11 best antibiotics for coughs

*Review of the best according to the editorial board. About the selection criteria. This material is subjective, not an advertisement and should not be regarded as a guide to purchase. Before buying it is necessary to consult with a specialist.

To prescribe or not to prescribe antibiotics for coughs? Of course, sometimes it is necessary to do it, but not always. After all, antibiotics are a means against microorganisms, against pathogenic bacteria. And if the cough will have an allergic nature? Then you need to treat it in a completely different way. But let’s understand in order what a cough is, in what types of coughs antibacterial drugs will be indicated, and what are the other symptoms in which microbial inflammation of the airways is more likely.

Everyone knows that coughing is a protective reflex, the task of coughing is to free the airways, remove foreign objects, viscous or liquid sputum (the so-called tracheobronchial secret) and maintain normal air conduction for adequate gas exchange. The speed of air flow in the upper airways during the coughing thrust can reach 100 km/h and even more.

Cough is an effective means of cleaning the lungs, and at the same time it is one of the most common complaints, not only during an office visit with a pulmonologist, but also in the practice of an ordinary local therapist. Experts count more than 50 different causes of cough, and only a few of them require the prescription of antibiotics.

How the cough works?

No matter what the cause of the cough, it is a reflex physiological act that develops through a single mechanism, and it can be any kind of cough: barking or hoarse, wet or whooping, with occasional coughing or whooping fits, as in whooping cough.

First there is irritation of the receptors, with which the mucosa of the upper airways and also the pleura are richly supplied. The nerve signal is transmitted to the cough center, which is located in one of the oldest brain regions that amphibians and reptiles already have – it is the medulla oblongata.

Naturally, the cough center is next to the respiratory center, and the respiratory center is a vital center, along with the circulatory and heart regulation centers, so these ancient parts of the brain emerged very first, in evolutionary development.

Now the ascending, sensitive part of the reflex arc must switch after analysis in the cough center to the motor. As a result, a strictly coordinated and well-ordered impulse goes from the cough center to many muscles of the chest, bronchi, diaphragm, and larynx muscles, and the coughing impulse results. If any of the nerve impulses come at a wrong time, or are too late, the reflex action will not be possible. Here is a simple example.

In order to cough, we need to open our mouth. No one thinks about it; everything happens “by itself”. But this is also a task of the cough center. In addition to giving nerve signals to the muscles that provide the cough, it also gives signals to the trigeminal nerve, and to the muscles that provide chewing and open our mouth. We can see that the cough reflex is very complex, but we are not consciously involved in it.

What kind of cough most often requires an antibiotic prescription, what kind of cough it is. This is important to know, because antibiotics given not with the “right” cough will do harm, and not help.

Moist and dry cough

Many would say that the main difference between dry cough and wet cough is its more debilitating effect on the body. Indeed, a wet cough ends with the expectoration of sputum, and that is why it is called a productive cough. Dry cough can be prolonged, distressing, and inconclusive. In a wet cough, the so-called sputum is secreted.

Normally, the mucous membrane of the respiratory tract must protect itself from external influences, from dust particles, and from microorganisms entering the tracheobronchial tree. The task of secreting mucus, or secretion, will fall to the bocalytic cells. The ciliated epithelium produces an oscillatory movement of the cell cilia, as if “sweeping” the mucosa, and directs the flow of the secretion upward, to the larger bronchi. The sputum is then expelled.

The task of the atrial epithelium is to remove mucus with particles of dust and germs stuck on it away from the alveoli, where gas exchange takes place. The normal ability of the atrial epithelium to expectorate is called mucociliary clearance by pulmonologists. The greater the capacity of the bronchi to clean themselves, the better for both the bronchopulmonary and immune systems. After all, even in a healthy person in the composition of the sputum there are dead white blood cells, and destroyed microbes, and particles of soot, inevitably getting into the lungs.

It is estimated that in a lifetime the average person enters into the lungs of about 5 kg of dust! Imagine several vacuum cleaner bags full of dust up to the top and you will understand what a gigantic job the cells of the mucous ducts do, clearing the lungs and bronchi of “garbage” every second. It is amazing that there are still smokers who knowingly clog the delicate bronchial mucosa with soot, tobacco tar, nicotine, carcinogen benzpyrene, radioactive isotope polonium-210, and other deadly substances.

Naturally, if the sputum is not drained, then such a cough will be dry. If the sputum is very thick, the small bronchi are clogged with it and it is difficult to expectorate, then such a cough will be called unproductive.

If the person does not have the strength to cough, then the expectoration of the sputum will also be difficult. It may be that sputum is not formed at all, or is formed in insufficient quantities. This is when, during coughing, there will be excruciating discomfort with farting in the throat, scratching behind the sternum, chronic coughing, and other symptoms.

Since the microorganisms to blame for the cough cause inflammation, it is obvious that antibacterial therapy and antibiotics for cough should be prescribed when there is a diagnosis of bronchitis, not just any cough. When do we have the right to talk about the diagnosis of bronchitis??

Cough or bronchitis?

Of course, not only bronchitis requires the prescription of antibiotics. It can also be pneumonia, or pneumonia of the lungs, or tracheitis, or microbial inflammation of the trachea. But, as a rule, isolated tracheitis does not occur, more often speak of tracheobronchitis. Most often the infection descends from the nose and throat to the lower parts of the airways, namely to the trachea, then to the bronchi and in some cases to the lungs, with the development of pneumonia.

In a healthy adult, it is not so easy to get microbial bronchitis. We have a well-developed diaphragm and chest muscles. Unlike babies, we are good at coughing, and this makes it easier to get the sputum out in time. If an adult coughs well, and he has a wonderful sputum discharge during bronchitis, it seriously reduces the risk of complications, and sinking the infection even deeper.

What are the symptoms and signs of bronchitis that will trigger the prescription of antibiotics for cough? Let me remind you right away that any use of antibiotics for coughs in no way stops the cough itself, they directly affect the cause of inflammation – the bacterial flora. When the cause is eliminated, its consequence, the cough, also stops. If during bronchitis to give the patient anti-cough medications that suppress the cough reflex, then this is a guaranteed way to get serious complications. During bronchitis you need to cough a lot and well, to thin the sputum and improve its discharge.

Symptoms and signs of bronchitis

Disease-causing microbes do not immediately begin to show their activity on the bronchial mucosa. It needs to be compromised initially, to be weakened, so that germs can more easily seize this beachhead. That is why classically, at the very beginning, a person has a banal respiratory viral infection – acute respiratory infections, runny nose, fever, flu-like syndrome, or the viral flu itself. Now, in late 2020, a coronavirus infection has been added, which, while in mild form, can also cause not only secondary bacterial pneumonia but also bronchitis, adding work for medics.

Usually after a couple of days of the course of a viral respiratory infection, a dry (viral) cough appears, attack-like, excruciating, and without sputum. This symptom shows that the upper respiratory tract is infected by a virus, so there is no point in prescribing antibiotics at this time. Microbes have not yet invaded the respiratory tract.

Then, about 4-6 days after the initial improvement, the condition worsens again, with a rise in temperature and a wet cough. Such productive cough is accompanied by periodic discharge of sputum, which changes its color.

If in viral infection the sputum is either transparent, vitreous, or whitish-gray in color, when a secondary, bacterial infection develops, the sputum color changes to yellowish, or greenish, with characteristic pus streaks. Festering is a sign of microbial infection, viral diseases do not form pus.

With classical bronchitis usually sputum usually comes out still in small quantities, and the breath changes its hue. If in the first phase of the viral infection there was rigid breathing, and the wheezing was dry, now the wheezing in the lungs acquires a moist character.

Accordingly, in this situation, we have all the clinical signs, and a characteristic history of symptoms, so that after examination, and listening to the lungs to prescribe antibiotics, rightly suspecting the transition of viral infection to bacterial, with the development of acute bronchitis. But so far, this is only a hypothesis. Ideally, we need to prove that indeed the cause of the secondary deterioration of the condition and the appearance of mucopurulent sputum was bacterial flora, and antibiotics are needed for cough.

Empirical and Rational Approach

Therefore, the best way to treat bronchitis will be a combination of so-called empirical and rational antibacterial therapy. At the initial appointment in the clinic, or at home, at the patient’s bedside, the doctor may be more or less likely to assume a microbial infection that has caused the bronchitis and cough. Therefore, the doctor immediately means a broad-spectrum antibiotic that is most likely to cope with microbial damage to the upper respiratory tract. But the doctor does not know exactly which germs caused the bronchitis. This approach to antibiotic treatment is called empirical.

In the vast majority of cases, that’s where it ends; a modern antibiotic, along with other treatments for bronchitis, wins, and the patient recovers. But in some cases, germs behave insidiously, the antibiotic fails to cope with the infection, and then the doctor has a choice: either change the antibiotic, or really find out which germs have caused the infection, and which drug a particular pathogen is sensitive to.

To do this, you need to take a sputum for a bacteriological examination, or, as they say, “do a bacterial culture” of the sputum. Clean colonies of pathogens will grow on nutrient media from the bronchial discharge, and they will be identified using specific microbiological tests, and then tested for sensitivity to test antibiotics. And only when the exact result of the sputum culture is ready and it is known which antibiotic is most effective, the doctor can, based on the evidence, prescribe a targeted treatment, that is, apply a rational antibiotic therapy.

Of course, in the most correct option, already at the first appointment, it is advisable to take sputum for analysis, so that immediately begin the treatment of bronchitis and cough rationally. But modern broad spectrum antibiotics are so effective in common cases that in a person with normal immune status it is usually not necessary. The doctor will therefore write a prescription for antibiotics at the first appointment.

Yes, indeed, recently in the Russian Federation antibiotics are sold only by prescription, and this is justified. The widespread availability of antibiotics, which used to be purchased without any restrictions, and used, among other things, incorrectly, led to a wide “acquaintance” with them of numerous populations of pathogenic and conditionally pathogenic microorganisms, with rapid formation of resistance.

Before describing today’s effective antibiotics used in wet cough, let’s talk a little about their features and differences from other medications, this will help to properly organize the treatment process.

The difference between antibiotics and other drugs

It is known that life on earth is a combination of intraspecific and interspecific competition. But the competition extends much further than different species, to different classes, different types of living things, and even to different kingdoms. Single-celled microorganisms and bacteria compete for a living environment with multicellulars, such as humans. And to destroy “uninvited guests” and created different types of antibiotics. Antibiotics are very different from other medications:

Many drugs affect the metabolism of human organs and tissues, And antibiotics work exclusively on foreign cells, almost always bacteria.

There may be antibiotics directed against protozoa (antiprotozoans), against fungi (fungicides, or antimycotics), but there are no antiviral antibiotics. If your doctor gives you an “antibiotic for a virus,” run away from such a pseudo-doctor. Because antibiotic affects the vital activity of microorganisms, but a virus has no vital activity. Viruses are dead crystals of alien hereditary information that multiply using human cells;

Second difference– there is a gradual decrease in the effectiveness of antibiotics as bacteria become resistant, or learn to overcome the damage caused by the drug.

This is the reason for the modern race for survival between microbes and the pharmaceutical companies who invent more and more antibiotics. Other drugs that humans use to treat hypertension, epilepsy, diabetes mellitus work on our bodies just as they did many years ago when they were discovered. The same Maninil, or insulin will help man in the same way it helped our grandparents. But antibiotics are a different matter, because here we are talking about the struggle for the survival of microorganisms involved with humans in a single infectious process.

Why an antibiotic for a cough didn’t work?

Germs multiply extremely quickly. In just a few hours, the microbial cell divides in half, and this extremely rapid renewal of structures and genetic information allows and rapid response to new antibiotics, beneficial mutations quickly develop. Doctors, biologists, and pharmacists have long studied ways to evade germs from antibiotics. Here are some of them:

1. The antibiotic can’t find a point of effect on the bacterium the way it used to. Microbes change their structure, such as changing the permeability of the cell wall, and the antibiotic cannot get in;
2. bacteria have learned to produce entirely new enzymes that destroy antibiotics. This is how the mechanism of pathogen resistance, which is called beta-lactamase resistance, arose;
3. Bacteria have been able to get the antibiotic out of their cell as quickly as possible by increasing metabolism. This is how Pseudomonas bacillus manages to survive in a surgical hospital setting, with the formation of hospital flora.

There are other mechanisms that simply alter the genome of a microbe and make it immune to many antibiotics.

How Antibiotics Work?

Antibiotics are of two kinds: some kill germs and destroy their cells; they are called bactericides. The second does not kill germs, but prevents them from multiplying. Many people will think that you should only use germicidal antibiotics. Why preserve germs? In fact, microbial cells live for a very, very short time, no more than a few hours, or at least no more than a day.

But if they are constantly attacked by white blood cells and attacked by antibodies, stopping them from multiplying under unfavorable conditions eventually leads to their rapid destruction. Bactericidal antibiotics kill many germs at once, but sometimes this is dangerous. When a pathogenic microorganism dies, its cell wall, or membrane, is destroyed, and a huge amount of antigens, toxins, and other substances are released, which can cause increased fever, and even infectious-toxic shock.

This is especially important in sepsis, when microorganisms are circulating in the blood, and it is not possible to destroy this microbial mass immediately, it is life-threatening for the patient. Then bacteriostatic drugs are used (classically, for example, levomycetin in meningococcal septicaemia – meningococcus), and in some cases this is the only option for a patient with a severe form of microbial infection to survive.

Sometimes we recall such a notion as “broad-spectrum or narrow-spectrum antibiotics. Indeed, this was relevant in the 20th century, but now germs “know” many antibiotics very well, they have developed cross-resistance. Broad spectrum antibiotics, which were extremely effective in the past, have become “small” and do not affect everyone; for example, the same benzylpenicillin. Narrow-spectrum antibiotics have lasted much longer, and sometimes are still used today. For example, rifampicin has been positioned as a tuberculosis antibiotic from the beginning, and it is still in that capacity.

The practical application of these findings is. In the case of bronchitis and cough, a modern antibiotic should be prescribed, which affects a large number of different types of microorganisms at once. Bronchitis and cough are very rarely caused by a single type of bacteria alone. Microbial associations sometimes occur, especially in low immunity settings.

Antibiotic therapy for bronchitis

This review includes popular, modern antibiotics used not only to treat bronchitis and cough, but also used to treat many other infections. These are infections of the gastrointestinal tract, genitourinary organs, soft tissue infections, ENT organs, and many other conditions.

Drugs are first designated by their INN, or international nonproprietary name. The following, in parentheses, are their own names. If there is only one drug, it is the original drug and if there is more than one, usually the original drug first and then the commercial copies from other companies, or generics.

If you can, you should always buy the original medicine. It is always more expensive, but also more effective. Its high price is due to years of laboratory research, clinical trials. It took a lot of time and money to develop the original drug. In addition, the original manufacturer always guarantees the reference quality of the substance, or chemical that is active.

The original drug is the flagship in quality, which all other manufacturers look up to. When the patent expires, other companies may also produce this medicine, but the price of generics will be lower, but the guarantee of the same quality substance as the original medicine may no longer remain. In other words, the cheapest analogue may be good for your wallet, but its effectiveness may be significantly lower than that of the original product.

Here is also the price range relevant to pharmacies of various forms of ownership in the Russian Federation for the end of 2020.

The listed drugs do not purport to be efficacy ratings in any way, and the order in which they are listed is random. There are many other antibiotics that are not listed, simply because of the excessive length of the article. All these antibiotics for bronchitis and cough are integrated into the guidelines of pulmonology, national and international clinical guidelines for the treatment of bronchitis and cough, and have an evidence-based basis.

There are no supplements or homeopathic medicines on this list that have not been confirmed to be effective by modern research. The inclusion of antibiotics in this list is not an advertisement or an offer to buy. Antibiotics are prescription only by the physician and according to the indications and contraindications. All information below is taken from public sources, solely from the official instructions for each medication.

The best antibiotics for coughs

Azithromycin (Sumamed)

Rating: 4.9

Sumamed is a highly effective antibiotic not only for various inflammatory diseases of the upper respiratory tract and for bronchitis, but also as a treatment for pneumonia triggered by covid-19 infection. The price of Sumamed is quite high (by the standards of the Russian consumer). A pack of 3 tablets with a combined weight of 1500 mg (or 0.5 g per tablet) is either in short supply or offered for about 600 rubles.

Sumamed is produced by the Croatian company Pliva, but you can buy some other azithromycin, for example domestically produced. Sumamed is a bacteriostatic broad-spectrum antibiotic belonging to the macrolide family. Macrolide antibiotics are excellent against various streptococci that very often cause upper respiratory tract inflammation in bronchitis, and tracheobronchitis. The drug is very well studied, and has more than 10 thousand scientific papers and publications in the largest international database of studies.

Azithromycin works by a mechanism that disrupts protein synthesis in bacterial cells. The effect of the antibiotic is dose-dependent. Once it is used in high enough concentrations, it also begins to show bactericidal activity. It begins to affect not only Gram-positive streptococci and staphylococci, but also Gram-negative bacilli, anaerobic flora, and intracellular parasites like chlamydia. Sumamed is prescribed one tablet daily for 3 days. This form of prescription shows that it is a powerful medication.

Advantages and disadvantages

The undeniable advantage of Sumamed, as well as quality azithromycin for cough is its high activity, as well as the patient’s ideal adherence to treatment. You do not need to take the antibiotic several times a day, but only once. By doctor’s decision, the number of days can be doubled, up to 6 days. Sumamed is active against so many microbes, for example, it is lethal to anaerobic flora, and anaerobes can cause bronchitis, especially in immunocompromised conditions. Individuals with HIV infection may also have upper respiratory tract infections with chlamydia, or even mycoplasma bronchitis. Azithromycin can successfully fight these pathogens as well.

A big plus of azithromycin is good tolerability. Allergic reactions or side effects occur very rarely. But all pleasure must be paid for, and the obvious disadvantage (for the Russians) may be considered the high price, in some cases over 1000 rubles. For a 6-day course of treatment.

But we should not forget another point of application of azithromycin: it is the treatment of sexually transmitted infections. For example, for the treatment of fresh gonorrhea, only a one-day course is enough: to be cured, you need only one tablet. This is why Sumamed can be considered a universal antibiotic that helps with various forms of respiratory tract infections.

Cefuroxime (Zinnate)

Rating: 4.8

This medicine, or cough antibiotic, is already from a completely different group, not macrolide drugs, but cephalosporins. Typically, most cephalosporins are drugs that are used in intramuscular injections. But you have to agree, treating ordinary bronchitis with injections is not quite pleasant. People accept intramuscular injections for severe illnesses, such as pneumonia. And in reviewing the antibiotics that are prescribed for cough and bronchitis, we will limit ourselves to oral medications exclusively.

There are several of these drugs and in the group of cephalosporins. These are bactericidal medications, and Zinnate is one of the most effective antibiotics for cough. True, it is not available in tablets, but in granules, from which a suspension is prepared. It is produced by the well-known British company Glaxo Wellcome, and the original drug costs no more than 330 rubles. per 50 ml bottle. This antibiotic acts as a prodrug, turning into another active ingredient in the body.

Zinnat is effective enough for Gram-positive cocci infection, as well as for bronchitis and tracheobronchitis caused by various Gram-negative flora. It is best taken with food. It is also very effective not only for cough and bronchitis, but also for angina, maxillary sinusitis, otitis media, skin and soft tissue infections, joints. In severe cases, intramuscular administration of the drug is combined (since it is also sold for intramuscular injections), and it is also administered orally. For adults, a dosage of 500 mg 2 times a day after 12 hours with meals is sufficient.

Advantages and disadvantages

In some cases, cefuroxime may cause side effects. Most often it is an increase in eosinophils in the blood, allergic urticaria. Remember that it is very undesirable to take alcohol during treatment with cephalosporins, because the same effect may develop as from taking Teturam. Alcohol in the body is under-oxidized, and stops at the stage of acetic aldehyde, which causes an extremely unpleasant feeling, and a severe condition. A big plus of cefuroxime can be considered affordability, low cost, and sufficient effectiveness.

Amoxicillin (Flemoxin Solutab)

Rating: 4.8

This is a very popular antibiotic for bronchitis and cough, is a synthetic aminopenicillin, more specifically amoxicillin. These are not just pills, but dispersible pills. That is, they need to be diluted in half a glass of warm water, and they will dissolve into a special suspension, with a fruity odor with a slight scent of penicillin. Available in staggered doses: 125mg, then 250, 0.5g, and 1g, or 1000mg.

It is a powerful antibiotic from the group of bacteriostatics, and its favorite target is staphylococci and streptococci, that is, gram-positive flora. It is the one that very often causes upper respiratory tract damage, bronchitis and cough, when you need an antibiotic. In uncomplicated bronchitis in adults, Flemoxin can be taken 0.25 g one to two times a day, with a more severe course, the dose can be doubled, or even up to 1 g daily, but only when indicated, as prescribed by the doctor. The course of treatment is from 1 to 2 weeks. This is a quality medicine produced by atellas Pharma from the Netherlands, and with European quality it has a low price. One pack of 20 500 mg tablets costs no more than 380 rubles.

Advantages and disadvantages

It is much more pleasant to swallow the suspension in water, with a smell of fruit, than to choke on a large pill of antibiotic. Flemoxin is well tolerated, and there is no connection of the drug with food intake, it can be taken both after meals and on an empty stomach. The patient already feels relief the day after treatment begins. The temperature decreases, feeling better, unpleasant feelings when coughing disappear. However, you need to consider the side effects that often develop on synthetic penicillins. It can be various allergic reactions, such as urticaria, or skin itching.

Simple Amoxicillin will not work against those germs that have beta-lactamase resistance, in which case, if such strains of resistant bacteria are detected in a bacteriological examination of sputum, Amoxicillin should be combined with clavulanic acid, for example, prescribing Augmentin. But still, in most cases Flemoxin in uncomplicated forms of bronchitis is well tolerated, and fulfills its role. The drug has a high quality at a low price.

Moxifloxacin (Avelox, Moxiflox, Rotomox)

Rating: 4.8

This antibacterial drug for cough and bronchitis is from another group, the fluorinated quinolones group. It may not be an antibiotic, but it is a complete and high-quality modern antibacterial drug of the latest generation. Avelox is also not cheap, it is produced in Germany (Bayer), and for five tablets of 400 mg will have to pay from 530 to 650 rubles.

Avelox is a highly effective drug that can help with atypical flora that cause bronchitis. Among other things, it affects pneumococci, and pneumococcal pneumonia is a severe complication of coronavirus infection, especially in the elderly. In general, the treatment of infections of the upper and lower respiratory tracts is the “horse” of Avelox. It is also successfully used in diseases of ENT-organs, with angina, acute maxillary sinusitis and otitis, is prescribed for infections of soft tissue and skin. Regimen of administration – once a day, regardless of meals. The doctor decides on the duration of the treatment.

Advantages and disadvantages

Avelox also creates an ideal adherence to treatment, because it is taken once a day. Since the drug is very effective, it is not prescribed together with other antibiotics, it alone copes with many infections. But there is one serious limitation to keep in mind. Fluoroquinolones (all), especially in high doses, and with prolonged use, affect cartilage, connective tissue, and should not be prescribed for children, including coughs and bronchitis.

Against the background of taking fluoroquinolones in adults can be various tendinitis, that is, inflammation of the tendons with a decrease in their density. I even suffered a rupture of Achilles tendon during exercise. But usually with bronchitis patients are treated at home, and do not experience physical exertion, but you should still be aware of this. Also Avelox and its analogues are undesirable to take against a background of intense insolation, you can not take sunbathing and sunbathing, it can cause photodermatitis, as well as cause its preparations of St. John’s wort. This drug is contraindicated in certain types of ventricular arrhythmias, as Avelox can provoke arrhythmias by prolonging certain intervals on the ECG.

Cefexime (Suprax)

Rating: 4.8

Cefixime is a modern, third-generation cephalosporin that works widely for a variety of pathogens that cause bronchitis, tracheobronchitis, and pneumonia. This is an encapsulated (in capsules) cephalosporin, which is rare: cephalosporins are usually drugs administered intramuscularly. As we remember, above we considered Zinnate as a representative of such oral cephalosporins. But Suprax manufactured by the Hungarian company Gedeon Richter is produced in 200 and 400 mg, and has a pronounced bacteriostatic effect. It stops the reproduction of bacteria, but does not destroy them.

The antibiotic Suprax is very good in children and also as a backup antibiotic. Children’s Suprax is available as granules for making a suspension, with a strawberry flavor. One bottle of pellets, to prepare a suspension will cost from 500 to 600 rubles. Cefixime may be used when penicillins are intolerant. It is a modern antibiotic, and it is not more expensive than Sumamed. A pack of 6 capsules of 400 mg can cost about 600 rubles.

Advantages and disadvantages

Suprax is a 3rd generation oral cephalosporin that works effectively. The antibiotic is excreted slowly, which is why it can be used for various inflammatory diseases of the respiratory system, daily, once a day. In most people, the antibiotic is well tolerated, including children. Suprax is a quality and relatively inexpensive drug.

Midecamycin (Macropen)

Rating: 4.8

Macropen is an antibiotic from the macrolide group, produced by KRKA (Slovenia). A pack of 16 0.4 g tablets is inexpensive, about 300 rubles. This is also a bacteriostatic drug, its activity is most pronounced against staphylococci and streptococci, but it also helps with infections of intracellular parasites. These are diseases like chlamydia, legionellosis and mycoplasma infection. And all these infectious agents can cause pneumonia in weakened individuals. Therefore, it can be considered that Macropen is indicated as a cough antibiotic for various severe atypical forms of pneumonia.

The drug is able to accumulate in tissues, effectively leaving the blood. Macropene concentrations in tissues are more than 100 times higher than in blood. The drug is low-toxic and well tolerated. Macropen is widely used if the patient is allergic to penicillins, such as Flemoxin Solutab. Macropen is also prescribed for chronic bronchitis, for various other infections. Dosing regimen – one tablet three times a day, on an empty stomach, an hour before a meal in adults.

Advantages and disadvantages

Macropen is a convenient and grateful drug. A definite disadvantage is the need to take it not once a day, but three times a day. But it has low toxicity, actively fights intracellular parasites, creates a high concentration in the tissues. Of course, it has some negative aspects, such as the possibility of cross-allergies with beta-lactam antibiotics, but usually with uncomplicated forms of bronchitis, when Macropen is prescribed in low dosages, this does not happen.

Clindamycin (Dalacin C)

Rating: 4.8

Clindamycin is another highly active bacteriostatic antibiotic that actively fights bronchial inflammation and cough. The Serbian company Chemopharm makes Clindamycin, which is very inexpensive and of high quality. For only 160 rubles. Available in 16 capsules of 150 mg each. Clindamycin is very good against pneumococci, which can cause severe bronchitis with cough, and pneumonia, especially after coronavirus infection. It is also possible to treat streptococcal and staphylococcal bronchitis with clindamycin, this drug is the second generation of the antibiotic lincomycin. In fairly high doses Clindamycin can even act on the causative agent of toxoplasmosis, which is not a bacteria. Interestingly, in addition to bronchitis, clindamycin is excellent for treating various forms of angina, and even tropical malaria, which is resistant to classical antimalarial drugs. Clindamycin is given to patients at 300 mg every 6 hours. The duration of the course is determined by the doctor.

Advantages and disadvantages

Clindamycin is probably the only drug on our list that is taken so often: four times a day. But this is the price to pay for its high efficacy. Clindamycin is also able to accumulate in bone tissue, which helps treat osteomyelitis and other bone infections, but it does not penetrate well into the central nervous system, and treatment of purulent meningitis and bacterial encephalitis with it is limited. It can cause side effects like diarrhea, but usually this side effect does not occur in dosages designed to treat cough and bronchitis. Also an absolute plus is the low cost and high availability.

Spiramycin (Rovamycin)

Rating: 4.8

The next antibiotic, but not so widely used for bronchitis and cough is Spiramycin, manufactured by the French company Sanofi Aventis. As a rule, they are not immediately “scattered”, they are left in reserve. This allows germs to rarely encounter it, and resistance to spiramycin does not occur as often. Also, it may well be used if the patient with bronchitis and cough is allergic to cephalosporins or penicillins. Bronchitis can be treated with Rowamycin, whose pills have a dosage of millions of units. So far this medicine is the most expensive in our list: you will have to pay an average of 1500 rubles for a pack of 16 tablets of Rovamycin.

This is a macrolide antibiotic, its “scope of responsibility” includes the fight against both gram-negative and gram-positive microorganisms. This is the group that includes the largest number of representatives that cause diseases of the upper and lower respiratory tracts. Rovamycin can also be successfully used to treat community-acquired pneumonia, including that caused by chlamydia and mycoplasma. The required dosage is up to 9 million. Units per day, divided into three doses, respectively, a maximum of 6 tablets. But one pack of spiramycin may not last long, so you should stock up on several packs beforehand.

Advantages and disadvantages

The most important disadvantage of the drug is the high price. Side effects are nausea, allergic rash. But, as a rule, in 1-2 days this unpleasant condition passes, and you can continue treatment. Novamycin should not be administered to children under six years of age, especially in high concentrations over 1.5 million units. This is a very effective current antibiotic, but it is usually prescribed when any broad-spectrum antibiotic has failed.

Amoxicillin + clavulanic acid (Augmentin)

Rating: 4.8

As we wrote above, bacteria have “learned to fight” penicillins, which are broken down by special microbial enzymes called beta-lactamases. To stop the work of these microbial enzymes, and to resume the effectiveness of penicillins, you need to protect the penicillin. It is necessary to additionally add an inhibitor of this enzyme, that is, the substance that interrupts its work. Clavulanic acid is just such a substance, disarming the “secret weapon” of microbes. If you add clavulanic acid to amoxicillin, there is an effective antibiotic called Augmentin, or Amoxiclav. Clavulanic acid is still being studied as a remedy for many antibiotics, and the number of articles posted on the most authoritative international medical research database on the acid is about 8,000.

It is also available in tablets, either 250, or 500 mg, and the same amount of clavulanic acid is added: 125mg. Augmentin is quite inexpensive: 300 rubles. In 14 tablets. If you consider the European quality (and this medicine is produced in the UK), it is quite inexpensive. Augmentin is intended for the treatment of various forms of inflammation of the respiratory tract, angina, pneumonia, it is used to treat angina, chronic sinusitis, otitis media. The drug is usually prescribed 1 tablet of 250 mg three times a day, but other prescriptions are also possible, depending on the doctor’s decision.

Advantages and disadvantages

Clavulanic acid increases the strength of amoxicillin in the fight against germs, and they temporarily (but not permanently) lost the ability to resist this effective antibiotic. On the plus side, we can consider the fact that the price of this new, improved drug not only did not increase, but it even became a little lower. This is dictated by the very wide distribution of this drug, because the high demand has generated even an excessive supply of various companies, and the drug in the market simply became a lot of. Also a plus of Augmentin can be considered its speed of action against pathogenic flora.

Clacid (Clarithromycin)

Rating: 4.7

A good alternative to many antibiotics would be clarithromycin, which is made in Italy by Abbott. This antibiotic for coughs can be bought both in tablets and in granules. For example, a pack of 14 pills of 500 mg will cost about 750 rubles. This, too, is a semisynthetic antibiotic from the macrolide group, effective against many pathogens of bronchitis, and other respiratory diseases. Clarithromycin also helps with mycoplasma and legionellosis pneumonia, angina, maxillary sinusitis and other ENT pathology. The maximum dosage of this drug is once a day, divided into two equal doses. Clarithromycin is also used in children, with the exception of the age of breastfeeding.

Advantages and disadvantages

To clarithromycin relatively infrequently develops microbial resistance, it is a highly effective antibiotic, easy to use, and located in the medium price range. There are also side effects, such as headache, sweating, taste disorders, rash. Usually after one or two days, these unpleasant symptoms disappear, and treatment can continue. There are some drugs that are not combined with taking Clacid. These are colchicine, statins for lowering cholesterol. This remedy is not recommended against a background of hypokalemia, that is, when low levels of potassium are diagnosed in the blood.

Josamycin (Wilpafen)

Rating: 4.7

Completes this list, but by no means existing drugs for the treatment of bronchitis and cough from the group of antibiotics, the powerful antibacterial drug josamycin. It comes in the form of tablets with a sweet strawberry scent, it is produced by the French company Astellas Pharma. A pack of 10 1000 mg tablets will cost about 750 rubles at the end of 2020. It is also a bacteriostatic macrolide antibiotic that exhibits the ability to kill germs in high concentrations. The drug is highly active against many microbes that cause lesions of the respiratory tract, ENT organs, angina. Jozamycin is able to cope with scarlet fever, and even diphtheria, of course, if antiphtheria serum is administered together. The dosage is 1 g per day, divided into 2-3 doses, depending on the indication and the severity of bronchitis or pneumonia.

Advantages and disadvantages

Vilprafen is a powerful antibiotic, but it should not be used in severe liver disorders. Of the side effects, decreased appetite, nausea, urticaria, or transient hearing loss are quite rare.

Conclusion

Of course, the fight against bronchitis, with bacterial inflammation and cough, is not limited to the appointment of only one antibiotic. You can give drugs with anti-inflammatory activity, reducing fever, pain relievers. Usually it is means from the group of NSAIDs: it is paracetamol, ibuprofen.

Mucolytic drugs are essential to liquefy viscous, thick sputum, to improve the productivity of the cough, the patient with bronchitis must necessarily have good coughing sputum. In addition to mucolytics, you can affect the strengthening of the cough reflex by prescribing herbal medicines based on thyme, plantain, thermopsis. It is very important to follow the regime of drinking, drinking plenty of alkaline mineral water is shown, which dilutes sputum and stimulates its excretion, postural drainage, which also facilitates expectoration of sputum.

It is also necessary to remember about prevention, so that a viral infection does not transform into a bacterial affection of the bronchi with cough. For this purpose it is necessary to be timely vaccinated against flu and pneumococcal infection, to harden oneself, to give up smoking (first of all), to treat timely chronic lung infections and to increase immunity.