As can be seen from the table, "protected" aminopenicillins against gram-positive bacteria superior to unprotected solely on activity against S. aureus susceptible to methicillin, and, with reservations - against epidermal staphylococci. Not hard to guess that this is due to the ability to suppress the production of staphylococcal penicillinases. Currently, the various beta-lactamases (destructive, including, antibiotics, penicillin group) produce not only staphylococci, but many gram-negative bacteria: morakselly, Klebsiella, Haemophilus influenzae, etc. Adding inhibitors of bacterial beta-lactamases of ampicillin or amoxicillin allows in such cases to overcome the resistance of microbes. If the resistance of bacteria to aminopenicillins associated with modification of the so-called penitsillinsvyazyvayuschih proteins (enzymes, located in the bacterial cell wall, is associated with penicillins and exert their bactericidal action), then no addition of inhibitors of beta-lactamases can not save the activity of antibiotics. Are there exceptions to this rule? Perhaps, yes. It is a penicillin-resistant pneumococcus and, as you've probably already guessed - about amoxicillin.
Domestic data on the prevalence of penicillin-resistant pneumococci not. In Russia, the proportion of pneumococcal disease among all Streptococcus pneumoniae, apparently, does not exceed 4-5%, although in some European countries (France, Spain, Hungary) - several times more. Pneumococci do not produce penicillinase to buy amoxicillin online. The stability of these microbes to penicillin is associated with a modification penitsillinsvyazyvayuschih proteins. However, amoxicillin, for not fully understandable reasons, usually retains clinical efficacy in the treatment of infections caused by penicillin-resistant pneumococci. Let him not at all similar infections, and even infections is not all localities, but in most cases, amoxicillin online is not only efficient, but sometimes (eg, acute otitis media) - is the drug of choice. The most likely explanation is that because of some reasons for this antibiotic has the largest among the penicillin affinity penitsillinsvyazyvayuschim proteins. Remember the comparison with "pick"?
For many years our country has two main aminopenicillins (ampicillin and amoxycillin) was used, only the first. It is difficult to say what it was due. Do I need to change habits? Yes, it is necessary. For several reasons. And not only that amoxicillin, ampicillin, and as is available the vast majority of our compatriots, does not suffer from an excess of cash. And not because he is - the new "Overseas miracle." Amoxicillin is available at Ukrainian enterprises (eg, Kiev enterprises "Kyivmedpreparat called Amoxil-ILC). It's just different.
First, amoxicillin is used 2-3 times a day (while ampicillin - 4 times). Consequently, the patient's willingness to comply with doctor's recommendation for appointment of amoxicillin will be higher than in the appointment of ampicillin. Secondly, eating virtually no effect on drug absorption (as opposed to ampicillin). As a result of increased physician confidence in achieving the goals of treatment. Third, in many common infections caused by pneumococci resistant to penicillin, amoxicillin achieves cure rates, which can not be said of ampicillin. Finally, there are numerous national and international guidelines for empirical treatment of infections of different locations where the two aminopenicillins preference is amoxicillin. This does not mean that ampicillin "exhausted" themselves. As a drug for parenteral use it for a long time to be an effective tool to combat infections. However, ampicillin for oral administration in the vast majority of cases should give way to amoxicillin.
It seems there is no need to list the indications for use of amoxicillin. For this is the appropriate instructions. But to stay on the main infections for which amoxicillin (alone or in combination with other antibiotics) is the drug of choice, apparently, it should be.
Diseases associated with Helicobacter pylori
Currently, many diseases with certainty, or presumably associated with this organism. The most convincing evidence obtained in this regard:
gastric ulcer and duodenal ulcer;
Primary non-Hodgkin's lymphoma of the stomach (MALT-lymphoma).
Since the mid-90's, at first - in the U.S. and then elsewhere in the world eradication (extermination, destruction) Helicobacter pylori is regarded as the most effective means of preventing recurrence of gastric ulcers and duodenal ulcers and is also a component of antiulcer therapy. So, according to a meta-analysis of seven randomized trials, eradication of H. pylori associated with reduced relative risk of recurrence of gastric ulcers and duodenal ulcers within 6 months to 80%. At the same time to prevent a relapse should be successfully treated with 2.8 man .
Cost of AmoxicillinIn the European recommendations for the eradication of Helicobacter pylori (The Maastricht Consensus Report, 1997) offers three options for the 7-day courses of therapy :
1. omeprazole 20 mg 2 times a day + amoxicillin 1000 mg 2 times a day + clarithromycin 500 mg 2 times a day;
2. omeprazole 20 mg 2 times daily + buy amoxicillin 500mg 3 times daily + metronidazole 400 mg 3 times daily;
3. omeprazole 20 mg 2 times daily + metronidazole 400 mg 3 times daily + clarithromycin 250 mg 2 times a day.
Of the recommendations submitted that the mandatory component of therapy aimed at eradication of H. pylori, is the appointment of a proton pump blocker omeprazole. In some countries, instead of the drug used other medications in this group: lansoprazole, pantoprazole. These medications are not antibacterial. However, blocking the H +-K +-ATPase parietal cells of gastric mucosa, they impede the flow of hydrogen ions into the lumen of the stomach in exchange for potassium. As a result, the acidity of gastric contents is reduced, and the microbe H. pylori becomes more vulnerable to the impact of antimicrobial agents. The latter are represented by different combinations of amoxicillin, clarithromycin and metronidazole.
Here we should make some small additions relating to clarithromycin and metronidazole. The first of them, in accordance with European recommendations in 1998, can be successfully replaced by azithromycin . With regard to the conditions of our market disadvantage of clarithromycin is its high cost: of all macrolide is the most expensive antibiotic. Azithromycin (sumamed) in this area is attractive and also better known to our physicians. With regard to metronidazole, instead of it can be used other drugs group nitroimidazoles - tinidazole. This is due primarily to the proliferation of strains of H. pylori, resistant to antibiotics. For example, in Europe, resistance to nitroimidazole (especially metronidazole) averages 30-40% for macrolides - 2-10% . And the only place amoxicillin is not endangered.
Nevertheless, I would like to warn against the indiscriminate eradication of H. pylori. Here are just some issues that deserve attention.
First, some researchers consider H. pylori as a component of "normal" microflora of man. To substantiate this hypothesis can be reduced, for example, the following data:
in developing countries, more than 80% of people infected with H. pylori by the age of 10;
frequency of detection of antibodies to H. pylori in healthy people in St. Petersburg is 44% - in children, 88% - of adults [6, 7].
Secondly, there is reason to believe that infection with H. pylori prevents the development of gastro-esophageal reflux and adenocarcinoma of the lower esophagus and upper stomach. In favor of this research shows Labenz J. et al. : the eradication of H. pylori 2-fold increased risk of gastroesophageal reflux.
Thirdly, it remains unclear whether to eradication of H. pylori buying amoxicillin, if the patient's therapy NSAIDs (nonsteroidal anti-inflammatory drugs), or will their purpose? The very issue arose because a large proportion of patients receiving HPVS, develops a peculiar lesion of the gastric mucosa, which was named HPVS-gastropathy. The basis of treatment by generic amoxil, and, unfortunately, the toxic effect is HPVS inhibition of the enzyme cyclooxygenase (COX), which entails the inhibition of prostaglandin synthesis . The latter, in turn, play an important role in maintaining the integrity of the gastric mucosa.
Different HPVS differ significantly in their ability to induce gastric damage. Numerous attempts to minimize the negative effects HPVS. In particular, HPVS combined with a synthetic prostaglandin (misoprostol), blocker of H +-K +-ATPase omeprazole, H2-blocker ranitidine histamine receptors. Another approach is designed to provide a preferential and selective inhibitors of the second isoform of cyclooxygenase (COX-2) production which is induced in the presence of inflammation. Another theoretical possibility to prevent the development HPVS-gastropathy (or reduce the likelihood of its development and severity of manifestations) is the eradication of H. pylori. Because infection with this parasite, as well as treatment HPVS are factors of ulcer formation, but with different mechanisms of realization of the negative effects of such a solution seems quite reasonable to buy amoxicillin online. In the European Guidelines for the treatment of infection H. pylori  indicated the usefulness of eradication in patients receiving HPVS, as well as in those cases where the designation of these drugs is only supposed. At the same time, the results of several randomized trials have cast doubt on the validity of this assertion. So, according to Hawkey C. et al. , eradication of H. pylori in patients receiving HPVS worsens scarring ulcers of the stomach and does not affect the frequency of exacerbation of peptic ulcer and the appearance of dyspepsia for 6 months.