Medicinal reference book geotar. Tactics for managing patients with rheumatism at the outpatient stage Treatment of reactive arthritis: what you need to remember
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Azithromycin is a systemic antibacterial drug, an azalide, part of the pharmacological group of macrolides. A fairly common remedy due to its wide spectrum of action and relatively affordable retail price. It is also well tolerated by children under 1 year of age. The most common form of release is capsules. ATC code is J01F A10. The antibiotic Azithromycin is the drug of choice for many inflammatory pathologies of various localizations. This is explained by the fact that a large number of pathogenic microorganisms show sensitivity to it: all streptococci, anaerobic microorganisms, ureaplasma, mycoplasma, campylobacteria and bordetella, often spirochetes.
Compound. This is a monocomponent drug, the main active ingredient of which is azithromycin itself. Depending on the dosage, 1 capsule or tablet contains the antibiotic azithromycin in a dose of 125, 250 or 500 mg.
In addition to the main active ingredient, the drug contains auxiliary agents:
- Lactose monohydrate.
- Sodium lauryl sulfate.
- Magnesium stearate.
Release form. The antibiotic azithromycin is available in several dosage forms, which allows it to be administered in various clinical situations.
Pills. Available in the form of film-coated, blue, biconvex tablets with a half line in the following doses:
- Dosage: 0.125 g. 1 package contains 6 tablets.
- Dosage is 0.5 g. It contains the antibiotic Azithromycin 3 tablets in one package.
Capsules. They look like hard, gelatin capsules with white or grayish powder inside. The color of the capsule depends on the dosage:
- 0.25 g capsule colored red. One package contains 6 capsules.
- Azithromycin 0.5 g capsules are blue in color. 1 package contains 6 capsules.
Suspension. It can be produced in the form of Azimed or Azithromycin Forte syrups, which initially have the form of a powder. You must prepare the suspension yourself. To do this, a dosage syringe and a measuring spoon are included with the bottle.
Azithromycin, the dosage and method of administration of which may have different variations, can be used in the treatment of many inflammatory diseases from various fields of medicine:
- Otolaryngological diseases:
- Damage to the paranasal sinuses - sinusitis: frontal sinusitis, sinusitis, ethmoiditis and sphenoiditis.
- Inflammation of the tonsils - tonsillitis, including tonsillitis.
- Inflammation of the mucous membrane of the pharynx - pharyngitis.
- Damage to the tympanic cavity - otitis media.
- Pathologies of the respiratory system:
- Inflammation of the lung tissue of various etiologies - pneumonia.
- Chronical bronchitis.
- Any surgical pathology in which sensitivity to azithromycin has been detected.
- Dermatovenerological diseases:
- Erysipelas.
- Impetigo.
- Secondary dermatoses.
- Genitourinary diseases:
- Inflammation of the cervix - cervicitis.
- Gonorrheal and other forms of inflammation of the urethra - urethritis.
- Bladder disease - cystitis.
- The early stages of erythema migrans are borreliosis or Lyme disease.
Contraindications. Like any other pharmacological drugs, the antibiotic Azithromycin has its contraindications. First of all, this is an individual intolerance to the drug by the patient - an allergy to the active drug itself - Azithromycin. Contraindications to this drug also include hypersensitivity to other antimicrobial agents from the macrolide group.
Side effects. The antibiotic azithromycin, in addition to its main therapeutic effect, can provoke adverse reactions. Possible adverse reactions from various organs and systems include:
- Gastrointestinal tract:
- Nausea.
- Vomit.
- Diarrhea.
- Flatulence.
- Stomach ache.
- Rarely - jaundice.
- Skin reactions:
- Erythema of various shapes and localization.
- Toxic necrolysis of the epidermis.
- Increased sensitivity to light.
- Central nervous system:
- Dizziness.
- Headache of varying localization and intensity.
- General malaise.
- Feeling of unreasonable anxiety.
- Rarely - convulsions or general agitation.
- Red bone marrow:
- Decrease in the number of leukocytes, neutrophils, platelets - leukopenia, neutropenia, thrombocytopenia.
- The cardiovascular system:
- Impaired conduction and rhythm of the heart, including ventricular tachycardia.
- Pain in the heart area.
- Genitourinary system:
- Inflammation of the vagina - vaginitis.
- Rarely - vulvovaginal candidiasis, pyelonephritis.
- Allergic reactions:
- Skin rashes.
- Angioedema - Quincke's edema.
- Stevens-Johnson syndrome.
Azithromycin: drug dosage for different age groups
The antibiotic Azithromycin is used to treat a variety of bacterial diseases. The most used dosage form is capsules. The dosage and frequency of administration of the drug is prescribed only by the attending physician individually, based on the clinical symptoms of the pathology and accompanying circumstances.
The dosage of this antibiotic for the treatment of diseases in children weighing less than 45 kg is established in accordance with body weight.
There are two main schemes for prescribing this drug for a child:
- 0.01 g/kg b.w. 1 per day. The course of treatment is 3 days.
- 0.01 g/kg b.w. upon first administration. Next - 3-4 administrations at a dose of 0.005-0.01 g/kg b.w. The total course dose should be 0.03 mg/kg b.w. child.
Specific treatment of various diseases in children with Azithromycin:
- Lyme disease in the stage of migratory erythema migrans: 0.02 g/kg b.w. on the first day of treatment, then - 5 injections of 0.01 g/kg 1 time per day.
- Pneumonia: intravenous administration of 0.5 g of antibiotic for 2 days, then transfer to 0.25 g capsules 2 times a day. The course of treatment is from 5 to 8 days.
For patients whose body weight is more than 45 kg, standard doses are used for different nosologies. For infectious diseases of the upper and lower respiratory system: 500 mg per day 1 time, course of administration - 3 days. Pathologies of the skin and mucous membranes - a dose of 1 g at the first administration, a further course - from 2 to 5 days, at a dose of 0.5 g per day.
Total dose - 3 g. For sexually transmitted diseases (STDs) and inflammatory pathologies of the genital organs, the antibiotic Azithromycin is prescribed in a single dose of 1 g. Borreliosis (used only in the stage of erythema migrans) - 1 g on the first day, then 0.5 g from 2 to 5 days.
Azithromycin: method of administration of various dosage forms
The antibiotic azithromycin is not recommended for use during pregnancy and breastfeeding. This is due to the fact that this drug has the ability to penetrate the hematological barrier between the placenta and the fetus and have a negative effect on the child in the womb. Category of exposure to the fetus according to the FDA is 8. The use of the antibiotic Azithromycin during pregnancy is permitted only if its positive effect on the mother’s body is more important than its harmful effect on the fetus.
Application. This antibacterial agent is available in many dosage forms, despite one common name Azithromycin. The method of application is slightly different from the release form:
- Tablets and capsules are used in the appropriate dosage 60 minutes before meals, or 2 hours later. The tablet or capsule is swallowed with a small amount of clean water. In most cases, 1 dose per day is sufficient.
- Suspension. The administration time is similar to Azithromycin capsules and tablets. The method of application is somewhat different, since the oral suspension itself must be prepared manually before use. To do this, you need to use a syringe to draw boiled water in the required amount and add it to the bottle, then shake thoroughly.
Also, you should take any dosage form of azithromycin with extreme caution if you have liver disease, kidney disease, or cardiac arrhythmias, as they can be significantly aggravated by the drug.
Pharmacological relationship with other drugs. The simultaneous use of Azithromycin with some other pharmacological groups of drugs can distort the effect on the body of both one and the other drug. Antacids. Drugs containing aluminum or magnesium hydroxide block the absorption of azithromycin through the mucous membranes of the gastrointestinal tract. Because of this, at normal dosages the concentration of the drug in the blood plasma is significantly reduced. Azithromycin itself can potentiate the action of digoxin. Drugs such as cyclosporine and hexobarbital and their analogues can increase the concentration of azithromycin in the blood.
Drugs made on the basis of azithromycin include:
- Sumamed.
- Chemomycin.
- Azax.
- Azitral.
- Sumamecin.
The average price for the antibiotic Azithromycin in the Russian Federation ranges from 80 to 100 rubles. Due to its relatively low price and wide spectrum of action, the possibility of use in many areas of medical activity, most doctors respond positively to azithromycin. Patients, in turn, note the fairly high effectiveness of the drug, the extremely rare occurrence of side effects and good tolerability in children.
KNF (medicine included in the Kazakhstan National Formulary of Medicines)
ALO (Included in the List of free outpatient drug provision)
Manufacturer: S.S.Sandoz S.R.L.
Anatomical-therapeutic-chemical classification: Azithromycin
Registration number: No. RK-LS-5No. 021394
Registration date: 22.05.2015 - 22.05.2020
Limit price: 884.23 KZT
Instructions
- Russian
Tradename
Azithromycin Sandoz®
International nonproprietary name
Azithromycin
Dosage form
Powder for the preparation of suspension for oral administration 100 mg/5 ml, 200 mg/5 ml
Compound
5 ml of suspension contains
active substance- azithromycin monohydrate 102.40 mg or 204.80 mg,
Excipients: refined sucrose, sucrose powder, xanthan gum, hydroxypropylcellulose, anhydrous trisodium phosphate, anhydrous colloidal silicon dioxide, aspartame, butter caramel, titanium dioxide (E 171).
Description
Powder from white to almost white in color, with an aromatic odor. The prepared suspension is a homogeneous suspension from white to almost white in color, with an aromatic odor, from sweet to slightly bitter taste.
Pharmacotherapeutic group
Antibacterial drugs for systemic use. Macrolides, lincosamides and streptogramins. Macrolides. Azithromycin.
ATX code J01FA10
Pharmacological properties
Pharmacokinetics
After a single oral dose, the bioavailability of azithromycin is 37%. The maximum concentration of azithromycin in blood plasma is achieved 2-3 hours after administration.
After oral administration, azithromycin is rapidly distributed into tissues and body fluids. Penetrates well into the respiratory tract, organs and tissues of the urogenital tract, skin and soft tissues. It accumulates intracellularly, due to which the concentrations of azithromycin in tissues are significantly higher (50 times) than in plasma, which indicates the high affinity of azithromycin for tissues and low binding of azithromycin to plasma proteins.
Concentrations of azithromycin in target organs (lungs, tonsils, prostate) exceed the MIC90 for pathogenic microorganisms after taking a single dose of 500 mg. Azithromycin accumulates in large quantities in phagocytes. Phagocytes transport the drug to the site of inflammation.
The half-life is from 2 to 4 days.
About 12% of the administered dose of azithromycin is excreted unchanged in the urine over the next 3 days. Particularly high concentrations of unchanged azithromycin were detected in bile. 10 metabolites have been identified that are formed through N- and O-demethylation, hydroxylation and other metabolic transformations. Relevant studies have confirmed that azithromycin metabolites do not exhibit antimicrobial activity.
In patients with mild to moderate renal failure (creatinine clearance 10-80 ml/min) who took 1 g of azithromycin once, the average Cmax and AUC0-120 increased by 5.1% and 4.2%. In patients with severe renal impairment, mean Cmax and AUC0-120 increased by 61% and 35% compared with individuals with normal renal function (creatinine clearance >80 mL/min).
In patients with mild to moderate hepatic impairment, there is no evidence of changes in the pharmacokinetics of azithromycin compared to patients with normal liver function. In such patients, increased urinary excretion of azithromycin is observed, possibly to compensate for reduced hepatic clearance.
The pharmacokinetics of azithromycin in elderly and young patients is the same. However, the maximum plasma concentration of azithromycin was higher (30-50%) in elderly patients, but accumulation was not observed.
Pharmacokinetics were studied in children aged 4 months to 15 years who took capsules, granules and suspension. With a dose of 10 mg/kg on day 1, followed by a dose of 5 mg/kg on days 2 to 5, the Cmax achieved was slightly lower than in adults.
Pharmacodynamics
The active substance of the drug Azithromycin Sandoz - azithromycin is a broad-spectrum antibiotic, the first representative of a new subgroup of macrolide antibiotics - azalides.
It has a bacteriostatic effect, but when high concentrations are created at the site of inflammation, it causes a bactericidal effect.
The mechanism of action is based on inhibition of protein synthesis in bacteria by binding to 50-S ribosomal subunits and preventing peptide translocation.
Sensitive strains
Gram-negative aerobic microorganisms: Haemophilus influenzae, Moraxella catarrhalis
Other microorganisms: Chlamydia pneumoniae, Chlamydia trachomatis, Mycobacterium avium, Mycoplasma pneumoniae, Legionella pneumophila
Strains for which acquired resistance may cause problems
: Staphylococcus aureus, Streptococcus agalactiae, Streptococcus pneumoniae, Streptococcus pyogenes
Other microorganisms: Ureaplasma urealyticum
Resistant strains
Gram-positive aerobic microorganisms: Staphylococcus aureus - strains resistant to methicillin and erythromycin, Streptococcus pneumoniae - strains resistant to penicillin
Gram-negative aerobic microorganisms: Escherichia coli, Pseudomonas aeruginosa, Klebsiella spp., Bacteroides fragilis
Indications for use
Treatment of infectious diseases caused by microorganisms sensitive to azithromycin:
acute bacterial sinusitis (properly diagnosed)
acute bacterial otitis media (properly diagnosed)
pharyngitis, tonsillitis
exacerbation of chronic bronchitis (properly diagnosed)
moderate to severe community-acquired pneumonia
skin and soft tissue infections
uncomplicated urethritis and cervicitis caused by Chlamydia trachomatis
Directions for use and doses
Children and teenagers (up to 18 years old)
For children aged one year and older, Azithromycin Sandoz is prescribed at a rate of 10 mg/kg once a day for 3 days or for 5 days, starting with a single dose of 10 mg/kg on day 1, then 5 mg/kg for the next 4 days, as indicated in the table. For children under 1 year of age, use of the drug is limited.
For children, the drug is prescribed based on weight:
Azithromycin Sandoz, dosage 200 mg/5 ml |
|||
Body weight, kg |
3-day therapy, ml |
5-day therapy, ml |
|
10 mg/kg/day |
10 mg/kg/day |
5 mg/kg/day |
|
It has been noted that azithromycin is effective in the treatment of streptococcal pharyngitis in the treatment of children in a single dose of 10 mg/kg or 20 mg/kg for 3 days, with a maximum daily dose of 500 mg. When comparing these two doses in clinical studies, similar efficacy was found, although bacterial eradication was higher with the 20 mg/kg dose.
However, penicillin is usually the drug of choice for the treatment of pharyngitis caused by Streptococcus pyogenes and to prevent any subsequent rheumatic fever.
Dose adjustment is not required for patients with mild to moderate renal failure (creatinine clearance 10 - 80 ml/min) and liver failure.
Scheme for the preparation of Azithromycin Sandoz, oral suspension for dosages of 100 mg/5 ml and 200 mg/5 ml:
Mode of application
The prepared suspension is intended for oral administration and can be taken with meals. Immediately after taking the suspension, you should drink a few sips of water or fruit juice to rinse and swallow the remaining amount of the suspension in the mouth, as well as to eliminate the slightly bitter taste of the suspension.
To prepare 20 ml of suspension (for a dosage of 100 mg/5 ml) you need:
draw 10 ml of chilled boiled water into a syringe;
add 10 ml of water from a syringe and shake well until a homogeneous suspension is obtained from white to almost white.
To prepare 30 ml of suspension (for a dosage of 200 mg/5 ml) you need:
shake the dry powder thoroughly in the bottle;
open the bottle cap and place the adapter in the neck of the bottle;
draw 15 ml of chilled boiled water into the syringe;
place the tip of the syringe into the adapter;
add 15 ml of water from a syringe and shake well until a homogeneous suspension is obtained from white to almost white.
Adults, elderly patients and children weighing more than 45 kg
Adults
For uncomplicated urethritis and cervicitis caused by Chlamydia trachomatis, prescribe a single dose of 1000 mg of the drug Azithromycin Sandoz. For other indications for use, 1500 mg of Azithromycin Sandoz is prescribed (500 mg once a day for 3 consecutive days) or the same dose (1500 mg) can be taken for 5 days: 500 mg on the 1st day, then 250 mg from 2nd to 5th day.
There are also other dosage forms available for the treatment of adult patients.
Elderly patients
The dosage regimen is the same as for adult patients. Since elderly people may already have ongoing proarrhythmogenic conditions, caution should be exercised when using the drug due to the risk of developing cardiac arrhythmias, including the torsade de pointes type.
Side effects
Side effects are listed according to their frequency: very often (≥1/10), often (≥1/100,<1/10), не часто (≥1/1000, <1/100), редко (≥1/10 000, <1/1000), очень редко (<1/10 000), частота неизвестна (невозможно оценить по имеющимся данным).
Often
diarrhea, abdominal pain, nausea, flatulence, gastrointestinal discomfort, soft stools
Often
-
itching and rashes
arthralgia
fatigue
decreased plasma bicarbonate levels
headache
vomiting, indigestion
decreased number of lymphocytes, increased number of eosinophils, basophils, monocytes and neutrophils
anorexia
visual impairment
Infrequently
candidiasis, pneumonia, vaginal infections, fungal infection, bacterial infection, gastroenteritis, pharyngitis, rhinitis, respiratory system disorders, candidal stomatitis
angioedema, hypersensitivity
anorexia
excitation
hypoesthesia, drowsiness, insomnia
leukopenia, neutropenia
dizziness, dysgeusia, paresthesia
hearing impairment, dizziness (vertigo), tinnitus
cardiopalmus
rush of blood
shortness of breath, nosebleeds
gastritis, constipation, flatulence, indigestion, dysphagia, bloating, dry mouth, belching, ulcerative stomatitis, hypersecretion of the salivary glands
rash, itching, urticaria, dermatitis, dry skin, hyperhidrosis
osteoarthritis, myalgia, back pain, neck pain
dysuria, pain in the kidney area
metrorrhagia, testicular disorder
asthenia, discomfort, fatigue, facial swelling, chest pain, hyperthermia, pain, peripheral edema
hepatitis, increased AST and ALT, increased levels of bilirubin, urea and alkaline phosphatase in the blood, hypercreatininemia, hyperkalemia, increased platelet counts, levels of sodium bicarbonate, chloride and glucose, decreased hematocrit,
increased uremia
Rarely
anxiety, depersonalization
liver dysfunction, cholestatic jaundice
photosensitivity
Unknown
pseudomembranous colitis
thrombocytopenia
hemolytic anemia
anaphylactic reaction
aggressiveness, anxiety, delirium, hallucinations
fainting, convulsions, psychomotor hyperactivity, anosmia, ageusia, parosmia, myasthenia gravis
ventricular tachycardia of the “pirouette” type, arrhythmia, including ventricular tachycardia, prolongation of the QT interval on the electrocardiogram
hypotension
pancreatitis, tongue color change
liver failure, in rare cases fatal, fulminant hepatitis, necrotizing hepatitis
Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme
arthralgia
acute renal failure, interstitial nephritis
Contraindications
hypersensitivity to azithromycin and other macrolide antibiotics or any of the excipients
severe liver and kidney dysfunction
rare hereditary forms of fructose intolerance, sucrase-isomaltase deficiency or glucose-galactose malabsorption syndrome (due to sucrose content)
phenylketonuria (due to aspartame content)
Drug interactions
Patients receiving azithromycin and antacids, you should not take these medicines at the same time. Azithromycin should be taken one hour before or two hours after antacid.
Cetirizine: In healthy volunteers, co-administration of azithromycin with 20 mg cetirizine for 5 days did not cause pharmacokinetic interactions or changes in the QT interval.
Didanosine (dideoxyinosine): Concomitant use of 1200 mg azithromycin with 400 mg didanosine in HIV-positive patients did not affect the pharmacokinetics of didanosine compared with placebo.
Atorvastatin: Concomitant use of atorvastatin (10 mg/day) and azithromycin (500 mg/day) did not cause changes in atorvastatin plasma concentrations (based on HMG-CoA reductase inhibition assay). However, there have been isolated case reports of rhabdomyolysis in patients receiving azithromycin and statins.
Cimetidine: in pharmacokinetic studies of the effect of a single dose of cimetidine on the pharmacokinetics of azithromycin, no changes in the pharmacokinetics of azithromycin were detected, provided that cimetidine was used 2 hours before azithromycin.
Efavirenz: Concomitant use of azithromycin 600 mg/day once and efavirenz 400 mg/day daily for 7 days did not cause any clinically significant pharmacokinetic interactions.
Zidovudine: simultaneous use of azithromycin (1000 mg once) and repeated doses of 600 mg or 1200 mg had no effect on the plasma concentration and renal excretion of zidovudine or its glucuronides. However, the use of azithromycin caused an increase in the concentration of the active metabolite zidovudine in peripheral blood mononuclear cells. The clinical significance of this interaction is unknown.
Nelfinavir: Concomitant use of azithromycin (1200 mg) and nelfinavir (750 mg 3 times daily) causes increased serum concentrations of azithromycin. No significant side effects were observed and no dose adjustment of azithromycin was required when used concomitantly with nelfinavir.
Indinavir: simultaneous use of a single dose of azithromycin 1200 mg did not cause a statistically significant effect on the pharmacokinetics of indinavir, which was prescribed 800 mg 3 times a day for 5 days.
Methylprednisolone: Azithromycin does not have a significant effect on the pharmacokinetics of methylprednisolone.
Midazolam: Concomitant use of 500 mg azithromycin by healthy volunteers for 3 days did not produce clinically significant changes in the pharmacokinetics and pharmacodynamics of midazolam at a single dose of 15 mg.
Sildenafil: In healthy male volunteers, there was no evidence of an effect of azithromycin (500 mg daily for 3 days) on the AUC and Cmax values of sildenafil or its main circulating metabolite.
Triazolam: Concomitant use of azithromycin 500 mg on day 1 and 250 mg on day 2 with 0.125 mg triazolam on day 2 in healthy volunteers did not have a significant effect on the pharmacokinetic parameters of triazolam compared with the use of triazolam and placebo.
Carbamazepine: In pharmacokinetic studies involving healthy volunteers, there was no significant effect on the plasma concentrations of carbamazepine and its active metabolite in patients receiving concomitant azithromycin.
Trimethoprim/sulfamethoxazole: Concomitant use of trimethoprim/sulfamethoxazole (160 mg/800 mg) for 7 days with 1200 mg azithromycin on day 7 did not significantly affect the Cmax, total exposure, or urinary excretion of trimethoprim or sulfamethoxazole.
When used together, azithromycin and digoxin possible increase in concentration digoxin in blood.
Potentiation of the anticoagulant effect has been reported following concomitant use of azithromycin and oral anticoagulants such as coumarin. Although a causal relationship has not been established, the need for frequent monitoring of prothrombin time should be considered when prescribing azithromycin to patients receiving oral anticoagulants such as coumarin.
Cyclosporine: In a pharmacokinetic study involving healthy volunteers who took azithromycin 500 mg orally for 3 days and then took a single dose of cyclosporine 10 mg/kg body weight, a significant increase in the AUC and Cmax values of cyclosporine was detected. Therefore, caution should be exercised when considering coadministration of these drugs. If such concomitant use is necessary, monitor cyclosporine levels and adjust the dose accordingly.
Fluconazole: Concomitant use of azithromycin (1200 mg once) did not change the pharmacokinetics of fluconazole (800 mg once). The total exposure and T1/2 of azithromycin did not change with simultaneous use of fluconazole, however, a decrease in Cmax of azithromycin was noted (by 18%), which had no clinical significance.
Neutropenia has been observed in patients receiving concomitant treatment with azithromycin and rifabutin. Although neutropenia has been associated with the use of rifabutin, a cause-and-effect relationship between the use of a combination of azithromycin and rifabutin and neutropenia has not been established.
Terfenadine: No evidence of interaction between azithromycin and terfenadine was reported in pharmacokinetic studies. There have been isolated cases reported where the possibility of such an interaction could not be completely excluded, but there was no concrete evidence that such an interaction occurred. It has been found that the simultaneous use of terfenadine and macrolides can cause arrhythmia and prolongation of the QT interval.
Theophylline: When azithromycin and theophylline were administered concomitantly to healthy volunteers, no effect of azithromycin on the pharmacokinetics of theophylline was observed. Theophylline levels may be elevated in patients taking azithromycin, so plasma theophylline levels should be carefully monitored in patients taking azithromycin and theophylline concomitantly.
Astemizole, alfentanil
There are no relevant data on the interaction of azithromycin with astemizole or alfenatil.
Caution should be exercised when used simultaneously with azithromycin due to the described interaction of erythromycin (macrolide antibiotic) with these drugs with an increase in their concentration and therapeutic effect.
special instructions
In isolated cases, serious allergic reactions such as angioedema and anaphylactic reactions (in rare cases fatal) have been reported after taking azithromycin. Some of these reactions predetermined the development of recurrent symptoms and required long-term observation and treatment.
The drug is contraindicated in patients with severe liver pathology (cases of fulminant hepatitis with the development of life-threatening liver failure have been reported). Some patients may have a pre-existing history of liver disease or may have been exposed to other hepatotoxic drugs. If signs and symptoms of liver dysfunction occur (rapidly developing asthenia, jaundice, dark urine, bleeding or hepatic encephalopathy), liver tests and related studies should be performed immediately. Azithromycin should be discontinued if liver dysfunction occurs.
When using almost all antibacterial drugs, including azithromycin, diarrhea associated with Clostridium difficile(CDAD), which can range from mild diarrhea to fatal colitis. Antibacterial treatment suppresses normal intestinal flora, leading to increased growth Clostridium difficile. Strains Clostridium difficile, producing hypertoxin A and B, contribute to the development of CDAD. Hypertoxin produced by strains Clostridium difficile, leads to increased morbidity and mortality rates because these organisms may be resistant to antimicrobial therapy and may lead to the need for colonectomy. CDAD should be considered in all patients who develop diarrhea after antibiotic use. A thorough medical history is necessary as CDAD has been reported 2 months after antibacterial therapy. In case of diarrhea associated with Clostridium difficile, the use of antiperistaltic drugs is contraindicated.
In patients with severe renal impairment (creatinine clearance<10мл/мин) наблюдалось увеличение системного воздействия азитромицина.
When treated with other macrolides, prolongation of cardiac repolarization and QT interval was observed, which were associated with the risk of developing cardiac arrhythmia and paroxysmal ventricular tachycardia of the “pirouette” type. A similar effect of azithromycin cannot be completely excluded in patients with an increased risk of prolongation of cardiac repolarization, so treatment should be used with caution in patients:
with hereditary or well-established prolongation of the QT interval;
who are currently being treated with other active substances that prolong the QT interval, for example, class IA and III antiarrhythmic drugs, cisapride and terfenadine; antipsychotics such as pimozide; antidepressants such as citalopram; fluoroquinolones such as moxifloxacin and levofloxacin;
with electrolyte imbalance, especially in the case of hypokalemia and hypomagnesemia;
with clinically significant bradycardia, cardiac arrhythmia or severe heart failure.
There are no data on possible interactions between ergot alkaloids and azithromycin, however, due to the theoretical possibility of ergotism, ergot and azithromycin derivatives should not be prescribed simultaneously.
Cases of exacerbation of symptoms of myasthenia gravis or development of myasthenia gravis have been reported in patients receiving azithromycin.
Safety and effectiveness of azithromycin for the prevention and treatment of infection caused by Mycobacterium avium complex(MAC) have not been established in children.
The following precautions should be observed before prescribing azithromycin:
Azithromycin powder for oral suspension is not suitable for the treatment of severe infections when a rapid and strong increase in the concentration of the antibiotic in the blood is necessary. Azithromycin is not the first choice drug for the treatment of infections where the incidence of resistance in isolated cases is 10% or higher.
In cases showing high resistance to erythromycin A, it is extremely important to take into account the gradual change in usual sensitivity to azithromycin and other antibiotics.
As with other macrolides, there is a high (>30%) level of resistance Streptococcus pneumoniae to azithromycin has been registered in some European countries. This result must be taken into account when treating infections caused by Streptococcus pneumoniae.
Pharyngitis/tonsillitis
Azithromycin is not the first choice drug for the treatment of pharyngitis and tonsillitis caused by Streptococcus pyogenes. For this, as well as for the prevention of acute articular rheumatism, treatment with penicillin should be chosen.
Sinusitis
In the vast majority of cases, azithromycin is not the first choice drug for the treatment of sinusitis.
Acute otitis media
In the vast majority of cases, azithromycin is not the first choice drug for the treatment of acute otitis media.
Skin and soft tissue infections
The main pathogen causing soft tissue infections is Staphylococcus aureus, in most cases resistant to azithromycin. Therefore, sensitivity testing should be a prerequisite for the treatment of soft tissue infections with azithromycin.
Infected burn wounds
Azithromycin is not prescribed for the treatment of infected burn wounds.
Sexually transmitted infections
When treating uncomplicated urogenital sexually transmitted infections, simultaneous infection should be excluded Treponema pallidum.
Neurological or mental disorders
Azithromycin should be administered with caution to patients with neurological or psychiatric disorders.
Azithromycin Sandoz, powder for oral suspension, 100 mg/5 ml, 200 mg/5 ml contains aspartame, which is a source of phenylalanine. It may have negative effects on patients suffering from phenylketonuria.
5 ml of the prepared suspension of the drug Azithromycin Sandoz, 100 mg/5 ml or 200 mg/5 ml contains 3.81 or 3.7 sucrose, respectively. This should be taken into account when using the drug in patients with diabetes.
Pregnancy
There are no data from appropriate controlled clinical trials on the results of azithromycin use in pregnant women. Animal studies have determined that azithromycin crosses the placenta. Preclinical studies in rats did not reveal the teratogenic effect of azithromycin. The safety of azithromycin during pregnancy has not yet been confirmed. Based on this, azithromycin can be prescribed during pregnancy only if the benefit from the expected therapeutic effect is expected to exceed the risk to the fetus.
Lactation period
Azithromycin Sandoz passes into breast milk. Since it is unknown whether azithromycin has an adverse effect on the baby through maternal milk, breastfeeding should be interrupted while taking azithromycin. Possible adverse reactions in a newborn may include diarrhea, the development of a fungal infection of the mucous membranes, as well as sensitization of the body. Feeding can be resumed 2 days after stopping azithromycin.
Children
Features of the effect of the drug on the ability to drive a vehicle or potentially dangerous mechanisms
In rare cases, there may be cases of dizziness and convulsions. In such cases, it is necessary to refrain from driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.
Overdose
Symptoms: reversible hearing loss, alopecia, nausea, vomiting, diarrhea.
Treatment: gastric lavage, use of activated carbon, and, if necessary, symptomatic treatment aimed at maintaining the vital functions of the body.
Release form and packaging
16.50 g of the drug (for a dosage of 100 mg/5 ml) in high-density polyethylene bottles with a capacity of 30 ml and 24.80 g of the drug (for a dosage of 200 mg/5 ml) in high-density polyethylene bottles with a capacity of 60 ml, with a screw cap with protection from opening by children and the first opening control ring.
1 bottle, together with a measuring syringe made of polyethylene/polypropylene and instructions for medical use in the state and Russian languages, is placed in a cardboard pack.
Storage conditions
Store at a temperature not exceeding 30 °C.
Keep out of the reach of children!
Shelf life
Store the prepared suspension at a temperature not exceeding 30 °C for no more than 5 days.
Do not use after the expiration date stated on the packaging.
Conditions for dispensing from pharmacies
On prescription
Manufacturer/Packager/Marketing Authorization Holder
S.S. Sandoz S.R.L., Romania
Livezeni Street, 7A, 540472 Targu Mures, Romania
Address of the organization that accepts claims from consumers regarding the quality of products (products) on the territory of the Republic of Kazakhstan
Representative office of JSC Sandoz Pharmaceuticals d.d. in the Republic of Kazakhstan, Almaty, st. Luganskogo 96,
Phone number: +7 727 258 10 48, fax: +7 727 258 10 47
e-mail: [email protected]
8 800 080 0066 - toll-free number within Kazakhstan
Attached files
557549221477976487_ru.doc | 153.5 kb |
303101551477977650_kz.doc | 161 kb |
Everyone may experience joint pain at some point, especially in old age. The cause of the unpleasant symptom is completely different pathologies, for example, inflammation of the joint or periarticular tissues, degenerative disorders, and rheumatism is often the cause.
Rheumatism is a serious chronic disease that requires timely and proper treatment. Therefore, if signs of pathology appear, the patient should consult a rheumatologist as soon as possible and begin treatment. Advanced rheumatism can cause life-threatening complications.
Rheumatism is inflammation of the joints
Rheumatism is a systemic disease in which inflammation of the connective tissue occurs in various parts of the body, most often the pathology affects the joints and heart. The disease is quite rare in our time, since it is possible to carry out timely treatment of infectious diseases.
Damage to joints in rheumatism occurs gradually, usually after an infectious disease. People suffer from rheumatoid arthritis between the ages of 5 and 13 years; in adult patients, only the consequences of the disease suffered in childhood or adolescence appear.
Pathology occurs after a recent streptococcal infection, that is, shortly before inflammation of the joint, the child has a sore throat. Very often, the infection is practically asymptomatic; the attending physician diagnoses acute respiratory infections and does not prescribe antibiotics.
To understand how rheumatism of the joints manifests itself, consider a few main symptoms and photos:
- Two weeks after suffering a sore throat or acute respiratory infection, the child’s condition sharply worsens, the temperature rises, weakness and headache appear;
- Pain occurs in one or more joints, most often in the knees or pelvis. Unpleasant sensations may disappear on their own from time to time, but the remission is temporary, and the condition will soon worsen.
- Most often, rheumatism of the heart and joints occurs, in which case the patient complains not only of pain in the joint, but also of aching pain in the chest.
- Rheumatoid arthritis is characterized by gradual involvement of several joints.
According to the World Joint Diseases Organization, 80% of people in the world have joint problems. The worst thing is that joint diseases lead to paralysis and disability. Today there is one effective remedy that differs from all previously existing means.
In rare cases, signs of the disease include lumps under the skin and characteristic rashes. Damage to other internal organs, such as the liver, kidneys, and lungs, is extremely rare. As a rule, this condition is a complication of an advanced form of rheumatoid arthritis.
Rheumatism of the joints: main causes
A disease such as rheumatoid arthritis occurs due to a streptococcal infection, which usually provokes pharyngitis and tonsillitis. Due to the pathogen entering the body, the body’s immune system is activated and tries to cope with the bacteria on its own, provoking inflammation of the connective tissue.
The disease may not occur in every person; there is a risk group:
- Patients with a hereditary predisposition to rheumatoid arthritis are more susceptible to the occurrence of pathology;
- More often the pathology occurs in females;
- Rheumatoid arthritis is typical for children from 5 to 13 years of age, up to 3 years and after 30, the pathology is extremely rare;
- Patients who often suffer from colds are more susceptible;
- People who have the D8/17 antigen in their bodies are also susceptible to the disease.
How to cure rheumatism of the joints
Only a rheumatologist can correctly diagnose rheumatoid arthritis, since it is necessary to make a differential diagnosis, that is, to exclude other pathologies with similar symptoms. To confirm the diagnosis, the specialist prescribes the following tests for rheumatism of the joints:
- Blood test for joint rheumatism;
- Radiography;
- Arthroscopy;
- Puncture and biopsy of the joint;
- ECG to detect heart problems.
If the doctor discovers damage to internal organs, he will refer the patient to see other specialists.
Treatment of rheumatoid arthritis is complex; first of all, it is necessary to get rid of the pathogen and the inflammatory process in the tissues; for this purpose, drugs for rheumatoid arthritis are prescribed. In each case, the doctor selects medications individually; self-medication for such pathologies is not recommended, it is dangerous to health.
The treatment complex also includes physiotherapy, therapeutic exercises, and diet. A correct lifestyle will help you quickly get rid of the infection, strengthen the immune system and normalize the motor activity of the joint, preventing its destruction.
Medicine for rheumatism of joints
Hospital treatment begins, the patient is prescribed the following medications for rheumatism of the joints and muscles:
- Non-steroidal anti-inflammatory drugs for rheumatism of the joints;
- Antibiotics;
- Glucocorticosteroids;
- Quinoline drugs.
Non-steroidal anti-inflammatory drugs help reduce the pain of rheumatoid arthritis, and also remove other manifestations of the disease, in particular swelling and impaired joint function. Such tablets and injections for joint rheumatism are effective in the initial stages of the disease; for more severe pain, corticosteroids are prescribed.
Steroid hormones have a pronounced anti-inflammatory and analgesic effect. But the downside of such drugs is the side effects, so their use is often not recommended. If you take corticosteroids constantly, they begin to destroy cartilage tissue.
Quinoline drugs are used for a long time, they help improve the permeability of cell membranes and promote a speedy recovery. Also, the doctor must prescribe antibiotics for rheumatism of the joints and heart to eliminate streptococcal infection.
Antibiotics for rheumatism of the joints
Treatment of pathology always begins with the prescription of an antibiotic, usually penicillin, since streptococcus is sensitive to this group of drugs.
If necessary, therapy can be carried out with two antibiotics in turn, then after penicillin amoxicillin and cephalosporins are prescribed. The duration of antibiotic treatment is on average 2 weeks.
Among the most popular and effective antibiotics are:
- penicillin
- oxacillin
- methicillin
- ampicillin
- erythromycin
- bicillin
It is important to note that you should not take antibiotics on your own without a doctor’s prescription, even if the patient is completely sure that he is suffering from rheumatism. It is impossible to confirm the diagnosis without testing, and improper treatment can lead to a worsening of the condition.
Ointment for rheumatism of joints
For a speedy recovery, various remedies for joint rheumatism, including external ones, are used. In complex treatment, you can use pharmaceutical ointments and traditional medicine, but you should not replace them with tablets for rheumatism of the joints, and it is recommended to select an ointment with your doctor.
To relieve inflammation and pain, use ointments with a non-steroidal anti-inflammatory drug, for example, Diclofenac, Nise. Such drugs quickly alleviate the condition and normalize the motor activity of the joint. Turpentine ointment is often prescribed for rheumatoid arthritis; it has an anti-inflammatory and disinfecting effect, and also relieves pain.
Another popular remedy for rheumatoid arthritis is Eucamon ointment. This remedy improves blood circulation in tissues, has a warming and anti-inflammatory effect, reduces pain and normalizes motor activity of the joint.
Ointments according to folk recipes with camphor are very effective. This substance warms, has an analgesic, anti-inflammatory effect, it is sold in pharmacies and has a very affordable price.
Recipe for ointment with camphor for rheumatism
You need to mix 15 grams of medical alcohol, 15 grams of chicken protein, 50 grams of mustard and the same amount of camphor. Beat the resulting mass until it becomes homogeneous and thick, similar to an ointment. The product is rubbed into the joints affected by rheumatoid arthritis before bed every day.
Nutrition for rheumatism of the joints
Diet for rheumatism of the joints plays an important role in treatment; nutrition should be balanced, low-calorie, since the patient should not gain weight during treatment, so as not to subsequently create a load on the diseased limbs and not provoke their destruction.
- meals should be fractional, 5-6 times a day in small portions;
- food should be tasty and varied, but at the same time dietary;
- It is prohibited to consume alcohol and drugs;
- It is recommended to avoid salty, spicy, very sweet foods;
- It is necessary to exclude semi-finished products, canned food, and fast food from the menu;
- It is recommended to steam, boil or bake food;
- For cooking you need to use only natural and fresh products.
It is recommended to follow the diet not only during the period of exacerbation of the disease, but also after treatment. It is important to understand that rheumatism often causes inflammatory and degenerative disorders in adulthood, and the condition is aggravated by excess weight, consumption of junk food, alcohol, and a passive lifestyle.
sustavof.ru
Rheumatism: treatment of the disease
Rheumatism is a chronic inflammatory disease that affects connective tissues and joints, primarily involving the cardiovascular system. The risk group includes children and young people, with the majority being women.
Rheumatism - symptoms, diagnosis
Rheumatism of the joints - treatment is based on the manifestation of the clinical picture of this disease, combining painful syndrome of large joints and carditis. Also characteristic signs of rheumatism include:
- feverish state with elevated body temperature up to 40°C accompanied by sweating;
- acute pain in the joints, increasing depending on the stage of the disease (in primary attacks the pain is less pronounced, in secondary attacks it is more intense);
- swelling and redness of soft tissues in the affected area;
- limited movement;
- characteristic of symmetrical damage to the joints of the lower extremities;
- damage to the cardiovascular system.
How to treat rheumatism? First of all, this is the diagnosis of rheumatism, which plays a vital role in the treatment of the disease. First, you need to understand the etiology of this disease. So, the reasons for the development of the disease can be:
- streptococcal infection (scarlet fever, tonsillitis, pharyngitis);
- genetic predisposition;
- infection through the blood, for example due to poor nutrition;
- hypothermia of the body.
Specialized methods for detecting rheumatism have not been fully studied at the moment. Diagnosis should be made by a specialized, experienced rheumatologist through a thorough examination and a series of laboratory tests:
- identifying the concentration of antibodies in the body;
- isolation of group A streptococci from respiratory tract cultures.
Rheumatism: treatment with various methods
It should be noted that according to statistics, about 5% of the total world population suffers from rheumatism, moreover, 70% of the total number are pediatric patients. As a rule, the main reason is failure to timely seek qualified medical help.
How to cure rheumatism? To do this, let’s consider the basic treatment regimen: hospital – sanatorium – dispensary observation.
The first stage (6-8 weeks) is inpatient treatment, which should begin as early as possible, due to the positive effect of treatment due to the reversibility of many processes in the cardiovascular system and connective tissues. Set of measures taken at this stage:
- drug treatment;
- physiotherapeutic procedures;
- physiotherapy.
The cure for rheumatism is antiallergic and anti-inflammatory therapy (a course of antibiotics, immunosuppressants, the use of non-steroidal and antihistamines). The fundamental point of this stage is the sanitation of the focus of streptococcal infection.
The second stage is the referral of the patient to a rheumatological or cardiological sanatorium. The purpose of this stage is to apply the appropriate regimen, carry out a number of therapeutic and preventive procedures to achieve maximum lull in the rheumatic process, as well as the ability to restore the functionality of the body’s cardiovascular system.
The third stage is based on comprehensive rehabilitation - clinical observation of the patient, which in turn includes regular medical examination, bed rest during periods of exacerbation, and the appointment of measures to prevent relapse of the disease.
Traditional methods of treatment
A special place is occupied by the treatment of rheumatism with folk remedies. In alternative medicine, infusions, decoctions, and rubbings of various herbs and plants are used. Let's look at the most common recipes:
- Dissolve salt (2.5 teaspoons) in water (1 glass). We use it like rubbing, but not with our hands, but with a flannel napkin.
- Alcohol-based red pepper tincture with the addition of vegetable oil.
- An ointment consisting of horse chestnut fruits is considered an effective remedy. Recipe: mix the powdered mixture of chestnut fruits with camphor oil, coat a slice of bread with a thin layer and apply to the affected area.
- Garlic cloves (40 grams) are crushed and poured with vodka (100 ml). Next, leave for 8-10 days at room temperature in a dark place, shaking occasionally. Strain and take 8-10 drops orally before meals three times a day.
Rheumatism - prevention
Currently, there are a number of proven measures to prevent rheumatism. If rheumatism is diagnosed, preventive treatment is as follows:
General actions aimed at activating the body’s immune forces:
- hardening;
- playing sports;
- general hygiene measures;
- avoiding hypothermia.
Mandatory treatment of acute diseases of the respiratory tract, cardiovascular system, sanitization of foci of infection.
For patients with chronic rheumatism, it is necessary to undergo quarterly examinations with a rheumatologist, especially during periods of exacerbation, a course of sanitation with NSAIDs and bicillin should be carried out.
It should be noted that antibiotics for rheumatism are prescribed in the initial stage of the disease and in complicated situations.
Nutrition for rheumatism is one of the main and mandatory measures.
The diet for rheumatism should be complete and balanced; limiting table salt and carbohydrates is recommended. Food should be rich in vitamins, proteins, fruits, and vegetables. Because they contain potassium and phosphorus, which are so necessary for patients with rheumatism. It is also worth drinking more liquids and tea drinks with raspberries, linden and honey.
spina-sustav.ru
Antirheumatic therapy
Treatment. A three-stage treatment system is used: the first stage is long-term (4-6 weeks) inpatient treatment in the active phase; the second stage - post-hospital, sanatorium or resort treatment; the third stage is clinical observation, active bicillin-drug treatment.
Treatment of rheumatism should be as early as possible (in the first hours or days - up to 3 days from the onset of the disease, since at this stage changes in the connective tissue of the heart and other organs - the phase of mucoid swelling - are still reversible), comprehensive, adequate and strictly individual. In the active phase of rheumatism, the patient must be hospitalized; if this cannot be done, he must remain in bed at home.
The treatment complex should include: therapeutic and protective and motor regimen, balanced nutrition, medications and physiotherapeutic agents, exercise therapy (physical therapy). In case of active rheumatism or signs of severe circulatory failure, bed rest must be observed. The motor mode expands as the activity of the rheumatic process subsides or circulatory failure decreases. This usually takes about 2 weeks.
Food should be varied, rich in vitamins, proteins, and phospholipids. Protein food (at least 1 g per 1 kg of weight) has desensitizing properties, increases the body's immunobiological defense, improves myocardial contractility and liver function. Patients receiving glucocorticoid hormones, which have a pronounced catabolic effect, should consume especially protein-enriched foods.
Vitamins increase the body's protective properties.
Vitamin C has a normalizing effect on metabolism, anti-inflammatory, stimulating the production of glucocorticoid hormones.
B vitamins increase the performance of the heart muscle, improve coronary circulation, and help slow down the heart rate.
A lack of vitamin C and bioflavinoids makes connective tissue vulnerable to the action of streptococcal antigen, increases hyaluronidase activity, capillary wall permeability, complicates carbohydrate metabolism, and worsens enzymatic processes in connective tissue and liver. During the active phase of rheumatism, ascorbic acid is prescribed up to 1 g per day; as activity decreases, the dose is reduced by half.
It is believed that phospholipids reduce susceptibility to rheumatism, and therefore it is recommended to include 5-6 eggs per week in the diet. Excess carbohydrate foods contribute to the occurrence of allergic reactions, therefore, in the diet of patients with acute rheumatism, the amount of carbohydrates should not exceed 300-400 g per day.
Important importance is attached to vegetables and fruits, which contain large amounts of vitamins, as well as potassium and calcium.
Table salt and liquid are limited if blood circulation is impaired. In case of cardiovascular failure, food calories should be reduced at the expense of proteins and fats. Food should be well fortified, especially with vitamins A, B, C. It should be taken often and in small portions. In case of severe circulatory failure, a short-term (1-3 days) semi-starvation diet consisting of fruits, vegetables or milk (4-5 glasses per day) is indicated.
The following medications are used in the treatment of rheumatism:
I. Means of etiopathogenetic, antiallergic therapy: a) antibiotics; b) non-steroidal anti-inflammatory drugs (salicylates), indomethacin, diclofenac preparations, ibuprofen preparations, piroxicam, butadione, reopirin, mefenamic acid, etc.); c) glucocorticoids;
d) drugs with predominantly immunosuppressive effects (choline drugs, cytostatic immunosuppressants, antilymphocyte globulin).
II. Means of general, anti-dystrophic therapy that increases the body's defenses.
III. Symptomatic remedies (treatment of circulatory failure, disorders of water-salt metabolism, etc.).
Based on the fact that rheumatism is caused predominantly by beta-hemolytic streptococcus of group A, and also taking into account the presence of chronic foci of infection in a significant proportion of patients with rheumatism (tonsillitis, sinusitis, rhinitis, pharyngitis, odontogenic infection), antibiotics, in particular penicillin, must be prescribed in a dose 1500000 -2000000 IU/day.
Penicillin has a bactericidal effect, disrupting the synthesis of the cell wall of streptococcus during its development, leading to the death of the microbe. The course of treatment is at least 10 days. The question of the duration of penicillin administration is decided individually. After 10 days of penicillin therapy, they switch to bicillin-3 (600,000 units 2 times a week) or bicillin-5: (1,500,000 units once every 3-4 weeks). To create a more constant concentration of penicillin in the blood in the hospital, preference is given to bicillin-3.
If you are intolerant to penicillin, you can recommend semisynthetic penicillin preparations for the same time - oxacillin (0.5 g 4 times a day orally, or better yet 0.25-0.5 g intramuscularly every 4-6 hours), methicillin (1 g intramuscularly every 6 hours), ampicillin (0.25-0.5 g intramuscularly every 4-6 hours), erythromycin (0.25 g 4 times a day orally). In the future, they switch to the introduction of bicillin.
It should be borne in mind that a patient may have increased sensitivity to penicillin in the absence of it to bicillin-3 or bicillin-5, that is, sensitivity to bicillin in these cases should be judged not by the reaction to penicillin, but by the reaction to the drug, which will be administered (bicillin-3 or bicillin-5).
To avoid anaphylactic shock, sensitivity to the drug should be checked using conjunctival, sublingual, and scarification tests, and only then intradermal.
If you are intolerant to penicillin and other antibiotics and lack sensitivity to bicillin, this drug must be administered from the very beginning and continued throughout hospital treatment.
It should be borne in mind that antibacterial therapy does not cure rheumatism, but only prevents the effects of streptococcal infection (endo- and exogenous) on the body, i.e., creates the background for the more effective use of anti-inflammatory therapy. It has been suggested that the use of penicillin for the treatment of rheumatism is justified only for specific indications: the presence of an obvious infectious focus, signs of a possible streptococcal infection (clearly increased titers of anti-streptococcal antibodies, detection of streptococcal antigen in the blood or brain).
The mechanism of action of drugs used for rheumatism can be represented as follows:
1) stabilization of lysosomal membranes; 2) uncoupling of oxidative phosphorylation and thereby limiting the energetic supply of inflammation; 3) inhibition of proteolytic activity; 4) inhibition of proliferation of cellular elements in the area of inflammation;
5) influence on the metabolism of mucopolysaccharides and collagen proteins, etc.
Nonsteroidal anti-inflammatory drugs (often called “anti-rheumatic”) drugs now form a large group of drugs.
Acetylsalicylic acid (aspirin, anopyrin, acesal, novandol)
It has antipyretic, analgesic and anti-inflammatory effects, and also inhibits platelet aggregation. The main mechanism of action of acetylsalicylic acid is the inactivation of the enzyme cyclooxygenase, as a result of which the synthesis of prostaglandins, prostacyclins and thromboxane is disrupted. When used in high doses, the drug can inhibit prothrombin synthesis in the liver and increase prothrombin time. Some dosage forms contain magnesium.
Dosage regimen. The drug is available in tablets. Appointed individually. For adults, a single dose varies from 150 mg to 2 g, daily from 150 mg to 8 g; frequency of use 2-6 times a day. For children, a single dose is 10-15 mg/kg, frequency of use is up to 5 times a day.
Rheumatic arthritis responds well to treatment with salicylic drugs, but visceral rheumatic lesions are worse, especially in recurrent forms of the disease. After discharge from the hospital, patients should take acetylsalicylic acid at a dose of 2 g per day for a month. The main obstacle to prescribing effective doses of salicylic drugs is their toxic effect, which is manifested by dyspeptic syndrome, tinnitus, hearing loss, loss of appetite, and heartburn. Salicylic drugs irritate the gastric mucosa, often leading to erosive gastritis, ulcers, and bleeding. Preparations in powder form are recommended to be taken after meals with alkaline mineral water or milk.
Indomethacin (indobens, indovis, indomin, methindol, indotard)
Indomethacin preparations have anti-inflammatory, analgesic and antipyretic effects due to inhibition of prostaglandin synthesis. Suppress platelet aggregation. Oral and parenteral administration helps relieve pain, especially joint pain, and increase range of motion. The anti-inflammatory effect occurs by the end of the first week of treatment. With long-term administration they have a desensitizing effect. When applied topically, they eliminate pain, reduce swelling and erythema, help reduce morning stiffness, and increase range of motion.
Dosage regimen. The drugs are available in tablets, capsules, injection solution, ointment, and gel. Doses are set individually. Adults are prescribed 25-50 mg orally 3 times a day. The maximum daily dose is 200 mg. For long-term treatment, this dose should not exceed 75 mg. The drug should be taken after meals.
Intramuscularly prescribed 60 mg 1-2 times a day for 7-14 days. For maintenance treatment, 50-100 mg is prescribed once at night.
The most common side effects are nausea, anorexia, pain and discomfort in the abdomen, bloating, constipation, and diarrhea. In some cases, erosive and ulcerative lesions, bleeding and perforation of the gastrointestinal tract. With long-term use, dizziness, headache, agitation, sleep disturbances, irritability, fatigue, corneal clouding, conjunctivitis, hearing loss, and tinnitus are possible.
Diclofenac (Voltaren, Diclomax, Dicloran, Ortofen, Rumafen)
Diclofenac preparations have anti-inflammatory, analgesic and moderate antipyretic effects due to inhibition of the synthesis of prostaglandins, which play a major role in the pathogenesis of inflammation, pain and fever. For rheumatic diseases, they reduce pain in the joints at rest and during movement, as well as morning stiffness and swelling of the joints, and help increase range of motion. Suppress platelet aggregation. With prolonged use they have a desensitizing effect.
Dosage regimen. The drugs are available in tablets, capsules, injection solution, ointment, and gel. Doses are set individually. Adults are prescribed 25-50 mg orally 2-3 times a day. The maximum daily dose is 150 mg.
75 mg of the drug is administered intramuscularly, further treatment is carried out using tablets. Side effects include nausea, anorexia, pain and discomfort in the abdomen, flatulence, constipation, and diarrhea. Erosive and ulcerative lesions of the gastrointestinal tract may occur. Possible dizziness, headache, agitation, insomnia, irritability, fatigue. In rare cases, anemia, leukopenia, thrombocytopenia.
Ibuprofen (Brufen, Burana, Marcofen, Motrin)
The drugs are derivatives of phenylpropionic acid. They have anti-inflammatory, analgesic and antipyretic effects. This is due to inhibition of prostaglandin synthesis by blocking the enzyme cyclooxygenase.
Dosage regimen. The drugs are available in tablets, capsules, dragees, and in the form of a suspension for oral administration. Appointed individually. A single dose is 200-800 mg; maximum daily dose - 2.4 g; frequency of administration - 3-4 times a day.
The most common side effects are gastrointestinal disorders (nausea, anorexia, vomiting, epigastric discomfort, diarrhea); the development of erosive and ulcerative lesions of the gastrointestinal tract is possible, as well as headache, dizziness, sleep disturbance, agitation, skin rash, Quincke's edema, and visual impairment.
Piroxicam (Movon, Remoxican, Chotemin)
Piroxekam preparations have anti-inflammatory, analgesic and antipyretic effects. The mechanism of action is associated with inhibition of prostaglandin synthesis. Relieves pain of moderate intensity. The analgesic effect occurs 30 minutes after oral administration. The anti-inflammatory effect appears by the end of the first week of treatment. After a single dose of the drug, its effectiveness remains for 24 hours.
Dosage regimen. The drugs are available in tablets, capsules, injection solution, cream, and gel. Prescribed orally in a dose of 10 mg to 30 mg 1 time per day. Intramuscularly at a dose of 20-40 mg 1 time per day. Side effects include nausea, anorexia, pain and discomfort in the abdomen, bloating, constipation, and diarrhea. In some cases, erosive and ulcerative lesions of the gastrointestinal tract. Possible headache, dizziness, sleep disturbance, irritability; changes in peripheral blood.
Butadion
A drug from the group of pyrazolone derivatives. It has an anti-inflammatory effect due to inhibition of cyclooxygenase activity and a decrease in the synthesis of prostaglandins.
Dosage regimen. Available in tablets, dragees, and solution for injection. 200-400 mg is prescribed orally 3-4 times a day. After clinical improvement, the dose is gradually reduced. Parenteral treatment in individual doses. Side effects are similar to the above anti-inflammatory drugs.
Reopyrine (Pirabutol)
Combined drug. Contains butadione and aminophenazone. It has pronounced anti-inflammatory and analgesic activity.
Dosage regimen. The drug is available in pills and solution for injection. It is prescribed intramuscularly, 5 ml daily or every other day. Side effects: water and salt retention, glucosuria, hematuria; drowsiness is possible.
Of the corticosteroid hormonal drugs, preference is given to prednisolone, although prednisone, dexamethasone, and triamcinolone can also be prescribed. The initial daily doses of prednisolone and prednisone are usually up to 2-0.025 g, triamcinolone - 0.016-0.02 g, dexamethasone 0.003-0.0035 g. The dose is reduced for the first time after achieving clinical improvement, but not earlier than 1 week after the start of treatment. Subsequently, daily doses continue to be reduced, almost half a tablet of prednisolone every 5-8 days. Course doses of prednisolone are usually approximately 0.5-0.8 g. In case of severe heart failure and a tendency to hypertension, it is more advisable to use triamcinolone or dexamethasone. Triamcinolone (polcortolone) is used 4 mg 3-4 times a day, dexamethasone - 0.5 mg 1 to 6 times a day.
Glucocorticoid hormones for the treatment of active rheumatism have become less common. Together with salicylic and anti-inflammatory non-steroidal drugs, they are used for III, and less often for II degree of activity of the rheumatic process, diffuse rheumatic carditis. It is not advisable to use corticosteroid hormonal drugs with a minimal degree of activity, latent and continuously relapsing course of rheumatism. There is practically no hormone withdrawal syndrome in rheumatism, and therefore, if necessary (sudden development of serious complications), even a relatively high dose of corticosteroids can be sharply reduced or discontinued.
For patients with II and III degrees of rheumatism activity, the initial dose of hormones should be increased to 0.04-0.05 g per day or even higher.
Although complications are very rare when treating rheumatism with corticosteroids (mainly from the gastrointestinal tract), it is still necessary to replenish potassium losses by prescribing panangin, asparkam, potassium orotate, etc., 1-2 tablets 3-4 times a day. For fluid retention, spironolactone (veroshpiron, aldactone) and furosemide are prescribed.
Quinoline drugs (Delagil, Plaquenil) have a therapeutic effect in continuously relapsing forms of rheumatism and have a weak immunosuppressive effect. For the treatment of rheumatism, they are usually used in combination with salicylates. The dose of delagil is 0.25 g, plaquenil is 0.3-0.4 g per day. The course of treatment for a continuously relapsing course is from 3 to 6 months, and sometimes 9-12 months.
Cytostatic immunosuppressants - 6-mercaptopurine, imuran (azothioprine), chlorobutine are indicated only for those patients with continuously relapsing course and prolonged course of rheumatism who are resistant to treatment with both classical antirheumatic drugs, including corticosteroids, and quinoline drugs with their long-term, months-long use . The dose of 6-mercaptopurine, imuran (azothioprine) is 0.1-1.5 mg per 1 kg of weight, chlorobutin is 5-10 mg per day.
Means of general dystrophic therapy are anabolic steroids, protein hydrolysates, pyrimidine derivatives, gamma globulin preparations, etc. Anabolic steroids have a nonspecific anti-inflammatory effect. When they are included in complex therapy, the treatment time for patients with primary rheumatic carditis is reduced by 1.5 times, and the percentage of the formation of heart defects is reduced. Anabolic hormones improve the general condition of patients and the metabolism of the heart muscle. In medical practice, drugs from the testosterone group are most often used: methandrostenolone, dianobol, nerabol, etc. - 5 mg 2-3 times a day for 3-4 weeks.
Nerobol, retabolil, phenobolin are widely used - 25-50 mg per 1 ml once every 5-10-20 days. Usually three injections are given.
Albumin, which is administered intravenously, has a normalizing effect on impaired metabolic processes. Course dose is from 600 to 3000 ml, 6-15 infusions with an interval of 1-3 days.
Gamma globulin preparations (nonspecific gamma globulin, histoglobulin, etc.) stimulate the body's specific immune defenses. It is advisable to prescribe them together with desensitizing agents, as they have allergenic properties. Contraindicated in cases of high activity of the rheumatic process and pronounced progression of cardiac pathology.
For decompensation of the cardiovascular system, cardiac glycosides (strophanthin, corglycon, isolanide, digoxin, digitoxin), diuretics (furosemide, lasix, brinoldix, etc.) are used.
Traditionally, in the complex treatment of rheumatism, ascorbic acid and other vitamins, especially rutin, are prescribed in large doses (up to 1 g per day).
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Currently Treatment of rheumatism is carried out in 3 stages:
Stage I. Treatment in the active phase in a hospital;
I Stage I. Continuation of treatment of the patient after discharge in the cardio-rheumatology offices of the clinic;
I II stage. Subsequent long-term clinical observation and preventive treatment in the clinic.
Treatment options include:
- fight against streptococcal infection;
- suppression of active rheumatic process;
- correction of immunological disorders.
Stage I - treatment in the active phase in a hospital
Stage I requires bed rest for 2-3 weeks, a diet with limited sodium chloride (table salt) and a sufficient amount of complete proteins (at least 1-1.5 g per 1 kg of body weight).
Etiotropic therapy is carried out with penicillin, having a bactericidal effect on hemolytic streptococci of group A. Penicillin is prescribed in a dose of 1.5-4 million units for 10 days. Instead of penicillin, you can use polysynthetic penicillins (ampicillin, oxacillin, etc.).
In case of individual intolerance to penicillins, macrolides are used:
- spiramycin 6 million IU in two doses for 10 days;
- azithromycin 0.5 g 1 time for 3 days;
- roxithromycin 0.3 g 2 times a day for 10 days.
Active rheumatic process treated with various non-steroidal anti-inflammatory drugs (NSAIDs). Preference is given to indomethacin and diclofenac - the most effective drugs that have the least pronounced side effects. The daily dose of these drugs is 100 mg. Instead, you can prescribe acetylsalicylic acid at 4-5 g/day. These drugs should be taken until the activity of the rheumatic process is completely eliminated.
With high activity (III degree), severe primary rheumatic carditis with signs of heart failure (more common in young people) or signs of polyserositis, glucocorticosteroid drugs (prednisolone 1-1.5 mg/kg) are indicated. Once the clinical effect is achieved (usually after 2 weeks), the dose is gradually reduced followed by the administration of NSAIDs.
With a sluggish current process a greater effect is achieved from immunosuppressive therapy (correction of immune homeostasis) with the help of aminoquinoline derivatives of hydroxychloroquine (plaquenil), hingamine (delagil). These drugs are prescribed at 0.2 and 0.25 g, respectively, 1-2 times a day for a long time (at least 1 year). After a year, the dose can be reduced by half.
Stage II - continuation of treatment of the patient after discharge in the cardio-rheumatology offices of the clinic.
At stage II, drug therapy should continue in the doses with which the patients were discharged from the hospital. The duration of taking anti-inflammatory drugs in acute cases is usually 1 month, in subacute cases - 2 months; as mentioned above, aminoquinoline drugs are taken for a long time (1-2 years).
The outpatient stage also provides for mandatory bicillin prophylaxis for 5 years after an attack of rheumatism in doses of 1,500,000 units of bicillin-5 every 3 weeks.
Stage III - subsequent long-term clinical observation and preventive treatment in the clinic.
The task of stage III includes the stay of children and adolescents in a local rheumatological sanatorium, and for adults - referral for rehabilitation to a cardiological sanatorium.
For chronic tonsillitis, surgical treatment should be carried out only if conservative treatment is ineffective, as well as in cases where exacerbation of tonsillitis leads to relapse of rheumatism.
Patients with heart failure receive appropriate therapy with angiotensin-converting enzyme inhibitors (ACE inhibitors), cardiac glycosides, and diuretics (see “Heart failure”).
Patients with rheumatism are registered at the dispensary not only for the purpose of anti-relapse therapy, but also for timely detection of relapse, and if the valve disease progresses, for timely referral to a cardiac surgery facility.
Prognosis of rheumatism
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An immediate threat to life with rheumatism is extremely rare. The prognosis is mainly determined by the severity of the heart defect and the state of myocardial contractile function.
Prevention of Rheumatism
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Primary prevention consists of a set of public and individual measures aimed at preventing primary morbidity (increasing living standards, promoting a healthy lifestyle, in particular hardening, improving living conditions, combating overcrowding in kindergartens, schools, public institutions).
Early and effective treatment of sore throats and other acute streptococcal diseases of the upper respiratory tract is important. This is achieved by prescribing penicillin during the first 2 days, 1,500,000 units; on the 2nd day, bicillin-5 is administered, 1,500,000 units. If you are intolerant to penicillin, erythromycin can be prescribed for 10 days. Any treatment for sore throat should last at least 10 days, which leads to complete cure of the streptococcal infection.
Prevention of relapse of rheumatic fever (secondary prevention) is carried out in the hospital immediately after the end of 10-day treatment with penicillins (macrolides). The classic parenteral regimen is benzathine benzylpenicillin (retarpen, extensillin) 1.2-2.4 million units intramuscularly once for 3-4 weeks. The younger the patient is at the time of the first attack, the greater the likelihood of relapse. After a five-year follow-up, relapse rates generally decrease with age. Patients without rheumatic carditis during the first attacks should receive anti-relapse prevention for at least 5 years after the last attack, at least until the age of 21. For patients who had heart damage during a previous attack, prophylaxis is carried out for at least 40 years or more. For patients who have undergone heart surgery for rheumatic heart disease, secondary prevention is carried out for life.
Reactive arthritis is a disorder that appears as a response to an infection, for example, in the genitals, urinary system, and gastrointestinal tract.
Typically, arthritis occurs 20-25 days after the onset of infection.
In reactive arthritis due to infections of the genitourinary organs, the provoking factor is infections in the genitals, bladder, and urethra.
If the infection is related to food poisoning, then this condition is called enteroarthritis.
In 2% of people with such poisonings, joint inflammation may develop within a few weeks.
Genetic predisposition also plays a role in the development of the disease.
The disorder often occurs between 20 and 40 years of age.
Pain and swelling of the joints in the knees, elbows and toes are the first appearances of the disorder. Other joints can also become inflamed.
Reactive arthritis in diseases of the genitourinary system is accompanied by symptoms of inflammation of the prostate and urethra in the stronger half, the bladder, uterus, and vagina in women.
In this case, there may be a frequent desire to urinate, as well as a burning sensation at this moment. Pain and redness of the eyes, decreased visual acuity are caused by conjunctivitis, which can appear before the development of arthritis or in conjunction with joint damage.
Since the disorder has no specific symptoms, the diagnosis is generally made by excluding other causes of joint damage.
To make a diagnosis, it is important for the doctor to carefully question the person, examine him and study laboratory data.
Is the disease curable?
With reactive arthritis, the risk of relapses and the disorder becoming chronic is extremely high.
Nevertheless, treatment of reactive arthritis of the knee and other joints is quite possible, you just need to not delay treatment.
Drug treatment
Among antimicrobial drugs, in case of deviation, broad-spectrum agents are prescribed - azithromycin, doxycycline.
These drugs belong to different types and are taken according to certain regimens selected by the treating doctor. Antibacterial therapy alone does not improve arthritis. But the use of antibiotics neutralizes the root cause.
Therapy for articular syndrome is carried out by two main types of drugs - NSAIDs and hormones.
NSAIDs (diclofenac, salicylates, ibuprofen) are used in combination - internally in tablets and externally in ointments. These drugs stop biochemical reactions that cause inflammation of the joints.
Glucocorticoids - dexamethasone, diprospan - have a similar effect. These drugs are also used in combination - through oral administration and in the form of injections into the joint.
Both types of drugs have a lot of side effects, including impaired blood clotting, a toxic effect on the liver, stomach and intestines, and suppression of the immune system.
Although, decreased immunity in this disorder is more good than bad.
When the immune system is suppressed, the course of autoimmune reactions leading to joint damage is inhibited.
This is why immunosuppressive drugs are used for arthritis, which stop cell growth and reduce immunity. One such drug is methotrexate.
It stops cell growth, interrupts the course of immune and inflammatory processes, and therefore is the drug of choice for reactive arthritis.
But this medicine is also not without side effects - the suppression of protective functions does not go away without a trace. Among other things, methotrexate enhances the toxic effects of NSAIDs.
ethnoscience
Reactive arthritis and its treatment with folk remedies consists of using natural ingredients in combination with individual medications:
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How to treat reactive arthritis in children
conclusions
With proper treatment, the causes of the disease, manifestations of arthritis disappear after a few weeks. In half of those who experience the disorder, symptoms may recur. The condition can become chronic.
The sooner treatment of reactive arthropathy begins, the higher the likelihood that the lesion will be defeated in a short time, and its manifestations will not bother you for a long time.
Video: Reactive arthritis - associated symptoms
Reactive arthritis is an inflammatory disease affecting the joints that develops after suffering certain infections. A set of symptoms that indicate this disease.
Antibiotics for arthritis
Antibiotics in the treatment of arthritis
In some cases, treatment of arthritis requires the use of antibacterial therapy. Antibiotics for arthritis destroy pathogenic microorganisms that have entered the body, which provoke the development of inflammation in the joints and spread throughout the body. There are certain types of joint diseases that require treatment only with antibiotics.
This group of arthritis includes arthritis:
- With the addition of a purulent infection
- Inflammatory in nature
- Infectious origin
- Allergic origin
- Reactive
Use of antibiotics in the treatment of arthritis
After making an accurate diagnosis, the doctor prescribes a specific group of antibiotics, based on the infection that has entered the body. If the infection has entered the affected joint after a genitourinary infection, then antibacterial therapy of the tetracycline series is prescribed. Such drugs immediately block protein synthesis in pathogenic microorganisms. Promote a speedy recovery. If the infection has migrated to the joint from the source of the upper respiratory tract infection, then semi-synthetic penicillins are prescribed. Moreover, the infection can be a common cold. Penicillins are well tolerated by the patient. There are practically no side effects. And if the infection came from the affected intestine with bacteria, then fluorooxyquinolones are used. Such drugs have a wide spectrum of action. They qualitatively destroy the vital processes of bacteria. And they have a minimal effect on the microflora of the diseased intestine.
Classification of joint arthritis
Currently, all articular arthritis are divided into three groups. Let's look at knee arthritis in detail.
Knee arthritis groups:
Reactive arthritis begins with an infection in the joint. Moreover, the infectious process may first develop not in the joint, but, so to speak, in the urinary or digestive system. This type of arthritis is also called infectious. It has a rapid flow and spread.
Rheumatoid arthritis is the most common. With this type, specific cysts form in the area of the popliteal fossa. The cysts are called Baker's cysts. They bring severe pain and discomfort to the patient.
Arthrosis-arthritis is characterized by impaired microcirculation in bone and joint tissue. Spike-like formations, growths, or hardening occur on the bones. It is more common in advanced stages of the disease, with untimely treatment.
The cause of the pathology may be the presence of bone tissue injury (after an accident, sports injuries). Excessive stress on the joints over time also provokes the development of the disease, especially prolonged heavy lifting and excess weight. The progression of the disease can be the presence of a congenital pathology or impaired metabolism in the body. The most common cause is frequent infectious diseases, including seasonal colds, which were not treated in time.
Antibiotic treatment regimen
Antibacterial therapy is combined with other medications. Such complex treatment helps to completely destroy the infectious focus. Antibiotics for arthritis and arthrosis are taken according to the established treatment regimen:
- Semi-synthetic antibiotics are prescribed in tablets and taken once a day for a course of 7 days. The tablets can be chewed or split into pieces.
- Broad-spectrum antibiotics are usually taken twice a day (morning, evening) with an interval of 12 hours for seven days.
- For all drugs, the course of treatment is at least seven days. Otherwise, bacteria become accustomed to the medicine. The drug becomes ineffective when repeated.
- If after the full course the infection is not cured, another group of antibacterial therapy is prescribed.
- For better absorption into the blood, drugs are washed down with plenty of water. With the liquid, dissolved substances quickly enter the capillaries.
Antibiotics for arthritis of the knee joint of infectious etiology
Antibiotics for knee arthritis are the only effective treatment. They not only reduce pain, but also return the patient to a full life. One of the popular drugs in treatment is Minocycline. The drug has a qualitative effect on the source of the infectious process. Reduces stiffness of the knee joint, relieves swelling and pastiness. The knee joint becomes mobile, the joint fluid completely envelops the bone.
Treatment of rheumatoid arthritis with antibiotics
Treatment of rheumatoid arthritis with antibiotics is carried out in several stages. Treatment depends on the stage of the disease. In the early stages, Monocycline is used. The medication has a positive effect on joints, reduces swelling, and improves lymph circulation. Severe pain is relieved. If the damage to the joint has already gone far, then Doxycycline is prescribed. The drug blocks enzymatic activity that destroys cartilage and bone tissue. For a speedy recovery, antibiotics are prescribed in combination with anti-inflammatory drugs and herbal medicine. After a course of antibacterial therapy, a drug is prescribed to improve intestinal microflora. An integrated approach gives positive results from the very beginning of treatment.
How to take Azithromycin
One of the effective drugs in the treatment of reactive arthritis with antibiotics is Azithromycin. The drug is available in two dosage forms - capsules and syrup. Capsules and syrup are active against many pathogenic microorganisms (mycoplasma, chlamydia, ureaplasma). The drug has high bioavailability and lipophilicity. Helps increase the concentration of important substances several times. The medicine is removed from the body after 60 hours. Thus, it shows a long-term positive effect in treatment. The medication is easily tolerated by the body. Side effects are kept to a minimum. The only requirement for treatment with the drug is to drink plenty of fluids. Liquid facilitates absorption in the intestine.
Why it is better not to self-medicate, side effects
Antibacterial therapy is prescribed only by a doctor. Each group of antibiotics has its own specific spectrum of action. If you prescribe a medicine yourself, you may not be able to guess the type of bacteria that caused the infection and damage to the joints. In addition, antibiotics kill not only pathogenic microorganisms, but also beneficial ones. Incorrect use can trigger a relapse and cause adverse reactions. The most common include:
- Decreased immune status.
- Reducing the body's natural resistance to infections. Decreased concentration of protective antibodies.
- Changes in functioning and indigestion may appear on the part of the digestive tract. Changes in healthy microflora. Increased gas formation.
- From the circulatory system: changes in the main blood parameters, anemia, decrease in platelets and leukocytes.
- From the nervous system: sleep disturbance, dizziness, headache, increased excitability, apathy, malaise, tinnitus.
- From the skin: itching, burning, irritation of the epidermis, urticaria, swelling.
Conclusion
When the first symptoms of arthritis appear, you should consult a qualified specialist. The doctor, using modern diagnostic methods, can immediately determine the cause of the disease. Based on the data, he will select the necessary antibacterial therapy. As a rule, if you seek medical help in a timely manner, the disease has a favorable prognosis for the future.
Treatment of reactive arthritis: what you need to remember
Any infectious disease can cause reactive arthritis, which affects joints and some other organs. Most often, reactive arthritis affects the body of men aged 20 to 40 years. Women suffer from this disease much less often. Reactive arthritis, or Reiter's syndrome, affects parts of the body such as the eyes, skin, and urethra, but the most common problem area is the joints. The cause of the disease is infections, divided into three types:
- urogenital (pathogens - chlamydia);
- intestinal (pathogens - salmonella, E. coli);
- affecting the respiratory tract (causative agents - chlamydia, mycoplasma).
- Symptoms of reactive arthritis
- Diagnosis of the disease
- How is reactive arthritis treated?
- Treatment with folk remedies
Very often, reactive arthritis develops as a result of sexually transmitted chlamydial infection. Researchers have also determined that the syndrome is hereditary. The gene number HLA-B27 is responsible for this. A carrier of this gene is 50 times more likely to have the disease than others.
Doctors still cannot understand the fact that the disease can develop without bacteria entering the joint. There is an assumption that the cellular structure of chlamydia and mycoplasma is similar to the structure of human organs. Therefore, the immune system, having identified the body’s cells as foreign, begins to attack them.
Symptoms of reactive arthritis
The very first symptoms appear a month after infection. Basically, it is impossible to accurately determine from them that it is Reiter's syndrome: fever, weakness, weight loss - the listed symptoms are characteristic of many diseases. Then mainly the joints of the legs begin to hurt: ankle, hip, knee. It is not so common for the joints of the hands to become inflamed, but if such a problem occurs, the wrist joint and hand may suffer the most. If the infection gets into the fingers, then there is a danger of another disease - dactylitis.
At the same time, symptoms of diseases of other organs appear. For example, the eyes suffer from conjunctivitis or iridocyclitis. Sometimes, in the case of inflammation of the iris, if a person does not seek medical help in a timely manner, a person’s vision sharply decreases and then disappears completely.
Reactive arthritis also affects the mucous membrane, and along with it the skin. Many small ulcers may appear on the mucous membrane of any organ. They occur both in the mouth and on the male and female genital organs. It is important to remember that it is not so much these wounds that are dangerous, but the infection that can get into them and cause new problems and complications.
Diagnosis of the disease
The presence of reactive arthritis can only be determined through a special examination. Since the eyes, skin, joints and genitourinary systems are most susceptible to damage, special attention is paid to these parts of the body. With this type of arthritis, tests are performed to measure the erythrocyte sedimentation rate and the content of the so-called C-reactive protein. The results will indicate the presence or absence of inflammation.
The cause of the disease can also be determined after an analysis aimed at identifying chlamydia. To investigate the infection in the joint, a puncture of the joint is performed. You can use an x-ray, but this method does not always provide an accurate picture of the condition of the joint.
How is reactive arthritis treated?
Reactive arthritis is treated using different methods:
- Chlamydia and salmonella can be eliminated by taking antibiotics. The drug course of treatment lasts about a week and involves taking drugs such as doxycycline or azithromycin. Many patients have previously experienced treatment with erythromycin, but this inexpensive drug has various side effects. Often, after taking antibiotics (3 weeks after the last dose), the doctor gives a referral for additional tests in order to be sure that harmful microorganisms have been completely eliminated. If the drug does not help, re-treatment with another medication is prescribed. After complete recovery, it is not recommended to have sexual intercourse with the patient’s previous partners until they have completed the same course of treatment.
- Treatment of joints with antibiotics does not guarantee a 100% positive result. Infections are only the first to trigger the disease; in the future, the problem may have other causes. When treating joints, glucocorticoids or NSAIDs (non-steroidal anti-inflammatory drugs) are used. These drugs are prescribed in combination if the pain in the joints due to reactive arthritis is not severe, and the main signs of intoxication are absent. An anti-inflammatory ointment will be useful in this case, the use of which will perfectly complement drug treatment.
- Another method that is used during the healing process of a joint is the injection of hormones into the affected area. Such drugs - dexamethasone and diprospan - in tablet form are too harmful for the body, so they are prescribed by injection. This way they have the maximum positive effect. Some joints, such as the feet, are not comfortable to treat in this way. Then the doctor prescribes dimexide, which is applied in the form of applications in the area of the sore joint.
- In case of severe, ongoing pain, the doctor should prescribe hormonal drugs in the form of tablets. These are betamethasone and methylprednisone, which are taken for a week. The dose should be gradually reduced as inflammation decreases.
- Basic drugs are also used. The doctor prescribes them in combination with hormones. Previously, the main drug was sulfasalazine, which over time began to be replaced by methotrexate. It, unlike other similar medications, does not cause as many side effects, and at the same time has a more active effect on the problem area. At the same time, methotrexate is not very expensive, which makes it accessible to many who need it.
You need to take methotrexate 2 times a day from the first to the fourth day, after which there is a three-day break and the course is repeated. The duration of its administration depends on the intensity of inflammation. Sometimes this drug is used for chronic arthritis. During the entire course of treatment, the patient must be under the supervision of a physician.
In addition to drug treatment, there is physical therapy. There are such varieties as:
- transcutaneous electrical stimulation;
- paraffin baths;
- course of treatment with leeches;
- ultrasound therapy;
- massage.
Physiotherapy is usually used in the last stages of recovery. Before starting such treatment, you should discuss with your doctor which type to use.
Treatment with folk remedies
Together with drug treatment and physiotherapy, various remedies that have been known to traditional medicine for many years are often used. But we must not forget that, as in other cases, the issue of using folk remedies must be discussed with a doctor.
A very effective method is a compress of cabbage leaves and honey. Treatment is carried out as follows. Several large leaves are separated from a head of cabbage, heated, trimmed to the shape of the joint, and then the inside is filled with honey. The resulting compress should be applied to the inflamed joint, and pressed tightly with cellophane on top. This way, the joint will always be warm. For convenience, the compress should be wrapped around the leg with a handkerchief or scarf.
This compress is applied at night when the leg is motionless. At this time, all the beneficial substances in honey are absorbed through the skin into the leg. In the morning it is removed, the procedure is repeated daily until a positive effect appears.
Other well-known folk remedies useful in the treatment of reactive arthritis include celery juice, cinquefoil and mustard compresses, which perfectly perform their therapeutic function and effectively complement the main course of treatment.
It is always necessary to remember that the sooner a person seeks help, the higher the likelihood that the body will be cured very soon, and reactive arthritis will not bother you for a very, very long time.