Sumamed in the treatment of gonorrhea. Features of the treatment of gonorrhea with one tablet

Many patients are wondering how to take Sumamed for gonorrhea. Sumamed is a broad-spectrum antibiotic that can be taken in the treatment of a number of diseases caused by various microorganisms and protozoa.

How does Sumamed work?

The drug has a bacteriostatic effect, that is, it is able to completely or partially stop the growth and reproduction of microorganisms. This drug belongs to the group of macrolides. Macrolides are antibiotics with the least toxic effect and, as a rule, are safely tolerated by patients undergoing treatment with Sumamed.

This drug effectively affects the following types of microorganisms:

• aerobic, which require oxygen to survive;
• anaerobic, which require an oxygen-free environment to function.

In some cases, treatment is complicated by the fact that the bacteria listed above develop resistance to this drug. This happens especially often if the treatment regimen prescribed by the doctor and the dosage of Sumamed are violated.

The main active ingredient of the remedy is. This substance slows down the growth and reproduction of bacteria due to the ability to inhibit protein synthesis of microbial cells. If the treatment regimen involves a high dosage of azithromycin, then this substance has a bactericidal effect.

How to take the drug?

What are the indications for the use of Sumamed? Among the bacteria that this drug acts on are microorganisms that cause:

• respiratory tract infections, including pharyngitis, tonsillitis, otitis media, bronchitis, pneumonia;
• infectious diseases of the stomach and duodenum;
• skin infection, including acne, dermatoses;
• urinary tract infections such as urethritis, cervicitis, gonorrhea.

It is necessary to treat gonorrhea, or gonorrhea, in a complex way, including antibiotics. Combining antibiotics prevents the development of bacterial resistance and successfully treats the patient for gonorrhea.

With gonorrhea, Sumamed is included in the treatment regimen with the following drugs:

• Ceftriaxone;

The therapeutic effect of the drug largely depends on the timeliness of the treatment of the disease. As a rule, the treatment of gonorrhea with antibiotics, including Sumamed, lasts from 1 week.

It must be remembered that all the presented schemes can be used for treatment only as prescribed by a doctor. All recommendations are for informational purposes only and cannot be taken as a guide to self-treatment.

Treatment of gonorrhea with Sumamed in most cases is carried out on an outpatient basis.

The course, scheme and dosage of antibiotics is prescribed based on the severity of the disease and the individual tolerance of the drugs.

Contraindications

This drug has a number of contraindications that must be considered when prescribing and taking:

1. Violations of the liver and kidneys. In such a situation, the drug is taken with caution under the supervision of a doctor, or even stopped taking.
2. Pregnancy or breastfeeding. The therapeutic drug is dangerous in the 1st trimester of pregnancy, and it can be taken in the 2nd and 3rd trimesters only on the advice of doctors if the intended benefit to the mother is higher than the possible harm to the fetus.
3. In cases of urgent need to take the drug during lactation, breastfeeding is stopped.
4. High sensitivity to the macrolide group of antibiotics. Simultaneous reception with such means as Ergotamine and Dihydroergotamine is prohibited.

It is impossible to overestimate the treatment of gonorrhea with one pill when it comes to the health of the patient. The number of patients taking drugs from the azalide group once is steadily growing.

This is facilitated by the high efficiency of such means as:

• azithromycin;
• roxithromycin;
• sumamed.

Principles of treatment for gonorrhea

For effective therapy, it is necessary to determine the sensitivity of the pathogen to antibiotics. Significant assistance to the patient is provided by laboratory data. The doctor prescribes a treatment aimed at ridding the body of germs.

Symptomatic drugs reduce the manifestations of the disease: pain, spasms. Pathogenetic treatment prevents the further spread of microbes in the mucous membranes of organs. Therapy is carried out after consultation with a doctor (under his guidance) in order to avoid complications.

In the acute form of the disease, the doctor prescribes drugs for the treatment of gonorrhea after receiving these tests. Antibiotics act on strains and are effective when taken in a course.

In the chronic form of the process, drugs that increase the patient's immunity and local antiseptics have a therapeutic effect.

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Effectiveness of antibiotics in the acute form of the disease

Treatment of gonorrhea is carried out successfully with the help of antibacterial drugs. Cephalosporins with course use give the best results. Antibiotics of other groups are often prescribed for the treatment of patients with allergic reactions, which are effective in the uncomplicated course of the disease.

Urogenital gonorrhea is treated with gentamicin plus single dose erythromycin, or gemifloxacin and azithromycin at the dose recommended by the physician. A single-dose regimen of antibiotics is effective in killing gonococci.

The drug is prescribed depending on the resistance of the strain in the region. A single dose of the drug causes the death of microorganisms, but before starting treatment, the patient's sensitivity to the active substance should be determined. With the development of resistance to penicillin, it is necessary to treat the disease with the use of ciprofloxacin and cefixime. An effective antibiotic is amoxicillin, which is prescribed with probenecid.

Treatment of gonorrhea with suspected simultaneous infection with syphilis is carried out with ciprofloxacin or azithromycin.

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Azalides and their properties affecting the development of gonococcus

Bacteriostatic antibiotics have a wide range of effects on pathogenic microorganisms. Gonorrhea is treated with:

• sumamed;
• Azinoma capsules;
• azithromycin.

Azalides are well absorbed in the body, entering the patient's blood plasma. The drugs penetrate into the cells of the pathogen and disrupt protein synthesis in them, slowing down the growth and reproduction of microorganisms.

Azalides are highly effective substances that destroy cocci, gram-negative pathogens, pale spirochete. When prescribing drugs of this series, the doctor takes into account their antagonism to cephalosporins, penicillins. Azalides quickly and intensively penetrate the tissues of the body and are the drugs of choice for venereal diseases. The use of the drug contributes to the activation of protective mechanisms in the patient's body and causes the death of the pathogen.

The active substance of azalides is concentrated in fibroblasts, and then released in the foci of infection. The drugs usually do not cause adverse reactions in patients with gonorrhea. Medicines from the azalide series are prescribed to elderly patients without special dose adjustments.

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Azithromycin is the best of the fast-acting antibiotics

The doctor prescribes a one-tablet regimen for gonorrhea using azithromycin. The drug is easy to use. The patient during treatment is asked to stop sexual activity for the duration of therapy. Treatment with azithromycin is carried out to persons in contact with a sick gonorrhea. The antibiotic has a number of advantages: it is quickly absorbed, stable in an acidic environment, and actively affects gonococci. The drug is not recommended for patients with concomitant diseases (liver, kidney), children under 3 years old, nursing mothers.

Gonorrhea is treated with a single dose of the drug in doses prescribed by the doctor. Chronic forms of the disease involve the use of azithromycin in a single dose (with its subsequent adjustment within 4 days). The drug is combined with antimicrobial agents, but has low activity in the treatment of venereal lesions of the pharynx. Treatment of children and pregnant women with the drug is unacceptable, because multiple side effects develop: diarrhea, changes in renal enzymes.

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How to be treated with roxithromycin?

A semi-synthetic drug from the group of macrolides is recommended for the treatment of gonorrhea in a hospital setting. The medicine is taken once orally. The dose is sufficient to ensure the complete death of gonococci. Gonorrhea tablets are quickly absorbed from the stomach into the bloodstream, disrupting protein synthesis inside the microbial cell. Do not prescribe the drug to pregnant women and nursing mothers.

Chronic and gonorrheal urethritis, as well as mixed forms of the disease, which are difficult to treat, require the rational use of antimicrobial drugs. The effectiveness of roxithromycin has been proven in the treatment of individuals with uncomplicated gonorrhea. The causative agent of the disease is inside the cells and is inaccessible to many drugs. Roxithromycin penetrates into the cell, which contains the gonococcus. The drug binds to plasma proteins and is destroyed in the patient's liver. Tablets can not be crushed, divided into parts. The medicine is taken separately from food, drinking plenty of water. The doctor determines the dosage of the drug depending on its tolerance to the patient.

Gonorrhea pills and injections are the main ways to treat a sexually transmitted disease. Such drugs are most often represented by penicillins, tetracyclines, cephalosporins, sulfonamides and fluoroquinolones. Only a specialist can determine which antibiotics can be used individually for each patient.

Treatment of gonorrhea with one tablet

There is a considerable range of antibacterial drugs against gonorrhea, which involve taking in the amount of one tablet. Treatment with the following antibacterial agents is widely practiced:

1. Azithromycin.
2. Roxithromycin.
3. Sumamed.

In acute gonorrhea, patients are prescribed a single dose of 2 g of azithromycin, or divide this dose into 2 doses. In the chronic form of the disease, only a single dose is recommended.

This tool has a long list of side effects, is contraindicated in chronic diseases of the liver and kidneys, during breastfeeding. In the treatment of venereal lesions of the pharynx, the drug is not used due to low efficiency.

The dosage of roxithromycin is determined by the doctor individually. The drug is taken separately from food, not divided into parts. Roxithromycin is indicated for the treatment of uncomplicated and mixed forms of the disease, which are difficult to treat with other means.

Sumamed is a modern drug, the most effective in the fight against strains prone to permanent mutations. The dosage of the antibiotic is determined depending on the severity of the disease and the individual tolerance of the drug.

After using 1 tablet of these drugs, patients disappear most of the typical symptoms of gonorrhea - burning, itching, discharge with pus. The appointment of such potent agents should only be performed by a specialist.

Necessary examinations before prescribing the drug

Before using the above drugs, the doctor must conduct a diagnosis, including a detailed examination of the patient and testing for gonococci. Making a correct diagnosis is preceded by a study of the patient's history and a series of studies:

• bacterioscopic;
• bacteriological;
• molecular biological tests (PCR, enzyme immunoassay).

A prerequisite for proper diagnosis is the delivery of a smear for gonorrhea. In women, the biomaterial is taken from the cervix, vagina, urethra, in men - from the urethra.

Gonorrhea pills for men

If gonococcus is detected, the treatment of the disease in men is carried out using:

1. Penicillins.
2. Cephalosporins.
3. Macrolides.
4. Fluoroquinolones.

Penicillins help to suppress the amino acid and vitamin metabolism of pathogens, disrupt the development of cell walls. The effectiveness of these drugs is quite high, which allows them to be used as the main drugs.

The most commonly prescribed drugs in this group include ampiox, amoxicillin, augmentin, oxacillin. The disadvantage of using penicillins is the likelihood of side effects in the form of headache, nausea, and malaise.

Cephalosporins are antibiotics with a wide spectrum of action and high bactericidal activity. The most commonly prescribed ciprofloxacin, tseporin. The latter drug is used in cases of severe forms of infection.

Macrolides are the least toxic among modern antibiotics, and rarely show side effects on the patient's body. For gonorrhea in men, erythromycin, macrofoam, amimicin are used.

Fluoroquinolones are among the most powerful drugs with a pronounced effect aimed at inhibiting the vital activity of pathogens. With gonococcal infection, ofloxacin, norilet, tavanic, pefloxacin will become effective.

The treatment regimen is individual in each case. How many days to take the selected drug - only a specialist decides.

Many of these drugs also treat syphilis. This disease belongs to a sexually transmitted disease, but it is more severe. In the initial stage, the patient has such a symptom as the development of ulcers, at a later stage, hair may fall out, unbearable bone pains appear.

Preparations for women

If a woman is sick with an acute form of gonorrhea, treatment is carried out using the above groups of drugs. In tablets, azithromycin, cefixime, doxilan, doxycilin, sinersul, rifampicin are prescribed.

Often in female patients, gonorrhea occurs in parallel with other sexually transmitted diseases. In more than 30% of cases, it is combined with chlamydia, which requires the appointment of the following drugs:

• ornidazole;
• metronidazole;
• tinidazole.

If candidiasis is detected, ketoconazole, fluconazole are additionally prescribed. If gonorrhea and cytomegalovirus are combined, treatment is supplemented with herpevir, acyclovir, cycloferon.

Additional treatment of gonorrhea in women is carried out with the help of douching (potassium permanganate, miramistin solution, silver nitrate). Also locally applied drugs in suppositories (terzhinan, hexicon, betadine, mykozhinaks).

Intramuscular injections

Intramuscular injections at an early stage of gonorrhea are designed to help quickly get rid of a sexually transmitted disease. There are drugs that can defeat gonorrhea as a result of just one injection. The list of those includes:

1. Zinacef.
2. Modevid.
3. Netromycin.
4. Piprax.
5. Novosef.

Other drugs for injection can cure an acute head start of gonorrhea within 3-7 days. In men, longacef, ketocef, cefotaxime are used for this purpose. In most cases, the injection is quite painful, requiring the drug to be diluted with lidocaine prior to administration.

For the treatment of women, injections of ceftriaxone, bicillin 3 or 5, benzylpenicillin, rifogol, rocefin will be effective. Injections with any drugs should be performed deep enough, into the region of the upper quadrant of the gluteus maximus muscle (as shown in the photo).

Antibacterial therapy for gonorrhea

Treatment of acute gonorrhea with injections and tablets is the most effective way to fight infection in patients of various categories. It is important to remember that no folk recipe is able to provide equivalent results. Any home treatment can only be considered as an auxiliary.

Among the equally effective drugs for men and women include:

• ampicillin;
• ampiox;
• sulacillin;
• spectinomycin;
• bactrim;
• trichopol.

During antibiotic therapy, it is important to consider the possible development of allergic reactions to gonorrhea drugs. To avoid their appearance, half an hour before the introduction of an antibiotic, the patient is recommended to take antihistamines (1 tablet of diphenhydramine, pipolfen, tavegil).

Features of the use of popular antibiotics

Ampicillin is an effective semi-synthetic antibiotic prescribed for the treatment of the acute form of the disease in male and female patients. The dosage in this case is the same - 3.0 g (0.5 g every 4 hours during the day, and every 8 hours at night). In complicated forms of gonorrhea, the course dose can be increased to 10.0 g.

Ampiox is a mixture of ampicillin and oxacillin. If there is acute and subacute gonorrheal urethritis in men and acute gonorrhea in women, the drug is recommended to drink 0.5 g every 4 hours 5 times a day. The duration of the course is 2 days.

Sulalicin is an effective drug administered intramuscularly at a dose of 1.5 g with a break of at least 8 hours. Spectomycin is a strong antibiotic used to treat acute gonorrhea without complications. The injection is done intramuscularly, once. The dose for men will be 2.0 g, for women - 4.0 g.

Bactrim should be taken in the amount of 4 tablets every 8 hours. For a full course of treatment of acute gonorrhea, 20 tablets will be sufficient.

Trichopol is taken 1 tablet three times a day. The course is at least a week.

Chronic gonorrhea responds well to treatment with bicillin. It also provides for taking drugs to increase the patient's immunity, and the use of local antiseptics.

After the exacerbation is removed and the course of antibiotics is completed, patients are often prescribed physiotherapy. It may include procedures with ultrasound, enema, electrophoresis, phonophoresis, darsonvalization.

The cost of medicines against gonorrhea

Medicines for gonorrhea can be bought at every pharmacy, and they can be quite inexpensive. The price of the most commonly prescribed medicines is shown in the table below:

The cure for gonorrhea in men and women depends on how the disease proceeds and at what stage it is found. It is necessary to start treatment immediately, since gonorrhea can become the causative agent of more serious diseases.

It is necessary to treat this disease with antibiotics that belong to the penicillin group. If a person has intolerance to these drugs, then they are replaced with sulfanilamide.

Treatment regimen for gonorrhea

If you are not distinguished by a constant change of sexual partner, then you are unlikely to know that gonorrhea is a very dangerous disease that, if not properly and untimely treated, can lead to infertility.

Treatment methods are reviewed and supplemented by venereology specialists. To date, there are some principles for the treatment of this disease.

If the disease proceeds in an acute form, then the treatment looks like this: cyprobay half a gram once or nolicin 0.8 grams is also a single use. In the case of the chronic stage, abaktal should be taken at 0.6 g. within 4 days.

Treatment of gonorrhea with pills

Treatment of gonorrhea with pills is effective only when administered correctly. Today you can easily find many drugs that help get rid of gonorrhea, but not all are effective. Why?

This happens because each person has an individual disease and it is impossible to prescribe the same drugs to everyone.

The most effective drug are penicillin antibiotics. However, it is worth noting that they are strictly prohibited for pregnant and lactating women.

gonorrhea pills treatment- Antibiotics are usually prescribed for treatment. They are able to quickly and effectively neutralize the infection and remove it from the human body. Ampicillin is excellent for fighting this disease. It is easily and quickly absorbed inside and starts the fight.

If the disease is already progressing, then the medicine should be taken every few hours. In the chronic stage, the dose is increased on the recommendation of the attending physician - venereologist. If positive dynamics is not observed, then the patient is prescribed other drugs.

Treatment of gonorrhea with one injection - myth or reality

Before deciding to get rid of gonorrhea with one injection, you should visit a competent doctor and pass the necessary tests. Since this approach will only help those patients in whom the disease has appeared recently, and there are no concomitant infectious diseases.

Today, medicine is actively developing, and it is really possible to get rid of gonorrhea with one injection. For this, the infection must have occurred recently and the disease must not be chronic.

To this end, you need to visit a venereologist and become healthy again!

This is a modern, fast and effective method of treating gonorrhea today. However, it does not apply to the disease in the chronic stage.

Treatment of gonorrhea with sumamed

Treatment of gonorrhea with sumamed is the latest remedy for venereal diseases. Its peculiarity is that the drug has an instant effect and is applied for a short period of time.

The drug has been tested and is excellent in the treatment of gonorrhea. However, remember that only a venereologist can prescribe competent treatment, so you should not experiment on your health, as they can lead to serious complications.

Gonococcal infection: treatment, general information

Although long-acting penicillins (particularly benzathine benzylpenicillin) are effective for syphilis, they are not used for gonorrhea. Phenoxymethylpenicillin, semisynthetic penicillins, and first-generation cephalosporins are also not recommended for the treatment of gonorrhea. In 1993, the US Centers for Disease Control published new guidelines for the treatment of gonorrhea. They were developed with the following considerations in mind:

- simplicity and effectiveness of a single dose (injection) of the drug;

- a significant prevalence of strains resistant to penicillins (including ampicillin and amoxicillin) and tetracyclines (more than 30% of strains in the United States and more than 50% in developing countries);

- high frequency of combination of gonorrhea with chlamydia;

According to CDC recommendations (Table 150.1), adults with uncomplicated gonococcal urethritis, gonococcal cervicitis, gonococcal proctitis, or gonococcal pharyngitis are given one of the four most effective drugs (ceftriaxone, cefixime, ciprofloxacin, ofloxacin) once. At the same time, doxycycline is prescribed for the treatment of possible chlamydia for 7 days. Doxycycline can be replaced by azithromycin 1 g orally once: this regimen is highly effective and convenient, but more expensive. In addition, drug interactions between azithromycin and drugs prescribed for the treatment of gonorrhea have not yet been studied.

In 1997, fluoroquinolone-resistant strains of Neisseria gonorrhoeae were still rare in the US. An expected increase in the prevalence of such strains in the future will reduce the effectiveness of ciprofloxacin and ofloxacin, as has already happened in Southeast Asia (for example, in the Philippines, Malaysia, Hong Kong and Cambodia).

Azithromycin, 2 g orally once, is effective in gonorrhea, but has a pronounced side effect on the gastrointestinal tract.

Pregnant women with intolerance to cephalosporins for the treatment of gonorrhea are prescribed spectinomycin, 2 g / m once. Doxycycline is contraindicated during pregnancy, therefore, for the treatment of concomitant chlamydia, erythromycin or erythromycin stearate (500 mg orally 4 times a day for 7 days) or erythromycin ethyl succinate at an equivalent dose is prescribed instead. If the pregnant woman does not tolerate such high doses of erythromycin, the drug is prescribed 250 mg orally 4 times a day for 14 days. You can also use amoxicillin, 500 mg orally 3 times a day for 7-10 days.

Every patient with gonorrhea is required to undergo serological tests for syphilis and are offered to undergo an anonymous test for HIV infection. In the incubation period of syphilis (before seroconversion), combined treatment with ceftriaxone and doxycycline is effective; the effectiveness of cefixime has not been established, fluoroquinolones are ineffective. However, in itself, taking doxycycline for 1 week in many cases leads to a cure for syphilis in the incubation period. However, all gonorrhea patients with syphilis and those who have had sexual contact with a syphilis patient should receive additional treatment appropriate to the stage of syphilis.

Choosing quick antibiotics for gonorrhea in women and men

Gonorrhea is one of the most common sexually transmitted diseases today. It is transmitted mainly through sexual contact, although it can also be transmitted in everyday life: through hygiene items, common areas. Newborns become infected during childbirth, through the mucous membranes.

The disease is not only clinically manifested by extremely unpleasant symptoms, but can also cause severe complications (prostatitis, infertility). The only effective treatment is antibiotic therapy.

Antibiotics for gonorrhea in men and women

Antibacterial therapy is the only way to cure this STD. At the same time, when choosing treatment, doctors are guided not only by the social significance of the disease, but also by the risk of developing severe complications. According to international standards, the resistance of gonococci to the prescribed drug should not exceed 5%.

In this regard, the effectiveness of drug therapy is constantly monitored in all regions. The causative agent of gonorrhea has several mechanisms for the formation of resistance to antibiotics, so over time, generally accepted treatment regimens lose their relevance. At the moment, gonococci are sensitive to drugs such as ceftriaxone, ciprofloxacin, ofloxacin, and penicillin for gonorrhea no longer helps, like tetracyclines.

In addition, new strains are emerging that are also resistant to fluoroquinolones. In modern dermatovenerological practice, several antibiotics are used for the treatment of gonorrhea. At the same time, they are divided into main and reserve (the second group is assigned if the first is intolerable or ineffective). In addition, macrolides are used to prevent chlamydia as a concomitant infection.

Ceftriaxone

Ceftriaxone is a third-generation cephalosporin antibiotic with a wide spectrum of antibacterial action. Destroys the microorganism, preventing the synthesis of its cell wall.

It is characterized by the highest rates of bioavailability - absorbed by 100% - and low toxicity. The only contraindication to its use is individual intolerance to penicillins, cephalosporins and carbapenems.

In the antibiotic therapy of gonorrhea, Ceftriaxone is the drug of choice - that is, it is most effective against the pathogen of all possible. In addition to good tolerability and effectiveness, it has another undoubted advantage: the full course of treatment for an uncomplicated acute infection consists of just one injection.

Ciprofloxacin

It belongs to the group of antibiotics-fluoroquinolones that inhibit the biosynthesis of DNA of a bacterial cell. It acts bactericidal against gram-negative pathogens, causing additional destruction of the cell wall.

It is widely used in purulent inflammatory processes of various localization. Contraindicated in kidney and liver dysfunction, hypersensitivity, as well as persons under 18 years of age. Ciprofloxacin, like ceftriaxone for gonorrhea, is the drug of choice and is administered once orally.

Ofloxacin

Ofloxacin is another first-line antibacterial used to treat gonorrhea, a second-generation fluoroquinolone. Like other drugs of its group, it has a detrimental effect on microorganisms due to a violation of DNA synthesis.

Similarly, it has a rather high toxicity, as a result of which it is contraindicated in children and persons with hypersensitivity. For uncomplicated infections, one dose of Ofloxacin is taken by mouth.

Spectinomycin

A tricyclic antibiotic from the aminoglycoside class, which has a bacteriostatic effect on pathogenic bacteria.

Penetrating into the cell, it prevents the biosynthesis of the protein necessary for growth. It is active mainly in relation to gram-negative microorganisms, including gonococci. It is characterized by low toxicity and, accordingly, a small list of contraindications and side effects. With gonorrhea in an uncomplicated form, it is a reserve drug, and with an infection with complications, it is one of the main ones.

Cefotaxime

Intended for parenteral administration, the third-generation cephalosporin antibiotic has been successfully used to treat respiratory and urogenital infections.

Interferes with formation of a cellular wall of a pathogenic bacterium, destroying it. It does not have a strong toxic effect on the body, but it is contraindicated not only for people with individual intolerance, but also for pregnant women. The injection is done once.

Cefuroxime

Reserve antibiotic of the cephalosporin group (2nd generation), designed to combat inflammatory diseases of the respiratory system, genitourinary system, and musculoskeletal system.

It is produced in various dosage forms, including for parenteral administration, however, tablets are used for gonorrhea. Pregnant, lactating, premature babies are prescribed with caution, allergy sufferers are contraindicated.

Lomefloxacin

Another antibiotic taken for gonorrhea once orally.

Refers to fluoroquinolones, acts bactericidal on pathogenic microorganisms. The main purpose of the drug is the treatment of urogenital infections (both complicated and uncomplicated). Additionally, it can be used in combination with other drugs for antibiotic therapy of tuberculosis. Children, pregnant women, people with hypersensitivity is contraindicated. In the case of gonorrhea, it is included in the list of reserve medicines.

This third-generation cephalosporin is effective against a wide range of pathogenic bacteria and is prescribed for inflammatory processes in the respiratory and urinary organs.

In the case of complicated gonorrhea, Cefixime is taken orally, while being a reserve medication. It is used according to the scheme drawn up by the doctor in accordance with the severity and nature of the complication. Like other cephalosporins, it is characterized by low toxicity and a small number of contraindications (individual intolerance).

Azithromycin

The first representative of the azalide subclass from the group of semi-synthetic macrolide antibiotics.

It acts bacteriostatically due to the suppression of protein synthesis, and when the dose is increased, it exhibits a bactericidal effect. The spectrum of antimicrobial activity includes most of the known gram-negative, gram-positive and atypical pathogens. Due to its powerful therapeutic effect and convenient dosage regimen, it is widely used in various fields of medicine, showing low toxicity.

Unlike the antibiotics listed above, Azithromycin for gonorrhea is not used to treat the underlying disease, but to prevent chlamydia. This infection often accompanies gonococcal infection, so azalides are necessary for preventive purposes. In parallel with the injections, a single dose of 1 gram of Azithromycin is prescribed for any form of the underlying disease, except for those cases when the therapy is carried out in pregnant women (they can take erythromycin or spiromycin).

Doxycycline

It is an alternative to the previous drug used for the prevention of chlamydia in case of hypersensitivity to macrolides.

Belongs to the group of tetracycline antibiotics, acts bacteriostatically on chlamydia. Unlike Azithromycin, which is taken once, Doxycycline is prescribed for a seven-day course. At the same time, the toxicity inherent in tetracyclines causes a list of contraindications: childhood, pregnancy, liver failure, allergies.

Antibiotic regimens for gonorrhea

There is no single principle for the treatment of this disease, since it can occur in acute and chronic forms with complications. It also requires adjustment of appointments and doses in accordance with age and individual characteristics.

Guided by the requirements for the effectiveness and safety of antibiotic therapy, dermatovenereologists use the following schemes:

• acute gonorrhea localized in the lower genitourinary system is treated with a single injection of 250 mg of ceftriaxone intramuscularly or with a single oral dose of ciprofloxaine or ofloxacin (500 or 400 mg, respectively). In case of intolerance, drugs from the reserve group are prescribed. For the prevention of chlamydia, in parallel, take 1 gram of Azithromycin once (or Doxycycline - 100 mg twice a day for a week).
• Antibiotics for chronic gonorrhea that occurs with complications, as well as for disseminated infection, are administered intramuscularly or intravenously within 24-48 hours until an objective improvement. Assign Ceftriaxone (1 gram intramuscularly or intravenously per day), Cefotaxime (1 g intravenously with an eight-hour interval), Spectinomycin intramuscularly or Ciprofloxacin intravenously every 12 hours (2 grams and 400 mg, respectively). Subsequently, the patient is transferred to oral administration of Cefixime or Ciprofloxacin, determining the duration of the course in accordance with the nature of the complication.
• Treatment of newborns is carried out for a week (up to 10 days with meningitis) by intravenous or intramuscular injections of the daily dose of the drug in two doses with a 12-hour interval. The daily amount of Cefotaxime is 25 mg per kg of body weight, and Ceftriaxone - from 25 to 50.
• With the defeat of the mucous membranes of the pharynx, gonococcal pharyngitis is formed. With such a diagnosis, gonorrhea is treated with Ciprofloxacin and other drugs according to the treatment regimen for an acute uncomplicated form.
• Gonococcal conjunctivitis is treated in adults with a single intramuscular injection of one gram of Ceftriaxone, and in newborns with one intramuscular or intramuscular injection containing no more than 125 mg of the active substance.
• Antibiotic therapy during pregnancy is carried out at any time in accordance with the severity of the disease. The main drugs in this case are Spectinomycin or Ceftriaxone, and fluoroquinolones and tetracyclines are strictly contraindicated.

The above treatment regimens for gonorrhea are for guidance only and cannot be used for self-treatment without consulting a dermatovenereologist. A visit to the doctor is mandatory, since bacteriological analysis (including control) and specialist supervision are necessary for successful treatment.

Description of the disease

Gonorrhea, better known to the people as gonorrhea, has been known since biblical times. Even then, a high degree of contagiousness of the disease was noted, the need to isolate the patient, and attempts were made to treat (washing, astringents and antiseptics). However, such therapy did not have the desired effect and the disease often led to death. Only with the advent of antibiotics in medicine in the middle of the last century did a complete cure become possible.

Cause and route of infection

The main route of infection is unprotected sexual intercourse, as a result of which the organs of the genitourinary system are predominantly affected. In everyday life, the pathogen is transmitted from the carrier through household items, and during childbirth - from mother to newborn.

Signs of gonorrhea

After a short incubation period (from 3 to 7 days), after the introduction of the pathogen into the body, symptoms of infection occur, and in men - almost always, and in women - only in half of the cases. The characteristic features of gonorrhea are:

• purulent discharge from the urethra or vagina;
• itching, burning in the vulva;
• pain during urination and frequent urge to urinate;
• in men, pain can spread to the perianal zone.

These symptoms are characteristic of the acute form of the disease. Without appropriate treatment, the infection spreads to the pelvic organs, kidneys, the pathogen enters the bloodstream (bacteremia), the skin and joints are affected. Gonorrhea passes into the chronic stage, which outwardly manifests little, but leads to serious complications. Women in whom the disease does not have external manifestations often suffer from infertility.

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Sumamed for gonorrhea

In the treatment of urogenital diseases caused by STIs, doctors use antibacterial medications, other drugs for general and local therapy. Sumamed has a good effect. In gonorrhea, it can be prescribed as an antibiotic with a bacteriostatic effect.

The mechanism of action of the drug

The active substance of Sumamed is called azithromycin (azithromycin). It is azalide, a third-generation macrolide with bacteriostatic properties. Its action is aimed at suppressing the vital activity of a wide range of microorganisms sensitive to azithromycin.

After using the drug inside, its active component is delivered by phagocytes to the focus of the disease. Then the substance binds to the protein of the pathogenic cell and begins to inhibit its synthesis, reproduction processes and other mechanisms of life. As a result, such exposure leads to the disappearance of microbes.

Sumamed inhibits protein synthesis:

• chlamydia;
• gonococcus;
• mycoplasmas;
• streptococcus aureus;
• other bacterial infections of the respiratory, urinary, reproductive system.

With a single dose, azithromycin is finally eliminated from the body after 5-7 days. At the same time, the therapeutic effect of azithromycin remains for a week after taking the medication.

Doctors recommend taking Sumamed for urethritis, gonorrhea (gonorrhea), cervicitis, in case of damage to the mucous membranes of the eyes, throat by gonococcus. Since the causative agent of a sexually transmitted disease is not only transmitted sexually, the pathology can also affect children in the family of an infected person. Antibiotic Sumamed is allowed to be used in the treatment of gonorrhea in a child older than 6 months.

Dosage and treatment regimen for gonorrhea

During the research phase of the action of Sumamed, clinicians treated fresh, acute and complicated gonorrhea in 22 men and women aged 18-40 years. After therapy, doctors evaluated the effectiveness of the drug based on laboratory tests and subjective feelings of patients.

Based on the results of the control check, 100% cure of fresh gonococcal infection and 96% elimination of the complicated form of the disease were confirmed. Therefore, the drug is considered an effective remedy against gonorrhea.

An approximate scheme for the treatment of gonorrhea by Sumamed for people over 18 years of age:

• Complicated gonococcal infection with systemic manifestations. Sumamed is taken once at a dose of 1 g (2 tablets / capsules of 500 mg each). The drug is repeated on the 7th and 14th day. That is, with complicated gonorrhea, a person should drink 1 g of Sumamed for 3 weeks in a row with an interval of 7 days;
• Localized fresh gonococcal infection. With gonorrhea, the dosage of Sumamed is 1 g (2 tablets or capsules of 500 mg each). The medicine is taken once.

In the treatment of gonorrhea, Sumamed can be combined with the use of Doxycycline, Ceftriaxone. The dosage, frequency of administration and duration of the course of each drug depends on the form of venereal disease, so the calculation should be carried out only by a doctor.

Monitoring the effectiveness of gonorrhea treatment

At the end of the course of treatment, the patient is sent for the delivery of biomaterial for bacteriological and bacterioscopic examination. If a person is re-diagnosed with gonococcus, he will be prescribed other drugs. The complete cure of gonorrhea is confirmed by the negative results of the control diagnostics after therapy after 2, 5 and 8 weeks (3 tests within 60 days).

Incorrect administration of the drug can reduce the sensitivity of the microorganism to azithromycin. Treatment of urogenital infectious diseases is complicated by violation of medical recommendations regarding daily and course dosages of Sumamed. To prevent gonorrhea from spreading throughout the body, the treatment regimen selected by the doctor should be strictly observed.

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Azithromycin for gonorrhea

Today, the treatment of gonorrhea is a medical problem that is very relevant throughout the world, and its solution requires a serious approach. One of the most effective means is Azithromycin for gonorrhea - it is a broad-spectrum antibiotic that has a number of advantages over similar drugs.

So, for example, unlike other antibiotics, Azithromycin is quickly absorbed into the blood, does not break down in acidic environments, and relatively quickly removes gonococci from the body. Moreover, according to some reports, gonococcus is not detected in patients a day after taking the drug. And this is not surprising - the treatment of gonorrhea with Azithromycin can affect any constantly mutating strains of gonococci.

The convenience of treatment with Azithromycin lies in the frequency of taking the drug, which makes it possible to increase patient compliance, simplify the course of treatment and make it more effective. In the case of an acute course of the disease, the dosage of Azithromycin for gonorrhea is as follows: a single dose of 1.5-2 g of the drug or a double dose of 1 g. Tablets should be taken one hour before meals. Occasionally, intravenous administration of the drug is prescribed.

In chronic gonorrhea, a single dose of the drug is prescribed at a dosage of 1 g, followed by an increase by 250 mg every day for 4 days. The drug can be combined with other antibacterial agents, and its effectiveness in the treatment of acute gonorrhea reaches 90-93% in the case of a single dose of 1 gram of the drug. In the case of increasing the dose to 2 grams, the efficiency increases to 99%.

It should be noted that Azithromycin is most effective in the treatment of gonorrhea of ​​the pharynx and cannot be used to treat children and pregnant women.

Azithromycin (Sumamed), as the drug of first choice in the treatment of urogenital chlamydia

V.A.Akovbyan
NIIEM named after N.F. Gamaleya RAMS

Azithromycin (sumamed) as a first-line preparation in treatment of urogenital chlamydia infection

V.A. Akovbyan
N.F. Gamaleya Research Institute of Experimental Medicine of the Academy of Medical Science of Russia

Currently, the list of drugs with proven activity against chlamydia includes about a dozen original drugs representing 3 groups of antibiotics - macrolides, tetracyclines and fluoroquinolones. However, only two of them, azithromycin and doxycycline, are recommended by the European and American guidelines for the treatment of STIs, as well as by the domestic "Methodological materials for the diagnosis and treatment of the most common STIs and skin diseases" as drugs of choice for the treatment of urogenital chlamydia (UC), while the rest are classified as reserve drugs. But, even in this pair of "azithromycin-doxycycline" preference is given to azithromycin. What is the basis for the adherence of clinicians dermatovenereologists, obstetrician-gynecologists, urologists to azithromycin? And how did this choice come about?

A bit of history: non-gonococcal urethritis

Since Neisser's discovery of gonococcus in 1879, sexually transmitted inflammatory urogenital diseases have been divided into two parts, those caused by gonococcus (gonorrhea proper) and the so-called non-specific non-gonococcal urethritis (NGU). A huge amount of research has been devoted to the study of the etiology of NGU, a wide variety of pathogens - bacterial, viral, mycotic, Trichomonas, the so-called L-organisms and others - were called the cause. It has been empirically found that penicillins, cephalosporins, and spectinomycin do not lead to clinical recovery of NGU, while erythromycin, rifampicin, macrolides, and fluoroquinolones have been shown to be quite effective. The explanation of this phenomenon became possible when it was possible to establish that one of the causes of NGU is chlamydia.

Having found specific inclusions inside epithelial cells from the urethra of men suffering from NGU, Harkness in 1950 called them "large viruses". Similar formations have already been found in patients with venereal lymphogranuloma, and subsequently in patients with trachoma. It was these "large viruses" that were later called chlamydia. In 1959 Jones, Collier and Smith singled out C. trachomatis from the cervical canal of a woman who gave birth to a child with ophthalmia neonatorum, and in 1964 chlamydia were first isolated from the urethra of men suffering from conjunctivitis. But before C. trachomatis were recognized as a sexually transmitted microorganism that causes urogenital inflammatory diseases, it took some time, which was associated with the difficulties in diagnosing these bacteria. Initial selection C. trachomatis was carried out in the yolk sac of chicken embryos, then in McCoy cell cultures, but only after the introduction of direct immunofluorescence methods and, later, DNA diagnostics, the detection of chlamydial antigen became an accessible and routine procedure in clinical practice. Epidemiological studies show that the spread C. trachomatis in a population depends on various factors: age, gender, educational level, characteristics of sexual behavior, region of study. C. trachomatis is the cause of the development of chronic inflammatory diseases of the genitourinary organs in men, PID and infertility in women, and also causes hyper and dysplastic changes in the mucous membrane of the cervix. All this testifies to the social and medical significance of urogenital chlamydial infection and requires the use of antibacterial drugs with proven therapeutic efficacy in the treatment. The difficulties that arise in solving this problem are explained by rather specific features C. trachomatis:

Macrolides

The name "macrolide" comes from a macrocyclic lactone ring of 12 to 17 carbon atoms, to which several carbohydrate residues are attached. Most macrolides contain 14, 15 or 16 membered rings. The era of macrolide antibiotics dates back to the late 50s, when erythromycin was first introduced into clinical practice, which proved to be an extremely effective treatment for many bacterial infections, especially intracellular pathogens. The disadvantage of oral dosage forms of erythromycin was its inactivation in the acidic gastric environment, which required the release of the antibiotic in special acid-resistant shells, as well as in the form of various salts and esters. A new wave of interest in erythromycin dates back to 1976 during an epidemic outbreak of pneumonia of unknown origin, a disease that later became known as Legionnaires' disease. Dedicated pathogen - Legionella pneumophila proved to be insensitive to broad-spectrum antibiotics - aminoglycosides and cephalosporins, while treatment with erythromycin was effective. At the same time, side effects from the gastrointestinal tract were observed in patients, which, apparently, was associated with the effect of the 14-membered macrolide ring on the peristaltic activity of the small intestine. Further research led to the creation of three new macrolides azithromycin, clarithromycin and dirithromycin, of which only azithromycin can be used both intravenously and orally.

Azithromycin

Azithromycin is the first representative of the azalide subclass, which differs in structure from classical macrolides; it has a 15-membered macrocyclic ring, but the presence of methylated nitrogen in the ring gives it special properties - high acid resistance, an expansion of the spectrum of antimicrobial activity, and the ability to penetrate the cell wall. Azithromycin was developed by specialists of the pharmaceutical company PLIVA (Croatia), a patent for the drug was obtained in 1980. The pharmacokinetics and pharmacodynamics of the drug became an unexpected discovery even for the creators of the drug after oral administration, the concentration of azithromycin in various tissues and cells turned out to be 100 or more times higher, than in the blood an even higher concentration is observed in inflamed tissues. It became clear that this drug can be effective against infectious agents that are located intracellularly and affect tissues. By binding azithromycin in lysosomes, the cells accumulated the drug, at the same time turning into a kind of reservoir, which contributed to a significant expansion of the half-life of the drug in tissues. Accumulation of azithromycin in large amounts in phagocytes created ideal conditions for drug delivery to inflammation sites. There is considerable evidence that phagocyte delivery of azithromycin plays a critical role in clinical success and can clear most infections within 5 days.

It is very important that azithromycin, unlike erythromycin and clarithromycin, does not inhibit cytochrome P-450 and does not affect the metabolism of other drugs in the liver. This is important because azithromycin does not interact with drugs that are broken down by the cytochrome P-450 system in the liver when co-administered, 50% of the drug is excreted in the bile unchanged, and about 6% of the dose is excreted in the urine, depending on the routes of administration and dose.

Mechanism of action

The antibacterial effect of macrolides is the inhibition of RNA-dependent protein synthesis in sensitive prokaryotes. Azithromycin is active against many Gram-positive bacteria, including Str. pneumoniae, Str. pyogenes. It is known that C. trachomatis, M. pneumoniae, L. pneumophila do not respond to beta-lactam antibiotics, because they do not have receptors corresponding to these antibiotics, the so-called penicillin-binding proteins. Furthermore, C. trachomatis And M. pneumoniae do not have cell walls (in the classical view). Insofar as C. trachomatis is an obligate intracellular pathogen, the ability of macrolides to create high intracellular concentrations, leading to inhibition of protein synthesis by microorganisms, significantly enhances the effect of azithromycin against chlamydia.

Pharmacokinetics

For some antibiotics, in particular azithromycin, the determination of serum concentration is not a demonstrative indicator for assessing clinical efficacy, while the determination of antibiotics in cells and tissues is a difficult task. Features of the pharmacokinetics of azithromycin are that it is concentrated at the site of inflammation more than in serum or intact tissue. Key indicators of the pharmacokinetics of azithromycin are presented in the table.

table. Pharmacokinetics of azithromycin

After oral administration, azithromycin is rapidly absorbed: the peak concentration (0.4 μg / ml) after taking 500 mg occurs after 2-3 hours. When administered intravenously to volunteers at 500 mg, 1, 2 and 4 g, drug tolerance was good, and the half-life T1 / 2 was more than 60 hours. The bioavailability of the intravenous form is 100%. The drug continued to be detected in the blood 192 hours after intravenous administration of 1 g, 240 hours after administration of 2 and 4 g. The high half-life is due to the fact that azithromycin is characterized by rapid uptake by cells and tissues and slow release from tissues. There is another property of the drug, which is difficult to explain from the standpoint of today's knowledge. The addition of blood serum to the Mueller-Hinton medium when studying the sensitivity of microorganisms to azithromycin leads to a unique drop in the values ​​of the minimum inhibitory concentration (MIC) of azithromycin against St. aureus from 0.25 to 0.004 µg/ml (more than 60-fold decrease), vs. S. pneumoniae from 0.12 to 0.004 µg/ml (30-fold decrease), similar data are not given for chlamydia.

Tissue and cellular pharmacokinetics

Concentrations of azithromycin in tissues exceed those in serum by 80-1000 times. The peak concentration usually occurs 24-48 hours after the first dose. The difference between azithromycin and other macrolides is that high tissue concentrations are maintained for many days after completion of treatment, this phenomenon is called the post-antibiotic effect. With a single dose of 500 mg of azithromycin, the concentration of the drug in the tonsils, lungs, kidneys, prostate, stomach was higher than 2 μg / ml, and it remained at this level for more than 8 days. The same studies showed that T1 / 2 of azithromycin in the prostate was 2.3 days.

Studies have shown that oral administration of azithromycin at a dose of 500 mg for 3 days is comparable in results to 10 days of administration of amoxicillin-clavulanate at a dose of 625 mg 3 times a day in the treatment of respiratory diseases.

In vitro studies have shown that azithromycin accumulates in various cells - polymorphonuclear leukocytes, macrophages and fibroblasts, and the concentration of the drug in phagocytic cells exceeds its concentration in the interstitial fluid by more than 200 times, and in fibroblasts by 4000 times.

Due to the two nitrogen atoms in the composition, azithromycin is a weak base and therefore has a high affinity for an acidic intracellular environment, especially for lysosomes and phagosomes. 70% is located in lysosomes, while 30% in the rest of the cell. Legionella micdadei". Monocytes containing the microbe were exposed to azithromycin at various concentrations from 0 to 0.32 µg/ml. While the MIC 90 of azithromycin for legionella is 2 μg / ml, the intracellular concentration of azithromycin 0.04 μg / ml already stopped the growth of bacteria, and the concentration of 0.16-0.32 μg / ml reduced the reproduction of microbes by 10-100 times. These studies, on the one hand, show the high intracellular activity of azithromycin, and, on the other hand, the conditionality of estimates of the MIC value, at least for intracellular pathogens. The entry of azithromycin into macrophages, monocytes, neutrophils occurs quite quickly, and the release is slow, approximately within 24 hours. This allows the azithromycin to be retained in the neutrophils during circulation. Eventually, this results in the antibiotic being released by the neutrophils in the inflammatory foci where they migrate.

Thus, azithromycin is characterized by high antimicrobial (anti-chlamydial) activity, the ability to penetrate and accumulate inside cells, be additionally delivered to inflammatory foci inside macrophages and polymorphonuclear leukocytes, and not interact with other simultaneously prescribed drugs. It should be noted that all these properties are established only for the original drug, i.e. synthesized for the first time and passed the cycle of all experimental and clinical studies. The only original azithromycin drug distributed in Russia and Eastern Europe is Sumamed (PLIVA).

The original drug is always one, while its reproduced copies, so generics (generics) can be many. Numerous studies show that quality standards for generics often do not match those of the original drug, and the quality of different generic drugs is not the same. The main requirement for generics is the need to match the original in terms of bioequivalence. This should always be taken into account when choosing a treatment protocol.

Azithromycin, like some other antibiotics (aminoglycosides, fluoroquinolones, azalides, and others), belongs to the so-called. "concentration-dependent" drugs. The main pharmacokinetic and pharmacodynamic parameters that determine the clinical and microbiological efficacy of these drugs are the ratio between the area under the pharmacokinetic curve and the IPC -PFC 24 / IPC, as well as the ratio between the maximum concentration and the IPC - C max | IPC. In other words, the antimicrobial activity of these antibiotics is mainly related to the MIC value, and not to the time factor. The effectiveness of a macrolide against a particular infectious agent will be maximized when the MIC of the antibiotic for that pathogen is maintained for at least 40-50% of the time between dosing intervals. "Concentration-dependent" antibiotics are characterized by a pronounced post-antibiotic effect, meaning the continuation of the therapeutic effect of the drug after stopping its use.

Treatment

The impossibility of standardizing the conditions for cultivating chlamydia created certain difficulties in determining their sensitivity to antibiotics. In addition, as with other bacteria, in vitro data on susceptibility of chlamydia to certain antibiotics do not always correspond to the results of their real clinical use. Therefore, the current use of various antibiotics and treatment regimens for urogenital chlamydia is based both on pharmacokinetic and pharmacodynamic data and on the results of clinical observations. Currently, there are a significant number of scientific publications on the treatment of urogenital chlamydia. The reference drug for azithromycin is almost always doxycycline, as the most studied and closest in treatment results to azithromycin.

In the STI treatment guidelines mentioned, the recommended dose of azithromycin for the treatment of UC is 1 g orally as a single dose. In foreign sources, no distinction is made between the treatment of uncomplicated and complicated forms of UC, while in domestic methodological materials for the treatment of the latter, it is proposed to prescribe the drug 1 g once a week, for a course of 3 g. It seems appropriate to present data summarizing the results of large randomized trials. Huge factual material, a single research protocol and statistical processing of the results significantly increase the reliability of the data presented.

Lau and Qureshi conducted a meta-analysis of 12 randomized controlled trials on the results of the use of azithromycin (1 g once) and doxycycline (100 mg twice a day, 7 days) in men older than 15 years and non-pregnant women suffering from genital chlamydial infection. Microbiological cure was evaluated in 1543 patients, side effects in 2171. It turned out that the microbiological cure for azithromycin was 97%, for doxycycline 98%, side effects were observed in 25% and 23% of patients, respectively. In another report, the results of 9 randomized trials were summarized - 1800 male and female patients with UC. Clinical cure 2 weeks after the end of antibiotics was: in patients who received azithromycin 91.4%, doxycycline 92.7%; microbiological cure of 92.7% and 96.0%, respectively, with no statistical differences confirmed. The same study reported that after 5 weeks, microbiological cure rates in patients treated with azithromycin were higher than those treated with doxycycline, due to the higher relapse rate in the latter case. Similar results are given in reviews by other authors. If earlier experts refrained from prescribing azithromycin to pregnant women, now these restrictions have been lifted, because the absence of a teratogenic effect in this antibiotic is considered proven. Domestic researchers also report on the efficacy and safety of azithromycin in the treatment of chlamydia in pregnant women.

New opportunities and perspectives

Currently, the possibilities of using azithromycin for the treatment of chlamydial infection have expanded significantly due to the use of its dosage form for intravenous administration. Intravenous administration of azithromycin is used to treat PID, and is also included in Russian and international standards for the treatment of community-acquired pneumonia. The use of modern technology of "step therapy" (successive change of regimens) allows minimizing the risk of post-injection complications, increasing the convenience of treatment (especially taking into account a single dose of azithromycin in any of the forms), and is also pharmacoeconomically beneficial (including reducing the average patient stay). in a hospital bed). Azithromycin is administered intravenously at a dose of 500 mg once a day for 1-2 days, followed by the administration of the drug orally at a dose of 250 mg for 7 days. The standard equivalent dosing regimens for azithromycin are both 3-day 500 mg once daily and a five-day regimen (250 mg daily, doubling the dose on the first day of treatment). With the appointment of one azithromycin according to the scheme of stepwise therapy for PID, recovery was observed in 97.1% of sick women. If metronidazole 400 mg 3 times a day for 12-14 days was added to the indicated treatment, then the success rate of treatment changed slightly - 98.1%.

International guidelines for the treatment of sexually transmitted infections when choosing a drug require activity against the main possible pathogens, for example C. trachomatis, N. gonorrhoae etc. It should be noted that negative PCR results for the presence of C. trachomatis scrapings from the endocervical canal do not exclude possible infection of the upper reproductive system.

When highlighting Chlamydia spp. azithromycin or doxycycline is recommended. In order to increase the effectiveness of the prevention of early and late secondary complications (prostatitis, orchitis, proctitis) and given the wide prevalence of intracellular infections in the population, the possible association with other specific pathogens, intravenous empirical therapy with etiotropic drugs with high tissue accumulation, for example, azithromycin, is recommended, especially when urgent catheterization and other manipulations in "unscheduled patients".

In 2001, there were reports of a new regimen for the appointment of azithromycin for the treatment of complicated forms of urogenital chlamydia, the drug was administered orally 1 g once a week for 3 weeks, in total for a course of 3 g. After taking azithromycin according to this regimen, the microbiological cure in women was 96, 1%, in men 97.8%, and in patients in the comparison group treated with doxycycline, these figures were 85.5% and 87.0%, respectively. Adverse reactions with the appointment of azithromycin were observed less frequently than doxycycline (2 and 12%, respectively). The long-term results of treatment of UC with azithromycin according to the indicated scheme were as follows: within 2 years, relapses were observed in 1.2% of men and 2.5% of women; in the comparison group (doxycycline), relapses were observed in 7.8 and 10.2% of men and women, respectively. Other authors also report the successful use of this azithromycin regimen. Microbiological cure in this study was observed in 87.1% of men and 89.3% of women with complicated forms of chlamydial urogenital infection, the clinical effect was slightly lower: 80.6% and 85.7%, respectively. In the treatment of uncomplicated forms, the microbiological cure rates were higher - 93.1% in men and 90.5% in women.

When analyzing clinical studies, it is noteworthy that the spread of the results of effectiveness in the treatment of chlamydial infection with azithromycin lies in the range of 85-100%, moreover, a comparison of the results within 90-100% is statistically unreliable. When analyzing the differences in the results of clinical and microbiological data after the treatment, it seems to us that one should keep in mind the information presented in an interesting review by Morton and Kinghorn:

• the presence of chlamydia in the urogenital tract may not be accompanied by any clinical manifestations, therefore, we can talk about the existence of "carriage" of chlamydia; in this case, eradication of the pathogen with the appointment of appropriate antibiotics will be successful (100%);
• it is considered proven the possibility of spontaneous elimination of chlamydia from the body after some time without treatment;
• negative test results for chlamydia a month after the end of treatment do not always mean their absence in the body with the possibility of a subsequent relapse of the disease;

The considerations presented are interesting, although not indisputable. But in practical medicine, it is necessary to adhere to certain principles that ensure the rational behavior of the doctor in order to achieve the ultimate goal - to cure the patient. These, in our opinion, are the following:

• C. trachomatis are an absolute pathogen for humans, the eradication of which is the goal of ongoing therapy;
• the use of certified diagnostic test systems will minimize errors in the identification of the pathogen;
• treatment of urogenital chlamydia should be carried out on the basis of uniform standards with a broad evidence base.

Almost the same clinical and microbiological efficacy of azithromycin and doxycycline is considered proven. Further comparison of these drugs shows that the only advantage of doxycycline is its low price, while the disadvantages are much greater: long periods of treatment, complications from the gastrointestinal tract, toxic-allergic reactions from the skin, photosensitivity to ultraviolet radiation, contraindications for prescribing to pregnant women and children.

High clinical and microbiological efficacy, ease of use, a small number of side effects, the possibility of using for the treatment of pregnant women and children, a variety of dosage forms of azithromycin make it the drug of first choice in the treatment of urogenital chlamydia. In this situation, the value of the price factor ceases to be decisive: after detailed information, the final choice of the drug remains with the patient.