Zomax

Zomax is an azalide macrolide that has a broad spectrum of antimicrobial activity.

Indications Zomaxa

It is used in inflammatory and infectious processes caused by the influence of pathogens that are sensitive to azithromycin:

• diseases affecting the lungs with bronchi and ENT organs;
• pathologies affecting subcutaneous tissues and epidermis;
• diseases associated with the urogenital system and not having complications;
• as a complex element in the destruction of Helicobacter bacteria.

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Release form

The substance is released in tablets of 0.5 g, 2-3 pieces inside a pack, and in addition - in capsules of 0.25 g, 6 pieces inside cell plates. There is 1 plate in a box.

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Pharmacodynamics

Minimal doses of azithromycin have bacteriostatic activity, and higher doses lead to the development of bactericidal effect. The drug irreversibly inhibits protein binding inside the ribosomes of bacteria, which destroys the binding of functional proteins, with the inhibition of their reproduction and growth.

Zomax demonstrates the effect of relatively gram-negative and -positive microbes: pneumococci, influenza bacilli, Staphylococcus aureus with pyogenic streptococci, Ducrey bacilli, bacteroids with agalactiae streptococci, H.parainfluenzae, Escherichia coli and Moraxella catarrhalis, as well as paracoccus and pertussis bacilli, spirochetes Borrelia burgdorferi, as well as chlamydia and gonococci.

The medicine also acts on chlamydia pneumoniae, mycoplasma pneumoniae and legionella pneumoniae. The bactericidal effect develops in relation to pathogens ureaplasma with toxoplasmosis and helicobacter.

At the same time, azithromycin exhibits anti-inflammatory activity – it suppresses the formation of pro-inflammatory cytokines, as a result of which oxidative stress is suppressed and the production of leukotrienes PG and thromboxane is reduced.

The anti-inflammatory properties of the drug are comparable to the effect exerted by NSAIDs.

The drug quickly penetrates into the leukocytes, after which it is released at low speed within the infectious area, which creates the preconditions for local influence on the inflammatory-infectious area.

Azithromycin can stimulate immune activity and also activate neutrophil apoptosis after the process of sanitization of the affected area, thereby slowing down local damage and reducing the risk of possible involvement of host cells in immune activity.

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Pharmacokinetics

The medication continues to maintain its activity in the acidic environment of the stomach, due to which its therapeutic effect develops.

When taken orally, blood levels of the drug are recorded after 2-3 hours. Intracellular accumulation of high levels of azithromycin in affected tissues occurs with the participation of macrophages with leukocytes, which carry the drug to the affected area, releasing it there. In this case, high levels are formed inside the tissues, significantly exceeding the serum levels of the drug.

The half-life is 54 hours. The Cmax level is determined after 2.5-2.96 hours after the administration of 0.5 g of azithromycin (the substance in the blood plasma is 0.4 mg/l).

Bioavailability values are 37%. Metabolic processes develop inside the hepatobiliary organs. The drug is 50% excreted with bile (unchanged substance), and another 6% is eliminated with urine.

Dosing and administration

Zomax is administered orally. It is prescribed in short courses of 3-5 days, with 1-time use per day. The use of the drug is prohibited in combination with food, because this disrupts its absorption in the gastrointestinal tract. It should be taken 1 hour before a meal or 2 hours after.

For children weighing over 45 kg, as well as adults, the medication is used according to the following schemes:

• diseases affecting ENT organs and lungs with bronchi, as well as epidermal infections: 1-time intake per day of 0.5 g of the substance. The cycle lasts 3 days;
• chronic form of erythema of a migratory nature: on the 1st day – 1000 mg of azithromycin, in the period of the 2nd-5th days – 0.5 g;
• lesions of the urogenital system (without complications): take 1000 mg of the drug once a day;
• destruction of Helicobacter: 1000 mg of the drug over a 3-day cycle, in combination with combination substances;
• other inflammations and infections: use 0.5 g of the drug once a day. The cycle is 3 days.

If a dose of the drug is missed, therapy should be resumed within the next 24 hours. Further doses are administered at 24-hour intervals.

In case of chronic renal failure (SCF values are within 10-80 ml/minute), no dosage change is required.

If the SCF values are below 10 ml/minute, the medication should be used with extreme caution.

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Use Zomaxa during pregnancy

Azithromycin is used in nursing or pregnant women only if there is a high probability of helping the mother.

Contraindications

Main contraindications:

• appointment to people with intolerance to azithromycin, macrolides or components of the drug;
• use in patients weighing less than 45 kg.

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Side effects Zomaxa

It is believed that azithromycin is one of the safest antibacterial substances, because its use only occasionally leads to the occurrence of life-threatening adverse drug reactions.

Epidermal lesions in the form of dermatitis may be observed. Rarely, symptoms of Quincke's edema, urticaria, photophobia, and also TEN and Stevens-Johnson syndrome have been recorded.

Occasionally, disorders associated with the functioning of the nervous system occur: a feeling of anxiety, drowsiness or nervousness, dizziness or headaches, taste or olfactory disorders, signs of seizures, paresthesia and sleep disorders.

Macrolides occasionally cause hearing loss or tinnitus, especially with prolonged use of high doses of the drug. These symptoms can be reversed after discontinuing azithromycin.

Macrolides can prolong the QT interval, which increases the likelihood of heartbeat or rhythm disorders, the development of ventricular tachycardia and a decrease in blood pressure.

The use of azithromycin causes dyspepsia much less frequently than the use of other antibacterial drugs. Rarely, bowel disorders, intestinal flatulence, glossitis, hepatitis, and intrahepatic cholestasis occur. Pancreatitis, oral candidiasis, pseudomembranous colitis, and loss of appetite occurred occasionally.

Symptoms may occur in the form of asthenia, vaginitis, tubulointerstitial nephritis, and also arthralgia and candidiasis.

Changes in test results are occasionally recorded: a single decrease in the values of leukocytes and platelets with neutrophils. More often, symptoms of a decrease in blood bicarbonate and lymphocyte levels, an increase in the level of blood urea, eosinophils, bilirubin, AST with ALT and creatinine appear. Hyperglycemia occasionally develops.

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Overdose

Administration of large doses of Zomax may cause nausea with vomiting, bowel disorders and hearing loss, which is curable.

When such disorders develop, gastric lavage is first performed, and then symptomatic measures are taken.

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Interactions with other drugs

It is necessary to combine the drug very carefully with ketoconazole, haloperidol and quinidine, as well as with lithium, haloperidol and terfenadine, because these substances prolong QT values, which potentiates the symptoms of myocardial repolarization.

Antacids do not affect the absorption parameters of Zomax.

The combination of cetirizine with the drug slightly potentiates the repolarization that occurs within the myocardium.

The drug does not affect substances inactivated by the hemoprotein system.

Use together with ergot alkaloids leads to the appearance of symptoms of ergotism.

The therapeutic effect of digoxin may be enhanced when used in combination with azithromycin, because the latter increases the Cmax level of digoxin.

The activity of coumarin anticoagulants for oral administration is potentiated when used together with the drug.

Zidovudine, when combined with the drug, may increase the levels of active metabolic product within mononuclear cells, although this does not have any clinical consequences.

The maximum absorption rates of cyclosporine are increased when administered together with azithromycin, which may alter the medicinal properties of the former. Therefore, the dosage of this substance must be adjusted.

Fluconazole reduces the Cmax values of azithromycin by 18%, but this does not affect the clinical picture.

Nelfinavir significantly increases plasma levels of azithromycin, which increases the adverse effects of the latter.

The combination of Zomax with rifabutin rarely leads to neutropenia, which should be taken into account when monitoring the patient.

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Storage conditions

Zomax must be kept at temperatures in the range of 15-25°C.

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Shelf life

Zomax can be used for a period of 36 months from the date of release of the pharmaceutical product.

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Analogues

The analogs of the drug are Azithromycin, Azitrus, Azitral and Sumamed with Zitrox and Azaks, as well as Zitrolide, Azitrox, AzitroSandoz, Hemomycin with Azitsin and Zetamax with Zi-factor.

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