Levobax

Levobax is an antimicrobial agent with pronounced bactericidal properties.

Indications Levobaxa

It is used to treat people with chronic prostatitis, pulmonary inflammation, and also diseases affecting the skin and soft tissues that develop under the influence of flora sensitive to levofloxacin.

In addition, the tablets can be used to eliminate sinusitis in the acute stage and exacerbated bronchitis, which has a chronic form.

When treating severe pulmonary inflammation, as well as diseases caused by the activity of Pseudomonas aeruginosa, the medication should be used in combination with other antimicrobial drugs.

Release form

The product is released in the form of an infusion liquid, in 100 ml bottles. There is 1 such bottle inside the box.

The drug is also produced in tablets, 7 pieces inside a blister pack. There is 1 such plate in a pack.

Pharmacodynamics

The active ingredient of Levobax is levofloxacin, an artificial component from the fluoroquinolone category. Its effect develops by influencing bacterial topoisomerase 4, as well as DNA gyrase.

The drug has activity against a wide range of gram-positive and -negative microbes. For example, the following strains are sensitive to levofloxacin:

• pneumococcus, streptococcus agalactia, streptococcus pyogenes;
• Staphylococcus aureus and Staphylococcus epidermidis, as well as Enterococcus faecalis;
• Enterobacter aerogenes, Enterobacter agglomerans, Enterobacter sakazakii, Enterobacter cloacae;
• E. coli;
• Pfeiffer's bacillus, Haemophilus parainfluenzae;
• category Viridans streptococci;
• Proteus mirabilis, Proteus vulgaris;
• Klebsiella oxytoca and Friedlander's bacillus;
• fluorescent pseudomonas, Pseudomonas aeruginosa;
• Moraxella catharalis;
• Acinetobacter anitratus, Acinetobacter baumannii and Acinetobacter calcoaceticus;
• Legionella pneumophila, Chlamydophila pneumoniae, Pertussis bacillus;
• Citrobacter freundii and Citrobacter koseri;
• Clostridium perfringens, Mycoplasma pneumoniae, Morgan's bacillus, Providence Rettger and Stewart, and Serratia marcescens.

Spirochetes are resistant to levofloxacin. Cross-resistance to the drug and other fluoroquinolones may also develop. However, cross-resistance to antimicrobial drugs from other groups and Levobax usually does not develop.

Pharmacokinetics

After oral administration, the level of absolute bioavailability of the drug reaches 100%. Peak values of the substance in the plasma are recorded after 1 hour after administration. Food intake does not affect the level of bioavailability and the rate of absorption of the drug.

About 40% of the drug is synthesized with plasma protein. Its active element almost does not pass into the cerebrospinal fluid. Levofloxacin forms high medicinal concentrations inside the bronchi, lung tissue, urinary system organs, prostate, and at the same time inside the secretion released by the bronchi.

The drug is metabolized in the liver, and excreted mainly through the kidneys as an unchanged element (about 5% of the drug is excreted as metabolic products). The half-life of the component is approximately 6-8 hours in people with healthy kidney function.

In people with renal failure, the half-life may be prolonged (with CC values below 20 ml/minute, this period may be prolonged to 35 hours).

Dosing and administration

Using tablets.

The medicine is taken orally, without crushing the tablet before use. The medication is taken without reference to food intake. The daily dose of Levobax can be taken in 1 dose or divided into 2 parts (a single dose should not exceed 0.5 g).

The duration of the course, as well as the dosage of the drug, are selected by the doctor for each patient individually.

People with community-acquired pneumonia, acute stage of sinusitis, chronic type of prostatitis of bacterial origin, and in addition to this, with infections affecting the skin and subcutaneous layers, are often prescribed the use of 0.5 g of the drug per day. When treating community-acquired pneumonia, the dose of the drug can be increased to 1 g per day.

People with chronic bronchitis in the acute stage and with infections affecting the urinary system are usually prescribed 0.25 g of the drug per day. People with exacerbated bronchitis, if necessary, can increase the dosage to 0.5 g per day. The duration of such treatment is usually within 7-10/14 days. In case of uncomplicated urinary system infections, the therapy lasts 3 days, and in case of chronic prostatitis - 28 days.

Treatment with Levobax should be continued until negative microbiological test results are obtained or for another 2 days after the clinical manifestations of the disease have disappeared.

Use of infusion fluid.

The medicine is administered intravenously through a drip. The rate of infusion cannot be higher than 0.25 g/half hour. If blood pressure values begin to decrease during the procedure, the infusion must be stopped immediately. Taking into account the patient's condition, it is necessary to switch to oral administration of the medicine (tablets) as quickly as possible. The duration of such treatment and the dosage of the drug are selected by the doctor.

In the treatment of community-acquired pneumonia, infections in the area of the skin surface and subcutaneous layers, and along with this chronic prostatitis of bacterial origin, 0.5 g of the drug is usually administered per day. When eliminating skin infections and community-acquired pneumonia, the daily dose of the drug can be increased to 1 g (the portion is divided into 2 infusions).

During the treatment of infections in the urethra, 0.25 g of the drug is usually administered per day.

The total duration of treatment (both parenteral use and oral administration) cannot exceed 2 weeks (except for therapy for prostatitis, when the course can be extended up to 28 days).

For people with kidney problems, the dose of Levobax (both forms) should be adjusted.

With CC values within 20-50 ml/minute, 0.25 g of the drug is usually used on the 1st day, and then 125 mg is taken per day. If a severe degree of the disease is observed, the dose on the 1st day can be increased to 0.5 g, and then the drug is used in a portion of 125 mg at intervals of 12 hours.

If the CC level is below 20 ml/min on the 1st day, 0.25 g of the drug is usually used, and then it is taken in a portion of 125 mg at intervals lasting 48 hours. In pathologies that have a severe degree of expression, the dose can be increased to 0.5 g for the 1st day, and then the patient should take 125 mg of the drug at intervals of 12-24 hours.

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Use Levobaxa during pregnancy

It is prohibited to prescribe Levobax to pregnant women due to the risk of developing lesions in the articular cartilage area in the fetus.

In women of reproductive age, the possibility of pregnancy should be excluded before starting treatment. During the use of the drug, it is recommended to use reliable contraceptives. If pregnancy occurs during the therapy, it is necessary to notify your doctor.

During lactation, the drug can be used only if breastfeeding is stopped during therapy.

Contraindications

Main contraindications:

• the presence of hypersensitivity to levofloxacin or other antimicrobial drugs from the fluoroquinolone category;
• The tablets are prohibited for people with lactase deficiency, galactosemia, and also glucose-galactose malabsorption;
• appointment to persons with epilepsy (also if there is a history of epilepsy);
• the patient has a history of tendinitis that developed due to the use of fluoroquinolones.

The medication is prescribed with caution in the following cases:

• people who use corticosteroids, as well as elderly patients (due to the high probability of rupture in the Achilles tendon area in this group of patients);
• appointment to persons prone to developing seizures;
• people with a deficiency of the element G6PD in the body, as well as with functional disorders of the liver or kidneys;
• patients with diabetes mellitus, as well as with psychotic disorders and photophobia (also if there is a history of photosensitivity);
• use in people with congenital prolongation of the QT interval syndrome;
• for electrolyte imbalances and pathologies in the cardiovascular system.

Side effects Levobaxa

The use of the drug may lead to the following side effects:

• disorders in the functioning of the nervous system: the appearance of causeless anxiety, hallucinations, suicidal thoughts, seizures, headaches and paresthesia. Development of a depressive state, tremors in the limbs, agitation, polyneuropathy, as well as disorders of the sleep-wake regime. In addition, disorders of taste, smell, and at the same time vision and hearing may occur, and in addition, tinnitus occurs. There is data on the appearance of disorders of motor coordination and extrapyramidal symptoms;
• problems with the hematopoiesis function and cardiovascular system: decreased blood pressure, development of thrombocyto-, leuko-, pancyto- or neutropenia, as well as agranulocytosis, eosinophilia and hemolytic anemia. Prolongation of the QT interval also occurs;
• digestive and hepatobiliary system disorders: decreased plasma glucose levels, decreased appetite, bloating, bowel disorders, nausea, dyspepsia symptoms, hepatitis, vomiting, hyperbilirubinemia, and increased activity of liver enzymes. At the same time, the use of drugs can cause pseudomembranous colitis, acute liver failure, and severe liver pathologies;
• disorders of the musculoskeletal system: pain in the muscles or joints, rhabdomyolysis, myasthenia, as well as tendonitis and ruptures in the tendon area;
• signs of allergy: urticaria, Quincke's edema, bronchospasms, allergic pneumonitis, vasculitis, TEN, hyperhidrosis, photosensitivity, Stevens-Johnson syndrome and anaphylaxis;
• Others: occurrence of candidiasis, superinfection, acute renal failure, hypercreatininemia, pain in the sternum, limbs and back, and in addition, exacerbation of porphyria. Also, use of the drug may lead to false-positive results of studies on opiates.

Overdose

The use of very large doses of the drug can cause seizures, dizziness, and also a disorder of consciousness. In addition, intoxication with Levobax leads to prolongation of the QT interval. At the same time, in case of poisoning with tablets, digestive disorders are noted (erosions in the area of the gastric mucosa and vomiting).

The drug has no antidote. If signs of poisoning appear, stop the infusion or perform gastric lavage and take antacids with enterosorbents (oral form of the drug). If necessary, symptomatic measures are taken. People with an overdose of levofloxacin should be under the supervision of medical workers (ECG monitoring and monitoring the general condition of the victim is required until the signs of poisoning completely disappear).

Peritoneal dialysis and hemodialysis procedures will not lead to a decrease in levofloxacin levels.

Interactions with other drugs

When taken orally with iron medications, sucralfate, and also with aluminum- and magnesium-containing antacids, the bioavailability of the drug decreases.

Levobax cannot be combined with ethanol.

The infusion fluid must not be mixed with heparin, alkaline solutions, and other parenteral agents (this includes 5% glucose solution, saline solution, and 2.5% dextrose solution inside Ringer's solution).

It is prohibited to combine levofloxacin with medications that lower the seizure threshold.

The combination of the drug with cimetidine, fenbufen and probenecid leads to an increase in its values in plasma.

An increase in the half-life of cyclosporine is observed when it is used in combination with the drug.

It is necessary to monitor the level of coagulation in case of combined use of the drug together with vitamin K antagonists.

Use with caution in people taking medications that prolong the QT interval.

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Storage conditions

Levobax in any form of production must be kept at temperatures no higher than 25°C.

The infusion fluid should be kept in a dark place, protected from light (however, the solution can remain stable for 3 days under the light of a room lamp).

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Shelf life

Levobax tablets can be used for 3 years from the date of release of the therapeutic agent.

The infusion of the drug has a shelf life of 2 years. An opened bottle of the drug should be used for administration immediately. Any remaining drug after infusion of the required therapeutic dose should be disposed of.

Application for children

It is prohibited to prescribe this medicine to children.

Analogues

The analogs of the drug are Oftaquix, Levofloxacin, Loxof with Leflozin and Tigeron, as well as Glevo, Abiflox, L-Flox, Levoximed with Levoflox and Tavanic with Levomak, Eleflox, Flexid and Floracid.