Levofloxacin instructions for use tablets for adults 500. Levofloxacin solution for infusion "belmedpreparaty

The date: 04.07.2020

Levofloxacin is a pharmacological bactericidal drug with a broad spectrum of action.

The preparation contains fluorocarboxyquinolone.

The drug is a crystalline powdery substance of white color with a yellowish tint, soluble in liquid.

pharmachologic effect

Levofloxacin is an antibiotic. The main active ingredient is hemihydrate, which is an isomer of ofloxacin.

A distinctive characteristic of the drug is the increased efficiency of action, which is explained by the levorotatory formula of the substance.

It is used as an antibacterial drug of synthetic origin.

The bioavailability of the drug in the form of tablets is about 99%.

The absorption of the substance by the gastrointestinal tract is carried out within a short period of time.

The drug can be used regardless of food intake, due to the fact that in this case there is no significant effect on the duration of absorption.

After taking the drug, it actively spreads throughout the body, and quickly penetrates into the tissues, including the tissues of the respiratory organs.

It is characterized by stability, being in the blood and during excretion through urine, without forming decay products that are toxic to the body.

The composition of the drug (with a volume of 100 ml) includes 500 mg of Levofloxacin in its pure form, as well as auxiliary substances: sodium chloride, chlorous acid, sodium edetate.

Mechanism of action

The drug has an effect on most microorganisms with aerobic metabolism.

Among them are strains that are sensitive to the effects of ampicillin, methicillin.

The action of the drug occurs by blocking the work of enzymes, due to which the synthesis of DNA molecules occurs.

In turn, this leads to the fact that pathological microorganisms are not ways to divide, and their spread stops.

The use of drugs in medicine

Indications for the use of Levofloxacin:

Limitations and contraindications

Contraindications for use:

individual intolerance to the substances that make up the drug;
diseases of ligaments and tendons caused by the use of drugs from the group of fluoroquinolones;
during pregnancy and during breastfeeding;
epileptic seizures;
age limit (children under the age of 18);
(in the elderly).

Forms of drug release

Levofloxacin is available in the following forms:

infusion for intravenous administration, distributed in vials of 0.5 g of active ingredient for every 100 mg of solution;
tablets - 250m, packs of 10pcs, 0.25g each;
tablets - 500 mg, packs of 10 0.5g each.

Based on the instructions for use and reviews of medical practitioners, the following doses of Levofloxacin are recommended, depending on the disease and its severity:

The drug must be taken in accordance with the required dosage. With a daily dose of 0.5 g of the drug, you need to take one 0.5 g tablet or two 0.25 g tablets.

Intravenous infusion for drip injection into a vein is used twice a day - 0.5 g of the active ingredient.

Overdose cases

An overdose of the drug is possible even with a slight excess of the recommended dosage.

Overdose symptoms:

nausea, vomiting;
headache;
disturbances of consciousness;
excessive sleepiness;
confused speech;
trembling and weakness in the body.

A lethal outcome is possible with a single use of a dose exceeding 0.25 g of active ingredient per kg of body weight.

This is important to remember!

When interacting with drugs that include antacids and suralfates, the effectiveness of the drug is sharply reduced.

In the presence of renal failure, taking the drug in combination with other pharmaceuticals may have a negative effect.

When using drugs to strengthen joints and tendons, the simultaneous administration of Levoflaxacin leads to an increase in the likelihood of rupture.

In addition, the drug is contraindicated during pregnancy, as well as during breastfeeding. Taking medication by children under 18 is also contraindicated.

Medical opinion

Reviews of doctors about Levofloxacin are offered below.

The medication was prescribed to a patient diagnosed with acute pyelonephritis. Admission was accompanied by side effects in the form of constant nausea, vomiting, weakness.

After five days of admission, there were practically no side effects, and the patient was discharged 13 days after the start of admission.

Doctor - urologist, Konstantin Evgenievich

Prescribed Levofloxacin intravenously 0.5 g. The patient had complications with cystitis. After a short-term intake (about 9 days), the patient's condition improved, with practically no side effects.

Intern Valery

A very powerful drug. Even despite the large number of side effects, it allows you to get rid of infectious diseases in the shortest possible period of time.

Kirill Antonovich

What do patients think?

Short excerpts from patient reviews about Levofloxacin, which were collected on various forums:

It perfectly performs the function of an antibiotic, however, as a modern medicine, it does not hold out due to the large number of side effects. Already on the first day of admission, he suffered from cadidosis, as well as diarrhea.
The antibiotic is very powerful, but after one pill, severe headaches began. The pressure is all right, I'm 23 years old. I can imagine how older people feel when they take this drug. After the second pill, there was a constant desire to sleep.
I took Levofloxacin for 5 days, at first I had a headache, I could hardly think, my stomach was twisting. In the last two days of admission, pain in the shoulder appeared. The list of side effects indicates that you can not take if the tendons are damaged, most likely I ran into this.
Saw to get rid of cystitis. There were no side effects, but after 2 weeks the infection returned in an even more severe form.
The antibiotic can affect the head. Got a mental breakdown.

Patient Advice:

Before taking the medicine, the day before, it is recommended to take about 10 tablets of activated carbon, in order to reduce the likelihood of body intoxication. It should also be done after the end of the course of admission.
It is best to drink tablets with plenty of ordinary boiled water.... Despite the fact that the intake of the antibiotic does not depend on meals, it is recommended to take it after meals.
During the reception it is recommended to limit physical and stress load on the body.

Most of the negative reviews from patients are solely due to the side effects of taking Levofloxacin.

Pros and cons of the drug

Benefits of the drug:

a wide range of actions (diseases of the urinary system, skin of the body, respiratory tract, prostate diseases, etc.);
convenient form of admission;
high efficiency;
low cost and availability.

Disadvantages of the drug:

many side effects;
the risk of intoxication of the body;
the possibility of death in case of severe overdose;
mental impact;
a large number of contraindications.

Despite the large number of side effects and other disadvantages, Levofloxacin is an effective drug that is actively used to treat various infectious diseases.

Buying a medicine and storing it

Price of Levofloxacin tablets:

0.5g (5 pcs.) - 270-460 rubles;
0.5g (10 pcs.) - 510-613 rubles;
0.5g (14 pcs.) - 615 - 690 RUB;
0.25g (5 pcs.) - 290 - 300 rubles;
0.25g (10pcs.) - 305-480 RUB;
solution - 0.5 g (100 ml) - 170-890 r;
drops for eyes 1 ml - 30-45 rubles, 5 ml - 110 - 140 rubles.

The medicine must be stored at a temperature of no more than 25 degrees, preferably in a dark place protected from direct sunlight.

It is unacceptable to store the drug in places accessible to children. Dispensing of the drug in the pharmacy is carried out by prescription.

Drug analogs

There are many medicines with a similar composition, and also have common indications and contraindications, but many of which are cheaper than Levofloxacin.

Common analogues:

The use of analog drugs is permissible only after prior consultation with the attending physician, who must prescribe a course of treatment and the correct dosage.

Composition of the medicinal product Levofloxacin

1 tab.
levofloxacin (in the form of hemihydrate) 250 mg

10 - blisters (1) - cardboard packs.

Film-coated tablets, white or off-white, capsule-shaped, with a score on one side.
1 tab.
levofloxacin (in the form of hemihydrate) 500 mg

Excipients: hydroxypropyl cellulose LF, microcrystalline cellulose 102, sodium starch glycolate, crospovidone, croscarmellose sodium, colloidal silicon dioxide, magnesium stearate, hydroxypropyl methylcellulose 15 CPS, purified talc, titanium dioxide, triacetin.

5 - blisters (1) - cardboard packs.
10 - blisters (1) - cardboard packs.

Dosage form

Film-coated tablets, white or almost white, round.

Pharmacotherapeutic group

Antibacterial drug of the fluoroquinolone group

Pharmacological properties

A broad-spectrum antibacterial drug from the group of fluoroquinolones. The active substance is levofloxacin - the levorotatory isomer of ofloxacin. Levofloxacin blocks DNA gyrase, disrupts supercoiling and stitching of DNA breaks, inhibits DNA synthesis, and causes deep morphological changes in the cytoplasm, cell wall and membranes.

It is active against most strains of microorganisms both in vitro and in vivo, incl. in relation to aerobic gram-positive microorganisms: Corynebacterium diphtheriae, Enterococcus spp. (including Enterococcus faecalis), Listeria monocytogenes, Staphylococcus spp. coagulase-negative and methicillin-sensitive (including moderately sensitive), Staphylococcus aureus (methicillin-sensitive), Staphylococcus epidermidis (methicillin-sensitive), Staphylococcus spp. (coagulase-negative), Streptococcus spp. (groups C and G), Streptococcus agalactiae, Streptococcus pneumoniae (penicillin-sensitive, moderately sensitive, resistant), Streptococcus pyogenes, Streptococcus viridans (penicillin-sensitive, moderately sensitive, resistant); aerobic gram-negative microorganisms: Acinetobacter spp. (including Acinetobacter baumanii), Actinobacillus actinomycetemcomitans, Citrobacter freundii, Eikenella corrodens, Enterobacter spp. (including Enterobacter aerogenes, Enterobacter agglomerans, Enterobacter cloacae), Escherichia coli, Gardnerella vaginalis, Haemophilus ducreyi, Haemophilus influenzae (ampicillin-sensitive and resistant), Haemophilus parainfluenzae, Helicobacterella spp. (including Klebsiella oxytoca, Klebsiella pneumoniae), Moraxela catarrhalis (producing and non-producing β-lactamases), Morganella morganii, Neisseria gonorrhoeae (penicillin-sensitive, moderately sensitive, resistant), Neisseria meningitlla sppidis (including Pasteurella conis, Pasteurella dagmatis, Pasteurella multocida), Proteus mirabilis, Proteus vulgaris, Providencia spp. (including Providencia rettgeri, Providencia stuartii), Pseudomonas spp. (including Pseudomonas aeruginosa), Salmonella spp., Serratia spp. (including Serratia marcescens); anaerobic microorganisms: Bacteroides fragilis, Bifidobacterium spp., Clostridium perfringens, Fusobacterium spp., Peptostreptococcus spp., Propionibacterum spp., Veilonella spp .; other microorganisms: Bartonella spp., Chlamydia pneumoniae, Chlamydia psittaci, Chlamydia trachomatis, Legionella spp. (including Legionella pneumophila), Mycobacterium spp. (including Mycobacterium leprae, Mycobacterium tuberculosis), Mycoplasma hominis, Mycoplasma pneumoniae, Rickettsia spp., Ureaplasma urealyticum.

Pharmacokinetics

Levofloxacin is rapidly and almost completely absorbed after oral administration. Food intake has little effect on the rate and amount of absorption. The bioavailability of 500 mg of levofloxacin after oral administration is almost 100%. After taking a single dose of 500 mg of levofloxacin, Cmax is 5.2-6.9 μg / ml, Tmax - 1.3 hours, T1 / 2 - 6-8 hours.

Plasma protein binding - 30-40%. It penetrates well into organs and tissues: lungs, bronchial mucosa, phlegm, organs of the genitourinary system, bone tissue, cerebrospinal fluid, prostate gland, polymorphonuclear leukocytes, alveolar macrophages.

In the liver, a small portion is oxidized and / or deacetylated. It is excreted from the body mainly by the kidneys by glomerular filtration and tubular secretion. After oral administration, approximately 87% of the dose taken is excreted in the urine unchanged within 48 hours, less than 4% in the feces within 72 hours.

Levofloxacin - indications for use

Infectious and inflammatory diseases caused by sensitive microorganisms:

Acute sinusitis;

Exacerbation of chronic bronchitis;

Community-acquired pneumonia;

Complicated urinary tract infections (including pyelonephritis), uncomplicated urinary tract infections;

Prostatitis;

Skin and soft tissue infections;

Septicemia / bacteremia (associated with the above indications);

Abdominal infections.

Contraindications

- epilepsy;

Tendon lesions during previous treatment with quinolones;

Children and adolescents (up to 18 years old);

Pregnancy;

Lactation period (breastfeeding);

Hypersensitivity to the components of the drug and to other quinolones.

The drug should be used with caution in the elderly due to the high likelihood of a concomitant decrease in renal function, with a deficiency of glucose-6-phosphate dehydrogenase.

Cautions for use

Restrictions on use: Age up to 18 years (safety and efficacy have not been determined); it should be borne in mind that levofloxacin causes arthropathy and osteochondrosis in young growing animals of various species. With care: diagnosed or suspected diseases of the central nervous system, accompanied by a predisposition to seizures or a decrease in the seizure threshold (epilepsy, severe cerebral atherosclerosis); the presence of other risk factors for the development of seizures or a decrease in the seizure threshold (concomitant use of certain medications, impaired renal function); simultaneous treatment with corticosteroids (increased risk of tendinitis), deficiency of glucose-6-phosphate dehydrogenase (hemolysis is possible).

Application during pregnancy and lactation: Application during pregnancy is possible only if the expected effect of therapy outweighs the potential risk to the fetus (adequate strictly controlled studies of the safety of use in pregnant women have not been conducted).
Levofloxacin was not detected in breast milk, but, according to the data for ofloxacin, it can be assumed that levofloxacin may pass into the breast milk of lactating women and cause serious adverse reactions in breastfed babies. Breastfeeding women should stop either breastfeeding or taking levofloxacin (given the importance of the drug to the mother).

Precautions: The occurrence of seizures and toxic psychoses has been reported in patients treated with quinolones, incl. levofloxacin. Quinolones can also cause an increase in intracranial pressure and stimulation of the central nervous system with the appearance of tremor, anxiety, anxiety, confusion, hallucinations, paranoia, depression, sleep disturbances, rarely - suicidal thoughts and actions; these phenomena may occur after taking the first dose.
In clinical trials of other quinolones, when using multiple doses, ophthalmic disorders have been noted in patients, including cataracts, multiple point clouding of the lens. The relationship between these phenomena and the use of drugs has not been established.
It was reported about the development of severe and fatal hypersensitivity reactions and anaphylactic reactions while taking quinolones, incl. levofloxacin, often developing after the first dose. Some reactions were accompanied by cardiovascular collapse, hypotension, shock, seizures, loss of consciousness, tingling sensation, angioedema (including tongue, pharynx, glottis, or facial edema), airway obstruction (bronchospasm, shortness of breath, acute respiratory distress syndrome) , shortness of breath, hives, itching, and other skin reactions. It was reported about the development of severe and fatal reactions in patients while taking quinolones, incl. levofloxacin, caused by both hypersensitivity reactions and unexplained reasons; these reactions occurred mainly after the administration of repeated doses and manifested themselves in the form of the following manifestations: fever, rash or severe dermatological reactions (acute epidermal necrolysis, Stevens-Johnson syndrome), vasculitis, arthralgia, myalgia, serum sickness, allergic pneumonitis, interstitial nephritis, acute renal failure, hepatitis, jaundice, acute liver necrosis or liver failure, anemia (including hemolytic and hypoplastic), thrombocytopenia (including thrombocytopenic purpura), leukopenia, agranulocytosis, pancytopenia, other changes in the blood. At the first manifestations of a skin rash or other manifestations of hypersensitivity, levofloxacin should be immediately canceled and the necessary measures taken.
It is necessary to bear in mind the possibility of developing pseudomembranous colitis if the patient develops diarrhea while taking antibacterial agents. Treatment with antibacterial agents alters the normal flora of the colon and can lead to increased clostridial growth. If a diagnosis of pseudomembranous colitis is established, levofloxacin should be discontinued and appropriate treatment initiated.
Cases of rupture of the tendons of the shoulder, arm, Achilles tendon, requiring surgical treatment or leading to long-term dysfunction of the limb, have been reported in patients receiving quinolones, incl. levofloxacin. In post-marketing studies, there has been an increased risk of tendon rupture with concomitant use of corticosteroids, especially in elderly patients. If pain, inflammation or tendon rupture occurs, levofloxacin should be discontinued immediately; the patient should be at rest and avoid exertion until the diagnosis of tendonitis or tendon rupture is completely ruled out. Tendon rupture is possible both during therapy with quinolones (including levofloxacin) and after the completion of treatment.
Despite the fact that the solubility of levofloxacin is higher than that of other quinolones, it is necessary to maintain adequate hydration during treatment with levofloxacin in order to avoid the formation of excessively concentrated urine.
It is prescribed with caution in renal failure; since the excretion of levofloxacin can be reduced, careful clinical observation and appropriate laboratory studies should be carried out before and during therapy. In patients with decreased renal function (Cl creatinine In patients exposed to direct sunlight during treatment with quinolone drugs, moderate to severe phototoxic reactions were observed. In clinical studies, phototoxic reactions were observed in less than 0.1% of patients receiving levofloxacin ...
While taking quinolones, incl. levofloxacin, there was an increase in the QT interval on the electrocardiogram and rare cases of arrhythmias. In post-marketing studies, rare cases of ventricular fibrillation-flutter have been reported in patients treated with levofloxacin. It is not recommended to prescribe levofloxacin concurrently with other drugs that prolong the QT interval, incl. class IA and III antiarrhythmic drugs. If the patient has risk factors for the development of ventricular fibrillation, such as hypokalemia, severe bradycardia, cardiomyopathy, the use of levofloxacin should be avoided.
As with other quinolones, changes (disturbances) in blood glucose levels have been reported, including symptomatic hyper- and hypoglycemia, in most cases this was observed in diabetic patients simultaneously receiving oral hypoglycemic agents (for example, glibenclamide) or insulin. Close monitoring of blood glucose levels in these patients is recommended. If a hypoglycemic reaction develops against the background of levofloxacin, levofloxacin should be discontinued immediately and appropriate therapy should be started.
As with taking any strong antimicrobial drug, it is advisable to periodically assess the functions of body systems, including renal, hepatic, hematopoietic.
The patient should be warned:
- about the advisability of drinking plenty of fluids;
- that levofloxacin can cause neurological side effects (for example, dizziness of varying severity), in this regard, the patient should know how he reacts to levofloxacin before engaging in activities that require a quick response and associated with increased concentration;
- during treatment, strong solar or artificial ultraviolet radiation should be avoided; if phototoxic reactions (for example, skin rash) appear, treatment should be discontinued.

Special instructions: Before starting therapy, appropriate tests should be performed to identify the causative agent of the disease and assess sensitivity to levofloxacin. Levofloxacin treatment may be started pending the results of these tests. After receiving test results, appropriate therapy should be selected. Culture testing carried out periodically during therapy with levofloxacin provides information on the persisting sensitivity of the pathogenic microorganism to levofloxacin and on the possible emergence of bacterial resistance.

Drug interactions

Weaken the effect, reducing absorption from the gastrointestinal tract and systemic concentration: sucralfate, magnesium- and aluminum-containing antacids, iron salts, zinc-containing multivitamins, didanosine (chewable / soluble tablets and baby powders for the preparation of oral solutions) - an interval of at least 2 hours between doses must be observed of the above agents and levofloxacin.
There was no clinically significant effect of levofloxacin on the pharmacokinetics of cyclosporin (an increase in plasma levels of cyclosporine was reported under the influence of other quinolones). Levofloxacin had no significant effect on theophylline pharmacokinetics and vice versa.
In clinical studies on healthy volunteers, there was no significant drug interaction between levofloxacin and theophylline. However, since the simultaneous use of theophylline with other quinolones was accompanied by an increase in T1 / 2 and serum theophylline concentration and a subsequent increase in the risk of theophylline-dependent adverse reactions, with the simultaneous use of levofloxacin and theophylline, careful monitoring of theophylline level and appropriate dose adjustment is necessary. Adverse reactions, incl. convulsions may occur regardless of the increase in serum theophylline concentration.
In studies on healthy volunteers, there was no significant drug interaction between levofloxacin and the R- or S-isomers of warfarin. In post-marketing studies, cases of an increase in the effect of warfarin were reported when used simultaneously with levofloxacin, while an increase in prothrombin time was accompanied by episodes of bleeding. With the simultaneous use of levofloxacin and warfarin, careful monitoring of INR, prothrombin time and other indicators of coagulation is necessary, as well as monitoring of possible signs of bleeding.
Cimetidine and probenecid increase the AUC and T1 / 2 of levofloxacin and decrease its clearance (dose adjustment with simultaneous administration is not required).
NSAIDs can increase the risk of CNS stimulation and seizures.
In diabetic patients receiving oral hypoglycemic agents or insulin, while taking levofloxacin, hypo- and hyperglycemic states are possible (careful monitoring of blood glucose is recommended).

Levofloxacin - method of administration and dosage

The drug is taken orally 1 or 2 Tablets are taken before meals or between meals, without chewing and drinking a sufficient amount of liquid (from 0.5 to 1 glass).

The dosage regimen is determined by the nature and severity of the infection, as well as the sensitivity of the suspected pathogen.

The following doses are recommended for adult patients with normal or moderately reduced renal function (CC more than 50 ml / min).

With sinusitis, the drug is prescribed 500 mg 1 time /, for 10 - 14 days.

With exacerbation of chronic bronchitis - 250 mg or 500 mg once a day - 7-10 days.

With community-acquired pneumonia - 500 mg 1-2 for 7-14 days.

For uncomplicated urinary tract infections - 250 mg 1 time / within 3 days.

With prostatitis - 500 mg 1 time / within 28 days.

For complicated urinary tract infections, including pyelonephritis, 250 mg 1 time / for 7-10 days.

In case of skin and soft tissue infection, 250 mg 1 time / or 500 mg 1-2 for 7-14 days.

With septicemia, 250 mg or 500 mg 1-2 are prescribed for 10-14 days (after intravenous administration to continue therapy).

For infections of the abdominal cavity, 250 mg or 500 mg are prescribed once / for 7-14 days (in combination with antibacterial drugs acting on the anaerobic flora) to continue therapy after intravenous administration.

In case of impaired renal function, the dose is changed in accordance with the data below.
Creatinine clearance 250 mg / 24 h 500 mg / 24 h 500 mg / 12 h
first dose 250 mg first dose 500 mg first dose 500 mg
50-20 ml / min then 125 mg / 24 h then 250 mg / 24 h then 250 mg / 12 h
19-10 ml / min then 125 mg / 48 h then 125 mg / 24 h then 125 mg / 12 h
Less than 10 ml / min including hemodialysis and CAPD) then 125 mg / 48 h then 125 mg / 24 h then 125 mg / 24 h

No additional doses are required after hemodialysis or continuous ambulatory peritoneal dialysis (CAPD).

In case of impaired liver function, no special dose selection is required, since levofloxacin is metabolized in the liver only to an extremely insignificant extent.

For elderly patients, no change in the dosage regimen is required, except in cases of low creatinine clearance.

As with the use of other antibiotics, treatment with Levofloxacin tablets of 250 mg and 500 mg is recommended to be continued for at least 48-78 hours after normalization of body temperature or after reliable destruction of the pathogen.

If the drug is missed, it is necessary to take the pill as soon as possible, until the time of the next dose approaches, then the drug is taken according to the recommended scheme.

Side effects

The incidence of side effects is presented according to the following criteria: often - in 1-10 patients out of 100, sometimes - in less than 1 patient out of 100, rarely - in less than 1 patient out of 1,000, very rarely - in less than 1 patient out of 10 000, in some cases - less than 0.01%.

Allergic reactions: sometimes - itching and redness of the skin; rarely - anaphylactic and anaphylactoid reactions (with symptoms such as urticaria, narrowing of the bronchi and possibly severe suffocation); in very rare cases - swelling of the skin and mucous membranes (for example, in the face and pharynx), a sudden drop in blood pressure and shock; hypersensitivity to solar and ultraviolet radiation; allergic pneumonitis; vasculitis; in some cases: severe reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome) and exudative erythema multiforme. General allergic reactions may sometimes be preceded by milder skin reactions, may develop after the first dose, a few minutes or hours after the drug is administered.

From the digestive system: often - nausea, diarrhea, increased activity of liver enzymes in the blood serum; sometimes - loss of appetite, vomiting, abdominal pain, indigestion; rarely - severe diarrhea with blood in the feces (in very rare cases, it can be a sign of intestinal inflammation and even pseudomembranous colitis), an increase in the level of bilirubin in the blood serum; very rarely - hepatitis.

From the side of metabolism: very rarely - hypoglycemia (should be taken into account in patients with diabetes mellitus) with the following possible symptoms: "wolfish" appetite, nervousness, perspiration, tremors. Experience with other quinolones indicates that they are capable of exacerbating pre-existing porphyria. A similar effect is not excluded when using the drug levofloxacin.

From the side of the central nervous system and peripheral nervous system: sometimes - headache, dizziness and / or numbness, drowsiness, sleep disturbances; rarely - depression, anxiety, psychotic reactions (for example, with hallucinations), discomfort (for example, paresthesia in the hands), tremors, psychomotor agitation, confusion, convulsive syndrome, anxiety; very rarely - impaired vision and hearing, impaired taste and smell, decreased tactile sensitivity.

From the side of the cardiovascular system: rarely - increased heart rate, decreased blood pressure; very rarely - vascular collapse; in some cases - lengthening of the QT interval.

From the musculoskeletal system: rarely - tendon lesions (including tendonitis), joint and muscle pain; very rarely - rupture of tendons, for example, the Achilles tendon (this side effect can be observed within 48 hours after the start of treatment and can be bilateral in nature), muscle weakness, which is of particular importance for patients with bulbar syndrome; in some cases, muscle lesions (rhabdomyolysis).

From the urinary system: rarely - increased serum creatinine levels; very rarely - acute renal failure (interstitial nephritis).

From the hematopoietic system: sometimes - eosinophilia, leukopenia; rarely, neutropenia; thrombocytopenia (may be accompanied by increased bleeding); very rarely - agranulocytosis, the development of severe infections (persistent or recurrent increase in body temperature, deterioration of health); in some cases - hemolytic anemia; pancytopenia.

Others: sometimes - general weakness (asthenia); very rarely - fever. Any antibiotic therapy can lead to the development of secondary infection and superinfection.

Overdose

The following symptoms were observed in mice, rats, dogs and monkeys after administration of high doses of levofloxacin: ataxia, ptosis, decreased locomotor activity, shortness of breath, prostration, tremor, convulsions. Doses exceeding 1500 mg / kg orally and 250 mg / kg i.v. significantly increased mortality in rodents.
Treatment of acute overdose: gastric lavage, adequate hydration. It is not excreted by dialysis, there is no specific antidote.

Storage conditions

The drug should be stored in a dry, dark place, out of the reach of children, at a temperature not exceeding 25 ° C. Shelf life is 3 years.

Content

The medicine Levofloxacin is considered a broad-spectrum antibacterial agent. The specified medication is recommended for a patient with infectious and inflammatory diseases of the ENT organs, skin and soft tissues, respiratory tract, urinary organs. The conservative treatment regimen is individually selected by the doctor, self-medication is dangerous to health.

Composition and form of release

Levofloxacin is available in 3 dosage forms - tablets 250 and 500 mg, infusion solution 0.5%, drops 0.5% (for use in ophthalmology). Round yellow pills have a biconvex shape, a longitudinal notch. The tablets are packaged in a cardboard box of 5 or 10 pcs., Attach instructions for use. Transparent eye drops are poured into dropper bottles with a volume of 5 or 10 ml. The green-yellow infusion solution is available in 100 ml bottles. Features of the chemical composition:

Drug release form	Active ingredients	Excipients	Shell composition
tablets, 1 pc.	levofloxacin hemihydrate (250 or 500 mg)	hypromellose, calcium stearate, primellose, microcrystalline cellulose, polysorbate 80	titanium dioxide, iron oxide yellow dye, talc, hypromellose, macrogol 4000
drops, 1 ml		benzalkonium chloride, sodium chloride, 1 M hydrochloric acid solution, disodium edetate dihydrate, water for injection
solution for infusion, 1 ml	levofloxacin hemihydrate (5 mg)	sodium chloride, water for injection

Pharmacological properties

The medical product Levofloxacin is a representative of the group of fluoroquinolones with a pronounced antimicrobial effect in the body. The active substance with bactericidal properties disrupts DNA supercoiling, provokes morphological changes in the cells of pathogenic microorganisms. Microbes lose their ability to reproduce, die off en masse. According to the instructions, the drug is active against bacteria of the gram-positive and gram-negative series, certain strains.

When the drug is taken orally on an empty stomach, the bioavailability index is 100%. The maximum concentration in blood plasma of levofloxacin hemihydrate reaches 1 hour after taking a single dose. Metabolism takes place in the liver. The half-life process lasts 6-7 hours. According to the instructions, the antibiotic is excreted by the kidneys in the urine by 85%.

Levofloxacin is an antibiotic or not

The specified medication belongs to the pharmacological group of fluoroquinolones, is characterized by systemic action in the body. Levofloxacin is a synthetic antibacterial agent that, in comparison with antibiotics, is less likely to provoke an allergic reaction. The drug has pronounced bactericidal, antimicrobial properties, it is recommended for the complex treatment of infections caused by the activity of penicillin-resistant strains of pneumococcus, Escherichia coli, Klebsiella spp., Enterobacter spp., Citobacter spp.

Indications for use

Detailed instructions for the use of Levofloxacin describe diseases in which such a pharmaceutical appointment is appropriate. Medical indications for all forms of release of the specified medication:

tablets: sinusitis, inflammation of the paranasal sinuses, pneumonia, otitis media, bronchitis, urethritis, pyelonephritis, cystitis, uncomplicated prostatitis of a bacterial nature, furunculosis, pyoderma, abscess, pneumonitis, urogenital infections in adults, atheroma;
solution for infusion: anthrax, sepsis, chronic bronchitis, tuberculosis, biliary tract infections, impetigo, pyoderma, complicated pneumonia with blood poisoning, complicated prostatitis, panniculitis;
drops: superficial infections of the eyes of bacterial origin.

Method of administration and dosage

The medicinal product Levofloxacin is intended for oral, intravenous, and external use. The duration of treatment with tablets is 1-2 weeks, with solution for infusion - from 1 to 3 months (depending on medical indications), with eye drops - 5-7 days. The optimal dosage of the antibacterial agent is individually determined by the attending physician.

The medicinal product is intended for oral administration. Tablets are supposed to be drunk on an empty stomach or in between meals, washed down with plenty of liquid. The recommended doses are defined in the instructions, depending on the diagnosis:

bacterial sinusitis: once a day, 500 mg, course - 10-14 days;
chronic bronchitis of the stage of relapse: 250 or 500 mg 1 time per day, course - 7-10 days;
community-acquired pneumonia: 500 mg 1-2 times a day for 1-2 weeks;
prostatitis: 1 tab. Levofloxacin 500 once a day, course - 4 weeks;
infection of the skin and soft tissues: 0.5-1 g once a day, course - 7-14 days;
urinary tract infections: 250 mg once a day, course - 10 days;
bacterial prostatitis: 500 mg once a day, course - 28 days;
bacteremia, septicemia: 250 or 500 mg 1 time per day, course - 14 days.

Levofloxacin ampoules

The infusion solution is intended for slow intravenous infusion. According to the instructions, the duration of admission of 100 ml of the drug is at least 60 minutes, the number of procedures is 1-2 per day. After a few days, the patient is transferred to the tablet form of the specified antibiotic. The solution is administered intravenously at 500 mg, the number of daily sessions depends on the diagnosis:

skin infections: twice a day for 7-14 days;
sepsis, pneumonia: 1-2 times a day for 7-14 days;
pyelonephritis of the acute stage: 1 time per day for a course of 3-10 days;
skin infections: 1,000 mg for 2 daily doses for 1-2 weeks;
anthrax: Levofloxacin intravenously 1 time per day for 2 weeks.

Drops

In case of eye infection, Levofloxacin is prescribed in the form of eye drops for external use. The first 2 days it is required to inject 1-2 caps into each conjunctival sac. of the specified medication every 2 hours. On the third day, it is recommended to use the medicine no more than 4 times a day for 1 week. If necessary, antibiotic therapy is extended.

special instructions

To minimize the risk of damage to articular cartilage, treatment of adolescents with this medication is contraindicated. The instructions for use contain important recommendations for patients:

For patients after peritoneal dialysis or hemodialysis, the administration of additional doses is contraindicated.
In chronic kidney disease, patients of retirement age are prescribed medication with caution.
With organic lesions of the brain during antibiotic therapy, convulsive syndrome develops.
In acute deficiency of glucose-6-phosphate dehydrogenase under the influence of fluoroquinolones, the destruction of erythrocytes (hemolysis) occurs.
When wearing contact lenses, it is required to temporarily abandon the use of drops, otherwise the adsorption of the active substance slows down.
The treatment requires laboratory monitoring of hemoglobin, bilirubin, creatinine in the blood.
When using eye drops, it is required to temporarily give up driving a personal car, power mechanisms, it is important to wait until vision is restored.
Levofloxacin tablets in gynecology are prescribed for infections as part of complex therapy (simultaneously with means for vaginal administration).
The medicine, with prolonged use, can provoke dysbiosis, therefore, probiotics are prescribed to normalize the intestinal microflora.

During pregnancy

The drug Levofloxacin is not recommended for use when carrying a fetus, because in this way you can harm the health of an unborn child. When breastfeeding, the medication is also contraindicated. If necessary, drug therapy is required to temporarily transfer the baby to adapted mixtures, to stop lactation.

Levofloxacin for children

Since this medication negatively affects the condition of the cartilage tissue, it is categorically contraindicated to use it in patients under 18 years of age according to the instructions. In childhood, it is recommended to select other antibacterial agents, having previously consulted with the local pediatrician. Levofloxacin is especially dangerous for the health of adolescents.

Levofloxacin and alcohol

During antibiotic therapy, alcohol intake is contraindicated. for two reasons - a decrease in the therapeutic effect, an increase in the severity of side effects. Alcohol enhances the diuretic effect, as a result of which the active substances are quickly excreted from the body, slowing down recovery. In addition, the interaction with ethanol increases the stress on the nervous system. The patient complains of migraine attacks, dizziness, insomnia, convulsions.

Drug interactions

Since Levofloxacin is part of a combination therapy, it is important to consider the risk of drug interactions. The instructions provide the following recommendations:

With the simultaneous use of quinolones with theophylline, the risk of developing convulsive syndrome increases.
In combination with sucralfate, iron salts, magnesium or aluminum-containing antacids, the antibacterial effect is reduced.
Cimetidine and Probenicid slightly slow down the elimination of the antibacterial drug, which is important to remember for patients with chronic liver and kidney diseases.
Concomitant use with glucocorticosteroids increases the risk of tendon rupture, disruption of the ligamentous apparatus.
When used together with vitamin K antagonists, systematic monitoring of the blood clotting index is important.
In a combination of an antibacterial drug with Cyclosporin, the half-life of the latter increases.
When using eye drops, the risk of drug interactions is minimal.
Do not add sodium bicarbonate or heparin to the infusion solution.
For infusions, a combination with Ringer's solution with dextrose, saline and parenteral nutrition solution is allowed.

Side effects

Levofloxacin is well tolerated by the body, but doctors do not exclude a deterioration in health at the beginning of the course. The instructions for use describe possible side effects:

digestive system: increased work of liver enzymes, nausea, vomiting, gastralgia, diarrhea, symptoms of pseudomembranous colitis, intestinal upset;
cardiovascular system: tachycardia (heart palpitations), arterial hypotension, vascular collapse;
nervous system: depression, hallucinations, limb tremors, feelings of internal anxiety;
urinary system: interstitial nephritis, increased serum bilirubin and creatine concentration, renal failure, Lyell's syndrome;
musculoskeletal system: aching pain and weakness in the muscles, rhabdomyolysis (muscle damage), tendonitis (inflammation of the tendons);
respiratory system: bronchospasm;
hematopoietic organs: agranulocytosis, pancytopenia, hemolytic anemia, a decrease in the number of neutrophils (neutropenia), glucose, basophils, leukocytes, platelets (thrombocytopenia), a jump in eosinophils in the blood;
skin: small rash, urticaria, dermatitis, erythema, swelling and hyperemia of the epidermis, itching, burning;
organs of vision: conjunctival chemosis, blepharitis, photophobia, erythema on the eyelids, decreased visual acuity;
others: fever, fever, leukocytoclastic vasculitis, hyperthermia, hypersensitivity to the effects of ultraviolet radiation, sunlight.

Overdose

With a systematic overestimation of the daily dose of Levofloxacin, the work of the nervous system is disrupted. The patient is worried about convulsions as in epilepsy, symptoms of depression, fainting and confusion. Other symptoms of an overdose: signs of dyspepsia, bouts of vomiting. Treatment is symptomatic. Doctors prescribe dialysis. There is no specific antidote.

Contraindications

The use of Levofloxacin is not allowed for all patients according to indications; antibiotic therapy can harm some patients. The instructions provide a complete list of medical contraindications:

the patient's age up to 1 year;
pregnancy;
lactation;
hypersensitivity of the body to active substances;
epilepsy;
renal failure.

Terms of sale and storage

The medicine is sold in pharmacies, dispensed with a prescription. According to the instructions, stored in a dry, dark place out of the reach of small children. Shelf life - 2 years (opened bottle - 30 days). The expired medication must be disposed of.

Analogs

If the medication does not work or causes side effects, it is recommended to replace it. Reliable analogs with a brief description:

Tsipromed. Antibiotic in the form of eye drops for external use. According to the instructions, daily doses depend on the severity of the disease. The course of treatment is 7–21 days.
Betacyprol. A drug for the treatment of infectious eye diseases. According to the instructions, the patient is prescribed 1-2 caps. into each conjunctival sac. The duration of therapy depends on the severity of the disease.
Vitabact. Eye drops with antibacterial effect for external use. Allowed for pregnant women, nursing mothers under medical supervision.
Decamethoxin. An antibiotic is prescribed for the treatment of infectious diseases of the ENT organs, soft tissues. The drug has several forms of release, daily doses are reflected in the instructions.
Ofloxacin. Antibacterial tablets are characterized by a systemic effect in the body. The average dose is 200-800 mg for 2 daily doses for 7-14 days.
Floxal. These are drops and ointment that are used in ophthalmology to destroy pathogenic flora. According to the instructions, the patient will have to be treated for 5 to 14 days, depending on the severity of the disease.
Tsiprolet. Antimicrobial drug in the form of tablets and eye drops. The first form of release is for patients over 18 years old, the second is recommended for children from 1 year old.
Ciprofloxacin. These are tablets for oral administration with a bactericidal effect, which lead to the death of sensitive bacteria. The drug is supposed to be taken in full course.
Okomistin. The drug in the form of eye drops exhibits high therapeutic activity against chlamydia, herpes virus, fungi, adenoviruses.
Oftadek. Eye drops effective for infectious conjunctivitis. According to the instructions, 2 drops are prescribed. up to 6 times a day. the doctor determines the duration of treatment individually.

Levofloxacin price

The cost of a medicine depends on the form of release, the amount of medicine in each package, the manufacturer and the rating of the Moscow pharmacy. The average price of the drug varies from 100 to 300 rubles.

Video

Release form

Pills

Composition

1 tablet contains: levofloxacin hemihydrate 512.46 mg, which corresponds to the content of levofloxacin 500 mg.Excipients: microcrystalline cellulose - 61.66 mg, hypromellose - 17.98 mg, croscarmellose sodium - 18.6 mg, polysorbate 80 - 3.1 mg, calcium stearate - 6.2 mg. Shell composition: (hypromellose - 15 mg, hyprolose (hydroxypropyl cellulose) - 5.82 mg, talc - 5.78 mg, titanium dioxide - 3.26 mg, iron oxide yellow (yellow oxide) - 0.14 mg) or (dry mixture for film coating containing hypromellose 50 %, hyprolose (hydroxypropyl cellulose) 19.4%, talc 19.26%, titanium dioxide 10.87%, iron oxide yellow (yellow oxide) 0.47%) - 30 mg.

Pharmacological effect

Broad-spectrum antimicrobial agent, fluoroquinolone. It has a bactericidal effect. Blocks DNA gyrase (topoisomerase II) and topoisomerase IV, disrupts supercoiling and stitching of DNA breaks, inhibits DNA synthesis, and causes deep morphological changes in the cytoplasm, cell wall and membranes. It is active against Enterococcus faecalis, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus pyogenes and Streptococcus agalactiae, Viridans group streptococci, Enterobacter cloacae, Enterobacter aerogenes, Enterobacter agglomerans, Enterobacter sakazakii, Escherichia coli, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Klebsiella oxytoca, Legionella pneumoniae, Moraxella catarrhalis, Proteus mirabilis, Proteus mirabilis, Pseudomonas aeruginosa, Pseudomonas fluorescens, Chlamydia pneumoniae, Mycoplasma pneumoniae, Acinetobacter anitratus, Acinetobacter baumannii, Acinetobacter bacteri calcoacella, Providerus Providcncia stuartii, Serratia marcescens, Clostridium perfringens.

Pharmacokinetics

When taken orally, it is absorbed from the gastrointestinal tract quickly and almost completely. Food intake has little effect on the rate and completeness of absorption. Bioavailability is 99%. Cmax is reached after 1-2 hours and when taking 250 mg and 500 mg is 2.8 and 5.2 μg / ml, respectively. Plasma protein binding - 30-40%. It penetrates well into organs and tissues: lungs, bronchial mucosa, phlegm, organs of the genitourinary system, polymorphonuclear leukocytes, alveolar macrophages. In the liver, a small portion is oxidized and / or deacetylated. Renal clearance is 70% of the total clearance. T1 / 2 - 6-8 hours. It is excreted from the body mainly by the kidneys by glomerular filtration and tubular secretion. Less than 5% of levofloxacin is excreted as metabolites. In unchanged form, 70% is excreted in the urine within 24 hours and 87% in 48 hours; in feces for 72 hours, 4% of the dose taken orally is found. After intravenous infusion of 500 mg for 60 minutes, Cmax is 6.2 μg / ml. With intravenous single and multiple administration, the apparent Vd after administration of the same dose is 89-112 L, Cmax - 6.2 μg / ml, T1 / 2 - 6.4 hours.

Indications

Infectious and inflammatory diseases caused by microorganisms susceptible to levofloxacin: Acute bacterial sinusitis; Exacerbation of chronic bronchitis; Community-acquired pneumonia; Complicated infections of the kidneys and urinary tract, including pyelonephritis; Chronic bacterial prostatitis; Skin and soft tissue infections.

Contraindications

Hypersensitivity to levofloxacin or other quinolones. Renal failure (with creatinine clearance less than 20 ml / min. Due to the impossibility of dosing this dosage form). Epilepsy. Tendon lesions after previous treatment with quinolones. Children and adolescents (up to 18 years old). Pregnancy and lactation. It should be used with caution in the elderly due to the high likelihood of a concomitant decrease in renal function, as well as with a deficiency of glucose-6-phosphate dehydrogenase.

Precautions

From the digestive system: nausea, vomiting, diarrhea, anorexia, abdominal pain, pseudomembranous enterocolitis, increased activity of hepatic transaminases, hyperbilirubinemia, hepatitis, dysbiosis. From the side of the cardiovascular system: lowering blood pressure, vascular collapse, tachycardia. From the side of metabolism: hypoglycemia (increased appetite, sweating, tremors). From the side of the central nervous system and peripheral nervous system: headache, dizziness, weakness, drowsiness, insomnia, paresthesia, anxiety, fear, hallucinations, confusion, depression, movement disorders, convulsions. From the senses: impairment of vision, hearing, smell, taste and tactile sensitivity. From the musculoskeletal system: arthralgia, myalgia, tendon rupture, muscle weakness, tendonitis. From the urinary system: hypercreatininemia, interstitial nephritis. From the hematopoietic system: eosinophilia, hemolytic anemia, leukopenia, neutropenia, agranulocytosis, thrombocytopenia, pancytopenia, hemorrhages.

Application during pregnancy and lactation

Levofloxacin is contraindicated during pregnancy and lactation (breastfeeding).

Method of administration and dosage

The drug is taken orally 1 or 2 times a day. Do not chew the tablets and drink a sufficient amount of liquid (from 0.5 to 1 cup), can be taken before meals or between meals. Doses are determined by the nature and severity of the infection, as well as the sensitivity of the suspected pathogen. For patients with normal or moderately reduced renal function (creatinine clearance\u003e 50 ml / min.), The following dosage regimen is recommended: sinusitis: 500 mg once a day - 10-14 days; exacerbation of chronic bronchitis: 250 mg or 500 mg once a day - 7-10 days; community-acquired pneumonia: 500 mg 1-2 times a day - 7-14 days. uncomplicated urinary tract infections: 250 mg once a day - 3 days; prostatitis: 500 mg - 1 time per day - 28 days; complicated urinary tract infections, including pyelonephritis: 250 mg once a day - 7-10 days; infections of the skin and soft tissues: 250 mg once a day or 500 mg 1-2 times a day - 7-14 days; septicemia / bacteremia: 250 mg or 500 mg 1-2 times a day for 10-14 days; intra-abdominal infection: 250 mg or 500 mg once a day - 7-14 days (in combination with antibacterial drugs acting on the anaerobic flora). Patients after hemodialysis or continuous ambulatory peritoneal dialysis do not require additional doses. Patients with impaired liver function do not require a special selection of doses, since levofloxacin is metabolized in the liver only to an extremely insignificant extent. As with the use of other antibiotics, it is recommended to continue treatment with Levofloxacin for at least 48-78 hours after normalization of body temperature or after laboratory-confirmed recovery.

Side effects

Allergic reactions are sometimes itching and redness of the skin. rarely - general hypersensitivity reactions (anaphylactic and anaphylactoid reactions) with symptoms such as urticaria, bronchoconstriction and possibly severe suffocation. very rarely - swelling of the skin and mucous membranes (for example, in the face and pharynx), a sudden drop in blood pressure and shock, hypersensitivity to sunlight and ultraviolet radiation (see Special instructions), allergic pneumonitis, vasculitis. in some cases, severe skin rashes with blistering, for example, Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome) and exudative erythema multiforme. General hypersensitivity reactions may sometimes be preceded by milder skin reactions. The above reactions may develop after the first dose, a few minutes or hours after the administration of the drug. From the side of the digestive system, often - nausea, diarrhea, increased activity of liver enzymes (for example, alanine aminotransferase and aspartate aminotransferase). sometimes - loss of appetite, vomiting, abdominal pain, digestive disorders. rarely - diarrhea with an admixture of blood, which in very rare cases can be a sign of intestinal inflammation and even pseudomembranous colitis (see Special instructions) .From the metabolic side, very rarely - a decrease in the concentration of glucose in the blood, which is of particular importance for patients with diabetes mellitus (possible signs of hypoglycemia: increased appetite, nervousness, perspiration, tremors). Experience with other quinolones indicates that they are capable of exacerbating porphyria in patients already suffering from this disease. A similar effect is not excluded when using levofloxacin. On the part of the nervous system, sometimes - headache, dizziness and / or numbness, drowsiness, sleep disturbances; rarely - anxiety, paresthesias in the hands, tremors, psychotic reactions such as hallucinations and depression, agitated state , convulsions and confusion. very rarely - visual and hearing impairments, impaired taste and smell, decreased tactile sensitivity. On the part of the cardiovascular system, rarely - increased heart rate, decreased blood pressure. very rarely - vascular (shock-like) collapse. in some cases - lengthening of the Q-T interval. From the side of the musculoskeletal system, rarely - tendon lesions (including tendonitis), joint and muscle pain; very rarely - tendon rupture (for example, the Achilles tendon). this side effect can be observed within 48 hours after the start of treatment and can be bilateral in nature (see Special instructions), muscle weakness, which is of particular importance for patients with bulbar syndrome. in some cases - muscle damage (rhabdomyolysis). On the part of the urinary system, rarely - an increase in the level of bilirubin and creatinine in the blood serum. very rarely - deterioration of renal function up to acute renal failure, interstitial nephritis. On the part of the hematopoietic organs, sometimes an increase in the number of eosinophils, a decrease in the number of leukocytes. rarely - neutropenia, thrombocytopenia, which may be accompanied by increased bleeding. very rarely - agranulocytosis and the development of severe infections (persistent or recurrent fever, deterioration in well-being). in some cases - hemolytic anemia. pancytopenia Other sometimes - general weakness. very rarely - fever.

Interaction with other drugs

Levofloxacin increases the T1 / 2 of cyclosporin. The effect of levofloxacin is reduced by drugs that inhibit intestinal motility, sucralfate, magnesium- and aluminum-containing antacids and iron salts (a break between doses of at least 2 hours is required). With the simultaneous use of NSAIDs, theophylline increases convulsive readiness, GCS - increase the risk of tendon rupture. Cimetidine and drugs that block tubular secretion slow down the excretion of levofloxacin. Levofloxacin solution for intravenous administration is compatible with 0.9% sodium chloride solution, 5% dextrose solution, 2.5% Ringer's solution with dextrose, combined solutions for parenteral nutrition (amino acids, carbohydrates, electrolytes). Levofloxacin solution for intravenous administration should not be mixed with heparin and solutions with an alkaline reaction.

special instructions

Levofloxacin is used with caution in elderly patients (there is a high likelihood of a concomitant decrease in renal function). After normalization of temperature, it is recommended to continue treatment for at least 48-78 hours. Duration of intravenous infusion of 500 mg (100 ml of infusion solution) should be at least 60 minutes. During treatment, it is necessary to avoid solar and artificial UV radiation in order to avoid damage to the skin (photosensitization). If signs of tendinitis appear, levofloxacin is immediately canceled. It should be borne in mind that in patients with a history of brain damage (stroke, severe trauma), seizures may develop, with glucose-6-phosphate dehydrogenase deficiency - the risk of hemolysis. Influence on the ability to drive vehicles and control mechanisms: During the period of treatment, it is necessary to refrain from engaging in potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions.

To date, the fight against the resistance of pathogenic bacterial flora is considered an urgent problem in domestic and foreign pharmacology. This process is associated with a mutation in the genes of the microorganism, which is inherited. Antimicrobial resistance is increasing every year, which requires the introduction of new and often more expensive drugs and their combinations into clinical practice. Levofloxacin, the instructions for use of which describe in detail the dosage and other aspects of administration, is not a fundamentally new antibiotic, but remains effective against a wide range of representatives of the pathogenic flora.

Quinolone class drugs have become known relatively recently. The first drug of this group was used in 1962, it was nalidixic acid. In the 1980s, fluorine and piperazine were added to the structural formula, later all medicines with such a chemical composition were called fluoroquinolones. They differ from their predecessors in a wider spectrum of antimicrobial activity.

The main component of the drug is Levofloxacin, the instructions for use call the isomer of the same name of a previously synthesized antibiotic from the group of fluoroquinolones ofloxacin. Due to its effectiveness, the drug is widely used to treat infectious diseases of unknown etiology, lesions of bone, cartilage tissue, abdominal cavity, ENT organs, and the genitourinary system. According to doctors, the medication is successfully used to prevent bacterial complications in patients with severe immunodeficiency. Levofloxacin, instructions for use confirm its action, a first-line drug for the treatment of nosocomial pneumonia.

Given the wide range of indications for admission, the medicine is available in the form of:

solution for injections, which are administered only intravenously, with a dosage of the active ingredient of 5 mg in 1 ml of injection, usually in a package of 1 ampoule or bottle;
coated tablets of 0.25 and 0.5 g;
drops for eyes 0.5% in bottles of 5 and 10 ml.

The medicine is produced both under the original name and in the form of analogs under various trade marks, for example, Levofloxacin-Teva, Remedia, etc. The price of the medicine also depends on the country - the manufacturer. Although in some cases the high cost is justified, since this is due to the quality of the substance used to prepare the drug, the speed of action and bioavailability.

As for the principle of "work" of the drug Levofloxacin, the instructions for use describe it in insufficient detail. The active component of the antibiotic penetrates the bacterial cell membrane and influences the reproduction process by inhibiting specific enzymes. In gram-negative microorganisms, Levofloxacin inhibits the production of DNA hydrase topoisomerase II, which regulates the processes of correct DNA twisting. In gram-positive bacteria, this antibiotic from the group of fluoroquinolones blocks the activity of type IV topoisomerase, which also regulates the processes of spiralization of DNA molecules.

All antibiotics - fluoroquinolones are divided into four generations depending on their spectrum of activity. The earliest drugs mainly affect only gram-negative pathogens and do not create sufficiently high concentrations in tissues. In the late 1980s, second-generation fluoroquinolones, active against staphylococci, appeared on the pharmaceutical market. The spectrum of action of third-generation drugs is even wider, destroying also pneumococci and intracellular pathogens.

If we talk about the activity of the antibiotic Levofloxacin, the instructions for use list the bacteria that the medication fights against:

fecal enterococcus, the most pathogenic type of enterococcus, the main cause of persistent nosocomial infections of the urinary tract, myocardium and other organs;
staphylococcus aureus and Staphylococcus aureus, one of the most common bacteria;
pneumococcus, the main causative agent of meningitis and pathologies of ENT organs;
strains of β-hemolytic streptococcus, long-term exposure to which leads to autoimmune processes;
the rare Streptococcus viridians, which causes endocarditis;
various strains of enterobacter, causing diseases of the digestive and urinary system, the lower parts of the respiratory tract;
e. coli, is considered a conditionally pathogenic bacterium, with uncontrolled reproduction can cause peritonitis, colpitis, prostatitis;
hemophilic bacillus, the causative agent of meningitis, pericarditis, pneumonia and other serious diseases, due to its structure, is practically not destroyed by the body's own immune cells;
pfeifer's bacillus, the cause of serious bacterial diseases of the upper and lower respiratory tract;
klebsiella, the main causative agent of urinary tract infections;
legionella, a frequent "inhabitant" of contaminated air conditioning filters, the causative agent of legionellosis;
moraxella catarrhalis, causes otitis media, sinusitis and other diseases of the ENT organs;
proteus mirabilis, often becomes the cause of the development of infections of the genitourinary system;
pseudomonas aeruginosa, causes nosocomial infections, especially lesions of the urinary organs, soft tissues;
chlamydophyllum pneumonia, a frequent causative agent of respiratory infections;
mycoplasma, is the cause of pneumonia and other lesions of the lungs and bronchial tree;
acinetobacter, causes systemic bacterial infections of the bloodstream, ENT - organs, nervous system, musculoskeletal system;
bordet-Zhangu bacterium, the causative agent of whooping cough;
citrobacter, often causes sepsis, meningitis, gastroenteritis, infectious pathologies of the organs of the excretory system;
morgan bacteria, the causative agent of intestinal infections;
proteus, causes bacterial diseases of the digestive tract;
providence Rettgeri, as a result of exposure to the pathogen, pathologies of the urinary system develop, resistant to other antibiotics;
serrations, populate the respiratory and urinary tract, causing the corresponding symptoms;
clostridium, causative agent of foodborne diseases.

This antibiotic also has a postantibiotic effect. This is the name of the ongoing suppression of bacterial growth after stopping the drug. That is why, for some diseases, the antibiotic can be taken once a day, and a reduction in the duration of treatment is also allowed.

When taken in the form of tablets, Levofloxacin quickly enters the bloodstream. The bioavailability of this antibiotic is much higher than analogues, and according to medical reviews, it is up to 99%. Penetrates into all affected tissues, mainly excreted by the kidneys within 1 - 2 days after ingestion.

Despite all the advantages of the drug, there are certain contraindications regarding the use of an antibiotic at an early age. In the description of clinical trials conducted on animals, there is evidence of a negative effect on the development of articular cartilage. Therefore, the prescription of the drug Levofloxacin, instructions for use are limited to children and adolescents under 18 years of age.

Levofloxacin: what helps, indications and contraindications, possible side effects

The main indications for prescribing a medicine are the following diseases:

lesions of the ENT organs: otitis media, sinusitis;
infections of the lower parts of the respiratory system: pneumonia, bronchitis, including exacerbation of chronic processes;
complicated and uncomplicated lesions of the urinary system: pyelonephritis, urethritis, cystitis;
infections of the reproductive system, including venereal: bacterial prostatitis, gonorrhea, chlamydia;
diseases of the skin and soft tissues: suppurating atheromas, abscesses, boils;
sepsis;
eye infections;
intra-abdominal infections, including peritonitis.

The antibacterial drug Levofloxacin from which it helps is described in detail in the annotation, has a wide spectrum of activity against gram-negative and gram-positive pathogens.

However, like any other potent drug, this antibiotic from the group of fluoroquinolones has a number of contraindications, these are:

pregnancy;
breastfeeding period;
age up to 18 years (eye drops with Levofloxacin can be used in children from 1 year old);
pseudomembranous colitis;
epilepsy and other disorders of the central nervous system, accompanied by seizures;
damage to the tendons and connective tissues caused by previous treatment with antibiotics - quinolones;
renal failure;
hypersensitivity to levofloxacin and excipients used in the manufacture of the drug.

The antibacterial agent is usually well tolerated. The occurrence of side effects is associated with the dose of the drug. But even if the doctor prescribes the drug in the maximum allowable amount, the incidence of adverse reactions does not exceed 13.5% (based on the results of clinical studies conducted in the United States).

Often, against the background of the use of the drug, disorders of the digestive tract are noted, these are:

decreased appetite;
pain and discomfort in the abdomen;
nausea;
vomiting;
constipation or vice versa, diarrhea;
disruption of the liver, which in the clinical analysis of blood is reflected in the form of an increase in the concentration of transaminases, bilirubin and alkaline phosphatase), and the patient may complain of discomfort in the right hypochondrium;
dysbiosis, in isolated cases, intestinal and oral candidiasis;
colitis.

In 1 - 4% of patients, when taking Levofloxacin, the following adverse reactions from the central nervous system were noted:

headaches;
insomnia;
nightmares;
sudden mood swings;
general weakness;
dizziness;
anxiety, the appearance of a feeling of fear;
in 1% of patients, doctors observed the appearance of seizures.

Side effects from the skin are noted both with oral and injectable administration of Levofloxacin.

Development is possible:

photodermatosis;
rashes;
phlebitis at the injection site or dropper.

In 1.5 - 2% of patients taking Levofloxacin, from which the drug can be consulted by a doctor, there are changes in the hematopoietic system. Sometimes the level of leukocytes, platelets and erythrocytes decreases (although in some cases leukocytosis and an acceleration of the erythrocyte sedimentation rate are noted, which is mistaken for a lack of treatment effect), an increase in the concentration of eosinophils.

Lesions of the musculoskeletal system are observed in 1% of patients. They manifest as inflammation of the skeletal muscles, joint pain, damage and sometimes rupture of tendons. Most often, such adverse reactions are noted in older men.

If the amount of antibiotic recommended by the doctor is significantly exceeded, symptoms of an overdose may appear. The central nervous system is the first to react. A person is in a semi-conscious state, dizziness occurs, and sometimes convulsive seizures of the epileptic type begin. Also, with an overdose of Levofloxacin, all signs of indigestion (nausea, vomiting, diarrhea) appear. On examination, erosive damage to the intestinal mucosa is sometimes found.

Therefore, if clinical signs of an overdose appear, an urgent need to consult a doctor. However, the treatment of this condition is symptomatic.

Despite the fact that this antibiotic only affects the DNA of bacteria and does not affect the body's own cells, special care must be taken when combining Levofloxacin with other drugs. So, when combined with Metronidazole, Theophylline, Imipenem and Fenbufen, the likelihood of seizures increases.

The effectiveness of Levofloxacin is significantly reduced when used in parallel with antacids containing iron, aluminum and mania. However, this reaction can be avoided by taking an antibiotic two hours before or 2 hours after taking these drugs.

The use of glucocorticosteroids concurrently with levofloxacin increases the likelihood of tendon rupture. When an antibiotic is combined with Probenicid and other medicines for the symptoms of gout, it affects the pharmacokinetics of the antibacterial agent, which is associated with an increased load on the kidneys. As a result of this interaction, symptoms of an overdose of Levofloxacin may appear. Doctors draw attention to the fact that when administered simultaneously with the immunosuppressant Cyclosporine, its dosage must be adjusted.

How to take Levofloxacin: dosage features, use during pregnancy and childhood

Due to the broad spectrum of action and high activity of fluoroquinolones, these drugs are a kind of heavy artillery in the treatment of bacterial infections. And uncontrolled intake of Levofloxacin can lead to the development of resistance of the pathogenic flora to the action of both this drug and other, weaker antibiotics.

As for the dosage of this drug, it is also determined by the doctor depending on the localization of the focus of infection, the severity of the patient's condition and the severity of clinical symptoms.

for sinusitis, tonsillitis, otitis media and other infections of ENT organs: 500 mg 1 time per day for 10 - 14 days;
acute bronchitis: one tablet (500 mg) once a day for up to 10 days;
with exacerbation of chronic bronchitis: 0.25 g 1 time per day, take the medicine for up to 2 weeks;
with pneumonia: the first days of treatment, the drug is administered intravenously, 100 ml twice a day, then, with positive dynamics, the patient is transferred to oral administration of the drug at a dosage of 250-500 mg twice a day;
for cystitis and other urinary tract infections: in severe disease, Levofloxacin is administered intravenously (50 ml) once a day, or in uncomplicated pathology, 250 mg is administered orally once a day for 3 to 10 days;
for bacterial infections of the epidermis and soft tissues: 100 ml twice a day intravenously, starting from 3 - 4 days of illness - 250 - 500 mg 1 - 2 times a day in the form of tablets for 2 weeks;
peritonitis and other intra-abdominal lesions: 50 - 100 ml 1 time per day intravenously or 250 - 500 mg in the form of tablets for 2 weeks, if necessary, Levofloxacin is combined with other antibiotics;
for eye infections: the first 2 days of therapy - 1 - 2 drops every 2 hours (excluding sleep time), from 3 to 7 days of treatment - in the same dosage 4 times a day.

The use of the drug for inflammation of the prostate gland

To date, urologists agree that antibiotics must be used in chronic prostatitis. Moreover, the course of antibiotic therapy is indicated even in the absence of pathogenic flora in the secret of the prostate gland. Fluoroquinolones are ideal for treating prostatitis. Levofloxacin is characterized by high bioavailability and concentration in the tissues of the prostate gland. In addition, unlike other powerful antibiotics, this drug from the group of fluoroquinolones can be used both parenterally in a hospital setting, and orally, in the form of tablets for outpatient treatment.

In the USA, a clinical study was conducted regarding the effectiveness of Levofloxacin in the treatment of chronic prostatitis at a dose of 500 mg per day. There was a significant improvement in the condition in 75% of patients. In the course of the same test, it was proved that if prostatitis proceeds without the addition of chlamydial infection, the amount of Levofloxacin can be reduced to 250 mg per day.

In parallel with how to take Levofloxacin for prostatitis, it is allowed to take non-steroidal anti-inflammatory drugs. According to indications, it is possible to use corticosteroids, while the dose of drugs is adjusted. As for the duration of treatment, on average it is 28 days or more.

Features of use in children, during pregnancy and lactation

According to strict medical indications and under the supervision of doctors, Levofloxacin and other antibiotics from the group of fluoroquinolones were used to treat children. After analyzing 10,000 medical records, doctors came to the conclusion that the frequency of adverse reactions does not exceed that in adults. However, the data on the possible damage to the tendons in children while taking Levofloxacin have not been refuted. Therefore, pediatricians refrain from prescribing this antibiotic.

The drug is not prescribed for pregnant women either. It is thought to cross the placental barrier and may cause damage to the joints of the fetus. But in clinical trials on animals, this effect of Levofloxacin has not been confirmed. There are data on the use of the drug for the treatment of 10 pregnant women with resistant abdominal infection for 2 weeks at the recommended dose. Subsequently, no pathologies of cartilage tissue were noted in newborns. In the medical literature, 130 cases of antibiotic use in the first three months of bearing a child are reported without any consequences.

Levofloxacin passes into breast milk, therefore, breastfeeding should be suspended during treatment. Lactation can be resumed no earlier than 2 - 3 days after the end of the intake of this fluoroquinolone.

special instructions

Like other powerful antibiotics, Levofloxacin is prohibited from being dispensed in pharmacies without a doctor's prescription. However, almost all pharmacists turn a blind eye to these requirements. However, when selling, pharmacists are reminded of the dangers of self-medication. Store the package with the medicine away from children, in a cool place protected from direct sunlight. The room temperature should not exceed 25 ° C. The shelf life is 24 months from the date of production.

Regardless of the dosage and duration, how to take Levofloxacin, the following rules must be observed during treatment:

when used orally, the tablets are drunk before meals, the drug is administered intravenously regardless of the meal;
the tablets are swallowed whole with plenty of water or unsweetened tea;
the antibiotic affects the functioning of the nervous system, therefore, care must be taken when driving or other work associated with increased concentration of attention;
in patients who have had a stroke, the risk of convulsive syndrome increases while taking Levofloxacin;
to reduce the risk of photodermatosis, it is recommended to minimize exposure to the open sun;
in case of tendonitis or exacerbation of colitis, you must immediately stop taking the antibiotic;
levofloxacin should be used under medical supervision in patients with hereditary metabolic pathologies associated with impaired synthesis of 6-phosphate dehydrogenase;
using eye drops can cause short-term burning and watery eyes.

Analogues of Levofloxacin with the same composition and indications for use are the following drugs:

Glevo (India);
L-Optic, eye drops (Romania);
Levoximed (Turkey);
Levolet (India);
Levotek (India);
Levoflox (India);
Levofloxacin - Teva (Israel);
Leflobact (Russia), in addition to the "standard" solution for infusion and tablets of 250 and 500 mg, is available in the form of capsules of 750 mg;
Oftaquix, eye drops (Finland);
Remedia (India);
Tavanik (Germany), according to reviews the most effective analogue of Levofloxacin;
Fleksid (Slovenia).

According to the opinions of doctors, Levofloxacin is the optimal agent for the treatment of persistent bacterial pathologies. However, before prescribing a medicine, it is necessary to evaluate all the pros and cons. If the risk of side effects is high, they try to find a safer antibiotic. Feedback from patients confirms a quick result of treatment, and complications arise only in isolated cases.

After the doctor has prescribed the scheme of how to take Levofloxacin, the original drug or its analogues can be purchased at any pharmacy. According to the Internet pharmacy piluli.ru, a pack of 10 500 mg tablets costs 603 rubles, one bottle of solution for intravenous infusion costs 119 rubles. For comparison, the price of 100 ml of Tavanic (1 ampoule) is 1200 rubles, and 10 tablets of 500 mg each - 949 rubles.