The most effective antibiotics for chlamydia. Treatment of chlamydia - drugs, treatment regimens for chlamydia Main aspects of treatment

Chlamydia is an infectious pathology caused by chlamydia and transmitted primarily through sexual contact. Antibiotics for chlamydia are the main treatment method.

Chlamydia is an infection that occurs when the pathogenic gram-negative bacteria Chlamydia enters the body. The most dangerous types of chlamydia for humans are:

• Chlamydia psittaci - carried by birds, often leading to conjunctivitis.
• Chlamydia pneumoniae - infection occurs through contact with an infected person, causes respiratory chlamydia and atypical pneumonia.
• Chlamydia trachomatis - found only in humans, can cause a number of diseases, most often ocular and urogenital.

The latter type leads to infection when a large number of pathogens come into contact with the mucous membranes. In most cases it is transmitted sexually. In men, a clear clinical picture of the disease is recorded less often than in women.

Antibiotics in the treatment of disease

Before prescribing medications, it is necessary to exclude the presence of concomitant infections caused by decreased immunity due to exposure to chlamydia. Additionally, an analysis of the sensitivity of bacteria to the antibiotic is required.

Antibiotics for chlamydia in women and men are selected the same, the duration of therapy is from 14 to 30 days.

In the chronic form, a repeat course is often required after a period of time when the pathogens enter the active reproduction phase.

The need also arises if the dosage of the drug is insufficient during the first treatment: it does not kill bacteria and increases their resistance to the drug. Symptoms may subside for a while, creating a false appearance of recovery.

Later, the exacerbation will recur, but the previous remedy will be ineffective; a medicine with a different active ingredient is needed.

Effective drug classes

To combat chlamydia, antibiotics are needed that penetrate the cell. Three groups are used:

Macrolides

The choice depends on the individual characteristics of the body and the sensitivity of infections.

Amoxiclav ® for chlamydia

A representative of the penicillin group of semi-synthetic origin. Belongs to the group of inhibitor-protected penicillins (amoxicillin ® + clavulanic acid). It has a wide spectrum of action, but is ineffective against intracellular pathogens.

For chlamydia, it can be prescribed as an additional antibiotic only if a streptococcal infection is associated. However, Amoxiclav ® should not be combined with aminoglycosides. The drug is suitable for pregnant women, but a nursing woman should not take it: amoxicillin passes into breast milk in high concentrations.

Ofloxacin ® for chlamydia

The drug belongs to fluoroquinolones, its advantage: the sensitivity of strains resistant to other drugs. It has good bioavailability; the rate of absorption is not affected by food (with the exception of very fatty foods and milk).

It is not combined with antacids, as they negatively affect the absorption of the drug. If necessary, they can be taken a few hours after Ofloxacin ® .

To combat the infection, tablets or injections are prescribed, which have the same bioavailability and are interchangeable without changing the dosage. Compared to Ciprofloxacin ®, the drug is better combined with other medications and can be used in complex therapy. Not prescribed for children under 18 years of age, pregnant women and during lactation, as well as patients with liver kidney pathologies, individual intolerance to fluoroquinolones, etc.

Erythromycin ® in the treatment of chlamydia

It belongs to macrolides, is able to stop the proliferation of pathogens, and when consumed in high doses, accumulates in tissues and has a bactericidal effect.

It is highly effective against a number of pathogens and can be used as part of complex therapy, since it combines well with antibacterial agents of other groups. For chlamydia, it is used orally in tablet form.

Considered safe for pregnant women and children from birth. Disadvantages include frequent incidence of gastrointestinal adverse reactions and the requirement for four doses, which is more difficult to comply with.

At the moment it is rarely used, preference is given to another macrolide - azithromycin ®.

Ciprofloxacin ® in the fight against chlamydia

It has a bacteriostatic effect, stopping the proliferation of pathogens, and has a bactericidal effect.
It accumulates in tissues in high concentrations and is suitable for combating mixed urogenital infections.

Due to genomic mutations, there are cases of chlamydia resistance to ®. Like other representatives of the fluoroquinolone group, it has a damaging effect on the growth of cartilage tissue, therefore it is contraindicated in children under 18 years of age, women during pregnancy and breastfeeding.

It is poorly tolerated by patients and often causes side effects from treatment.

Macropen ® for pregnant women with chlamydia

The drug belongs to macrolides and acts by disrupting the process of division and regeneration in pathogenic cells. It has a wide spectrum of action and is used for mixed infections, when other pathogens are detected along with chlamydia. They remain sensitive to ® for a long time.

The antibiotic is effective against mycoplasmosis and chlamydia; it can be used in pregnant women (at 20 and 30 weeks) and children over 3 years of age. Macropen ® in the form of a suspension is acceptable for therapy in newborns.

It is contraindicated in case of liver failure and individual intolerance. With long-term use, it is necessary to monitor the level of liver enzymes.

Klacid ® in the treatment of chlamydia

Macrolide type drug with clarithromycin ® as an active ingredient. It fights a number of diseases and is equally effective against intra- and extracellular pathogens. Rarely used in combination with other drugs, because it is incompatible with many drugs.

Contraindications include pregnancy and breastfeeding. Prescribed with caution for liver pathologies. For children, the drug is prescribed in the form of a suspension.

Tetracycline ®

Rulid ®

It belongs to the new generation of macrolides, is active against most urogenital diseases, and equally effectively affects foci of infection of various locations. Its advantages: the ability to accumulate evenly in tissues and liquids, the possibility of once a day.

It is quickly absorbed into the gastrointestinal tract, the maximum concentration of the active substance is observed already 20 minutes after administration. Used when the disease is combined with ureaplasmosis. Contraindicated in nursing women, during pregnancy, and children weighing less than 40 kg.

Rules for taking antibiotics

The treatment regimen prescribed by the doctor must be followed. Also follows:

• Take the medicine at the same time to maintain the desired concentration of the active substance in the cells. Its reduction can cause addiction in pathogenic microorganisms and increase their resistance.
• Avoid alcohol, spicy foods, and follow a diet.
• Avoid overexertion, which reduces the body's defenses.
• Avoid sexual contact until complete recovery, otherwise re-infection is possible.
• Treatment should be carried out simultaneously with a sexual partner.
• Get re-tested after treatment.

Both partners must complete the course, even if one does not have acute symptoms. Therapy is often supplemented with antifungal and immunostimulating agents. If there are problems with the liver, hepatoprotectors may be prescribed to support it.

Alternative Treatment Options

In the fight against chlamydia, you can use anti-inflammatory herbs that have a bactericidal effect. But their effect is weak, and long-term use is required for possible recovery. If the body is severely weakened, medicinal infusions and preparations will be ineffective. Drug therapy can be combined with folk remedies, subject to consultation with a doctor.

When is it appropriate to use antibiotics?

Treatment should be immediate when a pathogen is detected. Chlamydia can be asymptomatic for a long time. More often, patients seek help in the acute phase of the disease, with pronounced symptoms.

The most dangerous is the chronic type, which is characterized by the transition of the pathogen to the L-form, which is insensitive to antibacterial therapy.

Chlamydia can cause such severe complications as Reiter's disease (urethritis, conjunctivitis, reactive arthritis), urethral structures, orchiepididymitis, chronic prostatitis, endometritis, salpingo-oophoritis, etc.

Over time, they can inhibit immune blood cells, leading to chronic inflammation of the pelvic organs, male and female infertility.

Antibiotics are used against chlamydia and in pregnant women to avoid complications (including fetal death) and possible infection of the child during childbirth. They are prescribed by a doctor after confirmation of the diagnosis by laboratory tests. In rare cases, it is possible to monitor a patient with a low level of antibodies in the blood, which depends on the progression of the disease. Therapy is most effective in acute forms of infection, when bacteria are most sensitive to drugs.

Chemotherapy for urogenital chlamydia in women and men is not as simple as it seems at first glance. And the selection of the optimal antibiotic against chlamydia is the key to successful treatment of the disease. Today, the pharmaceutical market is filled with many antibacterial drugs.

Some of them have a wide spectrum of action, while others, on the contrary, are specific to pathogenic microorganisms. One way or another, the choice is large, and you should navigate it correctly.

– one of the most common sexually transmitted diseases (go hand in hand with it). For this reason, special attention is paid to the treatment of this infection in men and women. Despite this, analysis of the disease in the early stages is almost impossible. In the later stages, the situation is easier, but the risk of associated complications and the difficulty of therapy increases.

The treatment regimen and choice of antibiotic depends on what form of urogenital chlamydia we are dealing with. According to one classification, there are 2 forms: infection of the lower and upper sections. The latter is also called the “complicated form”.

Selecting chemotherapy based only on these parameters is not enough. Other factors need to be taken into account:

• Duration of infection;
• The presence of chlamydia in a sexual partner.

The first stems from the fact that when a microorganism stays in a person for a long time, a stable relationship arises between them. In addition, prolonged infection and inadequate chemotherapy can lead to persistence of the pathogen, which requires a special approach in choosing an antibiotic.

Diagnostics

Before treating an infection, it must be diagnosed. Modern laboratory analysis can help with this. Depending on the symptoms, urine, feces are given, or a scraping is taken and research is carried out. There is a serological analysis, ELISA, PCR, bacteriological analysis (cultural method).

Each method has its pros and cons: one analysis is long, another is quick, the third does not provide information about the activity of ureaplasma, and the fourth is the opposite... One way or another, you need to get tested.

Treatment

There are many publications on, but even a modern doctor has a hard time navigating such an abundance of literature. Drugs for the treatment of chlamydia are divided into several groups: macrolides, tetracyclines and fluoroquinolones - available in tablets and injections. The name comes from their chemical structure.

It is clear that their pharmacological effect differs significantly. Other groups of antibiotics are at least powerless, since the microorganism has developed immunity to them. It is worth noting that today there is no unified method for determining the resistance of chlamydia; the accumulated data is primarily the result of clinical experience.

Treatment of lower chlamydia

Tetracyclines are the prototype of broad-spectrum antimicrobial drugs. They have a bacteriostatic effect against many G+ and G- bacteria, including various anaerobes, rickettsia, chlamydia, mycoplasma and L-forms, as well as some protozoa, such as amoebas. Equal concentrations of tetracyclines in body fluids and tissues have approximately the same antimicrobial activity.

The differences between individual drugs are not significant. Variations in clinical effectiveness are due largely to the absorption, distribution, and elimination of specific drugs. However, the sensitivity of different strains of certain types of microorganisms to drugs of this series varies.

Tetracyclines, accumulating in the body, disrupt the interaction of structures lying inside, which suppresses protein synthesis and subsequently leads to inhibition of cell growth and development. The selectivity of protein synthesis by microorganisms is explained by the low ability of mammalian cells to concentrate tetracyclines. It should be noted that tetracyclines are the main weapon in the treatment of chlamydia.

The first line drug is. Dosage form – capsules or tablets. It is used orally during meals with plenty of liquid. Prescribe 100 mg of the drug twice a day for two weeks.

The first loading dose is 200 mg. In 90-100% of cases, the infection can be cured. Combined with its low cost, this gives the drug a great advantage over tetracycline and metacycline, which are used as an alternative.

In addition to these benefits, tetracycline is highly bioavailable, better absorbed, and has a long half-life. It is a known fact that antibiotics of the tetracycline group are capable of binding to divalent metals, which significantly reduces the bioavailability of the drug.

Doxycycline does not have this disadvantage, and the patient does not need to be prescribed a special diet. Tetracyclines are contraindicated in children and pregnant women, and persons suffering from renal failure. Side effects: gastrointestinal disorders, allergies, photosensitivity.

Macrolides are considered the most effective group of antibiotics. First-line drugs include, a single use of which provides a high concentration of the drug in the tissues. In this case, the antibiotic remains in places of inflammation for more than seven days.

The use of alternative antibiotics, as injections or tablets, is allowed: spiramycin, roxithromycin, erythromycin, josamycin, clarithromycin, midecamycin or amoxicillin. Erythromycin is inferior to the presented drugs in terms of pharmacokinetics, digestibility and frequency of administration.

Side effects: similar to tetracyclines, plus liver disorders (jaundice, increased transaminase activity and cholestasis)

Fluoroquinolones are the most studied group of antimicrobial agents. Many effective drugs have been synthesized, but not all of them exhibit significant activity against Chlamydia trachomatis. Antibiotics of the III-IV generations can be noted, which have greater activity and frequency of administration compared to previous analogues.

Despite all the promise of fluoroquinolones, modern guidelines highlight one antibiotic that is most active against chlamydia - ofloxacin. Unlike others, it is 100% bioavailable. An antibiotic of 400 mg is used 2 times a day for 10 days. Other possible drugs with a similar dosage frequency: pefloxacin, lomefloxacin, levofloxacin, moxifloxacin.

After fluoroquinolone therapy, there is a high probability of relapse of chlamydia, so drugs in this group are not included in the first line. Contraindications: children under twelve years of age and pregnant women, persons with impaired renal and liver function. Side effects: gastrointestinal disorders (nausea, vomiting, diarrhea), allergic reactions, inflammation and destruction of tendons, photosensitizing effect.

Treatment of the upper sections

For chlamydia of the upper genitourinary tract, the same antibiotics are used - they take pills or give injections, but in a shorter course (up to 3 weeks). In this regard, azithromycin is very convenient, which is used in 3 courses of 1 g per week.

It is for this complex treatment of all possible infections that erythromycin is used. In medicine, this type of therapy is called a syndromic approach. Treatment of chlamydia with erythromycin is based on neutralizing the division of reticular bodies of the virus under the influence of the active substance of the drug. The progressive activity of erythromycin is characterized by the number of minimum inhibitory concentrations on pathogens. It accumulates in large quantities in the kidneys, liver and spleen. Bioavailability is good and amounts to 30-40%.

Erythromycin for chlamydia is often prescribed as part of multicomponent treatment regimens, along with other drugs tetracycline, macrolide and fluoroquinolone groups. It significantly enhances the action of cephalosporins, tetracyclines and penicillins, which have too little activity and can allow infectious persistence.

Treatment of chlamydia with erythromycin is several times more effective than the use of azithromycin, for example, sumamed, for the same purpose. The only drawback of the medicine is that in some cases it is difficult to tolerate by the body, which is associated with the occurrence of dyspeptic imbalance. The course duration of treatment is 7-9 days, depending on the stage and form of the disease. The pharmacological form of the drug is tablets, which should be taken 500 mg twice a day. This medication should be used for the treatment of chlamydia only as prescribed by the attending physician, since the main active ingredient can provoke acute allergic reactions in 10% of cases of use. For local treatment of infectious inflammation, an erythromycin-based ointment is recommended.

The drug is contraindicated for use during breastfeeding, as it easily passes into breast milk. It is also not compatible with taking hormonal contraceptives, as it reduces their effectiveness several times.

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Features of the treatment of chlamydia.

• The sooner it starts chlamydia treatment, the more effective it is.
• It is imperative that all sexual partners of the patient be examined and, if chlamydia is detected, treated (even in the absence of symptoms).
• With inadequate antibiotic therapy for chlamydia, the disease may progress to a chronic stage with the formation of antibiotic-resistant L-forms.
• There is no single treatment regimen for chlamydia. Antibiotic therapy is mandatory. And the use of immunomodulators, enzymes, hepatoprotectors and other drugs is considered individually.
• Good nutrition and a healthy lifestyle are essential for recovery. During the treatment period, it is not recommended to engage in sexual activity; drinking alcohol is strictly prohibited. It is necessary to temporarily avoid spicy food. You should also refrain from excessive physical activity.

In the treatment of chlamydia, 3 main groups of drugs are used.

1. Antibiotics: tetracyclines, macrolides, fluoroquinolones.
2. Immunomodulatory drugs.
3. Systemic enzyme therapy drugs.

1. Antibacterial drugs.
When prescribing antibiotics for chlamydia, the following circumstances must be taken into account:

Today, in the treatment of chlamydia, it is most rational to use 3 groups of antibiotics: tetracyclines, macrolides, fluoroquinolones.

a) Tetracyclines
Doxycycline (vibramycin, unidox solutab). The first dose is 0.2 g, then for two weeks 2 times a day, 0.1 g. The course should be 2.5 - 4 g of the drug. Disadvantages: side effects: nausea and vomiting, rarely - impaired bone formation, defects in tooth enamel. The use of tetracyclines is contraindicated during pregnancy and breastfeeding and in children under 14 years of age. Unidox Solutab and vibramycin are better tolerated than doxycycline.

b) Macrolides.
Macrolides are the safest antibiotics. They have a minimum of side effects and are well tolerated. All of them are active against treponema pallidum, mycoplasma, ureaplasma, and gonococcus, which allows them to be used for mixed infections. The effectiveness of macrolides, according to experts, reaches 91-97%.

• Erythromycin. Its effectiveness is 85% - 95%. Disadvantages: severe dyspeptic disorders and the need for 4 doses. Use 500 mg 4 times a day for 2 weeks.
• Vilprafen (josamycin). It is considered the most effective in most cases and the safest. For a fresh form of chlamydia - 500 mg 2 times a day for 2 weeks. For chronic - 500 mg 3 times a day for 4 weeks. The initial dose is 1 g once. Resistance to josamycin develops less frequently than to other antibiotics from the macrolide group.
• Rovamycin (spiromycin). Prescribed 3 million units 3 times a day for 2 weeks.
• Rulid (roxithromycin). Use 150 mg 2 times a day for 2 weeks.
• Macropen (midecamycin). Prescribed 400 mg 3 times a day for 2 weeks.
• Sumamed (azithromycin). Prescribed according to the following scheme: the first day 1 g once, then 0.5 g for 7 days. The course is designed to take 3 g of the drug. Recently, resistance of chlamydia to sumamed has been noted. Therefore, you can replace it with Chemomycin, the active ingredient of which is also azithromycin.
• Klacid (clarithromycin). Take 250 mg twice daily for 2-3 weeks.

During pregnancy, it is allowed to use erythromycin 500 mg 4 times a day for 2 weeks or rovamycin 3 million units 3 times a day for 2 weeks.

c) Fluoroquinolones.
They are less effective than macrolides and tetracyclines. However, they are active against gonococcus, mycoplasma, and gardnerella. Contraindicated during pregnancy, as well as in children under 14 years of age. They have a significant number of side effects.

• Ofloxacin (zanocin, tarivid) 200 mg after meals 2 times a day for 10 days.
• Abactal (pefloxacin). Fresh and uncomplicated chlamydia - 400 mg twice a day for 1 week. Chronic form – 10-12 days.
• Maxaquin (lomefloxacin). For a fresh, uncomplicated form - 400 mg once a day for a week. For chronic use - 400-600 mg/day, course 28 days.
• Tsiprobay, Tsiprolet, Tsifran (ciprofloxacin). For fresh, uncomplicated forms of chlamydia, 500 mg is taken at the first dose, subsequent doses are 250 mg twice a day for 7 days. For chronic and complicated forms - 500 mg twice a day for 12 days.

2. Immunomodulatory therapy.
With chlamydial infection, suppression and changes in the state of the immune system occur, which creates the basis for the chronicization of the process. Therefore, during treatment it is necessary to act not only on the pathogen itself, using antibiotics, but also to increase the body’s resistance, strengthening the immune system. However, immunomodulators are not always used - in each specific case individually.

The following immunomodulators are used:

• Immunomax. The recommended dose for adults is 100-200 U IM 1 time/day. Course of treatment – ​​6 injections on days 1, 2, 3, 8, 9, 10 of treatment.
• Polyoxidonium. It is used to treat atypical forms of chlamydia in cases of impaired immunological status. Polyoxidonium increases the formation of antibodies and the body's immune resistance. Used in a course of 10 injections of 6 mg every other day.
• Erbisol. 2 injections per day: 2 ml in the morning at 8 o’clock and in the evening at 22 o’clock, course 20 days. It also protects the liver, being a hepatoprotector.

3. Systemic enzyme therapy.
Preparations for systemic enzyme therapy normalize the permeability of cell membranes in areas of inflammation. Thus, higher concentrations of antibiotics penetrate into the cell at lower doses. They enhance the effect of antibiotics, increasing their concentration in the blood serum by 20-40%. They block mechanisms that trigger allergic (including to medicinal drugs) and autoimmune reactions, accelerate the elimination of toxins, and provide decongestant and analgesic effects.

Preparations:

• Wobenzym. Prescribed 3 tablets. 3 times a day 30 minutes before meals, with a glass of water, course 2-4 weeks.
• Phlogenzyme. Prescribed 2 tablets. 3 times a day 30 minutes before meals, with a glass of water, course 2-4 weeks.

4. Hepatoprotectors.
The prescription of this group of drugs is due to the long-term use of antibiotics, which are metabolized in the liver, creating an increased load on it. Moreover, tetracyclines and fluoroquinolones are hepatotoxic and can cause liver damage. Preparations:

• Essentiale - 2 caps. 2-3 times a day with meals, course 2-4 weeks
• Karsil - 70 mg 3 times a day after meals, course 2-4 weeks
• Legalon - 70 mg 3 times a day after meals, course 2-4 weeks

5. All other groups of drugs are used individually.
If dysbacteriosis has developed, use eubiotics Bifidumbacterin, Acylact, etc.
Vitamins and antioxidants may also be prescribed.

How to make sure that you are cured?
The disappearance of clinical manifestations of chlamydia after a course of treatment is not proof that the body has gotten rid of the pathogen. Sometimes the use of antibiotics leads only to local improvement. Therefore, a month after completion of antibiotic therapy, it is necessary to conduct control tests. If chlamydia is not found, then repeated tests are carried out after a month. If after a month the tests for the presence of chlamydia are negative, only then will it be possible to talk about the effectiveness of the treatment.

The following laboratory tests are used:

• ELISA for IgA - there is no IgA during recovery.
• PCR – upon recovery, PCR is negative.
• All other laboratory diagnostic methods are uninformative.