The same, effective, timely therapy for any IMP leads to the frequency of higher symptoms and bacteria and better reinfection prevention. Unfortunately, treatment can lead to antibiotic resistance to pathogens and bacteria reviews and has a detrimental effect on intestinal flora and vagina, so it's important to consult your doctor immediately and choose it properly.
Clinical suggestions for the treatment of acute uncomplicated cystitis
The American Infectious Disease Specialist Association (IDSA) is working with the European Microbiology Association and the Infectious Disease (ESCMID) published a clinical proposal for treatment with uncomplicated cystitis and pyelonephritis in 2011. This document is a priceless reference at the IMP Office. This manual discusses important factors in choosing the optimal treatment:
- the nature of uropathogens resistance;
- Urepogenic bacterial sensitivity to antimicrobial drugs;
- Possible side effects of antimicrobial drugs.
For sensitivity, two important facts are recorded in this leadership:
- The stability of uropathogens to antibiotics has increased in recent years;
- The nature of the resistance shows significant geographical variability between the country and the region.
Therefore, the suggestions are regularly reviewing as they are constantly developing obstacles, development of new tools and conducting research showing the excellence and inefficiency of drugs. According to and suggestions and research, they are best suited to the need for medicines for the treatment of uncomplicated cystitis, the following ingredients:
- phosphomicin;
- nitrofurantine.
The following selection criteria are used: pharmacokinetics, interactions, probability of beating (the probability that microorganisms are sensitive to antibiotics), resistance development, specific use for imps, effectiveness, side effects, dose frequency, treatment duration, cost.
This study includes the following drugs: amoxicillin (with or without clavulanic acid), nitrofurantin, sulfametizol, trimtoprime, co-trimoxazole, ciprofloxacin, norfloxacin, offloxacin and phosphomicin trometamol.
Characterization of the first line of lower urinary tract infection treatment
Table 1. The first line for the treatment of cystitis
| Material | Dose | The duration of treatment |
| Phosfomicin trometamol | 3 g a single dose | Single dose (once) |
| Nitrofurantine | 50-100 mg four times a day | 5-7 days |
Phosfomicin trometamol
Phosfomycin opened in 1969 as a new class of phosphone antibiotics.
Active ingredient: phosphomicin. Release form: Details for the preparation of the solution, in packaging 1 or 2 packages, a phosphomic dose of 3 g/bag, 2 g/bag.
It refers to clinical and pharmacological groups to uroantiseptics, antibiotics (phosphonic acid derivatives).
The spectrum of actions
Phosfomycin has bactericidal activity from a broad spectrum of actions in relation to:
- Staphylococci (Staphylococcus spp. );
- Enterococci (Enterococcus spp. );
- Haemophilus spp;
- Most intestinal gram-negative bacteria, including 95. 5% E. coli, produce expanded spectrum β-lactamase (BLRS);
- Strain E. coli producing metal-β-lactamase sensitive to phosphomic;
- Citrobacter spp. ;
- Enterobacter spp. ;
- Klebsiella spp. , Klebsiella pneumoniae;
- Morganella Morganii;
- Mirabilis proteus;
- Pseudomonas spp. ;
- Serratia SPP.
The peculiarity of the drug
- Trometamol phosphomicin is prescribed exclusively for the treatment of acute uncomplicated cystitis in the form of a single dose of 3 g and is not prescribed for pyelonephritis.
- It is best absorbed if you take it before eating.
- Achieve a high concentration in the urine and maintain a high level for more than 24 hours.
In several studies, clinical efficacy and microbiology of phosphomicin with other antimicrobials of the first line with uncomplicated cystitis were compared. The clinical efficiency of one dose (3 g) of phosphomicin is 91% (healing occurs in 91% of patients). The indicators are comparable to nitrofurantoine (93%), trimetrome-sulfametoxazole (93%) and fluoroquinolones (90%) in acute uncomplicated cystitis.
Advantages of treatment with phosphomic
The microbiology level of phosphomicin healing (80%) is lower than 88-94%comparable antibiotics. However, the new meta -new analysts 27 Studies have not revealed the difference in the effectiveness between phosphomic and other antibiotics for the treatment of cystitis and discover the following facts:
- Phosfomycin causes poor reactions, most importantly - including pregnant women.
- The additional benefit is to treat multi -presistant microorganisms. Some in vitro studies show that phosphomicin is active in relation to staphylococcus aureus compiled by Vancico and the Gram-negative stick that produces the BLR.
- Effective in IMP treatment caused by K. pneumoniae. Enterobacteriaceae produces carbapenemase (in a dose of 3 g, repeat every 48-72 hours).
- It has minimal side effects on the body. This is indicated by the high frequency of E. coli vulnerability in areas with frequent use of phosphomic with uncomplicated cystitis in women;
- Facility of single dosage mode.
Indication
- acute cystitis (origin of bacteria);
- recurrent cystitis (bacterial origin);
- uretritis (non -specific bacteria);
- Bacteriuria pregnant women without symptoms;
- IMP after operation;
- IMP Prevention.
The dose and method of application
| Moderate acute cystitis treatment | Repeated/Heavy form of IMP | The prevention of |
| Adults - 3. 0 g (1 package) once
Children (from 5 years old) - 2. 0 g once |
Adults - 3. 0 g twice, second reception after 24 hours | First technique: 3. 0 g 3 hours before operating/diagnostic procedure
Second Tricks: 3. 0 g 24 hours after the main |
Suggestions for use
- Follow all the instructions on the label.
- Phosfomycin is usually prescribed in one dose.
- Do not take large/smaller quantities or longer if it is not prescribed by the doctor.
- It can be used simultaneously/after meals.
- Phosfomycin is a powdered drug, before using it must be diluted with water. Do not take dry powder without adding water.
- Dissolve a 1/2 cup of cold water, mix and drink immediately. You can add a little water to the same glass, be careful of shaking and drink immediately to make sure the dose is complete.
- Don't mix with hot water.
- It's nice to take it overnight. There will be longer rest between urine, which will ensure the presence of longer drugs in the bladder and more effective effects.
- Store at room temperature from moisture and heat in the original packaging.
Other instructions:
- Symptoms cannot pass immediately, after 2-3 days;
- It is necessary to contact the urologist if the symptoms do not disappear within 3 days after treatment, fever or other new complaints will appear;
- Before applying the patient, it is recommended to consult a doctor to make sure that phosphomic is an antibiotic suitable for treatment. In addition, urine analysis may be needed before and after taking this medicine.
Contraindications:
- Children under 5;
- allergic reactions to components;
- Severe renal failure.
General side effects:
- nausea, stomach disorders, slightly diarrhea;
- headache, dizziness;
- Itching or vaginal discharge (rarely).
Drug interaction
Concurrent intake with Meteclopramide is not recommended to avoid weakening phosphomic action.
Therefore, the facility of a single dose regime, in vitro activity in relation to a resistant gram stick that results in both moderate and immature, uncomplicated cystitis, And the minimum tendency for side damage makes phosphomics a useful option in the treatment of lower MVP infections (cystitis, urethritis).
Nitrofurantine
Active ingredient: nitrofurantine. Release form: tablet, dose 100 mg, 50 mg.
It refers to clinical and farm groups to uroantiseptics, antimicrobials.
Nitrofurantine, related to the group of synthetic nitrophins, was originally presented in the form of microcrystalline. In 1967, a form of macrocrystalline with better gastrointestinal tolerance was available.
Currently, there are two main types of nitrofurantine: macrocrystalline form and a mixture of microcrystalline and macrocrystalline (25 mg makrocrystals plus 75 mg monohydrate). Mixed species in patented double transmission systems, in the Russian Federation are not registered and unregistered.
The mechanism of action
Nitrofurantin bacterial activity mechanisms include several websites:
- prevents ribosome broadcasting;
- damage to bacterial DNA;
- Intervene in the CREBS cycle.
Nitrofurantine is active in connection with:
- More than 90% of intestinal strains that cause IMP;
- Enterococcus, including resistant to vanchromicin;
- Klebsiella spp. ;
- SPP Proteus. ;
- Staphylococci (gold and saprophytic) is usually vulnerable.
Resistance to drugs is rare, possibly due to various areas of drugs. However, proteus, Serratia and pseudomonas have natural resistance to nitrofurantoine.
Nitrofurantino can also be an additional option for oral antimicrobial treatment of acute uncomplicated cystitis caused by the bacteria that produces the BLR.
Pharmacokinetic. Absorption increases when eating. The concentration of nitrofurantine in the serum is low or not defined at standard doses, the prostate gland content is not detected. It is primarily released with urine, where the concentration of the drug (from 50 to 250 mg/ml) is easily over 32 mg/ml MPC.
Nitrofurantine should not be prescribed to patients with significant kidney failure (creatinine release<60 m/min), but the studies observe the high efficiency of the drug in patients with the release of 60-30 ml/min creatinine.
Safe to use in pregnant women and children.
Hints: Cystitis (origin of bacteria) treatment and prevention.
Dosage. It is prescribed by the urologist individually based on the severity of the condition, the duration and severity of the symptoms.
Common dose for adults with cystitis:
- From 50 to 100 mg orally 4 times daily for 1 week or at least 3 days after urine infertility reaches. Common dose for adults for the prevention of cystitis:
- From 50 to 100 mg orally once a day before bedtime. Child doses for the treatment of cystitis:
- 1 month and older: 5-7 mg/kg/day (up to 400 mg/day) orally in 4 doses. The dose of regular children for the prevention of cystitis:
- 1 month and above: from 1 to 2 mg/kg/day (up to 100 mg/day) orally in 1-2 ceremonies.
Most experts agree with the 5 -day course of medicine for the treatment of uncomplicated cystitis. Studies show early clinical healing frequency with nitrofurantoine from 79% to 95% and microbiological healing frequency from 79 to 92%. In the aggregate of clinical effectiveness studies, they showed general equivalent between nitrofurantoin, prescribed for 5 or 7 days, and trimetrome-sulfametoxazole (beads), cyprofloxacin and one dose of phosphomycin (Monural) trometamol (Monural). However, the speed of microbiological healing always shows a better effect on comparative drugs.
Suggestions to patients
- It is necessary to follow all the prescriptions and the doctor's instructions in the instructions for the medication.
- Do not use large quantities or smaller or longer than recommended.
- It is best to take nitrofurantine with food (increased bioavailability).
- It is recommended to observe the receipt over the specified period. Symptoms can pass early, but treatment should not be stopped while the infection is completely eliminated. Dosity can increase the risk of further development of infections against antibiotics and the risk of relapse.
- Nitrofurantine does not treat viral infections, for example, colds or flu.
Side effect
General side effects:
- headache, dizziness;
- gas formation, stomach disorders;
- mild diarrhea;
- Itching or vaginal discharge.
Less frequently found:
- diarrhea -watery or bleeding;
- pain suddenly or discomfort in the chest, breathing, dry cough;
- difficulty breathing;
- fever, chills, pain in the body, fatigue, weight loss that cannot be described;
- numbness, tingling or pain in the hands or feet;
- Liver problems - nausea, pain in the upper abdomen, itching, fatigue, loss of appetite, dark urine, clay, yellow disease (skin or eye);
- Syndrome such as lupid - joint pain or edema with fever, swollen glands, muscle aches, chest pain, vomiting, unusual thinking or behavior, rash.
Serious side effects may be more likely in the elderly, long or weak people.
Contraindications:
- serious disorders of renal excretion function;
- kidney failure;
- Oliguria;
- failure of dehydrogenase glucose-6-phosphate;
- pregnancy;
- age up to 1 month;
- allergic reactions to components;
- XN II-III Level;
- cirrhosis;
- chronic hepatitis;
- acute porphyria;
- breastfeeding.
Application during pregnancy
Category of Medicines Related to Pregnancy: In (According to the FDA - US Health Agency). It is believed that this drug will not harm the unborn child in the early stages of pregnancy. In the last 2-4 weeks of pregnancy, it is contraindicated.
Nitrofurantine can penetrate breast milk, when breastfeeding is not prescribed.
Special instructions
- The risk of peripheral neuropathy increases with the presence of anemia, diabetes mellitus, severe Mon, violation of electrolyte balance, vitamin B. deficiency.
- Nitrofurantine is not used for the treatment of prostatitis, kidney cortical wounds, purulent paranephritis. With pyelonephritis, they are not prescribed due to inefficiency.
- Nitrofurantine can produce incredible results with certain laboratory glucose (sugar) in urine.
Drug interaction
- With incompatible fluoroquinolons.
- Antacid based on magnesium trilate, nastyx acid while taking antimicrobial activity nitrofurantine.
- The secretion of the channel that prevents the secretion of the channel is not prescribed, as they increase the toxicity of nitrofurantine (increased blood content), reducing bactericidal properties (reduced urine content).
Nitrofurantine is considered to be the first -line therapeutic drug in acute uncomplicated cystitis because:
- 5 -day course effectiveness;
- Small risk of side effects and damage to a person's normal flora;
- minimum bacterial resistance;
- The effectiveness comparable to other antimicrobial drugs.