Levofloxacin is an antibacterial drug of synthetic origin and characterized by a wide range of effects on fluoroquinolone groups contained as an active component.
The drug can block the DNA gyrase complex, disrupt supercoiling, inhibit DNA synthesis, and profoundly change the cytoplasm of cells.
Shows activity towards most microscopic organisms, the level of which depends on the degree of the highest concentration or area of pharmacokinetics.
Indications for use of the drug
The medicine can help in the treatment of diseases caused by the appearance and development of infectious bacteria that are sensitive to the active component.
For patients of the adult age category, the drug can be used for therapy:
- community-acquired pneumonia;
- anthrax;
- prostatitis, sinusitis;
- damage to tissues and skin surface;
- problems with the organs of the biliary system.
A feature of this drug is its rapid absorption into the bones, lungs, and ureteric organs.
Elderly patients must take this medicine carefully, as there is a possibility of increasing the load on the paired organ. If there is kidney failure or deterioration in their performance, a complete failure of their activity may occur.
Taking such a drug should be carried out in the complete absence of excess radiation and sunlight, so as not to cause damage to the skin and soft tissues.
Opinion of specialists and doctors
The point of view of doctors and patients who took the drug Levofloxacin:
This is an antibiotic belonging to the group of fluoroquinolones and has a wide spectrum of effects. Excellently helps in the treatment of respiratory infectious diseases, otitis media, lesions of the ureteral canals caused by chlamydia, microplasmas, and dangerous bacteria. Like any other medicine, it can create side effects caused by the individual characteristics of the body. For this reason, I advise you not to resort to self-treatment, not to listen to friends who “helped quite well,” but to visit a qualified specialist. He will prescribe the necessary treatment course and will constantly monitor its effectiveness. It’s a good idea to get tested for the presence of individual intolerance to the components of the drug.
Yupashevsky N.V., doctor
An excellent product, characterized by a wide range of effects, affordable, providing excellent therapy to patients in need of antibacterial treatment. The drug is well tolerated. Recommended for the treatment of infected tissues, as a prophylactic after surgery.
Efremov I.A., doctor
An excellent antibiotic, broad spectrum of action, excellent tolerability. There are no disadvantages.
Almasri A.M., doctor
Weak remedy. My husband took it for prostatitis, but the results appeared only from the moment a second medication, Smartprost, was added to the treatment. Probably, this combination should have been used immediately. Personally, I didn't like the medicine. Before him, my husband took another remedy - it helped much better and faster.
Alexandra, 47 years old
I took it for a whole week and got rid of Staphylococcus aureus. The drug didn't help! But now my jaws hurt really bad! This is the treatment!
Bella, 35 years old
They prescribed me this drug for bronchitis. I suffered from a strong cough, the phlegm did not clear for a long time. I took it for three days and felt significant relief. It became much easier to cough, phlegm began to appear, and breathing became easier. The range of effects of such a drug is really wide. My mother was prescribed it for sinusitis. The treatment took a long time, but the effect still came. I believe that the medicine is universal and helps against many diseases. We did not note any negative manifestations. After the appointment I felt great.
Igor, 46 years old
I suffered from sinusitis, and the attending physician prescribed me to take Levofloxacin 500. At first I took another antibiotic, but after such a course of treatment it did not improve. Ultimately, I had to change the drug and perform a puncture. After about three days I felt significant relief. The sinusitis went away, but problems with the gastrointestinal tract began. I don’t know which of the drugs harmed him, but the recovery process took more than a month.
Ira, 27 years old
I was prescribed this drug for pneumonia, other antibiotics did not help. It was administered intravenously, the course was eight days. The medicine gave excellent results and was prescribed immediately. But after such therapy I felt nausea, which disappeared after about thirty minutes. There was a moment when the drug got under the skin because the nurse was unable to puncture the vein. The burning sensation was intense, lasting for at least an hour, and the skin in this area became thicker. The next day a decent bruise formed.
Dasha, 52 years old
The attending physician prescribed this medicine for chronic prostatitis. The course of therapy lasted exactly four weeks. During this time, I discovered one curious feature - at the initial stage I took a Russian drug from the company Virtex. The result was not impressive, the pain continued to haunt me. But when the package (ten tablets) ran out, I purchased Levofloxacin-Teva, produced in Israel. I did not change the dosage. After the first dose I felt noticeable relief, and after three days the pain symptoms completely disappeared. Probably our drugs are not of very high quality!
Nikolay, 63 years old
My husband treated cystitis with this medicine. The temperature rose to almost forty degrees, there was blood in the urine. The therapeutic course consisted of taking Trichopolum and Levofloxacin. Already on the second day, my husband felt significant relief.
Valentina, 50 years old
The value of levofloxacin for respiratory and urogenital infections in outpatient practice
The first fluoroquinolone drugs appeared in clinical practice in the early 1980s. They were characterized by a wide spectrum of antimicrobial activity and favorable tissue pharmacokinetics (concentrations in most tissues exceeded serum levels). The unique mechanism of action of fluoroquinolones on microbial cells (inhibition of DNA gyrase or topoisomerase IV) explained the lack of cross-resistance with other classes of antimicrobial agents.
The most well-studied early fluoroquinolones are ciprofloxacin and ofloxacin. Fluoroquinolones have taken leading positions in the treatment of various bacterial infections, primarily nosocomial ones, the main pathogens of which are gram-negative bacteria.
The disadvantage of early fluoroquinolones is their low natural activity against gram-positive microorganisms, primarily Streptococcus pneumoniae, which did not allow these drugs to be recommended for the treatment of community-acquired respiratory infections.
At the end of the 1990s. drugs of the fluoroquinolone group appeared, fundamentally different in antimicrobial properties from earlier drugs. These differences are, first of all, characterized by significantly higher natural activity against gram-positive bacteria (pneumococci, staphylococci) and atypical microorganisms (chlamydia, mycoplasmas). These drugs were called "new fluoroquinolones" or "respiratory fluoroquinolones." The first of the respiratory fluoroquinolones was levofloxacin, later other drugs appeared (gemifloxacin, moxifloxacin).
Due to the high activity of the new fluoroquinolones against Gram-positive microbes, including S. pneumoniae, resistant to other antibiotics, they were mainly marketed for the treatment of community-acquired respiratory tract infections, and therefore they are sometimes called “respiratory fluoroquinolones.” Also, new fluoroquinolones, along with increased activity against gram-positive bacteria, retain, and in some cases exceed, the high activity of earlier fluoroquinolones against gram-negative bacteria.
Levofloxacin is characterized by high natural activity against all pathogens of community-acquired respiratory infections. In addition, levofloxacin is characterized by good tissue pharmacokinetics, in particular, high tissue and intracellular concentrations of the drug are maintained at therapeutic levels for 24 hours.
A large number of controlled clinical studies have shown:
- Levofloxacin is not inferior in effectiveness to β -lactam antibiotics for community-acquired respiratory infections;
- Levofloxacin in monotherapy is not inferior in effectiveness to combined regimens ( β -lactam + macrolide) for pneumonia of any severity;
- Levofloxacin is characterized by higher efficacy in monotherapy compared to the ceftriaxone/macrolide combination in severe community-acquired pneumonia;
- Higher effectiveness of levofloxacin compared to macrolide antibiotics for community-acquired legionella pneumonia;
- The advantage of levofloxacin compared to macrolide antibiotics in exacerbation of COPD both in eradication of Haemophilus influenzae and in the duration of the relapse-free period.
The most common causative agents of urinary tract infections are Escherichia coli and other enterobacteriaceae; gram-positive microorganisms are less common. Levofloxacin is characterized by high natural activity against these pathogens, comparable to the activity of ciprofloxacin, and superior to it against staphylococci and enterococci.
In recent years, in almost all regions of the world, there has been an increase in the resistance of urogenital strains of Escherichia coli and other enterobacteria to almost all antimicrobial drugs, including fluoroquinolones. The decrease in the sensitivity of enterobacteria to levofloxacin is compensated by high concentrations of the drug in the urine (250-300 μg/ml), which is many times higher than the MIC90 values. It is also characterized by good penetration into the tissues of the genitourinary system, where its concentrations are 2-5 times higher than serum concentrations. This explains the fact that, despite some reduction in the sensitivity of uropathogens, levofloxacin continues to demonstrate high efficacy against urogenital infections in controlled clinical trials.
Levofloxacin also has good penetration into the secretions and tissue of the prostate gland, which are difficult to reach for most antibiotics. An hour after a single dose of 250 mg, the concentration of levofloxacin in the prostate secretion averaged 0.89 mcg/ml, in the seminal fluid -3.25 mcg/ml, with an average concentration in the blood of -1.7 mcg/ml. The clinical effectiveness of levofloxacin has been confirmed in controlled clinical studies.
Levofloxacin has advantages over earlier fluoroquinolones in the treatment of chronic bacterial prostate and urogenital chlamydia, both in tissue pharmacokinetics and higher natural activity against some actual pathogens, primarily Enterococcus faecalis, Ureaplasma urealyticum, Chlamydia trachomatis.
Thus, along with community-acquired respiratory infections, levofloxacin can be positioned as a drug of choice in the treatment of complicated urinary infections, bacterial prostatitis and some other sexually transmitted diseases.
Recommendations for wider use of levofloxacin for respiratory and urinary infections in outpatient practice are supported by data on the good tolerability and safety of the drug.
What to remember: contraindications
With swelling and brain injury, there is a risk of seizures. If severe muscle tremors and ligament damage are observed, it is recommended to immediately stop taking the drug.
Doctors, when prescribing medicine to treat children, recommend acting very carefully. It can only be taken by patients who have reached the age of eighteen, when the body has completely completed the formation process.
This need is caused by the fact that medicine taken at an earlier age can have a negative effect on its cells - the opposite effect appears. This rule applies to women carrying a child. The medicine can harm the still developing fetus.
Taking into account all the features of the effect, doctors have identified the following contraindications:
- Do not use during pregnancy and breastfeeding, or for children under eighteen years of age;
- patients suffering from hypersensitivity to medicinal components;
- patients with tendon pathologies.
Antibiotic levofloxacin®: analogues are cheaper
The drug was developed by specialists from the Japanese company Daichii and patented in 1987. In 1993 it was officially included in clinical practice, and in 1997 it was approved in the USA. After the patent expired, it began to be produced all over the world: in Europe it is known as Tavanik® (by Sanofi-Aventis), in the CIS you can buy Israeli, German, Indian, Russian and Belarusian analogues. Available in the form of tablets of 250 and 500 mg, solution for infusion, as well as drops used in ophthalmology.
The price of the original drug is from 600 rubles for 10 tablets containing 500 mg of active substance. Levofloxacin® 250 mg is naturally cheaper, as is the solution for intravenous administration (120 rubles per 100 ml).
Substitutes often cost less:
- Leflobact®250 mg (Russia) – 55 rubles;
- Levolet®250 mg (India) – 190 rub.;
- Glevo®500 mg (India) – 376 rubles.
Levofloxacin-teva® is produced in Israel, 7 and 14 tablets per pack, costing 419 and 712 rubles, respectively, which also helps save on the course of treatment. The main generics of Levofloxacin® can be classified according to several criteria.
Read further: Instructions for use of levofloxacin® tablets and reviews
According to active substance
The drugs given below (for convenience - in the table) are produced on the basis of levofloxacin, which is active against many pathogens: gram-positive enterococci, diphtheria bacilli, several types of staphylococcus, pneumococci; gram-negative Enterobacter spp., Escherichia coli, Proteus spp., Klebsiella, Neisseria, Shigella, Salmonella. It is also effective against Mycobacterium tuberculosis and some anaerobes. Prescribed for systemic treatment of infections of the paranasal sinuses, bronchi, lungs, urinary system, joints, skin and soft tissues.
Note: Abiflox® and Tigeron® drugs in Russia can only be purchased in the online store.
Levofloxacin® - the original drug and generics - is taken on an empty stomach in strict accordance with the instructions and prescriptions of the doctor. A dosage of 250 mg is recommended for infections of the urinary system (1 tablet per day for 5-10 days). From 250 to 500 mg per dose is prescribed for infections of soft tissues and skin and bronchitis for 1-2 weeks. At least 500 mg should be taken (1-2 times a day) in case of pneumonia, septicemia, prostatitis and tuberculosis.
Considering the high toxicity of fluoroquinolones, only a doctor should prescribe treatment and select dosages!
By generation of respiratory quinolones
Sparfloxacin ® , a fluoroquinolone derivative, belongs to the third generation, like Levofloxacin ®. This drug is active primarily against gram-negative pathogens, including Pseudomonas spp. and staphylococci.
Treponema pallidum is resistant to this antibiotic, so it is not used for syphilis. Eating food does not affect absorption, so it can be taken at any time. Absorbed a little worse (by 90%, in contrast to the 99% bioavailability of Levofloxacin®). The course of treatment ranges from 1 day for genitourinary infections (single dose 200 mg) to 10 days in case of pneumonia, sinusitis or bronchitis.
Sparfloxacin® is prescribed for the same diseases caused by microorganisms sensitive to it. It is also effective for inflammation of the ovaries, gonorrhea, chlamydia, and leprosy. Contraindications are generally similar, but the list additionally includes heart and kidney failure, bradycardia. The side effects are similar. The undoubted advantage of this antibacterial agent is that pathogenic microorganisms extremely slowly develop resistance to it.
The cost of six tablets (200 mg of active ingredient each) is about 330 rubles.
Read further: Intestinal dysbiosis - symptoms and treatment in adults after antibiotics
Respiratory antianaerobic quinols: levofloxacin® or moxifloxacin®?
Under certain conditions, your doctor may prescribe a course of Moxifloxacin®. The drug represents the fourth generation of the fluoroquinolone class and exhibits a bactericidal effect against a wide range of pathogens. In addition to gram+ and gram- microorganisms, it effectively prevents the reproduction of DNA of atypical bacteria and anaerobes: Mycoplasma spp., Legionella spp. and chlamydia. Drug-resistant strains form very slowly, which makes it possible to successfully use it as an alternative to macrolides and beta-lactam antibiotics for respiratory diseases (pneumonia, bronchitis, sinusitis), soft tissue and skin infections.
Advantages:
- Wider spectrum of antimicrobial activity compared to levofloxacin.
- Lack of photosensitizing effect (allergic reactions do not occur when exposed to ultraviolet radiation, which is typical for fluoroquinolones of previous generations).
- There is no cross-resistance with other classes of ALD when prescribing complex antibiotic therapy.
There is no reliable data on the safety of Moxifloxacin® in children. Therefore, its use is not recommended. Can be used only for health reasons, strictly under the supervision of a doctor, provided that the child’s weight exceeds 33 kilograms (dose adjustment is not possible for lower body weights).
Flaws:
- Not effective in treating urinary tract infections.
- There is not enough information about the toxicity of the drug to judge its 100% safety.
- Contraindications, in addition to pregnancy, lactation and epilepsy, are also intestinal disorders (diarrhea). In addition, side effects from the gastrointestinal tract occur quite often.
- The absorption of the active substance is negatively affected by the simultaneous intake of multivitamin and mineral complexes, which are usually used to maintain immunity during antibiotic therapy.
Only the attending physician can choose the original or analogue of levofloxacin® 500 mg, taking into account laboratory analysis. Moxifloxacin® is usually used when the disease is caused by an anaerobic pathogen and other drugs are ineffective. Given the lack of information about the toxicity of the drug, it is unacceptable to prescribe it to yourself. The cost of 5 tablets of 400 mg is quite high: from 975 rubles. A course of treatment may require up to 2 packs.
Eye drops with fluoroquinolones
The original medicine is Levofloxacin® eye drops with a concentration of the active substance of 0.5%. Available in 1 ml dropper tubes, the minimum price in pharmacies is 53 rubles per package of 2 ml of solution.
It is used in the antibiotic therapy of superficial ophthalmic infections caused by various types of staphylococcus, streptococci, neisseria, pseudomonads, chlamydia and other microorganisms. They are also used as a prophylactic agent after surgery.
Strict contraindications are pregnancy, lactation, individual intolerance to certain components and age under one year. Side effects may include a burning sensation in the eyes, blurred vision, and the appearance of mucous strands. Less commonly – headache, swelling, dry cornea. Despite the mode of application (up to 8 times a day), an overdose is extremely unlikely. It is not recommended to wear hydrophilic contact lenses during treatment.
The following medications are analogues of drops:
- Phloxal ® . It is a 0.3% solution of Ofloxacin® in 5 ml bottles costing 170 rubles. It is used for blepharitis, conjunctivitis, keratitis, chlamydial infection and as prophylaxis after surgery. Contraindicated in pregnant and lactating women, as well as in persons with hypersensitivity to the components of the drug.
- Signicef ® – drops based on levofloxacin (0.5%, 5 ml). The list of indications, contraindications and side effects is the same as that of the original product. The price of one bottle is 230 rubles.
- Oftaquix ® . The French analogue costs from 220 rubles for a 5 ml bottle.
- Ofloxacin ® . It is a 0.3% solution in 5 ml containers (costs about 270 rubles). Instructions for use fully comply with Floxal.
- Tsipromed ® – eye drops, the active ingredient of which is ciprofloxacin (3 mg per ml, 5 ml in a bottle). Indicated for uveitis, blepharitis, conjunctivitis, dacryocystitis, as well as for the prevention of postoperative complications. Not used to treat pregnant and lactating women, children under one year of age who are prone to allergies to the components of the composition. Price – from 130 rubles.
- Ciloxane ® . An analogue of the previous drug, prescribed for corneal ulcers and conjunctivitis of bacterial origin. Use with caution during pregnancy and lactation; contraindicated in children under 12 years of age. There is no information about availability in Russian pharmacies.
- Uniflox ® is a product based on ofloxacin (5 ml of a 0.3% solution costs 115-135 rubles) with the same list of indications and contraindications.
All listed medications can only be used as prescribed by an ophthalmologist and in strict accordance with the instructions.
How to take the drug correctly: instructions
The use of such a drug and its dosage will depend on the type of disease and the form of the drug. The tablets are not chewed, but washed down with a sufficient amount of liquid. The infusion solution is used drip-wise with intravenous administration. If the patient suffers from renal failure, then the usual dosage is recommended to be halved. In other cases, the following doses are prescribed:
- Infections in the abdominal area - 250 (500) mg per day, for seven to fourteen days. At the same time, other drugs that have an antimicrobial effect are prescribed.
- Infection of tissues and skin - take 250 mg of the drug daily for two weeks.
- Complex therapy for septicemia - drug diffusion is administered intravenously, then tablets are prescribed - one per day.
- Complex infection of the ureteral canals - take one tablet for twelve days.
- Uncomplicated genital infections can be treated in three days, but prostatitis will require a whole month course.
- Pneumonia - involves taking pills (one at a time) for almost three weeks, and to treat sinusitis it will take fourteen days.
Side effects when taking medication
Most often, patients taking Levofloxacin may experience a gag reflex, allergies in the form of redness of the skin, rash, itching or burning. There is a high probability of swelling of the face and a drop in pressure in the arteries.
The nervous system can react with trembling of the hands, unsteady gait, unsteadiness in the legs, dizziness, nausea, confusion, deterioration of hearing and vision. Deviations in movement coordination are possible, mood disappears, and frequent depression appears, leading to epileptic seizures. In addition, your appetite may disappear, your mouth will feel dry, and pain will begin to bother you in the abdomen.
The heart rate may involuntarily become irregular.
Levofloxacin
Nosocomial infections caused by Pseudomonas aeruginosa
), may require combination treatment.
The prevalence of acquired resistance in cultured strains of microorganisms may vary by geographic region and over time. In this regard, information on drug resistance in a specific country is required.
For the treatment of severe infections or if treatment is ineffective, a microbiological diagnosis must be established with the isolation of the pathogen and determination of its sensitivity to levofloxacin.
Disability and potential irreversible serious adverse reactions associated with fluoroquinolones
The use of fluoroquinolones, including levofloxacin, has been associated with disability and the development of irreversible serious adverse reactions from various body systems that can develop simultaneously in the same patient.
Adverse reactions caused by fluoroquinolones include tendonitis, tendon rupture, arthralgia, myalgia, peripheral neuropathy, and nervous system side effects (hallucinations, anxiety, depression, insomnia, headaches, and confusion).
These reactions may develop from several hours to several weeks after starting levofloxacin therapy. The development of these adverse reactions was observed in patients of any age or without the presence of previous risk factors. If the first signs or symptoms of any serious adverse reactions occur, use of levofloxacin should be discontinued immediately. Fluoroquinolones, including levofloxacin, should be avoided in patients who have experienced any of these serious adverse reactions.
Methicillin-resistant streptococcus aureus
There is a high likelihood that methicillin-resistant Staphylococcus aureus will be resistant to fluoroquinolones, including levofloxacin. Therefore, levofloxacin is not recommended for the treatment of known or suspected infections caused by methicillin-resistant Staphylococcus aureus if laboratory tests have not confirmed the sensitivity of this microorganism to levofloxacin.
Patients predisposed to developing seizures
Like other quinolones, levofloxacin should be used with great caution in patients with a predisposition to seizures.
Such patients include patients with previous lesions of the central nervous system, such as stroke, severe traumatic brain injury; patients simultaneously receiving drugs that lower the seizure threshold of the brain, such as fenbufen and other similar non-steroidal anti-inflammatory drugs or other drugs that lower the seizure threshold, such as theophylline (see section "Interaction with other drugs").
Pseudomemdranosus colitis
Diarrhea that develops during or after treatment with levofloxacin, especially severe, persistent and/or bloody, may be a symptom of pseudomembranous colitis caused by Clostridium difficile
. If pseudomembranous colitis is suspected, treatment with levofloxacin should be stopped immediately and specific antibiotic therapy (vancomycin, teicoplanin or oral metronidazole) should be started immediately. Drugs that inhibit intestinal motility are contraindicated.
Tendinitis and tendon rupture
Rarely observed, tendonitis with quinolones, including levofloxacin, can lead to rupture of tendons, including the Achilles tendon. This side effect can develop within 48 hours after starting treatment and can be bilateral. Elderly patients are more prone to developing tendonitis. The risk of tendon rupture may be increased when taking corticosteroids concomitantly. If tendinitis is suspected, treatment with Levofloxacin should be stopped immediately and appropriate treatment of the affected tendon should be initiated, for example by providing sufficient immobilization (see sections “Contraindications” and “Side effects”).
In addition, post-transplant patients have an increased risk of developing tendonitis, so it is recommended to be careful when prescribing fluoroquinolones to this category of patients.
In patients with impaired renal function, the daily dose should be adjusted based on creatinine clearance.
Application for airborne anthrax infection
The use of levofloxacin in humans for this indication is based on susceptibility data from Bacillus anthracis obtained from in vitro and experimental animal studies, as well as limited data from the use of levofloxacin in humans. Treating physicians should refer to national and/or international documents that reflect the collectively developed point of view on the treatment of anthrax.
Hypersensitivity reactions
Levofloxacin can cause serious, potentially fatal, hypersensitivity reactions (angioedema, anaphylactic shock), further with initial doses (see section "Side effects"). Patients should immediately stop taking the drug and consult a doctor.
Severe bullous reactions
Cases of severe bullous skin reactions such as Stevens-Johnson syndrome or toxic epidermal necrolysis have been observed while taking levofloxacin (see section "Side effects"). In case of development of any reactions from the skin or mucous membranes, the patient should immediately consult a doctor and not continue treatment until his consultation.
Disorders of the liver and biliary tract
Cases of hepatic necrosis, including the development of fatal liver failure, have been reported with the use of levofloxacin, mainly in patients with severe underlying diseases, such as sepsis (see section "Side effects").
Patients should be warned to stop treatment and seek immediate medical attention if signs and symptoms of liver damage occur, such as anorexia, jaundice, dark urine, itching and abdominal pain.
Patients with kidney failure
Since levofloxacin is excreted mainly through the kidneys, patients with impaired renal function require mandatory monitoring of renal function, as well as adjustment of the dosage regimen (see section "Dosage and Administration"). When treating elderly patients, it should be borne in mind that patients in this group often have impaired renal function (see section “Dosage and Administration”).
Preventing the development of photosensitivity reactions
Although photosensitivity develops very rarely with the use of levofloxacin, to prevent its development, patients are not recommended to be unnecessarily exposed to strong solar or artificial ultraviolet irradiation (for example, visiting a solarium) during treatment and for 48 hours after the end of treatment with levofloxacin.
Superinfection
As with the use of other antibiotics, the use of levofloxacin, especially for a long time, can lead to increased proliferation of microorganisms (bacteria and fungi) that are insensitive to it, which can cause changes in the microflora that is normally present in humans. As a result, superinfection may develop. Therefore, during treatment, it is imperative to re-evaluate the patient’s condition, and, if superinfection develops during treatment, appropriate measures should be taken.
QT prolongation
Very rare cases of QT prolongation have been reported in patients taking fluoroquinolones, including levofloxacin.
When using fluoroquinolones, including levofloxacin, caution should be exercised in patients with known risk factors for prolongation of the QT interval: in patients with uncorrected electrolyte disturbances (with hypokalemia, hypomagnesemia); with congenital long QT syndrome; with heart disease (heart failure, myocardial infarction, bradycardia); while taking medications that can prolong the QT interval, such as class IA and III antiarrhythmic drugs, tricyclic antidepressants, macrolides, antipsychotics.
Elderly and female patients may be more sensitive to drugs that prolong the QT interval. Therefore, fluoroquinolones, including levofloxacin, should be used with caution (see sections “With caution”, “Dosage and administration”, “Side effects” and “Overdose”, “Interaction with other drugs”).
Patients with glucose-6-phosphate dehydrogenase deficiency
Patients with latent or manifest glucose-6-phosphate dehydrogenase deficiency are predisposed to hemolytic reactions when treated with quinolones, which should be taken into account when treated with levofloxacin.
Hypo- and hyperglycemia (dysglycemia)
As with the use of other quinolones, cases of hyperglycemia and hypoglycemia have been observed with the use of levofloxacin, usually in patients with diabetes mellitus receiving concomitant treatment with oral hypoglycemic drugs (for example, glibenclamide) or insulin preparations. Cases of hypoglycemic coma have been reported.
In patients with diabetes mellitus, monitoring of blood glucose concentrations is required (see section "Side effects").
Peripheral neuropathy
Sensory and sensorimotor peripheral neuropathy, which may have a rapid onset, has been reported in patients taking fluoroquinolones, including levofloxacin. If the patient develops symptoms of neuropathy, levofloxacin should be discontinued. This minimizes the possible risk of developing irreversible changes.
Exacerbation of pseudoparalytic myasthenia gravis (myasthenia gravis)
Fluoroquinolones, including levofloxacin, have neuromuscular blocking activity and may increase muscle weakness in patients with myasthenia gravis. Adverse reactions, including pulmonary failure requiring mechanical ventilation and death, have been reported with the use of fluoroquinolones in patients with myasthenia gravis.
The use of levofloxacin in a patient with an established diagnosis of pseudoparalytic myasthenia gravis is not recommended (see “Side Effects”).
Psychotic reactions
With the use of quinolones, including levofloxacin, the development of psychotic reactions has been reported, which in very rare cases progressed to the development of suicidal thoughts and behavior disorders with self-harm (sometimes after taking a single dose of levofloxacin (see section "Side effects")). reactions, treatment with levofloxacin should be discontinued and appropriate therapy should be prescribed.
The drug should be prescribed with caution to patients with psychosis or patients with a history of mental illness.
Visual impairment
If any visual impairment develops, immediate consultation with an ophthalmologist is necessary (see section “Side Effects”).
Effect on laboratory tests
In patients taking levofloxacin, the determination of opiates in urine may lead to false-positive results, which should be confirmed by more specific methods.
Levofloxacin may inhibit the growth of Mycobacterium tuberculosis
and subsequently lead to false-negative results of the bacteriological diagnosis of tuberculosis.
