The corresponding, effective and timely therapy of any IMP leads to a significantly higher frequency of symptomatic and bacteriological treatment and better prevention of reinfection. Unfortunately, the treatment can lead to antibiotics resistance to pathogens and comments bacteria and have negative effects on the intestinal and vaginal flora, so it is very important to immediately consult a doctor and choose it correctly.
Clinical recommendations for the treatment of simple acute cystitis
The American Society of Infectious Disease Specialists (Idsa) in collaboration with the European Society of Microbiology and Infectious Diseases (ESCMID) has published clinical recommendations for treatment with acute cystitis and Pyelonefrite in 2011. This document has become an invaluable reference in the Employment Office. This manual discuss important factors in choosing optimal treatment:
- the nature of the resistance of uropathogens;
- sensitivity of urepathogenic bacteria to antimicrobial drugs;
- The possibility of side effects of antimicrobial drugs.
As for sensitivity, two important events are noted in this leadership:
- The stability of uropathogens to antibiotics has increased in recent years;
- The nature of the resistance demonstrates a significant geographical variability between countries and even regions.
Therefore, the recommendations periodically review due to the constant development of the resistance, the development of new tools and the conduct of research that show the superiority and inefficiency of the drugs. Second and Recommendations and Research, the requirements for drugs for the treatment of simple cystitis, the following substances:
- phosphomycin;
- nitrofurantina.
The following selection criteria have been used: pharmacokinetics, interaction, probability of affecting (the probability that the microorganism is sensitive to antibiotics), the development of the resistance, the specific use for IMP, the effectiveness, the side effects, the frequency of dosage, the duration of the treatment, the cost.
The study included the following drugs: amoxicillin (with or without clavulanic acid), nitrofurantine, sulfametiizol, trometoproime, co-triimoxazole, ciprofloxacin, norfloxacin, offloxacin and phosphomycin trometamol.
Characterization of the first line of treatment of infections of the lower urinary tract
Table 1. First line for the treatment of cystitis
| Substance | Dosage | The duration of the treatment |
| Phosphomycin Trometamol | 3 g a single dose | A single dose (once) |
| Nitrofurantina | 50-100 mg four times a day | 5-7 days |
Phosphomycin Trometamol
Phosphomycin was opened in 1969 as a representative of the new dealer antibiotics class.
Active substance: phosphomycin. Release shape: granules for the preparation of the solution, in packaging 1 or 2 packages, phosphomycin dosage 3 g/bag, 2 g/bag.
It refers to the clinical and agricultural group to the Uroanti, to antibiotics (derivative of the phonfonico acid).
Spectrum of action
Phosphomycin has a bactericidal activity of a broad spectrum of action in relation to:
- Stafilococci (Staphylococcus spp. );
- Enterococchi (Enterococcus spp. );
- Haemophilus spp;
- Most intestinal gram-negative bacteria, including 95, 5% of E. coli, which produce β-lactamases of the expanded spectrum (Blrs);
- E. coli strains that produce metal-β-lactamase sensitive to phosphomycin;
- Citrobacter spp. ;
- Enterobacter spp. ;
- Klebsiella spp. , Klebsiella Pneumoniae;
- Morganella Morganii;
- Proteus Mirabilis;
- Pseudomonas spp. ;
- Serratia spp.
The peculiarity of the drug
- Trometamol phosphomycin is prescribed exclusively for the treatment of simple acute cystitis in the form of a single dose of 3 g and not prescribed for Pylonefrite.
- It is better absorbed if you take it before eating.
- It reaches a high concentration in the urine and maintains a high level for more than 24 hours.
In several studies, the clinical and microbiological effectiveness of phosphomycin with other antimicrobials of the first line with simple cystitis has been compared. The clinical efficiency of a dose (3 g) of phosphomycin is 91% (the treatment occurs in 91% of patients). The indicator is comparable to nitrofurantaine (93%), to the trimetrome-solfametoxazole (93%) and fluorochinolons (90%) in the acute cystitis without complications.
Advantages of phosphomycin treatment
The microbiological level of the phosphomycin of treatment (80%) is lower than that of comparable antibiotics of 88-94%. However, a recent destination -analysis of 27 studies did not reveal the differences in the effectiveness between phosphomycin and other antibiotics for the treatment of cystitis and discovered the following facts:
- Phosphomycin causes significantly less adverse reactions, which is the most important, even in pregnant women.
- A further advantage is to treat multi -resistant microorganisms. Numerous studies on Vitro have shown that phosphomycin is active in relation to the Aureus staphylococcus and gram-negative sticks that produce Blr.
- Effective in the treatment of the EMP caused by K. Pneumoniae. Enterabacteriaceae that produces CarbapeneMasi (in doses of 3 g, repeat every 48-72 hours).
- It has a minimum side effect on the body. This is indicated by the high frequency of the susceptibility of E. coli in the regions with frequent use of phosphomycin with simple cystitis in women;
- Convenience of a single dose mode.
Indications
- acute cystitis (bacterial origin);
- exacerbation of the recurring cystitis (bacterial origin);
- urethritis (non -specific bacterial);
- Bacteria of women in asymptomatic pregnancy;
- IMP after the operations;
- Prevention of the Emp.
Dosage and method of application
| Treatment of simple acute cystitis | Recurring/heavy forms of imp | Prevention of the EMP |
| Adults - 3, 0 g (1 package) once
Children (for 5 years) - 2, 0 g once |
Adults - 3, 0 g twice, the second reception after 24 hours | First technique: 3, 0 g 3 hours before the diagnostic operation/procedure
Second trick: 3, 0 g 24 hours after the primary |
Recommendations for use
- Follow all the instructions on the label.
- Phosphomycin is generally prescribed only in a dose.
- Do not take large/smaller quantities or longer if it is not prescribed by a doctor.
- It can be used simultaneously/after eating.
- Phosphomycin is a drug powder, before use must be diluted with water. Don't 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 more water to the same glass, shake with care and drink immediately to ensure a complete dosage.
- Don't mix with hot water.
- It's nice to take it overnight. There will be a longer break between urination, which will guarantee a longer presence of the drug in the bladder and a more effective effect.
- Store at room temperature far from humidity and heat in the original packaging.
Other instructions:
- Symptoms cannot pass completely 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 complaints will appear;
- Before applying the patient, it is recommended to consult a doctor to make sure that phosphomycin is an antibiotic suitable for treatment. In addition, urine analysis may be requested before and after taking this medicine.
Contraindications:
- Children under the age of 5;
- Allergic reactions to the components;
- Severe renal failure.
General side effects:
- nausea, stomach disorder, light diarrhea;
- headache, dizziness;
- Itching or vaginal exhaust (rarely).
Pharmacological interaction
Simultaneous intake with meteclopramide is not recommended to avoid weakening the action of phosphomycin.
Therefore, the convenience of a single -dose regime, in vitro activities in relation to sticks resistant to the gram that cause both simple and immature cystitis and simple, And the minimum tendency to lateral damage makes phosphomycin a useful choice in the treatment of infections of the lower MVP (cystitis, urethritis).
Nitrofurantina
Active substance: nitrofurantina. Release form: tablets, dosage 100 mg, 50 mg.
It refers on the basis of the clinical and agricultural group to the uroantifini, to the antimicrobials.
The nitrofurantina, related to the synthetic nitrofurns group, was originally presented in the form of a microcrystalline form. In 1967 the form of macrocrystalline with a better gastrointestinal tolerance became available.
Currently, there are two main types of nitrofurantina: a macrocrystalline shape and a mixture of microcrystalline and macrocrystalline shapes (25 mg of macrocrystals plus 75 mg of monohydrate). The mixed species in the patented double delivery system in the Russian Federation are not recorded and are not in circulation.
The mechanism of action
The mechanisms of bacterial activity of nitrofurantina include several sites:
- inhibition of the rebuzomial transmission;
- damage to bacterial DNA;
- Intervention in the Crebs cycle.
Nitrofurantina is active in relation to:
- over 90% of the intestinal strains that cause the imp;
- Enterococcus, including vancromic resistant;
- Klebsiella spp. ;
- Proteus spp. ;
- Staphylococci (golden and saprophytes) are generally sensitive.
The drug resistance is rare, probably due to more areas of the drug. However, Proteus, Serratia and Pseudomonas have a natural resistance to nitrofurantaine.
Nitrofurantino can also be an additional option for oral antimicrobial treatment of uncomplicated acute cystitis caused by bacteria that produce Blr.
Pharmacokinetics. Absorption improves when eating. The concentrations of nitrofurantina in the serum are low or are not defined at standard doses, the content of the prostate gland is not detected. It is mainly excreted with urine, in which the concentration of the drug (from 50 to 250 mg/ml) easily exceeds 32 mg/ml of MPC.
Nitrofurantina should not be prescribed to patients with pronounced renal failure (creatinine clearance<60 m/min), but the studies have observed a high efficiency of the drug in patients with creatinine clearance of 60-30 ml/min.
Safe for use in women and children in pregnancy.
Indications: Cystitis treatment and prevention (bacterial origin).
Dosage. It is prescribed by a urologist individually based on the gravity of the state, the duration and gravity of the symptoms.
The usual dose for adults with cystitis:
- From 50 to 100 mg orally 4 times a day for 1 week or for at least 3 days after the sterility of the urine. The usual dose for adults for cystitis prevention:
- From 50 to 100 mg orally once a day before bedtime. Dosage of children for the treatment of cystitis:
- 1 month and more: 5–7 mg/kg/day (up to 400 mg/day) orally in 4 doses. The usual dose of children for cystitis prevention:
- 1 month and more: from 1 to 2 mg/kg/day (up to 100 mg/day) orally in 1-2.
Most experts agree with the recommendation of a 5 -day drug of the drug for the treatment of simple acute cystitis. Studies showed the frequency of early clinical care with Nitrofurantaine from 79% to 95% and the frequency of microbiological care from 79 to 92%. In the aggregate of the study of clinical effectiveness, they indicate the general equivalence between nitrofurantaine, prescribed for 5 or 7 days and trimetrome-solfametoxazole (pearls), ciprofloxacin and a single dose of trometamol phosphomycin (Monurale). However, the speed of microbiological care has constantly demonstrated a slightly more favorable effect for comparison drugs.
Recommendations to patients
- It 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 quantities or longer than recommended.
- It is better to take nitrofurantina with food (increases in bioavailability).
- It is recommended to observe the reception during the entire prescribed period. Symptoms can pass first, but the treatment cannot be stopped while the infection is completely eliminated. The doses can increase the risk of further development of antibiotic resistant infections and the risk of recurrence.
- Nitrofurantina does not treat viral infections, for example a cold or influence.
Side effect
General side effects:
- headache, dizziness;
- Gas formation, stomach disorder;
- light diarrhea;
- Itching or vaginal exhaust.
Much less often they are:
- Watery or bloody diarrhea;
- Sudden pain or discomfort in the chest, whistle breathing, dry cough;
- difficulty in breathing;
- Fever, chills, pain in the body, fatigue, inexplicable weight loss;
- numbness, 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, clay feces, jaundice (yellowing of the skin or eye);
- The syndrome similar to Lupid - joint pain or edema with fever, swollen glands, muscle pain, chest pain, vomiting, thoughts or unusual behaviors, rashes.
The serious side effects can be more likely in the elderly, in the long term or weakened.
Contraindications:
- serious disorders of the excretory function of the kidneys;
- renal failure;
- Oliguria;
- insufficiency of glucose-6-phosphate dehydrogenase;
- pregnancy;
- age up to 1 month;
- Allergic reactions to the components;
- Xn II-III Stages;
- cirrhosis;
- chronic hepatitis;
- acute porphyria;
- lactation.
Pregnancy application
The category of the drug in relation to pregnancy: in (according to the FDA - US Health Agency). It is believed that this medicine will not damage a child not yet born in the early stages of pregnancy. In the last 2-4 weeks of pregnancy, it is contraindicated.
Nitrofurantina is able to penetrate breast milk, during breastfeeding it is not prescribed.
Special instructions
- The risk of peripheral neuropathy increases in the presence of anemia, diabetes mellitus, serious Monday, violation of the balance of electrolytes, lack of vitamins of group B.
- Nitrofurantina is not used for the treatment of prostatitis, injuries of the cortical substance of the kidneys, purulent paranephritis. With Pylonefrite, they are not prescribed due to inefficiency.
- Nitrofurantina can give unusual results with certain laboratory glucose (sugar) in the urine.
Pharmacological interaction
- With fluorochinolons it is incompatible.
- Anacids based on the magnesium of clover, Nastyx acid during the antimicrobial activity of nitrofurantina.
- The secretion of the channel that blocks the secretion of the channel is not prescribed, since they increase the toxicity of nitrofurantina (increases the blood content), reduce bactericidal properties (the content in the urine is reduced).
Nitrofurantina is considered the therapeutic remedy of the first not complicated acute cystitis line 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 drugs.