New crown virus infection combined with bacterial infection, what is the difference between eating roxithromycin, clarithromycin, azithromycin? Which is better?
The causative agent of the new coronavirus infection is the new coronavirus, avoid the blind or inappropriate use of antibiotics, especially the combination of broad-spectrum antibiotics. In the later stage of novel coronavirus infection, if the patient has the following symptoms, it often indicates secondary bacterial infection: 1. Bacterial infection manifestations such as repeated cough, yellow purulent sputum, yellow purulent discharge or pharyngeal purulent lichen. 2. Blood routine shows an increase in the level of white blood cell count and an increase in the proportion of classified neutrophils. Most of the pathogens are hemolytic streptococcus, Haemophilus influenzae, Streptococcus pneumoniae, staphylococcus, Moraxella catarrhalis, etc., and penicillins, cephalosporins, quinolones and macrolides can be selected according to local epidemiological history and experience.
Roxithromycin, clarithromycin, azithromycin are all macrolide antibiotics, which mainly act on the 50S subunit of bacterial cell ribosomes, hinder the synthesis of bacterial proteins, and belong to bacteriostatic agents in the growth phase. The antibacterial spectrum of this class of drugs includes staphylococcus, pyogenes and virida streptococcus, Streptococcus pneumoniae, Streptococcus faecal, Diphtheria bacillus, Bacillus anthracis, meningococcus, gonococcus, Pertussis, Clostridium gaseus, Brucella, Legionella, Helicobacter, Leptospira, Mycoplasma pneumoniae, Rickettsial and Chlamydia.
Roxithromycin is well absorbed orally, the blood concentration is high, the distribution is wide, and the drug concentration in the tonsils, sinuses, middle ear, lung, sputum, prostate and other urogenital tissues can reach effective therapeutic concentrations. The antibacterial spectrum and antibacterial effect are similar to erythromycin, and the effect on gram-positive bacteria is slightly worse than erythromycin, and the effect on Legionella pneumophila is stronger than erythromycin. The antimicrobial effect on Chlamydidium pneumoniae, Mycoplasma pneumoniae, and Ureaplasma urealyticum is similar or slightly stronger than erythromycin. The main adverse reactions are gastrointestinal reactions, but the incidence is significantly lower than erythromycin, occasionally rash, skin itching, dizziness, headache, abnormal liver function, peripheral blood cell decline, etc.
Clarithromycin is stable to acids and is rapidly absorbed orally through the gastrointestinal tract, but first-pass elimination is evident, and bioavailability is only 55%. It is widely distributed in the body, and the concentration of drugs in the nasal mucosa, tonsils and lung tissues is higher than that of blood, and the half-life is long (6 hours). The antibacterial activity of clarithromycin is the strongest of macrolide antibiotics, and the antibiotic effect on Staphylococcus aureus and Streptococcus pyogenes is 3 times longer than erythromycin, and its metabolites 14-hydroxyclarithromycin and clarithromycin have synergistic antibacterial activity. Common adverse effects include gastrointestinal reactions, headache, and transient elevation of serum aminotransferases. Allergic reactions can also occur, occasionally hepatotoxicity, pseudomembranous enteritis caused by Clostridium difficile.
Azithromycin is stable to acid and has little gastrointestinal irritation; It is widely distributed in the body, the plasma protein binding rate is low, the intratissue concentration can reach 10-100 times the blood concentration in the same period, the half-life is long (68 hours), and it is administered once a day. Azithromycin has higher activity against Legionella pneumophila, Haemophilus influenzae, mycoplasma, and chlamydia than erythromycin; It has higher antibacterial activity against gram-negative bacteria, and has a stronger effect on Borrelia than erythromycetes, and the strongest effect on Mycoplasma pneumoniae is the strongest in macrolides. The adverse reactions are mild, the incidence is significantly lower than erythromycin, and mild and moderate liver and kidney dysfunction can be used.
Finally, roxithromycin, clarithromycin, azithromycin three drugs can be used for new coronavirus infection combined with respiratory bacterial infection, such as acute laryngitis, sinusitis, otitis media, bronchitis and pneumonia, etc., and their clinical positioning is as an alternative drug for penicillin-allergic patients. Compared with the three drugs, each has its own length and shortness, clarithromycin has the strongest antibacterial activity, which can be used as the first choice, but the disadvantages are lower oral bioavailability, large dosage, and higher incidence of adverse reactions; Azithromycin has the strongest antibacterial activity against Mycoplasma pneumoniae, low incidence of adverse reactions, good safety, but the disadvantage is that the antibacterial activity of gram-positive bacteria such as Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus is not as good as that of clarithromycin and roxithromycin; Roxithromycin, which is somewhere between clarithromycin and azithromycin, is most widely used in the three drugs because its advantages are not prominent and its disadvantages are not obvious. #健康2023 #
