How to replace Levofloxacin

Levofloxacin is a drop that is classified as an antibiotic. The drug has a wide spectrum of action.

Mainly prescribed for eye diseases caused by bacteria. Available in special dropper bottles of 5 and 10 ml.

Drops are used to treat infections and as prophylaxis after surgery. Contraindications for use:

• age under 18 years;
• allergy;
• renal failure;
• pregnancy and lactation period.

Before use, you should consult your doctor and read the instructions.

More information about the drug can be found here

Oftadek

Oftadek eye drops are antimicrobial drugs. They produce antiseptic and antimicrobial effects against gram-positive and gram-negative bacteria. Used for complex treatment of eye diseases.

Indications for use:

• acute and chronic conjunctivitis;
• damage to the mucous membrane of the eyes by chlamydia;
• prevention of blenorrhea in newborns;
• prevention of complications in the postoperative period;
• processing of contact lenses.

Adverse reactions are rare. Price - 100-115 rubles.

Levofloxacin

The frequency of a particular side effect is determined using the following table:

Allergic reactions: sometimes – itching and redness of the skin; rarely - general hypersensitivity reactions (anaphylactic and anaphylactoid reactions) with symptoms such as urticaria, constriction of the bronchi and possibly severe suffocation; very rarely - swelling of the skin and mucous membranes (for example, in the face and throat), sudden drop in blood pressure and shock, increased sensitivity to solar 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 can develop after the first dose, a few minutes or hours after administration of the drug.

From 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 mixed with blood, which in very rare cases may be a sign of intestinal inflammation and even pseudomembranous colitis (see "Special Instructions").

On the metabolic side: very rarely - a decrease in the concentration of glucose in the blood, which is of particular importance for patients with diabetes (possible signs of hypoglycemia: increased appetite, nervousness, perspiration, trembling). Experience with the use of other quinolones suggests that they can cause exacerbation of porphyria in patients already suffering from this disease. A similar effect cannot be excluded when using the drug levofloxacin.

From the nervous system: sometimes - headache, dizziness and/or stupor, drowsiness, sleep disturbances; rarely - anxiety, paresthesia in the hands, trembling, psychotic reactions such as hallucinations and depression, agitation, convulsions and confusion; very rarely - impaired vision and hearing, impaired taste and smell, decreased tactile sensitivity.

From the cardiovascular system: rarely - increased heartbeat, decreased blood pressure; very rarely - vascular (shock-like) collapse; in some cases - prolongation of the QT interval.

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

From the urinary system: rarely - increased levels of bilirubin and creatinine in the blood serum; very rarely - deterioration of kidney function up to acute renal failure, interstitial nephritis.

From 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 increase in body temperature, deterioration in health); in some cases - hemolytic anemia; pancytopenia.

Other: sometimes - general weakness; very rarely - fever.

Any antibiotic therapy can cause changes in the microflora that is normally present in humans. For this reason, increased proliferation of bacteria and fungi resistant to the antibiotic used may occur, which in rare cases may require additional treatment.

Ciloxane

Ciloxan is an eye drop that effectively affects strains of many microorganisms. No clinically proven significance in ophthalmic infections. Safety in the treatment of corneal ulcers or bacterial conjunctivitis has not been established. The active ingredient is ciprofloxacin.

Main indications for use:

• corneal ulcers;
• eye infections;
• bacteriological eye lesions.

The only contraindication is hypersensitivity to the active substance. The price of the drug is 250-280 rubles.

Maxiflox

Maxiflox – antibacterial eye drops. The active ingredient is moxifloxacin. Belongs to antibacterial drugs of the fluoroquinol group. Used as a complex treatment.

Indications for use:

• infectious eye diseases;
• complex treatment of bacterial diseases;
• prevention of complications in the postoperative period.

Not recommended for use by children under 18 years of age, pregnant women and patients with hypersensitivity to the composition. Drops are released in dropper bottles of 5 ml. This packaging is convenient during use. It is recommended to use only after a doctor's prescription. Cost in pharmacies – 160 rubles.

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Instructions:

Clinical and pharmacological group

06.038 (Antibacterial drug of the fluoroquinolone group)

Release form, composition and packaging

White or almost white film-coated tablets, round.

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

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

White or almost white, capsule-shaped, film-coated tablets with a score line on one side.

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

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

pharmachologic effect

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

Active against most strains of microorganisms both in vitro and in vivo, incl. against 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, Helicobacter pylori, Klebsiella spp. (including Klebsiella oxytoca, Klebsiella pneumoniae), Moraxela catarrhalis (producing and non-producing β-lactamases), Morganella morganii, Neisseria gonorrhoeae (penicillin-sensitive, moderately sensitive, resistant), Neisseria meningitidis, Pasteurella spp. (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 magnitude of absorption. The bioavailability of 500 mg levofloxacin after oral administration is almost 100%. After taking a single dose of 500 mg of levofloxacin, Cmax is 5.2-6.9 mcg/ml, Tmax is 1.3 hours, T1/2 is 6-8 hours.

Plasma protein binding is 30-40%. Penetrates well into organs and tissues: lungs, bronchial mucosa, sputum, genitourinary organs, 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 primarily by the kidneys by glomerular filtration and tubular secretion. After oral administration, approximately 87% of the dose taken is excreted unchanged in the urine within 48 hours, less than 4% in the feces within 72 hours.

Dosage

The drug is taken orally 1 or 2 times a day. The tablets are taken before meals or between meals, without chewing and with 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.

For adult patients with normal or moderately reduced renal function (creatinine clearance more than 50 ml/min), the following doses are recommended.

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

For exacerbation of chronic bronchitis - 250 mg or 500 mg 1 time per day for 7-10 days.

For community-acquired pneumonia - 500 mg 1-2 times a day for 7-14 days.

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

For prostatitis - 500 mg 1 time / day for 28 days.

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

For skin and soft tissue infections, 250 mg 1 time / day or 500 mg 1-2 times / day for 7-14 days.

For septicemia, prescribe 250 mg or 500 mg 1-2 times a day for 10-14 days (after IV administration to continue therapy).

For infections of the abdominal cavity, 250 mg or 500 mg is prescribed 1 time / day for 7-14 days (in combination with antibacterial drugs acting on anaerobic flora) to continue therapy after IV administration.

In case of impaired renal function, doses are changed in accordance with the data below.

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

If liver function is impaired, no special dose adjustment is required, since levofloxacin is metabolized in the liver only to an extremely small extent.

For elderly patients, no change in 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 you miss a dose of the drug, you should take the pill as soon as possible before the time for the next dose approaches, then the drug is taken according to the recommended regimen.

Overdose

Symptoms: confusion, dizziness, disturbances of consciousness, convulsions, possible nausea, vomiting and erosive lesions of the mucous membranes. Studies have shown that when levofloxacin is used in doses exceeding the average therapeutic dose, it is possible to prolong the QT interval.

Treatment: if necessary, carry out symptomatic therapy. Levofloxacin is not eliminated by hemodialysis, peritoneal dialysis and continuous peritoneal dialysis. There is no specific antidote.

Drug interactions

There are reports of a pronounced decrease in the seizure threshold with the simultaneous use of quinolones and substances that can, in turn, reduce the seizure threshold. This also applies equally to the simultaneous use of quinolones and theophylline, fenbufen or similar NSAIDs.

The effect of levofloxacin is significantly weakened when used simultaneously with sucralfate, magnesium- or aluminum-containing antacids, as well as with iron preparations (the interval between doses should be at least 2 hours).

When used simultaneously with indirect anticoagulants, monitoring of blood clotting parameters is necessary.

The renal clearance of levofloxacin is slightly reduced when used simultaneously with cimetidine and probenecid (virtually no clinical significance, but the use of such a combination requires caution, especially in patients with impaired renal function).

When used together, levofloxacin slightly increases T1/2 of cyclosporine.

Concomitant use with GCS increases the risk of tendon rupture.

Use during pregnancy and lactation

The drug is contraindicated for use during pregnancy and lactation (breastfeeding).

Side effects

The frequency of side effects encountered 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, constriction of the bronchi and possibly severe suffocation); in very rare cases - swelling of the skin and mucous membranes (for example, in the face and throat), a sudden drop in blood pressure and shock; increased sensitivity to solar and ultraviolet radiation; allergic pneumonitis; vasculitis; in isolated 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 and may develop after the first dose, a few minutes or hours after administration of the drug.

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 stool (in very rare cases it can be a sign of intestinal inflammation and even pseudomembranous colitis), increased bilirubin levels in the blood serum; very rarely - hepatitis.

On the metabolic side: very rarely - hypoglycemia (should be taken into account in patients with diabetes mellitus) with the following possible symptoms: voracious appetite, nervousness, perspiration, trembling. Experience with other quinolones suggests that they can cause exacerbation of pre-existing porphyria. A similar effect cannot be excluded when using the drug levofloxacin.

From the central nervous system and peripheral nervous system: sometimes - headache, dizziness and/or stupor, drowsiness, sleep disturbances; rarely - depression, anxiety, psychotic reactions (for example, with hallucinations), discomfort (for example, paresthesia in the hands), tremor, psychomotor agitation, confusion, convulsions, anxiety; very rarely - visual and hearing impairment, impaired taste and smell, decreased tactile sensitivity.

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

From the musculoskeletal system: rarely - tendon damage (including tendinitis), 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), muscle weakness, which is of particular importance for patients with bulbar syndrome; in some cases - muscle damage (rhabdomyolysis).

From the urinary system: rarely - increased creatinine levels in the blood serum; 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, development of severe infections (persistent or recurrent increase in body temperature, deterioration of health); in some cases - hemolytic anemia; pancytopenia.

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

Storage conditions and periods

The drug should be stored in a dry place, protected from light, out of reach of children, at a temperature not exceeding 25°C. Shelf life: 3 years.

Indications

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;

— infections of the skin and soft tissues;

- septicemia/bacteremia (related to the above indications);

- infections of the abdominal organs.

Contraindications

- epilepsy;

- tendon damage due to previous treatment with quinolones;

- childhood and adolescence (up to 18 years);

- 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 glucose-6-phosphate dehydrogenase deficiency.

special instructions

When prescribing the drug to elderly people, it should be borne in mind that patients in this group often suffer from impaired renal function.

In severe pneumonia caused by pneumococci, levofloxacin may not provide an optimal therapeutic effect. Hospital-acquired infections caused by certain pathogens (including pseudomonas aeruginosa) may require combination treatment.

During treatment with levofloxacin, seizures may develop in patients with previous brain damage caused, for example, by stroke or severe trauma. Convulsive readiness may also increase with simultaneous use of fenbufen (or with other NSAIDs of a similar chemical structure).

While using levofloxacin, patients should avoid exposure to the sun and UV radiation.

If pseudomembranous colitis is suspected, levofloxacin should be discontinued immediately and appropriate treatment should be initiated. In such cases, drugs that inhibit intestinal motility should not be used.

Rarely observed with the use of the drug levofloxacin, tendinitis (primarily inflammation of the Achilles tendon) can lead to tendon rupture. In elderly people or with simultaneous use of corticosteroids, the risk of developing tendinitis is higher. If tendinitis is suspected, levofloxacin should be discontinued immediately and appropriate treatment should be initiated for the affected tendon, such as resting it.

In patients with glucose-6-phosphate dehydrogenase deficiency, hemolysis may develop when using fluoroquinolones, so prescribing the drug to this category of patients requires caution.

While using the drug, you should avoid drinking alcohol.

Use in pediatrics

Levofloxacin should not be used to treat children and adolescents due to the likelihood of damage to articular cartilage.

Impact on the ability to drive vehicles and operate machinery

During the treatment period, patients should avoid driving vehicles and other activities that require high concentration of attention and speed of psychomotor reactions, because During the use of levofloxacin, dizziness, drowsiness, and visual disturbances are possible.

Use for renal impairment

In case of impaired renal function, doses are changed in accordance with the data below.

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

Use for liver dysfunction

If liver function is impaired, no special dose adjustment is required, since levofloxacin is metabolized in the liver only to an extremely small extent.

Conditions for dispensing from pharmacies

The drug is available with a prescription.