The place of amoxicillin/clavulanate in treatment of community-acquired pneumonia

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Amoxicillin and pneumonia

Community-acquired pneumonia is a widespread infection, occupying an important place in the structure of morbidity and mortality of the population worldwide. Incidence of pneumonia in Europe is 2-15 per 1,000 persons per year . It rises to 25-44/1000 in old age and reaches 68-114/1000 in nursing home residents . In the United States, community-acquired pneumonia affects 4 million people annually. It is the cause of more than 1 mln. hospitalizations . There are also significant economic costs to society. For example, in the U.S. the annual cost of treatment is about $10 billion. per year .

The statistical average incidence of pneumonia is 10-15/1000 . The prevalence of community-acquired pneumonias among the elderly in Moscow is 17.4/1000 .

Pneumonias (including community-acquired pneumonias) are the 6th leading cause of death . Death rate from pneumonia continues to grow everywhere. In the United States, for example, between 1979 and 1994, the number of cases of pneumonia increased by 59%. it increased by 59% . To a considerable degree it is determined by the increase of elderly people’s share in the population structure. However, age-adjusted mortality also increased by 22%, indicating the role of other factors in the changing epidemiology of pneumonia .

A variety of microorganisms can act as etiological factors of community-acquired pneumonia (Table.). The main causative agent is Streptococcus pneumoniae, which accounts for approximately 15-35% of cases of. According to a meta-analysis of 122 publications from 1966 to 1995., pneumococcal pneumonias account for about 2/3 of all deaths in community-acquired pneumonia . Frequent pathogens also include Mycoplasma pneumoniae, Chlamydia pneumoniae, Haemophilus influenzae. Together with S. pneumoniae they cause over 60% of cases . Rarer etiological factors are chlamydiae, staphylococci, Klebsiella, enterobacteriaceae, and legionella . In certain situations and in a certain patient population, community-acquired pneumonia can also be caused by other microorganisms, such as anaerobes or viruses . Thus, anaerobes (Bacteroiodas, Prevotella и Fusobacterium) are often found in children with concomitant respiratory diseases – chronic tonsillitis and sinusitis, occurring in the elderly [11,12]. Approximately 50% of patients fail to establish the etiology of community-acquired pneumonia, even with intensive research. The reason for this is the lack of a test capable of identifying all potential pathogens, the limitations of each test separately, and the possibility of mixed infection, such as a combination of typical and atypical pathogens (M. pneumoniae, C. pneumoniae, Legionella spp.), occurring in 10–40% of cases .

In the vast majority of cases, treatment is started empirically. Its success is largely determined by the correct choice of antibiotic. One of the main requirements for an antimicrobial agent for initial therapy is sufficient breadth of action, covering common pathogens. Other important criteria for antibiotic selection include: efficacy and safety proven in adequate clinical trials; favorable pharmacokinetic properties; convenient mode of administration to ensure compliance with prescribed treatment; cost-effectiveness. Given the latter criterion, in severe and moderate forms of pneumonia, an important factor is the availability of drug forms for parenteral and enteral administration, which allows for a stepwise therapy. In many countries, due to high levels of antibiotic resistance S. pneumoniae, High activity against pneumococci is added to these criteria.

One of the most satisfying the above criteria of antibacterial agents is amoxicillin/clavulanate. In addition to a broad spectrum of antibacterial action, including common Gram-positive and Gram-negative pathogens of community-acquired pneumonia, it is active against microorganisms with acquired resistance due to the production of beta-lactamases (Klebsiella spp., staphylococci, M. catarrhalis, Haemophilus spp. и E. coli), anaerobes, and is superior to benzylpenicillin and ampicillin in activity against pneumococcus.

Amoxicillin/clavulanate has high bioavailability (90%) when administered orally, generates high concentrations in the lungs and pleural fluid, penetrates quickly into sputum and accumulates in the bronchial mucosa, and the content of both components of the drug significantly exceeds the concentration required to suppress the growth of most pathogens that cause respiratory tract infections, including beta-lactamase-producing strains H. influenzae и M. catarrhalis . The advantages of amoxicillin/clavulanate include the availability of dosage forms for oral administration and intravenous administration, which allows it to be successfully used for staggered therapy, thereby reducing the period of hospitalization and financial costs of treatment.

Amoxicillin/clavulanate is well tolerated. According to clinical trials, side effects are rare (8-14%), are mild and do not usually require discontinuation of treatment. When taken orally, they manifest themselves mainly in gastrointestinal. Their frequency is significantly reduced when the drug is taken with food. Allergic reactions (erythema, urticaria) are very rare.

High activity against pneumococci, Haemophilus influenzae and staphylococci, along with good tolerability, served as a reason for including amoxicillin/clavulanate in the majority of international and domestic standards for treatment of community-acquired pneumonia and bronchitis in adults and children. In clinical trials it is used as a standard reference drug in determining the effectiveness of new antibiotics in patients with bronchopulmonary diseases. Currently, amoxicillin/clavulanate is regarded as the leading drug in the treatment of community-acquired respiratory tract infections and as one of the most active antibiotics against S. pneumoniae, including strains with reduced sensitivity to penicillins .

Expert committees dealing with problems of management of community-acquired pneumonia in the context of the development of pneumococcal «epidemics», recommend amoxicillin/clavulanate as a first-line drug for adults and children [24,25]. The basis for this is, first, the results of experimental studies showing that the drug’s activity against S. pneumoniae with varying degrees of sensitivity to penicillin . According to a large collaborative international study (The Alexander Project) among a large number of studied antibiotics only amoxicillin/clavulanate and ceftriaxone created concentrations in blood serum and tissues needed to inhibit 90% of pathogens with moderate and high resistance to penicillin . Second, the activity of amoxicillin/clavulanate against resistant strains of S. pneumoniae can be increased by increasing the dose of the drug . Third, the results of randomized clinical trials suggest that amoxicillin/clavulanate is effective in approximately 90% of patients with pneumococcal pneumoniae, in t.ч. caused by penicillin- and cephalosporin-resistant strains of the microorganism . Fourth, data from large studies on antibiotic resistance also indicate that the level of resistance to S. pneumoniae to amoxicillin/clavulanate is significantly lower than to other antibiotics. Thus, in a study conducted in Spain – In a country that is home to penicillin-resistant clones S. pneumoniae , where the level of antibiotic resistance is highest, resistance to amoxicillin/clavulanate was 3.68%, while resistance to penicillin – 32.11%, azithromycin – 24.41%, cefpodoxime – 32.44%, cefuroxime – 34.11% and cefaclor – 69,9% . Similar results were obtained in a national multicenter prospective study in Portugal, in which 1,071 strains of S. pneumoniae, isolated in patients with community-acquired lower respiratory tract infections . Amoxicillin/clavulanate exhibited the highest activity in vitro among the antibiotics studied against S. pneumoniae, H. influenzae и M. catarrhalis.

According to experts, inhibitor-protected aminopenicillins, which include amoxicillin/clavulanate, are best suited for empirical antibacterial therapy of community-acquired pneumonia that requires hospitalization for the severity of the patient . Since they are not active against pathogens of atypical pneumonia (mycoplasmas, chlamydia, legionella), it is recommended to combine inhibitor-proof aminopenicillins with macrolides when the latter are suspected.

Amoxicillin/clavulanate is assigned a significant place by the scientific community of pulmonologists in practical recommendations for diagnosis, treatment and prevention of community-acquired pneumonia in adults . Oral medication is considered the drug of choice in the outpatient treatment of community-acquired pneumonia, both in patients with non-serious pneumonia under 60 years of age without comorbidities and over 60 years of age and/or with comorbidities. Hospitalized patients with community-acquired pneumonia are recommended intravenous drug administration or step therapy (intravenous administration followed by switch to oral administration when the condition stabilizes). When the patient is stable and the pneumonia is not severe, oral amoxicillin/clavulanate can be administered immediately. For severe pneumonia, the combination of intravenous amoxicillin/clavulanate with intravenous macrolide is recommended as the regimen of choice.

Amoxicillin/clavulanate is the drug of choice for the treatment of community-acquired lower respiratory tract infections in special clinical situations, including.ч. in patients with alcohol abuse, diabetes mellitus, destructive and abscessed, the potential pathogens of which are Enterobacteriaceae, S. aureus, K. pneumoniae and anaerobes . It is also recommended for patients with community-acquired pneumonia, running in the background of chronic obstructive pulmonary disease, etiological factors of which are H. influenzae, S. pneumoniae и M. catarrhalis, as well as with pneumonia developed with influenza and other viral infections. The results of a recent study have clearly demonstrated the rationality of amoxicillin/clavulanate for the treatment of anaerobic infections and related complications, such as lung abscess and necrotizing pneumonia . Amoxicillin/clavulanate are also among the drugs of choice for the treatment of pneumonia in individuals living in organized communities (nursing homes, orphanages, etc.).д.) .

Amoxicillin/clavulanate is FDA Category B for the risk of pregnancy, t.е. Studies in animals have not revealed any risk of adverse effects of the drug on the fetus . There are no reports of toxic effects of amoxicillin/clavulanate on the human fetus. Thus, it is not contraindicated for the treatment of community-acquired pneumonia in pregnant women.

Pharmacoeconomic data based on the results of randomized, double-blind studies involving a total of more than 2,000 patients indicate that amoxicillin/clavulanate is more cost-effective for lower respiratory tract infections than erythromycin, cefuroxime, ampicillin, and cefaclor .

Thus, despite the changing epidemiological situation, amoxicillin/clavulanate continues to be one of the most effective agents for treatment of community-acquired pneumonia in different categories of patients.

The use of amoxicillin in the treatment of upper respiratory tract diseases

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The review of the literature, devoted to the prevalence of etiopathogenetic mechanisms, clinical picture, methods of diagnostics and treatment of inflammatory diseases of ENT organs is presented – Acute rhinosinusitis and acute purulent otitis media. There is convincing evidence of the necessity of antibacterial therapy for these pathologies. It is emphasized that the drug of first choice for inflammatory diseases of ENT organs is a semi-synthetic antibiotic of aminopenicillin group – Amoxicillin, which holds its positions due to good tolerability, favorable safety profile, convenient regimen, the possibility of step therapy and low cost.

Acute respiratory viral infections (ARI) account for up to 90% of cases of infectious diseases. Temporary disability due to acute respiratory infections reaches 30% of total temporary disability. ARI can have a severe course and provoke life-threatening conditions, such as ENT-organ damage, pneumonia, myocarditis, especially in weakened patients and elderly patients.

According to modern epidemiological studies, rhinosinusitis occupies the leading position in the overall disease incidence in the USA and Western Europe. Rhinosinusitis has been shown to affect between 17 and 36% of patients who are hospitalized in otorhinolaryngology departments. Sinusitis accounts for an even larger proportion among outpatient upper respiratory tract diseases.

Rhinosinusitis is the most common chronic condition in the United States, according to the National Center for Disease Statistics. In Germany, between 7 and 10 million cases of acute or chronic sinusitis have been diagnosed each year over the last decade. Acute respiratory infections are complicated by bacterial rhinosinusitis in 0.5–2% of cases in adults and 5–10% of cases in children.

European Position Paperon Rhino sinusitis and Nasal Polyps (EPOS) of 2012. The following forms of rhinosinusitis are distinguished:

  • acute – duration not more than 12 weeks;
  • Chronic – Duration more than 12 weeks.

Classical signs of acute bacterial rhinosinusitis: increase in body temperature to subfebrile digits, purulent or mucopurulent nasal discharge, headaches in the perinasal projection, which persist for 3–4 days, or syndrome «double-sickening» (the appearance of the above symptoms after a passed viral rhinosinusitis, which lasted 5–6 days).

The most common pathogens of acute bacterial rhinosinusitis include Streptococcus pneumoniae and Haemophilus influenzae. In pathogenesis of acute bacterial rhinosinusitis the damage of perinasal sinus epithelium caused by cytotoxic action of viruses plays a major role, which as a rule leads to malfunctioning of epithelial cell cilia due to desquamation of surface layers of nasal cavity mucosa. This leads to inhibition of mucociliary clearance, which in turn creates favorable conditions for secondary bacterial infection with the formation of purulent exudate.

Another frequent complication in the practice of a general practitioner and otorhinolaryngologist is acute suppurative otitis media. It is now one of the most common childhood illnesses: about 71% of children have acute suppurative media otitis by the age of three. 95% of children have at least one episode of acute bacterial rhinosinusitis during the first 7 years of life. According to the Health Maintenance Organization, 48% of children have a single episode of perforative or nonperforative acute bacterial rhinosinusitis in the first six months of life or ≥2 cases in the first year of life. Increased incidence of exudative otitis media, including.ч. The following is an important indicator of the recurrent course of middle ear infections in children, which has been observed for several decades. In acute bacterial rhinosinusitis, the inflammatory process is not only in the tympanic cavity.

Antibiotics for pneumonia: the whole truth

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A hundred years ago, pneumonia was justifiably considered an extremely dangerous disease, because it often resulted in the death of the patient. The disease is still a threat today. But thanks to the advent of antibacterial drugs, its danger has been greatly reduced. When used properly as prescribed by a doctor, antibiotics ensure recovery and prevent complications of pneumonia. Conversely, uncontrolled use of these drugs can cause irreparable harm to a patient’s health.

What is pneumonia

A lung disease, mostly infectious, that affects the alveoli (the end sections of the lungs) and interferes with gas exchange at the lung level.

  • Chest pain
  • Cough with sputum
  • Fatigue
  • Shortness of breath, difficulty breathing
  • High fever

Symptoms occur in both mild and severe forms. This depends on the type of microorganism that caused the disease, the age of the patient and the general state of health. In adults who do not have serious pathologies, the disease runs easier. It is most dangerous for young children, the elderly, and people with weakened immune systems.

When pneumonia is suspected, laboratory tests of blood and sputum, chest X-ray. For a more detailed examination, a CT scan (computed tomography) of the lungs is used. If the diagnosis is confirmed, the doctor prescribes antibiotics. Their use is necessary to prevent further development of the infection and to prevent complications.

General principles of antibiotic therapy

Treatment begins as soon as the diagnosis is confirmed radiologically. Doctors use broad-spectrum antibiotics for therapy. After the exact determination of the microbial pathogen in the sputum, the treatment plan may be adjusted: the drug to which the identified microorganism is most sensitive is prescribed.

Also, replacement of one antibacterial agent with another is carried out if:

  • After taking the medication, no improvement occurs within 3 days.
  • Significant side effects have occurred from the use of a particular remedy.
  • The antibiotic is too toxic for a certain group of patients (children, pregnant women).

Decrease in fever, reduction of dyspnea, signs of intoxication, amount of sputum 72 hours after the start of treatment indicates the correct prescription of the drug.

Types of antibiotics for treating pneumonia

When prescribing drugs of this group, it is taken into account:

  • Type of pneumonia (cerebral pneumonia, aspiration pneumonia, focal pneumonia, prick pneumonia)
  • Age of the patient
  • The severity of the condition

New generation antibiotics are considered to be the most effective. They have the advantage of fast action on pathogens, fewer side effects, and better patient tolerance. Modern drugs have a long duration of action, so they are taken only 1-2 times a day. While 1st and 2nd generation antibacterials – Up to four.

Each group of antibacterials is effective against a specific type of pathogen. Thus, to combat pneumococci, the penicillin series is used. For pneumonia caused by chlamydia and mycoplasmas, prescribe macrolides, fluoroquinols. And cephalosporins destroy E. coli.

How the treatment is carried out

With a mild and moderate course of the disease, treatment at home is allowed. Therapy is carried out with antibiotics in tablets, capsules, in the form of suspension or syrup. In severe and complicated forms, injections are prescribed. If the disease is very severe, in the first days the drugs are administered intravenously, and later – intramuscular . And only after the condition improves, the patient is transferred to tablets. This change from one form of medicine to another is called «stepwise » course of treatment.

Antibacterials are prescribed for at least 7 days. Depending on the result of control radiological examination, then they are either cancelled or the treatment course is prescribed with the new antibiotics.

Antibiotics in the treatment of viral pneumonia

To treat viral pneumonia, completely different drugs are used than in the treatment of other forms of this disease. This is due to the fact that its causative agents are viruses that are not sensitive to antibacterial drugs. Therefore, their use is not only useless, but also dangerous. Using antibiotics incorrectly as prescribed causes the development of resistance in pathogenic bacteria. And when medications are really needed, they may not have the right effect. Antibiotics are used only if the pneumonia is mixed or if purulent complications develop.

Why antibiotics are ineffective

The decrease in the effectiveness of drugs is caused by:

  • Resistance of microorganisms to the particular drug prescribed for treatment
  • Frequent change of antibacterials, so that pathogenic microbes get used to them
  • Improperly chosen dosage

Most often such cases occur in patients who often self-medicate and take antibiotics without a doctor’s prescription.

Treatment of pneumonia cannot do without antibiotics. Today, it is the only effective measure to eliminate the microorganisms that caused the disease. But therapy should always be conducted under medical supervision. Self-administered and often improperly selected drugs, cause side effects, cause complications and extend the treatment period.

Antibiotics stop working: pneumonia and sepsis sets in. Antimicrobial resistance

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Polls show that about 35% of people believe that antibiotics kill viruses. Such drug ignorance costs lives: bacteria are becoming more and more resistant to medication. As a result, each year worldwide from antimicrobial resistance (antimicrobial resistance, resistance of bacteria to antibiotics — note. ed.) Approximately 700,000 people are dying.

Sepsis and Antimicrobial Resistance. Addiction of bacteria to antibiotics leads to both high mortality and economic decline.

Global losses due to antibiotic resistance were about $400 million of GDP in 2018, could rise to $8 trillion by 2050. Today 700,000 people around the world die each year from resistance, and from cancer — About 8 million 200 thousand. By 2050, the number of deaths from the effects of antimicrobial resistance will rise to 10 million per year.

Fewer and fewer new antibiotics appear on the market each year. Whereas in 1984 there were 18, in 1998 — 12, by 2012 that number had dropped to 4–5 per year.

Sepsis and pneumonia: prevention and treatment problems

As a result of increased antimicrobial resistance, the number of patients, such as pneumonia. In a severe case of the course of the disease occurs blood poisoning (sepsis), then saving the lives of patients — It takes several days.

In severe pneumonia, patients on IVH die in 64% of cases. To prevent sepsis it is necessary to administer antibiotics at least in the first four hours. Thus, if an antibiotic is administered in the first two to three hours, the lethality in sepsis increases one and a half times. If at the fifth or sixth hour of the disease, the mortality rate will already increase by half. The likelihood is minimal, of course, in the first hour of administering the drug.

While a number of bacteria were resistant to four groups of antibiotics in the 1980s, five were still effective. Lethality was in the order of 10–20%. From 2010 to the present time almost all antibiotic groups have become resistant to Klebsiella, except for three. As a result, patients infected with this bacterium had a fatality rate of 40–60%.

Antimicrobial resistance causes problems for clinics.

Among them — rapid spread of antimicrobial resistant bacteria by patients in the department, which significantly increases the risk of mortality of patients.

To change the situation, it is necessary to introduce the rational use of antibiotics and containment of resistance into the practice of medical organizations and programs.

Antibiotics in dentistry

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Antibiotics in dentistry are used to suppress pathogenic microflora in infectious-inflammatory processes of chronic nature, affecting the maxillofacial region of the head and oral cavity. Choosing antibiotics for periodontitis and other diseases, in order to avoid side effects, determining its dosage, method of administration and duration of treatment, consider the patient's somatic condition, his age, weight and features of the clinical picture.

Are antibiotics always effective? Dentistry – A branch of medicine dealing with foci of infections with anaerobic and aerobic pathogens of different groups, whose sensitivity to chemotherapeutic drugs varies. Because of this, it is advisable to use bactericidal (which destroys the cell membrane of the bacteria) and bacteriostatic (which inhibits their reproduction) drugs.

The action of antibiotics is different. They can accumulate in bone tissue («Tetracycline», «Lincomycin», «Metronidazole»), block the action of bacterial enzymes («Amoxiclav», «Amoxicillin»), disrupt the formation of the supporting polymer of the cell wall («Oxacillin»), disrupt protein synthesis («Azithromycin»).

According to the method of action on the pathological microflora there are three groups of antibiotics:

  • Penicillins in powders and tablets. The drug fights against strains of anaerobic, gram-negative and gram-positive bacteria. They can be administered to patients of any age, which greatly expands the range of patients. Prescribed in the treatment of periodontal process of inflammatory etiology.
  • Cephalosporins. A group of antibiotics with a different spectrum of action, including four generations of drugs. It is reasonable to prescribe the drug for therapeutic purposes (in periodontal and odontogenic pathologies) and prophylactic ones – Before traumatic volumetric surgery.
  • Monobactams Have narrow-spectrum antibacterial activity. It is reasonable to use the drug for treatment of infections caused by aerobic gram-negative flora.
  • Carbapenems. These drugs are not only used in dentistry: antibiotics have a broad spectrum of action and are prescribed for the treatment of severe nosocomial infections of soft and bone tissues with multiresistant and mixed microflora.

Antibiotics in dentistry are used to treat chronic and acute pathologies of purulent-inflammatory nature. The list of such diseases includes periostitis, phlegmons, maxillary sinusitis, osteomyelitis, abscesses, periodontitis. Antibiotic treatment is relevant for the prevention of complications. Prescribe the drug as a course before elective surgery in patients with diabetes mellitus, endocarditis, glomerulonephritis.

Antibiotics for periodontitis

Progressive destruction of the alveolar processes, bleeding and looseness of the gums, loose teeth, persistent dental plaque – These are the symptoms of periodontitis. Treatment – Antibiotics, vitamins, antiseptic drugs, physiotherapy, local remedies, diet. Such a comprehensive approach allows to avoid serious complications – loss of teeth.

The treatment process is corrected at neglected forms of pathology and at exacerbation. Purulent discharge from gingival pockets with mechanical action, gingival abscesses and fistulas, abnormal tooth mobility and displacement – is chronic periodontitis. Antibiotics and other medications in such a case can be injected, for example «Clindamycin», as well as locally for the oral cavity, preparations for a quick effect in the form of sprays and ointments (Lincomycin), applications.

Enlargement of lymph nodes, their painfulness on palpation – a sign of intoxication or microbial allergy, which, if untreated, can cause periodontitis. Treatment with antibiotics in this case is supplemented by biogenic stimulants and broad-spectrum antiseptics.

Antibiotics for periodontitis – The gold standard in dentistry. Just like antibiotics for periodontal disease, they effectively destroy the structure of pathogens, thereby relieving inflammation, relieving pain and other symptomatic manifestations.

Antibiotics after tooth extraction

One of the surgical procedures in dentistry – wisdom tooth extraction. Preoperative antibiotics are prescribed for prophylactic purposes for patients with glomerulonephritis, endocarditis, diabetes mellitus, immunocompromised. Prophylaxis is possible in case of planned extraction, which is performed in case of atypical position and mobility of the unit, in chronic cysts and periodontitis, in case of mechanical damage without the possibility of recovery after sanitation of the oral cavity.

Also prescribed antibiotic after tooth extraction, if the surgery was performed in an emergency. More often «Ciprofloxacin», What antibiotics to take after a tooth extraction – Is prescribed by the dentist, taking into account the specific microflora. The main indications for such an extraction – Acute purulent inflammatory diseases with localization on bone tissue, abscesses, lymphadenitis, phlegmon. Antibiotics are used during tooth extraction if the tooth is not subject to conservative treatment, including filling, due to extensive destruction and loss of its functionality.

Antibiotics are prescribed for extraction of the wisdom tooth, if the integrity of the bone or soft tissue was violated during the procedure, which can subsequently provoke an infection, inflammation, and the formation of a flush. Antibiotics after wisdom tooth extraction are prescribed for these complications:

  • Alveolitis. Develops on day 3-4 after surgery and is characterized by a dry grayish hole with a whitish plaque. The pathology is characterized by an unpleasant odor, soreness, swelling of the cheek, fever up to 38-39 °C.
  • Apical periodontitis. Periodontal inflammation of infectious, traumatic or medicamentous nature is treated in complex. It is necessary to provide outflow of exudate, prescribe broad-spectrum antibiotics, antiseptic treatment, canal filling.
  • Osteomyelitis. Purulent-necrotic process caused by pyogenic bacteria and mycobacteria. Hospitalization is necessary for this pathology. How and which antibiotics to take after tooth extraction for this pathology will be prescribed by the lead doctor.

What antibiotics are needed for dental treatment

Antibiotics for dental treatment are prescribed for inflammation of the bone tissue or the surrounding segment.

  • Abscess – frequently diagnosed inflammation of the tooth. Antibiotics are prescribed for gingival (flush), periodontal, or peripical localization of the infection. The cause of the abscess – Bacterial penetration into the dental pulp.
  • Antibiotics are prescribed when treating teeth affected by pulpitis. In this case, only the soft tissues are affected, there is no inflammation of the tooth root. Antibiotic helps with acute pain, temperature sensitivity, swelling, and other symptoms of pulpitis.

Antibiotic therapy in dentistry is provided for all infectious pathologies: necrotic process, sepsis, inflammation of the tooth root. Antibiotics are prescribed as a course of tablets, injections, ointments and solutions for applications.

Antibiotics in Food. How to choose a safe food product

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Most people are familiar with antibiotics as a medicine. Nowadays it is hard to find a person, adult or child, who hasn’t taken antibiotics at least once in his life.

Antibiotics were invented over 70 years ago to save lives and fight deadly diseases, but they are also a powerful allergen and can cause irreparable damage to the body.

Nowadays antibiotics are widely used in animal husbandry, poultry farming and fish farming.

Antibiotics are used to treat animals and birds as well as humans when they fall ill. Antibiotics are part of the so-called «growth hormones» To increase the rate of growth of livestock or poultry. If used improperly, they can get into milk, meat, and eggs.

Fish and seafood – This is a category of products that are literally bathed in antibiotics when grown under artificial conditions.

Antibiotics are used for heat treatment, sterilization, filtration in order to increase the shelf life in many technological processes in the manufacture of food products, which include milk and dairy products, meat, eggs, chicken, cheese, shrimp, and even honey.

Thus, it is clear that food products exposed to antibiotic contamination are exclusively animal, poultry and fish grown in artificial reservoirs. After administering antibiotics for a period until the antibiotic is eliminated from the body or its concentration drops below the acceptable limit, the animal may not be slaughtered in order to use its parts or whole as food. During the same period, it is also forbidden to use products from the animal (e.g., milk cannot be used even for processing – must simply be destroyed, usually poured into the ground, sewage, etc.). In case of non-compliance with regulations on the use of antibiotics they may be found in meat, milk, eggs, etc. (statistically they are found in 15-20% of all animal products).

In order to remove antibiotics from meat before slaughtering the animal should be kept 7−10 days without antibiotics. It is important to know that if the drug is left in the body of the animal, it is found mainly in the liver and kidneys.

Antibiotic content decreases as a result of heat treatment of meat of animals and poultry, when the drug together with the muscle juice passes into the broth, part of the drug is destroyed by the action of high temperatures. Compared to the initial amount, between 5.9% (grisin in poultry meat) and 11.7% (levomycetin in poultry meat) of the antibiotics in the muscle tissue remain after cooking. About 70% of the original amount of antibiotics passes into the broth. Approximately 20% of the original amount of antibiotics is destroyed by boiling.

Boiling, sterilization, fermentation have practically no effect on the antibiotic content of milk and dairy products. After boiling, 90 to 95% of the original amount of antibiotics remains in the milk, that is, 5 to 10% of their amount is destroyed. After sterilization, 92 to 100% of the original amount of antibiotics remains in milk. These data allow us to draw conclusions about the unsuitability of boiling and sterilization parameters for the destruction of antibiotics in milk.

Due to the fact that the groups of antibiotics used in humans and animals in agriculture are the same, residual amounts of antibiotics in food contribute to the emergence of resistant strains in humans as well. Accordingly, people who consume such products develop an immunity to taking antibiotics, and increasingly stronger drugs are required to obtain the expected effect of treatment.

Under the influence of antibiotics, the body loses the ability to resist various infections on its own. And, in addition, their widespread use has led to the emergence of bacterial strains that are resistant to these drugs, and, in the end, a person may be unprotected against infections and microorganisms.

The presence of antibiotics in the body can cause severe allergic reactions accompanied by severe itching, rashes, and in rare cases – swelling. Allergic effects occur even when antibiotics are very low in the food. For the last 40 years the number of people with allergic diseases has increased tenfold, especially among children.

Prolonged presence of antibiotics in the body may cause irritation of mucous membranes of the stomach, exacerbation of ulcerative and ulcerative states, imbalance of microflora in the intestines, disorders of the liver, kidneys, gall bladder, reactions of the nervous and circulatory systems in case of individual intolerance to antibacterial components.

Antibiotics from the body of a nursing woman can get into breast milk and cause weakening of the immune system and health problems in newborns.

Given the possible risk of harm to human health, legislation has established standards for the content of the most commonly used antibiotics in foods such as milk and dairy products, meat, including poultry, eggs and egg products: levomycetin, tetracycline group, streptomycin, penicillin, grisin, bacitracin. Their content in food products is not allowed (within the limits defined by the relevant methodologies), which is important for consumers to be aware of.

Rising resistance to antibiotics is reaching dangerously high levels worldwide. The range of drugs used in food industry now includes several dozen types of antibiotics and is constantly expanding, respectively, the content of many of them in food has not yet been regulated, and existing control measures can not determine the content of all used antibiotics in food.

This means that the responsibility for complying with the appropriate regulations on the use of antibiotics in agriculture rests entirely with the producer. However, due to the undeveloped (low) production culture, many producers, for the sake of increasing the profitability of production, do not comply with antibiotic regulations, because.к. At the very least, this requires the presence of personnel with special knowledge and skills; compliance with the necessary hygienic conditions in production, eliminating the need for disease prevention with antibiotics; destruction of food products containing antibiotics, etc.

The World Health Organization is therefore warning of the need for urgent action and Consumers International is calling for food companies to change their policies on antibiotics. Consumers have an important role to play in this process.

Although effective antibiotic control measures are in place, consumers should keep in mind that it is advisable to buy products of animal origin (meat, dairy products, eggs) from verified sellers and in authorized markets.

The sold products of animal origin shall be accompanied by the documents confirming their compliance with the regulatory requirements (unprocessed food products of animal origin – a document confirming veterinary and sanitary expertise, processed food products of animal origin – a declaration of conformity, meat and dairy products for baby food – certificate of state registration).

In addition, it should be noted that the carcass, half-carcass and quarter of the meat must bear a veterinary stamp; it is allowed to put an additional stamp of the commodity inspection mark. The following information must be specified in the shipping documentation for unpackaged slaughter products: type of meat of the productive animal from which slaughter product was obtained, name of the slaughter product, thermal condition of carcasses, half-carcasses, quarters and cuts («chilled», «Frozen»), the anatomical part of the carcass (for cuts); the slaughter products.

Dear Consumers! So, for today the possible way out of the current situation is to buy the products of animal origin (cattle meat, dairy products, eggs, poultry) from reliable manufacturers after a veterinary and sanitary expertise of raw materials.

Refrain from buying livestock, poultry, fish products of unsightly appearance and of dubious quality from unknown companies.

Refrain from buying the products in unsuitable places and premises: in the courtyard, from the trunk of the car, in the staircase, etc.п.

Amoxicillin and bladder infection. Cystitis

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Cystitis

Cystitis — Is inflammation of the bladder mucosa.

Cystitis can be acute and recurrent, infectious and noninfectious, complicated and uncomplicated. The most common form of the disease — Acute uncomplicated cystitis. Uncomplicated cystitis refers to cystitis in non-pregnant women without anatomical and functional abnormalities of the urinary system, without serious concomitant diseases.

Acute cystitis — one of the most common diseases in women. More than 50% of women have been diagnosed with this condition at least once in their lives.

Anatomy

Anatomically, the female urethra is much shorter and wider than the male urethra, is 2-4 cm long and is located close to natural possible sources of infection, such as the vagina and anus. In men, the length of the urethra is about 20 cm and is anatomically divided into several sections. Before entering the bladder, the urethra passes through the prostate gland, which is a natural barrier that prevents the entry of infection into the bladder.

Predisposing factors

Predisposing factors for the development of cystitis are:

  • Anatomo-physiological features of the female body, a change in the location of the urethra;
  • Excessive sexual activity;
  • A new sexual partner, frequent change of sexual partners;
  • Use of spermicides;
  • An episode of urinary tract infection (UTI) in childhood;
  • A history of urinary tract infections in the mother.

The causative agent of acute cystitis in 70-95% of cases is E.coli — Escherichia coli. Other pathogens, such as staphylococcus, Klebsiella, protei, are much less common.

Symptoms of acute cystitis

Symptoms of cystitis most commonly include:

  • frequent painful urination (dysuria); ;
  • Unpleasant urine odor.

These complaints alone or in combination occur in 90% of women with acute cystitis. Body temperature over 37.3°C is not characteristic of cystitis and may indicate a more serious inflammatory process in the kidneys — acute pyelonephritis.

Blood in the urine — hematuria — Usually causes panic fear in women, but is most often a sign of common cystitis.

The combination of pain during urination and an admixture of blood in the urine suggested acute bladder inflammation (hemorrhagic cystitis) rather than other, more serious urologic pathology — For example, a tumor of the urinary tract, in the presence of which dysuria is uncharacteristic.

Blood in the urine may also appear due to chronic cystitis, leading to an increase in the number of blood vessels (hypervascularization) in the submucosal layer of the bladder, their fragility and tendency to hemorrhage.

Other possible causes of hemorrhagic cystitis: radiation therapy, chemotherapy, use of certain medications.

Cystitis accompanied by blood in the urine may occur acutely, without signs of chronic inflammation and the preceding factors. The treatment algorithm is usually limited to the same measures as in acute cystitis without hematuria.

Diagnosis

The diagnosis of acute cystitis is established on the basis of the patient’s complaints. To clarify the diagnosis, a general urinalysis is used, ideally — urinalysis with test strips.

The prescription of treatment for acute cystitis is also possible only on the basis of the patient’s complaints (so-called empirical therapy), without obtaining the results of urinalysis. Urine sampling for culture (bacteriological study) is not obligatory for patients with uncomplicated cystitis. Urine culture is only necessary in a number of cases, such as: the presence of pregnancy, suspected acute pyelonephritis, a prolonged course of cystitis (more than 2 weeks), atypical course of the disease. In the presence of bacteria in the urine culture — more than 10? — The diagnosis of acute cystitis may be confirmed microbiologically.

The ultrasound or other imaging techniques are not included in the algorithm for diagnosing acute cystitis. There may be no specific findings on ultrasound of the bladder. Ultrasound signs such as «Thickening of the bladder wall» и «The presence of bladder suspension», Do not talk about the mandatory inflammation of its mucosa. The purpose of ultrasound most often is to rule out bladder tumors and ureteric stones.

Cystoscopy is contraindicated in acute cystitis.

Differential diagnosis

Vaginitis. Characterized by frequent urination associated with vaginal irritation. A mild, sluggish course. Predisposing factors may be excessive sexual activity, frequent changes in sexual partners (new sex partner). Blood in the urine, pain during urination, pain in the lower abdomen is usually absent. Examination may reveal a vaginal discharge that reveals an inflammatory process.

Urethritis. This disease is also characterized by frequent, painful urination, but the severity of symptoms is usually weaker than in acute cystitis. The most common causes of urethritis are gonorrhea, trichomoniasis, chlamydia and herpes simplex virus. The disease may also occur due to a change in sexual partner. urethral discharge is more common in men.

Treatment of cystitis

The basis of treatment of acute cystitis is antibacterial therapy.

It has been proven that 90% of women have symptoms of acute cystitis within 72 hours after starting antibiotic therapy.

First-line drugs for acute cystitis are those that create a high concentration of the active substance in the urine and a low concentration in the blood, that is, drugs that act primarily in the urinary tract.

Fosfomycin. A broad-spectrum antibacterial drug (granules for oral administration) with a high concentration of the active substance. In acute cystitis, its peculiarity is a single dose — One dose of the drug is enough (3 g for adults). Used for initial manifestations of cystitis. If there are signs of bladder inflammation within a few days, another dose may be used (24 hours after the first dose).

Nitrofurantoin macrocrystalline. Nitrofurantoin is one of the oldest antimicrobial drugs, but, nevertheless, the level of resistance to it has remained low for several decades. However, it should be remembered that the overly broad use of nitrofurantoin in the treatment of acute cystitis is unwarranted due to the relatively high frequency of adverse drug reactions to this drug, primarily acute and chronic pulmonary syndromes, which are often seen in the elderly. The recommended dose and duration of treatment of uncomplicated acute cystitis with nitrofurantoin is 50-100 mg x 4 times daily, 5-7 days for acute infection, 50-100 mg at night for prevention of recurrence.

Antibacterial drugs that act systemically, Are not recommended for the treatment of acute uncomplicated cystitis as first-line drugs, and can only be used as Possible alternative.

Cephalosporins. A group of broad-spectrum antibiotics. Produce high concentrations of the active substance not only in the urine but also in the blood. There are 4 generations of cephalosporins. Used for a variety of conditions: from sinusitis to peritonitis. In the treatment of acute cystitis, tablet forms of the antibiotic are most commonly used. Dosage: 400 mg (1 tablet).) x 1 time a day for 3-5 days.

Alternative antibacterial drugs:

Fluoroquinolones. A highly effective group of antibiotics, widely used in urological practice. Most commonly prescribed Ciprofloxacin, Levofloxacin. Used in the treatment of acute cystitis, but not currently recommended for empirical therapy due to increasing resistance in patients. Prescribed according to the results of bacteriological urine culture in the presence of sensitivity to them, more often used in the treatment of pyelonephritis, prostatitis. Contraindicated in pregnant women and patients under 18 years of age. Regimen: Ciprofloxacin (Ciprobacin, Ciprolet) — 250 mg x 2 times a day for 3-5 days.

Penicillins. The very first, artificially synthesized group of antibiotics. Representative: Amoxicillin. Not recommended for empirical therapy of acute cystitis due to increased E. coli resistance worldwide. However, the combination of Amoxicillin and clavulanic acid can be used in some cases, for example, in the presence of inflammation of the bladder mucosa in pregnant women. Regimen: Amoxicillin + clavulanic acid (Amoxiclav, Augmentin) 625 mg x 3 times a day for 7 days.

The basis of treatment cystitis in pregnant women is also the prescription of antibiotic therapy, but not all drugs are approved for use. Monural, Furamag and a penicillin antibiotic or cephalosporin group is acceptable.

The use of other drugs, herbal remedies, dietary supplements in the treatment of acute cystitis is ineffective, because there is a high probability of preservation of the pathogen and the occurrence of relapse of the disease.

Earlier recommendations to use a natural uroantiseptic have been encountered — Cranberries (plenty of cranberry juice). There is evidence in several studies of the effectiveness of cranberry in reducing the incidence of urinary tract infections in women. However, in a meta-analysis involving 24 studies and 4,473 patients, it was shown that foods containing cranberries, Do not statistically significantly reduce Frequency of urinary system infections, including acute cystitis in women.

If the patient for some reason demonstrates reluctance to drink antibiotics, it is allowed to prescribe anti-inflammatory drugs and analgesics to reduce the severity of dysuria and discomfort in the lower abdomen.

Phenazopyridine — Refers to analgesics for pain relief in inflammatory diseases of the bladder and urinary tract. Excreted with urine, providing local analgesic effect on urinary tract mucosa. Does not, by itself, get rid of bacteria or damage to the mucosa, is used only for symptom reduction. Can be used in conjunction with antibiotics to reduce discomfort. It is recommended to use no more than 2 days, as a longer treatment may mask the symptoms of the disease. Also used for elimination of discomfort, cutting during urination after bladder catheterization, endoscopic interventions, urethral surgeries.

Nonsteroidal anti-inflammatory drugs — Have a pronounced anti-inflammatory, analgesic, and moderate antipyretic effect. Widely used in urological practice, often in the form of rectal suppositories. The most popular: Diclofenac, Indomethacin, Ketoprofen. In special cases, in the absence of the possibility of taking an antibiotic and the presence of recurrent cystitis, can serve as the main medication for a short time.

Cystitis in men

Extremely rare. This is due to the longer urethra than in women, the smaller number of bacteria in the periurethral zone, the presence of antibacterial components in the prostate secretion. Factors contributing to cystitis in men include diagnostic manipulations and surgical procedures on the urinary tract, radiation therapy, chemotherapy, unprotected anal intercourse. Treatment is carried out with antibacterial drugs that are also used in the treatment of prostate inflammation: Ciprofloxacin 500 mg x 2 times a day, for at least 7 days.

After an episode of acute cystitis. Preventive measures

After adequate treatment of acute cystitis there is no need for additional examinations. Adequate fluid intake, avoidance of hypothermia, personal hygiene, hygiene of sexual life, timely treatment of gynecological diseases, sexually transmitted infections are recommended. Prophylactic use of any drugs after a single episode of acute cystitis is not indicated.

If the symptoms of cystitis occur within two weeks after treatment and the therapeutic effect is absent, the urine should be examined for culture and the sensitivity of the isolated pathogens to antibiotics should be determined (take a urine culture). According to the results of the bacteriological culture is recommended the appointment of an antibacterial drug according to the sensitivity to it of the pathogen.

Amoxicillin in the treatment of acute otitis media in children. Effectiveness

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Currently Amoxicillin remains the remedy of first choice for uncomplicated acute otitis media due to its safety, comparative effectiveness, pleasant taste, and low cost. In particular, amoxicillin is the most effective among available oral antimicrobials against both penicillin-insensitive strains and S. pneumoniae susceptible to it.

Increase doses From the traditional 40 to 80-100 mg/kg/day usually provides a good effect against strains — penicillin intermediates and some penicillin-resistant. The increased dose should be used especially in children under 2 years of age and those who have recently been treated with b-lactams or who are in a large pediatric population because, as noted earlier, in these children the prevalence of resistant S strains. pneumoniae are the highest.

Limitation of use amoxicillin is due to the fact that it can be inactivated by the b-lactamases of many strains that are nontypical of H. influenzae, and by most strains of M. catarrhalis. Fortunately, cases of acute otitis media caused by these pathogens often, but not always, resolve spontaneously. For children who are allergic to b-lactams or for whom taste or convenience of administration is important, azithromycin, which also has an excellent safety record, is a suitable first-line choice.

Resistance to Trimethoprim/sulfamethoxazole Many strains of H. influenzae, S. pneumoniae and the reported high rate of adverse outcome of acute otitis media in children initially treated with this drug suggest its unacceptability as a first-line treatment.

Often the duration of the treatment of acute otitis media is 10 days with an apparent extrapolation of the optimal duration of treatment of streptococcal pharyngitis with penicillin. However, 10 days may be excessive for some children and insufficient for others. Studies comparing a shorter treatment period to a longer treatment period suggest that a short course is often inadequate for children under 6 years of age, especially under 2 years of age.

Thus, in most cases treatment, which ensures concentration of antimicrobial agents in the tissues, for at least 10 days seems appropriate. A short course, 3-5 days, may be appropriate for older children in relatively mild cases who are improving rapidly, while treatment longer than 10 days is often required for very young children, or for severe acute otitis media, or those with a history of otitis media problems.

Main purpose dynamic observation Is to assess treatment outcome and differentiate between inadequate response to treatment and early relapse. Accordingly, the required period of dynamic observation should be individualized. Observation for several days is appropriate for children in early infancy with severe illness or children of any age with persistent pain. Follow-up for 2 weeks. Necessary in infants or young children with frequent relapses.

Perhaps, eardrum (BP) has not returned to normal, but a significant improvement in her appearance should be evident. For children with a single episode of acute otitis media and rapid improvement in her appearance, observation within 1 month. after the initial examination is insufficient, and for older children, it may not be necessary at all.

In essence acute otitis media — Is an infectious, confined space disease, and its resolution depends on both elimination of the pathogen and restoration of middle ear ventilation.

Contributing factors unsatisfactory response to first-line treatment in addition to antimicrobial ineffectiveness include inadequate treatment regimens, current or mixed viral infection, persistent auditory tube dysfunction and insufficient aeration, reinfection from other foci, or immature or compromised patient immunity.

Despite this, switching to an alternative or second-line remedy will seem appropriate, If there is inadequate positive trend in the symptoms or condition of the middle ear, as reflected in the appearance of the eardrum (OA), or persistent purulent nasal discharge indicates that the antimicrobial agent used is ineffective. Second-line products may also be used for acute otitis media in a child already receiving antimicrobial prophylaxis, or in a child with immunodeficiency, or in a child with a history of severe symptoms and problems with otitis media.

Tooth abscess – what is it, why is it dangerous, how to treat a pus

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The infection causes an inflammatory process in the soft and hard tissues. If not treated adequately and under the influence of high temperatures (especially with hot drinkers or in the summer heat), a tooth abscess is likely. To avoid complications, it is important to see a doctor in time.

What is an abscess

Dental abscess – Acute inflammation in the tooth root area with subsequent suppuration accompanied by severe throbbing pain.

It is not only dangerous for the affected tooth, but also for the body as a whole. It is possible when the pus bursts, the infection enters the bloodstream and begins sepsis.

Symptoms of a tooth abscess

The inflammatory process in the tissues of the tooth and gum proceeds in stages, accompanied by different symptoms:

  • Discomfort, mild swelling, possible gingival bleeding during tooth brushing, sensitive soreness on pressure.
  • In later stages, swelling increases, there is a reaction to hot and cold food. Long-lasting pain and an unpleasant odor occur. In addition to local changes, the abscess is accompanied by an increase in lymph nodes in the neck, an increase in body temperature, general malaise.

A bitter aftertaste is palpable in the mouth, and the tooth body may change its color. It is important to remember: the symptoms of a gum abscess can manifest themselves differently – Everyone has a different threshold of pain sensitivity, perceives signals subjectively. Therefore, you should not wait for an acute condition, a prudent step – Visit a dental clinic at the first unexplained sensations.

What may be the complications

Even if the pain is dulled and symptoms are less severe, do not postpone going to the dentist. Such a situation can be a signal that the root is dying off and further spreading the infection to the organs of the head or neck.

Do not heat the area. This approach will bring short-term relief, but will accelerate fistula formation and stimulate the release of pus.

Possible serious complications: brain inflammation, pneumonia. Risk of sepsis, osteomyelitis, damage to the sinuses or brain membranes.

Causes of dental inflammation

The main causes that cause an abscess of the gum of the tooth, infection of the pulp:

  • Advanced tooth decay with lesions of the root apex. Inflammation develops against the background of periodontitis.
  • Untreated gingivitis and periodontitis (gum disease). Often develops as a post-traumatic complication: pathogenic microflora accumulates in the periodontal pockets.
  • Weakened immunity after diseases (flu, sore throat, others).
  • Iatrogenic factors – Bacteria got in after using non-sterile instruments during treatment, injections, improper tooth extraction.

The development of the inflammatory process may be preceded by damage to the oral mucosa, the formation of boils.

Examples of work:

If you notice symptoms of an abscess?

Don’t delay, make an appointment with us to! Get a quality diagnosis and treatment!

Types and treatment of abscess

The nature of treatment depends on the cause of the gum inflammation, the size of the pus, its localization. The extraction of a unit is very rare today – Only in cases when it is too late to address the problem and the tooth can no longer be saved. Exception – Baby teeth, recent «Wise» Molars. After the surgery, the hole is cleaned and disinfected, and the healing process is monitored.

When choosing the method of intervention, the type of inflammation is taken into account. Distinguished:

  • Periodontal abscess . Develops in the pulp of the tooth, spreads to nearby areas. The goal of the dentist – Save the dental unit and restore the dental tissues. After cleaning, the canals are treated with modern antibacterial and antiseptic compositions to prevent reinfection. Only after that, a filling is made.
  • Periapical abscess . Pockets between the teeth and gums allow pathogenic microflora to multiply. A pus is formed, which is treated by opening, removing the contents. The pocket is cleaned and disinfected to prevent a recurrence.

Opening of the abscess with appropriate anesthesia – A small incision is made, pus is cleaned and the wound is rinsed with antiseptics. In case of severe suppuration, drainage of the mass is necessary, recovery therapy is required. Antibiotics, analgesics can be taken in parallel, under the doctor’s control, according to the doctor’s prescription. A comprehensive approach is important if the gum hurts and inflammation is detected.

Stages of treatment of a tooth abscess:

  • Make an appointment.
  • Diagnostics, X-ray examination to locate the nidus.
  • Formulation of a treatment plan, performance of procedures without pain under anesthesia.

Next, the doctor appoints the time of the visit for examination. And the patient will have healthy teeth and gums after healing. In general, the treatment of a gingival abscess consists of ensuring the outflow of purulent substance, eliminating the source of infection.

Abscess prevention

Tooth and gum inflammation – direct consequence of untimely treatment, delayed visit to the doctor. Therefore, the best way to prevent the disease – Pay attention to all daily hygiene procedures, professional cleaning at the dentist’s office and visit the dentist for preventive examinations once every six months.

Rational nutrition, avoiding bad habits, taking nutritional supplements of good quality are also important. Keep your smile beautiful and be healthy.

Antibiotics and COVID-19

Antibiotics for COVID-19: An easy way to hurt yourself

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Antibiotics and COVID-19

Antibiotics work only against bacteria, not viruses. COVID-19 is caused by a virus, and therefore antibiotics should not be used for prevention or treatment. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters#virus

Patients are often asked to prescribe some kind of “magic pill” that will cure them of coronavirus infection. And when the doctor refuses to write a prescription for them: they show articles in the media written by so-called “specialists” – about what should be treated. Or they tell the stories of relatives and friends who allegedly recovered thanks to one or another magic pill.

Very often antibiotics pretend to be a “magic pill”. In the minds of patients, these are medicines that help almost everything: a runny nose, pain, bring down the temperature, and so on.

At the same time, the purpose of antibiotics is to kill bacteria that are the cause of a particular disease. Antibiotics have no effect on viruses at all, so it is simply impossible to cure COVID-19 with them. Just as there is no point in treating flu, measles, chickenpox, viral hepatitis or any other viral diseases with them.

Coronavirus belongs to the category of acute respiratory infections and, in treatment, requires only auxiliary agents, and not the use of potent drugs (hormonal and antibiotics). Side effects can even be fatal!

Pneumonia is different

In part, patients are misled by the diagnosis of pneumonia, which often occurs as a complication of COVID-19. If we talk about ordinary pneumonia, then it is not only possible, but also necessary to be treated with antibiotics, because it is caused by pneumococci and some other bacteria. But there are pneumonias that are called atypical because they are caused by other pathogens – for example, the influenza virus or SARS-CoV-2 and other microorganisms.

The overwhelming majority of patients do not know how to distinguish such pneumonias from “common” ones, how they develop and how they should be treated. But it should be admitted that not all doctors are good at doing this.

“Patients often prescribe computed tomography for themselves. At the onset of the disease, they see that 10% of their lungs are affected, and therefore prescribe antibiotics for themselves. A few weeks later, CT shows that 25% of the lungs are already affected. “So, we need more antibiotics,” the patient believes and continues to self-medicate, ”says the independent doctor.

According to the doctor, such patients, after taking two or three types of antibiotics that could not help, are often diagnosed with drug-induced hepatitis. That is, one more problem is added to the problems that have already existed.

It makes them stronger.

But misuse of antibiotics has far worse consequences than drug-induced hepatitis and other complications. It is about antibiotic resistance. In simple terms, among bacteria well known to us, there are strains (varieties) that are insensitive to antibiotics, with which they were successfully treated before. Sometimes this means that they are not affected by any of the known antibiotics.

Already, at least 700,000 people worldwide die from diseases caused by antibiotic-resistant bacteria every year. We are not talking about some exotic diagnoses, but about well-known tuberculosis, sexually transmitted infections, the same pneumonia and the like.

Antibiotic-resistant bacteria are projected to kill 10 million people every year by 2050. WHO considers the problem of antimicrobial resistance (which includes antibiotics) as one of ten global health threats.

Our misconceptions

Several years ago, commissioned by WHO, a study was conducted in several countries to find out how well people understand what antibiotic resistance is.

64% of study participants believe that colds and flu can be treated with antibiotics (although these are viral diseases).

Almost a third of people believe that if they feel better after taking antibiotics for a few days, then treatment should be stopped. But this is how we “select” resistant bacteria that are least vulnerable to antibiotics.

And another two-thirds of the respondents believe that people who take antibiotics correctly do not face the problem of antibiotic resistance.

But this is a dangerous delusion. The fact is that resistance is not something that arises in the body of a person, but something that characterizes bacteria. If such bacteria have arisen in the body of one person, then another person can become infected with them, who did not violate any doctor’s prescriptions.

In other words, whether or not to take antibiotics and how to take them is by no means “everyone’s personal business.” If we do not change our practice of using antibiotics, then the world will go back a hundred years – to the period when people were dying from common pneumonia and other diseases caused by bacteria.

Science will save us, but not soon

Is it possible to somehow avoid such a prospect?

The study just mentioned found that 64% of participants believe that doctors will solve the problem of antibiotic-resistant bacteria before it gets too serious.

The truth is that humanity really needs new antibiotics, without which it will not be possible to defeat resistant bacteria. But, according to the WHO, among the antibiotics that pharmaceutical companies are developing today, very few are truly innovative. Most of them differ little from those already on the market.

True, drugs are at the stage of preclinical trials, on which great hopes are pinned. But even in the best case, the first of them will be available to patients in about 10 years. This means that scientists and doctors themselves will not solve this problem.

How everyone can contain resistant bacteria

Much depends on how responsibly each of us treats the use of antibiotics.

In particular, WHO recommends that the following rules be followed:

  • take antibiotics only if prescribed by a qualified doctor;
  • never demand antibiotics from the doctor if he says that this time they are not needed;
  • always follow your doctor’s recommendations for antibiotic use; in particular, this means that the course of treatment should last no less and no longer than prescribed by the doctor;
  • you cannot transfer your antibiotics for use to other people for whom they are not prescribed by a doctor.

There are other important rules that do not apply to taking antibiotics, but help prevent the emergence of resistant bacteria. They are designed to protect against bacterial infections – so that the need for antibiotics does not even arise. These recommendations include regular hand washing, safe sex, and timely vaccinations to prevent diseases, including bacterial ones.