Penicillin is the progenitor of modern antibiotics. Analogues of penicillin

Penicillins are the first AMPs developed on the basis of the waste products of microorganisms. They belong to the broad class of β-lactam antibiotics (β-lactams), which also includes cephalosporins, carbapenems, and monobactams. Common in the structure of these antibiotics is a four-membered β-lactam ring. β-lactams form the basis of modern chemotherapy, as they occupy a leading or important place in the treatment of most infections.

Classification of penicillins

Natural:

Benzylpenicillin (penicillin), sodium and potassium salts

Benzylpenicillin procaine (novocaine salt of penicillin)

Benzathine benzylpenicillin

Phenoxymethylpenicillin

Semi-synthetic:

isoxazolylpenicillins

aminopenicillins

Ampicillin
Amoxicillin

carboxypenicillins

Carbenicillin
Ticarcillin

ureidopenicillins

Azlocillin
Piperacillin

inhibitor-protected penicillins

Amoxicillin/clavulanate
Ampicillin/sulbactam
Ticarcillin/clavulanate
Piperacillin/tazobactam

The ancestor of penicillins (and in general all β-lactams) is benzylpenicillin (penicillin G, or simply penicillin), which has been used in clinical practice since the early 40s. Currently, the group of penicillins includes a number of drugs, which, depending on the origin, chemical structure and antimicrobial activity, are divided into several subgroups. Of the natural penicillins, benzylpenicillin and phenoxymethylpenicillin are used in medical practice. Other drugs are semi-synthetic compounds obtained as a result of chemical modification of various natural AMPs or intermediate products of their biosynthesis.

Mechanism of action

Penicillins (and all other β-lactams) are bactericidal. The target of their action is the penicillin-binding proteins of bacteria, which act as enzymes at the final stage of the synthesis of peptidoglycan, a biopolymer that is the main component of the bacterial cell wall. Blocking the synthesis of peptidoglycan leads to the death of the bacterium.

To overcome the widespread acquired resistance among microorganisms associated with the production of special enzymes - β-lactamases that destroy β-lactams, compounds have been developed that can irreversibly suppress the activity of these enzymes, the so-called β-lactamase inhibitors - clavulanic acid (clavulanate), sulbactam and tazobactam. They are used in the creation of combined (inhibitor-protected) penicillins.

Since peptidoglycan and penicillin-binding proteins are absent in mammals, specific macroorganism toxicity for β-lactams is uncharacteristic.

Activity spectrum

natural penicillins

They are characterized by an identical antimicrobial spectrum, but differ somewhat in the level of activity. The MIC value of phenoxymethylpenicillin in relation to most microorganisms, as a rule, is somewhat higher than that of benzylpenicillin.

Of major clinical importance is the resistance of oxacillin to staphylococcal β-lactamases. Due to this, oxacillin is highly active against the vast majority of strains of staphylococci (including PRSA) - the causative agents of community-acquired infections. The activity of the drug against other microorganisms is of no practical importance. Oxacillin has no effect on staphylococci, whose resistance to penicillins is not associated with the production of β-lactamase, but with the appearance of atypical PSB - MRSA.

The spectrum of activity of aminopenicillins is extended due to the action on some members of the family Enterobacteriaceae - E.coli, Shigella spp., Salmonella spp. And P. mirabilis, which are characterized by a low level of production of chromosomal β-lactamases. In terms of activity against Shigella, ampicillin is slightly superior to amoxicillin.

The advantage of aminopenicillins over natural penicillins is noted in relation to Haemophilus spp. The effect of amoxicillin on H. pylori.

According to the spectrum and level of activity against gram-positive bacteria and anaerobes, aminopenicillins are comparable to natural penicillins. However, Listeria are more sensitive to aminopenicillins.

Aminopenicillins are susceptible to hydrolysis by all β-lactamases.

The antimicrobial spectrum of inhibitor-protected aminopenicillins (amoxicillin / clavulanate, ampicillin / sulbactam) is expanded due to such gram-negative bacteria as Klebsiella spp., P. vulgaris, C. diversus, as well as anaerobes of the group B. fragilis that synthesize class A chromosomal β-lactamases.

In addition, inhibitor-protected aminopenicillins are active against microflora with acquired resistance due to the production of β-lactamase: staphylococci, gonococci, M.catarrhalis, Haemophilus spp., E.coli, P. mirabilis.

With regard to microorganisms whose resistance to penicillins is not associated with the production of β-lactamase (for example, MRSA, S.pneumoniae), inhibitor-protected aminopenicillins do not show any advantages.

The spectrum of action of carbenicillin and ticarcillin against gram-positive bacteria generally coincides with that of other penicillins, but the level of activity is lower.

Actinomycosis.

Since long-acting penicillins do not create high concentrations in the blood and practically do not pass through the BBB, they are not used to treat severe infections. Indications for their use are limited to the treatment of tonsillopharyngitis and syphilis (except neurosyphilis), the prevention of erysipelas, scarlet fever and rheumatism. Phenoxymethylpenicillin is used to treat mild and moderate streptococcal infections (tonsillopharyngitis, erysipelas).

Due to the increasing resistance of gonococci to penicillin, its empirical use for the treatment of gonorrhea is unjustified.

Oxacillin

Confirmed or suspected staphylococcal infections of various localization (with confirmation of sensitivity to oxacillin or with a slight risk of the spread of methicillin resistance).

Aminopenicillins and inhibitor-protected aminopenicillins

The main indications for the use of these drugs are the same. The appointment of aminopenicillins is more justified in mild and uncomplicated infections, and their inhibitor-protected derivatives - in more severe or recurrent forms, as well as in the presence of data on the high incidence of β-lactamase-producing microorganisms.

The route of administration (parenteral or oral) is selected depending on the severity of the infection. For oral administration, it is more appropriate to use amoxicillin or amoxicillin/clavulanate.

Additional indications for prescribing inhibitor-protected aminopenicillins are:

Carboxypenicillins and inhibitor-protected carboxypenicillins

The clinical significance of carboxypenicillins is currently declining. As indications for their use, nosocomial infections caused by susceptible strains can be considered. P.aeruginosa. At the same time, carboxypenicillins should be prescribed only in combination with other AMPs that are active against Pseudomonas aeruginosa (aminoglycosides of II-III generation, fluoroquinolones).

Indications for the use of ticarcillin / clavulanate are somewhat wider and include severe, mainly nosocomial, infections of various localization caused by multiresistant and mixed (aerobic-anaerobic) microflora:

Ureidopenicillins and inhibitor-protected ureidopenicillins

Ureidopenicillins in combination with aminoglycosides are used for Pseudomonas aeruginosa (in case of sensitivity P.aeruginosa).

Piperacillin / tazobactam is used to treat severe, predominantly nosocomial, mixed (aerobic-anaerobic) infections of various localization:

postpartum purulent-septic complications;

ZhVP, bile peritonitis, liver abscesses;

Drug Interactions

Penicillins should not be mixed in the same syringe or in the same infusion system with aminoglycosides due to their physical and chemical incompatibility.

The combination of ampicillin with allopurinol increases the risk of "ampicillin" rash.

The use of high doses of benzylpenicillin potassium salt in combination with potassium-sparing diuretics, potassium preparations or ACE inhibitors predetermines an increased risk of hyperkalemia.

Caution is required when combining penicillins active against Pseudomonas aeruginosa with anticoagulants and antiplatelet agents due to the potential risk of increased bleeding. It is not recommended to combine with thrombolytics.

The use of penicillins in combination with sulfonamides should be avoided, since this may weaken their bactericidal effect.

Cholestyramine binds penicillins in the gastrointestinal tract and reduces their oral bioavailability.

Oral penicillins can reduce the effectiveness of oral contraceptives by disrupting the enterohepatic circulation of estrogens.

Penicillins are able to slow down the excretion of methotrexate from the body by inhibiting its tubular secretion.

Information for patients

Inside penicillins should be taken with plenty of water. Ampicillin and oxacillin should be taken 1 hour before meals (or 2 hours after meals), phenoxymethylpenicillin, amoxicillin and amoxicillin / clavulanate - regardless of food intake.

Suspension for oral administration should be prepared and taken in accordance with the attached instructions.

Strictly observe the prescribed regimen during the entire course of treatment, do not skip the dose and take it at regular intervals. If you miss a dose, take it as soon as possible; do not take if it is almost time for the next dose; do not double the dose. Maintain the duration of therapy, especially with streptococcal infections.

Do not use expired or degraded preparations as they may be toxic.

Consult a doctor if improvement does not occur within a few days and new symptoms appear. If a rash, hives or other signs of an allergic reaction appear, stop taking the drug and consult a doctor.

Table. Preparations of the penicillin group.
Main characteristics and application features

INN	Lekform LS	F (inside), %	T ½, h *	Dosing regimen	Features of drugs
natural penicillins
Benzylpenicillin (potassium and sodium salt)	Since. d / in. 250 thousand units; 500 thousand units; 1 million units; 1.5 million units; 5 million units; 10 million units in a flask.	10-20	0,5-0,7	Parenterally Adults: 4-12 million units/day in 4-6 introductions; with streptococcal tonsillopharyngitis - 500 thousand units every 8-12 hours for 10 days; with meningitis and endocarditis - 18-24 million units / day 6 introductions Children: up to 1 month: see the section "The use of AMP in children"; older than 1 month: 50-100 thousand units / kg / day in 4 injections; with streptococcal tonsillopharyngitis - 25-50 thousand units / kg / day in 2 injections for 10 days; with meningitis 300-400 thousand units / kg / day in 6 introductions	The main natural penicillin. Primary activity against gram-positive microorganisms. High allergenicity
benzylpenicillin procaine	Since. d / in. 600 thousand units; And 1.2 million units; in a flask.	ND	24	V/m Adults: 600 thousand-1.2 million units / day in 1-2 injections Children: up to 1 month: see the section "The use of APM in children"; older than 1 month: 50-100 thousand units / kg / day in 1-2 injections	Indications: streptococcal infections of mild to moderate severity, outpatient forms of pneumococcal pneumonia. In case of an overdose, mental disorders are possible.
Benzathine benzylpenicillin	Since. d / in. 300 thousand units; 600 thousand units; 1.2 million units; 2.4 million units in a flask.	ND	A few days	V/m Adults: 1.2-2.4 million units once; with syphilis - 2.4 million units / day every 5-7 days (2-3 injections); for the prevention of rheumatism and recurrent erysipelas - 1.2-2.4 million units ґ once a month Children: 1.2 million units once; for the prevention of rheumatism - 600 thousand-1.2 million units ґ 1 time per month	Does not create high concentrations in the blood. Indications: syphilis, mild to moderate streptococcal infections, prevention of scarlet fever and recurrent erysipelas, year-round prevention of rheumatism
Benzylpenicillin (potassium salt)/ benzylpenicillin procaine/benzathine benzylpenicillin (1:1:1) (Bicillin-3)	Since. d / in. 1.2 million units per vial.	ND	A few days	V/m Adults and children: 1.2 million units once	Does not create high concentrations in the blood. Intravascular administration is not allowed. Indications: mild to moderate streptococcal infections, year-round prevention of rheumatism. Contraindicated in allergic to procaine (novocaine)
Benzathine benzylpenicillin/ benzylpenicillin procaine (4:1) ( Bicillin-5)	Since. d / in. 1.5 million units in a vial.	ND	A few days	V/m Adults and children: 1.5 million IU once; for the prevention of rheumatism - 1.5 million units ґ once a month	See Bicillin-3
Phenoxymethyl-penicillin	Tab. 0.1 g; 0.25 g; 0.5 g; 1.0 g; 1.5 g; 1 million units; 1.2 million IU Tab. sol. 600 thousand IU; 1 million IU Dragee 100 thousand units Pore. for susp. d / ingestion 0.3 g; 0.6 g; 1.2 g; 300 thousand IU / 5 ml Gran. for susp. d / ingestion 125 mg / 5 ml; 300 thousand IU / 5 ml Sir. 400 mg/ml; 750 thousand IU / 5 ml Cap. d / ingestion 150 thousand. IU/ml	40-60	0,5-1,0	inside Adults: 0.25-0.5 g every 6 hours; with streptococcal tonsillopharyngitis - 0.25 g every 8-12 hours for 10 days; for the prevention of rheumatism - 0.25 g every 12 hours. Children: 30-40 mg / kg / day in 4 divided doses; with streptococcal tonsillopharyngitis - 0.125-0.25 g every 8-12 hours for 10 days	Does not create high concentrations in the blood. Indications: mild to moderate streptococcal infections, year-round prevention of rheumatism
Isoxazolylpenicillins
Oxacillin	Caps. 0.25 g Tab. 0.25 g; 0.5 g Since. d / in. 0.25 g; 0.5 g in vial.	25-30	0,5-0,7	inside Adults: 0.5-1.0 g every 6 hours 1 hour before meals Children: up to 1 month: see the section "The use of AMP in children"; older than 1 month: 40-60 mg / kg / day in 3-4 doses (but not more than 1.5 g / day) Parenterally Adults: 4-12 g/day in 4-6 injections Children: 0.2-0.3 g / kg / day in 4-6 injections	Antistaphylococcal penicillin. When taken orally, it does not create high concentrations in the blood. Indications: staphylococcal infections (except those caused by MRSA)
Aminopenicillins
Ampicillin	Tab. 0.125 g; 0.25 g Caps. 0.25 g; 0.5 g Susp. d / ingestion 0.125 g / 5 ml; 0.25 g/5 ml Since. d / in. 0.25 g; 0.5 g; 1.0 g; 2.0 g Since. for susp. for oral administration 5 g Sir., 0.25 g/5 ml Since. d / cap. for oral administration for children 100 mg / ml	35-40	1,0	inside Adults: 0.5 g every 6 hours 1 hour before meals Children: 30-50 mg/kg/day in 4 divided doses Parenterally Adults: 2-6 g/day in 4 injections; with meningitis and endocarditis - 8-12 g / day in 4-6 injections Children: up to 1 month: see the section "The use of AMP in children"; older than 1 month: 50-100 mg / kg / day in 4 injections; with meningitis - 0.3 g / kg / day in 6 injections	The spectrum of activity is expanded due to E.coli, Salmonella, Shigella, β-lactamase non-producing strains H.influenzae. When taken orally, it does not create high concentrations in the blood. May cause non-allergic rash
Amoxicillin	Tab. 0.125 g; 0.25 g; 0.5 g; 0.375 g; 0.75 g; 1.0 g Tab. sol. 0.75 g; 1.0 g Caps. 0.25 g; 0.5 g Cap. for oral administration 100 mg/ml Gran. for susp. d / ingestion 0.125 g / 5 ml; 0.25 g/5 ml	75-93 **	1-1,3	inside Adults: 0.25-0.5 g every 8 hours; for the prevention of endocarditis - 3.0 g once Children: 30-60 mg/kg/day in 3 divided doses	Bioavailability is independent of food. Indications: infections of the DP and MVP of mild to moderate severity; eradication H. pylori; prevention of endocarditis
Carboxypenicillins
Carbenicillin	Since. d / in. 1.0 g in vial.	10-20	1	I/V Adults and children: 0.4-0.6 g / kg / day in 6-8 injections The introduction is carried out by slow infusion for 30-60 minutes	P.aeruginosa Low activity against Gram-positive cocci. May cause electrolyte disturbances, impaired platelet aggregation, phlebitis
Ureidopenicillins
Azlocillin	Since. d / in. 0.5 g; 1.0 g; 2.0 g; 4.0 g per vial.	ND	1	I/V Adults: 0.2-0.35 g / kg / day in 4-6 injections Children: up to 1 month: see the section "The use of AMP in children"; older than 1 month: 0.2-0.3 g / kg / day in 4 injections	The spectrum is expanded by Enterobacteriaceae and non-fermenting bacteria. The main clinical significance is activity against P.aeruginosa but now many strains are resistant.
Piperacillin	Since. d / in. 1.0 g; 2.0 g; 3.0 g; 4.0 g per vial.	ND	1	I/V Adults: 0.2-0.3 g / kg / day in 4-6 injections Children: 0.15-0.3 g / kg / day in 3-4 injections The introduction is carried out by slow infusion for 30 minutes	The spectrum is expanded by Enterobacteriaceae and non-fermenting bacteria. The main clinical significance is activity against P.aeruginosa but now many strains are resistant. Better tolerated than carbenicillin
Inhibitor-protected penicillins
Amoxicillin/ clavulanate	Since. for susp. d / ingestion of 0.156 g / 5 ml for children; 0.312 g/ 5 ml Tab. 0.375 g; 0.625 g; 1.0 g Since. d / cap. 0.063 g/ml Since. liof. d / in. 0.6 g; 1.2 g	90/75	1,3/1	Inside (during meals) Adults: 0.375-0.625 g every 8-12 hours Children: 40-60 mg/kg/day (as amoxicillin) in 3 divided doses I/V Adults: 1.2 g every 6 to 8 hours. Children: 40-60 mg/kg/day (as amoxicillin) in 3 doses	H.influenzae, representatives Enterobacteriaceae And B. fragilis.
Ampicillin/ sulbactam (Sultamicillin) Ampicillin/ sulbactam	Tab. 0.375 g Since. for susp. d / ingestion 0.25 g / 5 ml Pore. liof. d / in. 0.25 g; 0.5 g; 0.75 g; 1.0 g; 1.5 g; 3.0 g per vial.	ND	1/1	inside Adults: 0.375-0.75 g every 12 hours Children: 50 mg/kg/day in 2 divided doses Parenterally Adults: 1.5-12 g/day in 3-4 injections Children: 150 mg/kg/day in 3-4 injections	Spectrum expanded by PRSA producing β-lactamase strains H.influenzae, some representatives Enterobacteriaceae And B. fragilis. Greater opportunities for infections of the DP and MVP. Can be used for infections of the skin and soft tissues, intra-abdominal infections, for prophylaxis in surgery
Ticarcillin/ clavulanate	Since. liof. d/inf. 1.6 g and 3.2 g per vial.	ND	1/1	I/V Adults: 3.1 g every 6 to 8 hours in severe infections - every 4 hours Children: 0.2-0.3 g / kg / day in 4-6 injections The introduction is carried out by slow infusion for 30 minutes	Spectrum expanded by PRSA producing β-lactamase strains Enterobacteriaceae And B. fragilis. Used for nosocomial infections
Piperacillin/ tazobactam	Since. liof. d/inf. 2.25 g and 4.5 g per vial.	ND	1/1	I/V Adults and children over 12 years: 2.25-4.5 g every 6-8 hours The introduction is carried out by slow infusion for 30 minutes	Broad spectrum covering most Gram-positive and Gram-negative organisms B. fragilis. Used for nosocomial infections. Not intended for children under 12 years of age

* With normal kidney function

** Flemoxin Solutab

Antibiotics of the penicillin series are characterized by low toxicity, an extended spectrum of action. Penicillin antibiotics have a bactericidal effect on most strains of gram-positive, gram-negative bacteria, Pseudomonas aeruginosa.

The action of drugs from the list of penicillin antibiotics is determined by their ability to cause the death of pathogenic microflora. Penicillins act bactericidal, interacting with bacterial enzymes, disrupting the synthesis of the bacterial wall.

The targets for penicillins are multiplying bacterial cells. For humans, antibiotics of the penicillin group are safe, since the membranes of human cells do not contain bacterial peptidoglycan.

Classification

According to the method of production and properties, two main groups of penicillin antibiotics are distinguished:

• natural - discovered in 1928 by Flemming;
• semi-synthetic - created for the first time in 1957, when the active core of the antibiotic 6-APK was isolated.

A number of natural penicillins obtained from the Penicillum microfungus are not resistant to bacterial penicillinase enzymes. Because of this, the spectrum of activity of the natural penicillin series is narrowed compared to the group of semi-synthetic drugs.

Classification of the penicillin series:

• natural;
  • phenoxymethylpenicillin - Ospen and analogues;
  • benzathine benzylpenicillin - Retarpen;
  • benzylpenicillin - Procaine penicillin;
• semi-synthetic;
  • aminopenicillins - amoxicillins, ampicillins;
  • antistaphylococcal;
  • anti-pseudomonas;
    • carboxypenicillins;
    • ureidopenicillins;
  • inhibitor-protected;
  • combined.

Under the influence of the widespread use of antibiotics, bacteria have learned to produce beta-lactamase enzymes that destroy penicillins in the stomach.

To overcome the ability of bacteria producing beta-lactamase to destroy antibiotics, combined inhibitor-protected agents were created.

Action spectrum

Natural penicillins are active against bacteria:

• gram-positive - staphylococci, streptococci, pneumococci, listeria, bacilli;
• gram-negative - meningococci, gonococci, Haemophilus ducreyi - causing soft chancre, Pasteurella multocida - causing pasteurellosis;
• anaerobes - clostridia, fusobacteria, actinomycetes;
• spirochetes - leptospira, borrelia, pale spirochetes.

The spectrum of action of semi-synthetic penicillins is wider than that of natural ones.

Semi-synthetic groups of antibiotics from the list of the penicillin series are classified according to their spectrum of action, as:

• not active to Pseudomonas aeruginosa;
• antipseudomonal drugs.

Indications

As first-line drugs for the treatment of bacterial infections, antibiotics from the penicillin series are used in the treatment of:

• diseases of the respiratory system - pneumonia, bronchitis;
• ENT diseases - otitis media, tonsillitis, tonsillopharyngitis, scarlet fever;
• diseases of the urinary system - cystitis, pyelonephritis
• gonorrhea, syphilis;
• skin infections;
• osteomyelitis;
• blennorrhea of ​​newborns;
• bacterial lesions of the mucous membranes, connective tissue;
• leptospirosis, actinomycosis;
• meningitis.

natural penicillins

Natural benzylpenicillins are destroyed by both beta-lactamases and gastric juice. Preparations of this group are produced as medicines for injection:

• prolonged action - analogues with the names Bicillins numbered 1 and 5, novocaine salt of benzylpenicillin;
• short-acting - sodium, potassium salts of benzylpenicillin.

For a long time, they are released into the blood when intramuscularly administered depot forms of penicillins are slowly released from the muscle into the blood after an injection:

• Bicellins 1 and 5 - are prescribed 1 time per day;
• Benzylpenicillin novocaine salt - 2 - 3 rubles / day.

Aminopenicillins

Antibiotics from the list of aminopenicillins are effective against most infections caused by bacteria Enterobacteriaceae, Helicobacter pylori, Haemophilus influenzae, and other names of predominantly gram-negative bacteria.

The list of antibiotics of the aminopenicillins of the penicillin series includes drugs:

• ampicillin series;
  • Ampicillin trihydrate;
  • Ampicillin;
• amoxicillin;
  • Flemoxin Solutab;
  • Ospamox;
  • Amosin;
  • Ecoball.

The activity of antibiotics from the list of ampicillins and amoxicillins, the action spectra of drugs of these groups of penicillins are similar.

Antibiotics of the ampicillin series have a weaker effect on pneumococci, however, the activity of Ampicillin and its analogues with the names Ampicillin Akos, Ampicillin trihydrate is higher in relation to shigella.

Antibiotics of the group are prescribed:

• ampicillins - inside in tablets and injections in / m, in / in;
• amoxicillins - for oral administration.

The amoxicillin series is effective against Pseudomonas aeruginosa, but some members of the group are destroyed by bacterial penicillinases. Penicillins from the group of ampicillin antibiotics are resistant to penicillinase enzymes.

Antistaphylococcal penicillins

The group of antistaphylococcal penicillins includes antibiotics of the names:

• oxacillin;
• dicloxacillin;
• nafcillin;
• methicillin.

The drugs are resistant to staphylococcal penicillinases, which destroy other antibiotics of the penicillin series. The most famous of this group is the antistaphylococcal drug Oxacillin.

Antipseudomonal penicillins

Antibiotics of this group have a greater spectrum of action than aminopenicillins, they are effective against Pseudomonas aeruginosa, which causes severe cystitis, purulent tonsillitis, and skin infections.

The list of antipseudomonal penicillins includes:

• carboxypenicillins - drugs;
  • Carbetsin;
  • Piopen;
  • Carbenicillin disodium;
  • Timentin;
• a group of ureidopenicillins;
  • Secureopen;
  • Azlin;
  • baypen;
  • piperacillin Picillin.

Carbenicillin is available only as a powder for intramuscular injection. Antibiotics of this group are prescribed for adults.

Timentin is prescribed for severe infections of the genitourinary, respiratory system. Azlocillin and analogues are prescribed in injections for purulent-septic conditions:

• peritonitis;
• septic endocarditis;
• sepsis;
• lung abscess;
• severe infections of the genitourinary system.

Piperacillin is prescribed primarily for infections caused by Klebsiella.

Inhibitor-protected, combined agents

Inhibitor-protected penicillins include combined preparations, which include an antibiotic and a substance that blocks the activity of bacterial beta-lactamase.

As beta-lactamase inhibitors, of which there are about 500 varieties, are:

• clavulanic acid;
• tazobactam;
• sulbactam.

For the treatment of respiratory, genitourinary infections, mainly protected antibiotics of the penicillin series are used with the names:

• amoxicillin + clavunate;
  • Augmentin;
  • Amoxiclav;
  • Amoxil;
• ampicillin + sulbactam - Unazine.

From infections that occur against the background of weakened immunity, prescribe:

• ticarcillin + clavunate - Timentin;
• piperacillin + tazobactam - Tazocin.

Combined action drugs include the antibacterial agent Ampiox and its analogue Ampiox-sodium, including ampicillin + oxacillin.

Ampiox is available in tablets and as a powder for injection. Ampiox is used in the treatment of children and adults from severe sepsis, septic endocarditis, postpartum infection.

Penicillins for adults

The list of semi-synthetic penicillins, which are widely used for tonsillitis, otitis media, pharyngitis, sinusitis, pneumonia, includes drugs in tablets and injections:

• Hyconcil;
• Ospamox;
• Amoxiclav;
• Amoxicar;
• Ampicillin;
• Augmentin;
• Flemoxin Solutab;
• Amoxiclav;
• Piperacillin;
• Ticarcillin;

Against purulent, chronic pyelonephritis, bacterial cystitis, urethritis, endometritis, salpingitis in women, penicillins are prescribed:

• Augmentin;
• Amoxiclav;
• Ampicillin + sulbactam;
• Medoklav;
• Piperacillin + tazobactam;
• Ticarcillin with clavulanate.

Penicillins are not used against prostatitis, as they do not penetrate the prostate tissue.

With an allergy to penicillins, the patient may have urticaria, anaphylactic shock, and in the case of treatment with cephalosporins.

To avoid an allergic reaction, when allergic to beta-lactam antibiotics, which are penicillins and cephalosporins, antibiotics of the macrolide group are prescribed.

Exacerbation of chronic pyelonephritis in pregnant women is treated:

• Ampicillin;
• Amoxicillin + clavulanate;
• Ticarcillin + clavulanate;
• Oxacillin - with staphylococcal infection.

The list of non-penicillin antibiotics that a doctor may prescribe during pregnancy for tonsillitis, bronchitis or pneumonia includes drugs:

• cephalosporins;
  • Cefazolin;
  • Ceftriaxone;
• macrolides;
  • Azithromycin;
  • Clarithromycin.

Penicillins for the treatment of children

Penicillins are low-toxic antibiotics, which is why they are often prescribed for infectious diseases in children.

Preference in the treatment of children is given to inhibitor-protected penicillins intended for oral administration.

The list of penicillin antibiotics intended for the treatment of children includes Amoxicillin and analogues, Augmentin, Amoxiclav, Flemoxin and Flemoklav Solutab.

They are used to treat children and forms of the antibiotic Solutab of a non-penicillin series, the list includes analogues with names:

• Vilprafen Solutab;
• Unidox Solutab.

Medicines in the form of Solutab dispersible tablets are no less effective than injections, and cause less children's grief and tears during treatment. You can read about antibiotics in the form of dispersible effervescent tablets on the page "Antibiotic Solutab".

From birth, the drug Ospamox and a number of its analogues, which are produced in soluble tablets, granules and powder for suspension preparation, are used to treat children. The dosage is prescribed by the doctor, based on the age and weight of the child.

In children, the accumulation of penicillins in the body is possible, caused by the immaturity of the urinary system or kidney disease. An increased concentration of an antibiotic in the blood has a toxic effect on nerve cells, which is manifested by convulsions.

When such symptoms appear, treatment is stopped, and the antibiotic of the penicillin series is replaced by the child with a drug of another group.

Contraindications, side effects of penicillins

Allergy to penicillin analogues and cephalosporins is a contraindication for the use of the penicillin series. If a rash, itching appears during treatment, you need to stop taking the drugs and consult a doctor.

Allergy to penicillins can manifest as Quincke's edema, anaphylaxis.

The list of side effects of penicillins is small. The main negative manifestation is the suppression of beneficial intestinal microflora.

Diarrhea, candidiasis, skin rash - these are the main side effects from the use of penicillins. Less commonly, side effects of drugs of this series are manifested:

• nausea, vomiting;
• headache;
• pseudomembranous colitis;
• edema.

The use of certain groups of the penicillin series - benzylpenicillins, carbenicillins, can cause electrolyte imbalance with the occurrence of hyperkalemia or hypernatremia, which increases the risk of a heart attack, increased blood pressure.

A wider list of adverse reactions in oxacillin and analogues:

• violation of the leukocyte formula - low hemoglobin, low neutrophils;
• on the part of the kidneys in children - the appearance of blood in the urine;
• fever, vomiting, nausea.

To prevent the development of undesirable effects, it is necessary to follow the instructions for use, take the medicine in the dosage prescribed by the doctor.

For more information about each group of penicillin antibiotics, see the section "Drugs".

Antibiotics of the penicillin group are the first drugs created from the waste products of certain types of bacteria. In the general classification, penicillin antibiotics belong to the class of beta-lactam drugs. In addition to them, non-penicillin antibiotics are also included here: monobactams, cephalosporins and carbapenems.

The similarity is due to the fact that these drugs contain four-membered ring. All antibiotics of this group are used in chemotherapy and play an important role in the treatment of infectious diseases.

Properties of penicillin and its discovery

Before the discovery of antibiotics, many diseases seemed simply incurable, scientists and doctors around the world wanted to find a substance that could help defeat pathogenic microorganisms, while not causing damage to human health. People died from sepsis, wounds infected with bacteria, gonorrhea, tuberculosis, pneumonia and other dangerous and serious diseases.

A key moment in medical history is 1928 It was in this year that penicillin was discovered. Millions of human lives for this discovery are due to Sir Alexander Fleming. The accidental appearance of mold on the nutrient medium of the Penicillium notatum group in Fleming's laboratory and the observation of the scientist himself gave a chance to fight against infectious diseases.

After the discovery of penicillin, scientists faced only one task - to isolate this substance in its pure form. This case turned out to be quite complicated, but in the late 30s of the 20th century, two scientists Ernst Cheyne and Howard Flory managed to create a drug with an antibacterial effect.

Properties of antibiotics of the penicillin group

antibiotic penicillin inhibits the emergence and development pathogenic organisms such as:

This is only a small list of those pathogenic bacteria in which penicillin and all penicillin preparations suppress vital activity.

The antibiotic effect of penicillin is bactericidal or bacteriostatic. In the latter case, we are talking about the complete destruction of pathogenic organisms that caused the disease, most often acute and extremely severe. For diseases of moderate severity, antibiotics with a bacteriostatic effect are used - they do not allow bacteria to divide.

Penicillin is an antibiotic with a bactericidal effect. Microbes in their structure have a cell wall in which the main substance is peptidoglycan. This substance gives the bacterial cell stability, preventing it from dying even in very unsuitable conditions for life. By acting on the cell wall, penicillin destroys its integrity and disables its work.

In the human body, cell membranes do not contain peptidoglycan and therefore antibiotics of the penicillin group do not have a negative effect on our body. Also, we can talk about a small toxicity of these funds.

Penicillins have a wide range of dosages used, which is safer for the human body, since it makes it possible for a particular patient to choose a therapeutic dosage with minimal side effects.

The main part of penicillin is excreted from the body by the kidneys with urine (more than 70%). Some antibiotics of the penicillin group are excreted using the biliary system, that is, they are excreted with bile.

List of drugs and classification of penicillins

The basis of the chemical compound of the penicillin group is beta-lactam ring, therefore they belong to beta-lactama drugs.

Since penicillin has been used in medical practice for more than 80 years, some microorganisms have developed resistance to this antibiotic in the form of the beta-lactamase enzyme. The mechanism of the enzyme's work consists in the connection of the hydrolytic enzyme of a pathogenic bacterium with the beta-lactam ring, which in turn facilitates their binding, and as a result, the inactivation of the drug.

To date, semi-synthetic antibiotics are most often used: the chemical composition of a natural antibiotic is taken as a basis and subjected to useful modifications. Due to this, humanity can still resist various bacteria that constantly produce different antibiotic resistance mechanisms.

To date, the Federal Guidelines for the Use of Medicinal Products provides such a classification of penicillins.

Short acting natural antibiotics

Natural antibiotics do not contain beta-lactamase inhibitors, so they are never used against diseases caused by staphylococcus aureus.

Benzylpenicillin is active during treatment:

Side effects: for all antibiotics of the penicillin series, the main side effect is an allergic response of the body in the form of urticaria, anaphylactic shock, hyperthermia, Quincke's edema, skin rashes, nephritis. Possible failures in the work of the heart. During the introduction of significant dosages - convulsions (in children).

Restrictions on use and contraindications: hay fever, allergy to penicillin, impaired kidney function, arrhythmia, bronchial asthma.

Natural antibiotics with prolonged action

Benzylpenicillin benzathine is used in cases of:

• inflammation of the tonsils;
• syphilis;
• wound infections;
• scarlet fever.

It is also used to prevent complications after surgery.

Side effects: anemia, allergic response, abscess at the injection site of the antibiotic, headache, thrombocytopenia and leukopenia.

Contraindications: hay fever, bronchial asthma, propensity to allergies to penicillin.

Benzylpenicillin procaine is used in the treatment of:

It is used for relapses of erysipelas and rheumatism.

Side effect: convulsions, nausea, allergic reaction.

Contraindications: hypersensitivity to procaine and penicillin.

Antistaphylococcal agents

Oxacillin is the main representative of this group of antibiotics. The result of treatment is similar to benzylpenicillin, but unlike the second, this drug can destroy staphylococcal infections.

Side effects: skin rashes, urticaria. Rarely - anaphylactic shock, edema, fever, digestive disorders, vomiting, nausea, hematuria (in children), jaundice.

Contraindications: allergic reactions to penicillin.

Broad spectrum drugs

As an active substance, ampicillin is used in many antibiotics. Used to treat acute infections of the urinary and respiratory tract, infectious diseases of the digestive system, chlamydial infections, endocarditis, meningitis.

List of antibiotics that contain ampicillin: Ampicillin sodium salt, Ampicillin trihydrate, Ampicillin-Inotec, Ampicillin AMP-Forte, Ampicillin-AKOS, etc.

Amoxicillin is modified derivative of ampicillin. It is considered the main antibiotic, which is taken orally only. It is used for meningococcal infections, acute respiratory diseases, Lyme disease, inflammation of the gastrointestinal tract. It is used to prevent anthrax in women during pregnancy and children.

List of antibiotics that contain amoxicillin: Amoxicillin Sandoz, Amoxicar, Amoxicillin DS, Amoxicillin-ratiopharm, etc.

Side effects: dysbacteriosis, dyspeptic disorders, allergies, candidiasis, superinfection, CNS disorders.

Contraindications for this group of penicillins: hypersensitivity, mononucleosis, impaired liver function. Ampicillin is prohibited for newborns up to one month.

Antipseudomonal antibiotics

Carboxypenicillins contain active ingredient - carbenicillin. In this case, the name of the antibiotic is the same as the active ingredient. It is used in the treatment of diseases that are caused by Pseudomonas aeruginosa. Today, they are almost never used in medicine due to the availability of more powerful drugs.

Ureidopenicillins include: Azlocillin, Piperacillin, Mezlocillin.

Side effect: nausea, eating disorders, urticaria, vomiting. Possible headache, drug-induced fever, superinfection, impaired renal function.

Contraindications: pregnancy, high sensitivity to penicillin.

Features of the use of antibiotics of the penicillin group in children

The use of antibiotics in children's treatment is constantly given great attention, since the child's body has not yet fully formed and most organs and systems still not fully functional. Therefore, the choice of antibiotics for infants and growing children, doctors must be treated with great responsibility.

Penicillin in newborns is used for toxic diseases and sepsis. In the first years of life in children, it is used to treat otitis, pneumonia, meningitis, pleurisy.

With angina, SARS, cystitis, bronchitis, sinusitis, as a rule, children are prescribed Flemoxin, Amoxicillin, Augmentin, Amoxiclav. These antibiotics in relation to the child's body are the least toxic and the most effective.

Dysbacteriosis is one of the complications of antibiotic therapy, since beneficial microflora in children dies simultaneously with pathogenic microorganisms. Therefore, antibiotic treatment must be combined with the intake of probiotics. A rare side effect is an allergy to penicillin. in the form of a skin rash.

In infants, the excretory work of the kidneys is not sufficiently developed and the accumulation of penicillin is likely in the body. The result of this is the appearance of seizures.

Treatment with any antibiotics, even the latest generation, always has a significant impact on health. Naturally, they relieve the main infectious disease, but overall immunity is also significantly reduced. Since not only pathogenic bacteria die, but also healthy microflora. Therefore, it will take some time to restore the protective forces. If side effects are pronounced, especially those associated with the gastrointestinal tract, then a sparing diet is necessary.

Be sure to use probiotics and prebiotics (Bifidumbacterin, Linex, Bifiform, Acipol, etc.). The beginning of the reception must occur simultaneously with the start of the use of an antibacterial agent. At the same time, after a course of antibiotics, prebiotics and probiotics must be used for about 14 more days to populate the stomach with beneficial bacteria.

When antibiotics have a toxic effect on the liver, the use of hepatoprotectors can be recommended. These drugs will protect healthy liver cells and repair damaged ones.

Since immunity is reduced, the body is particularly susceptible to colds. Therefore, you need to take care of yourself and not overcool. Use immunomodulators, while it is desirable that they be of plant origin (purple Echinacea, Immunal).

If the disease is of viral etiology, then in this case antibiotics are powerless, even the latest generation and a wide spectrum of action. They can only serve as a prophylaxis in joining a bacterial viral infection. Antivirals are used to treat viruses.

To reduce the need to use antibiotics and get sick less often, it is necessary to lead a healthy lifestyle. The most important thing is not to overdo it with the use of antibacterial agents in order to prevent the development of bacterial resistance to them. Otherwise, it will not be possible to cure any infection. Therefore, always consult your doctor before using any antibiotic.

Antibiotics of the penicillin series are universal drugs that allow you to timely and effectively rid a person of bacterial pathologies. At the root of these medicines are mushrooms, living organisms that annually save millions of people around the world.

The history of the discovery of antibacterial agents of the penicillin series dates back to the 30s of the 20th century, when the scientist Alexander Fleming, who studied bacterial infections, accidentally identified an area in which bacteria did not grow. As further research showed, such a place in the bowl was mold, which usually covers stale bread.

As it turned out, this substance easily killed staphylococci. After additional research, the scientist was able to isolate penicillin in its pure form, which became the first antibacterial agent.

The principle of operation of this substance is as follows: during cell division of bacteria, to restore their own broken shell, these substances use elements called peptidoglycans. Penicillin does not allow the formation of this substance, which is why bacteria lose their ability not only to reproduce, but also to further develop, and are destroyed.

However, not everything went smoothly, after a while, the bacterial cells began to actively produce an enzyme called beta-lactamase, which began to destroy the beta-lactams that form the basis of penicillins. To solve this problem, additional components, for example, clavulonic acid, were added to the composition of antibacterial agents.

Action spectrum

After penetration into the human body, the drug easily spreads through all tissues, biological fluids. The only areas where it penetrates in very small amounts (up to 1%) are the cerebrospinal fluid, the organs of the visual system and the prostate gland.

The drug is excreted outside the body through the work of the kidneys, after about 3 hours.

The antibiotic effect of the natural variety of the drug is achieved by combating such bacteria:

• gram-positive (staphylococci, pneumococci, streptococci, bacilli, listeria);
• gram-negative (gonococci, meningococci);
• anaerobic (clostridia, actiminocetes, fusobacteria);
• spirochetes (pale, leptospira, borrelia);
• effective against Pseudomonas aeruginosa.

Penicillin antibiotics are used to treat various pathologies:

• infectious diseases of moderate severity;
• diseases of ENT organs (scarlet fever, tonsillitis, otitis media, pharyngitis);
• respiratory infections (bronchitis, pneumonia);
• diseases of the genitourinary system (cystitis, pyelonephritis);
• gonorrhea;
• syphilis;
• skin infections;
• osteomyelitis;
• blennorrhea that occurs in newborns;
• leptospirosis;
• meningitis;
• actinomycosis;
• bacterial lesions of mucous and connective tissues.

Antibiotics classification

Penicillin antibiotics have different production methods, as well as properties, which allows us to divide them into 2 large groups.

1. Natural, which were discovered by Fleming.
2. Semi-synthetic, were created a little later in 1957.

Specialists have developed a classification of antibiotics of the penicillin group.

Natural include:

• phenoxymethylpenicillin (Ospen, as well as its analogues);
• benzathine benzylpenicillin (Retarpen);
• benzylpenicillin sodium salt (Procaine penicillin).

It is customary to refer to the group of semi-synthetic agents:

• aminopenicillin (amoxicillins, ampicillins);
• antistaphylococcal;
• antipeseudomonas (ureidopenicillins, carboxypenicillins);
• inhibitor-protected;
• combined.

natural penicillins

Natural antibiotics have one weakness: they can be destroyed by the action of beta-lactamase, as well as gastric juice.

Medicines belonging to this group are in the form of solutions for injection:

• with an extended action: this includes a substitute for penicillin - bicillin, as well as novocaine salt of benzylpenicillins;
• with little action: sodium and potassium salts of benzylpenicillins.

Prolonged penicillins are administered once a day by intramuscular route, and novocaine salt - from 2 to 3 times a day.

Biosynthetic

The penicillin series of antibiotics consists of acids, which, through the necessary manipulations, are combined with sodium and potassium salts. Such compounds are characterized by rapid absorption, which allows them to be used for injection.

As a rule, the therapeutic effect is noticeable already a quarter of an hour after the administration of the drug, and it lasts for 4 hours (therefore, the drug requires repeated administration).

To prolong the effect of natural benzylpenicillin, it was combined with novocaine and some other components. The addition of novocaine salts to the main substance made it possible to lengthen the therapeutic effect achieved. Now it has become possible to reduce the number of injections to two or three per day.

Biosynthetic penicillins are used to treat such diseases:

• chronic rheumatism;
• syphilis;
• streptococcus.

For the treatment of moderate infections, phenoxylmethylpenicillin is used. This variety is resistant to the damaging effects of hydrochloric acid, which is contained in gastric juice.

This substance is available in tablets for which oral administration is allowed (4-6 times a day). Biosynthetic penicillins work against most bacteria, with the exception of spirochetes.

Semi-synthetic antibiotics related to the penicillin series

This type of drugs includes several subgroups of medicines.

Aminopenicillins actively work against: enterobacteria, Haemophilus influenzae, Helicobacter pylori. These include such drugs: ampicillin series (Ampicillin), amoxicillin (Flemoxin Solutab).

The activity of both subgroups of antibacterial agents extends to similar types of bacteria. However, ampicillins do not fight pneumococci very effectively, but some of their varieties (for example, Ampicillin trihydrate) easily cope with shigella.

The drugs in this group are used as follows:

1. Ampicillins by intravenous and intramuscular infections.
2. Amoxicillins by oral administration.

Amoxicillins actively fight Pseudomonas aeruginosa, but, unfortunately, some of the representatives of this group can be destroyed by bacterial penicillinases.

The antistaphylococcal subgroup includes: Methicillin, Nafitillin, Oxacillin, Fluxocillin, Dicloxacillin. These drugs are resistant to staphylococci.

The antipseudomonal subgroup, as the name implies, actively fights against Pseudomonas aeruginosa, which provokes the appearance of severe forms of tonsillitis, cystitis.

This list includes two types of drugs:

1. Carboxypenicillins: Carbetsin, Timentin (for the treatment of severe lesions of the urinary tract and respiratory organs), Piopen, disodium Carbinicillin (used only in adult patients by intramuscular, intravenous administration).
2. Ureidopenicillins: Picillin piperacillin (used more often for pathologies provoked by Klebsiella), Securopen, Azlin.

Combined antibiotics from the penicillin series

Combination drugs are also called inhibitor-protected drugs, which means that they block bacterial beta-lactamase.

The list of beta-lactamase inhibitors is very large, the most common are:

• clavulonic acid;
• sulbactam;
• tazobactam.

For the purpose of treating pathologies from the organs of the respiratory, genitourinary systems, the following antibacterial compounds are used:

• amoxicillin and clavulonic acid (Augmentin, Amoxil, Amoxiclav);
• ampicillin and sulbactam (Unazine);
• ticarcillin and clavulonic acid (Timentin);
• piperacillin and tazobactam (Tazocin);
• ampicillin and oxacillin (Ampiox sodium).

Penicillins for adults

Semi-synthetic drugs are actively used to combat sinusitis, otitis, pneumonia, pharyngitis, tonsillitis. For adults, there is a list of the most effective drugs:

• Augmentin;
• Amoxicar;
• Ospamox;
• Amoxicillin;
• Amoxiclav;
• Ticarcillin;
• Flemoxin Solutab.

To get rid of pyelonephritis (purulent, chronic), cystitis (bacterial), urethritis, salpingitis, endometritis, apply:

• Augmentin;
• Medoklav;
• amoxiclav;
• Ticarcillin with clavulonic acid.

When a patient suffers from an allergy to penicillin drugs, he may have an allergic reaction in response to taking such drugs (this can be a simple urticaria, or a severe reaction with the development of anaphylactic shock). In the presence of such reactions, the patient is shown to use funds from the group of macrolides.

• Ampicillin;
• Oxacillin (in the presence of the pathogen - staphylococcus aureus);
• Augmentin.

In case of intolerance to the penicillin group, the doctor may recommend the use of a group of reserve antibiotics in relation to penicillins: cephalosporins (Cefazolin) or macrolides (Clarithromycin).

Penicillins for the treatment of children

Based on penicillins, many antibacterial agents have been created, some of them are approved for use in pediatric patients. These drugs are characterized by low toxicity and high efficiency, which allows them to be used in young patients.

For babies, inhibitor-protected agents used orally are used.

Children are prescribed such antibiotics:

• Flemoklav Solutab;
• Augmentin;
• Amoxiclav;
• Amoxicillin;
• flemoxin.

Non-penicillin forms include Vilprafen Solutab, Unidox Solutab.

The word "solutab" means that the tablets dissolve when exposed to liquid. This fact facilitates the process of drug use by young patients.

Many antibiotics of the penicillin group are produced in the form of suspensions that look like a sweet syrup. To determine the dosage for each patient, it is necessary to take into account indicators of his age and body weight.

Only a specialist can prescribe antibacterial agents for children. Self-medication with the use of such drugs is not allowed.

Contraindications side effects of penicillins

Not all categories of patients can use penicillin drugs, despite all their effectiveness and benefits; the instructions for the drugs contain a list of conditions when the use of such drugs is prohibited.

Contraindications:

• hypersensitivity, personal intolerance or strong reactions to the components of the drug;
• previous reactions to cephalosporins, penicillins;
• violations of the functioning of the liver, kidneys.

Each drug has its own list of contraindications, indicated by the instructions, you should familiarize yourself with it even before starting drug therapy.

As a rule, penicillin antibiotics are well tolerated by patients. But, in rare cases, negative manifestations may occur.

Side effects:

• allergic reactions are manifested by skin rash, urticaria, tissue swelling, itching, other rashes, Quincke's edema, anaphylactic shock;
• on the part of the digestive tract, nausea, epigastric pain, digestive disorders may appear;
• circulatory system: an increase in blood pressure, heart rhythm disturbances;
• liver and kidneys: the development of insufficiency in the functioning of these organs.

To prevent the development of adverse reactions, it is very important to take antibiotics only as prescribed by the doctor, be sure to use auxiliary agents (for example, probiotics) that he recommends.

Mushrooms are the kingdom of living organisms. Mushrooms are different: some of them get into our diet, some cause skin diseases, some are so poisonous that they can lead to death. But mushrooms of the genus Penicillium save millions of human lives from pathogenic bacteria.

Antibiotics of the penicillin series based on this mold (mold is also a fungus) are still used in medicine.

In the 30s of the last century, Alexander Fleming conducted experiments with staphylococci. He studied bacterial infections. After growing a group of these pathogens in a nutrient medium, the scientist noticed that there were areas in the cup that were not surrounded by live bacteria. The investigation showed that the usual green mold, which likes to settle on stale bread, is to blame for these spots. The mold was called Penicillium and, as it turned out, produced a substance that kills staphylococci.

Fleming went deeper into the subject and soon isolated pure penicillin, which became the world's first antibiotic. The principle of the drug is as follows: when a bacterial cell divides, each half restores its cell membrane with the help of a special chemical element, peptidoglycan. Penicillin blocks the formation of this element, and the bacterial cell simply "resolves" in the environment.

But difficulties soon arose. Bacteria cells learned to resist the drug - they began to produce an enzyme called "beta-lactamase", which destroys beta-lactams (the basis of penicillin).

The next 10 years there was an invisible war between pathogens that destroy penicillin, and scientists that modify this penicillin. So many modifications of penicillin were born, which now form the entire penicillin series of antibiotics.

The drug for any kind of application spreads rapidly throughout the body, penetrating almost all its parts. Exceptions: cerebrospinal fluid, prostate gland and visual system. In these places, the concentration is very low, under normal conditions it does not exceed 1 percent. With inflammation, a rise of up to 5% is possible.

Antibiotics do not affect the cells of the human body, since the latter do not contain peptidoglycan.

The drug is quickly excreted from the body, after 1-3 hours most of it is excreted through the kidneys.

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All drugs are divided into: natural (short and prolonged action) and semi-synthetic (anti-staphylococcal, broad-spectrum drugs, antipseudomonal).

These drugs obtained directly from the mold. At the moment, most of them are obsolete, as pathogens have become immune to them. In medicine, benzylpenicillin and Bicillin are most often used, which are effective against gram-positive bacteria and cocci, some anaerobic and spirochetes. All these antibiotics are used only in the form of injections into the muscles, since the acidic environment of the stomach quickly destroys them.

Benzylpenicillin in the form of sodium and potassium salts is a short-acting natural antibiotic. Its action stops after 3-4 hours, so frequent repeated injections are necessary.

Trying to eliminate this drawback, pharmacists have created natural long-acting antibiotics: Bicillin and novocaine salt of benzylpenicillin. These drugs are called "depot-forms", because after injection into the muscle they form a "depot" in it, from which the drug is slowly absorbed into the body.

Examples of drugs: benzylpenicillin salt (sodium, potassium or novocaine), Bicillin-1, Bicillin-3, Bicillin-5.

Several decades after receiving penicillin pharmacists were able to isolate its main active ingredient, and the modification process began. Most drugs, after improvement, acquired resistance to the acidic environment of the stomach, and semi-synthetic penicillins began to be produced in tablets.

Isoxazolpenicillins are drugs that are effective against staphylococci. The latter have learned to produce an enzyme that destroys benzylpenicillin, and drugs from this group prevent the production of the enzyme. But you have to pay for the improvement - drugs of this type are less absorbed into the body and have a smaller spectrum of action compared to natural penicillins. Examples of drugs: Oxacillin, Nafcillin.

Aminopenicillins are broad-spectrum drugs. They are inferior to benzylpenicillins in terms of strength in the fight against gram-positive bacteria, but they capture a larger range of infections. Compared to other drugs, they stay in the body longer and better penetrate some of the body's barriers. Examples of drugs: Ampicillin, Amoxicillin. You can often find Ampiox - Ampicillin + Oxacillin.

Carboxypenicillins and ureidopenicillins antibiotics effective against Pseudomonas aeruginosa. At the moment, they are practically not used, since infections quickly acquire resistance to them. Occasionally, you can find them as part of a comprehensive treatment.

Examples of drugs: Ticarcillin, Piperacillin

Sumamed

Active ingredient: azithromycin.

Indications: Respiratory infections.

Contraindications: intolerance, severe renal failure, children under 6 months of age.

Price: 300-500 rubles.

Oxacillin

Active ingredient: oxacillin.

Indications: infections sensitive to the drug.

Price: 30-60 rubles.

Amoxicillin Sandoz

Indications: respiratory tract infections (including tonsillitis, bronchitis), urinary tract infections, skin infections, other infections.

Contraindications: intolerance, children under 3 years of age.

Price: 150 rubles.

Ampicillin trihydrate

Indications: pneumonia, bronchitis, tonsillitis, other infections.

Contraindications: hypersensitivity, liver failure.

Price: 24 rubles.

Phenoxymethylpenicillin

Active ingredient: phenoxymethylpenicillin.

Indications: streptococcal diseases, infections of mild and moderate severity.

Price: 7 rubles.

Amoxiclav

Active ingredient: amoxicillin + clavulanic acid.

Indications: infections of the respiratory tract, urinary system, infections in gynecology, other infections sensitive to amoxicillin.

Contraindications: hypersensitivity, jaundice, mononucleosis and lymphocytic leukemia.

Price: 116 rubles.

injections

Bicillin-1

Active ingredient: benzathine benzylpenicillin.

Indications: acute tonsillitis, scarlet fever, wound infections, erysipelas, syphilis, leishmaniasis.

Contraindications: hypersensitivity.

Price: 15 rubles per injection.

Ospamox

Active ingredient: amoxicillin.

Indications: infections of the lower and upper respiratory tract, gastrointestinal tract, genitourinary system, gynecological and surgical infections.

Contraindications: hypersensitivity, severe gastrointestinal infections, lymphocytic leukemia, mononucleosis.

Price: 65 rubles.

Ampicillin

Active ingredient: ampicillin.

Indications: infections of the respiratory and urinary tract, gastrointestinal tract, meningitis, endocarditis, sepsis, whooping cough.

Contraindications: hypersensitivity, impaired renal function, childhood, pregnancy.

Price: 163 rubles.

Benzylpenicillin

Indications: severe infections, congenital syphilis, abscesses, pneumonia, erysipelas, anthrax, tetanus.

Contraindications: intolerance.

Price: 2.8 rubles per injection.

Benzylpenicillin novocaine salt

Active ingredient: benzylpenicillin.

Indications: Similar to benzylpenicillin.

Contraindications: intolerance.

Price: 43 rubles for 10 injections.

For the treatment of children, Amoxiclav, Ospamox, Oxacillin are suitable. But Before using the medicine, you must always consult with your doctor to adjust the dose.

Indications for use

Antibiotics of the penicillin group are prescribed for infections, the type of antibiotics is selected based on the type of infection. It can be various cocci, bacilli, anaerobic bacteria, and so on.

Most often, antibiotics treat infections of the respiratory tract and genitourinary system.

In the case of treating children, you need to follow the instructions of the doctor, who will prescribe the desired antibiotic and adjust the dose.

In case of pregnancy, antibiotics should be used with extreme caution, as they penetrate the fetus. During lactation, it is better to switch to mixtures, as the medicine also penetrates into milk.

For the elderly, there are no special instructions, although the doctor should take into account the condition of the patient's kidneys and liver when prescribing treatment.

The main and often the only contraindication is individual intolerance. It occurs frequently - in about 10% of patients. Additional contraindications depend on the specific antibiotic and are prescribed in the instructions for use.

In case of side effects, you should immediately seek medical help, stop the drug and carry out symptomatic treatment.

Where does penicillin mold grow?

Almost everywhere. This mold includes dozens of subspecies, and each of them has its own habitat. The most notable are the penicillin mold that grows on bread (which also infects apples, causing them to rot quickly) and the mold used in the production of some cheeses.

How to replace penicillin antibiotics?

If the patient is allergic to penicillin, non-penicillin antibiotics can be used. Names of drugs: Cefadroxil, Cefalexin, Azithromycin. The most popular option is Erythromycin. But you need to know that Erythromycin often causes dysbacteriosis and indigestion.

Antibiotics from the penicillin series are a strong remedy against infections caused by various bacteria. There are quite a few of them, and treatment must be selected in accordance with the type of pathogen.

They seem harmless to the body due to the fact that the only contraindication is a hypersensitivity reaction, but improper treatment or self-medication can provoke resistance of the pathogen to the antibiotic, and you will have to select another treatment that is more dangerous and less effective.

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Familiar today antibacterial drugs less than a century ago made a real revolution in medicine. Mankind has received a powerful weapon to fight infections that were previously considered fatal.

The first were the antibiotics penicillins, which saved many thousands of lives during the Second World War, and are relevant in modern medical practice. It was with them that the era of antibiotic therapy began and thanks to them all other antimicrobial drugs were obtained.

This section provides a complete list of currently relevant antimicrobial drugs. In addition to the characteristics of the main compounds, all trade names and analogues are given.

Main title	Antimicrobial activity	Analogues
Benzylpenicillin potassium and sodium salts	Influence mainly on gram-positive microorganisms. Currently, most strains have developed resistance, but spirochetes are still sensitive to the substance.	Gramox-D, Ospen, Star-Pen, Ospamox
benzylpenicillin procaine	Indicated for the treatment of streptococcal and pneumococcal infections. Compared to potassium and sodium salts, it acts longer, as it dissolves and is absorbed more slowly from the intramuscular depot.	Benzylpenicillin-KMP (-G, -Teva, -G 3 mega)
Bicillins (1, 3 and 5)	It is used for chronic rheumatism with a prophylactic purpose, as well as for the treatment of infectious diseases of moderate and mild severity caused by streptococci.	Benzicillin-1, Moldamine, Extincillin, Retarpin
Phenoxymethylpenicillin	It has a therapeutic effect similar to the previous groups, but is not destroyed in an acidic gastric environment. Produced in the form of tablets.	V-Penicillin, Kliacil, Ospen, Penicillin-Fau, Vepicombin, Megacillin Oral, Pen-os, Star-Pen
Oxacillin	Active against staphylococci that produce penicillinase. It is characterized by low antimicrobial activity, it is completely ineffective against penicillin-resistant bacteria.	Oxamp, Ampiox, Oxamp-Sodium, Oxamsar
Ampicillin	Extended spectrum of antimicrobial activity. In addition to the main spectrum of inflammatory diseases of the gastrointestinal tract, it also treats those caused by Escherichia, Shigella, Salmonella.	Ampicillin AMP-KID (-AMP-Forte, -Ferein, -AKOS, -trihydrate, -Innotek), Zetsil, Pentrixil, Penodil, Standacillin
Amoxicillin	It is used to treat inflammation of the respiratory and urinary tract. After clarifying the bacterial origin of gastric ulcers, Helicobacter pylori is used for eradication.	Flemoxin solutab, Hikoncil, Amosin, Ospamox, Ecobol
Carbenicillin	The spectrum of antimicrobial action includes Pseudomonas aeruginosa and enterobacteria. The digestibility and bactericidal effect is higher than that of Carbenicillin.	Securopen
Piperacillin	Similar to the previous one, but the level of toxicity is increased.	Isipen, Pipracil, Picillin, Piprax
Amoxicillin/clavulanate	Due to the inhibitor, the spectrum of antimicrobial activity is expanded compared to the unprotected agent.	Augmentin, Flemoklav solutab, Amoxiclav, Amklav, Amovikomb, Verklav, Ranklav, Arlet, Klamosar, Rapiclav
Ampicillin/sulbactam		Sulacillin, Liboksil, Unazine, Sultasin
Ticarcillin/clavulanate	The main indication for use is nosocomial infections.	Gimentin
Piperacillin/tazobactam		Tazocin

The information provided is for informational purposes and is not a guide to action. All appointments are made exclusively by a doctor, and therapy is under his control.

Despite the low toxicity of penicillins, their uncontrolled use leads to serious consequences: the formation of resistance in the pathogen and the transition of the disease to a chronic form that is difficult to cure. It is for this reason that most strains of pathogenic bacteria are resistant to first-generation ABP today.

Use for antibiotic therapy should be exactly the medication that was prescribed by a specialist. Independent attempts to find a cheap analogue and save money can lead to a deterioration in the condition.

For example, the dosage of the active substance in a generic may differ up or down, which will negatively affect the course of treatment.

When you have to replace the medicine due to an acute lack of finances, you need to ask the doctor about it, since only a specialist can choose the best option.

Preparations of the penicillin group belong to the so-called beta-lactams - chemical compounds that have a beta-lactam ring in their formula.

This structural component is of decisive importance in the treatment of bacterial infectious diseases: it prevents the production of a special peptidoglycan biopolymer by bacteria, which is necessary for the construction of the cell membrane. As a result, the membrane cannot form and the microorganism dies. There is no destructive effect on human and animal cells for the reason that they do not contain peptidoglycan.

Medications based on the waste products of mold fungi are widely used in all areas of medicine due to the following properties:

• High bioavailability - drugs are quickly absorbed and distributed through the tissues. The weakening of the blood-brain barrier during inflammation of the meninges also contributes to the penetration into the cerebrospinal fluid.
• Broad spectrum of antimicrobial action. Unlike first-generation chemicals, modern penicillins are effective against the vast majority of gram-negative and positive bacteria. They are also resistant to penicillinase and the acidic environment of the stomach.
• The lowest toxicity among all ABPs. They are approved for use even during pregnancy, and the correct intake (as prescribed by the doctor and according to the instructions) almost completely eliminates the development of side effects.

In the process of research and experiments, many medications with different properties were obtained. For example, when belonging to the general series, penicillin and ampicillin are not the same thing. All penicillin antibiotics are well compatible with most other drugs. As for complex therapy with other types of antibacterial drugs, the combined use with bacteriostatics weakens the effectiveness of penicillins.

Careful study of the properties of the first antibiotic showed its imperfection. Despite a fairly wide range of antimicrobial activity and low toxicity, natural penicillin turned out to be sensitive to a special destructive enzyme (penicillinase) produced by some bacteria. In addition, it completely lost its qualities in an acidic gastric environment, therefore it was used exclusively in the form of injections. In search of more effective and stable compounds, various semi-synthetic drugs have been created.

To date, penicillin antibiotics, a complete list of which is given below, are divided into 4 main groups.

Produced by the fungi Penicillium notatum and Penicillium chrysogenum, benzylpenicillin is an acid in molecular structure. For medical purposes, it combines chemically with sodium or potassium to form salts. The resulting compounds are used to prepare injection solutions that are rapidly absorbed.

The therapeutic effect is noted within 10-15 minutes after administration, but lasts no more than 4 hours, which requires frequent repeated injections into muscle tissue (in special cases, sodium salt can be administered intravenously).

These drugs penetrate well into the lungs and mucous membranes, and to a lesser extent into the cerebrospinal and synovial fluids, myocardium and bones. However, with inflammation of the meninges (meningitis), the permeability of the blood-brain barrier increases, which allows for successful treatment.

To prolong the effect of the drug, natural benzylpenicillin combines with novocaine and other substances. The resulting salts (novocaine, Bicillin-1, 3 and 5) after intramuscular injection form a drug depot at the injection site, from where the active substance enters the blood constantly and at a low speed. This property allows you to reduce the number of injections up to 2 times a day while maintaining the therapeutic effect of potassium and sodium salts.

These drugs are used for long-term antibiotic therapy of chronic rheumatism, syphilis, focal streptococcal infection.
Phenoxymethylpenicillin is another form of benzylpenicillin used to treat mild infections. It differs from those described above in resistance to hydrochloric acid of gastric juice.

This quality allows the drug to be produced in the form of tablets for oral administration (from 4 to 6 times a day). Most pathogenic bacteria are currently resistant to biosynthetic penicillins, except for spirochetes.

See also: Instructions for the use of penicillin in injections and tablets

Natural benzylpenicillin is inactive against strains of staphylococcus that produce penicillinase (this enzyme destroys the beta-lactam ring of the active substance).

For a long time, penicillin was not used to treat staphylococcal infections, until oxacillin was synthesized on its basis in 1957. It inhibits the activity of beta-lactamases of the pathogen, but is ineffective against diseases caused by benzylpenicillin-sensitive strains. This group also includes cloxacillin, dicloxacillin, methicillin and others, almost not used in modern medical practice due to increased toxicity.

This includes two subgroups of antimicrobials intended for oral use and having a bactericidal effect against most pathogens (both gram+ and gram-).

Compared with the previous group, these compounds have two significant advantages. Firstly, they are active against a wider range of pathogens, and secondly, they are available in tablet form, which greatly facilitates the use. The disadvantages include sensitivity to beta-lactamase, that is, aminopenicillins (ampicillin and amoxicillin) are unsuitable for the treatment of staphylococcal infections.

However, in combination with oxacillin (Ampioks) they become resistant.

The preparations are well absorbed and act for a long time, which reduces the frequency of use to 2-3 times per 24 hours. The main indications for use are meningitis, sinusitis, otitis, infectious diseases of the urinary and upper respiratory tract, enterocolitis and eradication of Helicobacter (causative agent of stomach ulcers). A common side effect of aminopenicillins is a characteristic non-allergic rash that disappears immediately after withdrawal.

They are a separate penicillin series of antibiotics, from the name of which the purpose becomes clear. Antibacterial activity is similar to aminopenicillins (with the exception of Pseudomonas) and is pronounced against Pseudomonas aeruginosa.

According to the degree of efficiency are divided into:

• Carboxypenicillins, the clinical significance of which has recently been declining. Carbenicillin, the first of this subgroup, is also effective against ampicillin-resistant Proteus. Currently, almost all strains are resistant to carboxypenicillins.
• Ureidopenicillins are more effective against Pseudomonas aeruginosa, and can also be prescribed for inflammation caused by Klebsiella. The most effective are Piperacillin and Azlocillin, of which only the latter remains relevant in medical practice.

To date, the vast majority of strains of Pseudomonas aeruginosa are resistant to carboxypenicillins and ureidopenicillins. For this reason, their clinical significance is reduced.

The ampicillin group of antibiotics, highly active against most pathogens, is destroyed by penicillinase-forming bacteria. Since the bactericidal action of oxacillin resistant to them is much weaker than that of ampicillin and amoxicillin, combined drugs were synthesized.

In combination with sulbactam, clavulanate and tazobactam, antibiotics receive a second beta-lactam ring and, accordingly, immunity to beta-lactamases. In addition, inhibitors have their own antibacterial effect, enhancing the main active ingredient.

Inhibitor-protected drugs successfully treat severe nosocomial infections, strains of which are resistant to most drugs.

See also: About the modern classification of antibiotics by group of parameters

An extensive spectrum of action and good patient tolerance have made penicillin the optimal treatment for infectious diseases. At the dawn of the era of antimicrobial drugs, benzylpenicillin and its salts were the drugs of choice, but at the moment most pathogens are resistant to them. Nevertheless, modern semi-synthetic penicillin antibiotics in tablets, injections and other dosage forms occupy one of the leading places in antibiotic therapy in various fields of medicine.

Another discoverer noted the special effectiveness of penicillin against pathogens of respiratory diseases, so the drug is most widely used in this area. Almost all of them have a detrimental effect on bacteria that cause sinusitis, meningitis, bronchitis, pneumonia and other diseases of the lower and upper respiratory tract.

Inhibitor-protected agents treat even particularly dangerous and persistent nosocomial infections.

Spirochetes are one of the few microorganisms that have retained susceptibility to benzylpenicillin and its derivatives. Benzylpenicillins are also effective against gonococci, which makes it possible to successfully treat syphilis and gonorrhea with minimal negative effects on the patient's body.

Inflammation of the intestines caused by pathogenic microflora responds well to therapy with acid-resistant drugs.

Of particular importance are aminopenicillins, which are part of the complex eradication of Helicobacter.

In obstetric and gynecological practice, many penicillin preparations from the list are used both to treat bacterial infections of the female reproductive system and to prevent infection in newborns.

Here, penicillin antibiotics also occupy a worthy place: keratitis, abscesses, gonococcal conjunctivitis and other eye diseases are treated with eye drops, ointments and injection solutions.

Diseases of the urinary system, which are of bacterial origin, respond well to therapy only with inhibitor-protected drugs. The remaining subgroups are ineffective, since the strains of pathogens are highly resistant to them.

Penicillins are used in almost all areas of medicine for inflammation caused by pathogenic microorganisms, and not only for treatment. For example, in surgical practice, they are prescribed to prevent postoperative complications.

Treatment with antibacterial medications in general and penicillins in particular should be carried out only on prescription. Despite the minimal toxicity of the drug itself, its improper use seriously harms the body. In order for antibiotic therapy to lead to recovery, you should follow medical recommendations and know the characteristics of the drug.

The scope of application of penicillin and various preparations based on it in medicine is due to the activity of the substance with respect to specific pathogens. Bacteriostatic and bactericidal effects are manifested in relation to:

• Gram-positive bacteria - gonococci and meningococci;
• Gram-negative - various staphylococci, streptococci and pneumococci, diphtheria, Pseudomonas aeruginosa and anthrax, Proteus;
• Actinomycetes and spirochetes.

Low toxicity and a broad spectrum of action make antibiotics of the penicillin group the best treatment for tonsillitis, pneumonia (both focal and croupous), scarlet fever, diphtheria, meningitis, blood poisoning, septicemia, pleurisy, pyemia, osteomyelitis in acute and chronic forms, septic endocarditis, various purulent infections of the skin, mucous membranes and soft tissues, erysipelas, anthrax, gonorrhea, actinomycosis, syphilis, blennorrhea, as well as eye diseases and ENT diseases.

Strict contraindications include only individual intolerance to benzylpenicillin and other drugs in this group. Also, endolumbar (injection into the spinal cord) administration of drugs to patients with diagnosed epilepsy is not allowed.

During pregnancy, antibiotic therapy with penicillin preparations should be treated with extreme caution. Despite the fact that they have a minimal teratogenic effect, it is worth prescribing tablets and injections only in case of urgent need, assessing the degree of risk to the fetus and the pregnant woman herself.

Since penicillin and its derivatives freely penetrate from the bloodstream into breast milk, it is advisable to refuse breastfeeding for the duration of therapy. The medicine can provoke a severe allergic reaction in the baby even at the first use. To prevent lactation, milk must be expressed regularly.

Among other antibacterial agents, penicillins are favorably distinguished by their low toxicity.

Undesirable effects of use include:

• Allergic reactions. Most often manifested by skin rash, itching, urticaria, fever and swelling. Extremely rarely, in severe cases, anaphylactic shock is possible, requiring the immediate administration of an antidote (adrenaline).
• Dysbacteriosis. Imbalance of the natural microflora leads to digestive disorders (flatulence, bloating, constipation, diarrhea, abdominal pain) and the development of candidiasis. In the latter case, the mucous membranes of the oral cavity (in children) or the vagina are affected.
• neurotoxic reactions. The negative effect of penicillin on the central nervous system is manifested by increased reflex excitability, nausea and vomiting, convulsions, and sometimes coma.

To prevent the development of dysbacteriosis and avoid allergies, timely medical support of the body will help. It is desirable to combine antibiotic therapy with the intake of pre- and probiotics, as well as desensitizers (if sensitivity is increased).

For children, tablets and injections should be prescribed carefully, given the possible negative reaction, and the choice of a particular drug should be approached thoughtfully.

In the first years of life, benzylpenicillin is used in case of sepsis, pneumonia, meningitis, otitis media. For the treatment of respiratory infections, tonsillitis, bronchitis and sinusitis, the safest antibiotics from the list are selected: Amoxicillin, Augmentin, Amoxiclav.

The body of a child is much more sensitive to drugs than that of an adult. Therefore, you should carefully monitor the condition of the baby (penicillin is excreted slowly and, accumulating, can cause convulsions), as well as take preventive measures. The latter include the use of pre- and probiotics to protect the intestinal microflora, diet and comprehensive strengthening of immunity.

A little theory:

The discovery that made a real revolution in medicine at the beginning of the 20th century was made by accident. I must say that the antibacterial properties of mold fungi were noticed by people in ancient times.

Alexander Fleming - discoverer of penicillin

The Egyptians, for example, even 2500 years ago treated inflamed wounds with compresses from moldy bread, but scientists took up the theoretical side of the issue only in the 19th century. European and Russian researchers and doctors, studying antibiosis (the property of some microorganisms to destroy others), made attempts to derive practical benefits from it.

Alexander Fleming, a British microbiologist, succeeded in this, who in 1928, on September 28, found mold in Petri dishes with staphylococcus colonies. Its spores, which fell on the crops due to the negligence of the laboratory staff, germinated and destroyed the pathogenic bacteria. Interested Fleming carefully studied this phenomenon and isolated a bactericidal substance called penicillin. For many years, the discoverer worked on obtaining a chemically pure stable compound suitable for treating people, but others invented it.

In 1941, Ernst Chain and Howard Flory were able to purify penicillin from impurities and conducted clinical trials with Fleming. The results were so successful that by the year 1943, the United States organized mass production of the drug, which saved many hundreds of thousands of lives during the war. The merits of Fleming, Cheyne and Flory before mankind were appreciated in 1945: the discoverer and developers became Nobel Prize winners.

Subsequently, the initial chemical preparation was constantly improved. This is how modern penicillins appeared, resistant to the acidic environment of the stomach, resistant to penicillinase and more effective in general.

Read a fascinating article: The Inventor of Antibiotics or the History of Mankind's Salvation!

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Antibiotics of the penicillin series are several types of drugs that are divided into groups. In medicine, funds are used to treat various diseases of infectious and bacterial origin. The drugs have a minimum number of contraindications and are still used to treat various patients.

Once Alexander Fleming in his laboratory was engaged in the study of pathogens. He created a nutrient medium and grew staphylococcus aureus. The scientist was not particularly clean, he simply put beakers and cones in the sink and forgot to wash them.

When Fleming needed the dishes again, he found that they were covered with fungus - mold. The scientist decided to test his conjecture and examined one of the containers under a microscope. He noticed that where there is mold, there is no staphylococcus aureus.

Alexander Fleming continued his research, he began to study the effect of mold on pathogenic microorganisms and found that the fungus has a destructive effect on the membranes of bacteria and leads to their death. The public could not be skeptical about the research.

The discovery helped save many lives. Saved humanity from those diseases that previously caused panic among the population. Naturally, modern medicines have a relative similarity with those drugs that were used at the end of the 19th century. But the essence of medicines, their action has not changed so dramatically.

Penicillin antibiotics were able to revolutionize medicine. But the joy of discovery did not last long. It turned out that pathogenic microorganisms, bacteria can mutate. They mutate and become insensitive to drugs. As a result, penicillin-type antibiotics have undergone significant changes.

For almost the entire 20th century, scientists have been "fighting" against microorganisms and bacteria, trying to create the perfect drug. Efforts were not in vain, but such improvements have led to the fact that antibiotics have changed significantly.

New generation drugs are more expensive, act faster, have a number of contraindications. If we talk about those preparations that were obtained from mold, then they have a number of disadvantages:

• Badly digested. Gastric juice acts on the fungus in a special way, reduces its effectiveness, which undoubtedly affects the result of treatment.
• Penicillin antibiotics are drugs of natural origin, for this reason they do not differ in a wide spectrum of action.
• Medicines are quickly excreted from the body, approximately 3-4 hours after injection.

Important: There are practically no contraindications for such medicines. It is not recommended to take them in the presence of individual intolerance to antibiotics, as well as in the event of an allergic reaction.

Modern antibacterial agents are significantly different from penicillin, which is familiar to many. In addition to the fact that today you can easily buy medicines of this class in tablets, there are a great many varieties of them. Classification, the generally accepted division into groups, will help to understand the preparations.

Antibiotics of the penicillin group are conditionally divided into:

1. Natural.
2. Semi-synthetic.

All medicines based on mold are antibiotics of natural origin. Today, such medicines are practically not used in medicine. The reason is that pathogenic microorganisms have become immune to them. That is, the antibiotic does not act on bacteria in the proper way, to achieve the desired result in the treatment is obtained only with the introduction of a high dose of the drug. The means of this group include: Benzylpenicillin and Bicillin.

The drugs are available in the form of a powder for injection. They effectively affect: anaerobic microorganisms, gram-positive bacteria, cocci, etc. since the medicines are of natural origin, they cannot boast of a long-term effect, injections are often done every 3-4 hours. This allows not to reduce the concentration of the antibacterial agent in the blood.

Penicillin antibiotics of semi-synthetic origin are the result of modification of preparations made from a mold fungus. Medicines belonging to this group managed to give some properties, first of all, they became insensitive to the acid-base environment. That allowed to produce antibiotics in tablets.

And also there were medicines that acted on staphylococci. This class of drugs is different from natural antibiotics. But the improvements have had a significant impact on the quality of drugs. They are poorly absorbed, have a not so wide sector of action, and have contraindications.

Semi-synthetic drugs can be divided into:

• Isoxazolpenicillins are a group of drugs that act on staphylococci, as an example, the names of the following drugs can be given: Oxacillin, Nafcillin.
• Aminopenicillins - several drugs belong to this group. They differ in a wide sector of action, but are significantly inferior in strength to antibiotics of natural origin. But they can fight a large number of infections. Means from this group remain in the blood longer. Such antibiotics are often used to treat various diseases, for example, 2 very well-known drugs can be given: Ampicillin and Amoxicillin.

Attention! The list of medicines is quite large, they have a number of indications and contraindications. For this reason, before starting antibiotics, you should consult a doctor.

Antibiotics belonging to the penicillin group are prescribed by a doctor. Drugs are recommended to be taken in the presence of:

1. Diseases of an infectious or bacterial nature (pneumonia, meningitis, etc.).
2. Respiratory tract infections.
3. Diseases of the inflammatory and bacterial nature of the genitourinary system (pyelonephritis).
4. Skin diseases of various origins (erysipelas, caused by staphylococcus aureus).
5. Intestinal infections and many other diseases of an infectious, bacterial or inflammatory nature.

Reference: Antibiotics are prescribed for extensive burns and deep wounds, gunshot or stab wounds.

In some cases, taking medication can save a person's life. But you should not prescribe yourself such drugs yourself, as this can lead to the development of addiction.

What are the contraindications for drugs:

• Do not take medication during pregnancy or lactation. Drugs can affect the growth and development of the child. Able to change the quality of milk and its taste characteristics. There are a number of drugs that are conditionally approved for the treatment of pregnant women, but a doctor must prescribe such an antibiotic. Since only a doctor can determine the acceptable dosage and duration of treatment.
• It is not recommended to use antibiotics from the groups of natural and synthetic penicillins for the treatment of children. Drugs in these classes can have a toxic effect on the child's body. For this reason, medications are prescribed with caution, determining the optimal dosage.
• You should not use medications without visible indications. Use drugs for a long period of time.

Direct contraindications for the use of antibiotics:

1. Individual intolerance to drugs of this class.
2. Tendency to allergic reactions of various kinds.

Attention! The main side effect of taking medications is considered prolonged diarrhea and candidiasis. They are due to the fact that drugs affect not only pathogens, but also beneficial microflora.

The penicillin series of antibiotics is characterized by the presence of a small number of contraindications. For this reason, drugs in this class are prescribed very often. They help to quickly cope with the disease and return to a normal rhythm of life.

Medicines of the latest generation have a wide spectrum of action. Such antibiotics do not have to be taken for a long time, they are well absorbed and, with adequate therapy, can “put a person on their feet” in 3-5 days.

The question is which antibiotics are best? can be considered rhetorical. There are a number of drugs that doctors, for one reason or another, prescribe more often than others. In most cases, the names of drugs are well known to the general public. But still it is worth studying the list of drugs:

1. Sumamed is a drug used to treat infectious diseases of the upper respiratory tract. The active ingredient is erythromycin. The drug is not used to treat patients with acute or chronic renal failure, is not prescribed for children under 6 months of age. The main contraindication to the use of Sumamed should still be considered an individual intolerance to the antibiotic.
2. Oxacillin - available in powder form. The powder is diluted, and then the solution is used for intramuscular injections. The main indication for the use of the drug should be considered infections that are sensitive to this drug. Hypersensitivity should be considered a contraindication to the use of Oxacillin.
3. Amoxicillin belongs to a number of synthetic antibiotics. The drug is quite well-known, it is prescribed for sore throat, bronchitis and other respiratory tract infections. Amoxicillin can be taken for pyelonephritis (inflammation of the kidneys) and other diseases of the genitourinary system. The antibiotic is not prescribed to children under 3 years of age. A direct contraindication is also considered intolerance to the drug.
4. Ampicillin - the full name of the drug: Ampicillin trihydrate. An indication for the use of the drug should be considered infectious diseases of the respiratory tract (tonsillitis, bronchitis, pneumonia). The antibiotic is excreted from the body by the kidneys and liver, for this reason Ampicillin is not prescribed to people with acute liver failure. Can be used to treat children.
5. Amoxiclav is a drug that has a combined composition. It belongs to the latest generation of antibiotics. Amoxiclav is used to treat infectious diseases of the respiratory system, the genitourinary system. It is also used in gynecology. A contraindication to the use of the drug should be considered hypersensitivity, jaundice, mononucleosis, etc.

List or list of antibiotics of the penicillin series, which is available in powder form:

1. Benzylpenicillin novocaine salt is an antibiotic of natural origin. Indications for the use of the drug can be considered severe infectious diseases, including congenital syphilis, abscesses of various etiologies, tetanus, anthrax and pneumonia. The medicine has practically no contraindications, but in modern medicine it is used extremely rarely.
2. Ampicillin - used to treat the following infectious diseases: sepsis (blood poisoning), whooping cough, endocarditis, meningitis, pneumonia, bronchitis. Ampicillin is not used to treat children, people with severe renal insufficiency. Pregnancy can also be considered a direct contraindication to the use of this antibiotic.
3. Ospamox is prescribed for the treatment of diseases of the genitourinary system, infections of a gynecological and other nature. It is prescribed in the postoperative period, if the risk of developing an inflammatory process is high. The antibiotic is not prescribed for severe infectious diseases of the gastrointestinal tract, in the presence of individual intolerance to the drug.

Important: Called an antibiotic, the drug should have an antibacterial effect on the body. All those medicines that affect viruses have nothing to do with antibiotics.

Sumamed - the cost varies from 300 to 500 rubles.

Amoxicillin tablets - the price is about 159 rubles. for packing.

Ampicillin trihydrate - the cost of tablets is 20–30 rubles.

Ampicillin in the form of a powder intended for injection - 170 rubles.

Oxacillin - the average price of the drug varies from 40 to 60 rubles.

Amoxiclav - cost-120 rubles.

Ospamox - the price varies from 65 to 100 rubles.

Benzylpenicillin novocaine salt - 50 rubles.

Benzylpenicillin - 30 rubles.