Ciprofloxacin or Amoxicillin - which is better to choose?

For diseases of the ENT organs and bronchi, four main groups of antibiotics are used. These are penicillins, cephalosporins, macrolides and fluoroquinolones. They are convenient because they are available in tablets and capsules, that is, for oral administration, and they can be taken at home. Each group has its own characteristics, but for all antibiotics there are rules of administration that must be followed.

• Antibiotics should only be prescribed by a doctor for specific indications. The choice of antibiotic depends on the nature and severity of the disease, as well as on what medications the patient has previously received.
• Antibiotics should not be used to treat viral diseases.
• The effectiveness of the antibiotic is assessed during the first three days of its use. If the antibiotic works well, you should not interrupt the course of treatment until the time recommended by your doctor. If the antibiotic is ineffective (the symptoms of the disease remain the same, the fever persists), tell your doctor. Only the doctor decides whether to replace the antimicrobial drug.
• Side effects (eg, mild nausea, bad taste in the mouth, dizziness) do not always require immediate discontinuation of the antibiotic. Often it is enough just to adjust the dose of the drug or additionally introduce drugs that reduce side effects. Measures to overcome side effects are determined by your doctor.
• The consequence of taking antibiotics may be the development of diarrhea. If you have large, loose stools, consult your doctor as soon as possible. Do not try to treat diarrhea caused by taking an antibiotic on your own.
• Do not reduce the dose of the medicine prescribed by your doctor. Antibiotics in small doses can be dangerous because after their use there is a high probability of the emergence of resistant bacteria.
• Strictly adhere to the time of taking the antibiotic - the concentration of the drug in the blood must be maintained.
• Some antibiotics must be taken before meals, others after. Otherwise, they are absorbed worse, so do not forget to check with your doctor about these features.

Important information for the patient:

• They cause allergies less frequently than penicillins. But a person with an allergy to the penicillin group of antibiotics may develop a so-called cross-allergic reaction to cephalosporins.
• Can be used by pregnant women and children (each drug has its own age restrictions). Some cephalosporins are approved from birth.

The most common side effects: allergic reactions, nausea, diarrhea. Main contraindications: individual intolerance.

Which is better Amoxicillin or Ciprofloxacin

The doctor prescribes the drug depending on the nature of the infection and the patient’s sensitivity to the drug. Laboratory tests and other methods of examining the patient are taken into account. Antibiotics from the fluoroquinolone category have a number of adverse reactions, which may lead to their replacement with other drugs. For the treatment of respiratory organs, it would be preferable to take Amoxicillin.

If there are indications, the doctor may prescribe systemic medications with which medications interact well. The combined use of Ciprofloxacin and Amoxicillin is not allowed. Medicines, dosage regimens and dosages are selected by the doctor treating the patient. You cannot choose antibiotics for treatment on your own.

Penicillins

Main indications:

• Angina
• Exacerbation of chronic tonsillitis
• Acute otitis media
• Sinusitis
• Exacerbation of chronic bronchitis
• Community-acquired pneumonia
• Scarlet fever
• Skin infections
• Acute cystitis, pyelonephritis and other infections

Features: they are low-toxic, broad-spectrum antibiotics.

The most common side effects: allergic reactions.

Main contraindications: individual intolerance.

Amoxicillin

the broad-spectrum antibacterial drugs , but from a different group of penicillins. Like other betalactam antibiotics, it has a weak point - amoxicillin can be destroyed by betalactamase, which is produced by many bacteria. Therefore, doctors prefer to prescribe combination drugs consisting of amoxicillin and a betalactamase inhibitor (clavulonic acid).

Like ciprofloxacin, this antibiotic has a bactericidal effect on microorganisms by inhibiting the enzyme (transpeptidase), which is involved in the production of a component of the microbial cell wall (peptidoglycan). This leads to the destruction of bacteria.

The spectrum of action of penicillins is less than that of fluoroquinolones.

Amoxicillin is effective against:

• Aerobic gram-positive bacteria (staphylococci, streptococci)
• Aerobic gram-negative bacteria (Shigella, Salmonella, Neisseria, Klebsiella, Escherichia coli).

Pharmacokinetics

Bioavailability is high (93%), absorbed very quickly in the intestines. The effect of the drug begins within 15-30 minutes after ingestion. Eating does not affect its absorption and content in tissues. Amoxicillin is distributed to almost all tissues of the body, but at the same time the blood-brain barrier and the placenta are poorly susceptible to it. The half-life is quite short - 1.5 - 2 hours.

Release forms

Only forms for oral administration are provided:

• Tablets of 150, 250, 500 and 1000 mg, soluble form, 20 pieces per pack.
• Capsules or tablets of 250 and 500 mg in contour packaging of 16 pieces.
• Granules in a 100 ml bottle for the preparation of a suspension, dosage 250 mg/5 ml - a special release form for children.
• Amoxicillin is not available for intramuscular and intravenous administration.

Reception mode

The effect of the drug lasts about 8 hours, which requires increasing the frequency of administration to 3 times a day. This reduces its compliance.

Indications

The same as ciprofloxacin - treatment of inflammatory and infectious diseases, taking into account the sensitivity of pathogenic flora to it.

Contraindications

Individual intolerance, lactation, allergic diseases, infectious mononucleosis, lymphocytic leukemia, liver failure.

Pregnant women may use it with caution.

Comparison of two drugs

Benefits of Ciprofloxacin:

1. Due to the wider spectrum of action, the risk of developing superinfection caused by the growth of flora insensitive to the antibiotic is minimized (which cannot be said about amoxicillin monotherapy).
2. Bacteria develop resistance to fluoroquinolone antibiotics much more slowly than to penicillins.
3. Due to its wider spectrum of action and the lack of bacterial resistance to the drug, ciprofloxacin can be prescribed for emergency indications, without assessing the sensitivity of the microflora to it.
4. It is possible to use the drug intravenously, which is simply necessary for severe infectious lesions, when it is necessary to quickly achieve maximum concentrations of the antibiotic in the body.
5. The half-life of ciprofloxacin is two to three times longer than that of amoxicillin, which increases its compliance.
6. This is a fairly inexpensive antibiotic.

Amoxicillin benefits:

• Can be used in pregnant women and children due to low toxicity.
• The convenient form of release in the form of granules for preparing a suspension is indispensable for children.
• Unlike ciprofloxacin, it is effective against Treponema pallidum, which causes syphilis, as well as against ureaplasma.
• It is also not an expensive drug.

Important information for the patient:

• Drugs in this group are more likely than other antibiotics to cause allergies. It is possible to have an allergic reaction to several drugs from this group at once. If you experience a rash, hives, or other allergic reactions, stop taking the antibiotic and contact your doctor as soon as possible.
• Penicillins are one of the few groups of antibiotics that can be used by pregnant women and children from a very early age.
• Medicines containing amoxicillin reduce the effectiveness of birth control pills.

Ciprofloxacin

Antibiotic from the group of fluoroquinolones of the 2nd generation, widely used by medical practitioners. It is produced in many countries and has a large number of trade names. Tsiprolet, Tseprova, Tsiprobay, Tsiprosan, Tsiprolon, Ortsipol, Tsiprex, Tsiprodex are just a few of them, well known in our country.

The spectrum of action of ciprofloxacin is very wide; it destroys microorganisms by suppressing DNA gyrase, which is involved in the construction of the cell wall. The drug is slightly toxic to the cells of the human body, because they do not contain DNA gyrase.

This antibiotic effectively destroys a wide variety of microorganisms:

• Gram-negative aerobic bacteria (Escherichia coli, Shigella, Salmonella, Proteus, Yersinia)
• Other gram-negative bacteria (Pseudomonas, Neisseria, Campylobacter, Haemophilus influenzae)
• Some intracellular pathogens (legionella, chlamydia, listeria, brucella, corynebacterium, mycobacterium tuberculosis)
• Gram-positive aerobic bacteria (staphylococci, streptococci).

Ureaplasma, Bacteroides fragilis, Clostridia, Pseudomonas nocardia, as well as Treponema pallidum, which causes syphilis, are resistant to this drug.

Bacterial resistance to fluoroquinolones develops extremely rarely. This is due to the fact that after an adequate course of antibiotics of this group there are no persistent bacteria (able to survive and begin to reproduce), and also because the cells of microorganisms do not have enzymes that inactivate this antibiotic.

Pharmacokinetics

Ciprofloxacin is rapidly and almost completely absorbed from the intestine. Eating may slow down absorption, but does not affect the final plasma concentration of the drug (bioavailability is approximately 50-85%). The drug distributes well throughout the body, with the exception of fat-rich tissues (for example, nervous tissue).

This antibiotic is most widely used in urology and gynecology, because high levels of it in urine were noted when administered intravenously.

Release forms

For oral administration, the drug is available in film-coated tablets with a dosage of 250 mg, in a contour package of 10 pieces.

For the treatment of conjunctivitis and otitis, ciprofloxacin is available in the form of ear and eye drops (in a bottle of 5 ml of 0.30% solution).

For intravenous drip infusions, bottles with an infusion solution with a dosage of 2 mg/ml are used (100 ml of solution per bottle, 5-10 bottles per package).

Reception mode

Compliance (the patient's willingness to follow the doctor's recommendations) when prescribing ciprofloxacin is quite high. The frequency of dosing of the drug in tablets is convenient for patients (2 times a day), which is possible due to a longer half-life compared to penicillins. and the course of application is not very long (5-10 days). When used intravenously, it is sufficient to use the drug once a day.

Indications

Ciprofloxacin is used to treat inflammatory and infectious diseases. When prescribing, the sensitivity to the drug of those bacteria that caused the disease is taken into account.

Contraindications

The drug is not approved for use in children, pregnant and lactating women, as well as in case of individual intolerance.

Macrolides

Main indications:

• Infection with mycoplasma and chlamydia (bronchitis, pneumonia in people over 5 years of age)
• Angina
• Exacerbation of chronic tonsillitis
• Acute otitis media
• Sinusitis
• Exacerbation of chronic bronchitis
• Whooping cough

Features: antibiotics, used mainly in the form of tablets and suspensions. They act a little slower than antibiotics from other groups. This is due to the fact that macrolides do not kill bacteria, but stop their reproduction. Relatively rarely cause allergies.

The most common side effects: allergic reactions, abdominal pain and discomfort, nausea, diarrhea.

Main contraindications: individual intolerance.

Fluoroquinolones

Main indications:

• Severe otitis externa
• Sinusitis
• Exacerbation of chronic bronchitis
• Community-acquired pneumonia
• Dysentery
• Salmonellosis
• Cystitis, pyelonephritis
• Adnexit
• Chlamydia and other infections

Features: powerful antibiotics, most often used for severe infections. They can disrupt the formation of cartilage, and therefore are contraindicated for children and expectant mothers.

The most common side effects: allergic reactions, pain in tendons, muscles and joints, abdominal pain and discomfort, nausea, diarrhea, drowsiness, dizziness, increased sensitivity to ultraviolet rays.

Main contraindications: individual intolerance, pregnancy, breastfeeding, age under 18 years.