Levofloxacin

Levofloxacin is an antimicrobial drug.

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Indications Levofloxacin

It is used (tablets) to eliminate diseases of an infectious and inflammatory nature and caused by the activity of microbes sensitive to the drug:

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

The infusion solution for intravenous procedures is used in the treatment of infections developing in the lower urinary and respiratory systems, as well as in the skin, kidneys, subcutaneous layer, genitals and ENT organs.

Eye drops are used for superficial eye infections of bacterial origin.

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Release form

The drug is produced in tablets of 0.25 and 0.5 g (20 pieces inside a blister and 5 blister plates inside a pack; or 10 pieces inside a blister package, 9 or 10 such packages in a box), as well as 0.75 g (10 pieces inside a blister plate, 10 such plates in a pack).

It is also produced as an infusion solution, in bottles with a capacity of 0.1 or 0.15 l. There is 1 such bottle in a box.

It is also produced in the form of eye drops, in special 2 ml dropper tubes, 2 such tubes inside the package. It is also produced in 5 ml bottles, 1 such bottle with a dropper cap inside the box.

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Pharmacodynamics

Levofloxacin is an antibiotic from the fluoroquinolone category. 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 penicillin-resistant strains of enterobacter, pneumococcus, klebsiella, E. coli and citrobacter.

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

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Pharmacokinetics

After taking the drug on an empty stomach, the bioavailability level is approximately 100%. When taking the drug (0.5 g) with food, peak levels of the substance in the plasma are observed 60 minutes later.

The drug is distributed within the plasma along with the interstitial fluid, and in addition, it accumulates in large quantities within the tissues. Only 5% of the drug is subject to breakdown.

Up to 85% of the substance is excreted through the kidneys. The half-life of the drug is approximately 6-7 hours. At the same time, its post-antibiotic effect lasts 2-3 times longer.

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Dosing and administration

Scheme of use of tablets.

Levofloxacin tablets are taken orally, 1-2 times a day. The medicine should not be chewed, it is swallowed whole, washed down with 1 glass of plain water. It is allowed to take the tablet with or before food. Portion sizes are determined taking into account the severity and nature of the disease.

People with healthy renal function or mild renal impairment should take the drug in the following regimen:

• in case of exacerbation of chronic bronchitis - 0.25 or 0.5 g taken once a day. Treatment continues for 7-10 days;
• for sinusitis - 0.5 g of the drug once a day. The course continues for 10-14 days;
• in case of an infectious process in the urinary tract (without complications) – take 0.25 g of the drug once a day. Treatment lasts 3 days;
• for community-acquired pneumonia – use 0.5 g of the drug 1-2 times a day. The course lasts 7-14 days;
• for infectious lesions of the urinary tract (with complications) – take 0.25 g of the medication once a day for 7-10 days;
• for prostatitis - 0.5 g Levofloxacin once a day. Treatment continues for 1 month;
• for infectious processes in the subcutaneous layer and epidermis - take 0.25 g of the substance once a day or 0.5 g of the drug 1-2 times a day, for a period of 7-10 days;
• for infections in the intra-abdominal area – use 0.25 or 0.5 g of the drug once a day for 7-10 days (in combination with antibacterial drugs that affect the anaerobic flora);
• in case of bacteremia or blood poisoning – 0.25 or 0.5 g of the medication once a day. Therapy continues for 7-10 days.

Use of solution for intravenous infusions.

The medication is used 1-2 times a day, the solution must be administered through a dropper. If necessary, the solution can be replaced with a tablet form of the drug.

The course duration is a maximum of 2 weeks. It is necessary to carry out treatment during the entire course of the disease, and then another 2 days after the temperature has stabilized. The size of a 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 – administration of the solution once a day for 10-14 days;
• in case of sepsis or pulmonary inflammation – the procedure is performed 1-2 times a day for a period of 1-2 weeks;
• for pyelonephritis in the acute stage – a single use of the drug per day for 3-10 days;
• if an infectious lesion develops in the epidermis area, administer the drug twice a day for 1-2 weeks;
• for tuberculosis - the medication is used once or twice a day for 3 months;
• in chronic bronchitis during an exacerbation – administration of the drug once a day for 7-10 days;
• for prostatitis - the drug should be used once a day for a period of 14 days, after which switch to tablets in a 0.5 g portion, which are taken in a similar regimen;
• in case of infectious lesion of the gallbladder, the procedure is performed once per day;
• for anthrax - the medication is administered once per day. After the patient's condition has stabilized, he is transferred to tablets, which are taken according to a similar scheme for another 2 months;
• in case of infection in the peritoneum area – use the solution once a day for a period of 1-2 weeks.

In case of any pathologies, 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 must not be stopped in advance or deliberately missed. If a tablet or infusion is accidentally missed, the required dose must be used immediately and then the course must be continued as normal.

People with kidney problems (CR values less than 50 ml/minute) need to use the drug according to an individual schedule. Taking into account the CR values, the therapy regimen may be as follows:

• the level of CC is within 20-50 ml/minute – at the initial stage of the course, it is necessary to use the medicine in a dose of 0.25 or 0.5 g, and then use half the initial dose (0.125 or 0.25 g) daily;
• CC indicators in the range of 10-19 ml/minute - at first the medication is used in portions of 0.25 or 0.5 g, and then the patient is prescribed half of this portion, with a single use every 2 days.

During the period of using Levofloxacin, it is necessary to avoid exposure to the sun and also not to visit a solarium.

It should be noted that tendonitis occasionally develops in patients as a result of using the drug. If there is even the slightest suspicion of the development of an inflammatory process in the tendon area, it is necessary to stop using the drug and begin therapy to eliminate tendonitis.

At the same time, the drug can cause erythrocyte hemolysis in case of deficiency of the element G6PD in the body. Therefore, the drug should be prescribed to this group of patients with caution; during therapy, it is necessary to closely monitor the values of hemoglobin and bilirubin.

The medication has a negative effect on the ability to concentrate and the rate of development of psychomotor manifestations, which is why it is recommended to refrain from activities or work that require increased attention and quick response during its use. Such types of work include servicing various mechanisms and driving.

Using eye drops.

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

If it is necessary to use other eye medications as an adjuvant, it is necessary to observe an interval of 15 minutes between procedures.

When performing installations, avoid allowing the tip of the pipette to touch the tissues around the eyes and the eyelids.

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Use Levofloxacin during pregnancy

Levofloxacin should not be administered to pregnant women.

Contraindications

Among the contraindications:

• the presence of intolerance to the components of the drug;
• epileptic seizures;
• renal failure;
• quinolone-induced lesions involving tendons;
• breastfeeding period.

Caution is required when using the drug in elderly people, as well as those who have been diagnosed with a deficiency of the G6PD element in the body.

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Side effects Levofloxacin

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

Patients often experience diarrhea, nausea, and increased liver enzyme activity.

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

Rarely, severe bronchial spasms, anaphylaxis, tremors, worsening of porphyria, severe agitation, hallucinations, and confusion are reported. In addition, muscle pain occurs, blood pressure or platelet count decreases, creatinine or bilirubin levels increase. In addition, there is a feeling of intense anxiety, urticaria, bloody diarrhea, paresthesia in the hands, cramps, tendonitis, depression, and palpitations. Joint pain occurs, bleeding increases, and the number of neutrophils in the blood decreases.

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

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

Eye drops can cause the following negative effects:

• the appearance of mucous streaks on the eyes;
• burning sensation;
• redness of the conjunctiva;
• chemosis in the conjunctival area;
• swelling of the eyelid;
• eye itching;
• development of erythema on the eyelids;
• contact dermatitis;
• allergic symptoms;
• blepharitis;
• headaches;
• deterioration of vision;
• proliferation of papillae in the conjunctival area;
• eye irritation;
• photosensitivity;
• runny nose.

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Overdose

Levofloxacin intoxication most often provokes negative manifestations from the nervous system: dizziness, convulsions, a feeling of confusion, etc. Along with this, prolongation of the QT interval, gastrointestinal dysfunction, and erosion in the mucous membrane area may be observed.

Symptomatic measures are taken. Dialysis will not be effective; the drug has no antidote.

The probability of overdosing on eye drops is extremely low. It manifests itself in the form of irritation of the periorbital tissues - swelling, burning sensation, severe redness, as well as lacrimation and the appearance of stinging. If the patient has these symptoms, it is necessary to rinse his eyes with ordinary clean water. If the negative effects are severe, it is necessary to consult a specialist.

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Interactions with other drugs

A significant weakening of the medicinal efficacy is observed when combined with antacids containing iron salts, and also magnesium or aluminum, or with sucralfate. Therefore, these drugs should be used at intervals of at least 2 hours.

If combined use of drugs with vitamin K antagonists is required, blood clotting function will need to be monitored during treatment.

Probenecid with cimetidine slightly inhibits the excretion of the active ingredient Levofloxacin. For this reason, treatment in this combination should be carried out very carefully.

The half-life of cyclosporine is slightly prolonged when combined with the drug. Combination with GCS increases the risk of rupture in the tendon area.

Concomitant use with theophylline or NSAIDs increases the seizure readiness index.

Infusion fluid may be combined with the following intravenous medicinal solutions:

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

The drug should not be mixed 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.

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Storage conditions

Levofloxacin should be stored in a dry and dark place, out of the reach of children. Temperature values should not exceed 25°C.

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Shelf life

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

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Application for children

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

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Analogues

Analogues of eye drops are the following medications: Vitabact with Cipromed, Lofox and Betaciprol, as well as Okatsin with Floxal, Decamethoxin and Ciprolet with Oftalmol, as well as Ofloxacin. The list also includes Ciprofloxacin (also in the forms of Bufus and AKOS), Vigamox and Oftocipro with Zimar, Okomistin and Dancil, as well as Normax, Uniflox, Oftadek, Ciloxan with Moxifur and Ciprolon.

The tablets and solution have the following analogues:

• tablets - Xenaquin, Lomflox with Zarquin, Nolitsin and Lomatsin, and in addition to this Norfacine, Oflocid (and its forte form), Sparflo and Norilet, Faktiv with Tariferid and Tsirodok, as well as Tsiprex and Gatispane. The list also includes Tsipropan, Lomefloxacin, Ecocifol, Lofox with Lokson-400, Norbactin, Oflomac and Moximac, with Oflox and Normax. Along with this, Sparbact, Tsipraz, Plevilox and Tsifloxinal with Tseprova and Taricin;
• tablets together with intravenous solution - Geoflox, Ofloxacin with Abactal, Pefloxacin and Oflo with Ificro and Procipro. In addition, Ciprobay, Tsifran, Ciplox with Ciprolet, Avelox, Zoflox with Ciprofloxacin and Zanocin, as well as Ofloxacin, Quintor, Ciprobid with Tarivid and Unikpef;
• intravenous solution - Ciprolacer, Basidzhen with Cifracid and Ofloxabol, and also Ciprofloxabol and Cipronate;
• solution together with intravenous powder - Pefloxabol;
• tablets, as well as an intravenous concentrate and solution - the drug Ciprinol.

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Reviews

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

Among the disadvantages, many highlight the development of negative symptoms - among them the appearance of pain in the muscle area, as well as a feeling of severe weakness or confusion. The degree of expression of these and other side effects 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 about negative effects are quite common on forums - people who are going to use Levofloxacin need to keep this in mind.