The harm to human body is related to the different liver functions of each person; P450 enzyme
azithromycin
This product is suitable for the following infections caused by sensitive pathogenic bacteria:
1. Community-acquired pneumonia caused by Chlamydia pneumoniae, Haemophilus influenzae, Legionella pneumophila, Moraxella catarrhalis, Staphylococcus aureus or Streptococcus pneumoniae needs intravenous drip treatment first.
2. Pelvic inflammatory disease caused by Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma hominis needs intravenous drip treatment first. If you suspect anaerobic infection, you should also use anti-anaerobic antibiotics.
Generic name: azithromycin
English name: azithromycin
Chinese aliases: erythromycin, azithromycin, azithromycin, histamine.
English alias: azithromycin
pharmacodynamics
The antibacterial spectrum of azithromycin is the same as other macrolide antibiotics. The antibacterial effect on various staphylococcus, streptococcus and pneumococcus is slightly worse than erythromycin, and enterococci are resistant to this product; However, the effect of this product on some gram-negative bacteria is stronger than erythromycin. For example, the MIC of influenza bacteria, including β -lactamase producing strains, is 8 times lower than that of erythromycin, about 0.06 ~ 1 mg/L, and the MIC of Moraxella is 0.03mg/L, and its antibacterial effects on digestive cocci, digestive streptococci, Bacteroides and Bacteroides fragilis are similar or slightly worse than those of erythromycin. The effect on intracellular pathogens such as mycoplasma, chlamydia and Legionella is similar to erythromycin.
pharmacokinetics
This product is stable to gastric acid. Although the oral bioavailability is only 37%, and the peak blood concentration is about 0.4μg/ml 2 ~ 3 hours after a single dose of 0.5g, the tissue distribution is good and the protein binding rate is low (7% ~ 2~3h%). The elimination half-life is 12 ~ 14h and 12 ~ 30h after administration. More than 50% drugs are excreted through bile in their original form, and some of them are demethylated metabolites. The drug stays in the tissue for a long time and is slowly released. The original drug can still be detected in urine 14 days after a single dose. After 1 week, the urinary excretion rate was less than 6%, and the renal clearance rate was1.67 ~ 3.1.56 ml/s.
The concentration of this product in tissue is obviously higher than that in blood, mainly because the drug actively moves from local tissue to the above cells through neutrophils and phagocytes. Neutrophils that store drugs at infected sites are stimulated by bacteria to release drugs to play an antibacterial role.
indicate
Mainly used for respiratory tract, skin and soft tissue infections caused by sensitive bacteria and sexually transmitted diseases caused by chlamydia. It is effective for acute bronchitis, chronic obstructive pulmonary disease complicated with infection, pneumonia, etc. The bacterial clearance rate caused by influenza, pneumococcus and Moraxella is 90% and 85%. Used for boils, cellulitis, etc. Caused by pyogenic streptococcus and staphylococcus aureus, this product is used once a day 1 time for 5 days (total 1.5g), the cure rate is 53% ~ 74%, the effective rate is over 90%, and the curative effect is similar to that of oxacillin, erythromycin and cefalexin. Single dose 1g is similar to ciprofloxacin or doxycycline in the treatment of chlamydia infection.
dosage
Take this product at least before meals 1h or 2h after meals. Adults take 0.5g/kloc-0 once a day for 3 days. Or the first dose is 0.5g, and then 0.25g every day, and 5 days is a course of treatment. STDs can be treated with a single dose1g. The elderly can take medicine according to the adult dose. The daily dose of children over 6 months (under 45kg) is 10mg/kg, and the administration method and course of treatment are the same as those of adults. If azithromycin dry suspension is taken, it is 5ml (200mg) for 3 ~ 7 years old (15 ~ 25kg), 7.5ml (300mg) for 8 ~ 12 years old (26 ~ 35kg),12 ~/kloc-0.
[Formula and specifications] Capsule: 250mg// capsule.
Don't be careful
Patients with mild renal insufficiency do not need to adjust the dose. There is no mature scheme for dose adjustment of patients with moderate and severe renal insufficiency. Patients with hepatic insufficiency and liver disease should not choose this product. Pregnant women must fully weigh the pros and cons when choosing this product.
It is forbidden for people who are allergic to macrolides.
Management description
Azithromycin (AM) is excreted mainly through bile, so patients with liver dysfunction should be cautious. When the creatinine clearance rate is less than or equal to 40 ml/min, the dosage should also be adjusted appropriately.
counteraction
The main adverse reactions were gastrointestinal symptoms such as abdominal pain, nausea, vomiting and diarrhea, and the incidence rate was about 9.6%. Secondly, there is a rash, mostly mild to moderate, so there is no need to stop taking drugs. Occasionally, transaminase will rise temporarily.
Macrolide drugs such as erythromycin, neurovascular edema, anaphylactic shock and other serious allergic reactions are rare, but we should pay attention to them. Attention should be paid to the double infection caused by drug-resistant bacteria such as fungi after medication.
The reaction of central and peripheral nervous system was 65438 0.3%, and other rashes were ≤ 65438 0%. ALT and AST temporarily increased, which were 65438 0.7% and 65438 0.5% respectively, and a few white blood cells were abnormal. The incidence of side effects is not affected by the patient's age. Special tests show that the product will not cause neurological, hearing and ophthalmic abnormalities.
interaction
This product has no interaction with theophylline, warfarin, carbamazepine and methylprednisolone. Take this product before 1h or 2h after taking antacids. Two hours before taking this product, a single dose of cimetidine does not affect the blood concentration of this product. Some macrolides can affect the metabolism of digoxin, so continuous use of this product may increase the blood concentration of digoxin, which should be paid attention to. This product should not be combined with ergot drugs, because it can cause ergot poisoning in patients; In addition, it is reported that macrolides can increase the plasma concentrations of digoxin (changing intestinal flora), cyclosporine and amidazole (by inhibiting metabolism), so when AM is taken with these three drugs, it may also increase the plasma concentrations of these drugs. It is necessary to jointly monitor the plasma concentration of the latter.
Demisone
English name: Dexamethasone
Synonyms: Flumethasone, Demisone, atopalm, Delongni, Dexamethasone, Dexamethasone, Flumethylprednisolone, etc.
Chemical name: (1 1β, 16α)-9- fluoro-1,17,21-trihydroxy-/kloc-0.
Manufacturing patent: U.S. patent 3,007,923 (1961,Laboratory. France. Chimio, the others. )，GerPat 1， 1 13，690 ( 196 1)。 Co.), British patent 869,511(to Upjohn).
Dexamethasone was synthesized by Arth and Oliveto in 1958, Merck &; The company produces dexamethasone sodium phosphate. Up to now, the number of dexamethasone derivatives on the market has exceeded 12.
The chemical structure of dexamethasone is that fluorine atom is introduced into the 9α position of prednisolone B ring and methyl group is introduced into the 16α position of D ring; 9α fluoride and 16α methyl significantly enhanced its anti-inflammatory activity, while 16α methyl significantly reduced the side effects of dexamethasone in water and sodium retention. The clinical bioequivalent dose ratio of dexamethasone to prednisolone is 0.75:5, and the biological half-life is 36-54 hours, which belongs to long-acting glucocorticoid.
Dexamethasone, like other glucocorticoids, has pharmacological effects such as anti-inflammatory, anti-endotoxin, immunosuppression, anti-shock and stress response, so it is widely used in various departments to treat many diseases, such as autoimmune diseases, allergies, inflammation, asthma, dermatology and ophthalmology. Dexamethasone sodium phosphate injection is an indispensable first-aid medicine to save dying patients. In recent ten years, clinicians have used dexamethasone sodium phosphate to treat and prevent drug allergy caused by various Chinese and western medicines and to treat fever caused by viral cold, so that the clinical dosage of dexamethasone has increased year by year. So far, China has become the largest dexamethasone market in the world.
Glucocorticoids, such as dexamethasone, have no obvious adverse reactions in the application of physiological dose replacement therapy, and most of the adverse reactions occur in the application of pharmacological dose, which is closely related to the course of treatment, dose, drug type, usage and route of administration. The common adverse reactions are as follows: 1. Long-term use can cause the following side effects: face and posture, weight gain, edema of lower limbs, purple stripes, bleeding tendency, poor wound healing, acne, menstrual disorder, ischemic necrosis of humerus or femoral head, osteoporosis and fractures (including vertebral compression fractures and pathological fractures of long bones), muscle weakness, muscular atrophy and hypokalemia. Pancreatitis, peptic ulcer or perforation, growth inhibition in children, glaucoma, cataract, benign intracranial hypertension syndrome, abnormal glucose tolerance and aggravation of diabetes. 2. Patients may have mental symptoms: euphoria, excitement, delirium, anxiety, disorientation or inhibition. Mental symptoms include people who are prone to chronic wasting diseases and people who have mental disorders in the past. 3. Infection is the main adverse reaction of adrenocortical hormone. Mainly fungi, tuberculosis, staphylococcus, Proteus, Pseudomonas aeruginosa and various herpes viruses. 4. Glucocorticoid withdrawal syndrome. Sometimes patients have dizziness, fainting tendency, abdominal pain or backache, low fever, loss of appetite, nausea, vomiting, muscle or joint pain, headache, fatigue and weakness after stopping taking the drug. If careful examination can rule out adrenal hypofunction and recurrence of primary disease, it can be considered as glucocorticoid dependence syndrome.
Glucocorticoid dexamethasone, commonly known as "skin opium", is a banned ingredient in cosmetics. When consumers use cosmetics containing dexamethasone, their skin will feel obviously better at first, but long-term use will not only lead to dependence, but also lead to dermatitis and even various diseases.