Symptoms may be overcome earlier, but the treatment cannot be stopped while the infection is completely removed. The dose may increase the risk of further development of antibiotic infections and the risk of recurrence.
Nitrofurantin does not treat viral infections, for example, colds or flu.
Side effectsCommon side effects:
Headache, dizziness;
gas formation, stomach disorders;
Light diarrhea;
Itching or vaginal discharge.
Less often found:
diarrhea or diarrhea;
Sudden or uncomfortable pain in the chest, exhaled, dry cough;
shortness of breath;
Fever, chills, pain in the body, fatigue, unexplained weight loss;
numbness, tingling or pain in the arms or legs;
Liver - nausea, pain in the upper part of the stomach, itching, fatigue, loss of appetite, dark urine, clay feces, jaundice (jaundice or eyes);
Lupid -like syndrome - joint pain or edema when fever, swelling, muscle pain, chest pain, vomiting, thoughts or abnormal behaviors, rash detected.
Serious side effects may be more likely to be in the elderly, long -term or weakened disease.
Contraindications:
serious disorders of the excretory function of the kidneys;
renal failure;
Oliguria;
Glucose-6-phosphate dehydrogenase failure;
pregnant;
Age up to 1 month;
allergic reactions to components;
Stage xn II-III;
cirrhosis;
Chronic hepatitis;
acute Porphyria;
Breastfeeding.
Applied during pregnancyPregnancy -related drugs: Print (according to FDA - US health authority). It is believed that this drug will not be harmful to a child who has not given birth in the early stages of pregnancy. In the last 2-4 weeks of pregnancy, it is contraindicated.
Nitrofurantin can penetrate breast milk, during breastfeeding is not prescribed.
Special instructionsThe risk of peripheral neuropathy increases when anemia, diabetes, severe monitors, violating electrolyte balance, vitamin deficiency of group B of B.
Nitrofurantin is not used to treat prostatitis, the lesions of the kidneys of the kidneys, paranephr inflammation. With pyelonephritis, they are not prescribed due to ineffective.
Nitrofurantin can give abnormal results with some glucose in the laboratory (sugar) in the urine.
Drug interactionWith fluoroquinolons is incompatible.
Anti -acid -based magnesium drugs of trilicate, nastyx acid while using antibacterial activity of nitrofurantin.
The secretion of the channel to prevent the secretion of the channel is not prescribed, as they increase the toxicity of nitrofurantin (increased blood content), reducing bactericidal properties (the content of the urine is reduced).
Nitrofurantin is considered to be the treatment of the first line in cystitis without acute complications due to:
The effectiveness of a 5 -day course;
A small risk of side effects and damage to a normal flora of a person;
Minimum resistance of bacteria;
Effective equivalent to other antibacterial drugs.
