19.04.2019

Drug treatment of pneumonia in children according to official recommendations and standards. Sumamed in the treatment of pneumonia

Sumamed is a broad-spectrum drug that has a pronounced antibacterial therapeutic effect. It belongs to a new generation of drugs, which in turn belong to the group of macrolide antibiotics. This article will talk about whether Sumamed can be used for the flu, and how effective such a drug is in general.

Sumamed is often used against influenza, as it has an antibacterial therapeutic effect

It should be noted that Sumamed for the flu can only be used in extreme cases, when the disease has already caused severe complications and the body is simply not able to fight them on its own. This is justified by the fact that Sumamed has a pronounced antimicrobial effect, and colds are caused by a virus. Thus, it is initially indicated to use antiviral drugs to eliminate influenza.

Sumamed itself, after penetration into the body, quite quickly begins to exert its bactericidal effect. At the same time, it is characteristic that it acts directly on the source of inflammation, thereby eliminating the disease in the shortest possible period.

As the instructions for use indicate, this drug is effective against various infectious agents. This can be pneumococcus, staphylococcus, streptococcus, E. coli and dysentery coli.

The drug is absorbed quite quickly. It reaches its maximum concentration after administration after 2-3 hours.

The active substance of such an antibiotic penetrates well into respiratory system patient and soft tissues. Thanks to this, it can be used to treat a variety of diseases, including complications from lingering colds and flu.

The medicine is eliminated within 24 hours after administration. If taken regularly (once a day), this will be enough to maintain normal levels of the active substance in the body and its effects.

Release form

Sumamed for influenza, reviews of which will be given below, is available in one dosage form - powder for the preparation of an oral suspension. This powder is packaged in white matte bottles.

The dosage and treatment features are selected by the attending physician in each individual case (depending on the indications, age, weight of the patient and the presence of additional chronic diseases).

There are also Sumamed tablets and capsules, but they are used much less frequently.

Indications

The following indications and symptoms are identified for which it is allowed to prescribe Sumamed for acute respiratory viral infections and more:

Inflammation of the lungs (pneumonia). Typically, this complication develops from untimely treated influenza. It is accompanied by prolonged fever, severe shortness of breath, chest pain, cough and pallor. Due to the fact that the causative agent of pneumonia is pneumococcus, it would be reasonable to prescribe Sumamed in this condition, because its active substance can suppress the viability of the pathogenic bacterium.
Various infectious lesions sinuses. It could be purulent form sinusitis, sinusitis, pharyngitis and inflammation of the sinuses. This condition invariably accompanied by severe headaches, nasal congestion, profuse purulent discharge and high temperature. In advanced cases, a patient with these indications should be urgently hospitalized. This is especially true for the treatment of young children, the elderly and patients with chronic pathologies.
Acute infections that are sexually transmitted through unprotected sexual contact.
Various infectious lesions of the skin.
Acute infectious lesions of the ear canal (purulent otitis media).
Purulent form of sore throat.
Scarlet fever.

In addition, it is important to know that there are clinical indications for use of this antibiotic. For example, the attending physician may notice an inflammatory process in the body with an increase in the number of leukocytes and ESR. In this condition, tests will indicate the progression of inflammation and purulent lesions in the body.

Sumamed is often prescribed for pneumonia

Contraindications for use

Due to increased toxicity and large quantity contraindications for use, not all patients will be able to use Sumamed for influenza and ARVI. Thus, they highlight following states for which it is prohibited to prescribe such a drug:

Individual intolerance by the patient to antibacterial drugs of the macrolide group. In this condition, the observing physician must select an antibiotic for the person that belongs to a different therapeutic group and contains a different active substance.
Severe dysfunction of the renal system (chronic renal failure, failure of one kidney, etc.).
Sumamed should be prescribed with caution and only under the supervision of a doctor to people suffering from serious illnesses liver, including from chronic liver failure.
Severe myocardial pathologies, as well as the period after the patient has recently suffered a heart attack.
Period acute course all kinds of allergic reactions. An antibiotic should be used with caution if a person is prone to allergies.
Children's age (the drug is not used to treat children under three years of age). If it is necessary to prescribe an antibiotic for complications from an acute respiratory viral infection in a child, the doctor must choose the most appropriate one for the child. safe analogue Sumameda.
Patient intolerance to glucose and fructose.

Summamed should be prescribed with caution to people suffering from diseases of the nervous system, diabetes mellitus, as well as patients undergoing concomitant treatment with potent drugs.

It is important to know that Sumamed against influenza can only be used after a doctor’s prescription. This is especially true for the use of Sumamed for influenza in children. Self-medicating with this drug can be dangerous.

Self-medication can be dangerous for a person, so Sumamed should be prescribed by the attending physician

Use during pregnancy

Prescribing Sumamed while pregnant is extremely undesirable due to the risk of negative effects of its active substance on the fetus. Such a drug can be used during pregnancy only as a last resort, when the expected benefit to the mother will be higher than possible risks for the fetus.

As for taking Sumamed while breastfeeding, this is also undesirable. If it is necessary to prescribe the drug during lactation, a woman is recommended to stop breastfeeding and transfer the child to artificial formula.

Mode of application

Sumamed in the form of an oral suspension should be taken once a day an hour before meals. Preparing this medicinal solution is simple - you just need to dilute the powder in a small amount of water until it is completely dissolved.

Each time you need to prepare a fresh suspension. It is prohibited to store it in the refrigerator, because this way it may lose its healing effect.

Dosage calculations should be made using a measuring syringe. On average, acceptable daily dose the drug is 30 mg.

The permissible daily dose of the drug is 30 mg, but only after consultation with a doctor

Side effects

Sumamed after the flu can cause adverse reactions if taken incorrectly or treated with such a drug if the patient has serious contraindications to such therapy. The following possible side effects from treatment with this antibiotic are identified:

Various infectious lesions of the body. This means the appearance of candidiasis, pneumonia, respiratory pathologies, as well as pharyngitis.
Metabolic disease. In this case, a person may develop anorexia and a tendency towards it.
Development of all kinds of allergic reactions. This may include anaphylactic shock, itching, swelling, hypersensitivity and rash.
Most often occurs in the central nervous system headache, dizziness, disorientation and sleep disturbance. Less common are nervousness, depression, anxiety, hallucinations, fainting and loss of smell. Very rarely – convulsions.
IN digestive system There may be nausea, vomiting, abdominal pain, gastritis, dry mouth and worsening ulcers. Constipation, flatulence and pancreatitis occur very rarely.
Deterioration of kidney and liver function, hepatitis.

Additional possible side effects may include shortness of breath, chest pain, worsening heart function, nosebleeds, and blurred vision and hearing.

If any of the side effects described above develop, you should immediately stop therapy and consult a doctor. Treatment of adverse reactions, as well as overdose, is symptomatic.

It is important to know that Sumamed is able to influence the speed of a person’s reaction, so during treatment the patient needs to be extremely careful when driving vehicles.

Sleep disturbance can be one of the side effects of using the drug Sumamed

Reception features

In order for Sumamed to bring the expected effect of treatment for ARVI to children and adults, during therapy with it you must adhere to the following doctor’s recommendations:

You cannot exceed the dosage of the drug on your own, or combine it with other medications without your doctor’s permission.
When taking the drug by patients suffering from diabetes, it is necessary to take into account that the drug contains sucrose.
If you accidentally skip a dose, you should take it as soon as possible. the right dose. The next dose of medication should be in a day.
When treating with antibiotics for people suffering from impaired kidney or liver function, their condition must be constantly monitored and the functioning of these organs must be monitored by taking blood tests.

As for the reviews about this drug, most of them are positive. At the same time, patients note that Sumamed is well tolerated and its effectiveness in the treatment of complications from influenza. The main thing is to take the medicine at the exact dosage indicated.

Pneumonia, or pneumonia, is a common disease. It can be observed at any age. Pneumonia is most dangerous in infants and the elderly. Incorrect treatment this disease can lead to severe consequences and even death.

Treatment of pneumonia is, first of all, antibacterial drugs. Without them, it is almost impossible to cope with the infection. Previously, before the advent of antibiotics in the doctor’s arsenal, pneumonia often led to death, especially in weakened patients.

Today, pneumonia can be caused by various microorganisms:

viruses;
bacteria, chlamydia and mycoplasma;
fungi, including pneumocystis.

Depending on the pathogen, the doctor prescribes appropriate etiotropic treatment - antiviral, antibacterial or antifungal.

Among pneumonia, hospital-acquired and community-acquired forms are distinguished. The first is caused by a nosocomial infection that is resistant to most antimicrobials, so its treatment is quite complicated. However, it does not occur so often, usually in surgical and trauma departments, burn departments, and in bedridden patients.

All other cases of pneumonia are considered community-acquired. Most often they are the result of a cold, acute respiratory viral infection or bronchitis.

The most common bacterial pathogens of pneumonia are:

Pneumococcus.
Staphylococcus.
Haemophilus influenzae.
Klebsiella.
Chlamydia.
Mycoplasma.
Legionella.

If the disease is uncomplicated, treatment usually begins with the antibacterial drug azithromycin. In pharmacies it is known as Sumamed.

Sumamed

The active substance of Sumamed, azithromycin, belongs to the macrolide group of antibiotics. This is a broad-spectrum drug. The following microorganisms are sensitive to azithromycin:

staphylococci;
streptococci;
hemophilus influenzae;
legionella;
Moraxella;
Klebsiella;
chlamydia;
mycoplasma.

Azithromycin inhibits the synthesis of bacterial protein, due to this its antibacterial effect is achieved. Fecal enterococcus and methyl-resistant staphylococcus are resistant to the drug.

A significant list of sensitive microflora determines the choice of azithromycin as a first-line drug in the treatment of pneumonia. When prescribing, doctors also take into account the tolerability of this medicine.

Tolerability of Sumamed

Sumamed is a drug that is quite well tolerated by patients. Like any antibacterial medicine, a list of its possible side effects significant, but most of them are rare.

Most often, when treated with Sumamed, the following unpleasant effects are observed:

Headache.
Visual impairment.
Nausea.
Vomit.
Stomach ache.
Stool disorder such as diarrhea.

Rare complications include the following:

Fungal infection.
Changes in the blood - leukopenia, eosinophilia, neutropenia, anemia, thrombocytopenia.
Varied allergic reactions.
Eating disorder – anorexia.
Drowsiness or insomnia.
Irritability.
Hearing impairment.
Nose bleed.
Liver damage.
Pain in the back, neck, muscles.

In most cases, when treating pneumonia with Sumamed, patients do not present any complaints related to taking the medicine. In addition, the advantage of azithromycin is its short course of administration.

Admission course

Sumamed is available in the form of capsules and divisible tablets. There are different dosage regimens.

Azithromycin is often prescribed as etiotropic therapy for three days. The drug is taken regardless of food. If the next pill is missed, the next one should be taken as soon as possible.

There is also another antibiotic prescription regimen. In this case, Sumamed must be taken for five days, and the dosage will be changed in accordance with the recommendations of the attending physician.

Instead of tablets, adult patients may be prescribed capsules.

If not available at the pharmacy required dosage Sumamed can be taken 2 capsules instead of tablets. The frequency and duration of therapy is determined by the doctor.

IN childhood Treatment with azithromycin is also allowed. In this case, it is used in the form of a suspension or tablets.

Performance criteria

For pneumonia, it is not enough to just prescribe an antibiotic. Since in most cases it is not possible to perform sputum culture due to the length of the analysis, treatment is selected empirically. This means that therapy begins with the most powerful drug or combination of drugs.

In such a situation, it is very important to correctly assess its effectiveness, because further treatment depends on it. If an antibiotic does not work for a particular patient therapeutic effect, the drug must be replaced with a drug from another group.

The effectiveness of Sumamed for pneumonia is assessed after 72 hours. The following indicators are taken into account:

Fever. By the end of the third day, body temperature should normalize or remain within the limits of moderate subfebrile condition.
Well-being. On the background effective treatment the patient notes the disappearance of signs of intoxication and improvement in general condition already on days 2–3.
Symptoms of the disease. Cough, chest pain, shortness of breath should decrease.
Laboratory indicators. A repeated general blood test by the end of the third day shows positive dynamics.

If after 72 hours the patient still has a severe fever, the severity of the condition increases, the dynamics of laboratory parameters worsen, this indicates the ineffectiveness of Sumamed in a particular clinical case. This is almost always associated with a pneumonia pathogen that is insensitive to azithromycin.

Sumamed in pediatrics

In children, azithromycin can be prescribed almost from birth. For children under three years of age, the use of Sumamed suspension is recommended, as there is a risk of choking on the tablet.

The dose of the suspension is calculated based on the child’s body weight.

Treatment of pneumonia in pregnant women

There is no negative effect of azithromycin on the body of a woman and fetus during pregnancy, proven in clinical studies. So far, no teratogenic effect has been reported during treatment with this drug.

However, full-scale studies of the safety of Sumamed in pregnant women have not been conducted for ethical reasons. That is why such an antibiotic can be prescribed for pneumonia in women expecting a baby, but only when it is really necessary.

Indications for azithromycin therapy during pregnancy are determined only by the attending physician.

This statement is also true for the lactation period. An antibacterial drug in certain concentrations is able to penetrate into breast milk. There are no specific contraindications for treatment with Sumamed during breastfeeding. However, the doctor must consider the possible harm to the child and carefully evaluate the risks and expected benefits.

Contraindications

The list of contraindications for prescribing Sumamed for pneumonia is small. These include:

Allergic reactions to azithromycin.
Severe side effects during previous treatment with Sumamed.
Proven insensitivity of the pathogen to this antibiotic.
Severe liver dysfunction. Since Sumamed is excreted through this organ, it can sometimes cause liver damage with the development of fulminant hepatitis.

Combination with other drugs

It is not always possible to cure pneumonia with Sumamed alone. Despite the wide spectrum of action of this drug, there are pathogens against which its effectiveness is not high enough.

In such situations, the simultaneous administration of two antibiotics is justified - azithromycin and, for example, amoxicillin with clavulanic acid.

Two drugs that act on different pathogens, increase the likelihood of a patient being successfully cured of pneumonia.

Analogues

If the doctor prescribed Sumamed for the treatment of pneumonia, but you cannot find the original drug in the pharmacy, you can use its synonyms or analogues.

Azithromycin is the active ingredient in many drugs. The most popular are:

Asicin.
Azimed.
Azivok.
Azax.
Azinort.
Azipol.
Azitral.
Azitro Sandoz.
Azitrox.
Azithrome.
Azithromax.
Azithromycin.

If desired, you can replace Sumamed with a similar medicine based on azithromycin. But do not forget that sometimes the low price of a drug affects its quality. This is especially important for antibacterial agents.

Catad_tema Respiratory diseases - articles

Use of Sumamed for community-acquired respiratory tract infections

Published in the Collection of Proceedings of the All-Russian Scientific Society:
"Current problems of pulmonology" »» 2000 E.V. Andryushchenko, M.B. Bogdanov
Moscow representative office of JSC "Pliva" (Croatia)

Community-acquired respiratory tract infections in both children and adults represent the most common group of diseases, the treatment of which almost always raises the question of prescribing antibiotics. According to a number of researchers in the USA and England, respiratory tract infections account for 75% of all prescriptions written annually in outpatient practice, and most of them relate to the treatment of tonsillopharyngitis and bronchitis. This problem, despite its apparent simplicity given the huge selection of antibacterial agents that clinicians currently have at their disposal, worries both practitioners and clinical microbiologists. This is due to the fact that antibiotics outpatient setting are prescribed empirically and this poses the danger of the selected drug not matching the etiology of the disease, and, as a consequence, a high percentage of treatment failures and the spread of strains of resistant pathogens. It is believed that among the risk factors for the development of resistance, the role of prescribing low doses of drugs, treatment duration of more than 5 days and the adverse consequences of poor compliance are significant.

Macrolide antibiotics have always occupied a significant place in the treatment of respiratory tract infections in outpatient practice. In our country it is mainly erythromycin. Despite the fact that the spectrum of action of this antibiotic includes pneumococcus and intracellular pathogens, doctors and patients cannot be satisfied with a significant percentage of quite pronounced side effects from the gastrointestinal tract, nor a treatment regimen requiring 4 doses of the drug over 7 to 10 days. The latter, as is known, is due to too short period The half-life of this antibiotic is only 2 hours.

A very significant event that largely changed approaches to antibacterial therapy for respiratory tract infections in outpatient practice was the creation by a group of scientists from the PLIVA company, headed by Slobodan Djokic, of a new class of macrolides based on the erythromycin A molecule. The first and so far the only representative of this class of antibiotics is azithromycin, which For about 10 years now it has been known to domestic clinicians as SUMAMED.

Unlike erythromycin, azithromycin is stable in relation to the acidic environment of the stomach and exhibits higher activity against Haemophilus influenzae - one of the leading causative agents of respiratory tract infections in community settings. In the future, this situation may be very significant, since it is believed that by the year 2000, 45–50% of clinical strains of H. influenzae will be regarded as β-lactamase producing, and the level of resistance of H. influenzae strains to azithromycin is less than 1%. However, the most significant difference between this drug and other macrolides is its unique pharmacokinetic properties, which allow, after oral administration of the antibiotic, to note its rapid and targeted penetration into infected tissues and the creation directly at the site of inflammation of the therapeutic concentrations necessary for a good treatment result, which has been proven for lung tissue, bronchi, tonsils, contents of the paranasal sinuses and the middle ear cavity. Characterized by the slow release of azithromycin from cells, which is closely related to the process of phagocytosis and the preservation of high therapeutic concentrations of the antibiotic in tissues after stopping the drug for another 5–7 days after taking the last dose, which makes it possible to equate taking the drug for 3 days to 7–10 days. day course of treatment. This clinically important phenomenon is due to the long half-life of azithromycin, up to 72 hours.

It is these properties that made it possible to recommend a single dose of azithromycin during the day and, initially, a 5-day, and in the last three years, a 3-day regimen of its use for various respiratory diseases bacterial etiology. In the last decade, azithromycin has been actively used in the treatment of respiratory tract infections in Russia, but until now a 3-day course of its use in outpatient practice, especially in the treatment of infections lower section respiratory tract until it became routine.

In this regard, the purpose of this study was to analyze the assessment by practitioners of the effectiveness and safety of azithromycin (Sumameda ® from PLIVA Croatia), used in 3 and 5-day courses in the treatment of respiratory tract infections. The PLIVA company developed a questionnaire on antibacterial therapy, which was offered for completion to local doctors in various Moscow clinics from September 1998 to April 1999. Subsequently, statistical processing of the results was carried out using the X2 criterion.

An analysis of the effectiveness of antibacterial therapy for respiratory tract infections was carried out in 4571 patients. The study included older children school age and adults under 60 years of age. Of the total number of cases, 2653 patients received SUMAMED for a course of 3 days. 1623 patients were prescribed SUMAMED for 5 days and 295 patients, according to the decision of the attending physician, received other antibiotics for a course of 7–10 days. A comparative assessment of the effectiveness of a 3- and 5-day course of treatment with Sumamed was carried out in patients with tonsillopharyngitis (925 patients), otitis media (367 patients), sinusitis (346 patients), acute bacterial bronchitis (1169 patients), community-acquired pneumonia (606 patients) and exacerbation chronic bronchitis(863 patients).

Among patients with tonsillopharyngitis (Table No. 1), the vast majority of patients (77.2%) received Sumamed® for three days. P O According to practitioners, the effectiveness of Sumamed in this pathology was high (84.9%), which is fundamentally important for preventing possible severe complications of this disease, such as glomerulonephritis and endomyocarditis.

Table 1
Clinical effectiveness different modes SUMAMEDA ® in the treatment of tonsillopharyngitis (n=925)

There were no statistically significant differences in the outcome assessment as recovery during 3 (87.3%) and 5-day courses (76.3%) of treatment (p>0.05). These clinical data indirectly reflect the presence of therapeutic concentrations of the drug in the tonsil tissue, which makes it possible to effectively combat streptococcal infection. It is noteworthy that in the group of patients who received a 5-day course of treatment, the percentage of patients with an “improvement” rating (18.2%) was greater than in the group of a 3-day treatment regimen (11.9%). These data apparently reflect the tendency of doctors to prescribe a 5-day course of treatment for more severe or complicated disease in the expectation of a “stronger” manifestation of the antibiotic’s effect.

A similar situation was revealed when assessing the effectiveness of the results of using Sumamed ® in 3- and 5-day courses in the treatment of sinusitis (Table No. 2), when the assessment of the effect as “improvement” was more common in patients who received the antibiotic for 5 days (23.9%) than in the 3-day therapy group (13.4%).

table 2
Clinical effectiveness of various SUMAMEDA ® regimens in the treatment of sinusitis (n=346)

The frequency of use of a 3- and 5-day course of Sumamed ® for sinusitis differed as significantly as was observed in patients with tosillopharyngitis, which indirectly reflects the tendency of doctors to evaluate sinusitis as a more severe disease and the desire to continue treatment with antibiotics, although the data presented convincingly indicate that recovery in the group of patients receiving a 3-day course, it was achieved even slightly more often than with a 5-day course (85.4% 73.9%, respectively).

A frequent complication of acute respiratory viral infection is the development of acute bacterial otitis media, which in older children and adults is not always recognized on time. In our study, 367 observations of antibacterial therapy with Sumamed® in this regard were analyzed (Table No. 3).

Table 3
Clinical effectiveness of various SUMAMEDA ® regimens in the treatment of bacterial otitis media (n=367)

In acute otitis media, doctors also more often used a 3-day regimen of Sumamed ® (69.3%) than a 5-day regimen - 30.7%. In general, the result of treatment was assessed as recovery in 85.2% of patients.

There were no statistically significant differences in the effectiveness of 3 and 5-day courses of Sumamed ® use. Recovery was achieved in 87.4% of patients who received a 3-day course of therapy and in 80.4% of patients who received an antibiotic for 5 days (p>0.05).

Currently, the need for antibacterial therapy for acute bronchitis is widely discussed in the literature and among practitioners. Considering the unfavorable premorbid background and typical clinical signs of current bronchitis against the background of an acute respiratory viral infection, doctors are inclined to the need and advisability of prescribing antibiotic therapy in these situations. IN this study we have 1169 observations evaluating the use of Sumamed ® in patients acute bronchitis. Moreover, the vast majority of patients (67.2%) had a 3-day regimen of use. (Table No. 4).

Table 4
Clinical effectiveness of various SUMAMED* regimens in the treatment of acute bronchitis (n=1169)

There were no statistically significant advantages of a 5-day course of treatment for this pathology compared to a 3-day course in patients with acute bronchitis: recovery was noted in 86.2% of patients who received an antibiotic for 3 days and in 81% of patients who received an antibiotic for 5 days (p>0.05).

Particular attention of clinicians is attracted by the possibility of using the unique pharmacokinetic properties of SUMAMED in the treatment of community-acquired pneumonia. The possibility of recovery against the background of a gentle regimen of antibiotic therapy allows us to reconsider approaches to the need for hospitalization, which until recently seemed inevitable in the case of a diagnosis of pneumonia. Our results of assessing the effectiveness of Sumamed in patients with community-acquired pneumonia confirm the high effectiveness of this antibiotic in this pathology (Table No. 5).

In general, recovery was stated in 84.8% of patients and there were no differences in achieving such an effect during 3 and 5-day courses of treatment: the effect was assessed as recovery in 77.6% and 71.8% of patients, respectively ( p>0.05). However, the analysis shows that doctors, apparently for psychological reasons, knowing that the course of treatment for pneumonia cannot be less than 10 days, prefer a 5-day dose of the drug (57.3% of cases). Among our observations, there were two concerning the treatment of community-acquired pneumonia in adults, when Sumamed ® was prescribed at a dose of 500 mg once a day for 10 days, which is a significant violation of the instructions for use of this antibiotic. Apparently, in this situation, the doctor’s standard approach to the treatment of pneumonia works without taking into account the unique pharmacokinetic characteristics of this antibiotic, which give the clinician powerful opportunities in organizing etiotropic, gentle and highly effective treatment of pneumonia in an outpatient setting. Fortunately, in none of these cases the patients noted any side effects while taking Sumamed ® .

Table 5
Clinical effectiveness of various SUMAMEDA ® regimens in the treatment of community-acquired pneumonia (n=606)

A special category of patients consists of patients with exacerbation of chronic bronchitis. These are, as a rule, patients who have irreversible structural and morphological changes in bronchopulmonary tissue and antibiotic therapy for exacerbations of the disease is extremely difficult for them, however, when using sumamed in a third of patients, the effect was regarded as recovery and in 60% - as improvement without any differences in the effectiveness of 3 and 5 day courses of treatment. (Table No. 6).

Table 6
Clinical effectiveness of various SUMAMED* regimens in the treatment of exacerbations of chronic bronchitis (n=863)

The results obtained indirectly confirm that azithromycin covers the spectrum of leading bronchopathogens, including Haemophilus influenzae, and accumulates in therapeutic concentrations in infected bronchial and lung tissue. Doctors' adherence to a 3- or 5-day antibiotic prescription regimen in this clinical situation turned out to be almost equal: 50.1% and 49.9%, respectively.

We did not set ourselves the task of a comparative study of Sumamed ® with antibiotics of other classes, however, in our study, by the doctor’s decision, in 295 cases other antibiotics were prescribed for the treatment of respiratory tract infections on an outpatient basis (Table No. 7). Among antibiotics of other classes, penicillins were most often prescribed for the treatment of respiratory tract infections on an outpatient basis, and in the vast majority of patients it was benzylpenicillin and aminopenicillins (31.2%). Other macrolides (mainly erythromycin), lincomycin and fluoroquinolones were prescribed with almost equal frequency. The percentage of application is quite high sulfa drugs(14.3%), although data on the resistance of one of the leading bronchopathogens, pneumococcus, to co-trimoxazole are well known. Moreover, the risk of developing such severe side effects of antibacterial therapy as toxic epidermal necrolysis syndrome (Lyell's syndrome) and Stevens-Johnson syndrome is 10–20 times higher when using sulfonamides than when using beta-lactam antibiotics. Antibacterial drugs were quite often prescribed parenterally (46.4%), which can also be attributed to negative trends in outpatient practice, especially in pediatrics.

Table 7
Frequency of prescription of other antibiotics (in%) (n=295)

In modern conditions, doctors cannot help but worry about the safety of antibiotic therapy. In our study, under the conditions of spontaneous registration of side effects, it was found that the highest percentage of side effects, mainly in the form of an allergic rash, was recorded with the use of gentamicin (23%) and sulfonamide drugs (14.3%), i.e. precisely those antimicrobial agents that are not the drugs of choice in the treatment of this pathology, but due to some inertial reasons, stubbornly retain their position in outpatient practice.

As for Sumamed ® , its use in this study was well tolerated. Mild dyspeptic disorders were detected in 1.3% of patients; in no case were any side effects of an allergic nature recorded and no need to discontinue the course of treatment was required. Compared to other macrolides used in this study, Sumamed ® demonstrates significantly better treatment safety indicators: side effects when using other macrolides were noted in 12.2% of cases.

Thus, the significant experience of doctors in outpatient practice in Moscow, numbering more than four thousand observations of the use of Sumamed in the treatment of community-acquired respiratory tract infections, indicates its high effectiveness in this pathology. A fundamentally important point is the lack of objective advantages of a 5-day course of therapy with Sumamed ® compared to a short 3-day course daytime mode its use in all localizations of infection in the respiratory tract that we have considered. These data, combined with data confirming the good tolerability of SUMAMED ®, suggest that the use of this antibiotic once a day for 3 days fully meets the requirements for rational antibiotic therapy of respiratory tract infections in outpatient practice.

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18. Hofman J. et al. The prevalence of drug-resistant Streptococcus pneumoniae in Atlanta. NEJM 1995, 333, 481–486.
19. Roujeau J.C. et al. Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. NEJM 1995, 333, 1600–1608.

Pneumonia is a serious infectious inflammatory disease of the lungs. Although modern medicine allows you to successfully eliminate this disease, there is a possibility of aggravation of the process with the development serious complications and even the death of the patient. Pneumonia requires emergency treatment. They effectively treat pneumonia in Moscow at the Yusupov Hospital. The clinic's therapists and pulmonologists have extensive experience in treating inflammatory diseases lungs and use only effective methods of evidence-based medicine.

General principles of treatment of pneumonia

After confirming the diagnosis of pneumonia using X-ray and other studies, selection begins drug therapy.
the choice of drugs will depend on the nature of the causative agent of the disease. Most cases of pneumonia are caused by bacterial agents. What exactly the nature of the disease is can be determined by laboratory and instrumental studies. The pathogen can be most accurately identified using bacteriological analysis of sputum. However, it takes time to obtain its results. Therefore, treatment begins with broad-spectrum drugs that are active against various bacteria. The course of antibacterial therapy ranges from 5-7 days. The end of the course will depend on the body’s response to the therapy.

In addition to antibacterial therapy, agents are used to improve sputum discharge: mucolytics and expectorants. Reducing body temperature is done with the help of antipyretics. Antihistamines may also be prescribed to reduce the severity of the allergic reaction (redness skin, itching, etc.).

Physiotherapeutic procedures are used in the treatment of pneumonia. They improve metabolic processes in the lungs and gas exchange, normalize breathing, and promote the release of purulent contents to the outside. Physiotherapeutic procedures are widely used:

medicinal electrophoresis;
oxygen therapy;
massage;
physical therapy;
breathing exercises.

Treatment of pneumonia is recommended in a hospital, since there is a risk of developing dangerous complications. In the hospital, the patient is under constant supervision of medical personnel, which will allow them to quickly respond to changes in the patient’s condition. At the Yusupov Hospital, patients are provided with comfortable rooms that have everything they need for a comfortable stay. The Yusupov Hospital is equipped with a central supply and exhaust ventilation system, thanks to which purified air enters the wards. Each room has air conditioning, so you can adjust the air temperature individually. The diet at the Yusupov Hospital is prepared by a nutritionist, taking into account the patient’s condition and wishes. The diet includes all the necessary microelements to maintain the body.

Experienced general practitioners and pulmonologists use modern effective methods of therapy that allow achieving better results in the treatment of pneumonia. In the rehabilitation clinic, measures are taken with the patient to restore the functioning of the body after suffering a serious illness.

Sumamed for pneumonia in adults and children

Sumamed is a broad-spectrum antibacterial drug whose main active ingredient is azithromycin. This antibiotic is a macrolide that actively affects staphylococcus, streptococcus, legionella, mycoplasma, chlamydia, and hemophilus influenzae. Sumamed is the drug of choice for uncomplicated pneumonia. It is used to treat the disease in both adults and children. Antibacterial action azithromycin is due to inhibition of bacterial protein synthesis.

Sumamed is produced in the form of capsules, tablets and suspensions. For the treatment of adults, capsules or tablets are used, but for the treatment of children, it is better to use a suspension. It is easy to swallow and has a pleasant taste (children usually do not spit out the drug). The package with the suspension contains a special dispenser syringe, with which it is easy to measure the required dosage and give it to the child. The dosage of the suspension in children is calculated taking into account the child’s weight. The drug can be prescribed to children from 6 months.

The course of treatment with Sumamed is determined by the attending physician. The antibiotic prescription regimen includes 5 days. Then they may prescribe re-use of the drug or change the dosage. The effectiveness of the selected antibacterial agent for pneumonia is assessed within 48 hours. If at the end of this period there is no improvement in the patient’s condition and there is no positive dynamics, as evidenced by the research results, another antibiotic or complex of drugs is used.

The drug Sumamed is not used in the following cases:

individual intolerance to azithromycin;
insensitivity of the pathogen to this antibiotic, which is confirmed by tests;
severe liver damage.

Sumamed for pneumonia: tolerability and side effects

Sumamed is a drug that is well tolerated. Side effects are rare in adults and children. However, side effects of the drug include:

allergic reaction;
nausea, vomiting;
defecation disorders;
headache;
drowsiness, insomnia;
visual impairment;
hearing impairment;
development of fungal infection;
disruption of the circulatory system (anemia, leukopenia, neutropenia, thrombocytopenia);
liver damage.

Since most often the course of taking the drug does not exceed 5-7 days, patients rarely complain of adverse reactions. Children also respond well to this drug.

It is important to remember that any antibacterial drug is prescribed by the attending physician. Pneumonia is a dangerous disease that cannot be treated on its own, even if the patient has previously suffered a similar disease. The doctor assesses the patient’s condition and takes into account the risks of complications, so he selects therapy based on the individual’s individual characteristics. At the Yusupov Hospital, therapists use drugs whose effectiveness has been proven by research and personal practice to treat pneumonia. This allows you to achieve positive dynamics, which contributes to a speedy recovery.

You can make an appointment with a therapist or pulmonologist, or get specialist advice by calling the Yusupov Hospital.

yusupovs.com

Comments

Published in the Collection of Proceedings of the All-Russian Scientific Society:
“Current problems of pulmonology” »» 2000 E.V. Andryushchenko, M.B. Bogdanov
Moscow representative office of JSC "Pliva" (Croatia)

Community-acquired respiratory tract infections in both children and adults represent the most common group of diseases, the treatment of which almost always raises the question of prescribing antibiotics. According to a number of researchers in the USA and England, respiratory tract infections account for 75% of all prescriptions written annually in outpatient practice, and most of them relate to the treatment of tonsillopharyngitis and bronchitis. This problem, despite its apparent simplicity given the huge selection of antibacterial agents that clinicians currently have at their disposal, worries both practitioners and clinical microbiologists. This is due to the fact that antibiotics in outpatient settings are prescribed empirically and this poses the danger of the selected drug not matching the etiology of the disease, and, as a consequence, a high percentage of treatment failures and the spread of strains of resistant pathogens. It is believed that among the risk factors for the development of resistance, the role of prescribing low doses of drugs, treatment duration of more than 5 days and the adverse consequences of poor compliance are significant.

Macrolide antibiotics have always occupied a significant place in the treatment of respiratory tract infections in outpatient practice. In our country it is mainly erythromycin. Despite the fact that the spectrum of action of this antibiotic includes pneumococcus and intracellular pathogens, doctors and patients cannot be satisfied with either the significant percentage of quite pronounced side effects from the gastrointestinal tract, or the treatment regimen that requires 4 doses of the drug for 7 – 10 days. The latter, as is known, is due to the too short half-life of this antibiotic, which is only 2 hours.

Unlike erythromycin, azithromycin is stable in relation to the acidic environment of the stomach and exhibits higher activity against Haemophilus influenzae - one of the leading causative agents of respiratory tract infections in community settings.
In the future, this situation may be very significant, since it is believed that by the year 2000, 45–50% of clinical strains of H. influenzae will be regarded as β-lactamase producing, and the level of resistance of H. influenzae strains to azithromycin is less than 1%. However, the most significant difference between this drug and other macrolides is its unique pharmacokinetic properties, which allow, after oral administration of the antibiotic, to note its rapid and targeted penetration into infected tissues and the creation directly at the site of inflammation of the therapeutic concentrations necessary for a good treatment result, which has been proven for lung tissue, bronchi, tonsils, contents of the paranasal sinuses and the middle ear cavity. Characterized by the slow release of azithromycin from cells, which is closely related to the process of phagocytosis and the preservation of high therapeutic concentrations of the antibiotic in tissues after stopping the drug for another 5–7 days after taking the last dose, which makes it possible to equate taking the drug for 3 days to 7–10 days. day course of treatment. This clinically important phenomenon is due to the long half-life of azithromycin, up to 72 hours.

It is these properties that made it possible to recommend a single dose of azithromycin during the day and, initially, a 5-day, and in the last three years, a 3-day regimen of its use for various diseases of the respiratory tract of bacterial etiology. In the last decade, azithromycin has been actively used in the treatment of respiratory tract infections in Russia, however, until now, a 3-day course of its use in outpatient practice, especially in the treatment of lower respiratory tract infections, has not yet become routine.

In this regard, the purpose of this study was to analyze the assessment by practitioners of the effectiveness and safety of azithromycin (Sumameda ® from PLIVA Croatia), used in 3- and 5-day courses in the treatment of respiratory tract infections. The PLIVA company developed a questionnaire on antibacterial therapy, which was offered for completion to local doctors in various Moscow clinics from September 1998 to April 1999. Subsequently, statistical processing of the results was carried out using the X2 criterion.

An analysis of the effectiveness of antibacterial therapy for respiratory tract infections was carried out in 4571 patients. The study included children of high school age and adults up to 60 years of age. Of the total number of cases, 2653 patients received SUMAMED for a course of 3 days. 1623 patients were prescribed SUMAMED for 5 days and 295 patients, according to the decision of the attending physician, received other antibiotics for a course of 7–10 days. A comparative assessment of the effectiveness of a 3- and 5-day course of treatment with Sumamed was carried out in patients with tonsillopharyngitis (925 patients), otitis media (367 patients), sinusitis (346 patients), acute bacterial bronchitis (1169 patients), community-acquired pneumonia (606 patients) and exacerbation of chronic bronchitis (863 patients).

Table 1
Clinical effectiveness of various SUMAMEDA ® regimens in the treatment of tonsillopharyngitis (n=925)

table 2
Clinical effectiveness of various SUMAMEDA ® regimens in the treatment of sinusitis (n=346)

Table 3
Clinical effectiveness of various SUMAMEDA ® regimens in the treatment of bacterial otitis media (n=367)

Currently, the need for antibacterial therapy for acute bronchitis is widely discussed in the literature and among practitioners. Considering the unfavorable premorbid background and typical clinical signs of current bronchitis against the background of an acute respiratory viral infection, doctors are inclined to the need and advisability of prescribing antibiotic therapy in these situations. In this study, we have 1169 observations assessing the use of Sumamed ® in patients with acute bronchitis. Moreover, the vast majority of patients (67.2%) had a 3-day regimen of use. (Table No. 4).

Table 4
Clinical effectiveness of various SUMAMED* regimens in the treatment of acute bronchitis (n=1169)

Table 5
Clinical effectiveness of various SUMAMEDA ® regimens in the treatment of community-acquired pneumonia (n=606)

Table 6
Clinical effectiveness of various SUMAMED* regimens in the treatment of exacerbations of chronic bronchitis (n=863)

We did not set ourselves the task of a comparative study of Sumamed ® with antibiotics of other classes, however, in our study, by the doctor’s decision, in 295 cases other antibiotics were prescribed for the treatment of respiratory tract infections on an outpatient basis (Table No. 7). Among antibiotics of other classes, penicillins were most often prescribed for the treatment of respiratory tract infections on an outpatient basis, and in the vast majority of patients it was benzylpenicillin and aminopenicillins (31.2%). Other macrolides (mainly erythromycin), lincomycin and fluoroquinolones were prescribed with almost equal frequency. The percentage of use of sulfonamide drugs is quite high (14.3%), although data on the resistance of one of the leading bronchopathogens, pneumococcus, to co-trimoxazole are well known. Moreover, the risk of developing such severe side effects of antibacterial therapy as toxic epidermal necrolysis syndrome (Lyell's syndrome) and Stevens-Johnson syndrome is 10–20 times higher when using sulfonamides than when using beta-lactam antibiotics. Antibacterial drugs were quite often prescribed parenterally (46.4%), which can also be attributed to negative trends in outpatient practice, especially in pediatrics.

Table 7
Frequency of prescription of other antibiotics (in%) (n=295)

Thus, the significant experience of doctors in outpatient practice in Moscow, numbering more than four thousand observations of the use of Sumamed in the treatment of community-acquired respiratory tract infections, indicates its high effectiveness in this pathology. A fundamentally important point is the lack of objective advantages of a 5-day course of therapy with Sumamed ® compared to a short 3-day regimen of its use for all localizations of infection in the respiratory tract that we considered. These data, combined with data confirming the good tolerability of SUMAMED ®, suggest that the use of this antibiotic once a day for 3 days fully meets the requirements for rational antibiotic therapy of respiratory tract infections in outpatient practice.

Literature
1. Levy S.B. The challenge of antibiotic resistance. Scientific American 1998, March: 32–39.
2. Davey P.G., Bax R.P., Newey J. et al. Growth in the use of antibiotics in the community in England and Scotland in 1980–93/ BMJ 1996, 312, 613.
3. Guillemot D., Carbon C., Vauzelle-Kervroedan F. et al. Inappropriatity and variability of antibiotic prescription among French office-based physicians. J.Clin. Epidemiol. 1998, 51(1): 61–68.
4. Guillemot D., Carbon S., Balkau D. et al. Low dosage and long treatment duration of beta-lactam: risk-factors for carriage of penicillin-resistant Streptococcus pneumoniae. JAMA 1998, 279, 365–370.
5. Chun A.N.C. & Seitz J.A. Pharmacokinetics and biological availability of erythromycin. Infection, 1977, 5, Suppl. 1, 14–22.
6. Fass R.J. Erythromycin, clarithromycin and azithromycin: use of frequency distribution curves, scattergrams and regression analyzes to compare in vitro activites and describe cross-resistance. Antimicrob. Agents Chemother., 1993, 37, 2080–2086/
7. DunnC.J., BarradellL.B., Azithromycin. A review of its pharmacological properties and use as 3-day therapy in respiratory tract infections. Drugs 1996, 51(3), 483–505.
8. DoernG.V. Trends in antimicrobial susceptibility of bacterial pathogens of the respiratory tract. The American Journal of Medicine 1995, vol. 99, suppl. 68, 68–72.
9. Foulds G. et al. Concentrations of Azithromycin in human tonsillar tissue. Eur.J.Clin. Microbiol. Infect. Dis 1991, vol.10, 10, 853–855.
10. Karma P. et al. Azithromycin concentrations in sinus fluid and mucosa after oral administration. Eur.J.Clin. Microbiol. Infect. Dis 1991, vol.10, 10, 856–859.
11. Wise R. et al. The penetration of azalides and macrolides into the reapiratory tract. In: Program and abstracts of 2 International Conference on the Macrolides, Azalides and Streptogramins 1994, 41.
12. Foulda et al. The Pharmacokinetics of azithromycin in human serum and tissues. Journal of Antimicrobial Chemotherapy 1990, 25, suppl.A , 73–82.
13. Ficnar V. et al. Azithromycin: 3-day versus 5-day course in the treatment of respiratory tract infections in children. Journal of Chemotherapy 1997, vol. 9, 1, 39–43.
14. Arguedas A. Comparative trial of 3 days of Azithromycin versus 10 days of Clarthromycin in the treatment of children with acute otitis media with
effusion Journal of Chemotherapy 1997, vol. 9, 1, 44–50.
15. O’Doherty V. An open comparative study of azithromycin versus cefaclor in the treatment of jf patients with upper respiratiory tract infections. J. Antimicrob. Chemother. 1996, 37, suppl.С, 71–81.
16. Aydin E. A comparative study of azithromycin, cephalexin and penicillin V for the treatment of streptococcal pharingitis and tonsillitis in children. Microbiol B_LT 1996, 30, 233–238.
17. Verheij Th., J., M. et al. Acute bronchitis: general practitioners’ views regarding diagnosis and treatment. Family Practice 1990, 7, 175–180.
18. Hofman J. et al. The prevalence of drug-resistant Streptococcus pneumoniae in Atlanta. NEJM 1995, 333, 481–486.
19. Roujeau J.C. et al. Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. NEJM 1995, 333, 1600–1608.

medi.ru

pharmachologic effect

The active ingredient of the drug Sumamed is azithromycin. It is endowed with a wide range antimicrobial action. The drug is highly active both against gram (+) microorganisms and against gram (-) pathogens, anaerobes, spirochetes, mycoplasmas.

Azithromycin has a detrimental effect on the following pathogenic microbes:

pneumococci;
enterococci;
coli;
hemophilus influenzae;
gonococci;
legionella;
shigella;
salmonella;
staphylococci;
streptococci;
bacteroids;
clostridia;
peptococci;
chlamydia.

The drug has a bacteriostatic (stops the proliferation of microbes), and in high concentrations, a bactericidal (kills existing pathogenic microorganisms) effect.

The mechanism of influence of Sumamed lies in binding to ribosomes bacterial cell and cessation of protein synthesis, which is necessary for further reproduction of the microbe. Suppression of the synthesis of bacterial proteins leads to the suspension of their reproduction, and in high concentrations of the antibiotic, to the destruction of existing microbes.

In addition to the antimicrobial effect, Sumamed also has immunomodulatory activity, which consists of restoring the balance of protective T-helper cells immune system, normalizing the work of phagocytes, reducing the production of pro-inflammatory cytokines.

The immunomodulatory effect of the drug allows you to quickly restore the body's reserve forces weakened by the disease and correct defects in the immune system.

Azithromycin, in comparison with all other macrolides, creates the most high concentrations active substance in the lungs. This allows us to rightfully call it a leader among this group of drugs for the treatment of bacterial infections of the lower respiratory tract, including pneumonia.

Release form

Today the drug is available in the form:

tablets 125 mg, 500 mg;
capsules 250 mg, 500 mg;
powder for preparing a suspension 100 mg/5 ml;
lyophilized powder for preparing a solution for intravenous use(1 bottle – 500 mg)

An antibiotic is prescribed orally in solid dosage form (tablets, capsules) or in the form of a suspension, which is very convenient in childhood. In a hospital setting, the drug can be administered intravenously by drip, previously diluted with saline or 5% glucose solution.

Suspensions can contain 100 mg of azithromycin in 5 ml, or 200 mg of antibiotic in 5 ml of an already prepared product. A suspension with a higher dosage of the active substance is called Sumamed forte.

The doctor selects the optimal dosage and form of taking Sumamed, focusing on the patient’s age, severity of pneumonia, treatment conditions (outpatient or inpatient).

Indications

The drug is used for diseases caused by microorganisms sensitive to azithromycin:

tonsillitis;
pneumonia;
bronchitis;
pharyngitis;
laryngitis;
sinusitis;
otitis media;
urinary tract diseases;
stomach diseases associated with H. pylori;
Lyme disease.

Pneumonia is one of the leading areas in which Sumamed has established itself as the drug of choice. This is largely due to a wide spectrum of antibacterial activity, as well as the highest ability among all macrolides to accumulate in lung tissue and have a bacteriostatic and bactericidal effect.

Mechanism of action

The drug is well absorbed into gastrointestinal tract, exhibits resistance to acidic environments. Bioavailability is about 38%. Already 2.5-3 hours after taking azithromycin in the blood, its maximum concentration is reached, which can have a therapeutic effect.

The drug has a long half-life (about two days), which means a low frequency of dosing per day - once is enough. Reception medicine Once a day is very convenient for patients.

The bactericidal concentration, which does not give microbes sensitive to the drug a chance to survive, persists for another 5-7 days after taking the last dose of Sumamed.

Azithromycin disintegrates in the liver and is excreted primarily in bile.

The bioavailability of Sumamed depends little on food intake, but according to some data, it is better to take the antibiotic on an empty stomach at the same time.

Dosage and course of treatment for pneumonia

Adults are prescribed:

inside 500 mg once a day before meals for 3 days or 500 mg once on the first day, then 250 mg once a day from the 2nd to the 5th day;
intravenously by drop method slowly (over 3 hours) 500 mg of the drug dissolved in 500 ml of 5% glucose solution or saline solution NaCl.

Children are usually prescribed a Sumamed suspension at the rate of 10 mg per 1 kg of body weight on the first day of treatment, then 5 mg per 1 kg of body weight. The course of treatment does not exceed five days.

Sumamed for infusion is contraindicated in children under 16 years of age, therefore intravenous antibiotic administration is applicable only for adult patients.

If the permissible dose of the drug is significantly exceeded, they may develop following symptoms: hearing impairment, nausea, vomiting, diarrhea. When data becomes available clinical events it is necessary to rinse the stomach and call ambulance. It should be noted that an overdose is excluded if the dose of Sumamed recommended by the doctor is observed.

Contraindications

Allergic reactions to a group of macrolides.
Individual intolerance to the drug.
Severe liver dysfunction
Chronic renal failure.

The drug is prescribed with caution for cardiac arrhythmias.

Little has been studied of the effects of azithromycin on the fetus in pregnant women, as well as its use during lactation. During pregnancy, it is permissible to take the drug strictly when absolutely necessary and only under the supervision of a doctor.

Side effects

The medicine is generally well tolerated by patients, side effects while taking it, they occur very rarely.

Sometimes patients may experience stomach pain, nausea, and vomiting. Rarely, headaches, dizziness, and allergic reactions in the form of itchy skin rashes and urticaria occur.

With rapid intravenous administration of the drug, thrombophlebitis and phlebitis may develop due to the local irritant effect, therefore azithromycin must be administered only by slow drip intravenous infusion persons over 16 years of age.

Compared to other groups of drugs, macrolides, to which Sumamed belongs, are relatively recognized safe group antibiotics.

Combination of Sumamed with other antibacterial drugs

The combined use of Sumamed with other antibiotics in some cases leads to an increase in their therapeutic activity– to synergy.

There are rational combinations with high efficiency, recognized throughout the world. This is a combination with the following groups antibacterial agents:

B-lactams (penicillins, cephalosporins);
fluoroquinolones;
aminoglycosides;
rifampicin.

Sumamed is an effective drug recommended by doctors for pneumonia for both adults and children. Due to its relative safety, in extreme cases, Sumamed can be prescribed to pregnant women. Various shapes release of the antibiotic makes it convenient for use both on an outpatient basis and in a hospital setting.

Sumamed is a prescription drug. It is impossible to purchase it yourself at a pharmacy. It should be remembered that this medicine is prescribed only by a specialist and taken strictly in the indicated dosage. Changing the treatment regimen, reducing or increasing the dosage is strictly prohibited. This may negatively affect the therapeutic activity of the drug and cause deterioration in health.

ingalin.ru

Sumamed for pneumonia in adults

Sumamed was invented more than 30 years ago. Experts perceived the drug as a new word in antibiotic therapy. A powerful, broad-spectrum antibiotic seemed to be the ideal way to fight the infection. However, over time, new unknown aspects of the drug were discovered, which somewhat cooled the ardor of the idealists.

For example, only in 2013, American scientists discovered the effect of Sumamed on the heart muscle, which can be potentially dangerous. It is worth immediately noting that the probability of this effect is very small and hardly exceeds a hundredth of a percent.

Let's still try to figure out how effective and safe Sumamed is...

Before you continue reading: If you are looking effective method getting rid of constant colds and diseases of the nose, throat, lungs, then be sure to look into section of the site "Book" after reading this article. This information is based on the author’s personal experience and has helped many people, we hope it will help you too. NOT advertising! So, now back to the article.

History of creation

Sumamed was invented by a research group of the Croatian company Pliva. It can be noted that Pliva has been a source of special pride for Croatians for almost 100 years. The company employed outstanding scientists, among whom was a Croatian laureate Nobel Prize in chemistry 1975 Vladimir Prelog.

A group of chemists from Zagreb who managed to synthesize Azithromycin (the active ingredient of Sumamed) also achieved worldwide recognition. In 2000, scientists led by Dr. Slobodan Đokić became the winners of the prestigious American Chemical Society Heroes of Chemistry award for the invention of Azithromycin.

Croatia takes pride of place in the list of nine countries that have synthesized their own original antibiotics. To this day, Azithromycin or Sumamed is the most important pharmaceutical product invented in Croatia. And one of the most important in the world.

Sumamed walks around the planet

Sumamed is used all over the world. In 2010, Azithromycin became the most popular antibiotic in the United States. According to experts, revenue from the sale of original Azithromycin is about $1.5 billion per year.

The pharmaceutical giant Pfizer has exclusive rights to sell Azithromycin in America. Therefore, Sumamed is marketed in the USA under the brand name Zithromax.

However, in some European countries Sumamed's popularity is not so obvious. For example, in Sweden, Azithromycin is prescribed in only 4% of cases, although macrolides remain a popular group of antibiotics and make up up to 30% of all prescriptions for antibacterial agents.

Nevertheless, the World Health Organization included Sumamed in the list of essential medicines.

Antibiotic Sumamed: a bright representative of macrolides

Very often, when describing antibiotics, we come across the name of an entire class of drugs. And, if at the mention of penicillins most readers have associations with Alexander Fleming, then the word “macrolides”, as a rule, looks like an encrypted rebus.

So, let's decipher this gobbledygook. The macrolide antibiotic contains in its chemical structure a lactone ring consisting of 14–16 members. All drugs from this group have a similar spectrum of activity and, therefore, indications. But Sumamed stands out from the orderly row of macrolides in almost every indicator.

Sumamed is the first antibiotic from a new subclass of macrolides with a 15-membered lactone ring - azalides. It is a successor to erythromycin, but due to differences in the chemical structure it has much greater activity against many bacteria.

In addition, Sumamed differs from other macrolide drugs in its slow elimination from the body. Thanks to this property, we can successfully treat various infections in 3-5 days, taking an antibiotic only once a day. Erythromycin does not stand any comparison with Sumamed in this regard either. For successful therapy Erythromycin should be taken three or even four times a day, and the course of treatment can last up to two weeks.

Composition and release forms of Sumamed

Sumamed - tradename antibiotic Azithromycin, which is used in the form of a chemically stable dihydrate.

The Pliva company offers many forms of release of Sumamed.

Tablet and capsule forms of Sumamed

Sumamed tablets containing Azithromycin 500 mg;
Sumamed capsules 250 mg;
Sumamed tablets 125 mg.

Sumamed tablets are coated film-coated. The Sumamed package contains the minimum number of tablets required for a course of treatment: Sumamed 500 mg contains 3 tablets, and 250 mg and 125 mg - 6 tablets or capsules each.

Sumamed suspensions for children

The Pliva company produces a wide range of Sumamed children's suspensions. At the same time, the differences between in different forms consist not only in the dosage, but also in the volume of the finished suspension. The doctor can choose the release form depending on the age of the child and the severity of the disease. Sumamed, like the vast majority of other antibiotics, is quickly destroyed in a dissolved state. Therefore, Sumamed suspensions are prepared before use and are available in the form of a dry powder. So, let's list the children's forms of Sumamed:

Sumamed containing 100 mg of Azithromycin in 5 ml of suspension (the volume of the finished medicine is 20 ml);
Sumamed forte contains 200 mg of antibiotic in 5 ml of the drug (suspension volume 15 ml);
Sumamed forte 200 mg in 5 ml, volume 30 ml;
Sumamed forte 200 mg in 5 ml, volume - 37.5 ml.

Injection form

For the treatment of severe diseases, injectable Sumamed is produced. This form of release is most often used in hospitals. Parenteral Sumamed is available in powder form, from which a suspension is prepared before use.

"Smart antibiotic"

The high effectiveness of Azithromycin and the short course of treatment for most infections are due to the pharmacokinetic properties of the drug.

Sumamed is quickly and easily absorbed, reaching peak (maximum) concentrations in the blood and tissues within 2.1–3.2 hours after oral administration. At the same time, Azithromycin, unlike many other antibiotics, is able to penetrate through cell membranes. Thereby rare property Sumamed is effective against intracellular pathogens, which include chlamydia.

Once absorbed into the blood, the drug very quickly goes directly to the site of infection. The level of antibiotic in affected tissues is approximately 25–30% higher than in healthy tissues.

In addition, Azithromycin is well distributed in lipids, and therefore quickly absorbed by tissues. Moreover, the concentration of Sumamed in tissues is 50 times higher than the content in the blood.

Azithromycin is eliminated from the body within several days. Due to its long half-life, the drug can be taken only once a day, and the course of treatment lasts from one to five days.

And the last thing I would like to mention in this section. Sumamed is an acid-resistant drug. This means that it is not destroyed in the hydrochloric acid environment of the stomach and does not need additional protection.

Sumamed: spectrum of antibacterial activity of the drug

Sumamed is effective against many pathogenic microorganisms. Both clinically and in vitro, Azithromycin has been proven to be active against a wide range of pathogens, including:

streptococci;
pneumococcus - the causative agent of pneumonia;
pathogens of Haemophilus influenzae Haemophilus infections influenzae;
Moraxella;
gonorrhea pathogen Neisseria gonorrhoeae;
chlamydia - Chlamydophila pneumoniae and Chlamydia trachomatis;
mycoplasma.

Separately, I would like to note the high activity of Sumamed against methicillin-sensitive strains of streptococcus. These microorganisms, resistant to many antibiotics, cause severe nosocomial infections. After the invention of Azithromycin, it became possible to quickly and effectively treat the most dangerous hospital-acquired pneumonia and other diseases.

Sumamed's activity against some microorganisms has been proven only in vivo, that is, in vitro. Experience clinical application Azithromycin is not yet sufficient for infections. This group of microorganisms includes:

beta-hemolytic streptococcus of groups C, F, G;
viridans group streptococci;
whooping cough pathogen Bordetella pertussis;
ureaplasma;
legionella.

Indications for use of Sumamed

The indications for use of Sumamed include many infectious diseases. Oral forms of Sumamed, that is, capsules, tablets or suspension, are indicated for mild to moderate diseases. Severe forms of infections are treated, as a rule, in hospitals, including with the help of injection forms.

A special feature of Azithromycin is its high activity against gram-negative, gram-positive and other microorganisms, for example, chlamydia. Thanks to these properties, the drug is used for the most various infections: respiratory, genitourinary, post-surgical.

Let's take a closer look at the main diseases that are treated with Sumamed.

Respiratory tract diseases

acute bacterial exacerbations of COPD - chronic obstructive pulmonary disease - associated with Haemophilus influenzae, Moraxella or streptococcus;
acute bacterial sinusitis (inflammation of the sinus mucosa);
community-acquired pneumonia, the main pathogens of which are Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma and Streptococcus ( Mycoplasma pneumoniae and Streptococcus pneumoniae). Sumamed works great against all these microorganisms.

I would like to note that Azithromycin is not recommended for use for pneumonia in weakened patients with immunodeficiency, in the elderly, in people who require hospitalization due to severe course illness or concomitant pathologies. In such cases, the decision to select an antibiotic is made based on the patient's individual data.

pharyngitis and tonsillitis (inflammation of the mucous membrane of the pharynx and tonsils) caused by the streptococcus Streptococcus pyogenes. Penicillin antibiotics are considered the gold standard for these diseases. However, in case of direct contraindications to taking first-line drugs, the use of Sumamed is indicated.

Thus, Sumamed can also be prescribed for angina, but most often this prescription is associated with an allergy to Amoxicillin.

Dermatological diseases

Sumamed is indicated for uncomplicated skin infections caused by Staphylococcus aureus and streptococci Streptococcus pyogenes and Streptococcus agalactiae.

Borreliosis or Lyme disease

The drugs of choice for this bacterial infection are antibiotics from the group of penicillins and cephalosporins. However, more recently, convincing evidence has been obtained of the effectiveness of Sumamed in the initial stages of tick-borne borreliosis. Note that Azithromycin is indicated only in cases of the ring-shaped migratory form of the disease.

STDs: Sumamed as the drug of choice

The very harmless abbreviation STD hides not the most harmless infections, which were previously called simply and clearly - sexually transmitted diseases. So, STDs are the same diseases that are sexually transmitted.

Sumamed is distinguished by high activity against the causative agents of certain STDs, namely chlamydia and gonorrhea. So high that for chlamydia, Azithromycin is used as the drug of choice and even sometimes as part of monotherapy.

It is worth noting that the effect of Sumamed in high dosages can mask the symptoms of syphilis. Therefore, before treating pelvic inflammatory diseases, urethritis (inflammation of the urethra), cervicitis (inflammation of the cervical canal), the pathogen should be differentiated. Simply put, you need to make sure that the inflammatory processes in the urogenital tract are not caused by the pallidum spirochete, the causative agent of syphilis.

I would like to warn particularly desperate patients who have been diagnosed with chlamydia or gonorrhea against the temptation self-treatment Sumamed. Despite the high sensitivity of the causative agents of these infections, Chlamydia trachomatis and Neisseria gonorrhoeae, to Azithromycin, you should not take risks and take the medicine at random.

The fact is that if the dosage is not high enough or the course of treatment is relatively short, there is a very significant risk of microorganisms adapting to the antibiotic. If this trouble occurs, it will be even more difficult to cure these, frankly, not the most harmless infections.

Therefore, if the causative agents of chlamydia or gonorrhea are isolated, treatment must be started immediately, which must be prescribed by a qualified doctor. The correct treatment regimen, including Sumamed, strict adherence to the specialist’s recommendations - and in just a few weeks you can forget about these unpleasant diseases.

Sumamed dosage for children

Children's suspension of Sumamed, however, like adult forms, should be taken either one hour before meals, or after meals. This requirement is due to the fact that the bioavailability of Azithromycin decreases when used simultaneously with food.

Children's dosages of the drug depend on the type of disease. According to the instructions for use of Sumamed, the dose for children is:

for acute otitis media - 30 mg of Azithromycin per kg of body weight once or 10 mg per kg for three days;
for acute bacterial sinusitis - 10 mg per kg of body weight for three days;
for community-acquired pneumonia, the recommended dose of Sumamed suspension is 10 mg per kg of body weight once on the first day of treatment. Then the dosage of Azithromycin is reduced to 5 mg per kg of body weight, and the course of treatment, as a rule, does not exceed five days.

Information that is not in the instructions, or How much Sumamed suspension is needed?

Considering the variety of children's forms of Sumamed, it is sometimes difficult to figure out what volume of suspension will be needed for a course of treatment.

Let's try to systematize the information somewhat and clearly show how many milliliters of suspension are needed for standard treatment regimens.

For angina, Sumamed is used according to a different scheme, therefore the volume of the suspension is slightly different. It is calculated based on the course of treatment with Azithromycin at a dosage of 200 mg in 5 ml of suspension for five days. Let us repeat: children of any age with bacterial pharyngitis and tonsillitis need a high dosage suspension of Sumamed (200 mg/5ml).

Sumamed children's suspension: how to dilute correctly?

When reading the instructions for the Sumamed children's suspension for the first time, many parents are perplexed. The fact is that, at first glance, when diluting an antibiotic, a very mysterious transformation occurs, which contradicts the laws of physics. After all, when adding the recommended volume of water to the powder total suspension almost doubles.

This fact often confuses parents and makes them doubt the correctness of the instructions or their intellectual abilities.

In fact, there is no error in the annotation. In fact, due to the properties of the excipients contained in Sumamed, the final volume of the suspension increases after the addition of solvent.

Before diluting Sumamed powder, you need to prepare a cool boiled water. Highly purified water is also quite suitable. Using the syringe that comes with each package of Sumamed, it is necessary to measure the amount of solvent specified in the instructions for the drug:

to obtain 15 ml of Sumamed forte suspension you will need 8 ml of water;
to obtain 20 ml of suspension you need to add 12 ml of water;
to get 30 ml, 14.5 ml of water is enough;
To obtain 37.5 ml of medicine, only 16.5 ml of water is enough.

After adding water, it is important to thoroughly shake the bottle of medicine and try to get as homogeneous a suspension as possible.

Rules for receiving and storing Sumamed suspension

The Sumamed suspension, like any other two-component system, is heterogeneous. Azithromycin is practically insoluble in water, so liquid forms of the drug are suspensions - suspensions of the active substance in a solvent (water).

The antibiotic is much heavier than water, and it quickly settles to the bottom of the bottle. Therefore, before taking the Sumamed suspension, as well as any other suspension, it is very important to achieve the maximum possible distribution of Azithromycin in water. Only in this case will the dosage correspond to that stated in the instructions.

The prepared suspension can be stored at room temperature. Note that the temperature cannot be called above 25 degrees room temperature. If the thermometer exceeds these figures, you should place the bottle of medicine on the “warmest” shelf in the refrigerator, where the average temperature does not fall below 8–10 degrees Celsius.

At what age is Sumamed safe: these instructions for use

According to the information specified in the instructions for Sumamed, the drug in the form of a children's suspension is indicated for children older than 6 months. However, in practice, Sumamed is used to treat children whose weight has exceeded the five-kilogram mark. It is worth noting that the treatment of newborns and children less than six months old is carried out exclusively by neonatologists and pediatricians.

Sumamed at a dosage of 125 mg can be taken from the age of 3, if the child is able to swallow a tablet. In addition, Sumamed tablets for children are preferable if the child is highly sensitive to various flavors that contain suspensions.

Sumamed for adults: how much to take

The instructions for use of Sumamed indicate average therapeutic dosages of the drug for adults and children weighing more than 45 kilograms. Experts emphasize that children over the age of 12 can already take adult doses of Azithromycin.

The course of treatment with Sumamed depends on the location and severity of the infection.

— Respiratory tract and skin infections

The average treatment regimen for these diseases involves a three-day course of therapy with one Sumamed tablet at a dosage of 500 mg. The so-called course dose is 1.5 grams.

— Urogenital infections caused by Chlamydia trachomatis

According to official data given in the instructions for the original Sumamed, in an uncomplicated process, one gram of Azithromycin is enough to completely eliminate the pathogen. However, such a “light” scheme is used if the infection occurred very recently.

Note that chlamydial infection is usually diagnosed after a certain period of time after infection. Thus, in most patients, chlamydia is detected already in the chronic stage.

Based on these data, a simple conclusion can be drawn. Usually, full course treatment of chlamydia includes Sumamed in high dosages, the duration of therapy is determined individually.

— Lyme disease

For borreliosis, Sumamed is usually prescribed on the first day of treatment in a single dose of 1 gram, and from the second to the fifth day inclusive - 500 mg. The total course dose of Azithromycin in such cases is 3 grams.

Self-medication with antibiotics: forewarned is forearmed

You probably remember that antibiotics are prescription drugs. And Sumamed, of course, is no exception to the rule.

It is impossible to buy Sumamed without a prescription all over the world. Except, unfortunately, some countries of the former Soviet Union. Only here we are still treated with antibiotics “just in case of emergency.”

I would like to warn patients who “diagnosed” themselves with a bacterial infection, and at the same time determined the spectrum of activity and “prescribed” themselves, for example, Azithromycin. Correctly assign any Only a specialist can administer an antibacterial drug.

An amateur can easily confuse a bacterial infection with a viral one, which is not sensitive to antibiotics at all. In addition, there is the potential danger of developing insensitive strains of bacteria as a result of an incorrect course of treatment. And, of course, we must not forget about possible side effects, the likelihood of which increases many times with inadequate dosage.

So, if you really want to be treated, and not drive your body into a blind corner from which it is already difficult to find a way out, entrust treatment with Sumamed to a doctor.

Contraindications to treatment with Sumamed

Sumamed is contraindicated for:

— Individual hypersensitivity to Azithromycin.

The probability of such a reaction is quite small and is less than 1%. Usually, individual reaction develops in those patients who have already experienced allergies to medications.

If the patient has a history of a reaction to erythromycin or other antibiotics from the macrolide group, the likelihood of an allergy to Sumamed is extremely high, and the drug is not recommended for use.

— History of cholestatic jaundice associated with treatment with Sumamed

If you have developed cholestatic jaundice during previous treatment with Azithromycin, your doctor is unlikely to ever prescribe Sumamed to you again.

Pregnancy and Sumamed: when you can’t do without an antibiotic

We have already said that Azithromycin easily penetrates into a wide variety of body tissues due to its excellent lipid solubility. And, of course, overcoming the placental barrier is not a problem for such a ubiquitous antibiotic.

Several years ago, a group of scientists studied the effect of Azithromycin on the reproductive system of laboratory rats and mice. During the experiment, pregnant female experimental animals were given an absolutely fantastic dose of Sumamed. It would seem that no organism should have withstood a load of 200 mg of Sumamed per kilogram of body weight per day. However, laboratory rats are no strangers to the difficulties of fate. Imagine that at the end of the study, scientists did not register a single side effect of Azithromycin on the fetus!

Conducting clinical trials studying the effect of a drug on pregnancy in humans is associated with certain difficulties. After all, it’s simply impossible to find volunteers for such a task. So pharmacologists are content with data from animal experiments. And the drug falls into the so-called category B and is recommended for use by pregnant women if the benefit for the woman is higher than the possible risk of complications for the child.

The proven extremely low toxicity of Sumamed, coupled with encouraging data from experiments on laboratory rats, made it possible to use the medicine in pregnant women. Let us add that WHO - the World Health Organization - recommends Sumamed as a first-line drug for the treatment of chlamydia in pregnant women. And this fact serves as a kind of proof of the safety of Azithromycin for a child.

We add that in most cases, chlamydia treatment is carried out in the second trimester of pregnancy (after 20 weeks), when all the child’s organs are already formed.

Separately, I would like to note that the use of Azithromycin in lactating women has not yet been studied. Moreover, scientists have not yet proven the very fact of Sumamed’s penetration into breast milk. Despite this, the risk of exposure of the child to the antibiotic remains, and therefore the use of this drug during breastfeeding is not recommended.

We treat the infection, but we get dysbacteriosis. Diarrhea during treatment with Sumamed

One of the most common side effects with most antibiotics is diarrhea. The severity of diarrhea can vary from mild to very severe, accompanied by dehydration and requiring medical treatment.

The condition that we are accustomed to consider as dysbiosis during antibiotic treatment is actually pseudomembranous colitis. Its cause is a change in the composition of the intestinal flora and growth opportunistic bacteria. As a rule, antibiotic-associated diarrhea develops as a result of the proliferation of Clostridium Difficile, which produces two quite powerful toxins.

The risk group for the development of colitis includes patients with a history of diarrhea during treatment with any other antibiotics. That is, if ever treatment antibacterial drugs accompanied by diarrhea, then the likelihood of a recurrence of this side effect is quite high.

When pseudomembranous colitis appears, an urgent consultation with a doctor is necessary, who should first consider the feasibility of further treatment Sumamed.

In case of severe antibiotic-associated diarrhea, discontinuation of the drug is required. Oddly enough, to combat clostridia, you should select another antibiotic that is active specifically against Clostridium Difficile. In addition, in severe cases, rehydration therapy is required aimed at recovery water-salt balance in a dehydrated body.

Separately, I would like to note that if signs of pseudomembranous colitis appear, you should not take antidiarrheal drugs containing Loperamide (eg Imodium). Medicines in this group promote further growth of pathogenic bacteria. You should not take the antibiotic Levomycetin, beloved by many.

The perfect solution This unpleasant phenomenon must be detected by the attending physician. And no one else.

Adverse events: what can you expect during or after treatment?

We have already noted that, in general, Sumamed is well tolerated. However, the possibility of adverse reactions exists when treated with any medications. And, even if a placebo is no exception to this rule, then an antibiotic is even more so.

Pliva has been studying adverse reactions associated with Sumamed treatment for many years. All cases were carefully recorded. Let's try to list the main side effects of Azithromycin.

In more than 10% of cases of taking Sumamed, the following are noted:

Dyspeptic symptoms: flatulence, nausea, less often - vomiting and minor diarrhea. As a rule, these manifestations are easily corrected and do not require discontinuation of the drug.

In 1–10% of cases of treatment with Sumamed the following are registered:

Decreased appetite. To reduce the likelihood of anorexia, you should follow the rules for taking the drug (an hour before or after a meal).
Allergic reactions. In most cases, allergies manifest themselves in the form of a skin rash accompanied by itching. As a rule, this symptom does not require discontinuation of the drug. To reduce the intensity of manifestations, it is recommended to take antihistamines, for example, Loratadine or Desloratadine once a day.
Neurological manifestations. Headache and dizziness are among the most common side effects from the central nervous system.
Hearing impairment. During treatment high doses Sumamed over a long period of time may cause severe hearing impairment. The worst case scenario could be complete deafness. Against the background of such adverse events, the good news is that they spontaneously disappear after the end of treatment and do not require any correction.
Visual disturbances. During therapy with Sumamed, minor disturbances in visual clarity are allowed to occur, which cease after discontinuation of the drug.

In 0.1-1% of cases of taking Sumamed, the following are possible:

Infectious diseases. During treatment with antibiotics, a violation of normal microflora. This condition is accompanied by intensive growth of opportunistic microorganisms - fungi of the genus Candida, clostridia. During therapy, candidiasis of the mucous membranes of the genitals and mouth, as well as pseudomembranous colitis, occasionally develops.
Heartbeat.
Liver dysfunction. long-term treatment Sumamed may develop hepatitis and increase bilirubin levels.

In less than 0.1% of cases, treatment with Sumamed is possible:

ECG abnormalities.

One of the side effects that has caused quite a heated discussion among both infectious disease specialists and cardiologists is an increase in the QT interval on the electrocardiogram. This ECG shift is manifested by arrhythmia or ventricular tachycardia.

We have already mentioned that in 2013, American scientists published a warning about the possible effects of Azithromycin on the heart muscle. The potential risk of arrhythmias, including extremely dangerous ones associated with death, is especially pronounced in patients who take antiarrhythmic drugs.

The likely effect of Sumamed on heart rate is once again proven by the fact that antibiotics should be taken only with a prescription and under the close supervision of a doctor.

Sumamed analogues: what to choose?

Just 15 years ago you could find 1-2 analogues of Sumamed in pharmacies. Today, the pharmaceutical market can be said to be oversaturated with generics of Azithromycin.

There are so many analogues that listing them is not an easy task. Therefore, we will note only those analogues of Sumamed that deserve positive reviews both doctors and patients.

Traditionally, the highest quality generics are produced in the European Union. Among them worthy place occupy:

Hemomycin is a drug from the Serbian company Hemofarm, which has a very affordable price and excellent quality;
Azicide produced by the Czech company Zentiva.

Indian analogues of Sumamed are united by a fairly low price, but often the quality of some drugs leaves much to be desired. In our pharmacies you can buy:

Azitral;
Azimicin;
Zithrocin;
Sumamox;
Azivok;
Zimaks.

Russian analogues today compete with European generics:

Azitrox, manufacturer - Pharmastandard company;
Zitrolide produced by Valenta;
Z-Factor (Veropharm);
Ecomed, Avva Rus company;
AzitRus.

Separately, I would like to note an absolutely outstanding drug produced by the pharmaceutical concern Pfizer - Zetamax retard. It is available in the form of special microspheres, from which Azithromycin is slowly released. This generic is distinguished by its simply amazing half-life, thanks to which the Zetamax treatment regimen is laconic and simple. The standard course of treatment with the drug is a single dose for one day.

Finally, let us recall the storage conditions for Azithromycin. To preserve the properties of the drug, it is enough to place the packaging in a closed cabinet out of the reach of children.

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Release form

Indications

Contraindications for use

Use during pregnancy

Mode of application

Side effects

Reception features

Sumamed

Tolerability of Sumamed

Admission course

Performance criteria

Sumamed in pediatrics

Treatment of pneumonia in pregnant women

Contraindications

Combination with other drugs

Analogues

Use of Sumamed for community-acquired respiratory tract infections

General principles of treatment of pneumonia

Sumamed for pneumonia in adults and children

Sumamed for pneumonia: tolerability and side effects

pharmachologic effect

Release form

Indications

Mechanism of action

Dosage and course of treatment for pneumonia

Contraindications

Side effects

Combination of Sumamed with other antibacterial drugs

History of creation

Sumamed walks around the planet

Antibiotic Sumamed: a bright representative of macrolides

Composition and release forms of Sumamed

Tablet and capsule forms of Sumamed

Sumamed suspensions for children

Injection form

"Smart antibiotic"

Sumamed: spectrum of antibacterial activity of the drug

Indications for use of Sumamed

STDs: Sumamed as the drug of choice

Sumamed dosage for children

Information that is not in the instructions, or How much Sumamed suspension is needed?

Sumamed children's suspension: how to dilute correctly?

Rules for receiving and storing Sumamed suspension

At what age is Sumamed safe: these instructions for use

Sumamed for adults: how much to take

Self-medication with antibiotics: forewarned is forearmed

Contraindications to treatment with Sumamed

Pregnancy and Sumamed: when you can’t do without an antibiotic

We treat the infection, but we get dysbacteriosis. Diarrhea during treatment with Sumamed

Adverse events: what can you expect during or after treatment?

Sumamed analogues: what to choose?

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