Levomycetin

Levomycetin has an antibacterial effect. It prevents inflammation and eliminates infections in the area of any organs and tissues if they were provoked by microflora that is sensitive to chloramphenicol.

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Indications Levomycetin

It is used to treat diseases caused by the activity of bacteria that are sensitive to the influence of antibiotics (such as salmonella, staphylococci, shigella with neisseria, as well as streptococci, rickettsia, strains of proteus, leptospira with chlamydia, klebsiella and some other microbes).

Due to the fact that the drug has several different forms of production, chloramphenicol is able to penetrate directly into the affected area in the concentration necessary for therapy.

Diseases for which the drug is used in the form of a solution or liniment:

• epidermal infections of bacterial origin caused by the activity of microflora sensitive to the action of chloramphenicol;
• ulcers of a trophic nature;
• boils with bedsores, as well as wounds and burns complicated by infection;
• cracks in the nipple area that appear due to breastfeeding.

In case of purulent otitis, the ears are treated with an alcohol solution of the drug.

The tablets are usually used for urinary and biliary tract infections caused by microflora sensitive to the drug. They are also used for brucellosis with paratyphoid fever, as well as generalized salmonellosis, rickettsiosis, tularemia with typhoid fever, dysentery and yersiniosis with trachoma. In addition, they are used for meningococcal infections, chlamydia, brain abscess, lymphogranuloma in the groin area, infected wounds with pus, ehrlichiosis and purulent peritonitis.

The drug in eye drops is prescribed for the treatment of the following types of bacterial infections affecting the eyes: episcleritis with scleritis, blepharitis, conjunctivitis with keratoconjunctivitis, and also keratitis.

The medication will be ineffective if used to treat the above-described pathologies, but those caused by viruses, fungi and bacteria resistant to chloramphenicol.

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Release form

The drug is available in the form of 0.25% eye drops, capsules with tablets of 0.25 and 0.5 g, as well as in the form of 1%, 3%, as well as 5% and 0.25% alcohol solutions, tablets with prolonged activity (volume 0.65 g) and 1% and 5% liniment.

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Pharmacodynamics

Levomycetin is an antibiotic produced artificially. It is identical to substances produced during the life of Streptomyces venezuelae microbes.

Chloramphenicol promotes the death of many gram-negative and -positive microbes (including strains resistant to the effects of streptomycin and sulfonamides with penicillin), as well as rickettsia with spirochetes and some large viruses.

The drug has weak activity against clostridia, protozoa, pseudomonas aeruginosa and acid-resistant microbes.

The therapeutic effect of the drug is based on the ability of chloramphenicol to destroy the processes of bacterial protein binding. The drug blocks the polymerization processes of amino acid residues with activity associated with mRNA activity.

Resistance to chloramphenicol develops relatively slowly in bacteria. Cross-resistance to other chemotherapeutic drugs does not usually occur.

After local treatment, the required concentration of the drug is achieved inside the fibers in the vitreous body, and also inside the aqueous humor, iris and cornea. The substance does not penetrate into the eye lens.

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Pharmacokinetics

Pharmacokinetics after oral administration of chloramphenicol: absorption rates are 90%, bioavailability level is 80%. It takes 1-3 hours to reach peak drug values. Synthesis with proteins inside the plasma is 50-60% (in premature infants this figure reaches 32%).

The medicinal values of the drug in the bloodstream are maintained for 4-5 hours from the moment of taking the drug orally. About a third of the consumed portion is determined in the bile, and the highest concentrations of the drug are recorded in the liver with kidneys.

Levomycetin can penetrate the placenta, and its values in the fetal serum can reach 30-80% of the serum values in the mother. The drug also passes into the mother's milk.

Biotransformation processes mostly occur inside the liver (90%). The influence of intestinal normal flora leads to the development of hydrolysis processes, as a result of which inactive metabolic products are formed.

The drug excretion period is 24 hours (this process mainly occurs inside the kidneys – 90%). Approximately 1-3% of the drug is excreted through the intestines.

The half-life of the substance in an adult is 1.5-3.5 hours, in a child aged 1-16 years – 3-6.5 hours. In newborn babies (1-2 days from birth) this indicator is 24+ hours (if the child weighs little, then the half-life of the substance is longer). In children on the 10-16th day of life, the T1/2 value is 10 hours.

Hemodialysis is not very effective for drug excretion.

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Dosing and administration

Schemes for using eye drops.

Levomycetin should be instilled into the conjunctival sacs of the eyes (1 drop 3-4 times a day). The duration of the treatment cycle is usually within 5-15 days.

When instilling the medicinal substance, it is necessary to raise the head, throwing it back, then pull down the lower eyelid and instill the drug into the resulting cavity (it is important to remember that the dropper of the bottle should not touch the eyelid or eye).

After the instillation, the corner of the eye should be pressed with a finger and not blink for half a minute. If blinking cannot be held, it should be done very carefully so that the medicinal substance does not spill out of the eye cavity.

To treat purulent otitis, the medicine is instilled in the amount of 2-3 drops in each ear (the procedure is carried out 1-2 times a day). If the discharge from the ears is so much that it washes away the medicine, it should be used up to 4 times a day.

Sometimes doctors may recommend using drops in the nose for a runny nose of bacterial origin.

Using drops to treat barley.

The use of chloramphenicol, combined with boric acid (it is also contained in Levomycetin - as an auxiliary element), helps to prevent the occurrence of infection inside the conjunctiva, as well as the occurrence of complications after the abscess is opened. The drug also accelerates the maturation of the stye, slightly reduces the redness and severity of pain, and at the same time reduces the period required for recovery by 2-3 days.

The therapy should be carried out not only on the diseased eye, but also on the healthy one. The solution is instilled 1-2 drops at a frequency of 2-6 times a day. If severe pain is observed, the drug can be used hourly.

How to use tablets or capsules.

The medication should be taken 3-4 times a day (depending on the doctor's instructions). The size of a single adult dose is 1-2 tablets of 0.25 g. A maximum of 4 tablets of 0.5 g are allowed per day.

In extremely severe forms of the disease (for example, typhoid fever or peritonitis), the dosage may be increased to 3-4 g per day.

Therapy with tablets can last for a maximum of 10 days.

Methods of taking medications for diarrhea.

The drug is often used to treat diarrhea that develops as a result of food poisoning, and in addition in situations where intestinal disorder occurs due to a bacterial infection.

In case of diarrhea, tablets should be taken before meals - 1 piece with intervals of 4-6 hours. The maximum permissible portion per day is 4000 mg. If the disorder stops after taking the first 0.5 g tablet, the second one may not be taken.

Using medication to treat cystitis.

Cystitis is usually treated with tablets. In very severe forms of the disease, the doctor may prescribe injections of drugs (the solution is prepared from powder, which is diluted in injection water or novocaine) or jet intravenous injection of chloramphenicol in a glucose solution.

In the absence of other indications, for cystitis the medicine is taken in a standard dose at intervals of 3-4 hours.

Schemes for the appointment of alcohol solution.

Levomycetin in this medicinal form is used to treat affected epidermis or for application under a sealed bandage.

The duration of therapy is determined by the nature of the course of the disease, the degree of its severity, as well as the effectiveness of the treatment procedures.

Cracked nipples should be lubricated with a 0.25% substance after each feeding procedure. This treatment should last a maximum of 5 days.

Methods of using liniment.

Before the treatment procedure, it is necessary to clean the wound or burnt epidermis from dead tissue masses and pus. In addition, before applying the liniment, the wound is treated with a disinfectant - this can be 0.01% miramistin, 0.05% chlorhexidine, 0.02% water-based furacilin or 3% hydrogen peroxide.

The affected area is treated with a thin layer of the medicine, after which it is covered using a sterile bandage. In addition, it is allowed to soak a small piece of gauze with liniment, and then fill the wound area with it or cover the surface of the burn.

During the treatment of wound areas, the drug is used once a day, and in case of burns, it is used once a day or 2-3 times a week (in this case, the frequency of the procedures depends on the abundance of the purulent contents released).

When treating epidermal infections of bacterial origin, the affected areas are treated with a thin layer of the preparation (after the preliminary procedures described above) 1-2 times a day, without using a bandage. It is also recommended (if possible) to rub the substance into the affected area until it is completely absorbed. In this case, small areas of healthy epidermis around the affected area should be captured.

Wet areas must be dried with gauze before using Levomycetin.

When the drug is used under dressings, it should be applied once a day.

Single dose size is 0.25-0.75 g; daily dose is 1000-2000 mg of chloramphenicol. For a therapeutic cycle for one patient weighing 70 kg, it is necessary to use up to 3000 mg of the drug.

Cracked nipples should be treated with a thick layer of liniment, using a napkin.

Using drugs to eliminate acne.

Due to its ability to quickly suppress inflammation and the development of infection, the medication (alcohol solution or tablets) can be used to treat acne.

For problem skin, it is recommended to use a 1% therapeutic solution. It should be applied pointwise to avoid overdrying the epidermis and the emergence of bacteria resistant to chloramphenicol, which in the future may cause the development of purulent acne that is difficult to treat.

The medication is used from the moment the pimple appears until it is completely eliminated. It is important to remember that the drug cannot be used as a preventive measure.

When treating inflamed red pimples and acne, the drug is usually used in combination with other medications.

Most often, the following combinations of different medications with Levomycetin are used to eliminate acne:

• the medicine is used together with calendula tincture and aspirin. You need 4 tablets of chloramphenicol and aspirin, which need to be crushed into powder, and then poured with calendula tincture (40 ml of the substance is required);
• chloramphenicol with ethanol, boric acid, and salicylic acid. To make the medicinal substance, the components must be mixed in the following proportions: 5 ml of salicylic acid (2% liquid), 50 ml of ethanol and boric acid, and 5 g of chloramphenicol;
• camphor alcohol (80 ml) with salicylic acid (30 ml of 2% substance), chloramphenicol (4 tablets) and streptocide (10 tablets).

Based on the comments of patients, it can be understood that the above-described substances are highly effective in treating individual acne, but more extensive problems must be dealt with by first getting rid of the internal cause of the appearance of symptoms in the form of acne.

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Use Levomycetin during pregnancy

Both systemic and topical Levomycetin should not be prescribed to pregnant women. When using it during lactation, the infant should be transferred to formula feeding.

If there are medical indications, eye drops can be prescribed during lactation or pregnancy, but subject to strict adherence to the dosage portions indicated in the instructions.

Contraindications

Main contraindications:

• the presence of intolerance in the patient;
• depression of hematopoiesis processes within the bone marrow;
• acute form of porphyria, which has an intermittent nature;
• G6PD enzyme deficiency;
• liver or kidney failure.

Medicines applied externally are not used on large granulating wounds, and also on epidermis affected by fungi, psoriasis or eczema.

People who have previously used cytostatics or undergone radiation therapy, as well as infants (especially those under 1 month of age) and pregnant women, can be prescribed the drug only if there are strict medical indications.

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Side effects Levomycetin

Use of the drug may result in the appearance of systemic side effects:

• disorders affecting the digestive function: diarrhea, vomiting, dyspeptic symptoms, nausea, dysbacteriosis and irritation of the oral mucosa or pharynx;
• problems with the processes of hematopoiesis or hemostasis: thrombocytopenia, leukopenia or reticulocytopenia, and in addition, aplastic anemia, and hypohemoglobinemia with agranulocytosis;
• disorders affecting the functioning of the nervous system and sensory organs: neuritis in the optic nerve, taste or consciousness disorders, motor or mental disorders, depression, headaches, delirium, hallucinations (can be visual or auditory) and deterioration of auditory/visual acuity;
• signs of increased sensitivity;
• development of a secondary infection of fungal origin;
• dermatitis;
• cardiovascular form of collapse (usually in infants under 12 months).

The use of liniment, eye drops, and along with this, an alcohol solution can provoke the appearance of local allergic symptoms.

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Overdose

Severe complications associated with hematopoiesis often occur with prolonged use of Levomycetin in daily doses exceeding 3000 mg. Signs of the chronic stage of poisoning include: hyperthermia, paleness of the epidermis, bleeding with hemorrhages, sore throat and a feeling of weakness or fatigue.

When using large doses in newborn infants, the so-called "gray" syndrome may develop, among the main manifestations of which are: the epidermis acquires a bluish-gray tint, flatulence, hypothermia, vomiting, acidosis, and in addition, insufficiency of the cardiovascular system and circulatory collapse. Along with this, a disorder of the respiratory rhythm and the absence of neural reactions are noted, and in addition, a coma is observed.

Infants die in 2 out of 5 such cases. The cause of death is the accumulation of the drug in the body, associated with the immaturity of liver enzymes, as well as the direct toxic effect of the drug on the myocardium.

Cardiovascular syndrome develops when chloramphenicol levels in plasma exceed 50 mcg/ml.

To eliminate disorders, it is necessary to perform gastric lavage and give the victim enterosorbents with saline laxatives; in addition, a cleansing enema is also done. In severe intoxications, hemosorption and symptomatic measures are carried out.

Large doses of eye drops may cause temporary visual impairment. If the dosage is exceeded, rinse the eyes with running water.

In case of intoxication with external medicinal forms, irritation of the mucous membranes or epidermis may occur, as well as local symptoms of intolerance.

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Interactions with other drugs

When used locally, drug interactions do not develop.

Chloramphenicol potentiates the properties of antidiabetic drugs (increasing their levels in plasma and inhibiting their hepatic metabolism), and along with this, the effect of drugs that suppress hematopoietic processes in the bone marrow.

The medicine prevents the development of the bactericidal effect of penicillin.

In addition, the drug reduces the metabolism of phenobarbital and warfarin with phenytoin, increasing their values in the blood plasma and reducing the rate of their excretion processes.

The combination of Levomycetin with erythromycin, clindamycin or lincomycin leads to a mutual weakening of the medicinal properties of these drugs.

To prevent the suppressive effect on hematopoiesis, the combined use of chloramphenicol and sulfonamides should be avoided.

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Storage conditions

Levomycetin in the form of an alcohol solution, eye drops or tablets must be kept at temperatures no higher than 25°C, and in the form of liniment – at temperatures within 15-25°C.

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Shelf life

Levomycetin can be used within 5 years from the date of manufacture of the medicine (for tablets). The shelf life of the alcohol solution is 12 months; liniment and eye drops - 24 months. However, after opening the package with drops, they can be used for only 15 days.

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Application for children

Use of medication tablets in pediatrics.

This form of the drug should be taken with regular monitoring of serum chloramphenicol levels. Taking into account the age category, the daily dosage of the drug in children ranges from 25 to 100 mg/kg.

For newborns under 14 days of age (including premature babies), the daily dose of the medicine is calculated as follows: 6.25 mg/kg per dose. The medicine should be taken up to 4 times per day.

Infants over 2 weeks of age should be given 12.5 mg/kg of the drug per dose (at intervals of 6 hours) or 25 mg/kg (at intervals of 12 hours).

In case of treatment of severe forms of infections (for example, meningitis), the daily dose is increased to 75-100 mg/kg.

Scheme of drug application for diarrhea.

The medication can only be used with a doctor's prescription. However, it is often used in children who suffer from intestinal disorders.

Usually, children aged 3-8 years are prescribed to take 375-500 mg per day (125 mg per dose); children aged 8-16 years should take 0.75-1 g per day (0.25 g per dose).

In case of diarrhea, it is allowed to take the medicine once. If there is no improvement in the child's condition and negative symptoms persist 4-5 hours after taking the medicine, you need to consult a doctor.

Using eye drops in a child.

Newborns (up to 1 month from birth) can use drops only if there are strict indications. This remedy is also prescribed to infants with great caution. Usually, it is instilled 1 drop into the conjunctival sacs at intervals lasting 6-8 hours.

Children under 10 years of age should not be prescribed drops for barley.

Instructions for the use of external forms of drugs in children.

The medicinal solution cannot be used in infants under 12 months of age, and the liniment is not prescribed to newborns and premature babies.

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Analogues

Analogues of the drug are Fluimucil (for tablets), Bactroban, Gentamicin, Syntomycin with Levofenizole (generic), Lincomycin, Neomycin, Baneocin with Fuziderm and Fucidin (for liniment and solution).

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Reviews

Levomycetin in the form of a solution or tablets is mainly used to treat acne. Reviews indicate that both in the case of external treatment with a pure solution and in the case of using combined formulations (with Levomycetin, aspirin, calendula tincture, etc.), the medication quickly and effectively eliminates acne (just a few days are enough).

Many positive comments are also left regarding the eye drops of the drug. They usually act most effectively.

Among the advantages, patients also often note the low cost of the drug.