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*It is only for medical professionals to read for reference.
It should not be abused, but it should also be used as it is used to raise global awareness of antimicrobial resistance and reduce the abuse of antimicrobial drugs.
The World Health Organization (WHO) will be the third in November each year.
The week is designated as "World Antimicrobial Awareness Week"
.
The two commonly used antibiotics, azithromycin and cephalosporin, are certainly not unfamiliar to everyone, but there is a problem of overuse in clinical practice
.
For example, some parents of patients think that if their children have a cold, they will self-administer azithromycin or cephalosporin, or even give their children two drugs at the same time, believing that it will get better sooner
.
But in fact, the pathogens that cause many colds are viruses, and antibiotics are against bacteria.
When there is no evidence of combined bacterial infection, antibiotics are not needed
.
There are also some parents of patients who think that azithromycin combined with cephalosporin is a harmful mashup.
After the doctor issued such a prescription, they actually decided not to give their children the medicine, which caused the infection to worsen
.
Both of these extreme behaviors are undesirable.
Antibiotics should not be abused, and only when used when used to get the most benefit.
Our doctors and pharmacists should also explain the medication to the patient’s family when prescribing the prescription, and conduct reasonable drug linkage.
Used
.
Today, Jie Xiaoyao will talk to you about the combined use of azithromycin and cephalosporin
.
The "self-introduction" of azithromycin & cephalosporin.
The previous view believed that β-lactams and macrolides could not be used in combination.
The explanation from pharmacology textbooks alone is that β-lactams, which are fungicides in the breeding period, mainly interfere with the synthesis of cell walls during the active period of bacterial proliferation.
To kill bacteria[4]
.
However, macrolides are used as fast bacteriostatic agents to inhibit bacteria and keep them in a static state, so the number and proportion of bacteria in the breeding period will be reduced, affecting the bactericidal effect of β-lactams during the breeding period, and the pharmacological mechanism of the two Conflicting each other, so it is considered that the clinical effect is not good when used in combination
.
However, the conclusions drawn from the theory may not be consistent with the actual clinical situation
.
It is suggested that this theory should be in doubt for the time being, and the actual clinical application effect should be used as a reference
.
What is the actual effect of the combination? The combination of azithromycin and cephalosporins in the real world is exactly the opposite of pharmacological theory
.
The combination of the two drugs can cover the most common pathogens of children's community-acquired pneumonia: Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, etc.
, and can achieve better curative effects
.
Many literatures have reported that azithromycin combined with cephalosporins is more effective than single drug for lower respiratory tract infections and community-acquired pneumonia in children, and no obvious adverse reactions have been observed [1-3]
.
Therefore, many domestic and foreign guidelines such as the 2016 Chinese Guidelines and the 2019 US IDSA Guidelines recommend β-lactams combined with macrolides for the empiric antimicrobial treatment of community-acquired pneumonia (CAP)
.
What is the possible mechanism of azithromycin combined with cephalosporins to increase the efficacy? First of all, from the perspective of antibacterial spectrum, azithromycin can cover atypical pathogens, such as Mycoplasma pneumoniae, while Streptococcus pneumoniae has a higher resistance rate to macrolide drugs, but some cephalosporin drugs have better resistance to Streptococcus pneumoniae.
Antibacterial effect
.
These two pathogens are common pathogens of community-acquired pneumonia in children.
Therefore, when atypical pathogen infection is suspected, the combination of the two can increase the anti-infective effect and control the infection in a shorter period of time
.
Secondly, Azithromycin has unique pharmacokinetic characteristics
.
Human pharmacokinetic studies have shown that the concentration of azithromycin in lung tissue is much higher than that in blood.
Although the plasma half-life is not long, the concentration in the tissue is higher and the excretion is slower
.
The high concentration of azithromycin in the lung tissue can inhibit the growth of bacteria on the one hand, and on the other hand it can be used as a drug reservoir.
The azithromycin accumulated in macrophages can also be carried to the infected site to play a role
.
Based on these two reasons, it may be possible to improve the efficacy of the combination of the two
.
When will Azithromycin and Cephalosporins play against CP? According to the Expert Consensus on the Diagnosis and Treatment of Mycoplasma Pneumoniae Pneumonia in Children (2015 Edition), Mycoplasma pneumoniae is an important pathogen of community-acquired pneumonia in children, accounting for about 10%-40% of community-acquired pneumonia in children
.
Mycoplasma has no cell wall, and cephalosporin drugs are ineffective
.
Children are the first choice for macrolide drugs.
Azithromycin, the second-generation macrolide drug, only needs to be administered once a day, has fewer days of use, high bioavailability and high intracellular concentration, compliance and tolerance.
It has the characteristics of high receptivity and often becomes the first choice for treatment
.
Mycoplasma infection often destroys the respiratory barrier and causes secondary or combined bacterial infections
.
According to the "Guidelines for the Diagnosis and Treatment of Children’s Community Acquired Pneumonia (2019 Edition)", the doctor can apply macrolide antibiotics to treat children suspected of mycoplasma pneumonia based on the condition of the disease.
The dynamic changes of sexual indicators determine whether to combine the second and third generation cephalosporins
.
Does azithromycin have to "eat three and stop four"? Children's oral azithromycin has a 3-day program and a 5-day program, but the maximum total dose does not exceed 1500mg
.
As an alternative to the above two medication regimens, a single dose of 30 mg/kg (1 day regimen) can be taken in the treatment of acute otitis media in children [5]
.
Therefore, "eating three and stopping four" is a three-day plan.
As for whether you need to continue taking the oral medicine after "stopping four", or whether you need to "stop four", it must be determined according to the condition and follow the doctor's advice
.
For children's dosage, please refer to the following table↓ References: [1] Sun Xianyuan, Huawei, Sun Yun.
Analysis of the clinical efficacy of ceftriaxone combined with azithromycin in the treatment of children with acute lower respiratory tract infection[J].
Modern Diagnosis and Treatment, 2020, 14: 2229 -2230.
[2]Feng Kunyan.
Comparison of the effect and cost of different cephalosporin antibiotics combined with azithromycin in the treatment of community-acquired pneumonia in children[J].
Henan Medical Research,2019,01:119-120.
[3]He Weirong,Mo Huodi, Li Haiyan, Deng Jianying.
Comparison of the efficacy and safety of azithromycin in combination with different cephalosporin antibiotics on children with Mycoplasma pneumoniae infection[J].
Strait Pharmacy,2020,01:151-152.
[4] .
"Pharmacology" 7th edition.
[M].
Beijing: People's Medical Publishing House.
2015, 44.
[5] Instructions for Azithromycin Dry Suspension
It should not be abused, but it should also be used as it is used to raise global awareness of antimicrobial resistance and reduce the abuse of antimicrobial drugs.
The World Health Organization (WHO) will be the third in November each year.
The week is designated as "World Antimicrobial Awareness Week"
.
The two commonly used antibiotics, azithromycin and cephalosporin, are certainly not unfamiliar to everyone, but there is a problem of overuse in clinical practice
.
For example, some parents of patients think that if their children have a cold, they will self-administer azithromycin or cephalosporin, or even give their children two drugs at the same time, believing that it will get better sooner
.
But in fact, the pathogens that cause many colds are viruses, and antibiotics are against bacteria.
When there is no evidence of combined bacterial infection, antibiotics are not needed
.
There are also some parents of patients who think that azithromycin combined with cephalosporin is a harmful mashup.
After the doctor issued such a prescription, they actually decided not to give their children the medicine, which caused the infection to worsen
.
Both of these extreme behaviors are undesirable.
Antibiotics should not be abused, and only when used when used to get the most benefit.
Our doctors and pharmacists should also explain the medication to the patient’s family when prescribing the prescription, and conduct reasonable drug linkage.
Used
.
Today, Jie Xiaoyao will talk to you about the combined use of azithromycin and cephalosporin
.
The "self-introduction" of azithromycin & cephalosporin.
The previous view believed that β-lactams and macrolides could not be used in combination.
The explanation from pharmacology textbooks alone is that β-lactams, which are fungicides in the breeding period, mainly interfere with the synthesis of cell walls during the active period of bacterial proliferation.
To kill bacteria[4]
.
However, macrolides are used as fast bacteriostatic agents to inhibit bacteria and keep them in a static state, so the number and proportion of bacteria in the breeding period will be reduced, affecting the bactericidal effect of β-lactams during the breeding period, and the pharmacological mechanism of the two Conflicting each other, so it is considered that the clinical effect is not good when used in combination
.
However, the conclusions drawn from the theory may not be consistent with the actual clinical situation
.
It is suggested that this theory should be in doubt for the time being, and the actual clinical application effect should be used as a reference
.
What is the actual effect of the combination? The combination of azithromycin and cephalosporins in the real world is exactly the opposite of pharmacological theory
.
The combination of the two drugs can cover the most common pathogens of children's community-acquired pneumonia: Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, etc.
, and can achieve better curative effects
.
Many literatures have reported that azithromycin combined with cephalosporins is more effective than single drug for lower respiratory tract infections and community-acquired pneumonia in children, and no obvious adverse reactions have been observed [1-3]
.
Therefore, many domestic and foreign guidelines such as the 2016 Chinese Guidelines and the 2019 US IDSA Guidelines recommend β-lactams combined with macrolides for the empiric antimicrobial treatment of community-acquired pneumonia (CAP)
.
What is the possible mechanism of azithromycin combined with cephalosporins to increase the efficacy? First of all, from the perspective of antibacterial spectrum, azithromycin can cover atypical pathogens, such as Mycoplasma pneumoniae, while Streptococcus pneumoniae has a higher resistance rate to macrolide drugs, but some cephalosporin drugs have better resistance to Streptococcus pneumoniae.
Antibacterial effect
.
These two pathogens are common pathogens of community-acquired pneumonia in children.
Therefore, when atypical pathogen infection is suspected, the combination of the two can increase the anti-infective effect and control the infection in a shorter period of time
.
Secondly, Azithromycin has unique pharmacokinetic characteristics
.
Human pharmacokinetic studies have shown that the concentration of azithromycin in lung tissue is much higher than that in blood.
Although the plasma half-life is not long, the concentration in the tissue is higher and the excretion is slower
.
The high concentration of azithromycin in the lung tissue can inhibit the growth of bacteria on the one hand, and on the other hand it can be used as a drug reservoir.
The azithromycin accumulated in macrophages can also be carried to the infected site to play a role
.
Based on these two reasons, it may be possible to improve the efficacy of the combination of the two
.
When will Azithromycin and Cephalosporins play against CP? According to the Expert Consensus on the Diagnosis and Treatment of Mycoplasma Pneumoniae Pneumonia in Children (2015 Edition), Mycoplasma pneumoniae is an important pathogen of community-acquired pneumonia in children, accounting for about 10%-40% of community-acquired pneumonia in children
.
Mycoplasma has no cell wall, and cephalosporin drugs are ineffective
.
Children are the first choice for macrolide drugs.
Azithromycin, the second-generation macrolide drug, only needs to be administered once a day, has fewer days of use, high bioavailability and high intracellular concentration, compliance and tolerance.
It has the characteristics of high receptivity and often becomes the first choice for treatment
.
Mycoplasma infection often destroys the respiratory barrier and causes secondary or combined bacterial infections
.
According to the "Guidelines for the Diagnosis and Treatment of Children’s Community Acquired Pneumonia (2019 Edition)", the doctor can apply macrolide antibiotics to treat children suspected of mycoplasma pneumonia based on the condition of the disease.
The dynamic changes of sexual indicators determine whether to combine the second and third generation cephalosporins
.
Does azithromycin have to "eat three and stop four"? Children's oral azithromycin has a 3-day program and a 5-day program, but the maximum total dose does not exceed 1500mg
.
As an alternative to the above two medication regimens, a single dose of 30 mg/kg (1 day regimen) can be taken in the treatment of acute otitis media in children [5]
.
Therefore, "eating three and stopping four" is a three-day plan.
As for whether you need to continue taking the oral medicine after "stopping four", or whether you need to "stop four", it must be determined according to the condition and follow the doctor's advice
.
For children's dosage, please refer to the following table↓ References: [1] Sun Xianyuan, Huawei, Sun Yun.
Analysis of the clinical efficacy of ceftriaxone combined with azithromycin in the treatment of children with acute lower respiratory tract infection[J].
Modern Diagnosis and Treatment, 2020, 14: 2229 -2230.
[2]Feng Kunyan.
Comparison of the effect and cost of different cephalosporin antibiotics combined with azithromycin in the treatment of community-acquired pneumonia in children[J].
Henan Medical Research,2019,01:119-120.
[3]He Weirong,Mo Huodi, Li Haiyan, Deng Jianying.
Comparison of the efficacy and safety of azithromycin in combination with different cephalosporin antibiotics on children with Mycoplasma pneumoniae infection[J].
Strait Pharmacy,2020,01:151-152.
[4] .
"Pharmacology" 7th edition.
[M].
Beijing: People's Medical Publishing House.
2015, 44.
[5] Instructions for Azithromycin Dry Suspension
