Antibiotics in dentistry for treatment and prevention

One of the most severe, excruciating pains is toothache. It occurs for various reasons: caries, infection, loss of dental filling, inflammatory process, periodontal disease. In addition to severe pain, swelling of the cheeks, gums, and jaw may be observed. Failure to see a dentist in a timely manner often leads to the development of phlegmon and tooth loss. Broad-spectrum antibiotics are often used in dentistry. The drugs allow you to get rid of gumboil, inflammation, and pain. The remedies are selected individually and taken taking into account the doctor’s recommendation.

Dental antibiotic in adult and pediatric dentistry - features

Antibacterial agents have proven themselves in the treatment of various diseases caused by infections and pathogenic microbes. They are used to eliminate the inflammatory and infectious process in the oral cavity and maxillofacial region, as well as to suppress pathogenic microflora.

This group of drugs is used in the treatment of chronic and acute pathologies (implantation, surgery, periodontology, dentistry).

Dental antibiotics are prescribed for the following complications and infections:

• tooth abscess - an inflammatory process of the roots with abundant accumulation of pus;
• various inflammatory and purulent processes;
• periodontitis – inflammation of connective tissues (periodontal);
• pulpitis - a symptom of advanced caries, which often leads to the destruction of hard tissue;
• before surgery - to prevent inflammatory processes and complications;
• gumboil - gum disease.

In some cases, the drug is prescribed after tooth extraction and for the prevention of dental disease. The effect of the drugs is different. Use: to disrupt the formation of supporting polymers of cell walls, block the actions of microorganism enzymes, accumulation in bone tissue. Antibiotic therapy has also proven itself in pediatric dentistry.

Medicines for inflammation of gums and teeth

Antibacterial drugs are effective against inflammatory processes of tooth roots and gumboils. These are purulent diseases in the subnaosteal or subgingival part. They appear in the form of purulent sacs on the gums. Incorrect and untimely treatment leads to surgical intervention.

The main reasons for the appearance:

• jaw injury;
• complication after improper treatment of pulpitis and tooth extraction;
• consequences of acute respiratory viral infections, influenza;
• mechanical damage to gingival tissue;
• advanced forms of caries;
• inflammation of gum pockets;
• hypothermia.

Fluxes come in different types: ossifying, ordinary, serous-albumic, purulent, fibrous. They are manifested by symptoms such as general weakness, fever, severe toothache radiating to the temple, swelling, pathological mobility of teeth, enlarged lymph nodes in the neck, redness in the localized area.

An antibiotic for toothache that has developed as a result of gumboil helps at the initial stage of the disease. Medicines relieve symptoms. Additionally, vitamin and mineral complexes are prescribed to strengthen the immune system.

The operation is prescribed in advanced cases. The abscess is opened under local anesthesia, cleansing is carried out, and drainage is installed to release residual purulent masses. After surgery, the patient will have to take antibacterial drugs prescribed by the dentist.

Therapeutic treatment with antibiotics has a cumulative effect, so it is important to follow the dosage and not stop taking it prematurely. The choice of means depends on the cause of inflammation, the age of the patient, the characteristics of the disease and the degree of its neglect.

You can use drugs such as Amoxiclav, Lincomycin, Azithromycin, Citrolet, Clindamycin, Trichopolum, Biseptol.

The drugs are prescribed taking into account contraindications and individual tolerance. To avoid microbial resistance of the body, use for more than 10 days is contraindicated.

In childhood, flux is rare, but leads to serious consequences due to the accelerated spread of infection in the body. At the slightest sign of suppuration, you should immediately contact a specialist. Treatment is aimed at eliminating the source of the inflammatory process and generally strengthening the body and immune system.

Antibiotics for gumboil and inflammation of tooth roots -

Let's look at what antibiotics can be used for adults for gum gum disease. The choice here is quite large, for example, ranging from inexpensive antibiotics - such as lincomycin or amoxicillin, to more expensive drugs (for example, β-lactam antibiotics, 2nd generation fluoroquinolones and macrolides). Below we will look at the most popular antibiotics and tell you whether they work well for this type of dental inflammation.

1) Amoxiclav (or Augmentin) - these drugs contain a combination of “the antibiotic amoxicillin and clavulanic acid.” Many modern pathogenic bacteria produce β-lactamase enzymes that destroy amoxicillin. Clavulanic acid protects amoxicillin from the action of beta-lactamases, which greatly increases the effectiveness of the antibiotic. But using the most common amoxicillin (without combination with clavulanic acid) is pointless in dentistry.

The dosage regimen for adults is 500 mg 2-3 times a day (2 or 3 times depending on the severity of inflammation), the duration of administration is usually 5 days, but if necessary, the doctor can extend the drug for another 2-3 days. A package of the antibiotic Amoxiclav (15 tablets of 500 mg) costs from 330 rubles, and a package of the antibiotic Augmentin (14 tablets of 500 mg) costs from 180 rubles. And we do not recommend purchasing their Russian analogues containing a combination of “amoxicillin and clavulanic acid,” especially since they will not be cheaper.

Important: if you decide to purchase inexpensive amoxicillin (without clavulanic acid), then it should be used at least in combination with the antibiotic metronidazole (Trichopol). The latter is taken for purulent infections according to the same regimen - 500 mg 3 times a day (5-7 days in total). Only in this case can we expect at least some acceptable effectiveness from the treatment.

2) Ciprofloxacin (Tsiprolet) - this inexpensive, popular antibiotic belongs to the 2nd generation fluoroquinolones. The recommended regimen for use in adults is 500 mg 2 times a day (for 5 days), and the cost of a package of the Indian-made drug will be about 120 rubles. It works well for apical periodontitis, i.e. inflammation at the apex of the tooth root. In addition, the risk of developing diarrhea with this drug is lower - compared to β-lactam antibiotics (Amoxiclav, Augmentin).

Antibiotic Tsiprolet (10 tablets, 500 mg each) –

However, if we are talking about long-term apical periodontitis (especially if there have been cases of a fistula with purulent discharge in the projection of the tooth root), if there is acute pain indicating the formation of a purulent abscess at the apex of the tooth root, it would be optimal to prescribe an antibiotic containing the combination “ciprofloxacin” + tinidazole." These are drugs - “Ciprolet-A” or “Tsifran-ST”, in which, in addition to 500 mg of ciprofloxacin, each tablet also contains 600 mg of tinidazole.

Tinidazole is an antibacterial drug with antiprotozoal activity, i.e. it is effective against anaerobic microorganisms (which are especially numerous during the formation of pus at the site of inflammation). In addition, tinidazole is very effective against Clostridium difficile and Clostridium perfringens, which are responsible for the development of diarrhea while taking antibiotics, and thus, when taking combination antibiotics with tinidazole, diarrhea is practically excluded.

3) Azithromycin (Azitral) - it is usually prescribed for allergies to β-lactam antibiotics (for example, amoxicillin). There are different regimens of use, but according to studies for purulent odontogenic infections, the optimal treatment regimen is to take a single dose of 1000 mg for 1 day, after which the drug is taken for another 2 or 3 days at a dose of 500 mg once a day. But the price of this antibiotic will be high if we do not take into account Russian manufacturers.

For example, a good Indian drug with azithromycin “Azitral” will cost you 220 rubles per package of 3 capsules of 500 mg (it turns out that you will need to purchase 2 packages for the course). The short course of use is due to the fact that this antibiotic has a cumulative effect, and therefore, even after taking it, therapeutic concentrations of the antibiotic remain in the body for several days.

Is it worth using Azithromycin for complications of caries (apical periodontitis, swelling or fistula on the gum, or gumboil on the face) - it’s definitely not worth it. This is due to the fact that in patients with inflammation at the apex of the tooth, drugs with azithromycin show good effectiveness only in 50% of cases, and in the remaining half of patients, the sensitivity of the microflora in the inflammation site to azithromycin is regarded as “low”. Below we will also demonstrate scientific works that confirm this.

4) Lincomycin or Clindamycin are quite old antibiotics belonging to the lincosamide group. Moreover, clindamycin is a more effective analogue of lincomycin (in terms of effectiveness against certain types of pathogenic bacteria that cause purulent inflammation, it is 2-10 times more effective than lincomycin). The peculiarity of these antibiotics is a certain affinity for bone tissue, which is an advantage for purulent inflammation in the teeth, as well as their low price. The disadvantages include a narrow spectrum of antimicrobial action, as well as the fact that they often cause diarrhea.

The regimen for taking Lincomycin is 2 capsules 3 times a day, for a total of 5 days (a package of the drug costs only 60 rubles). Clindamycin dosage regimen: 1 capsule 150 mg 4 times a day for 4 days. The latter is the drug of choice for allergies to β-lactam antibiotics, which include penicillins, amoxicillin, cephalosporins, etc. Affordable price – pack of 16 tablets. 150 mg each (made in Serbia) costs approximately 160 rubles. To prevent diarrhea while taking antibiotics, they should also be combined with tablets. Metronidazole.

Is it worth using Lincomycin - modern studies show that lincomycin shows good effectiveness only in 36.8% of cases (in at least 63.2% of cases, pathogenic bacteria at the site of inflammation have only weak sensitivity to lincomycin). Moreover, if we are talking about a long-existing focus of inflammation in the area of ​​the tooth root (in the presence of a fistula or purulent abscess), lincomycin is effective only in 19% of cases, at the same time in 47.6% of cases it demonstrates only weak effectiveness, and in 33. 4% of cases – patients have complete resistance of the microflora in the inflammation site to lincomycin.

Summary (which antibiotic is better for inflammation at the root of the tooth) –

To compare the effectiveness of antibiotics in this article, the author of the article used personal experience in prescribing them, as well as the scientific work “Sensitivity of microbial associations of exudate of a periodontal pocket and odontogenic lesion to antibacterial drugs” (Makeeva I.M., Daurova F.Yu.), which was performed in 2016 at the Medical University. Sechenov, Moscow.

From this work we learn the following. In patients with apical periodontitis (inflammation at the apex of the tooth root), antibacterial drugs with the combination of amoxicillin + clavulanic acid were highly effective in 79-80% of cases, for ciprofloxacin (without tinidazole) - in 76% of cases, for azithromycin - from 66 % to 52% of cases, and for lincomycin - only from 36% to 19% of cases. Thus, if you have swelling of the gums or gumboil on your face, or there is acute pain when biting on a tooth, you should definitely not use lincomycin or azithromycin.

The 1st choice drugs are 2nd generation fluoroquinolones, namely the antibiotic ciprofloxacin (you can use the usual “Tsiprolet”, but the best drugs are those where ciprofloxacin is combined with tinidazole - these are “Ciprolet-A” or “Cifran-ST” ). Moreover, the last 2 drugs are the first choice drugs also for those patients who have a history of diarrhea during antibacterial therapy. In second place are β-lactam antibiotics such as Amoxiclav or Augmentin, which can be used as monotherapy or in combination with metronidazole (to enhance the effect in purulent inflammation).

If we are talking about the need for antibacterial therapy in a hospital setting (purulent abscesses, phlegmons, odontogenic osteomyelitis, etc.), then the drugs of first choice will be antibiotics of the cephalosporin group (i.m.), for example, the antibiotic Ceftriaxone.

Important: Remember that you should not take antibiotics on your own without a doctor's prescription. The choice of antibiotic is made by the doctor, taking into account the specific situation in the oral cavity, the severity of purulent inflammation, and also taking into account your chronic diseases. Antibiotics for gum gum disease are prescribed immediately after opening the tooth by a dentist, as well as after making a small incision in the gum (if necessary). But antibiotics cannot be a replacement for these medical procedures, because... Antibiotics are not able to “sterilize” infection in root canals and around the apex of the tooth.

Treatment with antibiotics for swelling of the gums near a tooth or acute pain when biting on a tooth is not the main treatment. If it is possible to save a tooth, the root canals must first be opened (to create an outflow of purulent discharge from the source of inflammation at the apex of the tooth root). And only after this are antibiotics prescribed. If you use an antibiotic just to suppress inflammation, you create a situation in which the infection at the site of inflammation becomes resistant to the antibiotic, and subsequent exacerbations of inflammation will be much more serious.

Antibiotics for toothache -

Tooth pain is a consequence of either inflammation of the nerve in the tooth (this disease is called pulpitis) or inflammation at the apex of the tooth root (apical periodontitis). Antibiotics for toothache do not quickly reduce it, because... they do not have an analgesic effect. True, they can reduce pain indirectly - by reducing inflammation, but this effect will develop for so long that it does not have any clinical significance.

An effective remedy for relieving toothache are non-steroidal anti-inflammatory drugs (NSAIDs), which include Nurofen, as well as other much stronger analgesics. You should start taking antibiotics before visiting the dentist only in one case, for example, if in the evening or at night you have acute pain when biting on a tooth or swelling of the gums/face, but you are planning an urgent visit to the dentist the next day.

Dental antibiotics for periodontal disease and periodontitis

Antibacterial drugs are often used in treatment regimens for periodontal disease. Moreover, each clinical case requires a special approach. Therapy is aimed at restoring normal microbial flora. Antibiotics are prescribed in the form of tablets, injections, ointments, and gels. The medicine is selected by a periodontist taking into account the severity of damage to periodontal tissues and the results of a diagnostic examination.

It is necessary to distinguish between periodontal disease and periodontitis, despite the similarity of symptoms:

• unpleasant odor;
• soreness;
• swelling, bleeding gums;
• feeling of unpleasant taste;
• pathological mobility of teeth.

Periodontitis is a consequence of exposure to pathogenic bacteria. Whereas periodontal disease often develops against the background of a metabolic-dystrophic disorder. Other provoking factors of pathology:

• genetic predisposition;
• pathological bite;
• gum injuries due to incorrectly selected dentures and crowns;
• deposits in subgingival pockets;
• hormonal imbalance;
• gastrointestinal exacerbations;
• infectious respiratory diseases;
• abnormal attachments of the frenulum;
• diabetes.

Although there are some differences, both diseases can lead to complete tooth loss. Severe forms require long-term treatment, including antibiotic therapy. Antibiotics used in dentistry for periodontitis and for the prevention of periodontal disease are prescribed in a course (up to 10 days), in the form of tablets, injections and topically.

Proper oral hygiene and nutrition are of great importance. If there is a deficiency of macro- and microelements in the body, an effective drug is selected. Professional teeth cleaning, at least 2 times a year, and regular removal of microbial plaque with high-quality pastes will prevent the development of periodontal disease.

Medicines for prevention

Prevention with antibacterial agents is a common technique in oral surgery and dentistry. Antibiotic therapy before and after surgery reduces complications.

It is advisable to use products with high bioavailability and minimal side effects. Requirements for medications used for preventive purposes:

• increased activity against pathogenic bacteria, more often found in ondontogenic inflammatory lesions;
• correspondence of the spectrum of action to representatives of the microflora located in the oral cavity;
• good penetration into tissue, especially during operations to open phlegmon and abscess.

An antibiotic when implanted in dentistry minimizes the risk of side effects. Actively fight against foci of infections and bacteria. Selected based on weight and age. Common drugs are penicillins and cephalosporins.

The prescription of drugs depends on the complexity of the surgical intervention and possible complications. Prevention is mandatory in case of prolonged surgery or unfavorable treatment.

Systemic antibiotics in the treatment of bacterial infections of the skin and soft tissues: focus on macrolides

Bacterial infections of the skin, causing purulent inflammation, were identified as a group of infectious dermatoses by the French scientist H. Leloir in 1891 under the name pyodermatitis (pyon - pus, derma - skin). Abroad, pyoderma is usually classified as a broad group of skin and soft tissue infections (SSTI), which includes, in addition to infections of the skin and its adnexal structures, infections of the subcutaneous fatty tissue and underlying tissues. In economically developed countries, SSTIs account for 1/3 of all infectious diseases. According to domestic studies, pustular skin infections account for 30–40% of all dermatological pathology in people of working age; in military personnel this figure reaches 60%. In pediatric dermatological practice, this pathology is one of the most common and accounts for 30 to 50% of all cases of visits to the doctor [1–3]. Etiology The main source of SSTIs are microorganisms that contaminate and colonize the surface of the skin. Gram-positive cocci S. aureus and S. Pyogenes, capable of penetrating into the thickness of the epidermis in the presence of its damage, undoubtedly play a leading role in the etiology of pustular skin infections. Moreover, S. aureus is the most common pathogen; infections caused by S. pyogenes, as well as a mixed infection involving both microorganisms, are somewhat less common. According to the results of foreign multicenter studies, in addition to S. aureus, S. pyogenes, Corynebacterium diphtheriae, P. aeruginosa, Enterobacteriaceae, Streptococcus spp. may be involved in the development of SSTI. The type of infection is of great importance in determining the etiological role of the suspected pathogen (Table 1). Unlike primary pyodermas, secondary ones, like most necrotizing SSTI infections, have a polymicrobial etiology. The virulence of the microorganism and the degree of bacterial contamination play an important role in the development of infection. It has been shown that the probability of developing an infection is directly proportional to the degree of bacterial contamination and virulence of the microorganism and inversely proportional to the strength of the body's protective reaction. The likelihood of colonization increases in the presence of skin diseases of allergic origin. Thus, in patients with atopic dermatitis, colonization of the affected areas with S. aureus is detected in 90% of cases [3]. Pathogenesis In the occurrence of one or another form of pyoderma, an important role is played by: the type of pathogen, its virulence, the state of the macroorganism, as well as various endogenous and exogenous predisposing factors that reduce the barrier and protective functions of the skin. The virulence of staphylococci and streptococci is determined by a number of pathogenic toxins and enzymes they secrete (coagulase, leukocidin, streptokinase, hyaluronidase streptolysin, hemolysins, etc.), which facilitate the penetration of pathogens into the skin, lead to damage and stratification of all layers of the epidermis, cause hemolysis and necrotization of the dermis and underlying tissues, disrupting their normal metabolism [4,5]. In the occurrence and development of SSTIs, the reactivity of the body and its mechanisms of resistance to microbial aggression are of great importance. The insufficiency of the immunocompetent system in this case is, as a rule, of a secondary (acquired) nature. It can form in the premorbid period as a result of previous or concomitant severe diseases. Diseases of the endocrine system (obesity, diabetes, insufficient activity of the pituitary-adrenal system, thyroid, gonads) contribute to a decrease in the body's anti-infective defense mechanisms. More than half of patients (52%) with chronic pyoderma abuse carbohydrates (usually easily digestible), which creates a constant overload of the insular apparatus of the pancreas and can contribute to carbohydrate metabolism disorders of varying degrees, the accumulation of carbohydrates in tissues, which are a favorable breeding ground for pyococci. A significant role is also assigned to the seborrheic skin condition. Due to an increase in the amount of sebum and changes in its chemical composition, a decrease in the sterilization properties of the skin and activation of pyogenic cocci occurs [6]. Of no small importance in the development of pustular skin diseases are chronic infectious diseases of various organs and tissues: periodontal disease, caries, gingivitis, tonsillitis, pharyngitis, infections of the urogenital tract, dysbacteriosis, intestinal intoxications, which reduce the general and local antibacterial resistance of the body and contribute to the development of subsequent specific sensitization in patients , which aggravates the course of the infectious process. A significant role in the development of chronic pyoderma is played by diseases of the central and autonomic nervous system, mental or physical overstrain, “debilitating diseases” - alcoholism, fasting, malnutrition (lack of proteins, vitamins, mineral salts, hypovitaminosis, especially A and C. Vitamin A is involved in In the process of keratin formation, vitamin C regulates the permeability of the vascular wall and is a synergist of corticosteroids). A major role in the development of pyoderma is played by various immunodeficiency conditions that arise as a result of congenital or acquired immunodeficiency (HIV infection, use of glucocorticosteroids, cytostatics and immunosuppressants). Defects in cellular antibacterial defense in the form of inhibition of the phagocytic activity of neutrophils, impaired chemotaxis, as well as a decrease in opsonic factors of blood serum and immunoglobulins contribute to chronic infection and frequent relapses [7]. Violations of the T-cell immune system are of major importance in the pathogenesis of SSTIs. The basis for disorders of specific mechanisms of immunological reactivity is a decrease in the number of T-lymphocytes in the peripheral blood, a decrease in the number of CD3 and CD4 cells and a change in their relationship with monocytes, which leads to a weakening of the T-cell immune response. Insufficiency of the patient’s immune system (immunological imbalance) and antigenic mimicry of the pathogen often lead to chronic infection and the formation of bacterial carriage, and irrational use of antibiotics leads to pathogen resistance [8]. Unfavorable environmental influences that violate the integrity of the skin and create an “entry gate” for infection are of significant importance in the development of bacterial skin infections. These primarily include the influence of high or low temperature, high humidity, leading to maceration of the skin, increased pollution and microtraumatization by occupational factors (oils, cement, coal dust). The entry point for infection occurs due to household microtraumas (cuts, injections), scratching and itchy dermatoses. Violation of the skin barrier in the form of dryness and thinning of the stratum corneum contributes to the penetration of microorganisms into the deep layers of the skin and underlying tissues, which leads to the development of the pyodermic process. Clinical types of SSTIs SSTIs are a fairly numerous and clinically heterogeneous group of diseases that lead to lesions of varying depth, prevalence and severity. A common symptom characteristic of all is the presence of local purulent inflammation, which in severe cases is accompanied by the development of a systemic inflammatory reaction. Clinical forms depend on the type of etiological factor, anatomical localization, association with skin appendages, depth and area of ​​the lesion, and duration of the process. In domestic dermatology, the classification of primary pyoderma was adopted, proposed by J. Jadasson back in 1934 and built on an etiological principle. It includes: staphyloderma, mainly affecting the skin around the appendages (sebaceous follicles, sweat glands); streptoderma, affecting smooth skin mainly around natural openings and mixed strepto-staphylococcal infections. In each of the three groups, depending on the depth of the lesion, superficial and deep forms are distinguished. In addition, pustular skin diseases are divided into primary, occurring on unchanged skin, and secondary, developing as complications against the background of an existing dermatosis, usually itchy (scabies, eczema, atopic dermatitis). According to the duration of the course, acute and chronic pyoderma are distinguished. Staphylococcal pyoderma is usually associated with skin appendages (hair follicles, apocrine glands). They are characterized by the formation of a deep pustule, in the center of which a cavity is formed, filled with purulent exudate. Along the periphery there is a zone of erythematous-edematous inflammatory skin. The suppurative process ends with the formation of a scar (Fig. 1). Streptococcal pyoderma most often develops on smooth skin, around natural openings (oral cavity, nose) and begins with the formation of phlyctena - a superficially located bubble with a flabby folded tire, inside which contains serous-purulent contents. The thin walls of the phlyctena quickly open, and the contents pour out onto the surface of the skin, drying out into honey-yellow layered crusts. The process tends to spread along the periphery as a result of autoinuculation (Fig. 2). Staphyloderma more often affects men, streptoderma – women and children [3,4]. In foreign literature, from a practical point of view, all SSTIs are divided into three main groups: primary pyoderma, overwhelmingly caused by S. aureus and pyogenic b-hemolytic streptococci (mainly group A), and developing on unchanged skin (folliculitis, impetigo, erysipelas) ; secondary pyoderma developing against the background of skin damage or concomitant somatic pathology (for example, bedsores, diabetic foot ulcers, infections after animal bites, postoperative wound and post-traumatic infections), as well as against the background of dermatoses accompanied by itching and scratching (allergic dermatitis, psoriasis, scabies and etc.); necrotizing infections, representing the most severe form of SSTI (cellulitis of polymicrobial etiology - synergistic cellulitis, necrotizing fasciitis, myonecrosis - gas gangrene) (Fig. 3). With this pathology, determining the depth and extent of the lesion is the priority of the surgeon, because Only with surgical treatment can the true extent of the infection be most accurately determined. The initial management of these patients is the same. It consists of early surgical intervention and the appointment of adequate antimicrobial therapy [9]. Treatment of SSTIs Treatment of patients with bacterial skin infections should be comprehensive (etiotropic and pathogenetic) and carried out after a thorough anamnestic, clinical and laboratory examination of the patient. It is necessary to identify and treat concomitant diseases, examine for foci of focal infection, and in the case of a long-term persistent process, study the immunostatus. The main and only method of etiotropic treatment of patients with SSTIs are antibiotics. In acute superficial non-common processes (impetigo, folliculitis, paronychia), therapy may be limited to the local use of antibiotics and antiseptics. In all other cases, systemic antibiotic therapy is required. Indications for systemic antibiotic therapy are deep forms of pyoderma: boils (especially localized on the face and neck), carbuncle, hidradenitis, erysipelas, cellulite. The listed forms of bacterial skin infections have a long, often chronic, recurrent course, a high prevalence of the process and are often accompanied by symptoms of general intoxication in the form of fever, headache, weakness, as well as the development of regional complications (lymphadenitis, lymphangitis). Antibiotics are used as an etiotropic agent in the treatment of bacterial dermatosis – Lyme disease. They are the drugs of choice for the treatment of acne vulgaris. In dermatovenerological practice, antibiotics are widely used both for the treatment of infectious dermatoses and diseases caused by sexually transmitted infections (STIs) [4]. Before prescribing an antibacterial drug, it is advisable to culture the pus to determine the sensitivity of the isolated microorganism to various antibiotics and, based on the results of the study, prescribe the appropriate drug. However, this is not always feasible, especially if complications of infection threaten or develop. As an analysis of modern literature and our own clinical experience shows, today the following groups of antibiotics are most often used in the treatment of bacterial skin infections: 1. β-lactams: a) natural penicillin, its durant forms and semi-synthetic penicillins; b) cephalosporins (1st–4th generation). 2. Macrolides. 3. Tetracyclines. 4. Fluoroquinolones. In recent years, penicillin and its durant drugs have rarely been used in the treatment of SSTIs, since the overwhelming number of pyococcal strains have acquired the ability to produce the enzyme b-lactamase (penicillinase), which suppresses the antibacterial activity of penicillin. In addition, β-lactams are drugs that have a high incidence of allergic reactions. Tetracyclines and aminoglycosides are currently used much less frequently. This is due to the large number of strains of microorganisms resistant to these antibiotics (which implies their low therapeutic activity), as well as the presence of severe side effects. It should be remembered that tetracyclines are contraindicated in pregnancy, children and patients with liver failure. Fluoroquinolones are prescribed mainly for the treatment of sexually transmitted diseases, due to the high sensitivity of urogenital infections to them, and for pyoderma they are used only when other groups of antibiotics are ineffective. However, in diseases of the central nervous system, in pregnant women, as well as in pediatrics, the range of their use is limited - they are prescribed mainly for health reasons. It is also necessary not to forget about the photosensitizing effect of fluoroquinolones and the associated precautions, especially in spring and summer [10]. Modern medical practice imposes certain requirements on the choice of antibiotic. First of all, the drug must have a wide spectrum of antimicrobial action and minimally expressed antibiotic resistance to microbial agents, have no severe side effects, have a minimal risk of allergic reactions, be convenient to use for the patient (availability of an oral form, a convenient dosage regimen) and affordable. In addition, it is very important that the antibiotic does not have clinically significant interactions with other drugs. Today, antibiotics – macrolides – fully meet these requirements. Classification and mechanisms of pharmacotherapeutic action of macrolides Macrolides have been widely used in clinical practice for more than 50 years. The first natural antibiotic of this group, erythromycin (a metabolite of Streptomyces erythreus), was obtained back in 1952. Macrolides can be classified by chemical structure and origin. The basis of the chemical structure of this class of antibiotics is the macrocyclic lactone ring. Depending on the number of carbon atoms in the ring, macrolides are divided into 14-, 15- and 16-membered (Table 2). Among macrolides, there are 3 generations: a) first generation: erythromycin, oleandomycin; b) second generation: spiramycin, roxithromycin, josamycin, clarithromycin, etc.; c) third generation: azithromycin (Azitral). The antibacterial effect of macrolides is based on disruption of the synthesis of ribosomal proteins of the microbial cell and thereby inhibiting the process of pathogen reproduction. They mainly have a bacteriostatic effect, which makes it advisable to prescribe them in the acute phase of inflammation. Macrolides belong to “tissue antibiotics”, i.e. when distributed in the body, they accumulate predominantly not in the bloodstream, but in those organs and tissues where there is inflammation, thereby creating high concentrations of the drug. Well distributed in the body, macrolides are able to overcome histohematological barriers (with the exception of the blood-brain barrier), significantly superior to β-lactam antibiotics. However, widespread (and often unjustified) use quickly led to the emergence of a high percentage of erythromycin-resistant strains of pathogens, especially staphylococci. This, in turn, has significantly reduced the use of erythromycin in clinical practice [11]. Interest in macrolides arose again in the early 80s of the 20th century, after the emergence of new generations of antibiotics of this group - azalides (in particular, azithromycin). Azithromycin was synthesized in 1983 from erythromycin. The drug in its pharmacokinetic properties surpassed all the indicators of its predecessor and became the first representative of the new group of antibiotics - azalids. The uniqueness of azithromycin is based on its exceptional pharmacokinetics. Azithromycin is stable in an acidic environment, due to which it is well absorbed after oral administration. Simultaneous intake with food reduces the absorption by 50%, so the drug is taken 1 hour before or 2 hours after eating. The lipophilicity of the azithromycin molecule provides, in addition to a high level of absorption in the intestines, also an excellent penetration of the drug into the tissue. The rapid penetration of azithromycin from the blood in the tissue is also ensured by a low level of binding of azithromycin with blood proteins, which makes it possible to achieve a rapid therapeutic effect in infections that affect the cells and tissue. A high concentration of the drug in the area of ​​lesion, 10-100 times higher than the concentration in the bloodstream, allows you to actively affect the pathogenic focus, thereby providing a quick clinical effect and an early recovery. Современные макролиды (в частности, азитромицин) проявляют наибольщую эффективность в отношении таких возбудителей, как S. pyogenus, S. aureus, S. pneumoniae, некоторых грамотрицательных микроорганизмов (гонококи), а также внутриклеточных возбудителей (в частности, Chlamidia trachomatis и Ureaplasma urealyticum) What causes their high demand in dermatovenerological practice [12]. The second -generation macrolides are important for antibacterial activity of the second -generation macrolides. Due to their ability to penetrate neutrophils and create high concentrations in them, many macrolides positively modify the functions of these cells, influencing, in particular, chemotaxis, the activity of phagocytosis and killing. Along with the antimicrobial effect, these antibiotics have moderate anti -inflammatory activity. Activating the cells of the macrophage row, they are able to penetrate them and during the migration of phagocytic cells into the focus of inflammation to go there with them. The uniqueness of these drugs also lies in the fact that they have a pronounced plain effect, that is, they retain high concentrations in the focus of inflammation for 5-7 days after the abolition. This sanogenetic effect made it possible to develop short treatment courses not exceeding 3-5 days, and a convenient dosage regimen (1 time per day). This, in turn, ensures the compliance of treatment and improves the quality of life of the patient. The most pronounced postbiotic effect in azithromycin is, which allows you to create an antibiotic concentration in the foci of infection, which is many times higher than the IPC in relation to active pathogens in the treatment of both acute and chronic infections. Recently, evidence of the immunomodulating action of azithromycin in an experiment on healthy volunteers has been obtained. The first phase of the immunomodulating effect is to degenerate neutrophils and oxidant explosion, which contributed to the activation of protective mechanisms. Upon reaching the eradication of pathogens, it was noted to reduce IL -8 products and the stimulation of neutrophil apoptosis, which minimized the severity of the inflammatory reaction [13]. Macrolides, both natural and semi -synthetic, compared to other antibiotics have a minimal effect on the normal microflora of the human body and do not cause dysbiosis. Therefore, azithromycin is considered not only as a highly effective, but also the safest antibiotic with a minimum number of contraindications to the appointment. Unwanted reactions when taking it as a whole are extremely rare and do not exceed 5%. The most common side effects are symptoms from the gastrointestinal tract (nausea, severity in the epigastric region), which are usually expressed moderately, do not require the cancellation of the drug and quickly pass when taking drugs after eating [11]. The clinical efficiency of azithromycin as comparative studies indicate, with IKMT among antibiotics used in outpatient practice, the most effective macrolides of the new generation, primarily 15- and 16 -member (azithromycin, josamycin, roxyromycin). The 20 -year positive experience in the use of azithromycin in domestic dermatovenerological practice has already been accumulated. In dermatology, it is the basic therapy of staphylococcal and streptococcus lesions of the skin and soft tissues (boil, impetigo, cellulite), and in venereological practice - in the treatment of SPPPs. Unlike most macrolides, azithromycin does not have clinically significant interactions with other drugs. It is not associated with the enzymes of the Cytochrome R450 complex, as a result of which it does not show a reaction of drug interaction with drugs metabolizing along this path. This property is important, since in real clinical practice, most patients who occur IKMT have background or related diseases, about which they receive appropriate treatment. It must also be emphasized that, along with good tolerance and lack of pronounced adverse reactions of macrolides (azithromycin), have another unconditional advantage compared to other groups of antibiotics - this is that it can be prescribed for pregnant women and children [14]. Currently, one of the most commonly used drugs in clinical practice is the Azitral (azithromycin) drug, produced by pharmaceutical. Azitral (azithromycin) is similar to the original azithromycin - the first representative of the Azalids subgroup from the group of macrolide antibiotics used in the treatment of IKMT and urogenital infections. Studies have shown that the clinical effectiveness of the drug prescribed in a single dose of 500 mg for 3 days is comparable to the effectiveness of most widely used antibacterial agents. This allows you to reduce the usual course of antibiotic therapy by 2-3 times, and the unique pharmacokinetic profile of Azitral provides one -time daily intake and high compliance of therapy [15]. Due to the features of pharmacokinetics and a kind of antimicrobial spectrum covering the main pathogens of the genitourinary tract infections, azithromycin is the first choice in the therapy of combined IPPPs, including chronic complicated urogenital chlamydia and in non -understanding women, and an alternative tool for the treatment of this disease during the period of pregnancy. With a single use of 1 g of azithromycin (azitral), its concentration in the tissue of the prostate and uterus exceeds the IPC for C. trachomatis (0.125 μg/ml) by 42.5 times, and in the cervical canal - 12 times, which is the therapeutic concentration for the treatment of this infection. Moreover, even after 2 weeks, the therapeutic concentration of azithromycin in the prostate tissue exceeds the MPC for C. trachomatis by 13.6 times. The authors proved that it was with such a technique in tissues where C. trachomatis is vegetated that a high therapeutic concentration of the drug is supported during 6–8 development cycles. The data obtained indicate the high efficiency of pulse - therapy with Azitral (1 g 1 time per week, a course dose of 3 g). In the complex treatment of chronic chlamydial urethropostatitis and mycouraplasmic and wardenelle infection associated with it. It is important to note that the drug Azitral is well tolerated by patients, is available in price and therefore can be widely used in therapy of complicated urogenital chlamydia and VZ [16,17]. The study of the effectiveness, safety and tolerance of azithromycin in 30 children from 6 months to 3 years with staphylococcal infections of various localization of ENT organs and skin showed that asytromycin (Azitral) is not inferior in effectiveness with anti -staphylococcal penicillins. Along with high efficiency, characterized by quick and persistent reverse dynamics of the main clinical symptoms and local inflammatory changes in 100% of cases, good tolerance of the drug and the lack of side effects in all children were noted. A wide range of antimicrobial activity, features of pharmacokinetics, a low percentage of unwanted phenomena and a number of advantages over other macrolides determine the priority of using the drug for various skin infectious processes (impetigo, furunculosis, folliculitis, cellulite, paronichia) in children. The effectiveness of azithromycin in pediatric practice, proved by clinical trials, allows you to recommend it as an alternative to b -lactam antibiotics, and in children with burdened allergoannesis - as a drug of choice [18,19]. One of the most important pharmacoeconomic indicators that determine the choice of antibiotic is the ratio of cost/efficiency. It is determined how the ratio of the cost of drug treatment (for oral drugs is equal to the cost of a course dose) to the share of successfully treated patients. It should be noted that Azitral among the existing drugs of azithromycin shows the optimal price/quality ratio [20]. It is known that the inefficiency of antibiotic therapy is largely determined by a decrease in sensitivity to the drug used. Currently, there is no clinically significant resistance to azithromycin. According to antibiotic resistance monitoring, resistance to azithromycin and other macrolides of the latest generation among the pathogens of IKMT does not exceed 2-10%. The sensitivity of S. Pyogenes is allocated in Russia to the antibiotic of azithromycin is 92%. As shown in a number of studies, the clinical effectiveness of azithromycin is higher than that of tetracyclines and B - lactam antibiotics. Comparative clinical and microbiological study of effectiveness in deep staphyloderma of the 5 -day course of azithromycin and 10 -day taking cephalexin showed higher therapeutic activity of macrolide. The eradication of the pathogen when using azithromycin was noted in 94%, with cephalexin in 90% of cases, clinical cure - respectively, in 56 and 53% of cases. At the same time, the frequency of adverse reactions, as a rule, does not require the abolition of the drug, does not exceed 5%, which is much lower than erythromycin (up to 14%) or oral forms of B - lactams [21,22]. Thus, azithromycin has a wide spectrum of antimicrobial action, high bacteriostatic activity in relation to sensitive infections for it, high bioavailability with selective effects in the focus of inflammation, it has low toxic, has a minimum of side effects and a convenient regime of administration. Consequently, the drug meets the modern requirements of rational antibiotic therapy and can be recommended for effective use in dermatovenerological practice.

References 1. Jones ME, Karlowsky JA, Draghi DC, Thornsberry C., Sahm DF, Nathwani D. Epidemiology and antibiotic susceptibility of bacteria causing skin and soft tissue infections in the USA and Europe: a guide to appropriate antimicrobial treatment. Int J Antimicrob Agent 2003; 22:406–19. 2. N.N. Murashkin, M.N. Gluzmina, L.S. Galustyan. Pustular skin lesions in the practice of a pediatric dermatologist: a fresh look at an old problem. RZHKVB: Scientific and practical journal, 2008, No. 4, p. 67–71. 3. Belkova Yu.A. Pyoderma in outpatient practice. Diseases and pathogens. Clinical microbiology and antimicrobial chemotherapy: No. 3, volume 7, p. 255–270, 2005. 4. T.A. Belousova, M.V. Goryachkina. Bacterial skin infections: the problem of choosing the optimal antibiotic. RMJ 2005, volume 13, no. 16, p. 1086–1089. 5. Takha T.V., Nazhmutdinova D.K. Rational choice of antibiotic therapy for pyoderma. RMJ 2008, volume 16, no. 8, p. 552–555. 6. Novoselov V.S., Plieva L.R. Pyoderma. RMJ 2004, volume 12, no. 5, p. 327–335. 7. Masyukova S.A., Gladko V.V., Ustinov M.V., Vladimirova E.V., Tarasenko G.N., Sorokina E.V. Bacterial skin infections and their significance in the clinical practice of a dermatologist. Consilium medicum 2004, volume 6, no. 3, p. 180–185. 8. T. File. Diagnosis and antimicrobial therapy of skin and soft tissue infections. Ohio, USA. Clinical microbiology and antimicrobial chemotherapy: No. 2, volume 5, p. 119–125, 2003 9. Shlyapnikov S.A., Fedorova V.V. The use of macrolides for surgical infections of the skin and soft tissues. GRM, 2004.–t.12, no. 4, pp.204–207 10. Guchev I.A., Sidorenko S.V., Frantsuzov V.N. Rational antimicrobial chemotherapy for skin and soft tissue infections. Antibiotics and chemotherapy. 2003, v. 48, 10, pp. 25–31 11. Parsad D., Pandhi R., Dogras S. A guide to selection and appropriate use of macrolides in skin infection Am J Clin Dermatol 2003; 4:389–97 12. Yakovlev S.V., Ukhtin S.A. Azithromycin: basic properties, optimization of application regimens based on pharmacokinetic and parameters. Antibiotics and chemotherapy. 2003 vol. 48, no. 2. - With. 22–27 13. Turovsky A.B., Kolbanova I.G. Macrolides in the treatment of respiratory tract infections from the position of an ENT doctor: pros and cons Consilium medicum, 2010, No. 4, vol. 12, p. 11 -14. 14. Prokhorovich E.A. Azithromycin. From clinical pharmacology to clinical practice. RMJ 2006, volume 14, no. 7, p. 567–572 15. Berdnikova N.G. Current aspects of the use of azithromycin (Azitral) in the treatment of community-acquired pneumonia in adults. RMJ 2006, volume 14, no. 22, p. 1625–1628. 16. Khryanin A.A., Reshetnikov O.V. Macrolides in the treatment of chlamydial infection in pregnant women (efficacy, safety, cost-effectiveness). RMJ 2008, volume 16, no. 1, p. 23–27. 17. Serov V.N., Dubnitskaya L.V., Tyutyunnik V.L. Inflammatory diseases of the pelvic organs: diagnostic criteria and principles of treatment. RMJ 2011, volume 19, no. 1, p. 46–50. 18. Talashova S.V. Some aspects of the use of antibacterial drugs in pediatrics using the example of macrolides. RMJ 2009, volume 17, no. 7, p. 464–466 19. Mazankova L.N., Ilyina N.O. The place of azalides in pediatric practice. RMJ 2008, volume 16, no. 3, p. 121–125. 20. Solovyov A.M., Pozdnyakov O.L., Tereshchenko A.V. Why is azithromycin considered the drug of choice for the treatment of urogenital chlamydial infection. RMJ 2006, volume 14, no. 15, p. 1160–1164. 21. Gurov A.V., Izotova G.N., Yushkina M.A. Possibilities of using the drug Azitral in the treatment of purulent-inflammatory diseases of the ENT organs. RMJ 2011, volume 19, no. 6, p. 405. 22. Klani R. Double-blind, double-dummy comparison of azithromycin and cephalexin in the treatmen of skin and skin structure infection. Eur.J. Clin. Microbiol. Infect.Dis. 1999, Oct. 10 (10) – p.880–84

Osteotropic antibiotics: what they are and what they are used for

Osteotropic antibiotics are often used in dental practice. An antibacterial drug (ABP) is prescribed:

• to eliminate the inflammatory-purulent process (chronic and acute) with peristitis, abscess, odontogenic sepsis, pericoronitis;
• as a prophylaxis against infectious complications after implantation and surgery;
• patients at risk (patients with diabetes, cardiovascular problems).

Antibacterial therapy is contraindicated for surgical interventions on bone tissue, bleeding, and large-area wounds in the oral cavity.

trauma/ab in the treatment of bone tissue infection

The duration of antibiotic release from the material in in vitro studies ranges from several hours to several days. The release of antibiotics from materials used in a simulated animal process takes longer. It lasts from several days to several weeks. However, the studies presenting these data make limited use of the full range of research methods, making comparisons between these products incomplete. Clinical recommendations for calculating the amount of material and the dosage of the antibiotic it contains have also not been developed [30].

The collagen sponge is the most striking example illustrating the materials of this group. It is a dense mesh porous material based on collagen obtained from sterile skin or Achilles tendon of animals. Since collagen is a major component of connective tissue and the main structural protein of all organs, it has several positive biological properties such as biocompatibility and non-toxicity. Moreover, the ability of collagen to secrete antibacterial drugs can be changed by transforming the porosity of the matrix or additional treatment with chemicals [28]. In addition, it may also attract osteoblasts to the site and stimulate their proliferation, thereby causing bone mineralization and callus formation, which promotes bone regeneration [19].

Collagen plates impregnated with gentamicin have been used to treat chronic osteomyelitis in Europe for ten years [4]. The product was made from sterilized bovine tendon into which gentamicin was injected. In vitro studies have shown that antibiotic release from collagen sponge lasts four days [9]. When the collagen sponge contained liposomal encapsulated antibiotic beads, the duration of release of antibacterial substances was three times longer than from a plain collagen sponge [17]. Polymyxin B and amikacin, in other experimental studies, had a longer duration of release in cases of Pseudomonas aeruginosa infection when the antibiotic was bound to type 1 collagen [7]. The MIC of the antibiotic was exceeded 600 times when using a collagen sponge impregnated with gentamicin, compared to using polymethyl methacrylate granules when its MIC was

Commonly used drugs for inflammation

In dentistry, several types of antibiotics are used for toothache and inflammation.

• Penicillin group. Prescribed at any age, with minimal side effects and easy tolerability. The main use is for periodontal inflammation. Effective against anaerobic bacteria.
• Cephalospoirins. They are used when it is necessary to perform dental manipulation with the risk of injury, as well as during periodontal and odontogenic inflammatory processes.
• Tetracyclines. Relieves swelling in the area of ​​bone and soft tissue.
• Imidazole and derivatives. They have a depressing effect on pathogenic microorganisms and quickly penetrate bone tissue. Recommended for extensive inflammatory lesions.
• Macrolides. Used during pregnancy and allergies to drugs of the penicillin group. Eliminates gram-negative and gram-positive bacteria.
• Lincosamides. Do not cause allergies. Used for severe bone tissue infections.

The prescription of osteotropic antibiotics is combined if the tests reveal different types of pathogenic microbes.

The use of antibiotics in modern dental practice is necessary today, because... Despite the development of dentistry, the number of patients with foci of acute and chronic inflammatory processes in the maxillofacial area and oral cavity is not decreasing, so the prescription of antibiotics in dental practice today is completely inevitable. Every day, a dentist is faced with situations when it is necessary to decide on antibacterial therapy: this is an exacerbation of chronic periodontitis, abscess formation of inflammatory periodontal diseases and endodontic-periodontal lesions. In addition, the need to use antibacterial drugs in dentistry is also dictated by the fact that any dental procedure is accompanied by the risk of bacteremia, which is of little importance for somatically healthy patients, but dangerous for people weakened by intercurrent diseases and the presence of conditions for local colonization of pathogenic microorganisms. Thus, when the endodontic instrument extends beyond the apex by 2 mm during canal treatment, bacteremia is detected in 54% of patients. If the canal is treated with a distance of 1 mm from the apex, bacteremia is detected in 31% of patients, and in the vast majority of cases anaerobic microflora is detected. Bacteria that enter the blood of healthy people are destroyed within 10 minutes due to immune defense factors, and bacteremia is transient [6], while for patients with somatic diseases, people taking drugs, alcohol, steroids, whose immune response is reduced or absent , bacteremia can pose a real danger.

Thus, in dental practice, antibiotics are used in the following clinical situations:

1. In the treatment of acute and exacerbation of chronic purulent-inflammatory processes in the maxillofacial area: odontogenic inflammatory processes, incl. periostitis, osteomyelitis, pericoronaritis, sinusitis, abscesses and phlegmon, severe infectious diseases of the oral cavity; for inflammatory periodontal diseases.
2. For the prevention of postoperative infectious complications.

Thus, the prescription of antibiotics in dental practice can be aimed at preventing infectious complications (antibiotic prophylaxis) and eliminating the existing inflammatory process (antibiotic therapy). The need for antibiotic prophylaxis is associated with the existing statistics of infectious complications of dental operations: thus, according to research results, the incidence of such complications is 3.3% for “clean” wounds, 10.8% for conditionally “clean” wounds, 16.3% for contaminated wounds , 28.6% – for “dirty” wounds [14]. Antibiotic prophylaxis refers to the use of antibiotics to prevent microbial colonization and reduce the risk of postoperative complications. The administration of the antimicrobial drug must be carried out no earlier than an hour and no later than 30 minutes before surgery, i.e. to bacterial contamination of tissues. The goal of antibiotic prophylaxis is to create an effective concentration of the drug in tissues throughout the entire operation and during the first 3-4 hours after surgery. The effective concentration of the antibiotic in the surgical wound must be maintained throughout the entire operation and, most importantly, maintained at the time of suturing, when microbial contamination reaches its maximum. As part of antibiotic prophylaxis, continued administration of an antibiotic after surgery for longer than 24 hours is undesirable, as it negatively affects the dynamics of the inflammatory response, leads to the growth of resistant strains, adverse drug reactions, additional costs and often does not lead to increased effectiveness in the prevention of infectious complications . On the other hand, administering antibiotics after surgery is ineffective. Antibiotic prophylaxis started after the “critical period” is considered late, and according to some data [11], has no effect at all.

Principles of antibiotic prophylaxis:

The benefit of prophylactic use of an antibiotic outweighs the risk of side effects, superinfection and the development of resistant strains.

The choice of drug for antibiotic prophylaxis must be made taking into account the most likely pathogen.

The antimicrobial drug must reach the site of action before microorganisms enter there.

The antibiotic concentration must be maintained throughout the entire period of possible contamination of the operating area.

Indications for antibiotic therapy [2, 4, 5]:

1. Increase in temperature, disturbance in general condition.
2. A history of diseases such as rheumatism, endocarditis, uveitis, iridocyclitis.
3. The patient has transplanted organs and foreign bodies (stents, prosthetic valves and joints).

These indications must be taken into account when choosing chemotherapeutic drugs during endodontic treatment and treatment of inflammatory periodontal diseases.

In modern dental practice, the following groups of antibiotics are most common [1, 7, 8]:

• penicillins (amoxicillin, co-amoxiclav) – first-line drugs;
• lincomycin - an antibiotic used for abscess formation;
• fluoroquinolones: ciprofloxacin, ofloxacin. These drugs are effective in the most severe cases during periodontal treatment when Aggregatibacter actinomycetemcomitans-associated periodontitis is detected, especially in patients with concomitant diabetes mellitus [3].

In recent years, along with a significant increase in the number of patients with purulent-inflammatory processes, there has been an increasingly widespread distribution of microorganisms with natural and acquired resistance to antibiotics, and the situation is often complicated by the fact that several pathogenic microorganisms are involved in the development of the inflammatory process. The difficulty of choosing a drug for antibiotic therapy in the treatment of purulent-inflammatory processes is due to the presence at the site of infection of various groups of aerobic and anaerobic pathogens that differ significantly in sensitivity to antibiotics. Therefore, the goal of rational antibiotic therapy is to select an effective antibacterial drug and its dose, which allows creating the necessary concentration of the active substance in the tissues to suppress the growth of pathogenic bacteria. For effective treatment of patients with purulent-inflammatory processes, there is a need for the combined use of antibiotics or drugs that include antibacterial substances that act on different groups of pathogens. These requirements are met by the combination drug Ciprolet A (A means effectiveness against anaerobes), the effect of which is due to the components included in its composition: ciprofloxacin 500 mg and tinidazole 600 mg.

Ciprofloxacin is a broad-spectrum antimicrobial agent, a fluoroquinolone derivative that affects gram-positive and gram-negative bacilli and cocci, Staphylococcus aureus, viridans streptococcus, Haemophilus influenzae, Escherichia coli, Pseudomonas aeruginosa.

Tinidazole is an antiprotozoal and antimicrobial agent, an imidazole derivative. Tinidazole is similar in structure and action to metronidazole. The activity of tinidazole is 1.5 times greater than that of metronidazole against anaerobes, which is successfully used when pathogen resistance to metronidazole is established.

The action spectra of ciprofloxacin and tinidazole ensure the high effectiveness of Ciprolet A against a wide range of pathogens, gram-positive, gram-negative aerobes and anaerobes. Resistance to it develops extremely slowly: bacterial cells do not have enzymes that inactivate it, and there are practically no persistent microorganisms left.

The undoubted advantage of the antibacterial drug Tsiprolet A is the frequency of administration (2 times a day), while for co-amoxiclav the frequency of administration is 2–3 times, and for lincomycin and metronidazole – 3 times a day. A very unpleasant side effect of antibiotic therapy is antibiotic-associated diarrhea [12, 13]. For Tsiprolet A, the probability of this side effect occurring is less than 1%, while for lincomycin it is 20–30, and for co-amoxiclav it is 10–25%. This is due to the activity of Tsiprolet A against Clostridium difficile [10]. The most important indicator that determines the effectiveness of an antibiotic in inflammatory diseases of the maxillofacial area is its ability to penetrate bone tissue. For Tsiprolet A, this figure is 0.27–1.20, which is twice as high as the same figure for co-amoxiclav and three times higher than for lincomycin [9].

Indications for use of the drug Tsiprolet A: infections of the ENT organs (otitis media, sinusitis, tonsillitis, pharyngitis); infectious and inflammatory processes of the oral cavity; infections of the skin and soft tissues (infected ulcers, wounds, burns, abscesses, cellulitis, ulcerative skin lesions); infections of bones and joints (osteomyelitis, septic arthritis); postoperative infections. Indications for use are related to the fact that its therapeutic concentrations are created, incl. in saliva, tonsils, lung tissue, bronchial secretions, bone tissue, muscles, synovial fluid, articular cartilage and skin, i.e. in all organs and tissues located in the oral cavity, maxillofacial and adjacent areas.

Such a wide range of application and high effectiveness of Tsiprolet A in the treatment of purulent processes in the maxillofacial area are due to the unique spectrum of antimicrobial activity of the drug: Tsiprolet A is active against the Enterobacteriaceae spp. family, which plays a key role in the development of severe purulent lesions in dentistry. Lincomycin, clarithromycin and metronidazole have no effect on these microorganisms. Tsiprolet A is effective against microorganisms that are also not affected by clarithromycin. This is Peptostreptococcus spp. and Fusobacterium spp. – anaerobic bacteria that contribute to the progression and spread of odontogenic infection [8, 9].

When prescribing Tsiprolet A, it is necessary to inform the patient that tinidazole, which is part of the drug, is not compatible with alcohol, because causes disulfiram-like reactions in the form of skin hyperemia, tachycardia, nausea, vomiting, etc., therefore, it is not recommended to take alcoholic beverages during the treatment period.

The wide spectrum of antimicrobial activity of the combined drug Tsiprolet A, the rapid creation of therapeutic concentrations in the organs and tissues of the oral cavity and maxillofacial area allow us to recommend it for wide use in dental practice.

Side effects and contraindications

Despite the fact that the antibiotic has proven itself well for toothache and inflammation, its use is contraindicated in case of kidney and liver pathologies, diabetes mellitus, and taking certain medications. Prescribed with caution to children, elderly patients, and pregnant women.

Possible side effects:

• dermatitis, urticaria, skin rashes and other allergic reactions;
• diarrhea, nausea;
• kidney and liver damage;
• headache;
• anemia;
• candidiasis of the mucous membranes.

Dental antibiotics are an irreplaceable thing. The drugs prevent a serious complication, but subject to the right choice and strict adherence to the doctor’s recommendations.

Author: Zhukov M.A.