Features of the most popular antibiotics used in angina

Antibiotics for angina are the only means that, if properly applied, avoid the development of severe and deadly complications of streptococcal infection. That is why, with accurate diagnosis of angina, it is necessary to take these medicines, and in each specific case the most appropriate preparation is prescribed for treatment.

Themselves of antibiotics, which can be (and are very likely to be) effective in angina, are quite a lot. Only cephalosporins are more than a dozen, and the most commonly used penicillin is 5 species. In addition, pharmaceutical companies and individual laboratories are constantly developing new drugs that are superior to their predecessors in some way. For this reason, in case of angina, the antibiotic in each case should be prescribed with a full understanding of its effectiveness, its advantages over other agents and safety.

Details about the treatment of angina with antibiotics

If you or your child has tonsillitis, and you do not fully understand what amoxicillin is better than azithromycin, or if it is inferior to bicillin, do not self-medicate! It may be dangerous. Moreover, even the angina itself many patients are confused with viral or fungal infections of the pharynx. In particular, many patients or parents of sick children are looking for antibiotics for angina and cough, despite the fact that cough itself practically never develops at the time of angina itself, which means that an antibiotic in this case is most likely not needed, since there is a viral infection.

A virus particle of the influenza A / H1N1 virus, which can not be affected by any antibiotic.

Remember: antibiotics from angina should be prescribed only by a doctor!

Ampicillin for angina in adults and children: how to take it and how is it safe

Choosing a specific antibiotic by angina, specialist assesses its activity, sensitivity to have pathogen, tolerability different tools in the patient, the severity of the disease in a particular case, other details specific to the patient and the particular drug. In this case, all of the available types of antibiotics for each situation the best would be one drug (called antibiotic of first choice line), according to certain parameters it will give way to some other means (second-line antibiotic of choice), and so on. For example:

1. The patient has a sensitivity of the causative agent of angina to penicillins. The antibiotic of the first line of choice here will be Amoxicillin, if it is intolerant, antibiotics of the second line of choice - cefadroxil or Azithromycin, with intolerance to -lactams and macrolides - to the lincosamides and third-line drugs are prescribed.

2. The causative agent of the disease is resistant to penicillins. In this case, the agents of the first line of choice will be inhibitor-protected penicillins - Amoxicillin with clavulanic acid (Augmentin), macrolides - preparations of the second choice line.

In the combination of amoxicillin and clavulanic acid, the second eliminates the protection of bacteria before amoxicillin itself.

In general, in practice, most often used several drugs that successfully and without consequences are treated with angina. Antibiotics, included in their composition, belong to several groups and have different properties.

Classification of antibiotics for the treatment of angina

The choice of an antibiotic for angina is most often carried out from the means of such groups:

1. Penicillins - Amoxicillin, ampicillin (Acillin), phenoxymethylpenicillin, benzylpenicillin (actually, penicillin), benzylpenicillin salts, ticarcillin. Maximum safe, well studied, in many cases highly effective (protected penicillins are effective almost always);

Amoxicillin for angina - when it was appointed?

2. Cephalosporins - Cefadroxil, Cephalexin, cephalothin, cefoperazone and others. Similar to penicillins, but the number of forms of their drugs is less, and therefore are used mainly in the form of injections for inpatient treatment;

3. Macrolides - Erythromycin, Azithromycin, josamycin, spiramycin, Clarithromycin. Very effective, but often cause side effects;

Clarithromycin 500mg and 250mg Information

4. Lincosamides - Lincomycin (Lincocin), Clindamycin (Cleocin). Effective as much as dangerous, and therefore with angina appointed only in exceptional cases.

All these substances are antibiotics of a wide spectrum of action. With angina, however, it makes no sense to pursue just the "broad-spectrum antibiotic", as the disease itself is caused by a narrow set of bacteria: group A hemolytic streptococcus (in 8 out of 10 cases), several strains of staphylococcus (1 out of 10), or both bacteria together (another 1 case out of 10). That is, it is enough that the drug is effective against streptococci and staphylococci, so that they can successfully treat the sore throat.

Hemolytic streptococcus group A
Hemolytic streptococcus group A, the main causative agent of angina.

On a note! Very rarely, angina is caused by gonococci - the causative agents of gonorrhea. However, these bacteria are sensitive to antibiotics, which treat streptococcal angina, and therefore there is no need to choose a specific agent for the treatment of this disease.

Gonococcus is a bacterium
Gonococcus is a bacterium that occurs mainly on the genitals and is sexually transmitted.

The main problem is that these pathogens (mostly staphylococci) constantly develop resistance to the substances that most often treat angina. Antibiotic, therefore, should be active against such resistant strains, if stability is determined or not determined at all. This is why the universal and extremely safe antibiotics of the penicillin group are increasingly being replaced by more severe means.

The main antibiotics against angina are:

- Amoxicillin;

- Azithromycin;

- Amoxicillin and clavulanic acid (Augmentin);

- Cefadroxil;

- Erythromycin;

- Bicillins.

Which of these antibiotics are selected for treatment in a particular case, read the materials:

What antibiotic is selected for angina in an adult?

What antibiotics to treat angina in children?

In 95% of cases, the disease is treated with a drug whose active ingredient is one of these substances. Therefore, they should be considered in more detail.


Preparations: Amoxicillin, Amoxil, Trimox.


Amoxicillin is active against all pathogens of angina, provided that they do not produce penicillinase. According to statistical data, in approximately one case out of four, this antibiotic against angina is ineffective precisely because of the resistance of bacteria to the penicillin group.

Important advantages of amoxicillin are:

1. Resistance to the action of gastric and intestinal enzymes, high digestibility. With angina this antibiotic can be taken regardless of meals;

2. Weak binding to blood proteins, due to which the maximum amount of the drug is in the affected tissues;

3. High speed of getting into the blood and reaching inflamed tissues. In fact, amoxicillin, drunk in the form of a pill, enters the bloodstream as quickly as ampicillin, injected intramuscularly.

Doctors prescribe amoxicillin only in a situation when the susceptibility of the causative agent of a sore throat is revealed. If sensitivity is not determined, or bacterial resistance is confirmed, macrolides or amoxicillin-based products with clavulanic acid are given instead.

sensitivity of bacteria to antibiotics
Check the sensitivity of bacteria to antibiotics. White coating is the bacteria themselves, the gray spots around the tablets are the nutrient medium purified from them. Antibiotics, around which there are no gray circles, do not act on the bacterium in the cup.

Safety and side effects

Amoxicillin is considered the safest antibiotic against angina. It very rarely causes digestive disturbances, it is not typical for it to affect the liver, kidneys and nervous system. Therefore, it is considered the first choice in patients of all ages, but especially in children. His doctors prefer to appoint pregnant women and nursing mothers.

Features of application

The course of treatment of angina with amoxicillin should last at least 10-12 days. Children older than 10 years, or weighing more than 40 kg, and adults are assigned to 0.5 g (1 tablet) 3 times a day. Children under 10 years of age should be prescribed amoxicillin preparations in the form of a suspension from the calculation for most amoxicillin:

1. Up to 2 years - 20 mg per kg of body weight 3 times a day;

2. From 2 to 5 years - 125 mg 3 times a day;

3. From 5 to 10 years - 250 mg 3 times a day.

Additional Information

Amoxicillin is an improved ampicillin. It was developed precisely in order to get rid of the disadvantages of the predecessor - low bioavailability and high degree of inactivation in the blood. Today, amoxicillin could be the ideal antibiotic for angina, if not for the high incidence of resistance to it pathogens.

By the way, in many respects the ineffectiveness of amoxicillin is associated with an incorrect and indiscriminate use of it, when the angina does not reach the end, or if the diagnosis is incorrect, patients treat them with viral and fungal infections. In particular, when patients are looking for "some kind of antibiotic for colds and sore throats", it is very likely that there is no quinsy in this situation (it does not occur from a cold), and the use of amoxicillin in this case is likely to contribute to the production of any bacteria in the body resistance to it. Later, when a patient has a real tonsillitis and antibiotics are really needed, seemingly non-dangerous symbionts in the throat will protect themselves from amoxicillin a dangerous pathogen.

With the high resistance of bacteria to amoxicillin, organizational complexity is associated with its administration. In particular, it is most often used as an antibiotic for catarrhal angina, when the doctor can wait with the appointment before receiving the results of bacterial examination. In cases of severe angina, in which an antibiotic should be prescribed urgently for rapid relief of the patient's condition, and consequently, without knowing the stability of bacteria, drugs are used to which the bacteria are resistant much less often.

And one more important point: in different countries in the sale of different drugs based on amoxicillin. Amoxicillin itself, as well as the European Flemoxin Solutab, are sold everywhere, but this antibiotic in angina in most countries doctors prefer to prescribe in the form of Amoxyl (as the most affordable). These funds act in the same way, but patients need to remember that they can not find the drug found on the Internet in a real pharmacy of their city.

On the photo - Amoxil packaging.


Preparations: Azithromycin, Zithromax.


Azithromycin is effective against all pathogens of angina, including those that synthesize penicillinase and are resistant to amoxicillin and other penicillins.

It is interesting! A special feature of azithromycin is that it is transported to inflamed tissues, attaching to the macrophage cells - participants in the immune response of the organism, which themselves move toward the focus of the infection. Due to this, azithromycin rapidly accumulates at the site of inflammation in high concentrations and acts more actively than other antibiotics.

Cell-macrophage, the task of which is to eat bacteria that are dangerous to the body.

Safety and side effects

Like other macrolides, azithromycin often causes digestive disorders, in particular - diarrhea, nausea, abdominal pain. And in children these side effects are observed more often. Other consequences of its reception - drowsiness, headaches, allergies - occur about the same frequency as when applying penicillins.

Precisely because of side effects, azithromycin is used mainly when amoxicillin is not likely to help.

Features of application

Azithromycin is known for its angina intake for 5 days - less than any other oral antibiotics. Wherein:

1. Adults are prescribed on the first day 1 tablet of the drug based on azithromycin, over the next 4 days - half the tablet;

2. Children are prescribed on the first day 10 mg per kg of body weight, then 5 mg per kg of body weight per day for 4 days.

There is also a scheme for taking the drug for 3 days, when adults are given 1 tablet a day, children - 10 mg per kg of body weight per day. However, as practice shows, when using such a scheme, treatment is often unsuccessful.

Structural formula of azithromycin
Structural formula of azithromycin.

Preparations of azithromycin for angina are given in the form of tablets or suspensions. Take them one hour before meals, or two hours after it. Azithromycin is partially digested by gastric juice, and taking it concurrently with food greatly reduces the effectiveness of therapy.

Additional Information

Azithromycin is an improved version of erythromycin. In comparison with its predecessor, it is more stable in the acidic environment of the digestive system and is more fully absorbed, and also less often causes side effects.

In the United States, the causative agents of angina are resistant to azithromycin in about 6% of cases (according to data for 2015), that is, in about 15 cases (4 times less often than for amoxicillin). It is lower than for erythromycin, but higher than for josamycin.

Azithromycin is prescribed in situations where the sensitivity of the causative agent of angina to antibiotics is not known, or the resistance of bacteria to penicillins has been confirmed. In particular, with lacunar angina, antibiotics are prescribed immediately after the diagnosis of the disease itself and even before the results of bacterial research are obtained, since in this situation the main task is to quickly alleviate the patient's condition, albeit at the cost of a digestive disorder (in the absence of appetite, this is not so critical) . In this situation, it is expedient to prescribe exactly azithromycin as an antibiotic of a broader spectrum of action, than a safer amoxicillin.

Amoxicillin and clavulanic acid: Augmentin

Preparations: Augmentin.

Augmentin is the first registered trade name for the complex of amoxicillin and clavulanic acid.


This antibiotic in angina is the most universal, since the resistance of bacteria to the complex of amoxicillin and clavulanic acid almost never arises.In addition, clavulanic acid itself has antibacterial activity and enhances the action of amoxicillin.

Safety and side effects

Drugs based on amoxicillin and clavulanic acid are much more likely than pure amoxicillin to cause side effects from:

1. Digestive system - diarrhea and nausea are recorded in about 5% of cases (more often in children);

2. Nervous system - dizziness, pain in the head (approximately 4% of cases);

3. Urinary system - interstitial nephritis (approximately 1% of cases).

Also, this antibiotic in angina can cause an allergy with hives and itching - in about 4% of cases (more often in adults).

All the side effects of taking these medications are mild and quickly disappear, but occur more often than with azithromycin, and therefore in general this combination is considered less safe.

Features of application

The duration of treatment is 12-14 days. Adults and adolescents are prescribed 1 tablet with 250 mg of amoxicillin 3 times a day before or after meals, in case of severe disease - 0.5 g three times a day or 1 g 2 times a day.

Children are prescribed as a suspension:

1. From 9 months to 2 years - 10 mg per kg of body weight 3 times a day;

2. From 2 to 12 years - 15 mg per kg of body weight 3 times a day;

3. From 2 to 7 years - 125 mg per day, divided into three doses;

4. From 7 to 12 years - 250 mg per day, divided into three doses.

Additional Information

Of all antibiotics for angina, amoxicillin and clavulanic acid are effective in the greatest number of cases. If not for their side effects, they could be considered the most versatile treatment.

In the photo, the drug Augmentin, a widely used amoxicillin-clavulanic acid:


Preparations: Cefadroxil.


The effectiveness of angina this antibiotic is similar to amoxicillin. Statistically, bacteria less often develop resistance to it than to amoxicillin, and therefore it can be prescribed more often. Cefadroxil is active against pathogens producing penicillinase, but is ineffective in angina caused by -lactam antibiotic-resistant pathogens.

penicillin with bacterial enzymes
The reaction of splitting the lactam ring and inactivating penicillin with bacterial enzymes

Safety and side effects

Cefadroxil is well tolerated, it is comparable in this respect to amoxicillin. Of the side effects for it are allergic reactions, dyspeptic disorders, rarely - liver failure.

Features of application

The course of treatment of angina with cefadroxil should be at least 10 days, optimally - 12-14 days.

Children with a body weight of more than 40 kg and an adult are prescribed 1-2 grams in 1 or 2 doses (the tablet has a mass of 0.5 g). Children with a body weight of up to 40 kg are prescribed 40 mg per kg of body weight per day for 1-2 doses.

Cefadroxil is active against pathogens

Additional Information

In comparison with amoxicillin, the most pronounced deficiency of cefadroxil is the higher price of preparations based on it.

In general, cefadroxil is also prescribed after culture examination of the smear from the throat of the patient. As a rule, with the help of this antibiotic, catarrhal sinus is treated, in which it is quite possible to wait for the results of bacteriosia, or with the successful softening of purulent sore throat symptoms by symptomatic means. Prescribe cefadroxil immediately after diagnosis, not knowing the sensitivity of the pathogen to antibiotics, is inappropriate.

Petri dish
Bacterial seeding in a Petri dish.


Preparations: Erythromycin.


Erythromycin is effective against all pathogens of angina, including against bacteria that are resistant to penicillins.

Resistance of the causative agents of angina to erythromycin in the United States is approximately 9%. It is the largest in the northern part (almost 14%), the lowest in the Central region (4.8%).

At the same time erythromycin has unsatisfactory pharmacokinetic indices. For example, it is split in large quantities in the stomach, and therefore for effective use it must be used in relatively large doses.

Safety and side effects

The main disadvantage of erythromycin is that it often causes digestive disorders. This is due both to the suppression of the intestinal microflora, and to the independent effect of this antibiotic on the activity of the musculature of the intestine.

In addition, erythromycin is ototoxic and often causes deterioration of hearing and tinnitus. However, these side effects are usually reversible.

On a note! Hearing impairment when taking erythromycin occurs more often in elderly patients, as well as in patients with renal or hepatic insufficiency.

Features of application

For adults, doctors prescribe the drug inside 1-2 g per day for 2-3 doses, for children older than 4 months - 40 mg per kg of body weight per day for 2-3 hours with an interval of at least 6 hours.If necessary, the intravenous dose is determined based on the body weight and the patient's condition.

For inpatient treatment, erythromycin, like many other antibiotics, is administered intravenously.

The duration of antibiotic intake is at least 10 days.

Additional Information

Erythromycin was the first antibiotic obtained in the macrolide class. On its basis, other drugs of this class were developed, in particular, safer azithromycin. To date, erythromycin is the optimal antibiotic for angina in terms of price-effectiveness ratio, if you do not take into account side effects from its use.

What antibiotics from angina will not help?

There is no sense in using the so-called "natural antibiotics" in angina, as some folk remedies refer to - onions, garlic, aloe vera, calanchoe, cyclamen. All of them have no effect on streptococcal infection, and attempts to replace them with the use of effective antibiotics fraught with the development of complications of angina.

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