How to increase the effectiveness and safety of antibiotic therapy of respiratory infections

man with respiratory tract infection

Today is used the strategy of the rational use of antibacterial drugs, the essence of which consists of two provisions: to recommend antibiotics only if there are indications for their use and to take into account the local resistance of the main pathogens of respiratory tract infections. It is important to understand from which drug to begin treatment.

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Antibiotics in the treatment of respiratory infections

Amoxicillin is a key antibacterial agent in the treatment of respiratory tract infections, since the vast majority of pathogenic microorganisms exhibit high sensitivity to it. For infections caused by H. influenzae, M. catarrhalis, producing β-lactamases, the assignment of protected aminopenicillins comes to the fore.

The same applies to the treatment of mild pneumonia. In the list of its numerous advantages – bactericidal activity against a number of common infectious agents, low toxicity and affordable cost.

The mechanism of action of amoxicillin lies in its ability to disrupt the synthesis of peptidoglycan – the main component of the cell membrane of microorganisms, which leads to the death of bacteria. At the same time, the drug does not have systemic toxic effects.

When administered orally, amoxicillin is rapidly absorbed in the small intestine, and its bioavailability is 75-90% (depending on the dose taken).

Currently, this antibacterial drug is used as a first-line agent in the treatment of respiratory infections of bacterial etiology. However, the desired result is not always achieved. This is due to the fact that oral forms of amoxicillin (tablets, capsules) have certain drawbacks.

German scientists found that 37.4% of GP patients had difficulty swallowing tablets and capsules (Schiele J.T. et al., 2013). As a rule, to facilitate swallowing, patients break down the tablets into parts or grind them into powder. The same happens when taking capsules: many just open them and use them without shell.

It should be remembered that with regard to antibacterial drugs, the violation of the integrity of the dosage form is unacceptable! The grinding and crushing of tablets and capsules makes them unsuitable for treatment, which is due to the change / loss of their inherent pharmacological properties and dramatically increases the potential hazard of use.

Forms of Amoxil

Among a wide range of oral forms of amoxicillin, Amoxil tablets attract special attention. Bioavailability of amoxicillin in the form of dispersible tablets is much higher (93-94%) than that of ampicillin (50%) and amoxicillin in capsules (70%) and does not depend on the method of taking the drug. Due to high bioavailability, Amoxil manages to create blood levels of amoxicillin, close to those in parenteral administration, which provides a high and predictable concentration of the drug in the focus of infection.

Dispersible form of amoxicillin is a more powerful “player”. It is widely used in the control of H. influenzae and M. catarrhalis, producing β-lactamases, for which amoxicillin is not effective enough.

It should be remembered that for certain categories of patients with respiratory infections, the appointment of dispersible forms of β-lactams provides a significant advantage:

  • patients with gastrointestinal pathology or risk factors predisposing to its appearance;
  • patients experiencing difficulty in swallowing tablets and capsules;
  • persons who require a transition to step therapy, etc.

The optimal period of transition from parenteral to oral therapy is 48-72 hours. As a rule, the oral form of the antibiotic used is used as the next step. If there is no such in the pharmaceutical market, it is possible to use an antibacterial agent that is similar in structure and properties to the parenterally administered antibiotic.

Amoxil is one of the most promising drugs in the prevention of the risk of developing antibiotic-resistant strains: thanks to a stable plasma concentration of clavulanate, faster and complete eradication of pathogens is ensured. A successful start of therapy provides amoxicillin, allowed for use in all age categories.

Thus, treatment of respiratory tract infections mainly begins with aminopenicillins. When pneumonia patients with risk factors for the presence of resistant flora, it is advisable to start treatment with protected aminopenicillins in tablet form (Amoxil).

In stationary conditions it is recommended to use stepwise therapy, that is, in the first 2-3 days, prescribe protected β-lactams intravenously (injection forms of Amoxil) with further transition to tablet forms of the same drug.

The use of dispersible forms of these antibacterial drugs is a great way to increase patients’ adherence to therapy and, therefore, their chances of winning in opposition to disease.