Levomycetin

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

[1], [2], [3], [4]

Indications Levomycetin

It is used to treat diseases caused by the activity of bacteria sensitive to the influence of antibiotics (such as salmonella, staphylococcus, shigella with Neisseria, and in addition streptococci, rickettsia, proteic strains, leptospira with chlamydia, Klebsiella and some other microbes).

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

Diseases in which the drug is used as a solution or liniment:

• epidermal infections of bacterial origin caused by the activity of microflora, sensitive to the action of chloramphenicol;
• ulcers that are trophic in nature;
• furuncles with pressure ulcers, and in addition wound lesions and burns, complicated by infection;
• cracks in the nipple area that appear in connection with breastfeeding.

When otitis purulent character, the ears are treated with an alcohol solution of LS.

Tablets are usually used for infections in the area of the urinary system and the GIW caused by the microflora, which is sensitive to the drug. They are also used in brucellosis with paratyphoid, and in addition, with generalized salmonella, rickettsiosis, tularemia with typhoid fever, dysentery and yersiniosis with trachoma. In addition, it is used for infections of meningococcal origin, chlamydia, cerebral abscess, lymphogranuloma in the groin, infected wounds with pus, erlichiosis and purulent peritonitis.

The drug in eye drops is prescribed for the treatment of such types of infections of bacterial origin affecting the eyes: epicleritis with scleritis, blepharitis, conjunctivitis with keratoconjunctivitis, and in addition keratitis.

Medication will be ineffective if it is used to treat the above pathologies, but at the same time provoked by viruses, fungi and chloramphenicol-resistant bacteria.

[5], [6]

Release form

The release of the drug is realized in the form of 0.25% drops for the eyes, capsules with tablets having a volume of 0.25 and 0.5 g, and in addition in the form of 1%, 3%, and 5% and 0.25% alcoholic solution, tablets with prolonged activity (volume 0.65 g) and 1% and 5% liniment.

[7], [8]

Pharmacodynamics

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

Chloramphenicol contributes to the death of many gram-negative and-positive microbes (among them strains resistant to streptomycin and sulfonamides with penicillin), and besides rickettsia with spirochetes and some large viruses.

The drug has a weak activity against clostridia, protozoa, pseudomonas aeruginosa and microbes that have acid resistance.

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

Resistance to chloramphenicol develops in bacteria quite slowly. Cross-referencing with respect to other chemotherapeutic drugs usually does not appear.

After local treatment, the desired concentration of drugs is reached inside the fibers in the vitreous humor, and also inside the watery moisture, iris and cornea. The substance does not penetrate the ocular lens.

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

Pharmacokinetics

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

Drug medications within the bloodstream are retained for 4-5 hours from the time the medication is taken orally. Inside the bile, about a third of the portion consumed is determined, and the highest concentrations of the drug are recorded inside the liver with the kidneys.

Levomycetin can penetrate the placenta, and its values inside the fetus can reach up to 30-80% of the serum in the mother. Also, the medicine passes inside the mother's milk.

Biotransformation processes for the most part occur inside the liver (by 90%). The effect of intestinal normoflora leads to the development of hydrolysis processes, as a result of which inactive metabolic products are formed.

The duration of excretion of the drug is 24 hours (this process mainly takes place inside the kidneys - by 90%). About 1-3% of LS is excreted through the intestine.

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

Hemodialysis for drug excretion is ineffective.

[14], [15], [16], [17], [18]

Dosing and administration

Schemes for the use of drops that are buried in the eye.

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

When the medicinal substance is instilled, it is necessary to raise the head, throw it back, then pull down the lower eyelid and drip the drug into the formed cavity (note that the dropper of the bottle should not touch the eyelid or the eye).

After the instillation, the corner of the eye should be pressed with a finger and not blink for half a minute. If the blinking can not be maintained, it is necessary to perform it very carefully, so that the medicinal substance does not pour out of the eye cavity.

To treat a purulent otitis media, the medication is instilled in the amount of 2-3 drops in each ear (the procedure is performed 1-2 times / day). If there are so many discharges from the ears that they wash the drug, it should be applied up to 4 times a day.

Sometimes doctors can advise to dig in drops in the nose - with a bacterial bacterial nasal infection.

The use of 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 appearance of infection within the conjunctiva, as well as the occurrence of complications after the abscess has been opened. Also, the drug accelerates the process of maturation of barley, slightly weakens the redness and severity of pain, and with it for 2-3 days reduces the period necessary for recovery.

Therapy must be carried out in relation not only to the diseased eye, but also to the healthy one. The solution drips 1-2 drops at a frequency of 2-6 times per day. If severe pain is noted, the drug can be used hourly.

Methods of using tablets or capsules.

You need to use medication 3-4 times a day (depends on the medical indications). The size of an adult single dose is 1-2 tablets with a volume of 0.25 g. For a day, a maximum of 4 tablets of 0.5 g can be taken.

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

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

Methods of drug use for diarrhea.

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

When diarrhea tablets should be consumed before eating - 1 piece with intervals equal to 4-6 hours. The maximum allowable dose per day is 4000 mg. At the termination of the disorder after using the 1st tablet 0.5 g, the 2-nd is allowed not to be used.

Use of a medicament to treat cystitis.

For the treatment of cystitis, tablets are usually used. In very severe forms of the disease, the doctor can prescribe injections of drugs (the solution is prepared from a powder that is diluted in injectable water or novocaine) or a jet intravenous chloramphenicol on a glucose solution.

In the absence of other indications, with cystitis, the drug is consumed in standard portions at intervals equal to 3-4 hours.

Schemes of the solution to alcohol.

Levomycetin in this medication is used to treat the affected epidermis or to apply under a hermetically sealed dressing.

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 ongoing treatment procedures.

Cracks in the nipples should be lubricated with 0.25% substance after each feeding procedure. Last such treatment should be a maximum of 5 days.

Methods of liniment application.

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

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

During the treatment of wound regions, the drug is applied 1-fold per day, and for burns it is used once a day or 2-3 times a week (in this case, the frequency of procedures depends on the degree of abundance of the purulent secretion).

When treating epidermal infections of a bacterial nature, the affected areas are treated with a thin layer of the drug (after the preliminary procedures described above) 1-2 times a day, without the use of a dressing. It is also recommended (if possible) to rub the substance into the affected area until it is completely absorbed. In this case, it is necessary to capture and small areas of healthy epidermis around the affected area.

Wet areas before using Levomycetin must be dried with gauze.

When the drug is used for bandages, it should be applied 1-fold per day.

The size of a single dosage is 0,25-0,75 g; daily - 1000-2000 mg of chloramphenicol. For the therapeutic cycle for one patient, whose weight is 70 kg, it is necessary to use up to 3000 mg LS.

To process cracks on the nipples, you need a thick layer of liniment, using a napkin.

Use of drugs when eliminating acne.

Due to the ability to rapidly suppress inflammation and develop infection, medication (a solution of alcohol or tablets) can be used to treat acne.

For problematic skin, a 1% therapeutic solution is recommended. It should be applied pointwise, to avoid drying the epidermis and the emergence of chloramphenicol-resistant bacteria, which in the future may cause the development of poorly amenable pimple-type acne therapy.

The medication is used from the moment of acne and until it is completely eliminated. It must be remembered that the drug should not be used as a preventive measure.

In the treatment of inflamed red acne, as well as acne, the drug is usually used in combination with other medicines.

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

• The medication is used together with a tincture of calendula and aspirin. It is necessary to 4 tablets of chloramphenicol and aspirin, which must be crushed, turning into a powder, and then pour it with tincture of calendula (requires 40 ml of substance);
• chloramphenicol with ethanol, boric, and also salicylic acid. To make medicinal substance, mix the components 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 single acne, but that with more extensive problems it is necessary to cope, first getting rid of the internal cause of the appearance of symptoms in the form of acne.

[21], [22],

Use Levomycetin during pregnancy

Both systemic and external local Levomycetin can not be administered to pregnant women. When it is used during lactation, it is necessary to transfer the baby to the feeding mixes.

If there are medical indications, eye drops may be prescribed during lactation or pregnancy, but with the condition that the dosage portions specified in the manual are strictly observed.

Contraindications

The main contraindications:

• presence of intolerance in the patient;
• depression of processes of hemopoiesis inside the bone marrow;
• The acute form of porphyria, which has an intermittent character;
• lack of enzyme G6FD;
• insufficiency of hepatic or renal activity.

Medications used externally, do not use on large wounds granulating type, and in addition to the epidermis, affected by fungi, psoriasis or eczema.

People who have previously used cytostatics or undergoing radiation therapy sessions, and in addition to infants (especially those whose age does not exceed 1 month) and pregnant, the drug can be prescribed only if there are strict medical indications.

[19]

Side effects Levomycetin

The use of the drug may lead to the appearance of systemic side effects:

• disorders affecting the digestive function: diarrhea, vomiting, dyspeptic symptoms, nausea, dysbacteriosis and irritation on the oral mucosa or throat;
• problems with the processes of hemopoiesis or hemostasis: thrombocyto-, leuko- or reticulocytopenia, and in addition aplastic form of anemia, and hypogemoglobinemia with agranulocytosis;
• disorders affecting the activity of the NA and sensory organs: neuritis in the optic nerve, disorder of taste or consciousness, motor or mental disorders, depression, headaches, delirium, hallucinations (may be visual or auditory), and deterioration of auditory / visual acuity;
• signs of increased sensitivity;
• the development of a secondary infection that has a fungal origin;
• dermatitis;
• cardiovascular form of collapse (usually in infants up to 12 months).

The use of liniment, drops for the eyes, and together with this solution on alcohol can provoke the appearance of local allergic symptoms.

[20]

Overdose

Severe forms of complications associated with hematopoiesis often occur with prolonged use of Levomycetin in daily portions exceeding 3000 mg. Among the signs of a chronic stage of poisoning: hyperthermia, pallor of the epidermis, bleeding with hemorrhages, pain in the throat and a feeling of weakness or fatigue.

When using large doses in newborn infants, the so-called "gray" syndrome can develop, among which the main manifestations are: the epidermis acquires a bluish-gray hue, develops flatulence, hypothermia, vomiting, acidosis, and in addition the failure of the CCC function and the circulatory form of collapse. Along with this, there is a disorder of the respiratory rhythm and the absence of neuronal reactions, and in addition there is a coma.

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

The syndrome of the cardiovascular type develops when the chloramphenicol levels inside the plasma exceed the level of 50 μg / ml.

To eliminate the disorders, it is necessary to perform gastric lavage and give the affected enterosorbents with saline laxatives; In addition, they also make a cleansing enema. With severe intoxication, hemosorption and symptomatic measures are performed.

Increased portions of eye drops can lead to transient weakening of vision. If the dosage is exceeded, it is necessary to rinse the eyes using running water.

When intoxication with external medicinal forms, irritation may occur on the mucous or epidermis, and in addition local symptoms of intolerance.

[23], [24], [25]

Interactions with other drugs

When the drug is used locally, interactions do not develop.

Chloramphenicol potentiates the properties of antidiabetic agents (increasing their indices inside the plasma, and also inhibiting their hepatic metabolism), and with it the influence of drugs that inhibit blood-forming processes inside the bone marrow.

The drug prevents the development of bactericidal effects of penicillin.

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

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 hemopoiesis, the combined use of chloramphenicol and sulfonamides should be discarded.

[26], [27], [28], [29]

Storage conditions

Levomycetin in the form of a solution for alcohol, eye drops or tablets should be kept at temperatures not higher than 25 ° C, and in the form of liniment - at rates within 15-25 ° C.

[30],

Shelf life

Levomycetin can be used within 5 years after the release of the drug (for tablets). The shelf life of the solution for alcohol is 12 months; liniment and eye drops - 24 months. In this case, after opening the package with drops, they can be used for only 15 days.

[31], [32], [33]

Application for children

Use of medication tablets in pediatrics.

To take this form of drugs follows, regularly monitoring the serum chloramphenicol values. Taking into account the age category, the daily dosage of the drug in children varies between 25-100 mg / kg.

Newborns less than 14 days old (including premature babies) also receive a daily dose of the drug as follows: 6.25 mg / kg per reception. For the day you need to take the medicine up to 4 times.

Breasts older than 2 weeks of age should be given 12.5 mg / kg of the drug per use (at intervals lasting 6 hours) or 25 mg / kg (at intervals of 12 hours).

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

Scheme of the drug for diarrhea.

Medication can be used only with the appointment of a doctor. But at the same time it is often used in children who suffer from intestinal disturbances.

Usually children aged 3-8 years are prescribed to take a day in the range of 375-500 mg (for 1 use - 125 mg); children aged 8-16 years per day should be consumed at 0.75-1 g (for 1 reception - 0.25 g).

With diarrhea, it is allowed to take 1 time medication. In the absence of improvements in the child's condition and the maintenance of negative symptoms 4-5 hours after the use of drugs, you should consult a doctor.

Use of drops for the eyes of the child.

Newborns (up to the 1st month after birth) can use drops only if there are strict indications. This remedy is also prescribed with a great care. Usually it is instilled in the first drop inside the conjunctival sacs with intervals lasting 6-8 hours.

Children under the age of 10 years can not be administered drops with barley.

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

Drug solution can not be used in infants until 12 months from birth, and liniment is not prescribed to newborns and premature babies.

[34], [35], [36]

Analogues

The analogues of the drug are Fluimucil (for tablets), Bactroban, Gentamicin, Synthomycin with Levovinizole (generic), Lincomycin, Neomycin, Baneocin with Fusiderm and Fucidin (for liniment and solution).

[37], [38], [39]

Reviews

Levomycetin in the form of a solution or tablets is mainly used to treat acne. The testimonies indicate that in case of external treatment with a clean solution, and in the case of using combined formulations (with Levomycetin, aspirin, calendula tincture, etc.), the medicine quickly and effectively eliminates acne (just a few days).

Many positive comments leave and concerning eye drops of a preparation. Usually they act as effectively as possible.

Of the pluses, patients also often note the low cost of the drug.