The corresponding, effective, timely therapy of an IMP leads to a significantly higher frequency of symptomatic and bacteriological healing and better prevention of reinfection. Unfortunately, treatment can lead to antibiotic resistance to pathogens and comment bacteria and have a disadvantageous effects on the intestinal and vaginal flora. Therefore, it is very important to consult a doctor immediately and select it properly.
Clinical recommendations for the treatment of acute uncomplicated sheet infection
The American Society of Infectious Disease Specialist (IDSA) in collaboration with the European Society for Microbiology and Infectious Diseases (ESCMID) published clinical recommendations for treatment with acute uncomplicated cystitis and pyelonephritis in 2011. This document became an easily foundation in the IMP office. In this manual, important factors are discussed when choosing optimal treatment:
- the type of resistance of the uropathogenic;
- Sensitivity of urepatogenic bacteria compared to antimicrobial drugs;
- The possibility of side effects of antimicrobial drugs.
With regard to the sensitivity, two important facts are found in this leadership:
- The stability of uropathogenic compared to antibiotics has increased in recent years.
- The type of resistance shows a significant geographical variability between countries and even regions.
Therefore, the recommendations regularly revise due to the constantly developed resistance, the development of new instruments and the implementation of research that show the superiority and inefficiency of medicinal products. Loud and recommendations and research are best fulfilled on the requirements for medication for the treatment of uncomplicated hystitis, the following substances:
- Phosphomicin;
- Nitrofurant.
The following selection criteria were used: pharmacokinetics, interaction, the probability of the hit (the probability that the microorganisms is sensitive to antibiotics), the development of resistance, specific use of imps, effectiveness, side effects, dosage frequency, treatment duration, costs.
The study included the following drugs: amoxicillin (with or without clavulanic acid), nitrofurant, sulfametizole, trimtoprime, co-trimoxazole, ciprofloxacin, norfloxacin, offloxacin and phosphomicin trometamol.
Characterization of the first treatment of infections of the lower urinary tract
Table 1. First line for the treatment of cystitis
| substance | dosage | The duration of the treatments |
| Phosfomicin trometamol | 3 g of a single dose | A single dose (once) |
| Nitrofurant | 50-100 mg four times a day | 5-7 days |
Phosfomicin trometamol
Phosfomycin was opened in 1969 as a representative of the new class of phosphon antibiotics.
Active substance: phosphomicin. Form of release: granulate for the production of the solution, in packaging 1 or 2 packages, dosage of phosphomicin 3 g/bag, 2 g/bag.
It refers to the clinical and color acological group to UroantiSeptics, antibiotics (derivative of phosphonic acid).
Spectrum of action
Phosfomycin has a bactericide activity of a broad spectrum of activity in relation to:
- Staphylococci (Staphylococcus Spp. );
- Enterococci (Enterococcus Spp. );
- Haemophilus SPP;
- Most intestinal gram-negative bacteria, including 95, 5% E. coli, produce the β-lactamas of the extended spectrum (BLRS);
- E. Coli tribes that produce metal-β-lactamase that are sensitive to phosphomicin;
- Citrobacter spp. ;
- Enterobacter spp. ;
- Klebsiella spp. , Klebsiella pneumoniae;
- Morganella Morganii;
- Proteus Mirabilis;
- Pseudomonas spp. ;
- Serratia spp.
The peculiarity of the drug
- Trometamol phosphomicin is prescribed exclusively for the treatment of acute uncomplicated cystitis in the form of a single dose of 3 g and not prescribed for pyelonephritis.
- It is best absorbed when you take it before eating.
- A high concentration in the urine and keeps a high level for more than 24 hours.
In several studies, the clinical and microbiological effectiveness of phosphomicin was compared with other antimicrobiders in the first row with uncomplicated cystitis. The clinical efficiency of a dose (3 g) phosphomicin is 91% (heals in 91% of patients). The indicator is comparable to nitrofurantoin (93%), trimetrome sulofametoxazole (93%) and fluorchinolons (90%) in acute uncomplicated cystitis.
Advantages of treatment with phosphomicin
The microbiological level of healing phosphomicine (80%) is lower than that of comparable antibiotics by 88–94%. However, a recent meta analysis of 27 studies did not result in the differences in the effectiveness between phosphomicin and other antibiotics for the treatment of cystitis and discovered the following facts:
- Phosfomycin significantly causes less undesirable reactions, which is most important - including pregnant women.
- An additional advantage is the treatment of multi -resistant microorganisms. Several studies by In-Vitro showed that phosphomicin is active in relation to vancico-resistance Staphylococcus Aureus and Gramnegative sticks that produce BLRS.
- Effective in the treatment of IMP caused by K. Pneumoniae.
- It has a minimal side effect on the body. This is indicated by the high frequency of the susceptibility of E. coli in regions with frequent use of phosphomicin with uncomplicated cystitis in women.
- Convenience of a single dose mode.
Indications
- Acute cystitis (bacterial origin);
- Determination of recurrent cystitis (bacterial origin);
- Urethritis (bacterial non -specific);
- Bacteriuria pregnant women asymptomatic;
- IMP after operations;
- Prevention of IMP.
Dosage and application method
| Treatment of simple acute blood inflammation | Recurring/heavy forms of IMP | Prevention of IMP |
| Adults - 3, 0 g (1 package) once
Children (from 5 years) - 2, 0 g once |
Adults - 3, 0 g twice, the second reception after 24 hours | First technology: 3, 0 g 3 hours before operation/diagnostic procedure
Second trick: 3, 0 g 24 hours after the Primary |
Recommendations for use
- Follow all instructions on the label.
- Phosfomycin is usually only prescribed in a dose.
- Do not take large/smaller quantities or longer if it is not prescribed by a doctor.
- It can be used at the same time/after eating.
- Phosfomycin is a powder medication that has to be diluted with water before use. Do not take a dry powder without adding water.
- Mix and drink a bag with 1/2 cup of cold water, mix and drink immediately. You can add a little more water to the same glass, shake and drink immediately to ensure a complete dosage.
- Do not mix with hot water.
- It's good to take it overnight. There will be a longer break between urination, which ensures a longer presence of the drug in the bladder and a more effective effect.
- Store at room temperature of moisture and heat in the original packaging.
Other instructions:
- The symptoms cannot pass immediately after 2-3 days;
- It is necessary to contact a urologist if the symptoms do not disappear within 3 days of treatment, a fever or other new symptoms occur.
- Before using the patient, it is recommended to consult a doctor to ensure that phosphomicin is a suitable antibiotic for treatment. In addition, urine analysis may be necessary before and after taking this drug.
Contraindications:
- Children under 5 years;
- allergic reactions to components;
- Heavy kidney failure.
General side effects:
- Nausea, gastric disease, minor diarrhea;
- Headache, dizziness;
- Itching or vaginal discharge (rare).
Drug interaction
The simultaneous intake with MetClopramide is not recommended to avoid the effect of the effect of phosphomicin.
Hence the convenience of a single dose regime, in vitro activity in relation to resistant gram -negative sticks that cause both simple and immature, uncomplicated cystitisPresent And the minimal tendency towards side damage makes phosphomicin a useful choice in the treatment of infections of the lower MVP (cystitis, urethritis).
Nitrofurant
Active substance: nitrofurant. Expansion form: tablets, dosage 100 mg, 50 mg.
According to the clinical and color acological group, it refers to uroantistics, antimicrobial.
Nitrofurant, in connection with the group of synthetic nitrofuran, was originally presented in the form of a microcrystalline form. In 1967 the form of macroristalline with improved stomach -intestine -tolerance was available.
There are currently two main types of nitrofurant: a macro -clustalline shape and a mixture of microcrystalline and macroristalline shapes (25 mg macrocracy plus 75 mg monohydrate). Mixed species in the patented double delivery system in the Russian Federation are not registered and are not in circulation.
The mechanism of action
The mechanisms of nitrofurant's bacterial activity include several places:
- Inhibition of ribosomal radio;
- Damage to the bacterial DNA;
- Intervention in the Crebs cycle.
Nitrofurant is in relation to:
- more than 90% of the intestinal tribes that cause the IMP;
- Enterococcus, including resistance to vancromicin;
- Klebsiella spp. ;
- Proteus spp. ;
- Staphylococci (golden and saprophytic) are usually susceptible.
The resistance to the medicine is rare, probably due to several areas of the drug. However, Proteus, Serratia and Pseudomonas have a natural resistance to nitrofurantoin.
Nitrofurantino can also be an additional option for the oral antimicrobial treatment of acute uncomplicated cystitis caused by bacteria that produce BRRs.
Pharmacokinetics. The absorption improves when eating. The concentrations of nitrofurant in the serum are low or not defined in standard doses, the content of the prostate is not proven. It is mainly excreted with urine, with the concentration of the drug (from 50 to 250 mg/ml) slightly exceeding 32 mg/ml MPC.
Nitrofurant should not for patients with a pronounced kidney failure (creatinine clearance<60 m/min) are prescribed, but the studies observed a high efficiency of the drug in patients with creatinine clearance of 60 to 30 ml/min.
Safe for use in pregnant women and children.
Indications: Cystitis (bacterial origin) treatment and prevention.
Dosage. It is prescribed by a urologist individually based on the severity of the state, the duration and the severity of the symptoms.
The usual dose for adults with cystitis:
- From 50 to 100 mg orally 4 times a day for 1 week or at least 3 days after reaching urinsterility. The usual dose for adults to prevent cystitis:
- From 50 to 100 mg orally the day before going to bed. Children's dose for the treatment of cystitis:
- 1 month and older: 5–7 mg/kg/day (up to 400 mg/day) orally in 4 doses. The usual children's dose to prevent cystitis:
- 1 month and older: 1 to 2 mg/kg/day (up to 100 mg/day) in 1-2 receptions orally.
Most experts agree to the recommendation of a 5-day medicine course for the treatment of acute uncomplicated flowering. Studies showed the frequency of an early clinical remedy with nitrofurantoin from 79% to 95% and the frequency of microbiological healing from 79 to 92%. Overall, the examination of clinical effectiveness indicates the general equivalence between nitrofurantoin, which are prescribed 5 or 7 days and trimetom sulfamet oxazole (pearls), cyprofloxin and a single dose of trometamol phosphomycin (monund). However, the speed of microbiological healing has constantly shown a somewhat cheaper effect for comparison medication.
Recommendations to patients
- It is necessary to follow all recipes and instructions from the doctor in the instructions for the drug.
- Do not use large or smaller quantities or longer than recommended.
- It is better to take nitrofurant with food (bioavailability increases).
- It is recommended to observe the reception throughout the prescribed period. The symptoms can pass earlier, but treatment cannot be stopped while the infection is completely eliminated. Doses can increase the risk of further development of antibiotics and the risk of relapse.
- Nitrofurant does not treat virus infections, such as a cold or flu.
Side effect
General side effects:
- Headache, dizziness;
- Gas formation, gastric disease;
- easy diarrhea;
- Itching or vaginal discharge.
Are found much less often:
- Aqueous or bloody diarrhea;
- Sudden pain or symptoms in the chest, whistling, dry cough;
- Difficulty breathing;
- Fever, chills, pain in the body, fatigue, inexplicable weight loss;
- Daubiness, tingling or pain in the hands or legs;
- Liver problems - nausea, pain in the upper part of the stomach, itching, feeling of fatigue, loss of appetite, dark urine, sound of sound, jaundice (yellowed of the skin or eyes);
- The Lupid - similar syndrome - joint pain or edema with fever, swollen glands, muscle pain, chest pain, vomiting, unusual thoughts or behavioral expenses, discovered rashes.
Serious side effects can be more likely in older, long -term sick or weakened people.
Contraindications:
- serious diseases of the kidney excretion function;
- Kidney failure;
- Oliguria;
- Glukose-6-phosphate dehydrogenase failure;
- Pregnancy;
- Age up to 1 month;
- allergic reactions to components;
- Xn ii-iii steps;
- Cirrhosis;
- Chronic hepatitis;
- Acute porphyria;
- Still -time.
Application in pregnancy
The category of the drug in relation to pregnancy: in (according to the FDAus health authority). It is believed that this medicine will not damage an unborn child in the early stages of pregnancy. It has been contraindicated in the last 2-4 weeks of pregnancy.
Nitrofurant can penetrate breast milk, not prescribed during the lactation.
Special instructions
- The risk of peripheral neuropathy increases in the presence of anemia, diabetes mellitus, severe mon, violation of the electrolyte balance, a lack of vitamins in group B.
- Nitrofurant is not used to treat prostatitis, lesions of the cortical substance of the kidneys, purulent paranephritis. With pyelonephritis, they are not prescribed due to inefficiency.
- With certain laboratory glucose (sugar) in the urine, nitrofurant can deliver unusual results.
Drug interaction
- With fluorchinolons are incompatible.
- Antacida based on the magnesium of trilicate, evil acid, while taking the antimicrobial activity of nitrofurant.
- Canal secretion that blocks channel secretion is not prescribed because it increases the toxicity of nitrofurant (the blood content increases), reduce the bactericidal properties (the content in urine is reduced).
Nitrofurant is considered a therapeutic means of the first line in acute uncomplicated glare due to:
- The effectiveness of a 5-day course;
- a small risk of side effects and damage to the normal flora of a person;
- Minimum resistance of bacteria;
- Effectiveness comparable to other antimicrobial medicines.