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Relationship to plasma proteins – 30-40%. It penetrates the tissues and organs: lungs, bronchial mucosa, sputum, organs of the urogenital system, polymorphonuclear leukocytes, alveolar macrophages. Antibiotic concentration in the skin 2 times, and in the lungs – from 2 to 5 times higher than serum. The volume of distribution after i / v infusion of 500 mg of levofloxacin ranges from 74 do112 l / kg. The volume of distribution following single and multiple in / in infusion of 500 mg of levofloxacin is 89-112 liters. In the liver, a small part of the drug is oxidized and / or deacetylated. Renal clearance is 70% of the total clearance. The T ½ -. 6-8 hours is derived from the body mainly by the kidneys by glomerular filtration and tubular secretion. Less primobolan depot for sale than 5% is excreted as levofloxacin metabolites. The unchanged in the urine within 24 hours to return to 70% and in 48 hours – 87% of the administered dose; in feces 72 h found 4% of an oral dose.
In patients with renal failure (creatinine clearance <50 mL / min), the half-life is lengthened levofloxacin that requires correction dose to avoid accumulation of the antibiotic. Hemodialysis and peritoneal dialysis are removed only a small part of levofloxacin, it is not necessary to introduce an additional dose of antibiotic after hemodialysis or peritoneal dialysis.

Indications

  • and acute exacerbation of chronic bronchitis caused by Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae , Haemophilus parainfluenzae catarrhalis or of Moraxella ;
  • pneumonia caused by Staphylococcus aureus, Streptococcus pneumoniae (including strains resistant to penicillin), Haemophilus influenzae, Haemophilus parainfluenzae, Escherichia coli, Klebsiella pneumoniae, Moraxella catarrhalis, Pseudomonas aeruginosa, Serratia marcescens, Chlamydophila pneumoniae, Legionella pneumophila , or Mycoplasma pneumoniae ;
  • intraabdominal infections caused by Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus spp , Citrobacter freundii, Enterobacter cloacae, Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, Morganella morganii, Serratia marcescens, Pseudonionas aeruginosa.;
  • uncomplicated and complicated skin and soft tissue infections caused by of Staphylococcus aureus, of Streptococcus pyogenes, of Enterococcus faecalis, of Streptococcus agalactiae, the Proteus mirabilis ;
  • uncomplicated and complicated urinary tract infections caused by Staphylococcus epidermidis, Staphylococcus saprophyticus, Enterococcus faecalis , Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis , or Pseudomonas aeruginosa;
  • and acute exacerbation of chronic bacterial prostatitis, caused by Escherichia coli, Enterococcus faecalis primobolan depot for sale or of Staphylococcus epidermidis ;
  • septicemia / bacteremia associated with the above indications;
  • complex therapy of drug resistant forms of tuberculosis.

Contraindications

  • hypersensitivity to levofoloksatsinu and other quinolones,
  • childhood and adolescence (18 years)
  • pregnancy,
  • lactation,
  • tendon injury during the earlier treatment of quinolones,
  • epilepsy.

Carefully

  • old age (a high likelihood of concomitant decrease of kidney function)
  • deficiency of glucose-6-phosphate dehydrogenase,
  • in patients with organic lesions of the central nervous system (a state after stroke, brain trauma).

Dosage and administration:
Infusion solution Levofloksabola ® 500 mg administered intravenously; administration duration -. at least 60 minutes
Conventional therapeutic dosage Levofloksabola ® for patients with normal renal function (creatinine clearance of> 80 ml / min) is 500 mg every 24 hours.In severe and life threatening infections, 500 mg administered every 12 hours.

Side effects:
When used in the recommended dosages and levofloxacin dosing regimens are well tolerated.
In order to evaluate the incidence of adverse reactions using the following criteria “often” (found in 1-10 patients out of 100), “sometimes” (occur in less than 1 patient out of 100) “rarely” (occur in less than 1 patient out of 1,000), “very rarely” (occur in less than 1 patient out of 10,000) and “in certain cases” (described only isolated cases). Allergic reactions : sometimes – itching and redness of the skin; rarely – anaphylactic and anaphylactoid reactions (manifested by symptoms such as urticaria, bronchospasm, and – in rare cases – swelling of the face, throat); very rarely – a sudden drop in blood pressure and shock; in some cases – Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell’s syndrome) and exudative erythema multiforme. With the skin side and subcutaneous tissue : Very rare – photosensitivity. From the digestive system : sometimes – nausea, diarrhea, loss of appetite, vomiting, pain abdominal pain, digestive disorders; very rarely – diarrhea with blood (in some cases this may be a sign of pseudomembranous colitis). Liver : increased alanine aminotransferase activity asparaginaminotransferazy; sometimes – increased levels of bilirubin in the blood serum; . very rarely – hepatitis On the part of metabolism: rarely – hypoglycemia. On the part of the central and peripheral nervous system : sometimes – headache, dizziness, and / or stiffness, drowsiness, sleep disturbances; rarely – paresthesia in hands, tremors, restlessness, anxiety states; Seizures and convulsions, and confusion, psychotic reactions such as hallucinations and depression; very rarely – visual and hearing impairment, disturbances of taste and smell sensitivity, reduction of tactile sensitivity. Since the cardiovascular system : rarely – tachycardia, drop in blood pressure; very rarely – vascular collapse; in some cases – lengthening of the QT interval. From the musculoskeletal system : rarely – joint and muscle pain; very rare – tendon lesions, including tendinitis, Achilles tendon rupture (. can be bilateral in nature and occur within 48 hours after the start of treatment), muscle weakness (of particular importance for patients with myasthenia gravis); in some cases, – rhabdomyolysis. From the urinary system : sometimes – increase in creatinine level in blood serum; very rarely – the deterioration of renal function up to acute renal failure (eg, due to allergic reactions – interstitial nephritis). From the hematopoietic system : sometimes – eosinophilia, leukopenia; rarely – neutropenia, thrombocytopenia; very rarely – agranulocytosis; in some cases – hemolytic anemia, pancytopenia. Other : sometimes – asthenia; very rare – fever, allergic pneumonitis, vasculitis.

Overdose symptoms : confusion, primobolan depot for sale dizziness, seizures, seizures, nausea, lengthening the interval QT, erosive lesions of the mucous membranes of the gastrointestinal tract. Treatment : Symptomatic and infusion therapy, medical supervision. Poor deleted when hemodialysis and peritoneal dialysis, so the efficiency of these methods in acute poisoning levofloxacin questionable. Levofloxacin specific antidote does not exist.

Interaction with other medicinal products
Co-administration of drugs that can lower the seizure threshold. (Theophylline, non-steroidal anti-inflammatory drugs – propionic acid derivatives for the treatment of rheumatic diseases) and levofloxacin can provoke an attack of convulsions
cimetidine and probenecid slightly slow renal clearance of levofloxacin, however, it does not clinical significance.
When simultaneous administration of cyclosporin and levofloxacin was a slight increase in half-life of cyclosporin blood plasma.
infusion solution Levofloksabola ® compatible with 0.9% sodium chloride, 5% dextrose solution, Ringer’s dextrose solution, combined solutions for parenteral nutrition (amino acids , carbohydrates, electrolytes).
You can not be mixed with heparin, antibiotics and other solutions having an alkaline reaction.

Specific guidance
in the treatment of elderly patients should be borne in mind that this group of patients often have impaired kidney function, which requires the appropriate dose adjustment.
During the infusion of levofloxacin may be a palpitation and transient drop in blood pressure. In marked fall in blood pressure injection of the drug immediately cease.
At simultaneous reception of drugs that reduce the seizure threshold activity (theophylline, non-steroidal anti-inflammatory drugs – propionic acid derivatives for the treatment of rheumatic diseases), as levofloxacin may provoke an attack of convulsions.
Levofloxacin rarely cause photosensitivity, but patients taking levofloxacin, it is recommended not to be exposed to excessive sunlight or artificial ultraviolet light (eg, exposure to the sun in the highlands or the solarium).
in the application of quinolones in patients with deficiency of glucose-6-phosphate dehydrogenase is possible hemolysis, so treatment with levofloxacin these patients should be carried out with extreme caution.
in applying the drug in patients with diabetes should be borne in mind that levofloxacin may cause hypoglycemia.
in case of suspected antibiotic-associated diarrhea and pseudomembranous colitis (severe, persistent diarrhea with or without blood in the patients receiving antibiotic) should be lifted immediately levofloxacin and start appropriate treatment (metronidazole, vancomycin per os, chelators, infusion therapy). In such cases, you can not use drugs that suppress intestinal motility.
If suspected tendinitis (especially inflammation of the Achilles tendon), discontinue treatment with levofloxacin and to the state of rest the affected tendon.
In the period of treatment must be careful when driving and occupation of other potentially hazardous activities that require concentration and speed of psychomotor reactions.

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