Among medicines, antibiotics of the latest generation, active against many microbes, occupy an important place. They are used to treat infectious pathologies, which significantly reduced the mortality of patients from pneumonia and pyelonephritis, which are common today. Due to antibiotics, the course is facilitated and recovery from bronchitis, sinusitis is accelerated, and it has also become possible to perform complex surgical operations. Even wound infections are successfully treated with antibiotics.
Broad Spectrum Antibiotics (ABSS)
This category of antimicrobials includes substances active against Gram-negative and Gram-positive organisms. The former are the causative agents of intestinal diseases, inflammatory pathologies of the genitourinary and respiratory systems. Gram-positive organisms often cause wound infections and mediate the occurrence of postoperative complications in surgery.
List of ABSS Miscellaneousrelease date
Some of the latest generation of broad-spectrum antibiotics are also active against protozoal infections. Examples are nitroimidazole derivatives - tinidazole, ornidazole and metronidazole. The most widely used metronidazole due to affordability. Its class analogue, tinidazole, is similar in its spectrum of antimicrobial activity, but is not used parenterally. In general, all groups of broad-spectrum antibiotics are presented as follows:
- natural penicillins;
- inhibitorprotected aminopenicillins;
- antipseudomonal penicillins, including inhibitor-protected ones;
- III generation cephalosporins, IV generation cephalosporins;
- aminoglycoside group;
- tetracycline antibiotics;
- macrolide antibiotics;
- antibiotics of a number of carbapenems;
- chloramphenicol;
- fosfomycin;
- rifampicin;
- dioxidine;
- sulfonamides;
- quinolones, fluoroquinolones;
- nitrofuran group;
- antibiotics of the nitroimidazole series.
This list does not include group names for narrow-spectrum antibiotics. They are specific to a small number of microbes and are effective against them. Narrow-spectrum drugs cannot be used to treat superinfections and are not used empirically. They are used as first-line antibiotics when the type of pathogen is established.
List of latest generations of ABSS
The above antimicrobialsare broad spectrum drugs. This is a complete list of groups of substances with activity against gram-positive and gram-negative microbes. However, the list contains both the latest generation antibiotics and earlier representatives of the group. Of the above representatives of the latest generations are the following groups of drugs:
- aminopenicillins resistant to beta-lactamase ("Sulbactam", "Ampicillin", "Clavulanate", "Amoxicillin");
- III and IV generation cephalosporins ("Cefotaxime", "Cefoperazone", "Ceftazidime", "Ceftriaxone", "Cefpirome", "Cefepime");
- 3rd generation aminoglycoside antibiotics ("Amicacin", "Netilmicin");
- 14- and 15-membered semi-synthetic macrolides ("Roxithromycin", "Clarithromycin", "Azithromycin");
- 16-mer natural macrolide antibiotics ("Midecamycin");
- III and IV generation fluoroquinolones (Levofloxacin, Sparfloxacin, Gatifloxacin, Trovafloxacin, Moxifloxacin);
- carbapenems ("Meropenem", "Imipinem-cilastatin", "Ertapenem");
- nitrofurans ("Nitrofurantoin", "Furazidin", "Ersefuril").
Antibiotics delisted
Previously protectedantipseudomonal penicillins have a wide spectrum of activity, however, they are used only against Pseudomonas aeruginosa due to the need to reduce the probable contact of the latter with a modern and powerful antibiotic. This prevents the risk of developing drug resistance in bacteria. The greatest effectiveness against Pseudomonas aeruginosa shows "Tazobactam". Occasionally, "Piperacillin" or "Clavulanate" are used as the latest generation of antibiotics for pneumonia caused by a hospital strain of the pathogen.
Also in this list there are no antibiotics of the latest generation of the group of natural and anti-staphylococcal penicillins. The former cannot be used in outpatient treatment due to the need for frequent intravenous or intramuscular administration. Forms that allow you to take them orally, do not exist. A similar situation has developed with cephalosporins. Having the same spectrum of activity as penicillins, they cannot be administered orally due to destruction in the stomach.
Cephalosporins and parenteral penicillins are the latest generation of effective antibiotics for pneumonia. Scientists of the National Academy of Sciences of the Republic of Belarus have achieved success in developing a dosage form for their enteral use. However, the results of studies have not yet been applied in practice, and drugs of this series can be used so far only in the work of inpatient he althcare facilities.
Highly effective antibiotics for children
Exploring the latest generation of antibiotics, a listdrugs recommended for children is significantly narrowed. In childhood, only representatives of a number of aminopenicillins (Amoxicillin, Clavulanate), cephalosporins (Ceftriaxone, Cefepime), macrolides (Azithromycin, Midecamycin, Roxithromycin, Clarithromycin) can be used. Fluoroquinolone antibiotics, carbapenems and nitrofurans cannot be used due to bone growth inhibition, liver and kidney toxicity.
Systemic nitrofurans are not used due to the lack of scientific data confirming the safety of the treatment. The only exception is "Furacillin", suitable for local treatment of wounds. Modern and highly effective antibiotics for children of the latest generation are as follows: macrolides, penicillins, cephalosporins (the names of the drugs are presented above). Other groups of antimicrobials are not recommended for use due to toxic effects and impaired skeletal development.
ABS for pregnant women
According to the classification of the FDA (USA), only some of the latest generation antibiotics can be used in the treatment of pregnant women, the list of which is extremely small. They are classified as Category A and B, meaning they have not been proven to be dangerous or have no teratogenic effects in animal studies.
Substances with unproven effects on the fetus, as well as with the presence of a toxic effect, can only be used if the therapeutic effect prevails overby-products (Category C and D). Category X drugs have a proven teratogenic effect on the fetus, therefore, if necessary, their use must be terminated.
During pregnancy, the following broad-spectrum antibiotics of the latest generation in tablets are used: protected aminopenicillins ("Amoclav", "Amoxiclav"), cephalosporins ("Cefazolin", "Ceftriaxone", "Cefepim"). Macrolides ("Azithromycin", "Clarithromycin", "Midecamycin", "Roxithromycin") are allowed to be used in the third trimester of gestation due to the fact that their teratogenic effect has not yet been fully studied, and one cannot speak unambiguously about its absence. It is also safe for pregnant women to use penicillin antibiotics in the absence of allergies.
The use of antibiotics in the treatment of bronchitis
All the latest generation broad-spectrum antibiotics can theoretically be used for bronchitis and pneumonia if their pharmacodynamic characteristics are optimal for this. However, there are optimal schemes for the rational treatment of such diseases. They consider options for successful combinations of antimicrobials with the goal of broad coverage of microbial strains.
Nitrofurans, nitroimidazole derivatives and sulfonamides are not rational to use in inflammatory diseases of the respiratory system. The most successful combination for bronchitis or mild pneumonia is a protected aminopenicillin with a macrolide ("Amoclave" +"Azithromycin"). Protracted bronchitis require the appointment of a cephalosporin instead of aminopenicillin ("Ceftriaxone" + "Azithromycin"). In this scheme, the macrolide can be replaced with another class analogue: Midecamycin, Clarithromycin or Roxithromycin.
All of these latest generation antibiotics for bronchitis have a pronounced effect, although clinical signs of the disease may continue to be present. The criterion for the effectiveness of treatment is the appearance of a cough with gradually cleared sputum and relief of fever. With COPD, shortness of breath also decreases, appetite improves, and the frequency of coughing decreases.
Effective treatment of pneumonia
Mild pneumonia is treated like bronchitis, but with a cephalosporin and a macrolide. For moderate or severe community-acquired pneumonia, a cephalosporin (Ceftriaxone or Cefepime) is prescribed with a representative of a number of fluoroquinolones (Ciprofloxacin or Levofloxacin). These broad-spectrum antibiotics of the latest generation suppress the community microflora well, and the effect of their use is noticeable on the second day of treatment.
Modern antibiotics of the latest generation for pneumonia (the names are given above) act on the pathogen, suppressing its vital activity or killing it. The first substances are called bacteriostatics, and the second bactericidal preparations. Cephalosporins,aminopenicillins and fluoroquinolones are bactericidal substances, and macrolides are bacteriostatics. Moreover, the combination of antibiotics aims not only to expand the spectrum of activity, but also to comply with the rules of combination: one bactericidal drug with one bacteriostatic.
Treatment of severe pneumonia in the ICU
In intensive care, where there may be patients with severe pneumonia and distress syndrome on the background of intoxication. The main contribution to the severity of the condition of such patients is made by pathogenic microflora that is resistant to most antimicrobial drugs. In such situations, carbapenems are used ("Imipinem-cilastatin", "Tienam", "Meropenem"), which are unacceptable for use on an outpatient basis.
Treatment of sinusitis and sinusitis
Modern antibiotics of the latest generation for sinusitis or sinusitis are used to destroy microbes. In such cases, a single bactericidal antibiotic may be used. However, with sinusitis, the main difficulty is the access of the antimicrobial drug to the site of inflammation. Therefore, the most commonly used drug is the cephalosporin series. An example is "Ceftriaxone" or "Cefepime". A third-generation fluoroquinolone, Levofloxacin, may also be prescribed.
Treatment of angina with modern antimicrobial agents
Latest generation antibiotics for angina are prescribed for the same purpose. Moreover, both with sinusitis and tonsillitis, the same antimicrobial agents can be used. The only difference is that in the case of inflammationtonsils, you can also use antiseptics, for example, "Furacillin" - a drug of a number of nitrofurans. Although angina can also be successfully used aminopenicillins protected by sulbactam or clavulanic acid (Amoclave, Amoxiclav, Ospamox). Moreover, drugs should be prescribed for 10-14 days.
Therapy for pyelonephritis and infections of the genitourinary system
Due to the contamination of the urinary tract with microbes, antibiotics of the latest generation in pyelonephritis are necessary for their treatment. Cephalosporins, fluoroquinolones and nitrofurans have the greatest therapeutic value here. Cephalosporins are used for relatively mild pyelonephritis, and fluoroquinolones ("Ciprofloxacin", "Levofloxacin", "Ofloxacin", "Moxifloxacin") - when the condition worsens against the background of already ongoing therapy.
The most successful drug, suitable both for monotherapy and for combination with "Ceftriaxone", is any representative of a number of nitrofurans - "Furamag"). A quinolone, Nalidixic Acid, can also be used. The latter create high concentrations in the urine and act actively against pathogens of genitourinary infections. Also, occasionally, with gardnellosis and vaginal dysbacteriosis, "Metronidazole" is used.
Drug resistance and its impact
Due to the constant change in the geneticmaterial of microorganisms, mainly bacteria, the effectiveness of many antimicrobial is greatly reduced. By acquiring resistance to drugs, bacteria gain the ability to survive in the human body, mediating the deterioration of infectious diseases. This forces researchers to look for and put into practice new antibiotics of the latest generation.
In total, during the existence of antimicrobial agents, about 7,000 substances have already been developed that are used in medicine in a certain way. Some of them have been phased out due to clinically important side effects or because microbes have become resistant to them. Therefore, today about 160 drugs are used in medicine. About 20 of them are the latest generation of antibiotics, whose names often appear in medical guidelines for antimicrobial therapy of infectious diseases.
