Among the drugs, an important place is occupied by antibiotics of the latest generation, active against many microbes. They are used to treat infectious pathologies, which significantly reduced the mortality of patients from today's commonplace pneumonia and pyelonephritis. Due to antibiotics, the course is facilitated and recovery with bronchitis, sinusitis is accelerated, and complex surgical operations have also become possible. Even wound infections are successfully treated with antibiotics.
Broad Spectrum Antibiotics (ABS)
This category of antimicrobials includes substances that are active against gram-negative organisms and gram-positive. The first are causative agents of intestinal diseases, inflammatory pathologies of the genitourinary and respiratory systems. Gram-positive organisms often cause wound infections and mediate the occurrence of postoperative complications in surgery.
ABSBS list of different release times
Some broad-spectrum antibiotics of the latest generation are also active against protozoal infections. An example is nitroimidazole derivatives - tinidazole, ornidazole and metronidazole. The most widespread metronidazole due to affordability. Its class analogue, tinidazole, is similar in spectrum of antimicrobial activity, but is not used parenterally. In general, all groups of broad-spectrum antibiotics are presented as follows:
- natural penicillins;
- inhibitor-protected aminopenicillins;
- anti-pseudomonas penicillins, including inhibitor-protected;
- third generation cephalosporins, fourth generation cephalosporins ;
- aminoglycoside group;
- tetracycline antibiotics ;
- macrolide antibiotics;
- antibiotics of a number of carbapenems;
- chloramphenicol;
- fosfomycin;
- rifampicin;
- dioxidine;
- sulfonamides;
- quinolones, fluoroquinolones;
- nitrofuran group;
- antibiotics of a number of nitroimidazole.
This list does not include the names of narrow-spectrum antibiotic groups. They are specific for a small number of microbes and are effective against them. Narrow-spectrum drugs cannot be used to treat superinfection and are not empirically applied. They are used as first-line antibiotics with the established form of the pathogen.
ABBS list of recent generations
The above antimicrobial agents are for a wide range of drugs. This is a complete list of groups of substances that are active against gram-positive and gram-negative microbes. However, the list contains both the latest generation of antibiotics and earlier representatives of the group. Among the above representatives of the latest generations are the following groups of drugs:
- beta-lactamase resistant aminopenicillins (Sulbactam, Ampicillin, Clavulanate, Amoxicillin);
- 3rd and 4th generation cephalosporins ("Cefotaxime", "Cefoperazone", "Ceftazidime", "Ceftriaxone", "Cefpir", "Cefepim");
- aminoglycoside III generation antibiotics (Amikacin, Netilmicin);
- 14- and 15-membered semi-synthetic macrolides (Roxithromycin, Clarithromycin, Azithromycin);
- 16-membered natural macrolide antibiotics ("Midecamycin");
- fluoroquinolones of the 3rd and 4th generations (Levofloxacin, Sparfloxacin, Gatifloxacin, Trovafloxacin, Moxifloxacin);
- carbapenems ("Meropenem", "Imipinem-cilastatin", "Ertapenem");
- nitrofurans (Nitrofurantoin, Furazidin, Ersefuril).
Deleted antibiotics
The previously mentioned anti-Pseudomonas penicillins have a wide spectrum of activity, however, they are used only against Pseudomonas aeruginosa due to the need to reduce the likely contact of the latter with a modern and powerful antibiotic. This prevents the risk of bacterial drug resistance. The most effective against Pseudomonas infection shows "Tazobactam." Occasionally, "piperacillin" or "clavulanate" are used as the last generation antibiotics for pneumonia caused by a hospital strain of the pathogen.
Also in this list there are no antibiotics of the last generation of the group of natural and antistaphylococcal penicillins. The former cannot be used in outpatient treatment due to the need for frequent intravenous or intramuscular administration. Forms that allow you to take them orally do not exist. A similar situation has developed with cephalosporins. Having the same activity spectrum as penicillins, they cannot be used orally due to destruction in the stomach.
Parenteral cephalosporins and penicillins are effective antibiotics of the latest generation in pneumonia. Scientists of the National Academy of Sciences of Belarus have achieved success in the development of a dosage form for their enteral use. However, the research results have not yet been put into practice, and drugs of this series can be used so far only in the work of inpatient healthcare institutions.
Highly effective antibiotics for children
Exploring the latest generation of antibiotics, the list of drugs recommended for children is significantly narrowed. In childhood, only representatives of a number of aminopenicillins (Amoxicillin, Clavulanate), cephalosporins (Ceftriaxone, Cefepim), macrolides (Azithromycin, Midecamycin, Roxithromycin, Clarithromycin) can be used. Fluoroquinolone antibiotics, carbapenems and nitrofurans cannot be used due to inhibition of bone growth, hepatic and renal toxicity.
Systemic nitrofurans are not used due to the lack of scientific data confirming the safety of treatment. The only exception is Furatsillin, suitable for topical treatment of wounds. Modern and highly effective antibiotics for children of the last generation are as follows: macrolides, penicillins, cephalosporins (drug names are presented above). The remaining groups of antimicrobials are not recommended because of the toxic effect and impaired skeleton development.
ABS for pregnant women
According to the FDA classification (USA), only some of the latest generation antibiotics can be used in the treatment of pregnant women, the list of which is extremely small. They belong to categories A and B, that is, their danger is not confirmed or there is no teratogenic effect in animal studies.
Substances with unproven effects on the fetus, as well as with the presence of a toxic effect, can be used only if the therapeutic effect prevails over the side effect (category C and D). Category X drugs are distinguished by proven teratogenic effects on the fetus, therefore, if necessary, termination of pregnancy is mandatory.
During pregnancy, the following antibiotics of the last generation of a wide spectrum of action in tablets are used: protected aminopenicillins (Amoklav, Amoksiklav), cephalosporins (Cefazolin, Ceftriaxone, Cefepim). Macrolides (Azithromycin, Clarithromycin, Midecamycin, Roxithromycin) are allowed to be used in the third trimester of gestation because their teratogenic effect has not yet been fully studied, and its absence cannot be unambiguous. It is also safe for pregnant women to use penicillin antibiotics in the absence of allergies.
The use of antibiotics in the treatment of bronchitis
All antibiotics of the last generation of a wide spectrum of action, theoretically, can be used for bronchitis and pneumonia, if their pharmacodynamic characteristics are optimal for this. However, there are optimal schemes for the rational treatment of such diseases. They take into account the options for successful combinations of antimicrobials with the aim of wide coverage of microbial strains.
Nitrofurans, derivatives of nitroimidazole and sulfonamides are irrational to use in inflammatory diseases of the respiratory system. The most successful combination for bronchitis or pneumonia of the mild course is protected aminopenicillin with macrolide (Amoklav + Azithromycin). Long bronchitis requires the appointment of cephalosporin instead of aminopenicillin (Ceftriaxone + Azithromycin). In this scheme, the macrolide can be replaced by another class analog: Midecamycin, Clarithromycin, or Roxithromycin.
All these antibiotics of the last generation with bronchitis have a pronounced effect, although clinical signs of the disease may continue to be present. A criterion for the effectiveness of treatment is the appearance of a cough with gradually cleansed sputum and relief of fever. With COPD, shortness of breath also decreases, appetite improves, and the frequency of coughing urges decreases.
Effective treatment for pneumonia
Mild pneumonia is treated according to the principle of bronchitis, but with the use of cephalosporin and macrolide. In moderate to severe pneumonia of out-of-hospital origin, cephalosporin (Ceftriaxone or Cefepim) is prescribed with a representative of a number of fluoroquinolones (Ciprofloxacin or Levofloxacin). These antibiotics of the last generation of a wide spectrum of action well suppress extra-hospital microflora, and the effect of their use is noticeable on the second day of treatment.
Modern antibiotics of the last generation in pneumonia (the names are presented above) affect the pathogen, inhibiting its vital activity or killing it. The first substances are called bacteriostats, and the second are bactericidal drugs. Cephalosporins, aminopenicillins and fluoroquinolones are bactericidal substances, and macrolides are bacteriostats. Moreover, the combination of antibiotics aims not only to expand the spectrum of activity, but also to comply with the rules of combination: one bactericidal drug with one bacteriostatic.
Treatment of severe pneumonia in the ICU
In intensive care, where patients with severe pneumonia and distress syndrome may be associated with intoxication. The main contribution to the severity of the condition of such patients is made by pathogenic microflora that are resistant to most antimicrobials. In such situations, carbapenems ("Imipinem-cilastatin", "Tienam", "Meropenem") are used, which are unacceptable for use on an outpatient basis.
Treatment of sinusitis and sinusitis
Modern antibiotics of the latest generation with sinusitis or sinusitis are used to destroy microbes. In such cases, a single bactericidal antibiotic may be used. However, with sinusitis, the main difficulty is the access of the antimicrobial drug to the site of inflammation. Therefore, the most commonly used drug is the cephalosporin series. An example is Ceftriaxone or Cepepime. Fluoroquinolone of the III generation - "Levofloxacin" can also be prescribed.
Treatment of angina with modern antimicrobial agents
The last generation antibiotics for angina are prescribed for the same purpose. Moreover, with sinusitis and tonsillitis, the same antimicrobial agents can be used. The only difference is that in the case of inflammation of the tonsils, you can also use antiseptics, for example, "Furacilin" - a drug of a number of nitrofurans. Although with angina, aminopenicillins protected with sulbactam or clavulanic acid (Amoklav, Amoksiklav, Ospamox) can also be successfully used. Moreover, drugs should be prescribed for 10-14 days.
Therapy of pyelonephritis and urinary tract infections
Due to the contamination of the urinary tract with microbes, the last generation antibiotics for pyelonephritis are necessary for their treatment. Cephalosporins, fluoroquinolones and nitrofurans have the greatest therapeutic value. Cephalosporins are used for a relatively mild course of pyelonephritis, and fluoroquinolones (Ciprofloxacin, Levofloxacin, Ofloxacin, Moxifloxacin) - with a worsening of the condition against the background of already ongoing therapy.
The most successful drug, suitable both for monotherapy and for combination with Ceftriaxone, is any representative of a number of nitrofurans - Furamag). Quinolone - "Nalidixic acid" can also be used. The latter create high concentrations in the urine and act actively against the causative agents of genitourinary infections. Also, metronidazole is occasionally used for gardnellosis and vaginal dysbiosis.
Drug resistance and its effect
Due to the constant change in the genetic material of microorganisms, mainly bacteria, the effectiveness of many antimicrobials is significantly reduced. By acquiring resistance to drugs, bacteria gain the ability to survive in the human body, mediating the deterioration in infectious diseases. This forces researchers to seek and put into practice new antibiotics of the latest generation.
In total, over the period of the existence of antimicrobial agents, about 7,000 substances have been developed that are used in a certain way in medicine. Some of them have dropped out of use due to clinically important side effects or due to the acquisition by microbes of resistance to them. Because to date, about 160 drugs are used in medicine. About 20 of them are the latest generation of antibiotics, whose names often appear in medical guidelines for antimicrobial therapy of infectious diseases.