Rational choice of antibiotic is the task of the treating doctor. Due to the increasing resistance of pathogens of various pathologies to antibacterial agents, doctors have to increasingly use reserve antibiotics in everyday practice. These are drugs to which microorganisms have not developed drug-resistant strains. However, they are more toxic and bacterial resistance develops fairly quickly.
General information
Antibiotics are a substance obtained naturally, synthetically or semi-synthetically, capable of destroying various microorganisms. They have been used as a medicine since the last century. The following groups of antibiotics are known: beta-lactams, aminoglycosides, tetracyclines, macrolides, fluoroquinolones, lincosamides and glycopeptides. They have a bacteriostatic and bactericidal effect.
WHO groups of antibacterial drugs
World Organizationhe alth care, all antibacterial agents are divided into three groups and recommendations are given on when to use them. This is to:
- contain antimicrobial resistance;
- optimize the treatment of infectious pathologies;
- maintain antibiotics on reserve to treat infections caused by multidrug-resistant pathogens.
Let's take a closer look:
- The second group includes medicines recommended as reserve and choice antibiotics for the treatment of certain infections. The use of drugs in this group increases the risk of resistance. Therefore, the use of "Ciprofloxacin" for the treatment of uncomplicated infections, such as cystitis or bacterial bronchitis, should be limited. Otherwise, the risk of further development of antibiotic resistance increases.
- The third group includes Colistin and some medications from the cephalosporin group. These drugs are called reserve or "last line". They are indicated for use in serious and severe infections when other therapies have failed.
This approach to the use of antibacterial agents allows:
- use antibiotics prudently and rationally;
- increase the effectiveness of therapy;
- decelerate the development of resistance to them.
Practical value of reserve antibiotics
During the use of these funds, there is a high probability of developingmicrobial resistance to them. Especially quickly it develops to such medicines as:
- Rifampicin;
- "Oleandomycin";
- "Streptomycin".
Slower to "Levomitsetin" and drugs of the group of penicillins and tetracyclines. Quite rarely to polymyxins. In addition, there is cross-resistance, and, moreover, it applies not only to the agent used, but also to medicines similar to it in molecular structure. The risk of resistance is minimal if the following rules are followed:
- rational purpose;
- optimally selected dose;
- duration of admission corresponds to the severity of the pathology;
- adequate combination of antibacterial agents.
In case of resistance to the main antibiotic, it is changed to the reserve one.
Colistin
This is an antibiotic of last resort, it is indicated when other antibacterial agents have no effect. Before using Colistin, a pathogenic bacterium is detected and tested for antibiotic sensitivity. The drug belongs to the group of polymyxins, and according to the chemical structure it is a cyclic polypeptide. The active substance is sodium colistimethate. Its bactericidal action is directed to gram-negative microorganisms. It disrupts the functions of the outer and cytoplasmic membranes, and also changes its structure. When taken orally, the drug is practically not absorbed in the gastrointestinal tract, it is excreted through the intestines. Used in the following dosage forms:
- Powder for solution for inhalation - indicated for the treatment of respiratory diseases of an infectious nature,
- Pills - treatment and prevention of gastrointestinal infections.
Antibiotic reserve "Colistin" works for ailments caused by microorganisms sensitive to its active substance. It has been proven to be highly effective in cystic fibrosis. In practice, the drug is rarely used to treat infections. One of the adverse effects is nephrotoxicity, i.e. toxic effects on the kidneys, causing their damage when administered to individuals with impaired renal function and damaged intestinal mucosa.
Features of the use of antibiotics included in the reserve
Antibiotics of the reserve group are inferior in one or more properties to the main ones, i.e. they have:
- rapid development of microbial resistance to them;
- little activity;
- many adverse events.
In connection with the above, they are indicated for intolerance or resistance of microorganisms to the main group of antibiotics.
To influence resistant strains of microorganisms, doctors recommend the following reserve medicines:
- Macrolides - Oleandomycin, Erythromycin.
- Combined - "Adimycin", "Sigmamycin", "Oletetrin", "Tetraolean".
Antimicrobials included in the reserve group used duringmedical practice
Below is a small list of reserve antibiotics.
- "Tetracycline" is prescribed in rare cases, as microbial resistance to it develops rather quickly. Therefore, it belongs to the reserve group and is indicated when other antibiotics are ineffective. The pharmaceutical industry produces both external and internal dosage forms of "Erythromycin". It is used in pathological conditions caused by staphylococcus aureus.
- "Levomycetin" refers to reserve funds in connection with serious adverse reactions - granulocytopenia, reticulocytopenia, aplastic anemia, ending in death. Thus, taking this antibiotic requires regular monitoring of the state of the hematopoietic system. To reduce the negative impact, it is prescribed for a short course of therapy. Repeated reception of "Levomitsetin" is not recommended. It is used to treat typhoid fever, brucellosis, and only in case of ineffective treatment with other antibacterial drugs.
- Gentamicin, Monomycin, Kanamycin, Neomycin are drugs of the aminoglycoside group with strong toxicity. Their reception is carried out under the strict supervision of a doctor and with the exception of contraindications for use in each individual.
- Vancomycin has the strongest ototoxicity.
Most often, "Gentamicin" is prescribed to fight a purulent infection. The drug "Monomycin" is only approved for the treatment of cutaneous leishmaniasis.
Reserve antibiotics:list
The antibiotics included in the reserve group include the following drugs. They are used only in a hospital setting:
- "Amicacin";
- Ceftazidime;
- Ciprofloxacin;
- Cefepim;
- Imipenem;
- Miropenem;
- Vancomycin;
- Rifampicin;
- "Amphotericin B".
Antibiotics used to treat cystitis
Fluoroquinolones of the following generations are the drugs of choice for the treatment of this disease:
- third - "Sparfloxacin", "Levofloxacin";
- fourth - Moxifloxacin.
These drugs are highly penetrating and create a fairly high concentration in the tissues. They are used once a day, since fluoroquinolone antibacterial agents have a long half-life. Prescribe medications in the maximum allowable daily dose. Due to the widespread use of fluoroquinolones in outpatient practice, there has been an increase in the resistance of urinary infection pathogens to them.
If there are contraindications to taking antibiotics of this group or obtaining data on resistance, the doctor corrects the treatment and recommends second-line drugs from the group of macrolides or tetracyclines, i.e. reserve antibiotics. With cystitis in a hospital setting, the duration of the course of treatment is from ten to fourteen days. In some cases, Meropenem, which belongs to carbapenems, is prescribed from the reserve group. The outcome of therapy is assessed bybacteriological culture of urine, as well as the normalization of the level of white blood cells in the urine.
Antibiotics for influenza and SARS
Can I take reserve antibiotics for respiratory infections? The attending physician recommends antibacterial medicines for influenza, SARS after the first symptoms of pneumonia, sinusitis, tonsillitis, etc. are detected. The penicillin group is prescribed in the absence of an allergic reaction to them. With resistance to penicillins, preference is given to fluoroquinolones, and these are reserve drugs. Their reception is prohibited for children, pregnant and lactating women. Cephalosporins are recommended for various pathologies of the respiratory system. For the treatment of complications of acute respiratory viral infections, the drugs of choice are macrolides, which are also reserve drugs. Antibiotics for SARS should be prescribed only when:
- Deterioration of the patient's condition.
- Accession of a bacterial infection.
- Appearance of purulent discharge.
- High temperature that lasts more than three days.
In order to optimally select the appropriate antibiotic, an antimicrobial culture is done.
Conclusion
In order to prevent the development of resistant forms of bacteria, it is necessary to replace widely used antibacterial agents with new, rarely used and newly created ones. These medicines are called reserve antibiotics. One of the most important tasks is the creation of new drugs with a pronounced selective effect, which would have activity against resistant forms of microbes and haveminimum negative impact on the body of the individual.
