What is metronidazole and how does it work. What are the common uses of metronidazole. How should metronidazole be taken. What are the potential side effects of metronidazole. How does metronidazole interact with alcohol.

Understanding Metronidazole: An Antimicrobial Powerhouse

Metronidazole is a versatile antibiotic that plays a crucial role in treating various infections. It belongs to a class of drugs known as antimicrobial agents and is particularly effective against anaerobic bacteria and certain protozoa. These microorganisms thrive in oxygen-poor environments, making metronidazole an ideal choice for infections in areas like the gums, pelvic cavity, and gastrointestinal tract.

Marketed under brand names such as Flagyl®, metronidazole is available in multiple forms, including tablets, oral liquid, suppositories, and injections. This diversity allows healthcare providers to tailor treatment to individual patient needs and specific infection types.

How does metronidazole work?

Metronidazole operates by interfering with the DNA of susceptible microorganisms. It enters bacterial cells and is activated by the organism’s enzymes, producing compounds that damage the bacterial DNA. This process inhibits bacterial replication and ultimately leads to cell death, effectively eliminating the infection.

Common Uses of Metronidazole in Clinical Practice

Metronidazole’s broad spectrum of activity makes it a valuable tool in treating various infections. Some of the most common applications include:

• Bacterial vaginosis
• Pelvic inflammatory disease
• Dental and gum infections
• Intra-abdominal infections
• Helicobacter pylori eradication (in combination with other antibiotics)
• Prevention of post-surgical infections in gynecological and intestinal procedures

Is metronidazole effective against all types of bacteria? No, metronidazole is primarily active against anaerobic bacteria and certain protozoa. It is not effective against aerobic bacteria or viruses, which is why it’s often used in combination with other antibiotics for certain infections.

Proper Administration of Metronidazole

To ensure the maximum effectiveness of metronidazole treatment, it’s crucial to follow the prescribed dosage and administration guidelines:

1. Take metronidazole tablets or liquid with plenty of water, preferably with or after a meal.
2. Space doses evenly throughout the day to maintain consistent antibiotic levels in the body.
3. Complete the entire course of treatment, even if symptoms improve before finishing.
4. For suppositories, follow proper insertion techniques and maintain hygiene.

What is the typical dosage for metronidazole? The dosage varies depending on the type and severity of the infection. For adults, a common oral dose is 400 mg two to three times daily. However, some infections may require different dosing regimens, including single large doses or extended treatment periods.

Metronidazole and Alcohol: A Dangerous Combination

One of the most critical aspects of metronidazole treatment is the strict avoidance of alcohol. Consuming alcohol while taking metronidazole can lead to a severe reaction known as the disulfiram-like effect.

Why is alcohol prohibited during metronidazole treatment?

Metronidazole interferes with the body’s ability to metabolize alcohol, leading to a buildup of acetaldehyde. This accumulation can cause symptoms such as:

• Severe nausea and vomiting
• Flushing and sweating
• Rapid heart rate
• Headache
• Dizziness

To prevent this reaction, patients must abstain from alcohol consumption during the entire course of metronidazole treatment and for at least 48 hours after completing the medication.

Potential Side Effects and Precautions

While metronidazole is generally well-tolerated, it can cause side effects in some individuals. Common side effects include:

• Nausea and vomiting
• Metallic taste in the mouth
• Diarrhea
• Loss of appetite
• Headache

Are there any serious side effects associated with metronidazole? Yes, although rare, some patients may experience more severe reactions such as peripheral neuropathy, seizures, or allergic reactions. It’s essential to report any unusual symptoms to a healthcare provider promptly.

Special considerations for metronidazole use

Certain individuals may need extra care or monitoring when taking metronidazole:

• Pregnant or breastfeeding women
• People with liver disease
• Individuals with a history of blood disorders
• Those with neurological conditions

Healthcare providers should be informed of any pre-existing conditions or medications to ensure safe and effective treatment with metronidazole.

Drug Interactions and Contraindications

Metronidazole can interact with various medications, potentially altering their effectiveness or increasing the risk of side effects. Some notable interactions include:

• Warfarin and other blood thinners
• Lithium
• Busulfan
• Disulfiram

Can metronidazole be taken with other antibiotics? In many cases, yes. Metronidazole is often combined with other antibiotics for certain infections. However, it’s crucial to follow the prescribed regimen and inform healthcare providers of all medications being taken.

Contraindications for metronidazole use

Metronidazole should not be used in individuals with:

• Known hypersensitivity to metronidazole or other nitroimidazole derivatives
• First trimester of pregnancy (unless absolutely necessary)
• Active neurological disorders
• Certain rare genetic disorders (e.g., porphyria)

Metronidazole in Special Populations

The use of metronidazole requires special consideration in certain patient groups:

Pediatric patients

Metronidazole can be used in children, but dosing is based on weight and age. Pediatric formulations may be necessary for accurate dosing in young children.

Geriatric patients

Older adults may be more susceptible to side effects and may require dose adjustments, especially if they have impaired liver or kidney function.

Pregnant and breastfeeding women

While metronidazole is generally avoided in the first trimester of pregnancy, it may be used in later stages if the potential benefits outweigh the risks. Breastfeeding mothers should consult their healthcare provider, as metronidazole can pass into breast milk.

How long does metronidazole remain in the body after the last dose? Metronidazole has a half-life of approximately 8 hours in adults with normal liver function. It is generally eliminated from the body within 48-72 hours after the last dose.

Emerging Research and Future Perspectives

As antibiotic resistance continues to be a global concern, research into metronidazole and its applications is ongoing. Some areas of current interest include:

• Development of new formulations for improved efficacy and reduced side effects
• Exploration of metronidazole’s potential in treating certain types of cancer
• Investigation of combination therapies to combat resistant infections
• Studies on the long-term effects of metronidazole use

These research efforts aim to enhance our understanding of metronidazole and optimize its use in clinical practice.

Antibiotic stewardship and metronidazole

As with all antibiotics, responsible use of metronidazole is crucial to prevent the development of resistance. Healthcare providers and patients alike play a role in antibiotic stewardship by:

• Prescribing metronidazole only when necessary
• Using the correct dosage and duration of treatment
• Completing the full course of antibiotics as prescribed
• Avoiding the use of leftover antibiotics or sharing medications

By adhering to these principles, we can help preserve the effectiveness of metronidazole and other antibiotics for future generations.

In conclusion, metronidazole remains a valuable tool in the fight against various infections. Its unique mechanism of action, versatility, and effectiveness against anaerobic organisms make it an indispensable part of modern antimicrobial therapy. As with any medication, proper use, awareness of potential side effects, and adherence to prescribed regimens are essential for optimal outcomes. Ongoing research and responsible antibiotic use will ensure that metronidazole continues to play a crucial role in healthcare for years to come.

Metronidazole for bacterial infection (Flagyl)

Swallow metronidazole tablets with plenty of water. Take them with a meal or a snack. Do not drink alcohol while you are taking metronidazole, and for 48 hours after finishing your course of treatment. Space your doses evenly throughout the day, and keep taking the medicine until the course is finished.

Metronidazole for bacterial infection

Flagyl

In this article

• About metronidazole
• Before taking metronidazole
• How to take metronidazole
• Getting the most from your treatment
• Metronidazole side-effects
• How to store metronidazole
• Important information about all medicines

About metronidazole

Type of medicine	Antimicrobial agent (antibiotic)
Used for	To treat or prevent infection
Also called	Flagyl®
Available as	Tablets, oral liquid medicine, suppositories, and injection

Metronidazole is an antibiotic used to treat a wide variety of infections caused by certain types of germ (anaerobic bacteria) and types of micro-organisms called protozoa. These types of organisms often cause infections in areas of the body such as the gums, pelvic cavity and tummy (stomach or intestines) because they do not need oxygen to grow and multiply.

Metronidazole is commonly prescribed to treat an infection called bacterial vaginosis. It is also prescribed before gynaecological surgery and surgery on the intestines, to prevent infection from developing. It can safely be taken by people who are allergic to penicillin.

Metronidazole is also used, alongside other medicines, to get rid of Helicobacter pylori, a bacterial infection often associated with stomach ulcers.

Metronidazole is available as a skin preparation also. This leaflet does not give information about metronidazole when it is used for skin conditions, but there is more information available in a separate leaflet called Metronidazole skin gel and cream.

Before taking metronidazole

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking metronidazole it is important that your doctor or dentist knows:

• If you are pregnant or breastfeeding.
• If you feel you will be unable to stop drinking alcohol for the duration of your treatment.
• If you have any problems with the way your liver works.
• If you have a rare inherited blood disorder called porphyria.
• If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
• If you have ever had an allergic reaction to a medicine.

How to take metronidazole

• Before you start this treatment, read the manufacturer’s printed information leaflet from inside your pack. The manufacturer’s leaflet will give you more information about metronidazole and a full list of metronidazole side-effects which you may experience from taking it.
• Take the tablets or liquid medicine exactly as your doctor or dentist tells you to. The dose you are given will depend upon what type of infection you have, and how severe the infection is.
• As a guide, a typical dose for an adult would be 400 mg two or three times a day, but your dose may be more or less than this. Doses for children depend upon the child’s age and weight. Your doctor will tell you what dose is right for you (or your child), and this will also be printed on the label of the pack to remind you.
• Space your doses evenly throughout the day, and keep taking the medicine until the course is finished, unless you are told to stop by your doctor. Your symptoms may return if you stop taking metronidazole before the end of the course prescribed for you.
• Most courses of metronidazole last for around seven days, but some may be as short as three days and some as long as 14 days. For certain infections you may be given a single, larger dose of metronidazole, usually five 400 mg tablets (2 g) to take at once.
• Take each of your doses with a snack or just after eating a meal. Swallow the tablets whole (that is, without chewing or crushing them) with a full glass of water.
• If you forget to take a dose, take it as soon as you remember and try to space your remaining doses evenly throughout the rest of the day. Do not take two doses together to make up for a forgotten dose.

If you have been given metronidazole suppositories

1. Remove the suppository from its wrapping.
2. Using your finger, gently push the suppository into your back passage (rectum) as far as is comfortable. Many people find that inserting a suppository is easier if they squat or bend forward.
3. Remain still for a few moments to help you to hold the suppository in place.
4. Wash your hands.

Getting the most from your treatment

• Important: do not drink alcohol while you are on metronidazole and for 48 hours after finishing your course of treatment. This is because drinking alcohol with metronidazole is likely to make you feel very sick (nauseated) and cause other unpleasant effects, such as the sensation of having a ‘thumping heart’ (palpitations), hot flushes and headache.
• While you are taking metronidazole your urine may look a darker colour than normal. On its own this is nothing to worry about. However, if you also experience tummy (abdominal) pain, or if you feel sick (nausea) or feel generally unwell, you should let your doctor know.
• If you buy any medicines, check with a pharmacist that they are safe to take with metronidazole. Some cough and cold preparations contain alcohol and should not be taken with metronidazole.
• If you need to take metronidazole for longer than ten days, your doctor may want you to have some tests. Make sure you keep any appointments that your doctor gives to you.

Metronidazole side-effects

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the metronidazole side-effects. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Metronidazole side-effects	What can I do if I experience this?
Feeling sick (nausea) or being sick (vomiting)	Stick to simple foods. Make sure you take your doses after a meal or a snack
Changes in the way things taste, furred tongue, sore mouth	Ask your pharmacist to recommend a suitable mouthwash
Lack of appetite	This should soon pass, but in the meantime choose food that you usually enjoy

If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.

How to store metronidazole

• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty. If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking. This medicine is for you. Never give it to other people even if their condition appears to be the same as yours. Never keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you. If you have any questions about this medicine ask your pharmacist.

• Manufacturer’s PIL, Flagyl® 200 mg and 400 mg Tablets; Sanofi, The electronic Medicines Compendium. Dated December 2021.

• Medicines Complete BNF 85th Edition; British Medical Association and Royal Pharmaceutical Society of Great Britain, London.

Doxycycline for malaria. Doxycycline medication info

Take doxycycline with plenty of water. Stand or sit up to take your doses – this will stop the capsules/tablets from causing any irritation to your throat. Make sure you continue to take the medicine until you finish the full course prescribed. Do not take indigestion remedies, or supplements containing iron, magnesium, or zinc at the same time as doxycycline as they stop it from working properly.

Doxycycline tablets and capsules

Periostat, Vibramycin-D, Oracea, Targadox

In this article

• About doxycycline
• Before taking doxycycline
• How to take doxycycline
• Getting the most from your treatment
• Can doxycycline cause problems?
• How to store doxycycline
• Important information about all medicines

About doxycycline

Type of medicine	A tetracycline antibiotic
Used for	Bacterial infections; to prevent malaria
Also called (UK)	Efracea®; Periostat®; Vibramycin-D®
Also called (USA)	Doryx®; Mondoxyne®; Monodox®; Okebo®; Oracea®; Targadox®; Vibramycin®
Available as	Capsules, modified-release capsules, dispersible tablets; oral liquid medicine (USA)

Doxycycline is an antibacterial medicine. This means that it stops infections caused by germs (bacteria). It is given as a treatment for a number of different types of infection, including chest infections, some skin conditions, sexually transmitted infections, and infections in or around the mouth.

Doxycycline is also used to prevent people from getting malaria when they travel to countries where malaria occurs. Although doxycycline can only be obtained on a prescription from a doctor, it is not prescribable on the NHS to prevent malaria. This means that you will be given a private (non-NHS) prescription and you will be asked to pay the full price for the tablets/capsules if you are taking it for this reason.

Because doxycycline can be given for so many different reasons, it is important that you know why your doctor is prescribing it for you. You will be prescribed a brand of doxycycline that is appropriate for your need, as not all brands are suitable for all of these indications.

Before taking doxycycline

Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking doxycycline it is important that your doctor or pharmacist knows:

• If you are pregnant, trying for a baby or breastfeeding.
• If you have any problems with the way your liver works, or if you have any problems with the way your kidneys work.
• If you have an inflammatory condition called systemic lupus erythematosus (also called lupus, or SLE).
• If you have a condition causing muscle weakness, called myasthenia gravis.
• If you are taking any other medicines. This includes any medicines which are available to buy without a prescription, as well as herbal and complementary medicines.
• If you have ever had an allergic reaction to a medicine.

How to take doxycycline

• Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about doxycycline, and will also provide you with a full list of the side-effects which you could experience from taking it.
• There are a number of different brands and strengths of doxycycline so it is important that you take doxycycline exactly as your doctor tells you to. It is likely you will be asked to take one dose a day, although some people will be asked to take two doses a day. If you have a problem with ulcers in your mouth, you could be asked to take four doses a day. How many doses you are asked to take will depend upon the reason for you taking it and the severity of the infection. Your doctor will tell you what dose is right for you, and this information will also be printed on the label of the pack to remind you about what the doctor said to you.
• If you have been given capsules to take, you must swallow these whole (do not open or chew them). Take them during a mealtime, with a glassful of water to make sure you have swallowed them properly. Make sure that you take them while you are sitting or standing up so that they do not get caught in your throat and cause irritation. This also means that you should not take them immediately before you go to bed.
• If you have been given dispersible tablets (Vibramycin-D®), you should stir these into a small glass of water to take them. If you are using the dispersible tablets because of recurrent mouth ulcers, rinse the solution around your mouth for 2-3 minutes, and then spit it out.
• If you forget to take a dose, take it as soon as you remember. Try to take the correct number of doses each day but do not take two doses at the same time to make up for a missed dose.
• Depending on what you are being treated for, your course of treatment could last from a week, to several months. Keep taking doxycycline until the course is finished unless you are told to stop sooner by a doctor.

Getting the most from your treatment

• Do not take indigestion remedies, or supplements containing iron, magnesium, or zinc at the same time as you take doxycycline. This is because doxycycline combines with these things, which makes it less effective in fighting infection. If you need to take an antacid or any such supplement, make sure you do not take it within two hours (either before or after) of taking doxycycline.
• Doxycycline may cause your skin to become more sensitive to sunlight than usual. Avoid strong sunlight and do not use sunbeds. Use a sun cream with a high sun protection factor on bright days, even when it is cloudy.
• This antibiotic may stop the oral typhoid vaccine from working. If you are having any vaccinations, make sure the person treating you knows that you are taking this medicine.

Additional information for protection against malaria

• If you are taking doxycycline to protect against malaria, you must start taking it 1-2 days before you travel. This is to ensure there is sufficient medicine in your bloodstream to give you the required protection. You should continue to take it throughout your stay and for a further four weeks after you have left the area.
• If you feel ill or develop a high temperature (fever) or flu-like symptoms while you are travelling or within one year (especially if it is within three months) of returning home, you should see your doctor straightaway. This is important, even if you have taken your antimalarial tablets correctly.
• Doxycycline will help reduce the risk of you getting malaria, but it is also important that you take the following precautions against being bitten by mosquitoes:
• Cover up bare areas of your arms and legs with long-sleeved, loose-fitting clothing, long trousers and socks. This is especially important if you are outside after sunset, as this is when mosquitoes feed.
• Use an effective insect repellant spray on your clothing and any area of your skin which is bare. If you are also using a sunscreen, apply the sunscreen first and the insect repellant afterwards.
• Spray the room with an insecticide each evening a couple of hours before you go to bed. Check your sleeping areas for mosquitoes – pay particular attention to furniture and areas under your bed where insects can hide.
• If you are sleeping in an unscreened room, use a mosquito net impregnated with an insecticide.

Can doxycycline cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the ones associated with doxycycline. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. Speak with your doctor or pharmacist if any of the following continue or become troublesome.

Doxycycline side-effects	What can I do if I experience this?
Stomach upset, indigestion, tummy (abdominal) pain	Stick to simple foods – avoid fatty or spicy meals. Take your doses after a meal or with a snack
Diarrhoea	Drink plenty of water to replace lost fluids. If this continues or is severe, speak with a doctor
Headache, other aches and pains	Drink plenty of water and ask a pharmacist to recommend a suitable painkiller. If the aches continue, let your doctor know
A yeast infection (thrush) which causes redness and itchiness in the mouth or vagina	Speak with a doctor or pharmacist for advice
Dry mouth, throat irritation	Remember to take your doses with a large glass of water while you are standing or sitting upright
Feeling anxious, increased sweating	If troublesome, speak with a doctor

Important: doxycycline can occasionally cause allergic reactions, such as a skin rash. Speak with a doctor as soon as possible if this happens to you.

In rare cases, treatment with tetracycline antibiotics such as doxycycline can cause an increase in blood pressure inside the skull. This can cause symptoms such as headache, being sick (vomiting) and vision problems such as blurred or double vision or loss of vision. If this happens to you, seek medical attention and do not take any more doxycycline.

If you experience any other symptoms which you think may be due to the medicine, discuss them with your doctor or pharmacist who will be able to advise you further.

How to store doxycycline

• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty. If you are having an operation or any dental treatment, tell the person carrying out the treatment which medicines you are taking. This medicine is for you. Never give it to other people even if their condition appears to be the same as yours. Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you. If you have any questions about this medicine ask your pharmacist.

• Manufacturer’s PIL, Vibramycin-D Dispersible Tablets 100 mg; Pfizer Ltd, The electronic Medicines Compendium. Dated November 2019.

• Manufacturer’s PIL, Doxycycline 50 mg and 100 mg capsules; Accord-UK Ltd, The electronic Medicines Compendium. Dated October 2020.

• Medicines Complete BNF 85th Edition; British Medical Association and Royal Pharmaceutical Society of Great Britain, London.

Antimicrobial agents. Classification of antimicrobials

According to the spectrum of activity , antimicrobials are divided into: antibacterial, antifungal and antiprotozoal. In addition, all antimicrobial agents are divided into narrow-spectrum and broad-spectrum drugs.

Narrow-spectrum drugs primarily against gram-positive microorganisms include, for example, natural penicillins, macrolides, lincomycin, fusidine, oxacillin, vancomycin, first generation cephalosporins. Polymyxins and monobactams are drugs with a narrow spectrum of action mainly on gram-negative rods. Broad-spectrum drugs include tetracyclines, chloramphenicol, aminoglycosides, most semi-synthetic penicillins, cephalosporins from the 2nd generation, carbapenems, fluoroquinolones. The antifungal drugs nystatin and levorin (only against Candida) have a narrow spectrum, and clotrimazole, miconazole, amphotericin B. 9 have a wide spectrum.0005

According to the type of interaction with the microbial cell antimicrobial drugs are divided into:

bactericidal – irreversibly disrupt the functions of the microbial cell or its integrity, causing immediate death of the microorganism, are used in severe infections and in debilitated patients,

bacteriostatic – reversibly block replication or cell division, are used for non-severe infections in non-debilitated patients.

According to acid resistance antimicrobials are classified into:

Acid resistant – can be used orally, eg phenoxymethylpenicillin,

Acid resistant – intended for parenteral use only, eg benzylpenicillin.

The following main groups of antimicrobials are currently used for systemic use.

¨ Lactam antibiotics

Lactam antibiotics ( Table 9.2) of all antimicrobial drugs are the least toxic, because, by disrupting the synthesis of the bacterial cell wall, they do not have a target in the human body. Their use in the presence of pathogen sensitivity to them is preferable. Carbapenems have the widest spectrum of activity among lactam antibiotics; they are used as reserve drugs – only for infections resistant to penicillins and cephalosporins, as well as for hospital and polymicrobial infections.

¨ Antibiotics of other groups

Antibiotics of other groups ( table 9. 3) have different mechanisms of action. Bacteriostatic drugs disrupt the stages of protein synthesis on ribosomes, bactericidal drugs violate either the integrity of the cytoplasmic membrane or the process of DNA and RNA synthesis. In any case, they have a target in the human body, therefore, compared to lactam preparations, they are more toxic, and should be used only when the latter cannot be used.

¨ Synthetic antibacterial drugs

Synthetic antibacterial drugs ( tab. 9.4 ) also have different mechanisms of action: inhibition of DNA gyrase, impaired incorporation of PABA into DHPA, etc. Also recommended for use when it is impossible to use lactam antibiotics.

¨ Side effects of antimicrobials,

their prevention and treatment

Antimicrobials have a wide variety of side effects, some of which can lead to serious complications and even death.

Allergic reactions

Allergic reactions may occur with any antimicrobial agent. Allergic dermatitis, bronchospasm, rhinitis, arthritis, angioedema, anaphylactic shock, vasculitis, nephritis, lupus-like syndrome may develop. Most often they are observed with the use of penicillins and sulfonamides. Some patients develop cross-allergy to penicillins and cephalosporins. Allergies to vancomycin and sulfonamides are often noted. Very rarely give allergic reactions aminoglycosides and chloramphenicol.

Prevention is facilitated by a thorough allergy history. If the patient cannot indicate which antibacterial drugs he had allergic reactions to, tests should be performed before the introduction of antibiotics. The development of an allergy, regardless of the severity of the reaction, requires the immediate withdrawal of the drug that caused it. Subsequently, the introduction of even antibiotics similar in chemical structure (for example, cephalosporins in case of allergy to penicillin) is allowed only in cases of emergency. Treatment of the infection should be continued with drugs from other groups. In severe allergic reactions, intravenous administration of prednisolone and sympathomimetics, infusion therapy is required. In mild cases, antihistamines are prescribed.

Irritant effect on the routes of administration

When administered orally, the irritant effect can be expressed in dyspeptic phenomena, when administered intravenously – in the development of phlebitis. Thrombophlebitis is most often caused by cephalosporins and glycopeptides.

Superinfection, including dysbacteriosis

The probability of dysbacteriosis depends on the breadth of the drug action spectrum. The most common candidiasis develops with the use of narrow-spectrum drugs after a week, with the use of broad-spectrum drugs – already from one tablet. However, cephalosporins relatively rarely cause fungal superinfection. On the 1st place in terms of frequency and severity of dysbacteriosis caused is lincomycin. Violations of the flora during its use can take on the character of pseudomembranous colitis – a severe intestinal disease caused by clostridia, accompanied by diarrhea, dehydration, electrolyte disturbances, and in some cases complicated by perforation of the colon. Glycopeptides can also cause pseudomembranous colitis. Often cause dysbacteriosis tetracyclines, fluoroquinolones, chloramphenicol.

Dysbacteriosis requires discontinuation of the used drug and long-term treatment with eubiotics after preliminary antimicrobial therapy, which is carried out according to the results of the sensitivity of the microorganism that caused the inflammatory process in the intestine. Antibiotics used to treat dysbacteriosis should not affect the normal intestinal autoflora – bifidobacteria and lactobacilli. However, in the treatment of pseudomembranous colitis, metronidazole or, alternatively, vancomycin is used. Correction of water and electrolyte disturbances is also necessary.

Impaired tolerance to alcohol – common to all lactam antibiotics, metronidazole, chloramphenicol. It is manifested by the appearance of nausea, vomiting, dizziness, tremors, sweating and a drop in blood pressure with the simultaneous use of alcohol. Patients should be warned not to drink alcohol during the entire period of antimicrobial treatment.

Organ-specific side effects for various drug groups:

Damage to the blood system and hematopoiesis – inherent in chloramphenicol, less often lincosomides, cephalosporins of the 1st generation, sulfonamides, nitrofuran derivatives, fluoroquinolones, glycopeptides. It is manifested by aplastic anemia, leukopenia, thrombocytopenia. It is necessary to cancel the drug, in severe cases, replacement therapy. Hemorrhagic syndrome can develop with the use of 2-3 generation cephalosporins that disrupt the absorption of vitamin K in the intestine, antipseudomonal penicillins that disrupt platelet function, metronidazole, which displaces coumarin anticoagulants from their bonds with albumin. Vitamin K preparations are used for treatment and prevention.

Liver damage – inherent in tetracyclines, which block the enzyme system of hepatocytes, as well as oxacillin, aztreonam, lincosamines and sulfonamides. Cholestasis and cholestatic hepatitis can cause macrolides, ceftriaxone. Clinical manifestations are an increase in liver enzymes and bilirubin in the blood serum. If it is necessary to use hepatotoxic antimicrobial agents for more than a week, laboratory monitoring of the listed indicators is necessary. In the event of an increase in AST, ALT, bilirubin, alkaline phosphatase or glutamyl transpeptidase, treatment should be continued with drugs from other groups.

· Damage to bones and teeth is typical for tetracyclines, growing cartilage – for fluoroquinolones.

Kidney damage is associated with tubular-damaging aminoglycosides and polymyxins, sulfonamides with crystalluria, albuminuria-causing cephalosporins, and vancomycin. Predisposing factors include old age, kidney disease, hypovolemia, and hypotension. Therefore, the treatment with these drugs requires preliminary correction of hypovolemia, control of diuresis, selection of doses taking into account kidney function and body weight. The course of treatment should be short.

Myocarditis is a side effect of chloramphenicol.

Dyspepsia, which is not a consequence of dysbacteriosis, is characteristic of the use of macrolides, which have prokinetic properties.

Various CNS lesions develop from many antimicrobials. Observed:

– psychosis during treatment with levomycetin,

– paresis and peripheral paralysis with the use of aminoglycosides and polymyxins due to their curare-like action (therefore, they cannot be used simultaneously with muscle relaxants),

– headache and central vomiting with sulfonamides and nitrofurans,

– convulsions and hallucinations with high doses of aminopenicillins and cephalosporins, resulting from GABA antagonism of these drugs,

– convulsions with imipenem,

9 0002 – excitation at use of fluoroquinolones,

– meningism in the treatment of tetracyclines due to their increased production of cerebrospinal fluid,

– visual disturbances in the treatment of aztreonam and chloramphenicol,

– peripheral neuropathy when using isoniazid, metronidazole, chloramphenicol.

· Hearing loss and vestibular disorders – a side effect of aminoglycosides, more characteristic of the 1st generation. Since this effect is associated with the accumulation of drugs, the duration of their use should not exceed 7 days. Additional risk factors are senile age, renal insufficiency and concomitant use of loop diuretics. Reversible hearing changes are caused by vancomycin. If there are complaints of hearing loss, dizziness, nausea, unsteadiness when walking, it is necessary to replace the antibiotic with drugs from other groups.

Skin lesions in the form of dermatitis are characteristic of chloramphenicol. Tetracyclines and fluoroquinolones cause photosensitivity. When treating with these drugs, physiotherapy procedures are not prescribed, and exposure to the sun should be avoided.

Sulfonamides cause hypothyroidism.

Tetracyclines, fluoroquinolones, sulfonamides are teratogenic.

· Possible paralysis of the respiratory muscles with rapid intravenous administration of lincomycin and cardiodepression with rapid intravenous administration of tetracyclines.

· Antipseudomonal penicillins cause electrolyte disturbances. The development of hypokalemia is especially dangerous in the presence of diseases of the cardiovascular system. When prescribing these drugs, monitoring of the ECG and blood electrolytes is necessary. In the treatment, infusion-corrective therapy and diuretics are used.

Microbiological diagnostics

The effectiveness of microbiological diagnostics, which is absolutely necessary for the rational selection of antimicrobial therapy, depends on compliance with the rules for the collection, transportation and storage of the test material. Rules for the collection of biological material include:

– sampling from the area as close as possible to the source of infection,

– prevention of contamination by other microflora.

The transport of the material must, on the one hand, ensure the viability of bacteria, and, on the other hand, prevent their reproduction. It is desirable that the material be stored before the start of the study at room temperature and no more than 2 hours. Currently, special tightly closed sterile containers and transport media are used to collect and transport the material.

To no lesser extent, the effectiveness of microbiological diagnostics depends on the correct interpretation of the results. It is believed that the isolation of pathogenic microorganisms, even in small quantities, always makes it possible to attribute them to the true causative agents of the disease. A conditionally pathogenic microorganism is considered a pathogen if it is isolated from normally sterile environments of the body or in large quantities from environments that are not characteristic of its habitat. Otherwise, it is a representative of the normal autoflora or contaminates the test material during sampling or research. The isolation of low pathogenic bacteria from areas uncharacteristic of their habitation in moderate amounts indicates the translocation of microorganisms, but does not allow them to be attributed to the true pathogens of the disease.

It is much more difficult to interpret the results of a microbiological study when sowing several types of microorganisms. In such cases, they are guided by the quantitative ratio of potential pathogens. More often significant in the etiology of this disease are 1-2 of them. It should be borne in mind that the probability of equal etiological significance of more than 3 different types of microorganisms is negligible.

ESBL susceptibility to beta-lactamase inhibitors such as clavulanic acid, sulbactam and tazobactam is the basis for laboratory tests for ESBL production by Gram-negative organisms. At the same time, if a microorganism of the Enterobacteriaceae family is resistant to 3rd generation cephalosporins, and when beta-lactamase inhibitors are added to these drugs, it demonstrates sensitivity, then this strain is identified as ESBL-producing.

Antibiotic therapy should only be directed to the true causative agent of the infection! However, in most hospitals, microbiological laboratories cannot determine the etiology of the infection and the sensitivity of pathogens to antimicrobials on the day of admission, so the primary empirical prescription of antibiotics is inevitable. At the same time, the peculiarities of the etiology of infections of various localizations, characteristic of this medical institution, are taken into account. In this connection, regular microbiological studies of the structure of infectious diseases and the sensitivity of their pathogens to antibacterial drugs are necessary in each hospital. Analysis of the results of such microbiological monitoring should be carried out monthly.

Table 9.2.

Lactam antibiotics .

9 0171

Amino-penicillins

90 183

Drug group		Name	Product characteristic 9 0004
Penicillins	Natural penicillins	sodium and potassium salts of benzylpene and- cillin	are administered only parenterally, last 3-4 hours			highly effective in their spectrum of action, but this spectrum is narrow, in addition, drugs are unstable to lactamases
		bicillin 1,3,5 0170	are administered only in pairs-enterally , effective from 7 to 30 days
		phenoxymethylpenicillin	drug for oral administration staphylococcal					oxacillin, methicillin, cloxacillin, dicloxacillin	have less antimicrobial activity than natural penicillins, but are resistant to staphylococcal lactamases, can be used per os
	ampicillin, amoxicillin, bacampicillin	broad-spectrum drugs, can be administered orally, but not resistant to beta-lactamases
	Combination	Ampiox – ampicillin + + oxacillin mazam, can be applied per os
	Antiblue-purulent	carbenicillin, ticarcillin, azlocillin, piperacillin, mezlocillin	have a wide spectrum of action, act on Pseudomonas aeruginosa strains that do not produce beta-lactamase, during treatment, rapid development of bacterial resistance to them is possible
	Lactamase-protected – preparations with clavulanic acid, tazobactam, sulbactam	amoxiclav, tazocine, thyment in, cyazine, unazine	drugs are a combination of broad spectrum penicillins spectrum of action and beta-lactamase inhibitors, therefore, they act on bacterial strains that produce beta-lactamase
	Cephalosporins	1st generation	cefazolin			not resistant to lactamase, have a narrow spectrum of action
cephalexin and cefaclor			used per os
2 generations		cefaclor, cefuraxime 90 170	applied per os		lactamase resistant, spectrum includes both gram-positive and gram-positive causative bacteria
		cefamandol, cefoxitin, cefuroxime, cefotetan, cefmetazole	parenterally only
3 generations		ceftizoxime, cefotaxime, ceftriaxone, ceftazidime, cefoperazone, cefmenoxime	couples only enteral use, have antipseudomonal activity		resistant to lactamases grammatrix -body bacteria, not effective against staphylococcal infections
		cefixime, ceftibuten, cefpodoxime, cefetamet	used per os, have anti-anaerobic activity
4 generations		cefipime, cefpiron	widest spectrum, parenteral
Cephalosporins with beta-lactamase inhibitors		spectrum of action of cefoperazone, but also affects lactamase-producing strains
Carbapenems	imipenem and its combination with cilostatin, which protects against destruction in the kidneys – thienem	More active against gram-positive microorganisms		have the widest of the lactams ny antibiotics spectrum of action, including anaerobes and Pseudomonas aeruginosa, and are resistant to all lactamases, there is practically no resistance to them, they can be used in almost any pathogens, except for methicillin-resistant strains of staphylococcus, and as monotherapy even in severe infections, they have an aftereffect
	Meropenem	More active against Gram-negative microorganisms
	Mono-bactams	aztreonam for gram-negative rods, but very effective and resistant to all lactamases

Table 9. 3.

Antibiotics of other groups .

Group of drugs
Glycopeptides	narrow gram-positive spectrum, but it is very effective, in particular, they act on methicillin-resistant staphylococci and on L-forms of microorganisms
Polymyxins		These are the most toxic antibiotics, they are used only for topical application, in particular per os, since they are not absorbed in the gastrointestinal tract
Fusidin		low toxicity , but also a low-effective antibiotic
Levomycetin		highly toxic, currently used mainly for meningococcal, ocular and especially dangerous infections
Lincos-amines	lincomycin, clindamycin	anaerobic cocci, penetrate bones well
Tetracyclins	natural – tetracycline, semi-synthetic – metacycline, synthetic – doxycycline, minocycline	broad-spectrum antibiotics, including anaerobes and intracellular pathogens, toxic
Amino glycosides	1st generation: streptomycincanamycin monomycin	highly toxic , used only locally for decontamination of the gastrointestinal tract, for tuberculosis	toxic antibiotics of a fairly wide range spectrum of action, have a bad effect on gram-positive and anaerobic microorganisms, but enhance the effect of lactam antibiotics on them, their toxicity decreases in each subsequent generation
	2 generations: gentamicin	widely used for surgical infections
	3 generations: amikacin, cin, netilmicin, tobramycin	act on some microorganisms resistant to gent mycin, against Pseudomonas aeruginosa the most effective is tobramycin
Macrolides	natural: erythromycin, oleandomycin0005	low-toxic, but also low-effective narrow-spectrum antibiotics, act only on gram-positive cocci and intracellular pathogens, can be used per os
	tromy -cin, flurithromycin	also act on intracellular pathogens, the spectrum is somewhat wider, in particular, it includes Helicobacter and Moraxella, they pass all barriers in the body well, penetrate into various tissues, have an aftereffect of up to 7 days
	azolides: azithromycin (Sumamed)	have the same properties as semi-synthetic macrolides
9 0002 Rifampicin		used primarily for tuberculosis
Antifungal antibiotics	fluconazole, amphotericin B	amphotericin B highly toxic, used when pathogens are not sensitive to fluconazole

Table 9. 4.

Synthetic antibacterials .

Drug group		Name	Product characteristic 9 0004
Sulfonamides	, etazol	short-acting drugs	broad-spectrum drugs, pathogens often develop cross-resistance to all drugs of this series
		sulfadimethoxine, 900 02 sulfapyridazine, sulfalene		long acting preparations
	Acting in the intestinal lumen	ftalazol, sulgin, salazopyridazine		salazopyridazine – used for Crohn’s disease, ulcerative colitis
	Topical application	sulfacyl sodium		mainly used in ophthalmology
Nitrofuran derivatives		furagin, furazolidone, nitrofurantoin	have a wide spectrum of action, including clostridia and protozoa, unlike most antibiotics, they do not suppress, but stimulate the immune system, they are applied topically and per os
Quinoxaline derivatives		quinoxidine, dioxidine anaerobes, dioxidine applied topically or parenterally
Quinolone derivatives		nevigramon , oxolinic and pipemidic acid	act on a group of intestinal gram-negative microorganisms, are used mainly for urological infections, resistance to them quickly develops
Fluoroquinolones		ofloxacin, ciprofloxacin, pefloxacin, lomefloxacin, sparfloxacin, levo floxacin, gatifloxacin, moxifloxacin, gemifloxacin coli and intracellular pathogens, are well tolerated to many strains that produce lactamases, are widely used in surgery, ciprofloxacin has the highest antipseudomonal activity, and moxifloxacin has the highest antianaerobic activity
8-hydroxyquinoline derivatives		nitroxoline, enteroseptol	act on many microorganism isms, fungi, protozoa, used in urology and intestinal infections
Nitroimidazoles		metronidazole, tinidazole	act on anaerobic microorganisms, protozoa
Specific anti-tuberculosis, anti-syphilitic, antiviral, antitumor drugs			mainly used in specialized institutions

Source: N. A. et al.
Fundamentals of clinical surgery. Practical guide. 2nd edition, revised and enlarged. – M.: GEOTAR-Media, 2009.

Antibiotics and antiseptics in dentistry for toothache, for treatment and prevention

Contents

• Antibiotics: what you need to know?
  • Antimicrobial selection
  • Indications for use of antibiotics in adults and schedules
    • Antibiotics for inflammation of the gums and teeth
    • For flux and toothache
    • For periodontitis and periodontitis
    • For gingivitis
    • After tooth extraction
    • Implant preparations
    • Preventive
  • Contraindications, precautions and adverse reactions
    • Pregnancy and lactation
  • FAQ
    • Can antibiotics be injected into the gums?
    • Why didn’t antibiotics help me?
    • How to reduce the risk of diarrhea?
• Antiseptics: what is it and what is it used for?
  • How to rinse your mouth correctly?

When bacterial infections develop, doctors prescribe antimicrobial therapy. Diseases of the teeth, inflammation of the periosteum and tissues are no exception. After diagnosis, dentists write prescriptions for antibiotics as indicated to reduce the risk of severe complications. The idea of ​​bacterial treatment of common diseases will help to form a list of drugs used in medical practice.

Antibiotics: what you need to know?

Untreated caries is more often the provocateur of toothaches. It corrodes the enamel, and microbes enter the pulp. Due to thermal and mechanical stimuli, pain appears. Cariogenic foci serve as a source of infection. Pathogens penetrate through the mucous membranes and provoke periodontitis and periostitis – inflammation in the gums and periosteum. The process is accompanied by a flux of the cheeks and jaws. Without appropriate therapy, bone tissue is destroyed over time.

For the destruction of bacterial microflora, patients are prescribed drugs with antimicrobial formulas according to indications. They are powerless against viruses or fungi. Active substances selectively affect infectious agents and microbial colonies. The similarity of chemical structures determines the mechanism of action. The medicine destroys pyogenic streptococci, staphylococci, peptococci and other pathogens in the oral cavity. Only bacteriostatic drugs stop reproduction; bactericidal cause the death of the population.

Selection of antimicrobials

Antibiotics in the treatment of teeth are prescribed according to indications from different pharmacological groups. Individually selected remedies relieve symptoms and prevent the development of pathological processes after surgery. In dental practice, widespread:

• Nitroimidazoles of synthetic origin for the inhibition of anaerobes – bacteria that live without oxygen. A well-known representative of the class is Metronidazole.
• Bactericidal aminoglycosides effective against oxygen dependent aerobes. Isepamycin and Amikacin inhibit reproduction even in microorganisms in the resting phase.
• Fluoroquinolones have microbial activity against the main types of pathogens. They inhibit enzymes and provoke the death of affected cells. Ciprofloxacin, Lomefloxacin, Levofloxacin belong to this class.
• Lincosamides include Lincomycin and Clindamycin. They interfere with protein synthesis in cells. Effective for preventing infection of periodontal tissues (peripheral structures).
• Tetracyclines. Effective against gram-negative and gram-positive microbes. The mechanism of action is similar to lincosamides.
• Penicillins. Popular representatives of this group are Amoxicillin and Ampicillin for the treatment of inflammation provoked by anaerobes.

Indications for use of antibiotics in adults and regimens

The doctor prescribes a course based on the clinical picture, the patient’s health status, contraindications. Due to the cumulative effect, it is important to adhere to the recommendations for dosage and number of days. Single dose – 500 mg. The frequency depends on the severity of symptoms, but does not exceed 2-3 times. With the right formula, the effect occurs after three days. At the discretion of the specialist extends the five-day course for a couple of days.

Antibacterial agents are indicated for the following conditions:

• ulcerative gingivitis;
• inflammation of the gums and pulp:
• apical periodontitis;
• osteomyelitis;
• diseases of periodontal tissues;
• periostitis and phlegmon;
• abscess;
• surgical interventions.

Antibiotics for inflammation of the gums and teeth

Bacteria accumulating on teeth and gums, chemical trauma or mucosal burns cause gingivitis and inflammation of periodontal tissues. This is evidenced by swollen gums, blood during brushing, severe discomfort in the mouth. For local therapy, rinsing with antiseptic solutions with Miramistin, Rotokan, Chlorhexidine is suitable. The complex therapy includes anti-inflammatory ointments “Cholisal”, “Periodontocide”. For oral administration, Amoxicillin or Azithromycin is prescribed.

For flux and toothache

Antibacterial drugs are effective in the treatment of purulent saccular formations and pathologies of the periosteum (periostitis). They relieve throbbing pain and swelling in the acute stage. If measures are not taken in time, the purulent secret will spread to healthy tissues and provoke an abscess. According to the protocol, Lincomycin, Flemoxin Solutab, Azithromycin, Citrolet, Clindamycin are prescribed. They are combined with Levomekol and Metrogil Denta ointments.

For periodontitis and periodontitis

Aggressive diseases are caused by anaerobic bacteria and fungi. Loose gums, bacterial plaque on enamel, abscesses, fistulas are classic symptoms of periodontal inflammation. The pathological process leads to loose teeth and loss. For complex therapy, the doctor recommends vitamins, antiseptic drugs, physiotherapy. To eliminate acute symptoms, Moxifloxacin, Metronidazole, Clindamycin injections are prescribed. To destroy the fungal flora on the gums, 0.2% Chlorhexidine, a solution of 0.1% Hexetidine are effective.

For gingivitis

The disease occurs in different forms. Catarrhal, ulcerative-necrotic process is treated according to established protocols. The choice of remedy depends on the phase of the course, the form and severity of the symptoms. Effective Sumamed, Metronidazole, Lincomycin.

After tooth extraction

In case of purulent granuloma, abscess, phlegmon, lymphodernitis, the roots are urgently removed and Ciprofloxacin is prescribed. When removing a wisdom tooth, therapy is indicated in case of development of alveolitis that occurs 3-4 days after surgery due to improper care. The problem is diagnosed by dryness of the hole with a whitish coating, discomfort, swelling of the cheek.

Implant preparations

Patients taking antimicrobial drugs after bone augmentation for implant prosthetics and beyond. When introducing pins, they minimize the risk of developing an inflammatory process due to the penetration of pathogenic microorganisms at the incisions / puncture sites. They protect against rejection of structures, pain when chewing in case of instant implantation.

The surgeon prescribes a wide range of drugs with combined semi-synthetic formulas. These are the groups of penicillin and amoxicillin with clavulanic acid: Flemoxin, Amoxiclav, Flemoclav, Amoxicillin, Tsiprolet. Antiprotozoal Tinidazole, bacteriostatic Lincomycin and Clindamycin give a good effect.

Prevention

In healthy people, pathogenic bacteria successfully cope with the immune system. In patients with weakened natural defenses, they enter the bloodstream and cause various pathologies with an acute course. Therefore, in some cases, antibiotic treatment is prescribed to reduce the risk of bacterial infection. There is a list of drugs with minimal side effects.

In patients with endocarditis, glomerulonephritis, diabetes, they are indicated for the prevention of complications before elective surgical interventions. It is mandatory to take people with rheumatic and cardiac pathologies, oncology. Tsiprolet-A or Cifran-ST, Amoxiclav, Augmentin are used for dental implantation, jaw fractures, salivary gland surgery.

Formulas are active against common pathogens.

Contraindications, precautions and adverse reactions

Reception is prohibited in renal and hepatic disorders. With caution, therapy is prescribed to elderly patients with diabetes mellitus due to the occurrence of side effects:

• allergic skin rashes;
• diarrhea and nausea;
• anemia;
• mucosal candidiasis.

Components from the tetracycline group increase the level of liver enzymes. Drugs from the aminoglycoside classes, cephalosporins, cause frequent urination, often with blood.

Use in pregnancy and lactation

Women during these periods are allowed to take drugs from a number of semi-synthetic penicillins, macrolides, some cephalosporins against gram-negative and gram-positive bacteria. Tetracyclines and aminoglycosides are banned. They have a negative effect on the hearing organs and bone tissue.

Frequently Asked Questions

Can antibiotics be injected into the gums?

In aggressive inflammatory processes, fistulas, abscesses, injections are administered. The components from the composition immediately enter the bloodstream and begin to work. After taking the pill, the process begins only after 30 minutes, when the active substances are broken down in the intestines. More often, Lincomycin is injected, which lingers in the bones for a long time. From there, the therapeutic components enter the inflammatory foci, where they suppress the pathogenic flora, remove intoxication and microbial allergies.

Why didn’t antibiotics help me?

This happens because of resistance – the ability of infectious agents to resist the action of active substances. The problem is typical for people who often take broad-spectrum antibiotics.

How to reduce the risk of diarrhea?

It is necessary to take enterosorbents and live microorganisms from the first day. Probiotics are swallowed 3 hours before taking the main drug. To restore the intestinal microflora, you need to drink a course of 15-18 days. BAK-SETCold/Flu, Immucil, Florasan-D are suitable.

Antiseptics: what is it and what is it used for?

They do not selectively act against infectious agents and are suitable for topical application. In practice use for:

• mouth rinses for stomatitis, braces;
• root canals after nerve removal;
• performing dental operations.

Sanguirythrin solution 0.03% of plant origin destroys the membranes of bacteria. Hydrogen peroxide destroys pathogenic flora and necrotic residues by releasing free oxygen. Iodine preparations such as betadine and phenol-containing listerine are effective against common types of bacteria, fungi, viruses, and protozoa.

How to rinse your mouth correctly?

After tooth extraction and stomatitis, experts recommend rinsing up to 3 times a day after meals.