What are the primary uses of Levofloxacin. How does Levofloxacin interact with other medications. What precautions should be taken when using Levofloxacin. What are the potential side effects of Levofloxacin. How should Levofloxacin be administered for optimal effectiveness.

Understanding Levofloxacin: A Powerful Antibiotic

Levofloxacin is a widely prescribed antibiotic belonging to the fluoroquinolone class of drugs. It is known for its broad-spectrum activity against various bacterial infections. This medication is often marketed under the brand name Levaquin and is available in both oral and injectable forms.

The effectiveness of Levofloxacin stems from its ability to inhibit bacterial DNA gyrase and topoisomerase IV enzymes, which are crucial for bacterial DNA replication. This mechanism of action makes Levofloxacin a potent tool in combating a wide range of bacterial pathogens.

Primary Indications for Levofloxacin Use

Levofloxacin is prescribed for numerous bacterial infections, including:

• Respiratory tract infections (pneumonia, bronchitis)
• Urinary tract infections
• Skin and soft tissue infections
• Prostatitis
• Sinusitis
• Certain types of bacterial gastroenteritis

Is Levofloxacin effective against all types of bacteria? No, it is not effective against all bacterial strains. While it has broad-spectrum activity, some bacteria may be resistant to Levofloxacin. Additionally, it is not effective against viral infections such as the common cold or flu.

Dosage and Administration Guidelines for Levofloxacin

The appropriate dosage of Levofloxacin varies depending on the type and severity of the infection being treated. Typically, it is administered once daily, which contributes to its convenience and patient compliance.

For most indications, the usual adult dose ranges from 250 mg to 750 mg per day. The duration of treatment can vary from 3 to 14 days, depending on the specific condition being treated.

Important Considerations for Levofloxacin Administration

1. Levofloxacin can be taken with or without food.
2. It should be taken with a full glass of water.
3. Patients should maintain adequate hydration during treatment to prevent crystalluria.
4. The medication should be taken at evenly spaced intervals to maintain consistent blood levels.

Can Levofloxacin be crushed or split? While the tablets can be split if needed, it’s generally recommended to swallow them whole. Always consult with a healthcare provider or pharmacist before altering the form of any medication.

Levofloxacin Interactions: Navigating the Complex Web of Drug Combinations

Levofloxacin has the potential to interact with numerous medications, which can affect its efficacy or increase the risk of adverse effects. Understanding these interactions is crucial for safe and effective treatment.

Major Drug Interactions with Levofloxacin

Several medications can have significant interactions with Levofloxacin:

• Antacids containing aluminum or magnesium
• Iron supplements
• Sucralfate
• Didanosine
• Warfarin
• NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

Why do antacids interfere with Levofloxacin absorption? Antacids containing metal cations like aluminum or magnesium can form complexes with Levofloxacin, reducing its absorption from the gastrointestinal tract. This can significantly decrease the antibiotic’s effectiveness.

QT Interval Prolongation Concerns

Levofloxacin has the potential to prolong the QT interval, which can lead to serious cardiac arrhythmias. This risk is increased when combined with other medications that also affect the QT interval, such as:

• Amiodarone
• Sotalol
• Quinidine
• Procainamide
• Certain antipsychotics and antidepressants

Healthcare providers must carefully consider these potential interactions when prescribing Levofloxacin and may need to adjust dosages or choose alternative medications in some cases.

Side Effects and Adverse Reactions Associated with Levofloxacin

While Levofloxacin is generally well-tolerated, it can cause a range of side effects, from mild to severe. Patients and healthcare providers should be aware of these potential adverse reactions.

Common Side Effects of Levofloxacin

The most frequently reported side effects include:

• Nausea and diarrhea
• Headache
• Dizziness
• Insomnia
• Rash

These side effects are usually mild and self-limiting. However, if they persist or worsen, medical attention should be sought.

Serious Adverse Reactions

While less common, some serious adverse reactions associated with Levofloxacin include:

• Tendon rupture or tendinitis
• Peripheral neuropathy
• Central nervous system effects (seizures, psychosis)
• Severe hypersensitivity reactions
• Clostridium difficile-associated diarrhea

Do all patients experience side effects from Levofloxacin? No, not all patients will experience side effects. The occurrence and severity of side effects can vary based on individual factors such as age, overall health, and concurrent medications.

Special Precautions and Contraindications for Levofloxacin Use

Certain patient populations require special consideration when prescribing Levofloxacin. Understanding these precautions is essential for safe and effective use of the medication.

Populations Requiring Caution

• Elderly patients: Higher risk of tendon disorders and CNS effects
• Patients with renal impairment: May require dose adjustment
• Patients with a history of seizures or lowered seizure threshold
• Individuals with known QT interval prolongation or risk factors for it
• Patients with myasthenia gravis: Risk of exacerbation

Contraindications for Levofloxacin Use

Levofloxacin is contraindicated in the following situations:

• Known hypersensitivity to Levofloxacin or other quinolones
• History of tendon disorders related to fluoroquinolone use
• Pregnancy and breastfeeding (unless potential benefits outweigh risks)
• Children and adolescents (due to the risk of musculoskeletal disorders)

Why is Levofloxacin not recommended for children? The use of Levofloxacin in children and adolescents is generally avoided due to the increased risk of musculoskeletal adverse effects, particularly tendon disorders. The developing musculoskeletal system in young individuals appears to be more susceptible to these effects.

Levofloxacin in the Context of Antimicrobial Stewardship

The use of Levofloxacin, like all antibiotics, must be considered within the broader context of antimicrobial stewardship. This approach aims to optimize antibiotic use to improve patient outcomes while minimizing the development of antibiotic resistance.

Principles of Antimicrobial Stewardship with Levofloxacin

1. Appropriate indication: Use only for confirmed or strongly suspected bacterial infections
2. Correct dosing: Ensure proper dose and duration based on the specific infection
3. De-escalation: Consider narrowing antibiotic spectrum once culture results are available
4. Monitoring: Regular assessment of treatment response and potential adverse effects

How does antimicrobial stewardship impact the use of Levofloxacin? Antimicrobial stewardship programs often reserve broad-spectrum antibiotics like Levofloxacin for more severe infections or cases where narrower-spectrum antibiotics have failed. This approach helps preserve the effectiveness of these important medications and reduces the risk of developing resistant bacterial strains.

Pharmacokinetics and Pharmacodynamics of Levofloxacin

Understanding the pharmacokinetics and pharmacodynamics of Levofloxacin is crucial for optimizing its use in clinical practice. These properties influence dosing strategies, efficacy, and potential for adverse effects.

Key Pharmacokinetic Properties

• Absorption: Rapid and almost complete oral absorption
• Distribution: Widely distributed throughout the body, including penetration into cerebrospinal fluid
• Metabolism: Minimal hepatic metabolism
• Excretion: Primarily renal excretion of unchanged drug

Pharmacodynamic Considerations

Levofloxacin exhibits concentration-dependent bactericidal activity. The key pharmacodynamic parameters include:

• AUC/MIC ratio (Area Under the Curve to Minimum Inhibitory Concentration)
• Cmax/MIC ratio (Peak Concentration to Minimum Inhibitory Concentration)

These ratios are important predictors of clinical and microbiological outcomes in patients treated with Levofloxacin.

How do the pharmacokinetic properties of Levofloxacin influence its dosing? The high oral bioavailability and once-daily dosing of Levofloxacin are a result of its favorable pharmacokinetic profile. The primarily renal excretion means that dose adjustments are necessary in patients with impaired kidney function to prevent drug accumulation.

Emerging Concerns and Future Directions in Levofloxacin Use

As with many antibiotics, the use of Levofloxacin faces challenges and evolving considerations in the medical community. Understanding these issues is crucial for healthcare providers and patients alike.

Antibiotic Resistance Concerns

The development of bacterial resistance to fluoroquinolones, including Levofloxacin, is a growing concern. Factors contributing to this include:

• Overuse and misuse of antibiotics
• Inappropriate prescribing practices
• Patient non-adherence to prescribed regimens

Efforts to combat resistance include implementing more stringent prescribing guidelines and enhancing surveillance of resistant strains.

Ongoing Research and Development

Research continues to explore new applications and formulations of Levofloxacin, as well as strategies to mitigate its adverse effects. Areas of interest include:

• Combination therapies to enhance efficacy and reduce resistance
• Novel drug delivery systems for targeted antibiotic delivery
• Genetic markers to predict individual susceptibility to adverse effects

What role might Levofloxacin play in future antibiotic strategies? While Levofloxacin remains an important antibiotic, its future role may evolve. It may be increasingly reserved for specific indications where its broad-spectrum activity is crucial, while newer, more targeted antibiotics are developed for other uses. Additionally, personalized medicine approaches may help optimize its use based on individual patient characteristics and genetic profiles.

In conclusion, Levofloxacin continues to be a valuable tool in the treatment of various bacterial infections. However, its use must be carefully considered in the context of potential side effects, drug interactions, and the growing concern of antibiotic resistance. As research progresses, our understanding and use of this powerful antibiotic will likely continue to evolve, aiming to maximize its benefits while minimizing risks to patients and public health.

Levaquin, Levofloxacin Systemic (levofloxacin) dosing, indications, interactions, adverse effects, and more

Drug maker no longer making antibiotic Levaquin

INDIANAPOLIS—  The makers of a popular antibiotic have halted production on the drug amid safety concerns.

Janssen pharmaceutical companies of Johnson & Johnson discontinued production of Levaquin in December 2017, including the oral and IV versions.

However, Levaquin may still be available in pharmacies until 2020.

“The decision to discontinue LEVAQUIN was made due to the wide availability of alternative treatment options, and our focus on developing innovative medicines designed to address unmet medical patient needs,” said Kelsey Buckholtz, a spokeswoman for Janssen in an email to RTV6.

As Call 6 Investigates reported this week, the U.S. Food and Drug Administration is requiring drug label changes for fluoroquinolone antibiotics sold under brand names like Levaquin, Cipro and Avelox.

The new labels will include more prominent and consistent warnings for mental health side effects.

A Janssen spokeswoman said Tuesday the company also discontinued making Floxin Otic ear drops, which is also a fluoroquinolone.

For several years, Call 6 Investigates has been looking into potential safety issues and concerning side effects associated with fluoroquinolone antibiotics including psychiatric problems, tendon rupture and nerve damage.

Purdue University student Shea McCarty died in 2013 after jumping out of a second story window and crashing his car into a cement embankment.

His mother, Heather McCarthy, said Shea was agitated and suffering mental health side effects from taking the antibiotic Levaquin.

RELATED | Mother blames antibiotic for son’s death | FDA announces antibiotic label changes following Call 6 report

Dr. Charles Bennett with the Southern Network on Adverse Reactions (SONAR) said Tuesday that Janssen’s decision will have little impact on public safety because other drug makers are still making the generic form, known as levofloxacin.

“Levaquin was only about 1 percent of the market share, and 99 percent was the generic,” said Bennett. “It was hard for them to make money given the lawsuits they were facing.”

Patients sued Johnson & Johnson, accusing the company of hiding debilitating side effects of Levaquin for their own financial gain.

On September 11, 2014, Bennett filed a petition with the FDA calling on the federal agency to change the drug labels to better warn patients of the risks.

On July 10, 2018, the FDA responded with a safety announcement in which it called for label changes on fluoroquinolones including more prominent and consistent warnings for mental health side effects.

The mental health side effects, according to the FDA, include disturbances in attention, disorientation, agitation, nervousness, memory impairment, serious disturbances in mental abilities, and delirium.

Heather McCarthy told Call 6 Investigates Monday the FDA’s announcement is a breakthrough in acknowledging the drugs’ effects.

“While justice is slow – this label will now open the doors to accountability for doctors who chose to ignore patient complaints,” McCarthy said in an email to RTV6 Monday. “I personally believe there is a never a reason for doctors not to listen to patients and with this labeling, there is no longer a viable excuse to ignore patient complaints associated with fluoroquinolones. The key here is ending the degradation that patients must go through when they believe they have had an adverse effect from these drugs.”

Dr. Bennett called the FDA’s July 10 announcement a “huge paradigm shift.”

In 2016, the FDA announced an updated boxed warning and medication guide that advised serious side effects with fluoroquinolones generally outweigh the benefits for patients with sinusitis, bronchitis and uncomplicated urinary tract infections who have other treatment options.

Patients with those conditions should only use fluoroquinolones as a last resort, according to the FDA.

Fluoroquinolones are intended to treat major infections like pneumonia, anthrax exposure, plague and urinary tract infections.

Call 6 Investigates contacted Janssen, the maker of Levaquin, about the FDA’s July 10 announcement.

“At Janssen, our first priority is the well-being of the people who use our medicines. Janssen is reviewing the Safety Labeling Change Notification and working with the FDA to ensure labeling will be updated appropriately to facilitate the safe and appropriate use of LEVAQUIN®,” said Kelsey Buckholtz, Janssen spokesperson in a statement to RTV6. “LEVAQUIN® (levofloxacin) has been used for nearly 20 years to treat bacterial infections, including those that may be serious or life-threatening. LEVAQUIN® is part of the important fluoroquinolone class of anti-infective prescription medications, and its safety profile remains well-known and established.”

Call 6 Investigates also contacted Bayer, who makes Cipro and Avelox, about the FDA’s label change.

Bayer released the following statement:

“Fluoroquinolones, including Cipro® (ciprofloxacin) and Avelox® (moxifloxacin), are an important class of antibiotics that treat a range of bacterial infections, some of which are serious and can be life-threatening. Cipro has been used in more than 600 million patients worldwide since becoming available by prescription in 1987. Avelox has been used by more than 200 million patients since it became available in 1999.

FDA, on July 10, 2018, issued an announcement [fda.gov] to reinforce safety information about the risks of low blood sugar levels and mental health side effects with fluoroquinolone antibiotics, and is requiring label changes for these products. This is a class-wide labeling change for all NDA and ANDA holders of fluoroquinolone antibiotics. Companies have 30 days to respond to the proposed label changes.  Bayer is currently reviewing the proposed Labeling Change Notifications for Cipro and Avelox, and we will respond to the agency within the required time frame.

The current approved product labeling of both Cipro and Avelox reflects the benefit-risk profile of these drugs in their approved indications, including information about the risks of mental health side effects and hypoglycemia (low blood sugar). 

Bayer’s highest priority is patient safety and we closely monitor the safety and efficacy of Cipro and Avelox on an ongoing basis. Bayer takes all reports of side effects very seriously, investigates them thoroughly, reports them to health authorities around the world as required and regularly evaluates whether the product’s benefit risk profile is adequately reflected in the product information.”

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Levofloxacin – Side Effects, Uses, Dosage, Overdose, Pregnancy, Alcohol

Levofloxacin can cause side effects that may be serious or even cause death (see “Drug Precautions”).

Levofloxacin can cause severe allergic reactions. Allergic reactions can happen in people taking fluoroquinolones, including levofloxacin, even after only 1 dose. Stop taking levofloxacin and get emergency medical help right away if you have any of the following symptoms of a severe allergic reaction:

• hives
• trouble breathing or swallowing
• swelling of the lips, tongue, face
• throat tightness or hoarseness
• rapid heartbeat
• faint
• skin rash

Skin rash may happen in people taking levofloxacin, even after only 1 dose. Stop taking levofloxacin at the first sign of a skin rash and call your healthcare provider. Skin rash may be a sign of a more serious reaction to levofloxacin.

Liver damage (hepatotoxicity) can happen in people who take levofloxacin. Call your doctor right away if you have unexplained symptoms such as:

•  
nausea or vomiting
•  
stomach pain
•  
fever
•  
weakness
•  
abdominal pain or tenderness
•  
itching
•  
unusual tiredness
•  
loss of appetite
•  
light colored bowel movements
•  
dark colored urine or yellowing of your skin or the whites of your eyes

Seizures have been reported in people who take fluoroquinolone antibiotics including levofloxacin. Tell your doctor if you have a history of seizures. Ask your doctor whether taking levofloxacin will change your risk of having a seizure. Central Nervous System (CNS) side effects may happen as soon as after taking the first dose of levofloxacin. Talk to your doctor right away if you get any of these side effects, or other changes in mood or behavior:

•  
seizures
•  
hear voices, see things, or sense things that are not there (hallucinations)
•  
feel restless
•  
tremors
•  
feel anxious or nervous
•  
confusion
•  
depression
•  
trouble sleeping
•  
nightmares
•  
feel lightheaded
•  
feel more suspicious (paranoia)
•  
suicidal thoughts or acts

Intestine infection (Pseudomembranous colitis). Pseudomembranous colitis can happen with most antibiotics, including levofloxacin. Call your doctor right away if you get watery diarrhea, diarrhea that does not go away, or bloody stools. You may have stomach cramps and a fever. Pseudomembranous colitis can happen 2 or more months after you have finished your antibiotic.

Changes in sensation and possible nerve damage (Peripheral Neuropathy). Damage to the nerves in arms, hands, legs, or feet can happen in people taking fluoroquinolones, including levofloxacin. Talk with your doctor right away if you get any of the following symptoms of peripheral neuropathy in your arms, hands, legs, or feet:.

•  
pain
•  
burning
•  
tingling
•  
numbness
•  
weakness
  • Levofloxacin may need to be stopped to prevent permanent nerve damage.


Serious heart rhythm changes (QT prolongation and torsades de pointes). 
Tell your doctor right away if you have a change in your heart beat (a fast or irregular heartbeat), or if you faint. Levofloxacin may cause a rare heart problem known as prolongation of the QT interval. This condition can cause an abnormal heartbeat and can be very dangerous. The chances of this happening are higher in people:

•  
who are elderly
•  
with a family history of prolonged QT interval
•  
with low blood potassium (hypokalemia)
•  
who take certain medicines to control heart rhythm (antiarrhythmics)

Increased chance of problems with joints and tissues around joints in children can happen. Tell your child’s healthcare provider if your child has any joint problems during or after treatment with levofloxacin.

Changes in blood sugar can occur. People who take levofloxacin and other fluoroquinolone medicines with oral anti-diabetes medicines or with insulin can get low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia). Follow your healthcare provider’s instructions for how often to check your blood sugar. If you have diabetes and you get low blood sugar while taking levofloxacin, stop taking levofloxacin and call your healthcare provider right away. Your antibiotic medicine may need to be changed.

Sensitivity to sunlight (photosensitivity). 

The most common side effects of levofloxacin include:

•  
dizziness
•  
headache
•  
constipation
•  
nausea
•  
diarrhea

Levofloxacin: safety and tolerability in HIV positive and negative children treated for MDR-TB | HTB

1 August 2016. Related: Conference reports, Paediatric care, TB coinfection, TB 2016 Durban.

Polly Clayden, HIV i-Base

Levofloxacin was safe and well tolerated in children with and without HIV in long-term use. The data provide additional support for its inclusion in paediatric TB treatment and prevention regimens. [1]

These findings were presented as a poster at TB2016 authored by South African investigators from: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town; Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch University, Cape Town; and Western Cape Government Department of Health, Brewelskloof Hospital, Worcester.

Levofloxacin is a fluoroquinolone and a key component of MDR-TB treatment in children. The drug is also included in two phase 3 trials of preventive therapy in MDR-TB exposed adults and children. The most notable side effects of fluroquinolones include: arthropathy, neuropsychiatric symptoms and QT interval prolongation. There have been persistent concerns about the safety of fluoroquinolones in children because of arthropathy in juvenile animals. Prospective data on levofloxacin in children is scarce, particularly on its long-term use.

The data were from a prospective, observational, cohort study conducted in Western Cape, South Africa. Children with MDR-TB in this cohort are routinely treated with a 6-7 drug regimen. The regimens include: a fluoroquinolone, a second-line injectable, ethionamide, terizidone, high-dose isoniazid, ethambutol, pyrazinamide, and occasionally other drugs such as PAS. At the beginning of the study levofloxacin was dosed at 10-15 mg/kg once daily and later at 15-20 mg/kg once daily.

There were 70 participants in the study with a median age of 2.1 years (range 0.4-7.3). Of these: 44% were 0-2; 50% were 2-5; and 6% were 6-15 years of age. Approximately half the group were girls; 17% were HIV-infected; and 23% and 35% respectively were underweight or short for their age. The children were followed for a total of 68.5 person years; median time 11.6 months (IQR 9.2-14.7).

The investigators reported that overall most adverse events were grade 1 or 2; the most frequent were vomiting (24 events in 19 children; 0.351 events/person-year) and ALT elevation (27 events in 22 children; 0.394 events/person-year). There were no arthritis events and only three grade 1 arthralgia events in three children (event rate 0.044 events/person-year).

Among grade 1 or 2 adverse events attributed to levofloxacin, vomiting (16 events in 14 children; 0.234 events/person year) and ALT elevation (18 events in 16 children; 0.263 events person year) remained the most reported.

There were three grade 3 and five grade 4 adverse events; seven were ALT elevation (none were attributed to levofloxacin) and one grade 3 headache, possibly related to levofloxacin. No adverse events led to permanent discontinuation of levofloxacin.

The investigators concluded that levofloxacin was safe and well tolerated and can be an option in TB treatment and preventative regimens. But they noted that making an assessment of adverse events associated with levofloxacin in multidrug regimens was hard – many adverse events were likely due to other second-line TB drugs. It is also likely that the event rates they reported overestimate those actually due to levofloxacin.

They suggested that mild arthralgia might be underestimated in young children but serious arthropathy is unlikely to have been missed. Neuropsychological events also might be underestimated. The investigators will report on QT prolongation elsewhere.

Comment

There are limited data on the use of second-line TB drugs in children. Second-line drugs are more toxic than those used in first-line treatment and adverse events are hard to monitor in children. Paediatric formulations are not usually available and doses using divided and/or crushed tablets are uncertain.

Pharmacokinetic data on which to base optimal dosing have been mostly absent until quite recently – thanks to the work of the Stellenbosch group who performed this levofloxacin evaluation. TB drugs are also frequently used with antiretrovirals in children with HIV and TB.

The data above are from a large ongoing study designed to characterise the pharmacokinetics and toxicity of second-line TB drugs for treatment and prevention of drug resistant TB in HIV positive and negative children, by age and HIV status.

We have previously reported findings from this excellent initiative as they have been presented. [2, 3, 4, 5]

References:

1. Garcia-Prats A et al. Safety and tolerability of levofloxacin in HIV-infected and uninfected children treated for multi-drug resistant tuberculosis. TB2016. 16-17 July 2016. Durban, South Africa. Poster abstract 101. Code PO11.
2. Clayden P. Paediatric TB: glimpses of PK data and a potential new approach to drug development. HTB. 1 February 2013.
   https://i-base.info/htb/20861
3. Clayden P. Preventing and treating TB in children – more baby steps . HTB. 1 December 2013.
   https://i-base.info/htb/24037
4. Clayden P. Pharmacokinetics and safety of moxifloxacin in children. HTB. 29 January 2015.
   https://i-base.info/htb/27733
5. Clayden P. Pharmacokinetics of old and new TB drugs for children. HTB. 1 Feruary 2016.
   https://i-base.info/htb/29602

Links to other websites are current at date of posting but not maintained.

Levaquin Users Face Risk of Nerve Damage

Antibiotics are often seen as harmless drugs – something taken to quickly “knock” an illness out of you or even used as a precaution to avoid a full-blown illness. There’s no denying antibiotics have saved lives, but there is growing concern the side effects from certain classes of antibiotics are putting users at serious risk.

One antibiotic receiving attention for serious side effects is Levaquin, which is a brand of fluoroquinolone. Levaquin is used to treat bronchitis, sinusitis, pneumonia, salmonella, staph, urinary tract infections, and a wide range of other bacterial infections. The most common risks associated with the medication involve muscles, tendons, joints, and the central nervous system. The complications that arise from using the medication are potentially permanent and can occur in combination, wreaking havoc on the health and well-being of the user.

Concerns about Levaquin were severe enough the US FDA took action and now requires all fluoroquinolone drugs to include a lengthy warning label listing the risks associated with using the drug, one of which includes the development of peripheral neuropathy.

What is Peripheral Neuropathy?

Peripheral neuropathy occurs when nerves malfunction because of damage or destruction that interfere with normal functioning. Sometimes this causes pain signals to occur when nothing is painful, or the opposite, in which no pain signal is sent if something is harmful. A common example is when someone with diabetes develops peripheral neuropathy that causes them to not feel pain associated with a wound that then develops into serious infections.

Peripheral neuropathy can affect one of the three peripheral nervous systems, including sensory, motor, and autonomic nerves, or any combination of the three. Symptoms of peripheral neuropathy include:

• Sharp, stabbing pains
• Tingling or numbness in the hands and feet
• Feelings of tightness in the hands and feet
• Buzzing or shocking sensations
• Thinning of the skin
• Weak, heavy feelings in the arms and legs
• Inability to hold objects without dropping them
• Sexual dysfunction, primarily in men
• Lowered blood pressure
• Digestive difficult and distress, including diarrhea or constipation
• Excessive sweating

Experienced alone, some of these symptoms don’t appear to be all that serious, but when combined and experienced over time, they can significantly impact a person’s quality of life.

Levaquin Contains Fluoride

Levaquin and all fluoroquinolones contain fluoride, which is a neurotoxin with the ability to enter the brain and damage the central nervous system. Some fluoroquinolones have already been removed from the market and those that remain have long black box warnings concerning the various risks. You can see the label for Levaquin here.

In addition to the risks Levaquin poses for peripheral neuropathy and muscle damage, some users have reported other symptoms, including visual difficulties, renal system issues, nausea and diarrhea, hearing problems, brain fog, skin rashes, depression, and disruptions to blood sugar metabolism. Some of these are included on the drug’s warning label.

Legal Action Taken Against Levaquin Manufacturer

There is growing effort within the legal community and here at Andrus Wagstaff to investigate claims on behalf of patients who allegedly developed peripheral neuropathy and other health problems after using Levaquin. Hundreds of lawsuits have been filed against Johnson & Johnson, the manufacturer of Levaquin. Plaintiffs in these cases claim the drug company was aware of the link between Levaquin and peripheral neuropathy years before it became public knowledge, but opted not to inform doctors or patients about the risk.

Some Antibiotics are Riskier than Others: What You Should Know about Quinolones

Danielle Pavliv, Nydera Booker Pharm. D., MPH, and Sophia Lee, National Center for Health Research

Antibiotics treat and prevent diseases caused by bacteria, and they are among the most widely used prescription medications. It might surprise you to know that  the Centers for Disease Control and Prevention (CDC) estimates that approximately half of the 100 million antibiotic prescriptions written each year in the United States are unnecessary. They are not effective treatments for the common cold, flu or other viral infections, and taking them when they are not needed can be harmful in two ways. #1: All medicines come with risks. Antibiotics also kill the good bacteria in your body that promote health-so taking them for the wrong illness means you get all the harm with none of the benefit. #2: The more an antibiotic is used, the more opportunities the bacteria have to learn to recognize and defend against this cure (antibiotic resistance). Antibiotics can save your life, but taking antibiotics when they are not truly needed increases the risk that these treatments will no longer be effective when people really do need them. So every instance of misuse ends up threatening the health of everyone.

Antibiotic resistance is a major public health issue and can result in longer hospital stays and an increase in the number of patients who die because their disease becomes more difficult to treat. There is also a significant cost to caring for these patients. It costs more than $5 billion annually to treat patients with antibiotic resistant infections.¹ According to the CDC, antibiotic resistance costs our country four times that in excess health care costs, with people spending 8 million more days in the hospital than they otherwise would.²

Some antibiotics can cause serious adverse reactions that may be life-threatening (for an example, read our article on a new antibiotic). Antibiotics are the second most common cause of anaphylaxis, a severe allergic reaction with rapid onset that affects the entire body (food allergies are the most common). Liver damage is another possible serious consequence. Antibiotics can even be deadly; for example, the Z-Pak is a very popular antibiotic that can cause fatal side effects, especially for the elderly and people with heart problems. Less serious and more common reactions include nausea, vomiting, diarrhea, and skin rash.

In 2021, a Scottish study looked at over 8,000 patients who received a diagnosis of colorectal cancer between 1999 and 2011. The researchers found that antibiotic use increased the risk of being diagnosed with colon cancer at all ages. It was already known that antibiotics could alter the bacterial environment in the gut, leading to colorectal cancer in older adults. However, the study also showed that antibiotic use was associated with an increased risk of a particular type of colon cancer called proximal colon cancer in patients under 50. The study reported that two specific classes of antibiotics, quinolones (such as Cipro and Levaquin) and sulfonamides/trimethoprim (Bactrim), were associated with proximal colon cancer in the group of early onset patients. Quinolones will be discussed at length later in this article, but this study confirms the need to be more cautious when selecting antibiotics.³

There are many different classes of antibiotics, grouped by their pharmacological properties and chemical compounds. While all of the approved antibiotics should be capable of treating bacterial infections, different types are often used to treat different types of infections. This article is focused on the risks and benefits of quinolones.

Cipro, Levaquin, and other Quinolones

Quinolones are a type of antibiotic that has much more serious side effects than was known when they were first approved by the FDA.  The most popular quinolones are fluoroquinolones, which include ciprofloxacin (Cipro), lomefloxacin (Maxaquin), norfloxacin (Noroxin), ofloxacin (Floxin), moxifloxacin (Avelox) and levofloxacin (Levaquin). All can be taken in pill form, and the last two can be injected or implanted. The different fluoroquinolonesvary slightly in ways that make them better or worse for some patients. For instance, not all are equally effective when taken in pill form. Some stay in the body longer than others so the patient doesn’t have to take them as often, some have a lower risk of side effects, while others have substantial risks whether taken alone or in combination with other drugs.⁴

Quinolones are broad spectrum antibiotics, which means they are effective against a wide range of diseases caused by bacteria.  They were approved by the FDA to treat conditions including lower respiratory tract infections, skin infections and urinary tract infections. In addition, some types of fluoroquinolone can also treat inflammation of the prostate, sinusitis, and gonorrhea.

However, potentially dangerous side effects include:^5,6

• Arrhythmia (heart rate rhythm is too fast, too slow or irregular)
• Tendon ruptures (more likely in those also taking corticosteroids)
• Changes in blood sugar levels (which can be dangerous for patients with diabetes who take oral medication for hypoglycemia, which is low blood sugar)
• Neuropathy (a kind of nerve damage which can cause pain and numbness, and can also affect internal organs in some cases)
• Central nervous system problems (such as insomnia, seizures, anxiety, paranoia, nervousness or agitation)

Fluoroquinolone cause more than 20,000 ER visits per year.⁷ A CDC study found that even the safer fluoroquinolones resulted in high rates of hospitalization due to psychiatric and neurologic adverse events. In addition to the adverse reactions bulleted above,  patients have developed hallucinations and suicidal thoughts shortly after taking these antibiotic,^8,9 or severe liver and kidney problems.^10,11 As mentioned above, quinolones were also associated with early onset of proximal colon cancer.³

That is why fluoroquinolones should be taken only when needed and for the appropriate amount of time.Unfortunately, the improper use of fluoroquinolones is widespread, with 1 in 3 patients being given them unnecessarily. This includes patients being given the drug for longer than necessary, for conditions not caused by bacteria, or for conditions where the use of another drug was more appropriate.¹² The result was longer hospital stays and more medication-related complications.

Some of the major reasons for the overuse of fluoroquinolones and other antibiotics include pressure from patients and the willingness of health care providers to prescribe antibiotics for common ailments that would clear up on their own. Advertisements and marketing also add to overuse, as does a lack of clear clinical guidance on the appropriate use of antibiotics.^13,14  And although antibiotics are not effective against colds, flu and other viral infections, yet they continue to be given to patients who “need” to take a prescription medication for these conditions.¹⁵

While many antibiotics can be obtained at low cost, fluoroquinolones are more expensive, especially when used to treat common ailments. One study comparing the cost of several antibiotics for treating an uncomplicated urinary tract infection (UTI) found that fluoroquinolones were among the most expensive. It cost $30.45 to treat a UTI patient with Ciprofloxacin (100mg twice daily) for three days as compared to only $11.64 with TMP-SMX (160/800mg twice daily) for three days.¹⁶

Black Box Warnings and Patient Response

In 2008, the FDA announced that fluoroquinolones needed a black box warning because of serious tendon damage – the agency’s most urgent warning about a drug’s risks and side effects.  The FDA states that risk of tendon rupture is even more likely “in people older than 60, in those taking corticosteroid drugs, and in kidney, heart, and lung transplant recipients.”¹⁷ In March 2011, the FDA added a second black box warning concerning the risk that these drugs would “exacerbate muscle weakness in persons with myasthenia gravis,” a kind of neuromuscular disorder.¹⁸

Black box warnings often reduce the number of prescriptions, so companies try to convince the FDA that the warnings are unnecessary and delay them for as long as possible. On October 30, 2012, Johnson and Johnson settled more than 800 lawsuits for failure to adequately warn patients prior to the FDA mandate of the risk of tendon ruptures associated with Levaquin, and the company faces thousands more such lawsuits.¹⁹ This highlights how even with FDA review, the risk of severe side effects from a “safe” drug may not be fully realized or made public until it has been on the market for several years.

Information about the serious health problems caused by these drugs has increased in recent years. In May 2016, the FDA encouraged physicians and other healthcare providers to avoid prescribing quinolones for uncomplicated urinary tract infections, sinus infections, and chronic obstructive pulmonary disease (COPD) unless other antibiotics had been tried and were unsuccessful.²⁰ Research has found that FDA’s advice resulted in fewer prescriptions for quinolones for these conditions. For example, in 2015, before the announcement, quinolones were prescribed for 42% cases of urinary tract infections treated with antibiotics. By late 2018, two years after the announcement, they were prescribed for only 19% of urinary tract infections treated with antibiotics.²⁰

On December 20 2018, the FDA released a report on the impact of fluoroquinolones on ruptures of the aorta, the main artery in the body.²¹ Tearing or rupture of the aorta, called aortic dissection or aneurysm, causes internal bleeding, often resulting in death. The report was based on reports that patients and physicians made to the FDA, which found an increased risk of aortic dissection/aneurysm in patients using fluoroquinolones.

A study by Lee et al revealed a doubling of the rate of aortic aneurysms in patients who took fluoroquinolones compared to patients who were not on that medication. The risk was especially high in patients over the age of 70. Another study (Pasternak et al) found a 60% increased risk in patients who took fluoroquinolones versus those who took amoxicillin. Daneman et al, looking exclusively at older patients over the age of 65, noted that patients on fluoroquinolones were twice as likely to have an aortic aneurysm within 30 days of taking the drug.

The FDA advises patients considering quinolones to speak with their doctor about any previous history of connective tissue disease illness, hypertension, atherosclerosis or genetic diseases that may put them at higher risk fromfluoroquinolones.

You can find more information on this issue here and you can report any adverse events you have been experiencing from taking fluoroquinolones here.

Bottom Line

Antibiotics can save lives and improve health, but their safe use requires “substantial evidence of effectiveness to justify any potential harm.”²² The number of people harmed by these drugs would be reduced if several precautions were taken. First and foremost, antibiotics should not be prescribed or taken for infections caused by a virus. Even when there is a bacterial infection, antibiotics should be chosen with care to ensure that patients receive the antibiotic that is most effective for their specific condition and comes with the fewest risks. Just as penicillins are best for syphilis and macrolides for tonsillitis, quinolones are only preferred for  treating certain types of bacterial infections, such as pneumonia, urinary tract infections, and some skin infections. For patients over 60 with any of these conditions, other antibiotics may be a safer option.

To reduce the spread of resistance for these antibiotics or other types, clinicians should choose a drug that is effective in the disease treatment or prevention, but does not disturb the body’s good bacteria.

Health care providers and pharmacists should explain potential side effects and any risk factors for any antibiotic, and also consider safer alternatives when possible The American College of Physicians has the following warnings for consumers:^23,24

• Don’t insist on antibiotics for yourself or your children.
• Ask your doctor, “Is this antibiotic really necessary?”
• Take only with a doctor’s instructions-don’t take antibiotics left over from old prescriptions, those given to you by friends or family, or purchased abroad without a prescription.
• Prevent infections by washing hands thoroughly. Wash fruits and vegetables thoroughly. Avoid raw eggs and undercooked meats-especially ground meats.
• Keep immunizations up-to-date, especially for influenza and pneumonia if you are a senior citizen or have a chronic illness.
• Finish each antibiotic prescription-even if you feel better. If you don’t finish the prescription some resistant bacteria may stay with you and multiply, requiring a different and most likely stronger antibiotic when the infection returns weeks later.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

The National Center for Health Research is a nonprofit, nonpartisan research, education and advocacy organization that analyzes and explains the latest medical research and speaks out on policies and programs. We do not accept funding from pharmaceutical companies or medical device manufacturers. Find out how you can support us here.

Related Articles:

When new drugs are harmful: Telavancin (VIBATIV) for skin infections
Choosing wisely: medication and treatments you probably DON’T need
Antibiotic uses and challenges — our comprehensive review published on Medscape

1. Goff DA. Antimicrobial stewardship: bridging the gap between quality care and cost. Curr Opin Infect Dis. 2011;24(suppl 1):S11-20.
2. Antimicrobial (Drug) Resistance; Quick facts. National Institute of Allergy and Infectious Diseases. http://www.niaid.nih.gov/topics/antimicrobialresistance/understanding/Pages/quickFacts.aspx
3. Bassett M. Are antibiotics linked to early-onset colorectal cancer? MedPage Today. https://www.medpagetoday.com/meetingcoverage/additionalmeetings/93412. July 3, 2021.
4. Centers for Disease Control and Prevention. Quinolones and the Clinical Laboratory. December 2010. Retrieved at: http://www.cdc.gov/HAI/settings/lab/Quinolones-Clinical-Laboratory.html.
5. Roberts, JR. Adverse reactions to fluoroquinolones. Emergency Medicine News. Oct 2008;30(10):16-18.
6. Powers JH, Phoenix JA, Zuckerman DM. Antibiotic uses and challenges-A comprehensive review from NRCWF. Medscape Family Medicine. June 2010. Retrieved from: http://www.medscape.com/viewarticle/723457.
7. Shehab N, Patel PR, Srinivasan A, Budnitz DS. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis. Centers for Disease Control and Prevention. 2008;47(6):735-743.
8. LaSalvia EA, Domek GJ, Gitlin DF, et al. Fluoroquinolone-induced suicidal ideation. Gen Hosp Psychiatry. 2010;32:108-10.
9. Labay-Kamara U, Manning S, McMahon T. Fluoroquinolone-induced suicidal ideation and suicidality. Psychosomatics. 2012 Jan-Feb;53:1.
10. Qian Qi, Nasr SH, Akogyeram CO, et al. Myoglobin-associated acute kidney injury in the setting of ciprofloxacin administration. Am J Kidney Dis. 2012;59(3):462-66.
11. Figueira-Coelho J, Pereira O, Picado B, et al. Acute hepatitis associated with the use of levofloxacin. Clin Ther. 2010 Sep;32(10):1733-7.
12. Werner NL, Hecker MT, Sethi AK, et al. Unnecessary use of fluoroquinolone antibiotics in hospitalized patients. BMC Infectious Diseases. 2011;11:187.
13. Karabay O, Ozdemir D, Guclu E, et al. Attitudes and behaviors of family physicians regarding use of antibiotics. JMID. 2011;1(2):53-57.
14. White AR (BSAC Working Party on the Urgent Need: Regenerating Antibacterial Drug Discovery and Development). Effective antibacterials: at what cost? The economics of antibacterial resistance and its control. 2011;66:1948-53.
15. The spread of superbugs: What can be done about the rising risk of antibiotic resistance? The Economist. Mar 2011.
16. Mehnert-Kay SA. Diagnosis and management of uncomplicated urinary tract infections. Am Fam Physician. 2005;72:451-6.
17. U.S. Food and Drug Administration. Information for Healthcare Professionals: Fluoroquinolone Antimicrobial Drugs [ciprofloxacin (marketed as Cipro and generic ciprofloxacin), ciprofloxacin extended-release (marketed as Cipro XR and Proquin XR), gemifloxacin (marketed as Factive), levofloxacin (marketed as Levaquin), moxifloxacin (marketed as Avelox), norfloxacin (marketed as Noroxin), and ofloxacin (marketed as Floxin)]. May 2009. Retrieved at: http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm126085.htm.
18. U.S. Food and Drug Administration. Risk of fluoroquinolone-associated Myasthenia Gravis Exacerbation February 2011 label changes for fluoroquinolones. March 2011. Retrieved at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm247115.htm.
19. Fisk, MC, Hawkins, B. Johnson & Johnson settles 845 Levaquin lawsuits. Bloomberg Businessweek. Nov 2011. Retrieved from: http://www.businessweek.com/news/2012-11-01/johnson-and-johnson-reaches-settlement-in-845-levaquin-cases
20. Tran PT, Antonelli PJ, Hincapie-Castillo JM, Winterstein AG. Association of US Food and Drug Administration Removal of Indications for Use of Oral Quinolones With Prescribing Trends. JAMA Internal Medicine. Published online April 19, 2021. doi:10.1001/jamainternmed.2021.1154
22. Powers JH. Risk perception and inappropriate antimicrobial use: Yes, it can hurt. Clin Infect Dis. 2009;48:1350-3.
23. Flynn R, Eckel E, Zuckerman D. National Research Center for Women and Families. The facts about medication for colds and the flu. May 2011. Retrieved at: https://www.center4research.org/2010/03/the-facts-about-medication-for-colds-and-the-flu/.
24. American College of Physicians. Antibiotics: Do you really need them? Retrieved at: http://www.acponline.org/patients_families/pdfs/health/antibiotics.pdf.

The Use of Systemic and Topical Fluoroquinolones

Abstract

Appropriate prescribing practices for fluoroquinolones, as well as all antimicrobial agents, are essential as evolving resistance patterns are considered, additional treatment indications are identified, and the toxicity profile of fluoroquinolones in children has become better defined. Earlier recommendations for systemic therapy remain; expanded uses of fluoroquinolones for the treatment of certain infections are outlined in this report. Prescribing clinicians should be aware of specific adverse reactions associated with fluoroquinolones, and their use in children should continue to be limited to the treatment of infections for which no safe and effective alternative exists or in situations in which oral fluoroquinolone treatment represents a reasonable alternative to parenteral antimicrobial therapy.

Overview

Fluoroquinolones are highly active in vitro against both Gram-positive and Gram-negative pathogens, with pharmacokinetic properties that are favorable for treating a wide array of infections. The prototype quinolone antibiotic agent, nalidixic acid, was first approved by the US Food and Drug Administration (FDA) for adults in 1964 and generally is considered to be the first generation of such agents. For more than 2 decades, nalidixic acid represented the prototypic fluoroquinolone approved by the FDA and was available for children 3 months and older, but it is no longer available. Subsequent chemical modifications resulted in a series of fluoroquinolone agents with an increased antimicrobial spectrum of activity and better pharmacokinetic characteristics.

Ciprofloxacin, norfloxacin, and ofloxacin have a greater Gram-negative spectrum (with activity against Pseudomonas aeruginosa). In 2004, ciprofloxacin became the first fluoroquinolone agent approved for use in children 1 through 17 years of age.

Levofloxacin is often referred to as a respiratory fluoroquinolone because it has increased activity against many of the respiratory pathogens, such as Streptococcus pneumoniae, Mycoplasma pneumoniae, and Chlamydophila pneumoniae, while retaining activity against many of the Gram-negative pathogens. A fourth-generation agent, moxifloxacin, displays increased activity against anaerobes while maintaining Gram-positive and Gram-negative activity and also has excellent activity against Mycobacterium tuberculosis; however, there are limited safety and dosing data available in children.

Animal toxicology data available with the first quinolone compounds revealed their propensity to create inflammation and subsequent destruction of weight-bearing joints in canine puppies.^1,2 This observation effectively sidelined further development or large-scale evaluation of this class of antibiotic agents in children at that time.

A policy statement summarizing the assessment of risks and benefits of fluoroquinolones in pediatric patients was published by the American Academy of Pediatrics (AAP) in 2006, and earlier recommendations remain, with updates as appropriate covered in this document.³ The statement indicated that the parenteral fluoroquinolones were appropriate for the treatment of infections caused by multidrug-resistant pathogens for which no alternative safe and effective parenteral agent existed. However, for outpatient management, oral fluoroquinolones were only indicated when other options were intravenous (IV) treatment with other classes of antibiotic agents. In 2011, the AAP published an updated clinical report because of the increased ophthalmologic and topical use of fluoroquinolones as well as data on lack of toxicity when used in children.⁴

Quinolones that are currently approved for pediatric patients by the FDA and available in an IV and oral suspension formulation are ciprofloxacin for the indications of inhalational anthrax, plague, complicated urinary tract infections (UTIs), and pyelonephritis and levofloxacin for the indications of inhalational anthrax and plague. A randomized, prospective, double-blind multicenter study of moxifloxacin for complicated intraabdominal infection in children, in which patients were randomly assigned to receive either moxifloxacin plus comparator drug placebo or comparator drug plus moxifloxacin placebo, was completed in July 2015, but no data are available at this time. Systemic quinolones licensed in the United States will be discussed in this report. In addition, this review will contain no discussion of the use of fluoroquinolones in infants younger than 6 months.

Safety

Animal Models

The original toxicology studies with quinolones documented cartilage injury in weight-bearing joints in canine puppies, with damage to the joint cartilage proportional to the degree of exposure.^1,2 Each quinolone has a different potential to cause cartilage toxicity,⁵ but given a sufficiently high exposure, cartilage changes will occur in all animal models with all quinolones.

Although initial reports focused on articular cartilage, subsequent studies suggested the possibility of epiphyseal plate cartilage injury,⁶ leading to fluoroquinolone clinical study designs lasting several years to assess growth potential. Data suggest that quinolone toxicity occurs as a result of concentrations present in cartilage that are sufficiently high to form chelate complexes with divalent cations, particularly magnesium, resulting in the impairment of integrin function and cartilage matrix integrity in the weight-bearing joints, which undergo chronic trauma during routine use.⁷

In studies of ciprofloxacin exposure to very young beagle puppies (one of the most sensitive animal models for quinolone toxicity), clinical evidence of arthrotoxicity was observed during a 14-day treatment course at 90 mg/kg per day but not at 30 mg/kg per day.^8,9 Apparent joint tenderness at the higher exposure resolved 6 weeks after the last dose of ciprofloxacin. Histopathologic evidence of cartilage injury was noted in virtually all animals given 90 mg/kg per day of ciprofloxacin. At this exposure level, the observed clinical signs all occurred during and shortly after treatment but resolved by 2 months after cessation, with no recurrent signs noted during the 5-month follow-up period. Histopathologic evidence of cartilage injury was also observed at 30 mg/kg per day, the dose currently recommended for children, and inflammation occurred in fewer than half the animals at this dose but persisted for 5 months after treatment, at full skeletal maturation. The “no observed adverse event level” (NOAEL) was 10 mg/kg per day, a dose at which neither clinical nor histopathologic evidence of toxicity was present, but a dose too low for therapeutic benefit.

Similar data were developed before FDA approval of levofloxacin for adults, documenting a NOAEL at 3 mg/kg per day for IV dosing for 14 days (approximately one-quarter the current FDA-approved dose of 16 mg/kg per day for children who weigh less than 50 kg). Levofloxacin has virtually 100% bioavailability, with total drug exposure being equivalent between IV and oral formulations at the same milligram per kilogram dose.¹⁰

Data from a lamb model, with growth rates and activity more closely mirroring humans than juvenile beagle dogs or rats, have been reported. Gross examination of articular cartilage and microscopic examination of epiphyseal cartilage did not reveal abnormalities consistent with cartilage injury or inflammation after a 14-day drug exposure to either gatifloxacin or ciprofloxacin that was equivalent to that achieved in children receiving therapeutic doses.¹¹

Human Studies

In 2004, the FDA released data about the safety of ciprofloxacin⁸ from an analysis of clinical trial 100169, which evaluated ciprofloxacin for the treatment of complicated UTI or pyelonephritis in children 1 through 17 years of age. The study was a prospective, randomized, double-blind, active-controlled, parallel-group, multinational, multicenter pediatric trial. Ciprofloxacin oral suspension was compared with oral cefixime or trimethoprim-sulfamethoxazole (TMP-SMX) in 1 stratum, and in the second stratum ciprofloxacin (IV alone or IV followed by oral suspension) was compared with a number of comparator regimens, including IV ceftazidime alone or IV ceftazidime followed by oral cefixime or TMP-SMX. Clinical end points were designed to capture any sign of cartilage or tendon toxicity. Arthropathy rates were 9.3% for ciprofloxacin versus 6% for the comparator group (Table 1).

TABLE 1

Rate of FDA-Defined Arthropathy 6 Weeks and 1 Year After Treatment With Ciprofloxacin or a Comparator

Adefurin et al¹² performed a systematic review of the safety data for 16 184 pediatric patients treated with ciprofloxacin by using case reports and case series and reported 1065 (6.6%) adverse events. The most frequently reported events were musculoskeletal (24%), followed by abnormal liver function tests (13%), nausea (7%), white blood cell count derangements (5.3%), vomiting (5.2%), and rash (4.7%). Arthralgia (50% of the 258 musculoskeletal adverse events) was the most common musculoskeletal adverse event reported. These data showed an estimated risk of 16 musculoskeletal adverse events per 1000 patients receiving ciprofloxacin (1.6%; 95% confidence interval: 0.9% to 2.6%), or 1 event for every 62.5 patients. All cases of arthropathy resolved or improved with medical management, which included drug withdrawal in some cases, and none of the studies found growth inhibition.

Levofloxacin safety data were collected on a large cohort of 2523 children who participated in prospective, randomized, unblinded clinical efficacy trials. Data were collected from a community-acquired pneumonia trial in children 6 months to 16 years of age (a randomized 3:1, prospective, comparative trial in 533 levofloxacin-exposed and 179 comparator-exposed evaluable subjects) and from 2 trials assessing therapy for acute otitis media in children 6 months to 5 years of age (1 open-label noncomparative study in 204 evaluable subjects and another randomized 1:1, prospective, comparative trial in 797 levofloxacin-exposed and 810 comparator-exposed evaluable subjects).¹³ In addition, after completion of the treatment trials, all subjects from both treatment arms were also offered participation in an unblinded, 12-month follow-up study for safety assessments, including musculoskeletal events.

The definitions of musculoskeletal events for tendinopathy (inflammation or rupture of a tendon as determined by physical examination and/or MRI or ultrasonography), arthritis (inflammation of a joint as evidenced by redness and/or swelling of the joint), arthralgia (pain in the joint as evidenced by complaint), and gait abnormality (limping or refusal to walk) were determined before starting the studies. The identity of study medication was known by parents, study personnel, and the subject’s care providers because reports of musculoskeletal events and any other adverse events were collected during the follow-up period. An analysis of these events occurred at 1, 2, and 12 months after treatment. The analysis of disorders involving weight-bearing joints documented a statistically greater rate between the levofloxacin-treated group and comparator group at 2 months (1.9% vs 0.7%; P = .025) and at 12 months (2.9% vs 1.6%; P = .047). A history of joint pain accounted for 85% of all events, with no findings of joint abnormality when assessed by physical examination. Computed tomography or MRI was performed for 5 of the patients with musculoskeletal symptoms; no signs of structural injury were identified. No evidence of joint abnormalities was observed at 12 months in the levofloxacin group.

A long-term follow-up study (5 years) in selected subjects from this cohort was published recently.¹⁴ The selection of the children for this long-term follow-up study was based on meeting 1 of the following criteria: (1) growth impaired or possibly growth impaired, defined as a documented height <80% of the expected height increase 12 months after treatment; (2) assessed by the investigator as having abnormal bone or joint symptoms during the original 12-month follow-up; (3) persisting musculoskeletal adverse events at the end of the original 12 months of follow-up; and (4) follow-up requested by the drug safety monitoring committee because of concerns for possible tendon/joint toxicity associated with a protocol-defined musculoskeletal disorder. Of the 2233 subjects participating in the previously described 12-month follow-up study, 124 of 1340 (9%) from the levofloxacin group and 83 of the 893 (9%) subjects in the comparator group were enrolled (207 total subjects), and 49% from each group completed the study. Although an increase in musculoskeletal events in the levofloxacin group had been noted at 12 months after treatment, the cumulative long-term outcomes of children with musculoskeletal adverse events reported during the 5-year safety study (including ongoing arthropathy, peripheral neuropathy, abnormal bone development, scoliosis, walking difficulty, myalgia, tendon disorder, hypermobility syndrome, and pain in the spine, hip, and shoulder) were slightly higher in the comparator group (0.1%) than in the levofloxacin group (0.07%). A total of 174 of 207 (84%) reviewed subjects were identified by the growth-impaired or possible growth-impaired criteria. Children from levofloxacin and comparator treatment groups had similar growth characteristics at the 5-year assessment, with equal percentages of children from each treatment group having (1) no change in height percentile, (2) an increase in percentile, or (3) a decrease in percentile. Of the 9 children that had less growth than predicted (6 of 104 [6%] from the levofloxacin group, 3 of 70 [4%] from the comparator group), none were believed by the drug monitoring safety committee to have drug-attributable growth changes. This 5-year follow-up study enrolled 48% of study participants from US sites compared with 20% from US sites enrolled in the original clinical trials.

A rare complication associated with quinolone antibiotic agents, tendon rupture, has a predilection for the Achilles tendon (and is often bilateral) and is estimated to occur at a rate of 15 to 20 per 100 000 treated patients in the adult population.¹⁵ Advanced age, along with antecedent steroid therapy and a particular subset of underlying diseases, including hypercholesterolemia, gout, rheumatoid arthritis, end-stage renal disease/dialysis, and renal transplantation, have been identified as risk factors and prompted an FDA warning about this serious adverse event for all quinolone agents. Although rare cases of Achilles tendon rupture can follow overuse injuries in children, to date there have been no reports of Achilles tendon rupture in children in association with quinolone use. In summary, although isolated studies of fluoroquinolone antimicrobial agents have suggested possible musculoskeletal toxicity in children, there is no evidence for long-term harm at this time.

Other potential adverse reactions of fluoroquinolone-class antibiotic agents, although very uncommon in children, include central nervous system adverse effects (seizures, headaches, dizziness, lightheadedness, sleep disorders, hallucinations) and peripheral neuropathy. In data from clinical trial 100169, the rate of neurologic events described were similar between ciprofloxacin-treated and comparator-treated children.⁸ Reported rates of neurologic events in the levofloxacin safety database were statistically similar between fluoroquinolone- and comparator-treated children.^16,17

Cardiotoxicity (see Additional Risks/Conditions), disorders of glucose homeostasis (hypo- and hyperglycemia), hepatic dysfunction, renal dysfunction (interstitial nephritis and crystal nephropathy), and hypersensitivity reactions have also been reported. Practitioners should be aware that fluoroquinolone-associated photosensitivity has been described, and patients should be counseled to use appropriate sun-protection measures. Rashes were more commonly noted in association with the use of >7 days of gemifloxacin in women younger than 40 years.

Resistance

Resistance has been a concern since the approval of quinolone agents, given the broad spectrum of activity and the large number of clinical indications. Multiple mechanisms of resistance have been described, including mutations leading to changes in the target enzymes DNA gyrase and DNA topoisomerase, as well as efflux pumps and alterations in membrane porins.¹⁸ The role of plasmid-mediated quinolone resistance determinants such as qnr genes, continues to increase. The phenotype conferred by these genes generally shows a low-level resistance to fluoroquinolones, but it also appears to encourage additional fluoroquinolone resistance mechanisms that lead to high-level resistance.¹⁹ Several surveillance studies have shown that after the introduction of fluoroquinolones into clinical practice, resistance rapidly develops, although less commonly in pediatric patients given the reduced use of these medications in children. In large-scale pediatric studies of levofloxacin for acute otitis media, the emergence of levofloxacin-resistant pneumococci was not shown after treatment, suggesting that the emergence of resistance during treatment is not a common event.²⁰ In adult patients, Pseudomonas resistance to both fluoroquinolones and other antimicrobial agents is problematic.²¹ Data on resistance in Escherichia coli isolated from adults with UTIs who were seen in emergency departments in the EMERGEncy ID NET, a network of 11 geographically diverse university-affiliated institutions, suggest a low but stable rate of resistance of approximately 5%,²² although in specific locations, rates of resistance for outpatients are closer to 10%.^23,24 Similar published data do not exist for children, although in current reports that include outpatient data, stratified by age, rates of fluoroquinolone resistance in E coli in children have been generally well below 3%.^24,25

Recent data from Canadian hospitals revealed that antimicrobial resistance rates continue to be higher in older age groups as compared with children and that there is considerable variability in age-specific resistance trends for different pathogens.²⁶ Data available from 4 large tertiary care children’s hospitals (Houston, Kansas City, San Diego, and Philadelphia) document ciprofloxacin resistance to E coli to range from 5% to 14% for 2014 (G.E. Schutze, MD, M.A. Jackson, MD, J. Bradley, MD, and T. Zaoutis, MD, personal communication, 2015) with rates that appear to be stable for the last 3 years. As fluoroquinolone use in pediatrics increases, it is expected that resistance will increase, as has been documented in adults. There is a clear risk of resistance in patients exposed to repeated treatment courses. Susceptibility data in patients with cystic fibrosis revealed a sharp increase in resistance to Pseudomonas strains when comparing rates from 2001 and 2011.²⁷ There is a correlation between fluoroquinolone use and the emergence of ciprofloxacin and levofloxacin resistance among Gram-negative bacilli in hospitalized children.²⁸ As expected, when the use of the fluoroquinolones (in particular levofloxacin) increased, the susceptibility of Gram-negative bacilli to ciprofloxacin and levofloxacin significantly decreased.²⁹

Additional Risks/Considerations

The incidence of Clostridium difficile–associated disease in children continues to increase across the United States. The AAP Committee on Infectious Diseases emphasizes the risks related to the development of C difficile–associated disease, which includes exposure to antimicrobial therapy.³⁰ Current data suggest that clindamycin, oral cephalosporins, and fluoroquinolone-class antibiotics are associated with an increased risk of both community-acquired and hospital-acquired C difficile–associated disease.^31,32

Cardiotoxicity of fluoroquinolones is well described in adults and relates to the propensity of such drugs to prolong the QT interval through blockage of the voltage-gated potassium channels, especially the rapid component of the delayed rectifier potassium current I(Kr), expressed by HERG (the human ether-a-go-go–related gene). Moxifloxacin has the greatest risk to prolong the QT interval and should be avoided in patients with long QT syndrome, those with hypokalemia or hypomagnesemia, those with organic heart disease including congestive heart failure, those receiving an antiarrhythmic agent from class Ia or class III (eg, quinidine and procainamide or amiodarone and sotaolo, respectively), those who are receiving a concurrent drug that prolongs the QTc interval independently, and those with hepatic insufficiency–related metabolic derangements that may promote QT prolongation. Levofloxacin also appears to prolong the QT interval, although at a lower risk than moxifloxacin. Ciprofloxacin appears to confer the lowest risk.³³ No cases of cardiotoxicity or torsades de pointes in children associated with fluoroquinolones have been reported to date.³⁴

Use of Fluoroquinolones in Pediatric Infections

Conjunctivitis

Although most clinicians use a polymyxin/trimethoprim ophthalmologic solution or polymyxin/bacitracin ophthalmic ointment for the treatment of acute bacterial conjunctivitis, an increasing number of topical fluoroquinolones are approved by the FDA for this indication in adults and children older than 12 months, including levofloxacin, ofloxacin, moxifloxacin, gatifloxacin, ciprofloxacin, and besifloxacin (Table 2). Conjunctival tissue pharmacokinetic studies that use conjunctival biopsies in healthy adult volunteers with besifloxacin, gatifloxacin, and moxifloxacin have been performed. All 3 agents reached peak concentrations after 15 minutes.³⁵ Although drug concentrations are only 1 indicator of potential clinical efficacy, the utility of agents with higher concentrations is tempered by the observation of a potential increase in ocular adverse events, such as eye pain,³⁵ and slower corneal reepithelialization with specific agents.³⁶ Bacterial eradication and clinical recovery of 447 patients aged 1 through 17 years with culture-confirmed bacterial conjunctivitis were evaluated in a post hoc multicenter study investigating besifloxacin and moxifloxacin ophthalmic drops.³⁷ Although better clinical and microbiologic response was noted for besifloxacin compared with placebo, similar outcomes were noted when compared with moxifloxacin. Both agents were reported to be well tolerated.

TABLE 2

Most Common Infections for Which Fluoroquinolones Are Effective Therapy

External Otitis, Tympanostomy Tube–Associated Otorrhea

Recommendations for optimal care for patients with otitis externa are outlined in a review of 19 randomized controlled trials, including 2 from a primary care setting, yielding 3382 participants.³⁸ Topical antibiotic agents containing corticosteroids appeared to be more effective than acetic acid solutions. Aminoglycoside-containing otic preparations were reported to cause ototoxicity if the tympanic membrane was not intact; fluoroquinolone-containing preparations represent a safer alternative to treat both otorrhea associated with tympanic membrane perforation and tympanostomy tube otorrhea. Eleven trials included aural toilet as a routine intervention, but the authors acknowledged that this treatment is not likely to be available in a typical primary care office setting.³⁸ The paucity of high-quality studies of antimicrobial agent–based topical therapy limited conclusions in this review. A small, prospective, randomized, open-label study in 50 patients with tympanostomy tube otorrhea or a tympanic membrane perforation showed comparable outcomes with either topical antibiotic therapy or topical plus systemic antibiotic agents.³⁹ For children with severe acute otitis externa, systemically administered antimicrobial agents should be considered in addition to topical therapy.⁴⁰

Which topical antibiotic agent is best for external otitis is unclear.⁴¹ High-quality studies that evaluated quinolone versus nonquinolone topical solutions are limited. A systematic review of 13 meta-analyses confirmed that topical antibiotic agents were superior to placebo and noted a statistically significant advantage of quinolone agents over nonquinolone agents in the rate of microbiologic cure (P = .035). Safety profiles were similar between groups.⁴⁰ Similarly, Mösges et al⁴² reviewed 12 relevant randomized controlled clinical studies involving 2682 patients and concluded that quinolone therapy achieved a higher cure rate (P = .01) and superior eradication rate (P = .03) than a non–fluoroquinolone-containing antibiotic-steroid combination. The clinical significance of these 2 reviews is reduced, however, when considering that bacterial persistence in the ear canal after treatment does not necessarily imply persistent acute otitis externa symptoms. A conclusion that quinolone and nonquinolone agents are similar in both microbiologic and clinical cure rates was reached in a study in more than 200 children, 90 of whom were evaluated for microbiologic response in a multicenter, randomized, parallel-group, evaluator-blinded study comparing once-daily ofloxacin drops with a 4-times-daily neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension. Microbial eradication was documented in 95% and 94%, respectively; clinical cure was achieved in 96% and 97%, respectively.⁴³ Treatment with fluoroquinolone agents has been well tolerated.

Acute Otitis Media, Sinusitis, and Lower Respiratory Tract Infections

Newer fluoroquinolones show enhanced in vitro activity against S pneumoniae, compared with ciprofloxacin. The clinical need for such agents to treat respiratory tract infections has largely been driven by the emergence of multidrug-resistant strains of this pathogen, such as serotype 19A pneumococcus. Current otitis media and acute bacterial sinusitis guidelines from the AAP and Pediatric Infectious Diseases Society/Infectious Diseases Society of America guidelines on community-acquired pneumonia in children support the use of levofloxacin as an alternative therapy for those with severe penicillin allergy and for those infected with suspected multidrug-resistant pneumococcus (ie, patients in whom amoxicillin and amoxicillin-clavulanate have failed).^44–46 Pharmacokinetic data for children 6 months and older are well defined for levofloxacin, the only currently available fluoroquinolone studied for respiratory tract infections in children.⁴⁷

Acute Bacterial Otitis Media

Clinical studies of levofloxacin and gatifloxacin have been conducted in children with recurrent or persistent otitis media but in those with not simple acute bacterial otitis media. Although studies of several fluoroquinolones have been reported, only levofloxacin is currently available in the United States. A prospective, open-label, noncomparative study of levofloxacin was performed in 205 children 6 months and older, 80% of whom were younger than 2 years. Tympanocentesis was performed at study entry and at least at 3 to 5 days into therapy for children who had treatment failure or persistent effusion. Bacterial eradication of middle-ear pathogens occurred in 88% of children, including 84% infected by pneumococci and 100% infected by Haemophilus influenzae. Levofloxacin treatment was well tolerated, with vomiting in 4% of patients documented as the most common adverse effect.⁴⁸ An evaluator-blinded, active-comparator, noninferiority multicenter study comparing levofloxacin with amoxicillin-clavulanate (1:1) involving 1305 evaluable children older than 6 months documented equivalent clinical cure rates of 75% in each treatment arm. Because tympanocentesis was not required, microbiologic cure rates could not be determined.¹⁷

Pneumonia

Although initially approved by the FDA for the treatment of pneumonia and acute exacerbation of chronic bronchitis in adults, ciprofloxacin therapy has not been uniformly successful in the treatment of pneumococcal pneumonia in adults at dosages initially studied 30 years ago. Failures are most likely the result of increasing pneumococcal resistance to ciprofloxacin and other fluoroquinolones documented since their first approval.⁴⁹ Ciprofloxacin is currently not considered appropriate therapy for community-acquired pneumonia in adults because of its resistance profile.

Fluoroquinolones with enhanced activity against S pneumoniae compared with ciprofloxacin (levofloxacin, moxifloxacin, gemifloxacin) have been used in adults for single-drug treatment of community-acquired pneumonia. These “respiratory tract” fluoroquinolones show in vitro activity against the most commonly isolated pathogens: S pneumoniae, H influenzae (nontypeable), and Moraxella catarrhalis as well as M pneumoniae, C pneumoniae, and Legionella pneumophila.^50–52 Although these agents are not the drugs of choice for pneumonia in previously healthy adults, they are recommended for adults with underlying comorbidities and for those who have been exposed to antibiotic agents within the previous 3 months and are, therefore, more likely to be infected with antibiotic-resistant pathogens.⁵³ Failures in the treatment of pneumococcal pneumonia have been reported with levofloxacin at 500 mg daily as a result of the emergence of resistance while receiving therapy or resistance from previous exposures to fluoroquinolones.⁵⁴ An increased dose of levofloxacin (750 mg daily, given for 5 days) is currently approved by the FDA for adults with pneumonia. The increase in drug exposure at the higher dose is recognized to overcome the most common mechanism for the development of fluoroquinolone resistance.⁵⁵

Of the fluoroquinolones, only levofloxacin has been studied prospectively in children with community-acquired pneumonia, documenting efficacy in a multinational, open-label, noninferiority-design trial, compared with standard antimicrobial agents for pneumonia.¹⁶ For children 6 months to 5 years of age, levofloxacin (oral or IV) was compared with amoxicillin-clavulanate (oral) or ceftriaxone (IV). For children 5 years and older, levofloxacin (oral) was compared with clarithromycin (oral) and levofloxacin (IV) was compared with ceftriaxone (IV) in combination with either erythromycin (IV) or clarithromycin (oral). Clinical cure rates were 94.3% in the levofloxacin-treated group and 94.0% in the comparator group, with similar rates of cure in both the younger and older age groups. Microbiologic etiologies were investigated, with Mycoplasma being the most frequently diagnosed pathogen, representing 32% of those receiving levofloxacin in both older and younger age groups and approximately 30% of those receiving comparator agents in both age groups. Pneumococci were infrequently documented to be the cause of pneumonia in study patients, representing only 3% to 4% of those who received levofloxacin and 3% to 5% of those receiving the comparator. Of note, the clinical response rate of 83% in children younger than 5 years, diagnosed by serologic testing with Mycoplasma infection and treated with amoxicillin-clavulanate, was similar to that in children treated with levofloxacin (89%), suggesting a high rate of spontaneous resolution of disease caused by Mycoplasma species in preschool-aged children, poor accuracy of diagnosis by serologic testing, or a clinical end-point evaluation after a treatment course that could not identify possible differences in response that may have been present in the first days of therapy.

Levofloxacin is now recognized as the preferred oral agent for children as young as 6 months of age with highly penicillin-resistant isolates (minimum inhibitory concentration of ≥4 μg/mL).⁴⁴ Although fluoroquinolones may represent effective therapy, they are not recommended for first-line therapy for community-acquired respiratory tract infections in children, because other better-studied and safer antimicrobial agents are available to treat the majority of the currently isolated pathogens.

Gastrointestinal Infections

Alghasham and Nahata⁵⁶ summarized the results of 12 efficacy trials by using a number of fluoroquinolone agents for infections caused by Salmonella and Shigella species, but only 2 of the 12 trials reported data on fluoroquinolones compared with nonquinolone agents. Patients were treated for typhoid fever (8 studies, including 7 for multidrug-resistant strains), invasive nontyphoid salmonellosis (1 study), and shigellosis (3 studies). Clinical and microbiologic success with fluoroquinolone therapy for these infections was similar when comparing children with adults. Recent data, however, show that fluoroquinolone resistance among isolates responsible for enteric fever in South Asia is very high (>90%), and the use of these drugs has been severely limited because of this.^57,58 Therefore, fluoroquinolones would not be an appropriate option in visitors returning from South Asia with enteric fever.

A prospective, randomized, double-blind comparative trial of acute, invasive diarrhea in febrile children in Israel was conducted by Leibovitz et al⁵⁹ comparing ciprofloxacin with intramuscular ceftriaxone in a double-dummy treatment protocol. A total of 201 children were treated and evaluated for clinical and microbiologic cure as well as for safety. Pathogens, most commonly Shigella and Salmonella species, were isolated in 121 children. Clinical and microbiologic cures were equivalent between groups.⁵⁹

In the United States, although cases of typhoid fever and invasive salmonellosis are uncommon, there are approximately 500 000 cases of shigellosis, with 62 000 of the cases occurring in children younger than 5 years.⁶⁰ Treatment is recommended, primarily to prevent the spread of infection. Ampicillin and TMP-SMX resistance is increasing, and multidrug-resistant strains are becoming common; the National Antimicrobial Resistance Monitoring System reported that 38% of strains isolated from 1999 to 2003 were resistant to both ampicillin and TMP-SMX. A 2005 outbreak of multidrug-resistant Shigella sonnei infection involving 3 states was reported in the Morbidity and Mortality Weekly Report⁶¹; 89% of strains were resistant to both agents, but 100% of strains were susceptible to ciprofloxacin. Recently, however, fluoroquinolone resistance has been noted to be increasing at an alarming rate in Asia and Africa, and these resistant isolates are also starting to be seen in the United States as well.^62,63 Treatment options for multidrug-resistant shigellosis, depending on the antimicrobial susceptibilities of the particular strain, include ciprofloxacin, azithromycin, and parenteral ceftriaxone. Nonfluoroquinolone options should be used if available.

Although ciprofloxacin has been regarded as an effective agent for traveler’s diarrhea in the past, resistance rates are increasing for specific pathogens in many parts of the world. Resistance to Campylobacter species is particularly problematic in patients with a history of international travel. Recent data from Campylobacter isolates from international travel revealed fluoroquinolone resistance of approximately 61%.⁶⁴ Therefore, fluoroquinolones would not be an appropriate option in the treatment of traveler’s diarrhea unless a pathogen is defined and antimicrobial susceptibilities are confirmed.

UTI

Standard empirical therapy for uncomplicated UTI in the pediatric population continues to be a cephalosporin antibiotic agent, because TMP-SMX– and amoxicillin-resistant E coli are increasingly common. The fluoroquinolones remain potential first-line agents only in the setting of pyelonephritis or complicated UTI when typically recommended agents are not appropriate on the basis of susceptibility data, allergy, or adverse event history. AAP policy continues to support the use of ciprofloxacin as oral therapy for UTI and pyelonephritis caused by P aeruginosa or other multidrug-resistant Gram-negative bacteria in children 1 through 17 years of age.³ If ciprofloxacin is started as empirical therapy, but susceptibility data indicate a pathogen that is susceptible to other appropriate classes of antimicrobial agents, the child’s therapy can be switched to a nonfluoroquinolone.

Mycobacterial Infections

The fluoroquinolones are active in vitro against mycobacteria, including M tuberculosis and many nontuberculous mycobacteria.^53,65 Increasing multidrug resistance in M tuberculosis has led to the increased use of fluoroquinolones as part of individualized, multiple-drug treatment regimens, with levofloxacin and moxifloxacin showing greater bactericidal activity than ciprofloxacin.⁶⁶ Treatment regimens that include 1 to 2 years of fluoroquinolones for multidrug-resistant and extensively drug-resistant tuberculosis have not been studied prospectively in children. Prevailing evidence supports the use of fluoroquinolones in the treatment of multidrug-resistant tuberculosis infections in children.^67,68 The extended administration of the fluoroquinolones in adults with multidrug-resistant tuberculosis has not shown serious adverse effects, and there is no evidence to date suggesting that this is different in children.⁶⁹ A recent study that focused on the use of levofloxacin for tuberculosis infection in an adult liver transplant patient population did show a risk of tenosynovitis in 18% of those treated, highlighting that the clinician needs to be aware that additional risk factors for poor wound healing (patients older than 60 years, those taking corticosteroid drugs, and those with kidney, heart, or lung transplants [black box warning for all fluoroquinolones]) may increase the risk of musculoskeletal adverse effects.⁷⁰

Other Uses

Ciprofloxacin and levofloxacin are among the acceptable antimicrobial agents for use in postexposure prophylaxis against Bacillus anthracis as well as for the treatment of many forms of anthrax (eg, cutaneous, inhalation, systemic) in children 1 month or older.⁷¹ Ciprofloxacin is one of the antimicrobial options in postexposure prophylaxis and/or treatment of plague as well.^72,73

Ciprofloxacin is effective in eradicating nasal carriage of Neisseria meningitidis (single dose, 500 mg for adults and 20 mg/kg for those older than 1 month) and preferred in nonpregnant adults. It can also be considered in younger patients as an alternative to 4 days of rifampin if ciprofloxacin-resistant isolates of N meningitidis have not been detected in the community.

Good penetration into the cerebrospinal fluid by certain fluoroquinolones (eg, levofloxacin) is reported, and concentrations often exceed 50% of the corresponding plasma drug concentration. In patients with tuberculosis, cerebrospinal fluid penetration, measured by the ratio of the plasma area under the concentration time curve from 0 to 24 to the cerebrospinal fluid area under the curve (0–24), was greater for levofloxacin (median: 0.74; range: 0.58–1.03) than for gatifloxacin (median: 0.48; range: 0.47–0.50) or ciprofloxacin (median: 0.26; range: 0.11–0.77).⁷⁴ In cases of multidrug-resistant, Gram-negative meningitis for which no other agents are suitable, fluoroquinolones may represent the only treatment option.

P aeruginosa can cause skin infections (including folliculitis) after exposure to inadequately chlorinated swimming pools or hot tubs. The disease is self-limited and the majority of children will not require antimicrobial therapy, but if they do, oral fluoroquinolone agents offer a treatment option that may be preferred over parenteral nonfluoroquinolone antimicrobial therapy. In addition, fluoroquinolones may be considered as part of an antimicrobial regimen in cases of infections after penetrating skin/soft tissue injuries in the setting of water exposure when P aeruginosa or Aeromonas hydrophila may play a significant role.

A recent systematic review of empirical fluoroquinolone therapy for children with fever and neutropenia found excellent outcomes with short-term safety. It should be emphasized, however, that these data were from studies in patients with low-risk fever and neutropenia (leukemia/lymphoma), of whom only a small proportion would be expected to have a serious occult bacterial infection.⁷⁵ Ongoing investigations will help define the role for these antimicrobial agents in patients with fever and neutropenia.

Summary

Fluoroquinolones are broad-spectrum agents that should be considered selectively for use in a child or adolescent for specific clinical situations, including the following: (1) infection caused by a multidrug-resistant pathogen for which there is no safe and effective alternative and (2) options for treatment include either parenteral nonfluoroquinolone therapy or oral fluoroquinolone therapy and oral therapy is preferred. In other clinical situations outlined previously, fluoroquinolones may also represent a preferred option (eg, topical fluoroquinolones in the treatment of tympanostomy tube–associated otorrhea) or an acceptable alternative to standard therapy because of concerns for antimicrobial resistance, toxicity, or characteristics of tissue penetration. If a fluoroquinolone is selected for therapy on the basis of the above considerations, practitioners should be aware that both ciprofloxacin and levofloxacin are costly.

Although adverse reactions are uncommon, because of the potential for risks of peripheral neuropathy, central nervous system effects, and cardiac, dermatologic, and hypersensitivity reactions in adults, in July 2016 the FDA added a safety announcement with updated box warnings restricting use of fluoroquinolone antibiotics in adults with acute sinusitis, acute bronchitis, and uncomplicated UTI to situations in which no other alternative treatment is available. No compelling published evidence to date supports the occurrence of sustained injury to developing bones or joints in children treated with available fluoroquinolone agents; however, FDA analysis of ciprofloxacin safety data suggests the possibility of increased musculoskeletal adverse events. Although studies were not blinded, with the potential for bias, children treated with levofloxacin both immediately after treatment and at a 12-month follow-up had an increased rate of musculoskeletal complaints but no physical evidence of joint findings. However, 5 years after treatment, no differences were seen between levofloxacin-treated and comparator-treated children. In the case of fluoroquinolones, as is appropriate with all antimicrobial agents, prescribing clinicians should verbally review common, anticipated, potential adverse events, such as rash, diarrhea, and potential musculoskeletal or neurologic events, and indicate why a fluoroquinolone is the most appropriate antibiotic agent for a child’s infection.

Lead Authors

Mary Anne Jackson, MD, FAAP

Gordon E. Schutze, MD, FAAP

Committee on Infectious Diseases, 2016–2017

Carrie L. Byington, MD, FAAP, Chairperson

Yvonne A. Maldonado, MD, FAAP, Vice Chairperson

Elizabeth D. Barnett MD, FAAP

James D. Campbell, MD, FAAP

H. Dele Davies, MD, MS, MHCM, FAAP

Ruth Lynfield, MD, FAAP

Flor M. Munoz, MD, FAAP

Dawn Nolt, MD, FAAP

Ann-Christine Nyquist, MD, MSPH, FAAP

Sean O’Leary, MD, MPH, FAAP

Mobeen H. Rathore, MD, FAAP

Mark H. Sawyer, MD, FAAP

William J. Steinbach, MD, FAAP

Tina Q. Tan, MD, FAAP

Theoklis E. Zaoutis, MD, MSCE, FAAP

Former Committee Members

John S. Bradley, MD, FAAP

Kathryn M. Edwards, MD, FAAP

Gordon E. Schutze, MD, FAAP

Ex Officio

David W. Kimberlin, MD, FAAP – Red Book Editor

Michael T. Brady, MD, FAAP – Red Book Associate Editor

Mary Anne Jackson, MD, FAAP – Red Book Associate Editor

Sarah S. Long, MD, FAAP – Red Book Associate Editor

Henry H. Bernstein, DO, MHCM, FAAP – Red Book Online Associate Editor

H. Cody Meissner, MD, FAAP – Visual Red Book Associate Editor

Liaisons

Douglas Campos-Outcalt, MD, MPA – American Academy of Family Physicians

Amanda C. Cohn, MD, FAAP – Centers for Disease Control and Prevention

Karen M. Farizo, MD – US Food and Drug Administration

Marc Fischer, MD, FAAP – Centers for Disease Control and Prevention

Bruce G. Gellin, MD, MPH – National Vaccine Program Office

Richard L. Gorman, MD, FAAP – National Institutes of Health

Natasha Halasa, MD, MPH, FAAP – Pediatric Infectious Diseases Society

Joan L. Robinson, MD – Canadian Paediatric Society

Jamie Deseda-Tous, MD – Sociedad Latinoamericana de Infectologia Pediatrica

Geoffrey R. Simon, MD, FAAP – Committee on Practice Ambulatory Medicine

Jeffrey R. Starke, MD, FAAP – American Thoracic Society

Acknowledgments

We thank Dr John S. Bradley, MD, FAAP, for his critical review and input into this manuscript.

Footnotes

• This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

• Clinical reports from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, clinical reports from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.

• The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

• All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

• FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

• FUNDING: No external funding.

• POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

• Copyright © 2016 by the American Academy of Pediatrics

Rules for the safe use of antibiotics

Today most diseases are treated with antibiotics. However, very few people know about the dangers and side effects of these drugs, why self-medication with antibiotics is dangerous, and what questions to ask your doctor before taking these drugs.

So, below are the basic rules that you need to familiarize yourself with before starting antibiotic therapy.

1. Be sure to tell the doctor prescribing you the antibiotic the following:

• Have you ever had an allergy to antibiotics, and if so, which ones.
• Do you suffer from liver and / or kidney disease. The fact is that all antibiotics are excreted from the body by the liver or kidneys. In case of malfunction of these organs, a dangerous overdose of the drug may occur.
• What medications did you take before seeing a doctor? When prescribing an antibiotic, these questions need to be known to the doctor, since many drugs cannot be taken at the same time.

2. To prevent many of the unwanted effects of self-medication, you should know the following rules:

• Antibiotics are effective only against bacteria, so it makes no sense to treat viral and fungal diseases such as influenza, hepatitis, thrush with them.
• The therapeutic effect of the antibiotic manifests itself within three days – if after this period there is no relief, the doctor must replace this antibiotic with another drug.
• Antibiotics should be taken in a course of five days or more. It should be remembered that even if the painful symptoms completely disappear, in no case should you stop taking the drug. This is due to the fact that a complete disruption of the bacterial life cycle takes just such a time.
• With incomplete treatment, resistance often develops, i.e. the resistance of the pathogen to the drug, and in the future this antibiotic will no longer be effective.
• It is extremely dangerous and undesirable to take several antibiotics at the same time.
• It is necessary to take the drug at a strictly defined time, since each antibiotic has its own lifetime in the body, and as a result of irregular intake, so-called “windows” are formed when a fresh dose of an antibiotic does not enter the bloodstream and bacteria have time to breathe and adapt to this drug the drug.

3. When self-medication with antibiotics, the following complications are most common:

• Disorders of the heart, manifested in the development of arrhythmias, which significantly increases the risk of heart attacks and strokes.
• Exerting a destructive effect on liver and kidney cells, which can cause hepatic or renal coma.
• Hearing impairment, up to complete deafness. Today this problem is common in pediatrics, when children are given “non-child” doses of antibiotics.
• Visual impairment.
• Disorders of intrauterine development of a child when taking antibiotics during pregnancy.
• Development of hallucinations, psychosis, conditions similar to epileptic seizures.

Source: http://medvestnik.by/

Cystitis: treatment of the disease | Clinic Rassvet

Fast passage

Cystitis is an inflammation of the lining of the bladder.

Cystitis is acute and recurrent, infectious and non-infectious, complicated and uncomplicated. The most common form of the disease is acute uncomplicated cystitis. Uncomplicated cystitis means cystitis of non-pregnant women without anatomical and functional abnormalities of the urinary system, without serious concomitant diseases.

Acute cystitis is one of the most common diseases in women. More than 50% of women have made such a diagnosis at least once in their life.

Anatomy

Anatomically, the female urethra is much shorter and wider than the male, is 2-4 cm long and is located close to natural sources of infection such as the vagina and anus. In men, the length of the urethra is about 20 cm, anatomically divided into several sections. Before entering the bladder, the urethra passes through the prostate gland, which is a natural barrier that prevents infection from entering the bladder.

Predisposing factors

The predisposing factors for the development of cystitis are:

• anatomical and physiological characteristics of the female body, changes in the location of the urethra;
• excessively active sex life;
• new sexual partner, frequent change of sexual partners;
• use of spermicides;
• episode of urinary tract infection (UTI) in childhood;
• maternal history of urinary tract infections.

The causative agent of acute cystitis in 70-95% of cases is E. coli – Escherichia coli. Other pathogens, such as staphylococcus aureus, klebsiella, proteus, are much less common.

Symptoms of acute cystitis

Cystitis symptoms most often include:

These complaints, alone or in combination, occur in 90% of women with acute cystitis. A rise in body temperature above 37.3 ° C is not characteristic of cystitis and may indicate a more serious inflammatory process in the kidneys – acute pyelonephritis.

Blood in urine – hematuria – usually causes panic in women, but most often it is a sign of commonplace cystitis.

The combination of pain during urination and blood in the urine speaks in favor of acute inflammation of the bladder (hemorrhagic cystitis), and not another, more serious urological pathology – for example, a tumor of the urinary tract, in the presence of which dysuria is uncharacteristic.

Blood in the urine can also appear as a result of chronic cystitis, leading to an increase in the number of blood vessels (hypervascularization) in the submucous layer of the bladder, their fragility and tendency to hemorrhage.

Other possible causes of hemorrhagic cystitis: radiation therapy, chemotherapy, the use of certain drugs.

Cystitis, accompanied by the appearance of an admixture of blood in the urine, may occur acutely, without the presence of signs of chronic inflammation and pre-existing factors. The treatment algorithm is most often limited to the same measures as in acute cystitis without hematuria.

Diagnostics

The diagnosis of acute cystitis is established on the basis of the patient’s complaints.To clarify the diagnosis, a general urine test is used, ideally a urine test with test strips (not common in Russia).

The appointment of treatment for acute cystitis is also possible only on the basis of the patient’s complaints (the so-called empirical therapy), without obtaining the results of urine analysis. Taking urine for culture (bacteriological examination) is optional in patients with uncomplicated cystitis. Urine culture is necessary only in a number of cases, such as: pregnancy, suspicion of acute pyelonephritis, prolonged course of cystitis (more than 2 weeks), atypical course of the disease.In the presence of bacteria in the urine culture – more than 10³ – it is possible to microbiologically confirm the diagnosis of acute cystitis.

Ultrasound or other imaging methods are not included in the acute cystitis diagnostic algorithm. A specific picture according to the ultrasound of the bladder may not be observed. Such ultrasound signs, such as “thickening of the bladder wall” and “presence of suspension of the bladder,” do not indicate the obligatory inflammation of its mucous membrane. The most common purpose of ultrasound is to exclude bladder tumors and ureteral stones.

Cystoscopy is contraindicated for acute cystitis.

Differential Diagnostics

Vaginitis . It is characterized by increased urination associated with vaginal irritation. It manifests itself as an erased, sluggish current. Predisposing factors may be excessive sexual activity, frequent change of sexual partners (new sexual partner). Blood in urine, pain when urinating, pain in the lower abdomen are usually absent.On examination, you can find vaginal discharge, the study of which reveals an inflammatory process.

Urethritis . This disease is also characterized by frequent, painful urination, but the severity of symptoms is usually weaker than with acute cystitis. The most common causes of urethritis are gonorrhea, trichomoniasis, chlamydia and herpes simplex virus. The disease can also occur due to a change in sexual partner. Discharge from the urethra is more typical for men.

Treatment of cystitis

Antibiotic therapy is the basis for the treatment of acute cystitis.

It has been proven that in 90% of women, after starting antibiotic therapy, the symptoms of acute cystitis disappear within 72 hours.

First-line drugs for acute cystitis are drugs that create a high concentration of an active substance in the urine and a low concentration in the blood, that is, drugs that act primarily in the urinary tract.

Fosfomycin (Monural) .A broad-spectrum antibacterial drug (oral granules) with a high concentration of active ingredient. In acute cystitis, its feature is a single dose – it is enough to drink one dose of the drug (3 g for adults). It is used for the initial manifestations of cystitis. If there are signs of bladder inflammation, another dose may be used for several days (24 hours after the first dose).

Macrocrystalline nitrofurantoin .Not on sale in Russia. The closest in chemical composition is Furazidin potassium salt (Furamag). Antimicrobial agent of a wide spectrum of action, belongs to the group of nitrofurans. Created to replace the outdated Furagin. It has improved absorption, a higher concentration of the active substance and fewer side effects. Dosing regimen for acute cystitis: 100 mg 3 times a day for 5 days.

Systemic antibacterial drugs are not recommended for the treatment of acute uncomplicated cystitis as first-line drugs, but can only be used as a possible alternative to .

Cephalosporins . A group of broad-spectrum antibiotics, but unlike Monural and Furamag, they contribute to the creation of a high concentration of the active substance not only in the urine, but also in the blood. There are 4 generations of cephalosporins. They are used for various diseases: from sinusitis to peritonitis. In the treatment of acute cystitis, tablet forms of an antibiotic are most often used, such as: Cefixim (Suprax, Suprax Solutab, Pantsef), Ceftibuten (Tsedex). Dosing regimen: 400 mg (1 tab.) x 1 time per day for 3-5 days.

Alternative antibacterial drugs:

Fluoroquinolones . A highly effective group of antibiotics, widely used in urological practice. Most often, Ciprofloxacin, Levofloxacin are prescribed. They are used in the treatment of acute cystitis, but are currently not recommended for empirical therapy due to the increase in resistance in patients. They are prescribed according to the results of bacteriological culture of urine in the presence of sensitivity to them, they are more often used in the treatment of pyelonephritis, prostatitis.Contraindicated for use in pregnant women and patients under 18 years of age. Dosing regimen: Ciprofloxacin (Tsiprobay, Tsiprolet) – 250 mg x 2 times a day for 3-5 days.

Penicillins . The very first, artificially synthesized group of antibiotics. Representative: Amoxicillin. Not recommended for empiric treatment of acute cystitis due to the increased level of E. coli resistance to it around the world. However, the combination of Amoxicillin and clavulanic acid can be used in some cases, for example, in the presence of inflammation of the bladder mucosa in pregnant women.Dosing regimen: Amoxicillin + clavulanic acid (Amoxiclav, Augmentin) 625 mg x 3 times a day for 7 days.

The basis for the treatment of cystitis in pregnant women is also the appointment of antibiotic therapy, but not all drugs are approved for use. It is permissible to prescribe Monural, Furamag and an antibiotic of the penicillin series or a group of cephalosporins.

The use of other drugs, herbal preparations, dietary supplements in the treatment of acute cystitis is ineffective, since there is a high likelihood of the pathogen retaining and the occurrence of a relapse of the disease.

Previously, there were recommendations to use a natural uroantiseptic – cranberry (a large amount of cranberry juice). Several studies have provided evidence to support the effectiveness of cranberry supplementation in reducing the incidence of urinary tract infections in women. However, in a meta-analysis of 24 studies and 4,473 patients, it was shown that foods containing cranberries did not statistically significantly reduce the incidence of urinary tract infections, including acute cystitis in women.

If the patient, for some reason, demonstrates a reluctance to drink antibiotics, it is allowed to prescribe anti-inflammatory drugs and analgesics to reduce the severity of dysuria and discomfort in the lower abdomen.

Phenazopyridine is a drug that has long been known abroad, but in Russia it appeared recently, under the trade name Fenazalgin. Refers to analgesics for relief of pain syndrome in inflammatory diseases of the bladder and urinary tract.It is excreted in the urine, providing a local anesthetic effect on the mucous membrane of the urinary tract. Does not by itself eliminate bacteria or damage mucous membranes, is only used to relieve symptoms . Can be used with antibacterial drugs to reduce discomfort. It is recommended to use no more than 2 days, as longer treatment can mask the symptoms of the disease. It is also used to eliminate discomfort, cuts during urination after catheterization of the bladder, during endoscopic interventions, operations on the urethra.

Non-steroidal anti-inflammatory drugs (NSAIDs) – have a pronounced anti-inflammatory, analgesic and moderate antipyretic effect. They are widely used in urological practice, often in the form of rectal suppositories. Most popular: Diclofenac, Indomethacin, Ketoprofen. In special cases, in the absence of the possibility of taking an antibiotic and the presence of recurrent cystitis, they can serve as the main drug for a short time.

Cystitis in men

It happens very rarely.This is due to a longer urethra than in women, fewer bacteria in the periurethral zone, and the presence of antibacterial components in the secretion of the prostate gland. Factors contributing to the onset of cystitis in men are diagnostic manipulations and surgical interventions on the urinary tract, radiation therapy, chemotherapy, unprotected anal sex. The treatment is carried out with antibacterial drugs, which are also used in the treatment of inflammation of the prostate gland: Ciprofloxacin 500 mg x 2 times a day for at least 7 days.

After an episode of acute cystitis. Preventive Measures

After adequate treatment of acute cystitis, there is no need for additional examinations. Adequate fluid intake, avoidance of hypothermia, personal hygiene, sexual hygiene, timely treatment of gynecological diseases, sexually transmitted infections are recommended. Prophylactic use of any drug after a single episode of acute cystitis is not indicated.

If symptoms of cystitis occur within two weeks after treatment, in the absence of a therapeutic effect, a urine culture should be performed to determine the sensitivity of the isolated pathogens to antibiotics (pass urine for culture).According to the results of bacteriological culture, it is recommended to prescribe an antibacterial drug according to the sensitivity of the pathogen to it.

How is acute cystitis treated at the Rassvet clinic?

Dawn urologists, like all doctors in our clinic, adhere to the principles of evidence-based medicine. No unnecessary examinations and ineffective drugs are prescribed. The diagnosis of acute cystitis is established on the basis of the patient’s complaints and the collected anamnesis; antibiotic therapy with first-line drugs is prescribed.Additional studies are carried out only in the presence of indications – the absence of the effect of the therapy.

It is important to know: in case of ineffectiveness of therapy or frequent relapses, cystitis is classified as recurrent, which, with some degree of simplification, can be called “chronic”.

Author:

Gardnerellosis | Description of the disease – meds.ru

Gardnerellosis is an infectious disease of the genital organs that affects various organs of the genitourinary system.

What causes gardnerellosis?

This ailment develops in women due to an increase in the vaginal microflora of a large number of anaerobic microorganisms (gardnerella). It does not develop in men. But there is a risk of introducing harmful bacteria into the urethra during intercourse.

Causes of gardnerellosis

A number of factors can provoke the disease. The causes of gardnerellosis include:

• decreased immunity;
• infectious diseases of the genitourinary system;
• intestinal dysbiosis;
• diabetes mellitus;
• long-term use of antibiotics, antibacterial, hormonal drugs, antidepressants;
• hormonal imbalance during pregnancy, childbirth, puberty and menopause;
• climate change and sleep disturbance;
• stress, overwork, chronic fatigue;
• promiscuous sex;
• daily use of spacers;
• long-term use of tampons;
• tight synthetic underwear.

Symptoms and clinical presentation of gardnerellosis

The incubation period for bacterial vaginosis is 3 to 10 days. Signs of gardnerellosis: itching and an unpleasant “fishy” odor in the vagina, muscle weakness, profuse discharge (whitish, yellowish and grayish), pain in the perineum, burning during urination and intercourse, redness of the labia.

Diagnosis of gardnerellosis

Diagnosis of gardnerellosis is carried out using laboratory tests.

Diagnostic methods

The following laboratory diagnostic methods are used.

Test strips. If a study of desquamated cells of the vaginal epithelium, vaginal discharge (in women) and discharge from the urethra of men shows an increase in acidity, then the presence of the disease is confirmed.

Polymer chain reaction. It helps not only to identify the DNA of gardnerella, but also to establish their number and sensitivity to antibiotics. PCR is a unique method for diagnosing a disease in men.It is used in the analysis of urogenital scrapings, urine and semen samples.

General blood test. A low white blood cell count will indicate the presence of anaerobic microorganisms.

Which doctor treats gardnerellosis?

At the first symptoms of gardnerellosis, it is recommended to consult a gynecologist. With concomitant intestinal dysbiosis, you can get advice about treatment from a gastroenterologist.

Treatment regimen for gardnerella

If gardnerella has been identified, treatment begins with minimizing the number of pathogens.After 3 days, they begin to restore the microflora of the genital area.

How to treat gardnerellosis is determined at each stage of treatment separately. Antibiotic therapy is applied first. Antibiotics are prescribed in the form of gels, ointments (Metronidazole and Clindamycin) and vaginal tablets (Levofloxacin, Doxycycline). The course of treatment is up to 10 days. Clindamycin is contraindicated in pregnant women. After undergoing antibacterial treatment, it is necessary to pass an analysis to confirm its effectiveness, as well as to exclude thrush.

At the next stage, the vagina is colonized with lactobacilli. This is a longer process, involving the use of tablets and vaginal suppositories (Lactonorm, Acylact, Lactobacterin).

The disease can occur in pregnant and lactating women. How to treat gardnerellosis in this case? Only candles can be used. Douching and antiseptic tampons have no therapeutic effect. In the treatment of intestinal dysbiosis, drugs Linex, Hilak-forte, Bifidumbacterin are used.To improve immunity – multivitamins (Vitrum and Biomax), immunostimulants (Schisandra and Echinacea).

Timely started treatment promotes recovery in 20-30 days.

Possible complications of gardnerellosis

Ignoring treatment is fraught with complications of gardnerellosis, such as inflammation of the appendages, infertility, premature birth, infection of the fetus during childbirth.

Measures for the prevention of gardnerellosis

It is not difficult to prevent the disease.It is only necessary to adhere to the basic rules: to observe the hygiene of the genitals, to adhere to a balanced and fortified diet, to streamline sexual intercourse.

Does the course of treatment differ from COVID-19 of a State Duma deputy and an ordinary Russian?

https://www.znak.com/2020-10-16/chem_lechat_koronavirus_v_rossii_i_budut_li_vas_lechit_kak_srednego_deputata_gosdumy 16 Since

COVID-19, the treatment regimens for the disease have changed several times.You can find dozens of different protocols with a list of drugs on social networks, and there are hardly more than two or three similar names. At the same time, there are general recommendations in the country.

But is the course of treatment of a State Duma deputy in Moscow different from the suggestions of a doctor at a district clinic in the Kurgan region?

The main source of information for doctors of all regions in Russia today is the temporary guidelines of the Ministry of Health of the Russian Federation, approved by the Deputy Minister of Health Evgeny Kamkin.On October 1, their new, eighth, 227-page edition was released, describing in detail what drugs should be used for COVID-19, how the lungs of a person who is already time to be hospitalized look like, and how to change treatment regimens depending on the course of the disease.

This recommendation is intended for physicians. Coronavirus does not need to be treated on your own. The correct treatment regimen can only be prescribed by a doctor, so if symptoms appear, you need to go to the hospital as soon as possible. In this case, the doctor will have to wait – sometimes up to several days.

Five main drugs for the treatment of COVID

It follows from the document that only five drugs are used to treat COVID-19 in Russia.

1. favipiravir – An expensive drug that has recently been released into the public sector, which is believed to interfere with the reproduction of the virus;
2. azithromycin – broad spectrum antibiotic;
3. interferon-alpha – local anti-inflammatory drug;
4. hydroxychloroquine is an antimalarial drug that must also block viral replication;
5. umifenovir , better known as arbidol, allegedly prevents the fusion of the virus and cells.

The effectiveness of at least the last two in the world raises questions – as TASS writes, full clinical trials of hydroxychloroquine have shown that it does not help either sick or healthy people as a prophylaxis. However, it is prescribed to humans in combination with antibiotics, especially azithromycin.

But there are a couple dozen more

Another two dozen drugs from the guidelines are struggling with the most dangerous consequences of COVID-19 – a cytokine storm, respiratory distress syndrome and thrombosis.As a prevention of thrombosis, doctors are advised to use sodium preparations, calcium nadroparin and unfractionated heparin (all of which are injected). To combat the release of cytokines – drugs based on monoclonal antibodies (sarilumab, tocilizumab, canakinumab and others), as well as glucocorticosteroids (methylprednisolone, dexamethasone and hydrocortisone).

All these drugs are divided into 14 regimens depending on the severity of the disease and whether a cytokine storm develops.Patients in mild forms may be prescribed a choice of favipiravir, hydroxyloroquine, or interferon with arbidol. In moderate forms, favipiravir or hydroxychloroquine with an antibiotic and monoclonal antibodies are prescribed. In severe cases of distress, favipiravir and tocilizumab are available without options.

But there are a couple of hundred more

The Ministry of Health prescribes a huge number of drugs for symptomatic treatment – for example, paracetamol as the first choice of antipyretic, mucolytics for the treatment of bronchitis and various drugs to combat rhinopharyngitis.

The final decision on the drug list rests with the specific hospital. The Health Committee of St. Petersburg Znak.com reported that in the latest version of the recommendations of the Ministry of Health, a large number of different drugs are prescribed, which during treatment can vary at the discretion of the doctor. The same was stated in the Sverdlovsk region.

As one of the patients who is being treated for coronavirus in Yekaterinburg right now told Znak.com, his doctor prescribed the antibacterial drug Biseptol, the antibiotic Sumamed and the Ural drug Triazavirin, which is used mainly in the Sverdlovsk region and is used instead of arbidol for mild disease.

In another clinic in Yekaterinburg, antiviral nobazit is prescribed in the outpatient treatment protocol, which is not mentioned in the recommendations of the Ministry of Health, the same azithromycin and vitamin C.

In case of deterioration and signs of bacterial infection, ceftriaxone and levofloxacin are prescribed (both are recommended by the Ministry of Health). At the same time, it is strictly forbidden to prescribe immunomodulators (Kagocel, Ingavirin and others) – as drugs that can worsen the course of the infectious process.

There is nothing about this in the document of the Ministry of Health, but interferon nasal drops remain the only recommended drug of this class.By the way, the Sverdlovsk Ministry of Health separately recommends them for the prevention of coronavirus.

However, in hospitals, according to Znak.com, both hydroxychloroquine and dexamethasone are actively used.

Approximately the same is prescribed in the Kurgan region. As a Znak.com reader, who was treated on an outpatient basis, in addition to azithromycin and levofloxacin, he was prescribed rinikold (or any analogue containing paracetamol), triazavirin, as well as a group of drugs for symptomatic treatment: vasoconstrictor for the nose, anti-inflammatory for the throat, and expectorants.

Deputies are treated differently?

As far as can be judged – the same.

For example, this week State Duma Deputy Maxim Ivanov published a list of medications prescribed for him after passing a positive test for COVID-19. Ivanov, who is undergoing outpatient treatment, prescribes the same azithromycin, vitamins D and C.

State Duma deputy from the Communist Party of the Russian Federation died of coronavirus

Also in his prescription nomides (oseltamivir, not mentioned in the recommendations of the Ministry of Health), viferon (mentioned interferon-alpha), drug for allergies and aspirin for the prevention of stroke and thromboembolism.As you can see from the list, there is nothing special in it, and even favipiravir is not allowed for an almost asymptomatic deputy.

On the other hand, we do not know how other high-ranking officials – governors, members of the government and the presidential administration – are treated. Recall that Prime Minister Mikhail Mishustin, ministers Yakushev, Falkov and Novak, Putin’s press secretary Dmitry Peskov and other high-ranking officials have already been ill with coronavirus. All of them survived the coronavirus without complications and did not spread about the methods of treatment.After contracting the infection, only one State Duma deputy died – the deputy chairman of the financial market committee, 67-year-old member of the Communist Party of the Russian Federation, Vakha Agayev.

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Are antibiotics a safe and effective adjunctive treatment for exacerbations of asthma?

Relevance

Asthma is a common long-term respiratory disease that affects adults and children around the world. People may experience a short-term worsening of their symptoms, often referred to as flare-ups (or asthma attacks).Flare-ups are usually treated by intensifying individual therapy (for example, taking steroid tablets for several days). Sometimes flare-ups can be caused by infections such as viruses. Sometimes a bacterial infection in the lungs or airways can cause an exacerbation. Symptoms of a bacterial infection include wheezing in the lungs, fever, and a cough with large amounts of discolored phlegm. Bacterial infections can be confirmed by laboratory tests, such as a blood test; however, they are not always available in primary care (from a general practitioner).Bacterial infections may require antibiotic treatment.

In this review, we wanted to find out if antibiotics are beneficial and safe for people with exacerbated asthma. Part of the motivation for this review is concern that antibiotics may be over-prescribed for patients with flare-ups of asthma.

Characteristics of research

We searched for studies that compared a group of people who were given any type or dose of antibiotic to a group of people who did not receive an antibiotic for an exacerbation.We only included studies that randomly assigned an antibiotic. We have included studies with adults and children from any time, anywhere in the world.

Main Findings

We found six studies that included 681 adults and children with asthma. Two of these studies were conducted over 35 years ago.

Overall, we found little evidence to suggest that antibiotics can reduce symptoms and improve breath test results when compared to no antibiotic use.We are not very confident about these results because only a small number of studies and people were included in our review. One of our primary outcomes – admission to an intensive care unit / high dependency unit (ICU / HDU) – was not reported.

We also cannot be sure that more or less adverse events (side effects) have occurred in people receiving antibiotics. Only 10 people (5 received antibiotics and 5 received placebo / no antibiotic) out of 502 had serious adverse events.

We did not find sufficient evidence for other important outcomes such as hospitalization or other exacerbation during the study follow-up period.

The most recent study found it difficult to include (recruit) people with asthma because so many of them had already received an antibiotic and were therefore unable to participate.

Quality of evidence

Overall, our confidence in the evidence presented in this review is low.We think it is possible that some studies on antibiotic use in exacerbation of asthma have been conducted but not published because we were able to find so few studies on such an important issue. We were also concerned about the extent to which the research findings apply to all people with asthma attacks, as most of the studies we found only included people in hospitals and emergency departments. In addition, two studies were outdated, and asthma treatments have changed a lot in 30 years.Since we found only a few studies, in some cases we cannot say which is better or worse, whether antibiotics are used or not, or there is no difference compared to no use. Finally, we had some concerns about how the studies were conducted, for example, in one study both the patients and the study staff knew who was getting the antibiotic and who was not; it could have influenced the behavior of patients or staff.

Conclusions

We have found very limited evidence that antibiotics can help people with asthma attacks, and we are still very unsure.In particular, we did not find sufficient information on significant outcomes such as hospitalization or side effects. However, serious side effects were very rare in the studies we found.

90,000 Who treated prostatitis with levofloxacin

Levofloxacin for prostatitis

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Based on the results of the analysis, I was prescribed the antibiotic Levofloxacin – one tablet 500 mg once a day.It became easier after 2 days, the temperature subsided and the pains disappeared. A week later, I felt much better, plus I was prescribed a good decongestant, in general, my affairs were on the mend.
The antibiotic had to be drunk for 14 days, it has a lot of side effects, and Levofloxacin is not combined with a whole list of medications. My intestines, stomach and sleep were all right, I was bothered only by attacks of rapid heartbeat, once I even began to choke. As it turned out, this is also a consequence of taking the drug.After the end of the treatment, I started having intestinal dysbiosis. But almost any antibiotic has a negative effect on the body, this is their feature.

Levofloxacin treated infectious prostatitis. The results of the treatment are positive, but there were side effects. The drug is aimed at destroying harmful bacteria that provoke the appearance and further exacerbation of the disease. The spectrum of action is wide. Due to the complete destruction of the infection and stopping its spread, the result of the treatment is quite quick.At the same time, the drug also destroys positive bacteria, thereby causing indigestion.
Available in 2 forms: tablets and injections. I was taking a pill. I consider this form of release to be convenient for home treatment. It is advisable to use injections in a hospital setting for severe prostatitis. 1 package contains 7 tablets, 500 mg each. A dosage of 250 mg is also presented. You need to take 500 mg of the drug per day. The course of treatment is 28 days, during this period, prostatitis can be completely cured.
Contraindicated in renal failure. Allergic reactions to components are possible. During the reception, I was worried about weakness, drowsiness, a small rash on the body.

Levofloxacin kills various types of bacteria, there are many of them. I took pills for a week – a dose of 500 mg, it did not cause much discomfort. But, however, even after a week of admission, I was tormented by frequent urge to use the toilet. Inflammation of the kidneys – pyelonephritis – was connected to prostatitis and cystitis. So, this antibiotic was removed, and injections of another antibiotic were prescribed.In principle, since doctors use it, you can use it, but it seems that there are more modern medicines.

The antibiotic is full of side effects. For a while, Levofloxacin helped, but then a stronger and wider-spectrum drug was prescribed. In any case, at first, the drug reduced pain, fever, and frequent urination around the 3rd day. And then things stopped moving. Symptoms diminished, but there was no recovery. In addition, my stomach was very twisted, I had no strength.

Levofloxacin was prescribed to me as the main antibiotic for 28 days.I took the maximum dose of the substance – 500 mg, that is, 1 tablet a day. By the evening of the 2nd day, the long-awaited relief came, the cutting pain dulled and the urge to need became less frequent and painful, finally I was able to rest and sleep a little.
Despite the fact that after 2 weeks I already felt completely healthy, I was strongly advised against stopping the treatment. I don’t know if this is due to an individual reaction to the drug, but I had problems with my blood pressure, it dropped to 90/80, although it was always normal before.We were worried about weakness, nausea and even vomiting. After another consultation with the attending physician, the dose was reduced to 250 mg. I think it helped because within a couple of days all the side effects were gone.

Levofloxacin for prostatitis

The need to take antibiotics for inflammation of the prostate gland arises when bacteria or microbes cause it. Levofloxacin with prostatitis is able to cope with most disease-causing parasites and prevent the disease from recurring.A lot of attention should be paid to the treatment of the disease, because without proper effort, a man can become impotent or sterile. The longer the inflammatory process is present, the worse the prostate functions, and the quality of sperm and erectile function depend on it.

Levofloxacin belongs to antibacterial drugs of the fluoroquinolone group. These are quite toxic drugs that have 4 generations. The drug in question belongs to the third, therefore, it is able to cope with a larger number of parasites than previous versions.It has a synthetic origin, but, despite this, it is able to compete with natural antibiotics.

Indications for use

In case of 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 required to improve blood circulation, facilitate urination, increase potency, etc. When the disease has an infectious nature, first of all, they try to limit the multiplication of pathogenic microorganisms and destroy them.Levofloxacin has a similar effect. It is used when a man experiences these symptoms:

• Pain when urinating
• Frequent urge to go to the toilet, especially at night
• Painful ejaculation
• Weakening of erection
• Temperature rise (from 37 to 40 degrees)
• General weakness

The stronger the inflammatory process, the more pronounced these symptoms are. At the stage of exacerbation, the patient may even be hospitalized, i.e.because pills alone can not cope with acute urinary retention or pain. Antibiotics are used after tests that will show which pathogens have appeared in the prostate gland.

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

Reviews about Levofloxacin for prostatitis are mostly positive, both from patients and from specialists.He copes well with the declared diseases, in the instructions he has indications for admission:

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 form of eye drops, it can be prescribed for superficial eye infections, to prevent complications after surgery or eye procedures.

Affirmative Action

Levofloxacin is a fluoroquinolone antibiotic, which means that it has a bactericidal and not bacteristatic effect on microorganisms. The difference between them is that in the first case the bacteria are destroyed, and then the second stops their reproduction and growth. The mechanism of the drug’s work looks like this: the synthesis of the DNA 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 property of influencing the “copying” of cells, which becomes impossible after exposure to one enzyme.

Thus, the likelihood of bacteria developing drug resistance is significantly reduced, because they cannot reproduce. Among the positive actions of Levofloxacin are also listed:

• Excellent penetration into organ tissues, into cells
• Elimination 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 to take 1 tablet per day)

Among various pathogens, the least resistant to the drug are anaerobic gram-positive and gram-negative bacteria, microorganisms.These include:

1. Staphylococcus
2. Streptococcus
3. Haemophilus influenzae
4. Peptostreptococcus
5. Moraxella bacterium catarrhalis

Chlamydia, legionella, mycoplasma, ureaplasma are also considered sensitive. The course of treatment with Levofloxacin for prostatitis may be possible if the disease is caused by enterococci, enterobacteria, Pseudomonas aeruginosa, Morgan bacteria, but they can acquire resistance 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 in 1-2 hours and is excreted in about 16 hours, completely excreted in the urine after 2 days. The higher the dosage, the longer it takes.

Instructions for receiving

The method of administration of the drug can be oral or intravenous. Levofloxacin tablets contain 250 or 500 mg of active substance, ampoule with solution – 100 ml.The instructions for use state that the capsules must be taken as follows:

• Half or a whole tablet (250-500 mg) once a day
• Preferably taken before or after meals
• Drink at least half a glass of water

Continue taking from 3 days to 2-4 weeks. With pneumonia or bronchitis, this can be from 7 to 14 days, with skin infections – the same, and with urinary tract infections – from 3 to 10 days. It is undesirable to start taking pills until the body temperature has stabilized.It is always recommended to repeat the technique at the same time.

Intravenous administration is done only with a dropper, because it is necessary that the substance enters the body slowly. Usually, a dose of 250-500 mg is administered within an hour, large volumes – in an hour and a half. If the condition is relieved, it is possible to switch to tablets. The duration of therapy is determined by the attending physician, the sensitivity of the parasite to the drug. For uncomplicated infections, treatment may take as little as 3 days; for severe infections, it may take several weeks.

The likelihood that Levofloxacin does not help with prostatitis is very small. The drug is too strong in order not to respond to pathogens, and if they were immediately resistant to it, the doctor should have initially prescribed a different medication.

Contraindications and side effects

Limitations to the intake of Levofloxacin are indications that apply to almost all antibiotics – hypersensitivity to components, childhood, pregnancy and lactation.However, due to the high toxicity of this agent, a few more points can be added:

1. Presence of epilepsy
2. Tendon disorders due to the intake of other fluoroquinolones
3. Pseudoparalytic myasthenia gravis

Restrictions on admission may occur in patients with a predisposition to seizures, deficiency of glucose-6-phosphate dehydrogenase, impaired renal or liver function, the elderly. Treatment of prostatitis with Levofloxacin may be contraindicated in the stronger sex with diabetes mellitus, psychosis, cardiovascular diseases.Side effects on the use of tablets or the introduction of a solution can appear both at standard dosages, and when they are exceeded. Appears more often than others:

• Nausea and vomiting
• Diarrhea
• Headache
• Drowsiness
• Decrease in blood pressure
• General weakness

Among the side effects are also increased heart rate, convulsions and tremors, disorders of smell, vision, hearing. Rarely there are dyspepsia and abdominal pain, allergic reactions.The latter are characterized by rashes and urticaria, itching and burning. With an unknown frequency, photosensitivity may increase, hypo- or hyperglycemia, and vascular collapse may occur. With intravenous administration, short-term pain at the injection site, inflammation, increased sweating is possible.

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

Additional recommendations

The course of Levofloxacin for prostatitis is undesirable to combine with such drugs as antacids (aluminum and magnesium-containing), funds with iron in the composition – they reduce the effectiveness of the antibiotic.If it is necessary to take them, it is recommended to make an interval between doses of at least 2 hours. Deterioration of work is observed when the drug is combined with other quinolones, anticonvulsants, non-steroidal anti-inflammatory drugs. With simultaneous use with anticoagulants, the risk of bleeding increases, and together with insulin, hypo- and hyperglycemic states.

Therefore, for patients with diabetes mellitus, it is necessary to constantly monitor the level of glucose in the blood and observe the correct dosages.Due to the fact that Levofloxacin can cause severe allergic reactions, up to 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 hepatic insufficiency, it is worth stopping the intake if symptoms of a worsening of the patient’s condition appear.

The drug does not interact with food, but it is forbidden to take it together with alcohol (most often, an aggravation of side effects from the central nervous system such as dizziness or numbness is observed).It is necessary to store the packaging 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 inflammation of the prostate is located below. In it, the specialist talks about the results of treatment, possible complications, analogues of the drug.

How to prevent the development of prostatitis?

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

Anti-inflammatory nonsteroidal drugs, adrenolytics, muscle relaxants, hormonal drugs, pain relievers and vitamin complexes are typical for getting rid of prostatitis.

One of the main tasks in treatment is to replenish the lack of nutrients in the body in order to raise immunity and help the prostate to regenerate tissues. For this purpose, rectal suppositories are often used, because it is easiest for them to bring substances to the prostate gland. What suppositories are popular for prostatitis:

1. Prostatilen
2. Prostopin
3. Vitaprost
4. Propolis DN
5. Pumpkin
6. Genferon

Suppositories can have a wide range of therapeutic properties, which is why they are used so often.Only the procedure from use is unpleasant, but for recovery it is worth to be patient. To strengthen the immune system, it is equally useful to start eating right, limiting or eliminating alcohol and cigarettes from your life. The patient’s menu should contain fresh fruits and vegetables, herbs and dried fruits. The greatest benefit for men, both healthy and sick, will bring seafood, onions and garlic, parsley, cabbage, lean meats, fresh juices.

It is better to refuse strong tea and coffee, becausebecause they can negatively affect potency. Semi-finished products, instant food, canned food, too fatty, salty or spicy food act in the same way. Sports activities will also affect immunity, but only regular ones. A set of exercises for prostatitis is easy to find on the Internet.

Levofloxacin does not help with prostatitis

With bacterial prostatitis, it is impossible to get rid of the pathology without eliminating the pathogenic agents that provoked the inflammatory process. Despite the bias of patients towards the use of antibiotics, only properly selected antibiotic therapy helps to get rid of male pathology of an infectious nature.

How to choose the right antibiotic

Absolutely different pathogenic and opportunistic organisms can act as agents provocateurs in prostatitis, which can multiply rapidly and cause inflammatory reactions in the organ. To suppress the vital activity of such particles, antimicrobial drugs are used.

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

For this, a bacterial culture of the secretion of the prostate gland is carried out. Based on the results obtained, the appropriate antibiotic can be selected.

Levofloxacin is recommended to be prescribed if:

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

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

Properties and spectrum of action of the drug

Levofloxacin, due to its ability to kill disease-causing particles at any stage of development, is an effective bactericidal drug. Unlike bacteriostatic drugs that stop the reproduction of microbes, that is, they affect only cell division, Levofloxacin destroys cells, both dividing and growing, and in a state of rest. Therefore, the drug is considered to be quite effective, with a wide range of action.

The mechanisms of the drug work correspond to the basic properties of the group of quinols, fluoroquinols. The drug, penetrating into the disease-causing cells, blocks the activity of certain enzymes involved in the formation of DNA. Due to pathological changes in the cell, processes develop that are incompatible with the life of microbes.

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

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

The lack of effect can be observed only in the treatment of a disease caused by bacteria that do not belong to the group of sensitive agents to levofloxacin.

Form of preparation

Levofloxacin is found in the form of a tablet preparation and a solution for injection.

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

• disodium edetate dihydrate;
• sodium chlorine;
• with deionized water.

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

The tablet form of the drug contains 500 mg of the 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 white top shell.

Prostatitis treatment

Levofloxacin is often used in the treatment of prostatitis caused by various disease-causing agents. It is allowed to use both a tablet preparation and an intravenous solution. Regardless of the selected method of using the drug, therapy for prostatitis is carried out for 28 days.

So, in 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 pills. It is recommended to take 1 tablet daily containing 500 mg of the medicinal component. The course should total 4 weeks with intravenous administration of the drug.

Prostatitis can be treated without injections. With this option of therapy, pills are taken throughout the course. Men with prostatitis are prescribed a daily pill containing 500 mg of the drug.

Attention! In the absence of significant improvements, it is advisable to re-culture to identify the sensitivity of bacteria to the drug.

Contraindications

Levofloxacin is strictly forbidden to prescribe:

• for personal intolerance to the ingredients of the drug;
• in the presence of allergic reactions;
• for renal failure;
• patients under 18 years of age;
• if inflammation of the tendons was previously observed with previous administration of similar drugs;
• patients with epilepsy.

There are also relative contraindications. The drug must be administered with caution at:

• severe renal dysfunction;
• glucose-6-phosphate dehydrogenated deficiency.

Such pathologies require close medical supervision during therapy with levofloxacin for prostatitis.

Overdose

Taking Levofloxacin it is necessary to strictly adhere to the dosages recommended by physicians. With uncontrolled intake of the drug in excess of safe doses, the following may appear:

• confusion and seizures;

90,009 dizziness and loss of consciousness;

• nausea;
• erosion of mucous coatings;
• changes in the rhythm of the heartbeat.

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

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

Side effects

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

• diarrhea;
• nausea;
• increased activity of liver enzymes.

Less common signs of complications appear:

• itching or redness of the skin;
• digestive abnormalities in the form of lack of appetite, belching, heartburn, vomiting;
• soreness in the abdomen;
• headaches or dizziness;
• numbness or drowsiness;
• general weakness and sleep disorders.

Quite rarely, reactions are observed in the form:

• urticaria;
• state of shock;
• bronchospasm and suffocation;

If any signs of side effects appear, taking the drug must be urgently stopped before consulting a doctor.When alarming symptoms that threaten life appear, an urgent appeal to doctors is required.

Combination of the drug with other drugs

While taking Levofloxacilin with anti-inflammatory nonsteroidal drugs in the form of Ibuprofen, Nimesulide, Paracetamol, Aspirin, the risk of seizures increases. Such a reaction is observed with the combined use of Fenbufnom, Theophylline.

The effectiveness of the drug is influenced 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.

When taking glucocorticoid drugs in the form of Hydrocortisone, Prednisolone, Methylprednisolone, Dexamethasone, Betamethasone against the background of Levofloxacin, tendon ruptures can be observed.

Attention! It is strictly forbidden to take alcoholic beverages together with an antibacterial drug. This combination provokes an increase in side effects associated with 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, no less influencing the development of pathology.

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

Diseases of the prostate gland, namely its inflammation, is the most common organ pathology among men under the age of 50 and the third most frequent in the population older than these years. Today we will look at how levofloxacin works in prostatitis?

According to domestic and foreign authors, approximately 25-45% of the stronger sex suffer from this ailment. Such a gloomy picture obliges doctors to look for the most effective ways to heal patients in the shortest possible time.

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 of 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.

Composition and mechanism of action of Levofloxacin

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

Precisely when the usual antibiotic does not help, you need to choose Levofloxacin. Its main advantages are:

1. Broad spectrum of therapeutic action (Streptococcusagalactiae, Staphylococcusepidermidis, Staphylococcusaureus, Streptococcuspneumoniae, Streptococcuspyogenes, Listeriamonocytogenes, Chlamydiapneumoniae and many others).
2. Better penetration directly into the prostate tissue. Approximately 92% of the dose is accumulated in the gland.
3. Excellent bioavailability and speed of action. The maximum concentration in the blood is reached after 1.5 hours.
4. The same dosage of the medication for oral and parenteral administration.
5. Intracellular action, which provides the ability to destroy atypical microbes.

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

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

How to use Levofloxacin correctly for prostatitis?

The drug has a very wide range of applications in addition to inflammation of the male organ. It is excellent for treating bacterial diseases of the urinary system, abdominal organs, community-acquired pneumonia, sepsis and other infectious processes.

Levofloxacin for prostatitis is most often used in tablets with a dosage of 0.25-0.5 g or infusion in 100 mg vials, which contain 0.5 g of active ingredient.

After therapy with this agent, the following effects are observed:

• Suppression of the focus of inflammation;
• Reduction of edema;
• Regression of pain sensations;
• Normalization of local and general body temperature;
• Elimination of pathological microflora from the gland tissue.

Treatment of prostatitis with Levofloxacin is most convenient for patients in the form of oral tablets. The daily dose of the drug is 500 mg.

The medicine is inactive in relation to food, so it practically does not matter when to drink it, but it is recommended to use it between lunch and dinner once or twice a day – it all depends on the stage of neglect of the disease that the patient has acquired. Be sure to drink 0.5 or 1 glass of water.

Tablets should not be chewed.The course of treatment is 28 days.

Injections have the same mode of use, but due to the constant need for injections, they remain unclaimed by patients with inflammation of the prostate gland.

Particular attention should be paid to situations when the patient has concomitant renal failure or other diseases of this system. Since 75% of the drug is excreted in the urine, violations of this process can significantly aggravate the course of the underlying disease.

For such people, you need to reduce the dose by half while maintaining the antibiotic regimen and observe the occurrence of any negative changes in the dynamics.

Side effects and contraindications

Levofloxacin for chronic prostatitis or any other form of ailment is one of the safest remedies.

However, in rare cases, such negative reactions are possible:

1. Nausea, diarrhea, vomiting;
2. Drop in blood pressure, tachycardia;
3. Dizziness, headache, general weakness, sleep disturbances;
4. Tremor, anxiety, depression;
5. Muscle and joint pain, tendovaginitis.

In addition, there are a number of contraindications for the use of this antibacterial drug:

1. Tendon and joint problems following a history of any fluoroquinolones;
2. Patient’s age up to 18 years;
3. Epileptic seizures, Jacksonian epilepsy;
4. Allergic reactions to the constituent components of the drug;
5. Renal failure stage IV-V.

Levofloxacin is one of the best options for the etiological treatment of bacterial prostatitis.However, self-medication is highly undesirable. Before use, it is imperative to undergo an examination of the whole body and consult a specialist to select an adequate dose and therapy regimen.

To cope with the inflammatory processes of the prostate gland, it is important to eliminate the main catalyst that causes the disorders. In approximately 30-40% of cases, the disease is provoked by infections trapped in the sterile microflora. Pathogens, their waste products, a negative effect on healthy cells – all this leads to serious dysfunction of the prostate and, as a result, inflammation in an acute or chronic form.

Mechanisms of action of Levofloxacin

The main therapeutic task in the fight against infectious inflammation is to kill bacteria in the prostate. The effect of the drug is associated with the following effect on pathogens:

Prevents the multiplication of pathogens by blocking cell division at the DNA level;

The effectiveness of Levofloxacin has been clinically and experimentally proven in chronic and acute prostatitis caused by the following microorganisms:

Gram-positive and gram-negative bacteria;

In other cases, an antibiotic can also help, but before prescribing a number of tests will be required, according to the results of which the urologist will determine the appropriateness of using the medication.

Pharmacology and release form

Levofloxacin belongs to the group of III generation fluoroquinols. Medicines of this type are distinguished by the same effect on pathogenic microbes, the ability to accumulate in places of greatest accumulation of pathogens, which contributes to their destruction and the complete recovery of the patient. Duration of admission is 28 days. Injections are given for the first decade, then they switch to tablets.

NSAIDs – increase the risk of seizures;

Indications and contraindications

The antibiotic has a rapid anti-inflammatory effect on the prostate, by inhibiting the activity of pathogens.Taking Levofloxacin for prostatitis begins after a complete examination of the patient and provided there are no contraindications.

Prescribing a medicine is prohibited for patients with the following pathologies and diseases:

severe renal failure;

Levofloxacin should be taken for 28 days. Some patients find it worthwhile to increase the dosage on their own for better results. In fact, the effectiveness of the antibiotic does not increase significantly, and the risk of complications becomes much greater.In case of overdose, dialysis and other therapeutic measures do not help. Symptomatic treatment is required.

confusion and seizures;

If symptoms of an overdose appear, the use of the antibiotic should be stopped and qualified medical help should be sought.

Treatment of the prostate with Levofloxacin

The dosage for prostatitis and the pharmacological form of the antibiotic is selected depending on the severity of the pathology. At the initial stage of inflammation, the recommended daily dose is 500 mg to 250 mg.twice a day. To achieve a stable remission, the administration of Levofloxacin is continued for a month.

The compatibility of Levofloxacin with other medicines is indicated in the instructions. The drug is not able to eliminate congestion. It is possible to prevent the development of relapse only after undergoing physiotherapy sessions and taking medications aimed at improving metabolism and restoring the basic functions of the prostate.

What can replace Levofloxacin

In general, the drug is well tolerated by patients.If there are contraindications and individual intolerance to the antibiotic, it is changed to analogues. You will need to choose a replacement if Levofloxacin does not help with prostatitis. In exceptional cases, the urologist will recommend an increase in dosage, but as practice shows, it is better to prescribe another drug.

When choosing an alternative, take into account that the body develops resistance (addiction) to any other fluoroquinolones. The optimal choice is a broad spectrum antibiotic of the latest generation with excellent pharmacological action.

Sources: http://otzyvman.