Appropriate, efficient, timely therapy of any IMP leads to a significantly higher frequency of symptomatic and bacteriological medicine and better prevention of re-information. Unfortunately, treatment can lead to antibiotic resistance to pathogens and comments bacteria and have harmful effects on intestinal and vaginal flora, so it is very important to consult a doctor immediately and select it properly.
Clinical recommendations for the treatment of acute uncomplicated cystitis
The American Society of Infectious Diseases (IDSA) in cooperation with the European Society of Microbiology and Infecting Diseases (ESCMID) published clinical recommendations for treatment with acute uncomplicated cystitis and petroleaphritis in 2011. years. This document became an invaluable reference in the IMP office. This manual speaks of important factors in choosing optimal treatment:
- the nature of urathatogen resistance;
- sensitivity of urinatogenic bacteria on antimicrobial medicines;
- Possibility of side effects of antimicrobial remedies.
As for sensitivity, two important facts are recorded in this leader:
- The stability of urathogenogen in antibiotics has increased in recent years;
- The nature of resistance shows significant geographical variability between countries, and even regions.
Therefore, the recommendations are periodically revised due to the continued development of resistance, new tools development and the implementation of research depicting the superiority and inefficiency of medicines. According to both recommendations and research, they are best meeting with drug requirements for treatment of uncomplicated cystitis, the following substances:
- phosphomycin;
- Nitrofurantin.
The following selection criteria used: pharmacokinetics, interactions, probability of hitting (the probability that microorganism is sensitive to antibiotics), resistance development, specific use, dosing frequency, costs.
The study included the following medications: amoxicillin (with or without clavulantic acid), nitrophrantine, sulfamethyl, trimoprim, co-trimoxazole, ciprofloxacin, norfloxacin, ofloxacin and phosphomycin trometamol.
Characterization of the first line of treatment of the inferrement of the lower urinary tract
Table 1. First row to treat cystitis
| Substance | Dosage | Treatment duration |
| Phosphomycin trumetamol | 3 g one dose | One dose (once) |
| Nitrofurantin | 50-100 mg four times a day | 5-7 days |
Phosphomycin trumetamol
Phosphomycin was opened in 1969. as a representative of the new class of phosphantata antibiotics.
Active substance: phosphomycin. Release form: Granules for preparing solutions, packing 1 or 2 packs, dosing phosphomycin 3 g / bag, 2 g / bag.
Refers to the clinical and pharmacological group to Uroantiseptics, antibiotics (phosphonic acid derivatives).
Stock spectrum
Phosphomycin has a bactericid activity of a wide range of action in relation to:
- Staphylococci (Staphylococcus spp. );
- Enterococci (Enerecoccus spp. );
- Hemophilus spp;
- Most intestinal grams-negative bacteria, including 95, 5% E. coli, producing β-lactamases of expanded spectrum (BLRS);
- E. Coli strains produce metal-β-lactamases sensitive to phosphomycin;
- Citrobacter spp. ;
- Enterobacter spp. ;
- Klebsiella spp. , Plebsella pneumoniae;
- Morganella Morganii;
- Proteus Mirabilis;
- Pseudomonas spp. ;
- Serratia spp.
Drug trait
- Trometamol phosphomycin is prescribed exclusively for the treatment of acute uncomplicated cystitis in the form of a single dose of 3 g, not prescribed for drinkingFrites.
- It is best absorbed if you take it before eating.
- Reaches a high concentration in urine and retains a high level for more than 24 hours.
In several studies, the clinical and microbiological efficiency of phosphomycin with other antimicrials of the first row with uncomplicated cystitis are compared. The clinical effectiveness of a dose (3 g) phosphomycin is 91% (revolution of 91% of patients). The indicator is comparable to nitrofurantoin (93%), trimeter-sulfamethoxolitis (93%) and fluoroquinolone (90%) in an acute noncomplicone cystitis.
Advantages of phosphomycin treatment
The microbiological level of phosphomycin cure (80%) is lower than comparable antibiotics by 88-94%. However, recent metalysis 27 studies did not reveal the differences in efficiency between phosphomycin and other antibiotics to treat cystitis and the following facts revealed:
- Phosphomycin causes significantly less harmful reactions, which is most important - including in pregnant women.
- Additional benefit is to treat more -resistant microorganisms. Several studies in Vitro showed that phosphomycin is active in relation to staphylococci resisting the staphylococular resistant, and gram-negative sticks produced by Blrs.
- Effectively in the treatment of IMP caused by K. pneumoniae. Enterobacteriaceae production of carbapenemas (in doses of 3 g, repeat every 48-72 hours).
- It has a minimum side effect on the body. This is marked with a high case frequency of E. Coli in regions with frequent use of phosphomycin with uncomplicated cystitis in women;
- Benefit of one dose mode.
Indications
- Acute cystitis (bacterial origin);
- deterioration of repetitive cystitis (bacterial origin);
- urethritis (bacterial nonspecific);
- Pregnant Bacteria asymptomatic;
- IMP after operations;
- Imp prevention.
Dosage and method of application
| Treatment of simple acute cystitis | Repeating / heavy forms of IMP | Imp prevention |
| Adults - 3, 0 g (1 pack) Once
Children (out of 5 years) - 2, 0 g Once |
Adults - 3, 0 g twice, second reception after 24 hours | First Technique: 3, 0 g 3 hours before the process / diagnostic procedure
Second trick: 3, 0 g 24 hours after the primary |
Recommendations for use
- Follow all instructions on the label.
- Phosphomycin is usually prescribed only in one dose.
- Do not take in large / smaller quantities or longer if it does not prescribe a doctor.
- Can be used simultaneously / after eating.
- Phosphomycin is a cure for powder, before use, must be diluted with water. Do not take dry powder without adding water.
- Melt a bag of 1/2 cup of cold water, mix and drink immediately. You can add a little more water in the same glass, to shake carefully and drink immediately to ensure a complete dose.
- Don't stir with warm water.
- It's good to take overnight. There will be a longer break between urination, which will ensure longer the presence of the medicine in the bladder and a more efficient effect.
- Store at room temperature away from moisture and heat in the original packaging.
Other instructions:
- Symptoms cannot completely pass immediately, after 2-3 days;
- Urologist needs to be contacted if symptoms do not disappear within 3 days after treatment, fever or other new complaints will appear;
- Before applying the patient, it is recommended to counseling with a doctor to check that phosphomycin is a suitable antibiotic for treatment. In addition, urine analysis can be needed before and after taking this medicine.
Contraindications:
- Children under 5 years of age;
- allergic reactions to components;
- Heavy kidney failure.
General side effects:
- Nausea, stomach disorder, light diarrhea;
- headache, dizziness;
- Itching or vaginal discharge (rarely).
Medication interaction
Simultaneous entry with metaphlopramide is not recommended to avoid weakening phosphomycin action.
Thus, the convenience of a dose regimen, in vitro activities in relation to resistant gram -negative sticks that cause simple and immature, uncomplicated cystitis, And the minimum tendency of lateral damage makes phosphomycin with a useful choice in the treatment of lower MVP infections (CISTITIS, URETRITIS).
Nitrofurantin
Active substance: Nitrofurantin. Release form: Tablets, dosage 100 mg, 50 mg.
Refers to the clinical and pharmacological group to Uroantiseptics, antimicrials.
Nitrofurantin, relating to a group of synthetic nitrofuran, was originally presented in the form of a microcystal form. In 1967. the form of macrocristal with improved gastrointestinal tolerance became available.
There are currently two main types of NitroFrantin: macrocristal shape and mixtures of microcrystalline and macrocristal shapes (25 mg macrocristal plus 75 mg monohydrates). Mixed species in a patented double delivery system, in the Russian Federation are not registered and are not in circulation.
Mechanism of action
Nitrofrantin's bacterial activity mechanisms include several websites:
- Inhibiting ribosomal broadcasting;
- Damage to bacterial DNA;
- Intervention in the Crebs cycle.
Nitrofurantin is active in relation to:
- More than 90% of intestinal strains causing imp;
- Enterecoccus, including resistant to vancrycin;
- Klebsiella spp. ;
- Proteus spp. ;
- Staphylococci (gold and saprophytic) are usually sensitive.
The drug resistance is rare, probably due to several areas of medicine. However, Proteus, Serratia and Pseudomonas have natural resistance to nitrofurantoin.
Nitrofurantino can also be an additional option for oral antimicrobial treatment with acute uncomplicated cystitis caused by bacteria produced by BLRs.
Pharmacokinetics. Absorption improves when eating. Nitrofrantine concentrations in serum are low or not defined on standard doses, the prostate content is not detected. It is excreted mainly with urine, where the concentration of the drug (from 50 to 250 mg / ml) easily exceeds 32 mg / ml mpc.
Nitrofurantin should not be prescribed by patients with the pronounced renal failure (creatinine cleanliness<60 m / min), but studies noticed the high efficiency of the drug in patients with creatin clearance of 60-30 ml / min.
Safe for use in pregnant women and children.
Indications: Treatment and prevention of cystitis (bacterial origin).
Dosage. It prescribes by urologist individually based on the severity of the state, duration and severity of symptoms.
Common dose for adults with cystitis:
- From 50 to 100 mg orally 4 times a day for 1 week or at least 3 days after the Urine Sterility arrives. Common dose for adults for cystitis prevention:
- From 50 to 100 mg orally once a day before bed. Children's dose to treat cystitis:
- 1 month and older: 5-7 mg / kg / day (up to 400 mg / day) orally in 4 doses. Common children's dose for cystitis prevention:
- 1 month and older: from 1 to 2 mg / kg / day (up to 100 mg / day) orally in 1-2 receptions.
Most experts agree with the recommendation of the 5-day cure for the treatment of acute uncomplicated cystitis. Studies showed the frequency of early clinical medicine with nitrofurantoin from 79% to 95%, and the frequency of microbiological medicine from 79 to 92%. In the aggregate of the study of clinical efficiencies, they point to the general equivalence of nitrofurantoin, prescribed 5 or 7 days, and trimetro-sulfametoxazola (beads), cyprofloxacin and one dose of Trometamol phosphomycin (monopara). However, the speed of a microbiological drug has constantly shown a slightly more favorable effect for comparing medications.
Recommendations to patients
- It is necessary to follow all doctors' recipes and instructions in medicine instructions.
- Do not use in large or smaller quantities or longer than recommended.
- It is better to take nitrophrantin with food (growth of bioavailability).
- It is recommended to observe the reception during the entire prescribed period. Symptoms can pass before, but treatment cannot be stopped while the infection is completely eliminated. Doses can increase the risk of further development of antibiotic resistant infection and relapse risk.
- Nitrofurantin does not treat viral infections, for example, cold or flu.
Side effect
General side effects:
- headache, dizziness;
- Gas formation, stomach disorder;
- light diarrhea;
- Itching or vaginal discharge.
They are very often found:
- water or bloody diarrhea;
- sudden pain or discomfort in chest, whistling breathing, dry cough;
- difficulty breathing;
- fever, coldness, body pain, fatigue, inexplicable weight loss;
- stiffness, tingling or pain in hands or legs;
- Problems with liver - nausea, pain in the upper part of the stomach, itchy, feeling fatigue, loss of appetite, dark urine, chair clay or eye);
- Lupid-similar syndrome - articulated pain or edema with fever, swollen glands, muscle pain, chest pain, vomit, unusual thoughts or behavior.
Serious side effects can be more likely in older people, long or weakened people.
Contraindications:
- serious disorders of the excrete kidney function;
- Kidney stop;
- Oliguria;
- Glucose-6-phosphate dehydrogenous malfunction;
- pregnancy;
- Age up to 1 month;
- allergic reactions to components;
- XN II-III phase;
- cirrhosis;
- Chronic hepatitis;
- acute porphyria;
- Lactation.
Application in pregnancy
Category of drugs in relation to pregnancy: in (according to the FDA - the US health agency). It is believed that this medicine will not harm the unborn child in the early stages of pregnancy. In the last 2-4 weeks of pregnancy, it is contraindicated.
Nitrofurantin is able to penetrate breast milk, during breastfeeding is not prescribed.
SPECIAL INSTRUCTIONS
- The risk of peripheral neuropathy increases in the presence of anemia, diabetes of melitus, severe terms, breach of electrolyte balance, lack of vitamin group B.
- Nitrofurantin is not used to treat prostatitis, lesions of the cortical substance of the kidneys, pure paranephritis. With pyelonephritis, they are not prescribed due to inefficiency.
- Nitrofurantin can give unusual results with certain laboratory glucose (sugar) in urine.
Medication interaction
- With fluoroquinolons are incompatible.
- Antacids based on magnesium triliques, gastyx acids while taking antimicrobial activity of nitrofrantin.
- The secretion of the channel that blocks the channel secretion is not prescribed, as the NitroFrantin's toxicity (blood increase) reduces bactericid properties (urine content is reduced).
Nitrofurantin is considered a first-order therapeutic drug in an acute uncomplicated cystitis due to:
- Efficiency of a 5-day course;
- Small risk of side effects and damage to the normal flora person;
- Minimum resistance of bacteria;
- Efficiency comparables with other antimicrobial drugs.