Levofloxacin

Levofloxacin is an antimicrobial medication.

[1], [2], [3], [4], [5], [6], [7]

Indications of the levofloxacin

It is used (tablets) to eliminate diseases that are of an infectious-inflammatory nature, and caused by the activity of microbes sensitive to the preparation:

• infection in the intra-abdominal area;
• acute stage of sinusitis;
• infectious processes inside the urinary tract (uncomplicated form);
• chronic bronchitis at the stage of exacerbation;
• non-hospital pneumonia;
• prostatitis;
• infectious lesions affecting the subcutaneous layer and epidermis;
• infection in the urinary system, with complications in the background;
• infection of the blood or bacteremia.

Infusion solution for intravenous procedures is used in the treatment of infections developing in the lower region of the urethra and respiratory systems, and also in the skin, kidneys, subcutaneous layer, genitals and ENT organs.

Eye drops are used for eye infections of a superficial type that are bacterial in nature.

[8], [9], [10], [11], [12], [13]

Release form

The release occurs in tablets with a volume of 0.25 and 0.5 g (20 pieces inside a blister and 5 blister packs inside a pack, or 10 pieces inside a blister pack, 9 or 10 such packs in a box), and 0.75 grams (10 pieces inside a blister plate, 10 such plates in a pack).

It is also produced in the form of an infusion solution, in bottles with a capacity of 0.1 or 0.15 liters. In the box there is one such bottle.

The release is carried out in the form of eye drops, in special tubes-droppers with a volume of 2 ml, 2 such tubes inside the package. Also produced in flacons with a capacity of 5 ml, 1 such flacon, complete with a lid-dropper inside the box.

[14], [15]

Pharmacodynamics

Levofloxacin is an antibiotic from the category of fluoroquinolones. The active element of the drug has a bactericidal effect - by slowing down the enzymes responsible for DNA replication inside bacterial cells.

This drug actively affects many bacteria that cause respiratory infections. It copes well with the elimination of infectious processes caused by resistant to penicillin strains of enterobacter, pneumococcus, klebsiella, E. Coli and citrobacter.

The medication shows high effectiveness in the treatment of tuberculosis and sinusitis.

[16], [17], [18], [19], [20], [21], [22],

Pharmacokinetics

After eating on an empty stomach, the bioavailability level of the drug is approximately 100%. When taking LS (0.5 g), along with food peak values of the substance inside the plasma are noted for 60 minutes later.

The medication is distributed inside the plasma together with the interstitial fluid, and besides it in large quantities cumulates inside the tissues. Only 5% of the drug is cleaved.

Through the kidneys up to 85% of the substance is excreted. The half-life of drugs is about 6-7 hours. At the same time its post-antibiotic effect lasts 2-3 times longer.

[23], [24], [25], [26], [27]

Dosing and administration

Scheme of the use of tablets.

Levofloxacin in tablets is consumed orally, 1-2 times per day. The medicine can not be chewed, it is swallowed whole, washed down with 1 glass of plain water. Allowed to take the tablet with food or before it. The sizes of portions are determined taking into account the severity and nature of the disease.

Persons with a healthy renal function or a mild form of its violation should use drugs in this mode:

• with exacerbated chronic bronchitis - 0.25 or 0.5 g with a single dose for a day. Treatment lasts for 7-10 days;
• with sinusitis - 0.5 g LS once a day. The course lasts for 10-14 days;
• in the infectious process in the urinary tract (without complications) - taking 0.25 g of the drug once a day. Treatment lasts 3 days;
• with non-hospital pneumonia - use 0.5 g LS 1-2 times / day. The course lasts 7-14 days;
• with infectious lesions of the urinary tract (with complications) - taking 0.25 g of medicine once a day, for 7-10 days;
• at a prostatitis - on 0,5 г Levofloksatsina once for a day. Treatment lasts 1 month;
• at infectious processes in the field of the subcutaneous layer and epidermis - taking 0.25 g of the substance once a day or 0.5 g of the drug 1-2 times / day, in the period of 7-10 days;
• with infections in the intra-abdominal area - the use of 0.25 or 0.5 g of the drug once a day, for 7-10 days (in combination with antibacterial drugs that affect the flora of anaerobes);
• at bacteremia or infection of blood - 0.25 or 0.5 g of medicament once a day. The therapy lasts 7-10 days.

Use of a solution for intravenous infusions.

The medication is applied 1-2 times / day, you need to inject the solution through a dropper. If required, the solution can be replaced with a tablet form of drugs.

The duration of the course is a maximum of 2 weeks. It is required to carry out treatment during the entire course of the disease, and then 2 more days after the temperature stabilization. The size of the standard portion of the solution is 0.5 g. A more precise mode of use and the required duration of therapy are selected individually, taking into account the nature of the pathology:

• in the acute stage of sinusitis - the administration of the solution once a day for 10-14 days;
• with sepsis or pulmonary inflammation - the procedure is carried out 1-2 times / day during 1-2 weeks;
• with pyelonephritis in the acute stage - a single application of drugs per day for 3-10 days;
• when developing an infectious lesion in the epidermis - to enter the drug twice a day for 1-2 weeks;
• with tuberculosis - the medication is used once or twice a day for 3 months;
• with the chronic form of bronchitis in the period of exacerbation - the administration of drugs once a day for 7-10 days;
• with prostatitis - the drug should be used once a day for 14 days, then go to the tablets in a dose of 0.5 g, which are used in a similar regime;
• with infectious damage to the ZHVP - the procedure is carried out once a day;
• with anthrax - the medication is administered once a day. After stabilization of the patient's condition, it is transferred to tablets, which are used according to a similar scheme in the period of 2 more months;
• with infection in the peritoneum - use the solution once a day for 1-2 weeks.

In any pathology after stabilization of the condition, the patient should be transferred to the use of tablets according to a similar scheme until the end of the therapeutic course.

Treatment is forbidden to stop beforehand or specially to miss drug receptions. If you accidentally skip a pill or infusion, you should immediately use the required dose, then continue the course in the standard mode.

Persons with problems in kidney function (KC values less than 50 ml / minute) are required to apply the drug on an individual schedule. Taking into account the QC values, the treatment regimen can be as follows:

• CC level within 20-50 ml / minute - at the initial stage of the course, it is necessary to apply the drug in a dose of 0.25 or 0.5 g, and then apply half the primary dose (0.125 or 0.25 g) daily;
• CK values in the range of 10-19 ml / minute - first the drug is used in portions of 0.25 or 0.5 g, and then the patient is assigned half of this dose, once a day for 2 days.

During the period of using Levofloxacin, it is necessary to avoid being under the sun, and besides not to visit the solarium.

It should be noted that due to the use of the medication, the patients occasionally develop tendonitis. If there is even the slightest suspicion of the development of the inflammatory process in the field of tendons, it is necessary to cancel the use of drugs and begin therapy to eliminate tendinitis.

However, the drug is able to cause erythrocyte hemolysis with a deficiency in the body element G6FD. Therefore, this group of treated patients should be administered cautiously; During therapy, you need to closely monitor the values of hemoglobin and bilirubin.

The drug has a negative effect on the ability to concentrate and the speed of development of psychomotor manifestations, which is why it is recommended that during the period of its use it be recommended to give up employment or work that requires increased attention and speed of response. Among such types of work - maintenance of various mechanisms and driving.

Applying drops to the eyes.

The drug is instilled in the area of the conjunctival sac of one or both eyes in a dose of 1-2 drops. This procedure should be followed at intervals of 2 hours (maximum 8 times per day), during the first 2 days of therapy. Further for another 3-7 days it is necessary to carry out the procedure at intervals of 4 hours (no more than 4 times / day). The total duration of treatment is usually 5-7 days.

If you need to use other eye medications as an auxiliary, you need to observe the interval between the procedures, which is 15 minutes.

At installations it is necessary to not suppose a touch of the tip of a pipette to tissues in area around of eyes and to eyelids.

[32], [33], [34], [35], [36], [37]

Use of the levofloxacin during pregnancy

Levofloxacin should not be given to pregnant women.

Contraindications

Among the contraindications:

• the presence of intolerance with respect to the components of the drug;
• epileptic seizures;
• kidney failure;
• The damage resulting from quinolone treatment affecting tendons;
• the period of breastfeeding.

Caution is necessary when using medicines by the elderly, and in addition, those who have found deficiency of the G6PD element in the body.

[28]

Side effects of the levofloxacin

The use of this drug can cause many side effects affecting various systems and organs.

Often patients have diarrhea, nausea, and an increase in the activity of liver enzymes.

Along with this, loss of appetite, insomnia, itching, headaches, vomiting and sensation of stupor, as well as reddening of the epidermis, a decrease in the number of leukocytes within the blood, abdominal pain, a feeling of general weakness or drowsiness, digestive disorders, dizziness and an increase in the level of eosinophils within the blood .

Occasionally reported the development of severe bronchial spasms, anaphylaxis, body trembling, exacerbation of porphyria, intense excitement, hallucinations and a sense of confusion. In addition, painful sensations appear in the muscles, the level of blood pressure or the number of platelets inside the blood decreases, the indices of creatinine or bilirubin in the blood increase. In addition, there is a feeling of great anxiety, hives, bloody diarrhea, paresthesia in the hands, convulsions, tendonitis, a state of depression, a strong heartbeat. There are painful sensations in the joints, bleeding increases and the amount of neutrophils inside the blood decreases.

Only a single occurrence of swelling in the pharynx or on the face, as well as blisters, and the development of the shock state are noted. Visual or taste disorders and problems with kidney function may appear, tactile sensitivity and the ability to distinguish smells may decrease. In addition, ruptures occur in the tendon area, the number of all blood cells decreases, resistant infections are formed, the pressure and glucose index and the number of basophils within the blood sharply decrease. Along with this, one can expect the development of intolerance with respect to UV radiation and sunlight, polyiform erythema, pneumonitis, muscle weakness, vascular collapse, vasculitis, rhabdomyolysis, hemolytic form of anemia, TEN, fever and tubulointerstitial nephritis.

In addition to the above negative symptoms, the drug, being an antibiotic, can lead to dysbiosis and increased proliferation of fungi. In this regard, when using it should also use antimycotics and drugs containing bacteria that normalize the balance of the intestinal microflora.

Drops for the eyes can cause such negative manifestations:

• the appearance of strands of a mucous nature in the eyes;
• burning sensation;
• redness of the conjunctiva;
• chemosis in the conjunctiva;
• swelling on the eyelid;
• ocular itching;
• the development of erythema in the eyelids;
• contact form of dermatitis;
• allergic signs;
• blepharitis;
• headache;
• deterioration of vision;
• proliferation of papillae in the conjunctiva;
• eye irritation;
• photosensitivity;
• runny nose.

[29], [30], [31]

Overdose

Intoxication Levofloxacin most often provokes negative manifestations from the NA: dizziness, convulsions, sensation of confusion, and more. Together with this, prolongation of QT-interval values, abnormal gastrointestinal function and erosion in the mucosal area can be noted.

Symptomatic measures are carried out. The dialysis procedure will not be effective; antidote does not have a drug.

The likelihood of an overdose of eye drops is extremely low. It manifests itself in the form of irritation of periocular tissues - swelling, burning sensation, severe reddening, and also lacrimation and the appearance of cuts. If the patient has these signs, it is necessary to wash his eyes with ordinary clean water. If the severity of the negative effects is required, consult a specialist.

[38], [39]

Interactions with other drugs

A significant weakening of drug efficacy is noted when combined with antacids containing iron salts, and in addition magnesium or aluminum, or with sucralfate. Therefore, these drugs should be used at intervals of at least 2 hours.

If a combined use of drugs with vitamin K antagonists is required, during the treatment it will be necessary to monitor the function of blood uptake.

Probenecid with cimetidine slightly inhibits the excretion of the active element of Levofloxacin. Because of this, treatment in this combination should be done very carefully.

The half-life of cyclosporine is not significantly prolonged when combined with the drug. Combination with GCS increases the risk of rupture in the tendon area.

Simultaneous use with theophylline or NSAIDs increases the rate of convulsive readiness.

Infusion fluid is allowed to combine with such intravenous drug solutions:

• Ringer's dextrose solution (2.5% concentration);
• dextrose solution (2.5% concentration);
• saline solution;
• used for parenteral nutrition solutions.

Do not mix the drug with solutions of baking soda or heparin.

Clinically important therapeutic interactions of the drug in the form of eye drops with other medicinal substances are extremely unlikely.

[40], [41]

Storage conditions

Levofloxacin should be kept in a dry and dark place, closed from penetration of children. Temperature values should not exceed 25 ° C.

[42], [43]

Shelf life

Levofloxacin in all dosage forms can be used for 2 years after the release of the therapeutic drug. The opened bottle with drops has a shelf life of 30 days.

[44]

Application for children

The drug is not used in children and adolescents under the age of 18 years.

[45], [46], [47]

Analogues

Analogues of eye drops are medicines: Vitabakt with Tsipromed, Lofoksom and Betaciprol, and in addition Okatsin with Floxal, Decamethoxin and Ciprolet with Ophthalmol, and also Ofloxacin. The list also includes Ciprofloxacin (also in the forms Bufus and AKOS), Vigamox and Oftotsipro with Zimar, Okomistin and Danzil, and in addition Normax, Uniflox, Oftadec, Ciloxane with Moxifur and Ciprolone.

Tablets and solution have such analogs:

• tablets - Xenacquin, Lomflox with Zarquin, Nolicin and Lomacin, and in addition Norfacin, Oflotsid (and its form fort), Sparflo and Norillet, Factiv with Tariferic and Tsirodoksom, as well as Tsipreks and Gatispan. The list also includes Cipropane, Lomefloxacin, Ecocylol, Lofox with Loxon-400, Norbaktin, Oflomak and Moximak, with Oflox and Normaks. Together with this, Sparbact, Cipraz, Plevilox and Cifloxinal with Ceprov and Taricin;
• tablets together with an intravenous solution - Geoflox, Ofloksin with Abaktal, Pefloxacin and Oflo with Isfipro and Protsipro. In addition, Ciprobay, Tsifran, Ziplox with Tsiprolet, Avelox, Zoflox with Ciprofloxacin and Zanotsin, as well as Ofloxacin, Quintor, Ciprobid with Tarivid and Unicipf;
• intravenous solution - Ciprolake, Basigen with Cyphricide and Ofloxabol, and at the same time Ciprofloxabol and Cypronate;
• solution together with intravenous powder - Pefloxabol;
• tablets, as well as intravenous concentrate and solution - the drug Ciprinol.

[48], [49], [50], [51], [52], [53]

Reviews

Levofloxacin receives predominantly positive reviews about its drug effectiveness. Doctors and patients say that the drug quickly eliminates negative symptoms and helps recovery.

Of the shortcomings, many singled out the development of negative signs - among them the appearance of pain in the muscles, and in addition feelings of strong weakness or confusion. The degree of severity of data and other adverse events may vary. But even with the development of negative symptoms, patients note that the drug significantly weakens the severity of the pathology, for the treatment of which it was used.

Comments in which we are talking about the appearance of negative effects are often found on forums - people who are going to use Levofloxacin, you need to bear this in mind.