Levofloxacin or lomefloxacin, which is more effective? What is the difference between ciprofloxacin and levofloxacin and which is more effective?

Antipyretics for children are prescribed by a pediatrician. But there are emergency situations with fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to be given to infants? How can you lower the temperature in older children? What medications are the safest?

Keywords

EXPERIMENTAL PLAGUE/ WHITE MICE / LEVOFLOXACIN / LOMEFLOXACIN / MOXIFLOXACIN / EXPERIMENTAL PLAGUE / ALBINO MICE / LEVOFLOXACIN / LOMEFLOXACIN / MOXIFLOXACIN

annotation scientific article on fundamental medicine, author of the scientific work - Ryzhko I.V., Tsuraeva R.I., Anisimov B.I., Trishina A.V.

The activity of levofloxacin, lomefloxacin and moxifloxacin against 20 FI + and 20 FI strains of Yersinia pestis. It was found that all strains used in the experiments are highly sensitive to fluoroquinolones. When mice are subcutaneously infected with a suspension of Y. pestis strains 231 FI + and 231 FI - at a dose of approximately 1000 LD 50 (10 4 micro cells), the ED 50 values of levofloxacin and moxifloxacin were 5.5-14.0 mg/kg, regardless of the phenotype of the infecting culture, and for lomefloxacin 18.5 mg/kg. Assessment of the influence of infectious doses of the pathogen on the effectiveness of therapy experimental plague when using a therapeutic dose equivalent to a human dose, fluoroquinolones showed high effectiveness (efficacy index 10 4). Treatment of infection for 7 days ensured survival of 90-100% of animals. Prophylactic use of lomefloxacin (after 5 hours and 5 days) turned out to be less effective (70-80% of surviving mice) for infection caused by an antigen-altered (FI -) variant of the pathogen. Levofloxacin and moxifloxacin provided 90-100% survival of animals during a 5-day course, regardless of the phenotype of the infecting pathogen strain. The study showed the promise of using levofloxacin, lomefloxacin and moxifloxacin for prevention and treatment experimental plague.

Efficacy of Levofloxacin, Lomefloxacin and Moxifloxacin vs. Other Fluoroquinolones in Experimental Plague Due to FI+ and FI - Strains of Yersiniapestis in Albino Mice

Activity of levofloxacin, lomefloxacin and moxifloxacin against 20 FI + and 20 FI strains of Yersinia pestis was studied. It was shown that the strains were highly susceptible to the fluoroquinolones. In the experiments on mice subcutaneously infected with suspension of strains 231 FI + and 231 FI of Y.pestis in a dose of about 1000 LD 50 (10 4 microbial cells) the ED 50 of levofloxacin and moxifloxacin was 5.5-14.0 mg/kg independent of the infectious culture phenotype and that of lomefloxacin was 18.5 mg/kg. Estimation of the impact of the pathogen infective dose value on the results of the experimental plague treatment with the therapeutic dose equivalent to the human one showed high efficacy of the fluoroquinolones (efficacy index of 10 4). The treatment for 7 days provided 90-100-percent survival of the animals. The prophylactive use of lomefloxacin (in 5 hours 5 days) was less efficient (70-80% of the survivals) in the animals infected with the antigen-changed (FI -) variant of the pathogen. Levofloxacin and moxifloxacin provided 90-100-percent survival of the animals treated for a course of 5 days independent of the pathogen phenotype. The study demonstrated that the use of levofloxacin, lomefloxacin and moxifloxacin was prospective for the prophylaxis and therapy of experimental plague.

Text of scientific work on the topic “The effectiveness of levofloxacin, lomefloxacin and moxifloxacin in comparison with other fluoroquinolones in experimental white mouse plague caused by fi + and fi -strains of the pathogen”

ORIGINAL ARTICLES

Efficacy of levofloxacin, lomefloxacin and moxifloxacin in comparison with other fluoroquinolones in experimental white mouse plague caused by FI+ and FI-strains of the pathogen

I. V. RYZHKO, R. I. TSURAEVA, B. I. ANISIMOV, A. V. TRISHINA

Research Anti-Plague Institute, Rostov-on-Don

Efficacy of Levofloxacin, Lomefloxacin and Moxifloxacin vs.

Other Fluoroquinolones in Experimental Plague Due to FI+ and FI- Strains of Yersiniapestis in Albino Mice

I. V. RYZHKO, R. I. TSURAEVA, B. I. ANISIMOV, A. V. TRISHINA Research Plague Institute, Rostov-on-Don

The activity of levofloxacin, lomefloxacin and moxifloxacin against 20 FI+ and 20 FI" strains of Yersinia pestis was studied. It was found that all strains used in the experiments were highly sensitive to fluoroquinolones. When mice were subcutaneously infected with a suspension of Y. pestis strains 231 FI+ and 231 FI- in a dose of approximately 1000 LD50 (104 microcells) ED50 values for levofloxacin and moxifloxacin were 5.5-14.0 mg/kg, regardless of the phenotype of the infecting culture, and for lomefloxacin - 18.5 mg/kg. Assessment of the effect of infectious doses of the pathogen on the effectiveness of therapy experimental plague, when using a therapeutic dose equivalent to a human dose, showed high effectiveness of fluoroquinolones (efficacy index - 104). Treatment of infection for 7 days ensured the survival of 90-100% of animals. Prophylactic use of lomefloxacin (after 5 hours - 5 days) turned out to be less effective (70-80% of surviving mice) against infection caused by an antigen-changed (FI-) variant of the pathogen.Levofloxacin and moxifloxacin provided 90-100% survival of animals during a 5-day course, regardless of the phenotype of the infecting strain of the pathogen. The study showed the promise of using levofloxacin, lomefloxacin and moxifloxacin for the prevention and treatment of experimental plague.

Key words: experimental plague, white mice, levofloxacin, lomefloxacin, moxifloxacin.

Activity of levofloxacin, lomefloxacin and moxifloxacin against 20 FI+ and 20 FI- strains of Yersinia pestis was studied. It was shown that the strains were highly susceptible to the fluoroquinolones. In the experiments on mice subcutaneously infected with suspension of strains 231 FI+ and 231 FI- of Y.pestis in a dose of about 1000 LD50 (104 microbial cells) the ED50 of levofloxacin and moxifloxacin was 5.5-14.0 mg/kg independent of the infective culture phenotype and that of lomefloxacin was 18.5 mg/kg. Estimation of the impact of the pathogen infective dose value on the results of the experimental plague treatment with the therapeutic dose equivalent to the human one showed high efficacy of the fluoroquinolones (efficacy index of 104). The treatment for 7 days provided 90-100-percent survival of the animals. The prophylactive use of lomefloxacin (in 5 hours - 5 days) was less efficient (70-80% of the survivals) in the animals infected with the antigen-changed (FI-) variant of the pathogen. Levofloxacin and moxifloxacin provided 90-100-percent survival of the animals treated for a course of 5 days independent of the pathogen phenotype. The study demonstrated that the use of levofloxacin, lomefloxacin and moxifloxacin was prospective for the prophylaxis and therapy of experimental plague.

Key words: experimental plague, albino mice, levofloxacin, lomefloxacin, moxifloxacin.

Introduction

Fluoroquinolones are now widely used clinically to treat infections. of various etiologies. The effectiveness of ciprofloxacin, pefloxacin and ofloxacin has been shown in experimental white mouse plague caused by virulent strains

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pathogen, both antigenically complete (I+ phenotype) and those that have lost the ability to produce capsular antigen - fraction I (I- phenotype). The high effectiveness of ciprofloxacin in experiments with subcutaneous and aerogenic infection of animals has also been proven by foreign researchers. There is information about the successful use of ciprofloxacin in the complex treatment of plague patients.

Table 1. Comparative data for determining the ED50 values of fluoroquinolones in experimental white mouse plague caused by isogenic strains of the plague microbe with FI+ and FI- phenotype

Antibacterial drug

Daily dose of the drug

Y.pestis 231, fenrtype

ED50 value, confidence interval, mg/kg

Lomefloxacin

Levofloxacin

Moxifloxacin

Ciprofloxacin

Ofloxacin

Pefloxacin

0.0b-0.125-0.25-0.5

0,125-0,25-0,5-1,0

0.04-0.08-0.1b-0.32

0.0b-0.125-0.25-0.5

0,125-0,25-0,5-1,0

3.0-b,25-12.5-25.0

6.25-12.5-25.0-50.0 2.0-4.0-8.0-1b.0

3.0-b,25-12.5-25.0

6.25-12,5-25,0-50,0

7.5 (not defined)

5.5 (not defined)

19.0 (15,0+25,0)

7.0 (not defined) 14 (3.5+28.5)

29,0 (21,0+37,0)

The high effectiveness of fluoroquinolones and their affordable cost make this group of drugs the most promising for providing medical institutions a reserve of antibacterial drugs in case of the occurrence of plague diseases of natural (infection, infection in natural plague foci) and artificial (bioterrorism) origin with the threat of its anthropogenic spread (MU 3.4.1030-01).

The effectiveness of newer representatives of fluoroquinolones - levofloxacin, lomefloxacin and moxifloxacin for plague infection has not been studied. The above drugs can expand the arsenal of drugs used for emergency prevention and treatment of plague. This is very important, since recently there have been increasing reports of the isolation of antibiotic-resistant strains of the plague microbe from people, including the detection of Yersinia pestis cultures with R-plasmids (incC, incP) of multiple drug resistance to streptomycin, tetracyclines, kanamycin, ampicillin, sulfonamides, spectinomycin .

The purpose of this study is to study the antibacterial activity of lomefloxacin, levofloxacin and moxifloxacin in vitro against FI+ and FI- strains of the plague microbe and their effectiveness in comparison with other fluoroquinolones in experimental white mouse plague caused by pathogens with different phenotypes.

Material and methods

Strains. In in vitro experiments, 20 Y. pestis strains producing the FI+ capsular antigen and 20 strains with the FI- phenotype were used. To infect white mice, virulent isogenic strains of the plague pathogen - Y. pestis 231 and Y. pestis 231 FI- - were taken. Y. pestis strain 231 FI- retained the typical plasmid profile, but consistently lost the ability to produce FI antigen.

Antibiotics: lomefloxacin (Searle, France), levofloxacin (Hoechst, Germany), moxifloxacin (Bayer, Germany), ciprofloxacin (Bayer, Germany), ofloxacin (Hoechst, Germany), pefloxacin (Reddy's Lab.LTD, India).

The minimum inhibitory concentration (MIC) of drugs was determined using the method of two-fold serial dilutions of antibacterial substances in Hottinger agar, pH 7.2±0.1. The inoculating dose was n^106 CFU/ml according to

industry standard for turbidity. Sensitivity assessment was carried out in accordance with the criteria developed for the family Egerobiumaceae (MUK 4.2.1890-04).

Determination of the effective dose values for 50% of animals (ED50) of antibacterial drugs was carried out on white mice infected subcutaneously with a dose of 104 microns. class (~1000 LD50). Animals (6 mice per group) were treated with 4 doses of fluoroquinolones (course 5 days). The duration of the experiment was 30 days with bacteriological control of cure.

An assessment of the influence of the infectious dose of the plague pathogen (101-102-103-104 microcells) on the effectiveness of the prophylactic use of antibacterial drugs was studied on white mice, using one therapeutic dose equivalent to the average daily human dose. Control animals infected with the same doses of the pathogen were not treated. Lethal dose values were calculated for 50% of culture animals LD50 in the experiment and control, followed by determination of the efficiency index (IE), i.e. the ratio of LD50 values in the experiment to LD50 values in the control.

The therapeutic efficacy of antibacterial drugs was assessed on white mice subcutaneously infected with a suspension of a daily agar culture at a dose of 104 microns. class (~1000 LD50). For prophylactic purposes, fluoroquinolones were used 5 hours after infection once a day (5-day course), for therapeutic purposes - 24 hours after infection (7-day course). The drugs were administered in doses corresponding to average daily human doses. 20 animals were used in each group. The observation period is 30 days with bacteriological control of cure. Statistical processing of the results was carried out according to the tables of A. Ya. Boyarsky.

As an additional control for the sanitation of the macroorganism from infection, intraperitoneal administration of a hydrocortisone suspension (5 mg/mouse) to surviving animals was used. The observation period is 14 days.

Results and discussion

A study of the sensitivity to fluoroquinolones of 20 strains of U. pei5 I+ and 20 strains of U. prusiis I" (including 231 and 231 I") showed that, regardless of the phenotype, all cultures of the pathogen were highly sensitive to lomefloxacin and levofloxacin. At the same time, the MIC values of these drugs did not differ from the MIC of ciprofloxacin (0.01-0.02 mg/l). The MIC values of ofloxacin were 0.04-0.08 mg/l, while pefloxacin and moxifloxacin were slightly higher - 0.16-0.32 mg/l.

In table 1 shows the ED50 values of lomefloxacin, levofloxacin and moxifloxacin in comparison with the ED50 of ciprofloxacin, ofloxacin and pefloxacin, obtained in experiments on white mice subcutaneously infected

ORIGINAL ARTICLES

Table 2. Comparative assessment of effectiveness indices (IE) provided by the prophylactic use of fluoroquinolones in experimental white mouse plague caused by pathogens with FI+ and FI phenotype

Infectious, io)a. Antibacterial ^napa^ Y.pestis 231, phegotype

mic. class duration

dose ratio IE value ratio IE value

"inc.na naornux ЁД50. "iiiic.ia gavsh^ LD50.

mice to chimu chik |). mice to chimu chik |).

infected cells infected cells

101 Lomefloxacin, 5 days, 125.0 mg 0/b > 104 104 0/b > 104 104

101 Levofloxacin, 5 days, 125.0 mg 0/b > 104 104 0/b > 104 104

101 Moxifloxacin 5 days, 100 mg 0/b > 104 104 0/b > 104 104

101 Ciprofloxacin, 5 days, 100 mg 0/b > 104 104 0/b > 104 104

101 Ofloxacin, 5 days, 100 mg 0/b > 104 104 0/b > 104 104

101 Control (without treatment) 4/4 3 - 3/4 5 -

~1000 LD50 V.przSh 231 and its isogenic variant 231 I-. The ED50 values of lomefloxacin, ciprofloxacin, pefloxacin and moxifloxacin for the pathogen strain with the I-phenotype were higher than for the original isogenic strain, antigenically complete. As for levofloxacin, no differences in its effectiveness depending on the phenotype of the infecting strain were established. The same can be said about ofloxacin (see Table 1). It must be emphasized that the ED50 values (mg/kg) for all drugs taken for the study were an order of magnitude lower than doses equivalent to daily human doses.

Assessment of the influence of infectious doses of U. rvsiis 231 I+ and 231 I- (101-102-103-104 microcells) on the index of effectiveness of antibacterial drugs (lomefloxacin, levofloxacin, moxifloxacin, ciprofloxacin, ofloxacin) used in prevention (initiation of treatment 5 hours after infection, course 5 days) in doses equivalent to daily human doses, again proved the high effectiveness of fluoroquinolones (IE was 104) (Table 2).

The final stage of the study was to study the effectiveness of lomefloxacin, levofloxacin and moxifloxacin in the prevention and treatment of experimental plague,

called subcutaneous infection of animals with ~1000 LD50 Ursus 231 I+ and 231 I- (Table 3). Two therapeutic doses of each drug were used. Lomefloxacin in a 5-day prophylaxis of experimental white mouse plague caused by the original strain of V. prussus 231 protected against the death of all animals. In case of plague caused by a pathogen strain with an I-phenotype, the preventive effectiveness of the drug decreased slightly (70-80% of survivors). Single animals died on the 15-17th day with the release of culture. Treatment of surviving animals with hydrocortisone (5 mg/mouse) showed the absence of death of animals in groups of mice infected with the strain Y. pros. with the isolation of a culture of the plague microbe. This indicates that the use of lomefloxacin for 5 days does not always lead to complete eradication of the plague pathogen from the body of animals infected with V. prophylactic 231 I-, which requires lengthening the course of prophylactic use to at least 7 days. This drug kept high activity(100% survivors) during treatment (7 days) of experimental white mouse plague, regardless of the phenotype of the infecting strain (see Table 3).

Table 3. Effectiveness of preventive and medicinal use lomefloxacin, levofloxacin and moxifloxacin for experimental white mouse plague caused by ~1000 LD50 isogenic strains of the plague microbe 231 and 231 F|■

Drug, method of administration Daily dose npenapaia Chumgot microbe strain, fetotype

mg/mouse mg/kg 231 231 FI" survival rate of mice, % +J95

Prevention (course 5 days)

Lomefloxacin, orally 1.25 b2.5 100 80+18

2,5 125,0 100 70+21

Levofloxacin, orally 1.25 b2.5 100 90+14

2,5 125,0 100 100

2,0 100,0 100 100

Treatment (course 7 days)

Lomefloxacin, orally 1.25 b2.5 100 100

2,5 125,0 100 100

Levofloxacin, orally 1.25 b2.5 95+10 90+14

2,5 125,0 100 100

Moxifloxacin, orally 1.0 50.0 100 100

2,0 100,0 100 100

Control without treatment 0(3.8) 0 (5.1)

Under the same experimental conditions, levofloxacin and moxifloxacin turned out to be highly effective drugs in the prevention and treatment of experimental white mouse plague (90-100% of survivors) infected with both the original strain of the plague microbe and a variant that has lost the ability to produce FI. Subsequent administration of hydrocortisone did not cause death in animals; no pathogen cultures were isolated.

Thus, fluoroquinolones with a prolonged action - levofloxacin, lomefloxacin and moxifloxacin - can serve as an alternative to the use of ciprofloxacin, ofloxacin and pefloxacin when there is a threat of anthropogenic spread of plague. Levofloxacin and moxifloxacin more effective than lomefloxacin with experimental white mouse plague caused by an antigen-modified strain of the plague microbe (FI-phenotype).

1. In terms of activity in in vitro experiments, levofloxacin and lomefloxacin do not differ from

LITERATURE

1. Ryzhko I.V., Shcherbanyuk A.I., Dudayeva R.I. et al. Comparative study of fluoroquinolones and third-generation cephalosporins in the prevention and treatment of experimental plague caused by typical and serologically atypical FI strains of the plague microbe. Antibiotics and Chemoter 1997; 1:12-16.

2. Samokhodkina E. D., Shcherbanyuk A. I., Ryzhko I. V. et al. Efficacy of ofloxacin in the prevention and treatment of experimental plague caused by natural and antigen-modified strains of the pathogen. Ibid; 2002; 3:26-29.

3. Byrne W. R., Welkos S. L., Pitt M. L. et al. Antibiotic treatment of experimental pneumonic plague in mice. Antimicrob Agents Chemother 1998; 42:3:675-681.

4. Russell P., Eley S. M., Green M. et al. Efficacy of doxycycline and ciprofloxacin against experimental Yersinia pestis infection. J Antimicrob Chemother 1998; 41:2:301-305.

ciprofloxacin are slightly superior to ofloxacin and pefloxacin against strains of the plague microbe with I+ and I- phenotype. Moxifloxacin is inferior in activity to levofloxacin and lomefloxacin and does not differ from pefloxacin.

2. The effectiveness index of all studied fluoroquinolones is 104. Levofloxacin, lomefloxacin and moxifloxacin are highly effective (90-100% of surviving animals) in the prevention and treatment of experimental white mouse plague caused by an antigenically complete strain of the plague microbe. Levofloxacin and moxifloxacin are superior in effectiveness to lomefloxacin in the 5-day prevention of experimental plague caused by a pathogen strain with an I phenotype (90-100% of surviving animals).

3. Levofloxacin, moxifloxacin and lomefloxacin are promising as an alternative to ciprofloxacin, ofloxacin and pefloxacin for emergency prevention and treatment of plague.

Dmitrovsky A. M. Pathogenesis, clinical manifestations, modern treatment principles and system medical care patients with plague: Author's abstract. dis. ...Dr. med. Sci. Almaty, 1997; 44.

Galimand M., Guiyoule A., Gerbaud G. et al. Multidrug resistance in Yersinia pestis mediated by a transferable plasmid. The New Engl J Med 1997; 337; 10: 677-680.

Ashmarin I. P., Vorobiev A. A. Statistical methods in microbiological research. L.: 1962; 177.

Paget Y. E., Barnes Y. M. Toxicity tests // Evaluation of drug activities pharmacometrics. London, 1964; 1: 135-167.

Boyarsky A. Ya. Statistical methods in experimental medical research. M.: 1955; 262.

One of the most important directions in the treatment of urological pathology of the male gland is the use of antibiotics. A huge breakthrough for doctors and patients was the invention of fluoroquinolones - a special class antibacterial agents, with the ability to penetrate directly into the tissue of the damaged organ.

At the moment, levofloxacin for prostatitis is considered the gold standard in its treatment.

The reason for the emergence of a new generation of antimicrobial agents was the incorrect approach to use similar drugs in past. Inadequate dosages, too short courses of therapy, and the choice of the wrong group of drugs have ensured the emergence of a mass of resistant strains of bacteria.

It is when a conventional antibiotic does not help that you need to choose Levofloxacin. Its main advantages are:

Wide range of therapeutic effects (Streptococcusagalactiae, Staphylococcusepidermidis, Staphylococcusaureus, Streptococcuspneumoniae, Streptococcuspyogenes, Listeriamonocytogenes, Chlamydiapneumoniae and many others).
Better penetration directly into prostate tissue. Approximately 92% of the dose accumulates in the gland.
Excellent bioavailability and speed of action. The maximum concentration in the blood is reached after 1.5 hours.
The same dosage of the drug for oral and parenteral administration.
Intracellular action, which makes it possible to destroy atypical microbes.

Thanks to these properties, fluoroquinolone becomes the basis for treatment of prostatitis. It gained its effectiveness thanks to a special levorotatory formula and the ability to block the enzyme DNA gyrase of the microbial cell.

As a result, the bacterium is unable to correctly reproduce the genetic structure, damage to the cytoplasm and membrane occurs, and the microorganism dies.

The drug has a very wide range of uses besides inflammation of the male organ. It perfectly helps with bacterial diseases of the urinary system and organs abdominal cavity, community-acquired pneumonia, sepsis and other infectious processes.

"Salutem Pro" - male strength and health at any age! Development of Israeli scientists against prostatitis! “Salutem Pro” is a herbal complex from Israel, thanks to its unique composition it will help in the shortest possible time.

How to choose the right antibiotic

Absolutely different pathogenic as well as opportunistic organisms can act as provocateur agents for prostatitis. They are capable of rapidly multiplying and causing inflammatory reactions in the organ. Antimicrobial drugs are used to suppress the vital activity of such particles.

However, the action of medications is designed to destroy certain groups of bacteria. To choose the right effective remedy for prostatitis, it is necessary to determine the type of microbes and their sensitivity to antibacterial drugs.

For this purpose, bacterial culture of the prostate secretion is carried out. Based on the results obtained, you can select the appropriate antibiotic.

anaerobic gram-positive bacteria;
anaerobic gram-negative agents;
simple anaerobic microorganisms;
other bacteria.

For the treatment of prostatitis, a course with Levofloxacin is prescribed

Levofloxacin shows good results as in the treatment acute forms pathology, as well as in chronic prostatitis of a bacterial nature.

Levofloxacin, due to its ability to kill pathogenic particles at any stage of development, is an effective bactericidal medicine. Unlike bacteriostatic drugs that stop the proliferation of microbes, that is, affecting only cell division, Levofloxacin destroys cells, both dividing and growing, and those at rest. Therefore, the drug is considered quite effective, having a wide range of action.

The mechanisms of action of the drug correspond to the basic properties of the group of quinols and fluoroquinols. The drug, penetrating into pathogenic cells, blocks the activity of certain enzymes involved in the formation of DNA. Thanks to pathological changes in the cell, processes develop that are incompatible with microbial life.

In this case, the bacteria not only lose their ability to reproduce, but also completely die. Thus, the drug can have a detrimental effect on most pathogenic particles found in prostatitis.

The drug is effective in fighting bacteria

The drug is quite often prescribed for exacerbations of pathology, the chronic course of the disease, since it, penetrating into the places of greatest accumulation of pathogenic agents, is able to effectively eliminate them and promote a complete cure.

Lack of effect can only be observed when treating a disease caused by bacteria that do not belong to the group of agents sensitive to levofloxacin.

Levofloxacin is available in the form of tablets and solution for injection.

The medicinal solution contains 0.5% of the active ingredient, supplemented with:

disodium edetate dihydrate;
sodium chlorine;
deionized water.

The solution is transparent with a yellowish or yellow-green tint.

The drug is available in various forms

The tablet form of the drug contains 500 mg of medicinal substance. You can also find tablets with 250 mg of the main ingredient and additives in the form of:

microcrystalline cellulose;
hypromellose;
iron oxide;
titanium dioxide;
primellose;
calcium stearate.

Round tablets with a white top coat.

Levofloxacin is often used in the treatment of prostatitis caused by various pathogenic agents. It is allowed to use both a tablet preparation and in the form of intravenous solutions. Regardless of the chosen method of using the drug, therapy for prostatitis is carried out for 28 days.

For the treatment of severe prostatitis, the drug is used in the form of injections.

So, for severe prostatitis, Levofloxacin is administered intravenously for the first week of treatment, or even 10 days. A single dosage is prescribed up to 500 ml daily. Further therapy continues with tablets. It is recommended to take 1 tablet containing 500 mg of the medicinal component daily. The total course with intravenous administration of the drug should be 4 weeks.

It is possible to treat prostatitis without the use of injections. With this type of therapy, tablets are taken throughout the course. Men with prostatitis are prescribed daily tablets containing 500 mg of the drug.

Attention! In the absence of significant improvements, it is advisable to carry out repeated bacterial culture to determine the sensitivity of bacteria to the drug.

in case of personal intolerance to the ingredients of the medicine;
in the presence of allergic reactions;
with renal failure;
patients under 18 years of age;
if inflammation of the tendons has previously been observed during previous use of similar medications;
patients with epilepsy.

Renal failure is a reason to refuse treatment with Levofloxacin

There are also relative contraindications. The drug should be prescribed with caution when:

severe renal dysfunction;
glucose-6-phosphate dehydrogenase deficiency.

Such pathologies require careful monitoring by physicians during therapy with levofloxacin for prostatitis.

When taking Levofloxacin, you must strictly adhere to the dosages recommended by doctors. With uncontrolled use of the drug in excess of safe doses, the following may occur:

confusion and seizures;
dizziness and loss of consciousness;
nausea;
erosions of mucous membranes;
changes in heart rate.

In case of an overdose of the drug, the heart rhythm may be disrupted.

In case of overdose, treatment is used to eliminate the corresponding symptoms. Any methods to speed up the withdrawal of the drug do not bring results.

Attention! Levofloxacin, when taken for a long time, can cause dysbiosis and contribute to the rapid proliferation of fungal organisms. To prevent such pathologies, it is recommended to take products containing beneficial bacteria and antifungal drugs.

In the form of negative consequences, symptoms can often be observed in the form of:

diarrhea;
nausea;
increased activity of liver enzymes.

Side effects from the drug may include diarrhea

Less common signs of complications include:

skin itching or redness;
digestive abnormalities such as lack of appetite, belching, heartburn, vomiting;
soreness in the abdomen;
headaches or dizziness;
drowsiness or drowsiness;
general weakness and sleep disturbances.

Reactions in the form of:

hives;
state of shock;
bronchospasms and suffocation;
Less commonly, blood pressure problems may occur when taking the drug.

If any signs of side effects appear, the drug should be immediately stopped until consulting a doctor. If alarming, life-threatening symptoms appear, emergency medical attention is required.

When taking Levofloxacillin simultaneously with anti-inflammatory non-steroidal drugs in the form of Ibuprofen, Nimesulide, Paracetamol, Aspirin, the risk of seizures increases. This reaction is observed with the combined use of Fenbufnom and Theophylline.

The effectiveness of the drug is affected by antacids in the form of Almagel, Rhenia, Phosphalugel, as well as iron salts. It is recommended to take these drugs with a time difference of at least 2 hours.

Other medications should be taken with caution in parallel with Levofloxacillin.

When taking glucocorticoid drugs in the form of Hydrocortisone, Prednisolone, Methylprednisolone, Dexamethasone, Betamethasone along with Levofloxacin, tendon ruptures may occur.

Attention! Taking alcohol-containing drinks together with an antibacterial drug is strictly prohibited. This combination provokes increased side effects related to the functioning of the central nervous system.

Treatment of prostatitis with antibacterial drugs can relieve a man of provoking factors in the form of pathogens, but does not eliminate stagnant effects, which no less influence the development of pathology.

More information about the drug can be found in the video:

For prostatitis, it is customary to use a large number of medications, because there is a need for a large number of therapeutic actions. It is necessary to improve blood circulation, facilitate urination, increase potency, etc. When the disease is infectious in nature, first of all they try to limit the proliferation of pathogenic microorganisms and destroy them. Levofloxacin has a similar effect. It is used when a man experiences the following symptoms:
- Pain when urinating
- Frequent urge to go to the toilet, especially at night
- Painful ejaculation
- Weakening erection
- Increase in temperature (from 37 to 40 degrees)
- General weakness
The stronger the inflammatory process, the more pronounced these symptoms manifest themselves. At the stage of exacerbation, the patient may even be hospitalized, because Acute urinary retention or pain may not be overcome with pills alone. Antibiotics are resorted to after tests that show which pathogens have appeared in the prostate gland.

Levofloxacin has a wide spectrum of action and is effective against a large number of bacteria. The patient can receive it only with a prescription from the attending physician.

Reviews of Levofloxacin for prostatitis are mostly positive, both from patients and specialists. He copes well with the stated diseases; the instructions for use include:
1. Infectious pathologies of the abdominal region
2. Chronic bronchitis and its exacerbation
3. Pneumonia
4. Prostatitis, urethritis
5. Pyelonephritis
6. Skin and soft tissue infections
For some infections, the use of Levofloxacin is possible only when other antibiotics have been ineffective, because it has a very powerful effect. In the shape of eye drops it can be prescribed for superficial eye infections, to prevent complications after surgical intervention or eye procedures.

Levofloxacin is a fluoroquinolone antibiotic, which means that it has a bactericidal rather than bacteriostatic effect on microorganisms. The difference between them is that in the first case the bacteria are destroyed, while in the second their reproduction and growth are stopped. The mechanism of operation of the drug looks like this: the DNA synthesis of the pathogenic cell is disrupted, its genetic code is disrupted and it dies. Moreover, the destruction occurs to such an extent that it has no opportunity to recover. They also have the ability to influence the “copying” of cells, which becomes impossible after exposure to one enzyme.

Thus, the likelihood of bacteria developing resistance to the drug is significantly reduced, because they cannot reproduce. Among positive action Levofloxacin is also listed as:
- Excellent penetration into organ tissues, inside cells
- Destruction of pathogens with minimal release of toxins from them
- Reducing swelling, relieving pain, normalizing temperature
- Good combination with other antibiotics (macrolides, penicillins)
- Long elimination period (allows you to take 1 tablet per day)
Among various pathogens, anaerobic gram-positive and gram-negative bacteria and microorganisms are the least resistant to the drug. These include:
1. Staphylococcus
2. Streptococci
3. Haemophilus influenzae
4. Peptostreptococci
5. Bacteria Moraxella catharalis
Chlamydia, Legionella, mycoplasma, and ureaplasma are also considered sensitive. A course of treatment with Levofloxacin for prostatitis may be possible if the disease is caused by enterococci, enterobacteria, Pseudomonas aeruginosa, Morgan's bacterium, but they can become resistant to the main substance of the drug - levofloxacin hemihydrate. It is absorbed into the body very quickly; absorption is not affected by food intake.

The maximum concentration of the element is reached after 1-2 hours and is excreted in about 16 hours; it is completely excreted from the body in the urine after 2 days. The higher the dosage, the longer it takes.

Mode of application medicine may be oral or intravenous. Levofloxacin tablets contain 250 or 500 mg of the active substance, an ampoule with a solution - 100 ml. The instructions for use state that the capsules should be taken as follows:
- Half or a whole tablet (250-500 mg) 1 time per day
- It is advisable to take before or after meals
- Drink at least half a glass of water
Continue taking from 3 days to 2-4 weeks. For pneumonia or bronchitis, this can be from 7 to 14 days, for skin infections - the same, and for urinary tract infections - from 3 to 10 days. It is not advisable to start taking pills until your body temperature has stabilized. It is always recommended to repeat the dose at the same time.
The likelihood that Levofloxacin does not help with prostatitis is very small. The drug is too strong not to react to pathogens, and if they were immediately resistant to it, the doctor should have initially prescribed a different drug.

Restrictions on taking Levofloxacin are indications that apply to almost all antibiotics - hypersensitivity to components, childhood, pregnancy and lactation. However, due to the high toxicity of this tool You can add a few more points:
1. Presence of epilepsy
2. Tendon damage due to other fluoroquinolones
3. Pseudoparalytic myasthenia
Restrictions on use may occur in patients with a predisposition to seizures, glucose-6-phosphate dehydrogenase deficiency, impaired renal or liver function, and the elderly. Treatment of prostatitis with Levofloxacin may be contraindicated in representatives of the stronger sex with diabetes mellitus, psychosis, and cardiovascular diseases. Side effects problems with the use of tablets or the administration of a solution may occur both at standard dosages and when they are exceeded. More often than others appear:
- Nausea and vomiting
- Diarrhea
- Headache
- Drowsiness
- Lower blood pressure
- General weakness
Side effects also include increased heart rate, convulsions and tremors, disturbances of smell, vision, and hearing. Dyspepsia and abdominal pain rarely occur, allergic reactions. The latter are characterized by rashes and hives, itching and burning. With an unknown frequency, photosensitivity may increase, hypo- or hyperglycemia, and vascular collapse may occur. At intravenous administration Possible short-term pain at the injection site, inflammation, increased sweating.

In case of an overdose, symptoms such as nausea and vomiting, confusion, and convulsions occur. If you find them, call ambulance or contact a specialist immediately.

It is not advisable to combine a course of Levofloxacin for prostatitis with drugs such as antacids (aluminum- and magnesium-containing), products containing iron - they reduce the effectiveness of the antibiotic. If it is necessary to take them, it is recommended to leave an interval of at least 2 hours between doses. Deterioration in performance is observed when the drug is combined with other quinolones, anticonvulsants, and nonsteroidal anti-inflammatory drugs. When used simultaneously with anticoagulants, the risk of bleeding increases, and together with insulin, hypo- and hyperglycemic states occur.

Therefore, for patients with diabetes, it is necessary to constantly monitor blood glucose levels and follow the correct dosages. Due to the fact that Levofloxacin can cause severe allergic reactions, including anaphylactic shock, you should be very careful when taking it for the first time and, if necessary, immediately consult a doctor. In case of renal or liver failure, you should stop taking it if symptoms of deterioration of the patient’s condition appear.

The drug has no interaction with food, but it is prohibited to take it with alcohol (most often, aggravation of side effects from the central nervous system is observed). nervous system like dizziness or daze). The packaging must be stored in a dry place where there is no access to sunlight. The shelf life of the tablets is 3 years; they are available from the pharmacy only with a prescription.

An excellent video about taking Levofloxacin for prostate inflammation is located below. In it, the specialist talks about the results of treatment, possible complications, analogues of the drug.

Treatment of inflammation of the prostate gland is carried out using a whole range of methods. Drug therapy is only one of them, but along with it it is necessary that the patient undergoes physical procedures, follows a diet and engages in physical therapy. Another technique, surgery, is used in extreme cases when medications have failed to help. Medicines for prostatitis are taken only after determining the cause of its development. If these were infectious agents, antibiotics like Levofloxacin are used; when the culprit is blood stagnation or injury, they resort to other means.

Typical for getting rid of prostatitis are anti-inflammatory non-steroidal drugs, adrenolytics, muscle relaxants, hormonal drugs, painkillers and vitamin complexes.

One of the main tasks in treatment is to compensate for the deficiency useful substances in the body to boost immunity and help the prostate regenerate tissue. For this purpose, rectal suppositories are often used, because It is easiest for them to deliver substances to the prostate gland. What suppositories are popular for prostatitis:
1. Prostatilen
2. Prostopin
3. Vitaprost
4. Propolis DN
5. Tykveol
6. Genferon
Suppositories can have a wide range of therapeutic properties, which is why they are used so often. The only thing that is unpleasant is the procedure, but it is worth being patient for recovery. To strengthen your immune system, it is equally useful to start eating right, limiting or eliminating alcohol and cigarettes from your life. The patient's menu should include fresh fruits and vegetables, herbs and dried fruits. The greatest benefits for men, both healthy and sick, will come from seafood, onions and garlic, parsley, cabbage, lean meats, and fresh juices.

It is better to avoid strong tea and coffee, because... they can negatively affect potency. The same is true for semi-finished products and food. instant cooking, canned food, too fatty, salty or spicy food. Exercise will also affect your immunity, but only regularly. A set of exercises for prostatitis is easy to find on the Internet.

By taking Levofloxacin for prostatitis with a course of treatment as prescribed by a leading specialist, you can cure the disease and get rid of unpleasant symptoms. Prostatitis is still a problem for men childbearing age. Disease associated with urination and sexual dysfunction causes psychological problems. Therefore, great importance is attached to its treatment.

The occurrence of acute or chronic prostatitis is characterized by symptoms:
1. Pain in the perineum.
2. Urinary disorder.
3. Sexual dysfunction.
Prostatitis is divided into three conditional groups:
- spicy;
- chronic;
- asymptomatic.
Prostatitis is often a complication after inflammatory processes in the bladder. Before prescribing drugs for the treatment of prostatitis, it is necessary to examine the prostate secretion to determine the causative agent of the inflammatory process.

When examining patients with chronic prostatitis, they find:
1. Ureaplasma.
2. Mycoplasmas.
3. Chlamydia.
4. Trichomonas.
5. Gardnerellas.
6. Anaerobes.
7. Candida mushrooms.
Unfortunately, the results bacteriological research can be received no earlier than 5 days from the date of the analysis. To prevent the patient from suffering, he is prescribed antibiotics that act on most of the bacteria that cause prostatitis. These drugs include Levofloxacin. If the patient's condition improves, treatment with the drug is continued for 2 weeks. If there is no improvement, the antibiotic is changed, taking into account the results of microbiological studies.

There are many pathogens that cause prostatitis. It is necessary to choose the right antibiotic to cure the disease. The wrong choice of antibiotic or interrupted treatment for prostatitis can have negative consequences for health. Under such conditions, resistance to a particular type of antibiotic often develops. Treatment for prostatitis lasts a long time, sometimes up to 8 weeks.

Chronic prostatitis must be treated with antimicrobial agents. They are prescribed even if no infection is detected in the prostate secretion.

In such cases, the choice of drug is determined by its pharmacological properties:
1. Penetration of the drug into the prostate tissue.
2. Creation of the necessary concentrations of the drug in the gland.
Medicines from the fluoroquinolone group, in particular Levofloxacin, have these properties.

The drug has the following properties:
1. Has a wide range of antibacterial effects.
2. Penetrates well into prostate tissue.
3. It reaches the prostate gland in large quantities.
4. It can be administered to the body in the form of tablets or infusions.
5. Has good activity against pathogenic bacteria.
Fluoroquinolones expand the possibility of treating prostatitis caused by bacteria and microorganisms. They are used if microbes are not detected in the prostate.

Levofloxacin is a universal drug for the treatment of inflammatory processes

Levofloxacin is used to treat almost all inflammatory bacterial diseases of the male genitourinary system:
1. Urinary tract infections.
2. Bacterial prostatitis.
3. Urethritis ( inflammatory processes in the urethra).
4. Orchitis (testicular disease).
5. Epididymitis (inflammation of the epididymis).
Its clinical activity is 75%. The combination of an antibiotic in the treatment of prostatitis and a drug from the alpha-blocker group gives a result of about 90%.

Scope of application:
1. Levofloxacin is capable of destroying pathogenic bacteria sensitive to it in any organs. In addition to treating infections associated with the genitourinary system, it is used to treat infections in other areas:
2. Respiratory organs and ENT: sore throat, bronchitis, tracheitis, pneumonia, otitis media.
3. Skin diseases: boils, bedsores, erysipelas.
4. Peritonitis.
5. Sepsis.
The action is aimed at blocking the process of bacterial DNA synthesis. Changes occur in the bacterial cell that are incompatible with its life activity. Under such conditions, microbes die. The drug is effective against a number of microorganisms.

Each infectious pathology is determined by one type of bacteria and is localized in one specific organ or system. To combat this pathology, a drug is needed that acts specifically on this type of bacteria. Broad-spectrum drugs have an inhibitory effect on several groups of such bacteria.

The therapeutic effect when treating the prostate with Levofloxacin is achieved by continuing its antimicrobial effect on microorganisms after it is completely removed from the body. Of course, this depends on the type of microbes and the concentration of the drug obtained.

The medicine is taken once a day. It is convenient and creates an advantage over other drugs.

But, like most such drugs, it has side effects:
- nausea;
- diarrhea;
- dizziness;
- insomnia.
After stopping the medication, all side effects disappear. While taking it, it is not recommended to be in the sun or visit a solarium. Negatively affects the speed of psychomotor reactions. You must stop driving a car for the entire duration of treatment.

The most popular drugs include the following:
1. Levofloxacin is a third generation antibiotic. Used in cases of moderate infections. Release form: tablets, solution for infusion, eye drops.
2. Moxifloxacin is a fourth generation antibiotic. Has a broader antibacterial effect. Used in cases of very severe infections. This type of antibiotic should not be prescribed immediately after diagnosing an infection. Frequent use will lead to the development of a resistant species of bacteria to this group. Release form: solution for infusion.
Levofloxacin is indicated for the treatment of prostatitis of any form. The greatest ease of use is to take the tablet once a day. The course of treatment with the drug depends on the severity of the infection and its nature. The drug should not be stopped before the full course. If you accidentally miss it, you should take the medicine immediately, then follow the usual regimen.

For quotation: Belousov Yu.B., Mukhina M.A. Clinical pharmacology levofloxacin // Breast cancer. 2002. No. 23. P. 1057

RGMU

IN Currently, fluoroquinolones (FQs) are considered as an important group of chemotherapeutic drugs within the class of quinolones - DNA gyrase inhibitors, characterized by high clinical efficacy (including oral administration), broad indications for use and constitute a serious alternative to other broad-spectrum antibiotics. More than 15 drugs from the PC group have been created, several new active compounds are undergoing clinical trials in order to obtain more effective drugs against gram-positive microorganisms, mycobacteria, anaerobes, atypical pathogens. An important task is also the development of drugs with minimal risk of side effects and high clinical efficacy.

Among PCs, there are currently two groups of drugs: early or old (norfloxacin, ciprofloxacin, ofloxacin, pefloxacin, lomefloxacin, etc.) and new or late (levofloxacin, sparfloxacin, gatifloxacin, gemifloxacin, etc.).

Ofloxacin has been used for more than 15 years and has high efficiency, good tolerability, low level of side effects and absence of significant drug-drug interactions. From a stereochemical point of view, ofloxacin is a racemic mixture of two optically active isomers: levorotatory (L-isomer, L-ofloxacin) and dextrorotatory (D-isomer, D-ofloxacin).

The levorotatory isomer of ofloxacin, L-ofloxacin, is currently known as levofloxacin (LF). The drug was developed in the late 1980s in Japan and was proposed for use after multicenter clinical trials conducted in Europe, America, and Asian countries. In Russia, levofloxacin was registered and approved for use in 2000 under trade name Tavanik (oral and parenteral forms).

Levofloxacin is 8-128 times more active than D-ofloxacin. In the chemical structure of LF, two main groups play a significant role: 4-methyl-piperazinyl, which increases absorption when taking the drug orally, increases its activity against gram-negative bacteria, extends the half-life, and the oxazine ring, which causes an expansion of the spectrum of activity against gram-positive bacteria. as well as prolongation of the half-life. Levofloxacin is characterized by 2 times greater activity than ofloxacin, and, therefore, is not inferior in activity to ciprofloxacin.

Levofloxacin has a unique, almost 100% bioequivalence when administered orally. The pharmacokinetic profile of LF is similar to that of ofloxacin. The half-life is 4-8 hours, that is, more than that of ciprofloxacin, T max - 1.5 hours (as with ciprofloxacin and ofloxacin), C max - 5.1 mg/l (that is, 4 times more than ciprofloxacin), which practically corresponds to Cmax when administered parenterally in an equivalent dose. Levofloxacin is almost 10 times more soluble than ofloxacin.

Activity spectrum

Levofloxacin, like other PCs, has a bactericidal action and a broad antimicrobial spectrum. PCs are active against most enterobacteria, gram-negative bacilli (Haemophilus influenzae, including b-lactamase-producing strains) and gram-negative cocci (gonnococcus, meningococcus, moraxella, including b-lactamase-producing strains), as well as Pseudomonas aeruginosa. Early PCs (ciprofloxacin, ofloxacin) have some activity against staphylococci and even less activity against streptococci and enterococci, in contrast to new PCs, including levofloxacin, which are highly active against Staphylococcus aureus (with the exception of methicillin-resistant strains), coagulase-negative staphylococci, streptococci, including pneumococcus (Table 1, 2). The MIC range of LF for staphylococci is 0.06-64 mg/l (with MIC 90 0.25-16 mg/l), for pneumococci the MIC range is 0.25-0.2 mg/l. Antipneumococcal activity does not depend on the degree of sensitivity to penicillin. Levofloxacin is somewhat less active against enterococci, although for some strains the MIC values are 0.5-1 mg/l. The drug is highly active against Listeria monocitogenes, Corinebacterium diphtheriae. Intracellular pathogens (chlamydia, mycoplasma, legionella) are susceptible to all PCs. Some new PCs are active against anaerobes, LF - partially. Of particular interest is the activity of LF against mycobacteria. The activity of LF against rickettsia, Bartonella and some other microorganisms is being studied.

Pathogen resistance

In the past decade, resistance to fluoroquinolones in the following pathogens has been reported in the United States: MRSA, enterococci, Pseudomonas sp. In subsequent years, increased resistance was reported in Salmonella, Shigella, Acinetobacter sp., Campiоbacter sp. and gonococcus. Selection of Staphylococcus aureus strains resistant to LF is observed much less frequently than to ciprofloxacin. There are known data on the resistance of pneumococci to PC. One of the lowest levels of pneumococcal resistance was noted for LF (overall 0.5% in 1997-2000 in the USA and Canada). The formation of resistance to levofloxacin is possible, but currently Resistance to the drug develops most slowly and does not cross with other antibiotics .

In the past decade, resistance to fluoroquinolones in the following pathogens was observed in the United States: MRSA, enterococci. In subsequent years, increased resistance was reported in Salmonella, Shigella, and gonococcus. Selection of Staphylococcus aureus strains resistant to LF is observed much less frequently than to ciprofloxacin. There are known data on the resistance of pneumococci to PC. One of the lowest levels of pneumococcal resistance was noted for LF (overall 0.5% in 1997-2000 in the USA and Canada). The formation of resistance to levofloxacin is possible, but at present.

Pharmacokinetics

Levofloxacin has some pharmacokinetic advantages over other PCs. This is determined by the resistance of the molecule to transformation and metabolism in the patient’s body. Levofloxacin, like ciprofloxacin, gatifloxacin, trovafloxacin and ofloxacin, exists in oral and parenteral forms and can be used in step therapy , unlike other PCs, which are only available in oral form.

Long-term T 1/2 allows you to prescribe LF once a day , which increases patient compliance. The oral bioavailability of LF reaches 100% and does not depend on food intake, which also makes it convenient for use. Most PCs are eliminated via a dual route (through the kidneys and liver). In contrast, LF is excreted primarily through the kidneys (90%), which requires dose adjustment in severe renal failure. However, the lack of metabolism by enzymes of the cytochrome p450 system determines the lack of interaction with warfarin and theophylline and other significant drug interactions. In a clinical and pharmacological study of mutual influence with the simultaneous administration of LF with non-steroidal anti-inflammatory, antidiabetic, antiarrhythmic drugs of class I and III, theophylline, warfarin, cyclosporine and cimetidine (Simpson I., 1999).

Levofloxacin is metabolized by only 5%. About 35% of LF binds to serum proteins, and therefore the drug is well distributed in tissues. It should be emphasized that PCs, including LF, perfectly penetrate into various tissues, creating high concentrations in the kidneys, prostate, female genital organs, bile, gastrointestinal tract, bronchial secretions, alveolar macrophages, pulmonary parenchyma, bones, as well as in the cerebrospinal fluid, therefore these drugs can be widely used for infections of almost any location. In addition, good intracellular penetration ensures their activity against atypical pathogens.

The clinical effectiveness of LF with a single dose of 250-500 mg/day is a significant advantage of the drug, however, in case of generalized infectious processes that occur in severe form, LF is prescribed twice.

Side effects and tolerability

Side effects of levofloxacin and other PCs are known from European and other international studies. In Europe, more than 5,000 patients were studied; approximately 130 million LF prescriptions were administered throughout the world during trials.

Levofloxacin has proven to be the safest PC with a low level of hepatotoxicity (1/650,000). Levofloxacin, along with ofloxacin and moxifloxacin, is safer with respect to pathological effects on the central nervous system. Cardiovascular negative effects of LF were observed much less frequently than with the use of other PCs (1/15 million prescriptions, for sparfloxacin - in 1-3% of cases). Diarrhea, nausea and vomiting are the most common side effects associated with LF, but they are much less common than with other FCs. The frequency of side effects of LF and other PCs is presented in table. 3.

It has been shown that increasing the dose of LF to 1000 mg/day does not lead to an increase in the number of side effects, and their likelihood does not depend on the patient’s age.

Overall level adverse reactions associated with LF is the lowest among PCs, and the tolerability of LF can be regarded as very good.

Levofloxacin for lower infections respiratory tract

community-acquired pneumonia

Community-acquired pneumonia is one of the most common diseases with a serious prognosis. The incidence of pneumonia in Europe ranges from 2 to 15 cases per 1000 people per year. According to A.G. Chuchalin, the prevalence of pneumonia among the adult population of Russia is 5-8 per 1000 people. In the USA, 2-3 million cases are registered annually community-acquired pneumonia, for which about 10 million medical visits are made per year. According to the Central Research Institute of Infectious Diseases of the Ministry of Health of the Russian Federation, more than 1.5 million adults in Russia suffer from pneumonia every year.

The overall mortality rate for pneumonia is about 20-30 cases per 100 thousand people per year. Mortality among low-risk outpatients is no more than 1%, and in patients hospitalized with pneumonia - up to 14% (in critically ill patients up to 30-40%) (Fine et al. 1999).

Pneumococcus remains the most common causative agent of community-acquired pneumonia - 30.5% (20-60%). Often found in young and middle age groups Mycoplasma pneumoniae(5-50%) and Chlamydia pneumoniae(5-15%). In older age groups, these pathogens are less common (1-3%). Legionella is a rare causative agent of pneumonia (4.8%), but it causes up to 10% of cases of severe pneumonia. Legionella pneumonia ranks second in mortality after pneumococcal pneumonia. H. influenzae more often causes pneumonia in smokers or against the background of chronic bronchitis (3-10%) and, according to some data, in Russia it ranks second in the etiology of severe pneumonia. Representatives of the family Enterobacteriaceae(E. coli, K. pneumoniae) occur in patients with risk factors ( diabetes, circulatory failure, etc.) in 3-10% of cases. Moraxella catarrhalis isolated in 0.5% of cases Relatively rarely isolated Str. pyogenes, Chl. psittaci, Coxiella burnetii etc. In severe pneumonia, Staphylococcus aureus occupies a relatively large proportion among bacterial agents; the probability of its detection increases with age or after influenza (3-10%), while the mortality rate can reach 50%. In 50% of cases it is not possible to isolate the pathogen, and in 2-5% of cases a mixed infection is detected.

For recent years All over the world there is a rapid increase in the resistance of pneumonia pathogens to antibacterial drugs. The proportion of pneumonia caused by pneumococcal strains resistant to penicillin (up to 51.4%) and cephalosporins, as well as macrolides (erythromycin up to 45.9%), tetracyclines and co-trimoxazole has increased significantly. However, in some regions, resistance to macrolides prevails over resistance to penicillin. In some countries, the incidence of pneumococcal resistance to penicillin can reach 60%. Large-scale studies of pneumococcal resistance to penicillin have not been conducted in our country. According to local studies in Moscow, the frequency of resistant strains is 2%, of strains with intermediate sensitivity - about 20%. The resistance of pneumococci to penicillin is not associated with the production of b-lactamases, but with the modification of the target of the antibiotic in the microbial cell - penicillin-binding proteins, therefore inhibitor-protected penicillins are also inactive against these pneumococci. Resistance of pneumococci to penicillin is usually accompanied by resistance to cephalosporins of the first and second generations, macrolides, tetracyclines, and co-trimoxazole.

The problem of pneumococcal resistance to antibiotics in Russia is not yet as pressing as in the West, but it should be remembered that the resistance of strains varies in each region. Risk factors for the development of resistance are old age and childhood, concomitant diseases, previous antibiotic therapy, and stay in nursing homes.

The resistance of Haemophilus influenzae to penicillins reaches 10%, and its resistance to new macrolides is increasing.

Antibacterial therapy pneumonia, in the vast majority of cases empirical, requires the use of drugs with a wide spectrum of action. When choosing a treatment method, the severity of the disease and risk factors are taken into account. Empirical therapy should always include pneumococcus, and antibiotics active against Mycoplasma and Legionella should be considered during influenza epidemics - S. aureus, and in elderly patients - Enterobacteriaceae. It is common practice for severe community-acquired pneumonia to begin treatment with a combination of antibiotics consisting of a macrolide and an agent active against Gram-negative enterobacteria, such as a cephalosporin. In addition, current guidelines recommend the use of the latest PCs for the treatment of community-acquired pneumonia requiring hospitalization.

Fluoroquinolones have a broad spectrum of antimicrobial activity. These drugs exhibit natural activity against almost all potential pathogens of community-acquired pneumonia. However use of early FH (ciprofloxacin, ofloxacin, pefloxacin) for community-acquired pneumonia was limited due to their weak natural activity against the main pathogen of pneumonia - S. pneumoniae. The minimum inhibitory concentrations (MICs) of early PCs against pneumococcus range from 4 to 8 μg/ml, and their concentration in bronchopulmonary tissue is much lower, which is not enough for successful therapy. Cases have been described in which FQ therapy for pneumococcal pneumonia was not successful. According to other data, it is possible to create a high tissue concentration of these drugs, sufficient for adequate antipneumococcal activity. This is confirmed by the clinical and bacteriological effectiveness of ciprofloxacin in the treatment of pneumonia and other lower respiratory tract infections, which is not inferior to standard therapy b-lactam antibiotics. The proven effectiveness of FQ for lower respiratory tract infections allows us to determine their place in the treatment of community-acquired pneumonia. In patients under 65 years of age, non-smokers, without serious chronic diseases The causative agent of community-acquired pneumonia in 80% of cases is pneumococcus and other streptococci, less often atypical microorganisms. Fluoroquinolones in this category of patients are an alternative for the treatment of moderate and severe pneumonia, for example, with allergies to penicillins. In patients over 65 years of age, heavy smokers, and those suffering from serious chronic somatic diseases, alcoholism causes pneumonia are predominantly gram-negative pathogens, namely H. influenzae, M. catarrhalis, Klebsiella spp., in a third of cases pneumococcus, often atypical pathogens. Fluoroquinolones are the drugs of choice in this category of patients, especially in outpatient treatment, since they can be prescribed orally for moderately severe disease with a single dose per day, which increases the compliance of elderly patients. When treating pneumonia that requires hospitalization, the advantage of PC is the possibility of using step-down therapy, which significantly improves the pharmacoeconomic aspects of treatment.

Against the background of increasing resistance of key pathogens respiratory infections to antibiotics (in particular, the spread of strains S. pneumoniae resistant to penicillin and macrolides) new or so-called respiratory fluoroquinolones(levofloxacin, moxifloxacin, gatifloxacin). New PCs have increased, in comparison with classical fluoroquinolones (ofloxacin, ciprofloxacin), activity against S. pneumoniae. It should also be emphasized that the high antipneumococcal activity of new PCs is observed regardless of the sensitivity of pneumococcus to penicillin and/or macrolides. The superiority of new PCs in relation to atypical pathogens is also obvious ( M. pneumoniae, C. pneumoniae, L. pneumophila). And finally, these antibiotics “inherited” the high activity of classical PCs against H.influenzae And M. catarrhalis. There is no doubt that the new PCs are an acceptable alternative to macrolides, amoxicillin/clavulanate and oral cephalosporins in the treatment of community-acquired pneumonia. To the obvious advantages of new PCs, one should add the possibility of taking them once a day and using them as part of step-down therapy.

In the studies conducted to date, including and patients with a severe and (or) prognostically unfavorable course of the disease, convincing evidence was obtained of superior or at least comparable clinical and microbiological effectiveness of LF monotherapy compared with traditional combination treatment (cephalosporins + macrolides). This circumstance, as well as an excellent safety profile, confirmed by many years of widespread clinical use, and the obvious economic advantages of monotherapy explain the presence of LF in modern treatment regimens for community-acquired pneumonia. Levofloxacin occupies a prominent place in modern treatment regimens for adult patients with community-acquired pneumonia not subject to hospitalization (Frias J., 1998; Bartlett J.G., 2000), as well as in a hospital setting (Frias J., 2000; Mandell L.A., 1997)

In case of community-acquired pneumonia, the clinical effectiveness of LF exceeded the effectiveness of therapy with ceftriaxone, cefuroxime (including in combination with erythromycin or doxycycline) and amounted to 96 and 90%, bacteriological effectiveness - 98 and 85%, respectively; the differences were statistically significant (File T.M., 1997).

According to I. Harding (2001), levofloxacin was more effective in the treatment of community-acquired pneumonia than clarithromycin, benzylpenicillin, ceftriaxone, amoxicillin/clavulanic acid.

In a randomized, double-blind, multicenter study, 518 patients with community-acquired pneumonia were tested. comparative analysis clinical effectiveness of the use of LF and amoxicillin/clavulanate. Clinical effectiveness when taking LF 500 mg once a day was 95.2%, when taking LF 500 mg 2 times a day - 93.8%, and when taking amoxicillin/clavulanate 625 mg 3 times a day - 95.3 %.

A multicenter, open-label, randomized study compared the effectiveness of LF and ceftriaxone in combination with erythromycin in patients with community-acquired pneumonia at high risk of adverse outcome. To 132 patients receiving LF, the drug was initially administered intravenously (500 mg once a day), then orally at the same dose for 7-14 days. In the comparison group, 137 patients received intravenous or intramuscular ceftriaxone (1-2 g once a day) and intravenous erythromycin (500 mg 4 times a day), followed by switching to oral amoxicillin/clavulanate (875 mg 2 times a day) together with clarithromycin (500 mg 2 times a day). Clinical effectiveness in group 1 was 89.5%, in group 2 - 83.1%. Thus, LF monotherapy is not inferior in effectiveness to traditional combination treatment in patients with a high probability of death.

In another multicenter randomized study in 456 patients with community-acquired pneumonia (group 1 - 226 patients received levofloxacin, group 2 - 230 patients received ceftriaxone and/or cefuroxime axetil), the clinical and microbiological effectiveness of LF administered intravenously (500 mg 1 time per day) was studied. and/or orally (500 mg once daily), compared with ceftriaxone administered intravenously (1.0-2.0 g 1-2 times daily) and/or cefuroxime axetil administered orally (500 mg twice daily). day). In addition, based on the specific clinical situation, 22% of patients in the second group were prescribed erythromycin orally (1 g 4 times a day). The clinical and microbiological effectiveness of LF monotherapy turned out to be significantly higher than the traditional treatment regimen. Thus, clinical success in patients of group 1 was 96%, in patients of group 2 - 90%, and the frequency of pathogen eradication in microbiologically examined patients was 98% and 85%, respectively.

The role and place of LF in the stepwise therapy of community-acquired pneumonia in comparison with traditional therapy were studied as part of a large-scale Canadian study ( CAPITAL Study), which included 1743 patients. To resolve the issue of the place of treatment and method of drug administration, the M.J. scale was used. Fine et al., 1997. If the patient's final score did not exceed 90 points, then treatment was carried out at home with the prescription of LF (500 mg 1 time/day, orally) for 10 days. If the final score was 91 or more points, then the patient was hospitalized and initially LF (500 mg 1 time/day) was administered intravenously. Upon reaching a stable state (ability to swallow food, negative results blood cultures, body temperature 38.0°C, respiratory rate<24/мин, частота сердечных сокращений <100/мин), лечение продолжалось с назначением оральной формы ЛФ (500 мг 1 раз/сутки). Использовали унифицированные критерии для выписки больного из стационара: возможность приема антибиотика внутрь; число лейкоцитов периферической крови < 12x109/л; стабильное течение сопутствующих заболеваний; нормальная оксигенация крови.

As a result, there were no significant differences in the frequency of re-hospitalization, mortality and quality of life among patients receiving LF as part of stepwise therapy or with standard treatment. At the same time, the introduction of stepwise therapy for LF led to a decrease in bed days for this nosological form by 18% and a reduction in costs by $1,700 (per patient).

The clinical efficacy and safety of LF and some new macrolides (azithromycin, clarithromycin) in the treatment of community-acquired pneumonia were compared using a meta-analysis of randomized controlled trials. The frequency of complete clinical recovery was clearly higher with the use of LF (78.9%) than with macrolides (azithromycin - 57%, clarithromycin 63.3%). A higher incidence of adverse drug events was noted when using LF - 36.6% (azithromycin - 12.6%, clarithromycin - 27.1%), but, according to the authors, the safety profile of LF is practically no different from macrolides, and levofloxacin can be recommended as an effective treatment for community-acquired pneumonia.

The presented data allows us to conclude that the clinical and microbiological effectiveness of levofloxacin monotherapy is no less than that of traditional treatment regimens for community-acquired pneumonia .

A large number of studies have confirmed not only the clinical advantage of LF, but also its economic superiority over other antibacterial drugs.

A study conducted at Tallahassee Medical Center showed economic advantage of using LF in the treatment of community-acquired pneumonia in comparison with traditional parenteral therapy. The estimated savings averaged $111 per patient.

A multicenter randomized controlled trial conducted in 19 Canadian hospitals assessed the economic outcome of treating adult patients with community-acquired pneumonia. Hospitals were divided into two groups: those using the study approach and those using conventional standard therapy. The management method studied included the use of LF as the antibiotic of choice and the use of the PSSI pneumonia severity index (Pneumonia Severity Scoring Index), according to which patients were divided into 5 classes and the question of the method of treatment (outpatient or inpatient) was decided. In hospitals using the conventional approach, the decision on hospitalization, the choice of antibiotic (with the exception of LF) and other decisions were made by the attending physicians. The analysis included 716 patients using the study method and 1027 patients using conventional therapy. In hospitals with the studied method, there were fewer hospitalizations than in hospitals with conventional therapy (46.5% and 62.2%, respectively, p = 0.01), and there was also a reduction in the length of stay of patients in the hospital by an average of 1.6 days and savings of $457-994 per patient, without reducing clinical effectiveness and quality of life.

A study conducted by the INOVA Health System showed that levofloxacin is a cost-effective alternative to ciprofloxacin for infectious diseases of various sites (upper and lower respiratory tract, urinary tract, skin and soft tissue, etc.) and that the use of disease risk criteria (PSI) can reduce the frequency of justified hospitalizations for community-acquired pneumonia, which also leads to cost savings. In addition, experience has demonstrated the economic and clinical benefits of using step therapy.

Another large, multicenter, prospective, open-label, randomized, active-controlled phase III trial included 310 outpatients and 280 inpatients with community-acquired pneumonia who were prescribed levofloxacin or cefuroxime axetil (intravenously or orally). The economic evaluation was conducted only for outpatients. It was found that the economic benefit of LF reaches $233 per patient (p=0.008).

A study conducted at the University of Texas Cancer Center demonstrated that the use of levofloxacin is safe, effective and cost-effective in the treatment of community-acquired pneumonia in adults in comparison with beta-lactam antibiotics and clarithromycin. In this study, sensitivity to the studied antibiotics was determined using MICs and a high level of resistance of the main pathogens of pneumonia (pneumococcus, Haemophilus influenzae, moraxella) to b-lactams was revealed, an increase in the resistance of atypical pathogens to macrolides and, in contrast, a low level of resistance to LF. Frequent cases of allergic reactions to b-lactams in comparison with LF and good tolerability of the latter also showed its advantage. The second study examined the question of optimal antibiotic therapy for community-acquired pneumonia in patients with various concomitant conditions (CHD, diabetes, chronic heart failure, alcoholism, nursing home care, work on livestock farms, etc.). As a result, among all FQs, only levofloxacin was recommended for the management of community-acquired pneumonia.

The next study examined the replacement of other PCs with levofloxacin in pneumonia and infections of other sites. Microbiological research, clinical and pharmacoeconomic assessments were carried out. As a result, replacing a more expensive drug (levofloxacin) with cheaper ones (ofloxacin, ciprofloxacin) turned out to be more profitable.

Chronic bronchitis in the acute phase

According to the results of the study by C.A. DeAbate (1997), the clinical and bacteriological effectiveness of LF when taken at a dose of 500 mg once a day for 5-7 days is comparable to a 7-10-day dose of cefuroxime at a dose of 250 mg 2 times a day. Clinical effectiveness was 94.5 and 92.6%, bacteriological - 97.4 and 92.6%, respectively.

According to M.P. Habib (1998), the clinical and bacteriological effectiveness of a single dose of 500 mg of LF for 5-7 days is comparable to a 7-10-day dose of cefaclor at a dose of 250 mg 3 times a day. Clinical effectiveness was 91.6 and 85%, bacteriological - 94.2 and 86.5%, respectively.

Nosocomial pneumonia

The etiology of nosocomial pneumonia is dominated by gram-negative flora ( Klebsiella sp., P. mirabilis, E. coli, H. influensae, P. aeruginosa). From the gram-positive flora there are S. aureus, less commonly pneumococci, often multidrug-resistant strains. Fluoroquinolones have long been successfully used in the treatment of this pathology. Considering the antimicrobial spectrum of LF, its prescription for nosocomial pneumonia may be completely justified. However, if there is a suspected or confirmed infection P. aeruginosa combination antibacterial therapy is required, usually with antipseudomonal b-lactam antibiotics to prevent the development of resistance.

Conclusion

Experience with the use of levofloxacin convincingly proves that it is a highly effective drug, comparable in effectiveness to other new fluoroquinolones. Levofloxacin is almost equally effective against both gram-positive and gram-negative aerobic flora, and also has high activity against atypical pathogens. Levofloxacin has almost ideal pharmacokinetic parameters and two dosage forms, oral and parenteral, which allows for maximum optimization of doses and treatment regimens and its use as part of suppository therapy. The high bactericidal activity of levofloxacin in combination with high maximum concentrations, good tissue penetration, and AUC indicators provides maximum therapeutic effect.

Among other drugs in the PC group, levofloxacin has the best tolerability with a low level of side effects.

Currently, levofloxacin is successfully used mainly for lower respiratory tract infections. However, given the wide antimicrobial spectrum, optimal pharmacokinetic parameters, good tolerability, levofloxacin can be used for infections of almost any localization (sinusitis, infections of the urinary tract, skin and soft tissues, pelvis, intra-abdominal infections, severe generalized infections, intestinal infections, infections transmitted sexually, etc.).

The formation of resistance to levofloxacin is possible, but currently resistance to the drug develops most slowly and does not cross with other antibiotics.

Along with high clinical efficacy, levofloxacin undoubtedly has pharmacoeconomic advantages, which is important in the modern healthcare system.

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The group of fluoroquinolones, to which the antibiotic Ciprofloxacin belongs, appeared relatively recently. The first drug of this type began to be used only in the 1980s. Previously, antibacterial agents of this class were prescribed only for urinary tract infections. But now, thanks to their broad antimicrobial activity, fluoroquinolones, including the antibiotic Ciprofloxacin, are prescribed for bacterial pathologies that are difficult to treat, or for unidentified pathogens.

The mechanism of the bactericidal action of this drug is based on penetration of the pathogenic microorganism through the cell membrane and influence on the reproduction processes.

Fluoroquinolones inhibit the synthesis of bacterial enzymes that determine the twisting of the DNA strand around nuclear RNA, this is type I topoisomerase in gram-negative bacteria and class IV topoisomerase in gram-positive bacteria.

The antibiotic Ciprofloxacin is active against a wide range of bacteria that are resistant to the action of most antimicrobial drugs (Amoxicillin and its more effective analogue Amoxiclav, Doxycycline, Tetracycline, Cefpodoxime and others).

As indicated in the instructions for use, the following strains of bacteria are sensitive to the action of Ciprofloxacin:

Staphylococcus aureus and saprophytic;
anthrax pathogen;
streptococcus;
legionella;
meningococcus;
Yersinia;
gonococcus;
hemophilus influenzae;
Moraxella.

E. coli, enterococci, pneumococci and some strains of Proteus are moderately sensitive. Mycoplasma and ureaplasma, listeria and other uncommon bacteria are resistant to the action of the antibiotic Ciprofloxacin.

The drug belongs to the second generation of fluoroquinolones, while its analogue of the same group, the no less common Levofloxacin, belongs to the third generation and is more used for the treatment of diseases of the respiratory tract.

The advantage of the antibiotic Ciprofloxacin is its wide range of release forms. Thus, for the treatment of bacterial eye infections, the medicine is prescribed in the form of eye drops to reduce the risk of systemic side effects. For severe illnesses, Ciprofloxacin injections are required, or rather infusions, the standard dosage is 100 mg - 200 mg/100 ml. After normalization of the patient’s condition, the patient is transferred to tablets (they are available with a concentration of the active component of 250 and 500 mg). Accordingly, the price of the drug differs.

The main ingredient of the medicine is ciprofloxacin; the presence of excipients depends on the specific form of the antibiotic. In a solution for infusion it is purified water and sodium chloride, in eye drops - various solvents and stabilizers, in tablets - talc, silicon dioxide, cellulose.

The antibiotic Ciprofloxacin is prescribed to children over 5 years of age and adults for the treatment of the following diseases:

lesions of the lower respiratory tract, including pneumonia caused by flora sensitive to fluoroquinolones;
infections of ENT organs, including sore throat, otitis, sinusitis;
diseases of the genitourinary system, for example, cystitis, pyelonephritis, urethritis, gonorrhea, bacterial prostatitis, adnexitis;
various intestinal infections (shigellosis, salmonellosis, typhoid fever, cholera, enteritis, colitis);
sepsis, peritonitis;
infections affecting the skin, soft tissues, bones and cartilage, bacterial complications after burns;
anthrax;
brucellosis;
yersiniosis;
borreliosis;
tuberculosis (as part of complex therapy);
specific prevention of bacterial infections in patients with immunodeficiency due to HIV or AIDS or the use of cytostatics.

The antibiotic Ciprofloxacin is prescribed in the form of eye drops for infections of the mucous membrane of the organs of vision. According to experts, no cases of bacterial flora developing resistance to the action of the drug have been identified to date. But fluoroquinolones are considered unsafe drugs, so they are not considered as first-line drugs for the treatment of uncomplicated bacterial infections.

Ciprofloxacin intramuscularly and in the form of eye drops and tablets

When taken orally, the antibiotic is absorbed quite quickly, mainly these processes occur in the lower parts of the digestive tract. The maximum concentration is achieved an hour and a half after using the Ciprofloxacin tablet. The overall bioavailability of the drug is high and amounts to about 80% (the exact concentration of the active ingredient in the body depends on the dose taken).

Only dairy products affect the absorption of the antibiotic, so they are advised to be excluded from the diet during treatment. Otherwise, food intake somewhat slows down the absorption of Ciprofloxacin, but the bioavailability indicators do not change.

The active component of the drug binds only 15-20% to plasma proteins. The antibiotic is mainly concentrated in the pelvic and abdominal organs, saliva, lymphoid tissue of the nasopharynx, and lungs. Ciprofloxacin is also found in synovial fluid, bone and cartilage tissue.

The drug enters the spinal canal in small quantities, so it is practically not prescribed for damage to the central nervous system. Approximately a third of the total dosage of Ciprofloxacin is metabolized in the liver, the rest is excreted by the kidneys in unchanged form. The half-life is 3-4 hours.

The exact amount of medication prescribed, as well as the duration of treatment, depends on many factors. First of all, this is the patient's condition. Standard recommendations regarding the use of any antibacterial agents are to continue taking them for at least three days after the temperature has returned to normal. This applies to both oral forms and the use of Ciprofloxacin intramuscularly.

For adults, the dosage of the drug is 500 mg twice a day, regardless of meals.

The annotation for the drug indicates the average duration of therapy:

for diseases of the respiratory tract - up to two weeks;
for lesions of the digestive system from 2 to 7 days, depending on the severity of the clinical picture and the causative agent of the infection;
for diseases of the genitourinary system, treatment for prostatitis lasts the longest - up to 28 days; to eliminate gonorrhea, a single dose is sufficient; for cystitis and pyelonephritis, treatment is continued for up to 14 days;
for infections of the skin and soft tissues - an average of two weeks;
for bacterial lesions of bones and joints, the duration of therapy is determined by the doctor and can last up to 3 months.

Important

Severe infection is an indication for increasing the daily dosage for an adult to 1.5 g.

Important

The maximum daily dosage of the drug in childhood should not exceed 1.5 g per day.

Ciprofloxacin is not used intramuscularly. The antibiotic solution is administered only intravenously. Moreover, its action develops much faster than that of tablets. The maximum concentration in blood plasma is reached after 30 minutes. The bioavailability of Ciprofloxacin solution is also higher. With intravenous injections, it is almost completely excreted unchanged by the kidneys within 3-5 hours.

Unlike tablets, for many uncomplicated bacterial diseases, one infusion of Ciprofloxacin is sufficient. In this case, the daily dosage for adults is 200 mg or two injections during the day. The required amount of the drug for a child is determined by the proportion of 7.5-10 mg/kg per day (but not more than 800 mg per day).

The ready-made solution for infusion is produced not in small ampoules, but in 100 ml bottles, the concentration of the active substance is 100 or 200 mg. The drug can be used immediately and does not require further dilution.

Eye drops with ciprofloxacin are intended for the treatment of various infectious eye lesions (conjunctivitis, blepharitis, keratoses and ulcers) caused by sensitive flora. The drug is also prescribed to prevent postoperative and post-traumatic complications.

The total volume of the bottle with drops is 5 ml, while 1 ml of solution contains 3 mg of active ciprofloxacin. For moderately severe symptoms of the disease and for preventive purposes, the drug is prescribed 1-2 drops in each eye every four hours. For complicated infections, the frequency of use is increased - the procedure is repeated every two hours.

Ofloxacin or Ciprofloxacin: which is better, other drug analogues, restrictions on use

The use of the drug is strictly contraindicated during pregnancy and lactation. In addition, Ciprofloxacin affects the formation of the structure of bone and cartilage tissue, so it is prescribed to children under 18 years of age only for strict medical reasons.

Also, a contraindication to taking the medication is hypersensitivity not only to Ciprofloxacin, but also to other medications from the fluoroquinolone group.

The use of antibiotics should be carried out under strict medical supervision in case of impaired renal excretory function or severe diseases of the central nervous system. If the use of Ciprofloxacin is started after surgery under general anesthesia, monitor pulse and blood pressure.

Unlike other, safer antibacterial drugs from the class, for example, penicillins, the risk of adverse reactions during therapy with Ciprofloxacin is high.

The patient is warned about the following possible side effects:

impaired vision clarity and color perception;
the occurrence of a secondary fungal infection;
digestive disorders accompanied by vomiting, nausea, heartburn, diarrhea; inflammatory lesions of the intestinal mucosa rarely develop;
dizziness, headache, sleep disorders, anxiety and other psycho-emotional disorders, sometimes convulsions;
hearing impairment;
acceleration of heart rate, arrhythmias against the background of low blood pressure;
shortness of breath, impaired lung function;
disorders of the hematopoietic system;
deterioration of kidney and liver function;
rashes, itching, swelling.

Ciprofloxacin is included in many drugs.

So, instead of this medication, the doctor may prescribe the following medications to the patient:

Tsiprolet (solution for infusion, eye drops, tablets of 250 and 500 mg);
Betaciprol (eye drops);
Quintor (tablets and infusion solution);
Tsiprinol (in addition to injection solution and regular tablets, there are also capsules with prolonged action);
Ciprodox (250, 500 and 750 mg tablets).

If we talk about analogues of this antibiotic, we should also mention other antibacterial agents from the group of fluoroquinolones. So, patients often ask their doctor, Ofloxacin or Ciprofloxacin, which is better? Or maybe replace it with more modern Norfloxacin or Moxifloxacin?

The fact is that the indications for use for all of the listed drugs are the same. Like Ciprofloxacin, they work well against the main pathogens of cystitis, pneumonia, prostatitis and other infections. But doctors emphasize that the “older” the generation of fluoroquinolone, the greater its activity against pathogenic flora. But at the same time, the risk of severe adverse reactions also increases.

Therefore, the question of Ofloxacin or Ciprofloxacin, which is better, is not entirely correct. An antibiotic should be prescribed solely on the basis of the identified pathogen and the general condition of the patient. In other words, if the doctor sees that Ciprofloxacin will cope well with, for example, pyelonephritis, then there is no need to prescribe stronger but less safe Norfloxacin or Lomefloxacin.

As for the cost of the antibiotic, it largely depends on the manufacturer and the purity of the substance used to produce the drug. Thus, domestic eye drops with Ciprofloxacin cost from 20 to 30 rubles. A package of 10 tablets with a dosage of 500 mg will cost 120-150 rubles. The cost of one bottle of solution for infusion ranges from 25-35 rubles.

Natalya, 50 years old

“Ciprofloxacin was prescribed to treat kidney inflammation. Before this, other, weaker antibiotics were prescribed, but only this drug helped. For the first few days I had to endure IV drips, then I was switched to pills. I was also pleased with the low price of the medicine.”

Given the high risk of dangerous adverse reactions, only a doctor should decide whether Levofloxacin or Ciprofloxacin is better. The drugs are quite toxic, so it is additionally recommended to take biochemical and clinical blood and urine tests to prevent possible complications of therapy.

Levofloxacin or Tavanic is used to treat infectious diseases caused by pathogens. These drugs are classified as 3rd generation fluoroquinolones, which have a broad spectrum of action. The advantages of medications are that they have relatively high bioavailability.

Brief characteristics of Levofloxacin

Levofloxacin is a highly effective antibiotic of the latest generation, acting against almost all groups of microorganisms. Available in the form of tablets and solution for injection. There are eye drops for the treatment of various forms of conjunctivitis.

Resistance to the active component of the drug develops as a result of a process of gradual mutation of the genes encoding DNA gyrase and topoisomerase-4.

Any form of Levofloxacin quickly spreads in cells and tissues and is completely absorbed due to its high bioavailability, which approaches 100%. This property of the drug allows you to quickly achieve its maximum plasma concentration in the blood. With a course of treatment, already on the 3rd or 4th day it is possible to achieve an effective weighted average content of the drug in the blood.

The drug binds to serum proteins in an amount of approximately 30 to 40%. A significant amount of the active substance is determined in the lung tissues. Penetrates well into bone tissue. This property makes it necessary to be careful when using some other drugs, because The patient may develop tissue damage to bones and joints.

The active component of the tablets and solution is metabolized slightly - no more than 5% of the previously used dose. Decomposition products are excreted through the kidneys. After oral administration, half of the drug consumed is eliminated within 6 to 8 hours. Elimination processes do not differ between different sex groups of patients and increase slightly due to renal and hepatic pathologies.

The drug helps with:

acute and chronic prostatitis;
acute and chronic tonsillitis;
cystitis;
inflammation of the maxillary sinuses;
presence of ureaplasmas;
inflammation of the bronchial mucosa;
pneumonia;
in the treatment of certain gynecological pathologies.

Levofloxacin is administered orally or through a dropper.

Brief description of Tavanik

Available in tablet form. One tablet contains 0.25 or 0.5 g of the active compound Levofloxacin. 1 ml of solution for parenteral administration contains 5 mg of the drug. It is mixed with saline and glucose.

It is quickly absorbed from the digestive tract and is almost completely absorbed, because its bioavailability approaches 100%.

Active against the following microorganisms:

It is effective in treating pathologies:

upper respiratory tract infections;
tuberculosis (used only as part of complex treatment);
inflammatory diseases of the upper respiratory tract;
pustular lesions of the epidermis;
bacterial inflammation of the prostate;
anthrax (as part of complex therapy).

Due to the nature of the action and possible reaction of the body, this medicine is strictly contraindicated for:

damage to joints or ligaments;
diabetes mellitus;
porphyria;
brain disease;
anemia associated with insufficient intake of glucose-6-phosphate dehydrogenase into the body;
disorders of a person’s mental state;
epilepsy;
bradycardia;
use of hypoglycemic drugs (severe hypoglycemia may develop);
chronic heart failure;
history of seizures;
systemic connective tissue disorders.

Which is better: Levofloxacin or Tavanic

Both drugs belong to fluoroquinolones and the amount of therapeutically active substance in them is also the same. It is difficult to determine which is better without a preliminary analysis of the state of the human body and its resistance to antibiotic therapy. Some patients are helped by Tavanic, others by Levofloxacin.

Although medications may contain various auxiliary components, they do not affect their pharmacological activity. Research shows that Levofloxacin is best used in the complex treatment of infectious pathologies.

Only the doctor decides which drug is best for each patient. Both medications are suitable for the treatment of respiratory and genitourinary infections.

Similarities

All fluoroquinolones are powerful and quite toxic drugs. Both Levofloxacin and Tavanic are characterized by side effects:

dyspepsia, manifested in antibiotic-associated diarrhea and pseudomembranous colitis;
disorders of liver function, manifested in the form of jaundice;
hypoglycemic disorders (tremors, anxiety, constant and severe feeling of hunger, severe sweating);
a sharp drop in blood pressure up to the development of a collapsed state;
severe heart rhythm disturbance;
toxic damage to the nervous system, manifested in the form of constant pain in the head, hallucinations, convulsions, and a sharp loss of sensitivity;
lesions of the musculoskeletal system, manifested in the form of pain in the joints, myasthenia gravis, inflammation of the tendons;
allergic reactions (local or systemic);
damage to the kidney tissue (in severe cases, acute renal failure may develop);
decreased levels of platelets and leukocytes;
destruction of red blood cells;
the appearance of pinpoint hemorrhages on the skin;
severe dysbacteriosis due to damage to the bacterial flora, candidiasis;
the emergence of cross-resistance and the development of superinfection.

The drugs cause a decrease in reaction speed and the ability to control complex mechanisms. Some patients experience drowsiness and constant increased fatigue. If cerebral circulation is impaired, there is a high risk of developing severe convulsions, therefore Levofloxacin and Tavanic are prescribed only for health reasons.

The drugs are toxic to the fetus. Therefore, couples should use contraception during fluoroquinolone treatment. Fluoroquinolones are prohibited for people receiving glucocorticosteroid drugs, because this combination leads to an increased risk of rupture of the ligamentous apparatus of the joints. The administration of fluoroquinolones along with anticoagulants provokes severe bleeding.

Medicines should be taken carefully in the following cases:

tendency to develop seizures;
treatment with Fenbufen;
manifestation of glucose-6-phosphate dehydrogenase deficiency;
renal dysfunction;
risk of changes in electrocardiogram parameters;
use of tricyclic antidepressants, antipsychotics and macrolide antibiotics;
condition after organ transplantation.

An overdose causes nausea, severe vomiting, and hallucinations. In severe cases, a coma may develop.

What is the difference

When analyzing the effectiveness of the products, it turns out that Tavanik is more effective. This is mainly due to the fact that purer components are used in the production of tablets or parenteral solution.

Tavanic is able to inhibit the activity of most microorganisms that cause severe infections of the urinary and respiratory tract, incl. tuberculosis. Positive dynamics are observed already in the middle of the therapeutic course, which does not happen when using cheaper analogues of the drug.

Tavanic has advantages compared to Levofloxacin:

has a wide range of therapeutic effects;
does not cause an allergic reaction when exposed to ultraviolet radiation on the body;
It is used with other antibacterial drugs and does not provoke allergies.

Some disadvantages of Levofloxacin:

many contraindications;
disrupts vitamin metabolism;
is not a completely safe medicine for infectious pathologies.

Levofloxacin eye drops have different names. They must be used strictly in accordance with the dosage. It is important not to change the recommended dosage regimen to avoid causing eye damage.

annotation scientific article on fundamental medicine, author of the scientific work - Ryzhko I.V., Tsuraeva R.I., Anisimov B.I., Trishina A.V.

Related topics scientific works on fundamental medicine, author of the scientific work - Ryzhko I.V., Tsuraeva R.I., Anisimov B.I., Trishina A.V.

Efficacy of Levofloxacin, Lomefloxacin and Moxifloxacin vs. Other Fluoroquinolones in Experimental Plague Due to FI+ and FI - Strains of Yersiniapestis in Albino Mice

Text of scientific work on the topic “The effectiveness of levofloxacin, lomefloxacin and moxifloxacin in comparison with other fluoroquinolones in experimental white mouse plague caused by fi + and fi -strains of the pathogen”

How to choose the right antibiotic

Levofloxacin is a universal drug for the treatment of inflammatory processes

Ciprofloxacin intramuscularly and in the form of eye drops and tablets

Important

Important

Ofloxacin or Ciprofloxacin: which is better, other drug analogues, restrictions on use

Brief characteristics of Levofloxacin

Brief description of Tavanik

Which is better: Levofloxacin or Tavanic

Similarities

What is the difference