Ciprofloxacin or ofloxacin which is better. Possibilities of clinical application of levofloxacin. Ofloxacin analogues for the active substance

And Urinary tract infection (UTI) is one of the most urgent problems of modern urology. Inadequate therapy of this condition often leads to bacteremia and sepsis. In the US, UTIs cause 7 million visits to a doctor each year and 1 million hospitalizations.

Treatment of urinary tract infection involves effective and timely antibiotic therapy, subject to the restoration of normal urodynamics, and aims to prevent urosepsis and the occurrence of relapses. Antibacterial drugs of the fluoroquinolone group are the drugs of choice for the treatment of UTIs worldwide.

An additional problem that significantly complicates the treatment of UTIs is the high resistance of microorganisms to most antibacterial drugs that have been used for a long time in urological practice. Hospitalism, inadequately long courses of treatment, and incorrect prescription of drugs often lead to the emergence of antibiotic-resistant strains. The emergence of a new effective drug for the treatment of UTI is a significant event and attracts close attention of doctors.

Levofloxacin (LF) - a new antimicrobial drug of the quinolone group - is the L-isomer of ofloxacin. Since levofloxacin accounts for almost all of the antimicrobial activity in the racemic mixture of isomers, its activity in vitro twice the activity of ofloxacin. Both drugs show a similar level of toxicity in animal experiments, which suggests that levofloxacin is more effective due to the lower level of side effects. LF is intended for the treatment of infectious and inflammatory processes caused by microorganisms sensitive to LF. Recent studies have demonstrated good efficacy of LF in the treatment of complicated and uncomplicated urogenital infections. The pharmacokinetics of LF is similar to that of ofloxacin: the half-life is approximately 6-7 hours, and the maximum concentration in blood serum is reached 1.5 hours after ingestion. The mechanism of action of LF is similar to that of all fluoroquinolones and consists in the inhibition of bacterial topoisomerase-4 and DNA gyrase, enzymes responsible for replication, transcription and recombination of microbial DNA.

LF has a wide spectrum of antimicrobial activity. LF affectsin vitro for the following infectious agents:

Aerobic gram-positive: Streptococcus agalactiae, Staphylococcus aureus and saprophyticus, Enterococcus faecalis, Streptococcus pneumoniae, Streptococcus pyogenes;

Aerobic gram-negative: Enterobacter cloacae, Escherichia coli, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Legionella pneumophila, Moraxella catarrhalis, Proteus mirabilis, Pseudomonas aeruginosa;

Other microorganisms: Chlamydia pneumoniae, Mycoplasma pneumoniae.

resistance to LF associated with spontaneous mutations, in vitro is relatively rare. Despite the presence of cross-resistance between Lf and other fluoroquinolones, some microorganisms resistant to quinolones may be sensitive to Lf.

LF is contraindicated in persons with hypersensitivity to LF or other quinolone drugs (their components). At present, the effect of LF on children, adolescents, pregnant and lactating mothers has not been studied.

The most commonly reported side effects are nausea (1.3%), diarrhea (1.1%), dizziness (0.4%) and insomnia (0.3%). All of the above effects are dose-dependent and quickly disappear after dose reduction or drug withdrawal.

The ease of use of LF - once a day - is another advantage of this drug. An analysis of scientific publications devoted to studies of the efficacy and tolerability of LF makes it possible to more clearly present its differences from other quinolones.

G. Richard et al. studied the efficacy and safety of LF 250 mg once daily versus ciprofloxacin 500 mg twice daily for 10 days in the treatment of 385 patients suffering from UTI symptoms in a randomized, double-blind, multicenter study. Before treatment, all patients underwent a bacteriological examination of urine, according to which all patients showed an increase in pathogenic microflora and the microbial count was 105 microbial bodies in 1 ml of urine. Clinical recovery was observed in 92% of patients treated with LF, and 88% of patients treated with ciprofloxacin. Side effects were noted in 4 and 3% of patients, respectively. The authors conclude that the efficacy and safety of LF therapy is comparable to that of ciprofloxacin.

Y. Kawada et al. compared the efficacy of LF at a dose of 100 mg twice a day (135 patients) and ofloxacin at a dose of 200 mg twice a day (126 patients) in the treatment of patients with complicated urinary infection. A positive clinical result was obtained in 83.7% of patients in the LF group and in 79.4% of patients in the ofloxacin group. These differences were not statistically significant. Side effects were noted in 4.9% of patients in the ofloxacin group. In the LF group, no such effects were noted, which, according to the authors, indicates a better tolerability of the drug.

No significant difference was found in the efficacy and tolerability of LF and other quinolones in a randomized, double-blind study by G. Richard et al. They used LF 250 mg once daily and ofloxacin 200 mg twice daily in 581 patients with uncomplicated UTI. Clinical improvement or cure was observed in 98.1% of patients in the LF group and in 97% of patients in the ofloxacin group.

In another study by G. Richard, I. Klimberg et al. compared the efficacy and tolerability of LF, ciprofloxacin and lomefloxacin in the treatment of 259 patients with acute pyelonephritis for 10 days. With the same efficiency, the authors note a significantly lower level of side effects in the treatment of LF compared with other drugs (gastrointestinal disorders in 2 patients and vaginitis in 1).

An interesting, in our opinion, study was performed by I. Klimberg et.al. They studied the efficacy and tolerability of LF and lomefloxacin in the treatment of complicated urinary infections. After randomization, patients received therapy with these drugs at a standard dosage for 7-10 days. At the same time, safety was assessed in 461 patients and microbiological efficacy in 336 of them. The average level of elimination of pathogens in the LF group was 95.5%, and in the lomefloxacin group - 91.7%. Side effects were noted, respectively, in 2.6 and 5.2% of patients. At the same time, photosensitivity and dizziness were more common in the lomefloxacin group, and nausea was more common in the LF group. Six patients in each group experienced various gastrointestinal disorders. The authors claim that the effectiveness of LF is approximately the same as other quinolones, while the tolerability of LF is somewhat better.

Thus, levofloxacin is a new antimicrobial drug used to treat infectious and inflammatory processes in the upper and lower urinary tract. Despite the fact that the effectiveness of the drug is close to that of other quinolones, the obvious advantages of LF are the low level of side effects and the possibility of a single dose per day. The existence of an intravenous form of the drug allows it to be more effectively used in the treatment of complicated urinary infections.

Materials and methods

We have undertaken a study of the effectiveness of LF in patients with complicated urinary tract infection. LF was administered to 20 patients (19 women and 1 man) aged 24 to 56 years (mean age 41.3 years) with complicated UTI observed at the Department of Urology of the Moscow State Medical University and in the CDC City Clinical Hospital No. 50. In 19 patients, there was an exacerbation of chronic pyelonephritis and chronic cystitis. One patient was prescribed the drug after contact ureterolithotripsy due to the development of infectious and inflammatory complications. LF was prescribed at a dose of 250 mg per day for 10 days.

The study included patients with UTIs in the initial stages of the development of inflammation, who had not taken antibacterial drugs before the start of the study.

The inclusion criterion was the presence of at least one clinical symptom (chills, pain in the lumbar region, dysuria, pain in the suprapubic region, nausea, vomiting) in combination with microbiological criteria:

The number of leukocytes in the urine is more than 10 in the field of view;

The number of colony-forming units of the pathogen> 104;

Sensitivity to LF according to the sample with disks.

Prior to taking the drug, all patients underwent a routine urological examination, including urine culture for flora with determination of sensitivity to antibiotics, general urinalysis, clinical and biochemical blood tests, ultrasonographic monitoring (ultrasound), X-ray urological examination. None of the examined had signs of impaired passage of urine through the upper urinary tract.

The analysis of the results was carried out on the basis of a subjective assessment of the effectiveness of treatment by patients and a doctor, as well as the dynamics of objective studies: blood and urine tests, ultrasound images, urine cultures performed before the start of treatment, on the 3rd, 10th and 17th days of treatment.

No clinical benefit from treatment was defined as persistence or worsening of clinical symptoms at any time after 3 days of treatment.

The comparison group consisted of 23 patients (mean age 38.7 years) with acute pyelonephritis who were treated with ciprofloxacin 1.0 g per day.

results

In 90% of patients, the effectiveness of LF therapy was considered very good, and in 10% - good. Tolerability of the drug was very good in 55% of patients, good in 40% and moderate in 5% of patients.

In the ciprofloxacin group, 70% of patients showed very good treatment efficacy, 18% - good. In 3 patients (12%), ciprofloxacin therapy was ineffective, which was expressed in the preservation of severe hyperthermia and local pain in the lumbar region. Two of them were operated on due to the development of purulent inflammation: they underwent a kidney revision, decapsulation and nephrostomy.

The main complaints of the patients were pain in the lumbar region from the affected organ, chills, frequent painful urination, weakness - all these complaints were associated with an active inflammatory process in the upper and lower urinary tract. By the end of treatment, all patients treated with levofloxacin and 88% of patients treated with ciprofloxacin felt satisfactory and had no complaints.

Ultrasound monitoring of the size of the kidneys and the thickness of the renal parenchyma, carried out throughout the study in the main group, recorded a positive trend: an increase in the size of the kidney affected by the inflammatory process and local thickening of the parenchyma regressed by 10-17 days of treatment in all patients.

Pain on palpation of the lumbar region on the side of the lesion also regressed in all patients by the end of the study.

Monitoring of the culture study of urine against the background of LF therapy revealed a positive trend, expressed in a progressive decrease in the degree of bacteriuria, and by the 10-17th day of therapy, the urine culture was sterile. In the treatment of LF, inflammatory changes in the peripheral blood regressed. This was reflected in the normalization of the number of leukocytes (Fig. 1) and the disappearance of the stab shift in the blood formula.

Rice. 1. Dynamics of the number of blood leukocytes in the treatment of LF

All patients of the main group with an acute inflammatory process in the upper urinary tract before treatment had severe leukocyturia, which regressed by 10-17 days, which was confirmed by control urine tests (Fig. 2).

Rice. 2. Dynamics of the number of leukocytes in the analysis of urine in the treatment of LF

In patients of the comparison group who completed the study, the blood count was also normalized, however, the decrease in blood leukocytosis was less significant (up to 7.8x109 on average), and leukocyturia remained at the level of 6-10 leukocytes per field of view.

Against the background of LF treatment, on the 3-10th day from the start of treatment, 6 patients (30%) experienced adverse reactions in the form of nausea, and 3 of them (15%) had episodes of diarrhea. It should be noted that these phenomena were insignificant. By the end of the study, complaints of nausea were made by 3 patients suffering from chronic gastritis for a long time. None of the patients required special treatment due to the above adverse reactions, and none of them refused therapy.

In the ciprofloxacin group, adverse reactions in the form of nausea and diarrhea that did not require discontinuation of the drug were noted in 18% of patients.

Discussion

According to our data, the efficacy and safety of LF treatment were found to be good to very good in 95% of patients. Similar results are given in their works by G. Richard, C. DeAbate et.al., who used the drug according to a similar scheme and received a clinical effect in 98.1% of patients. Kondo K. et al. report a 100% success rate for treatment with levofloxacin. Such high results are explained by the short duration of the use of levofloxacin in urological practice, which determines the absence of strains of microorganisms resistant to its action. It should be noted that resistance to drugs of this pharmacological group associated with spontaneous mutations in vitro, is extremely rare.

The effectiveness of levofloxacin therapy in patients with acute pyelonephritis in the study by G. Richard et al. was 92%, while in the comparison group, where treatment with ciprofloxacin was carried out, it was slightly lower and equaled 88%. At the same time, the number of side effects recorded during treatment and expressed in various intensities of dyspeptic symptoms was 2% in the levofloxacin group, and 8% in the ciprofloxacin group.

According to our data, bacteriological examination of urine on the 10th day of admission and 7 days after discontinuation of treatment showed the absence of bacteriuria in all patients included in the study. I. Klimberg et al. studied the microbiological efficacy of levofloxacin in 171 patients. The course of treatment was 10 days. The drug was taken in the standard dosage - 250 mg once a day. The average level of elimination of pathogenic agents in the group was 95.5%.

Fu K.P. et.al., examining the safety of levofloxacin therapy, concluded that the most common side effects were nausea (1.3%) and diarrhea (1.1%). Dizziness (0.4%) and insomnia (0.3%) are somewhat less common. In our patients, sleep disorders and dizziness were not observed, which is probably due to the small number of patients in the group compared to Fu K.P., however, diarrhea and nausea were also quite common in our patients.

Based on our clinical study of the effectiveness of 10-day LF therapy, we can conclude that levofloxacin is an effective and safe agent for the treatment of patients with complicated urinary tract infection.

Levofloxacin -

Tavanik (trade name)

(Aventis Pharma)

Levofloxacin ® is a levorotatory isomer of ofloxacin and is 2 times superior in antimicrobial activity.

The drug belongs to the third generation fluoroquinolones and is used to treat bacterial infections of various origins and localizations.

The tool has a wide spectrum of action and high efficiency. Levofloxacin ® is characterized by a bactericidal effect - it destroys the pathogen by inhibiting the synthesis of its DNA and destroying structural components (cell wall, cytoplasm and membranes). In modern pharmacology, there are many drugs of a similar composition.

The main features of levofloxacin preparations:

• Indications for use are pneumonia, bronchitis, sinusitis, pyelonephritis and urological infections, chlamydia, boils and abscesses, bursitis, adnexitis, prostatitis, proctitis, etc.
• Contraindications include individual intolerance, epilepsy, connective tissue (tendon) lesions provoked by quinolones, periods of pregnancy and lactation, age up to 18 years. Caution must also be exercised in elderly patients.
• Side effects of levofloxacin ® and its analogues, compared with the previous generation fluoroquinolones (ofloxacin ®), are much less pronounced and account for less than 1.1% of cases. When taking medications, headaches and muscle pains, tendon rupture, nausea, diarrhea, vomiting, heart rhythm disturbances and blood pressure fluctuations, allergic reactions (photosensitization, edema, anaphylaxis), visual impairment, insomnia, development of superinfection, etc. can be observed.

The drug was developed by specialists from the Japanese company Daichii and patented in 1987. In 1993 it was officially included in clinical practice, in 97 it was allowed in the USA. After the expiration of the patent, it began to be produced all over the world: in Europe it is known as (Sanofi-Aventis), in the CIS you can buy Israeli, German, Indian, Russian and Belarusian counterparts. Available in the form of tablets of 250 and 500 mg, solution for infusion, as well as drops used in ophthalmology.

The price of the original drug is from 600 rubles for 10 tablets containing 500 mg of the active ingredient. Levofloxacin ® 250 mg naturally costs less, as does the solution for intravenous administration (120 rubles per 100 ml).

Substitutes are often cheaper:

• Leflobakt ® 250 mg (Russia) - 55 rubles;
• ® 250 mg (India) - 190 rubles;
• (India) - 376 rubles.

Levofloxacin ® is produced in Israel, 7 and 14 tablets per pack, costing 419 and 712 rubles, respectively, which also helps to save on the course of treatment. The main generics of Levofloxacin ® can be classified according to several criteria.

By active substance

The following drugs (for convenience - in the table) are made on the basis of levofloxacin, which is active against a variety of pathogens: gram-positive enterococci, diphtheria bacillus, several types of staphylococcus, pneumococci; Gram-negative Enterobacter spp., Escherichia coli, Proteus spp., Klebsiella, Neisseria, Shigella, Salmonella. It is also effective against Mycobacterium tuberculosis and some anaerobes. It is prescribed for systemic therapy of infections of the paranasal sinuses, bronchi, lungs, urinary system, joints, skin and soft tissues.

Abril Formulas®, India Solution for infusion, 100 ml

Note: Abiflox ® and Tigeron ® preparations in Russia can be purchased only in the online store.

Levofloxacin ® - the original drug and generics - is taken on an empty stomach in strict accordance with the instructions and doctor's prescriptions. A dosage of 250 mg is recommended for infections of the urinary system (1 tablet per day for 5-10 days). From 250 to 500 mg per dose is prescribed for soft tissue and skin infections and bronchitis for 1-2 weeks. At least 500 mg should be taken (1-2 times a day) in case of pneumonia, septicemia, prostatitis and tuberculosis.

Considering the high toxicity of fluoroquinolones, only a doctor should prescribe treatment and select dosages!

By generation of respiratory quinolones

Sparfloxacin ® - a derivative of fluoroquinolone - belongs to the third generation, like Levofloxacin ® . This drug is active primarily against gram-negative pathogens, including Pseudomonas spp. and staphylococci.

Pale treponema is resistant to this antibiotic, so it is not used for syphilis. Eating does not affect absorption, so it can be taken at any time. It is absorbed a little worse (by 90%, in contrast to the 99% bioavailability of Levofloxacin ®). The course of treatment ranges from 1 day for genitourinary infections (once 200 mg) to 10 days in case of pneumonia, sinusitis or bronchitis.

Sparfloxacin ® is prescribed for the same diseases caused by microorganisms sensitive to it. It is also effective for inflammation of the ovaries, gonorrhea, chlamydia, leprosy. Contraindications are generally similar, however, the list additionally includes heart and kidney failure, bradycardia. Side effects are similar. The undoubted advantage of this antibacterial agent is that pathogenic microorganisms develop resistance to it extremely slowly.

The cost of six tablets (200 mg of the active ingredient each) is about 330 rubles.

Respiratory antianaerobic quinols: levofloxacin ® or moxifloxacin ® ?

Under certain conditions, the doctor may prescribe a course ®. The drug represents the fourth generation of the class of fluoroquinolones and exhibits a bactericidal effect against a wide range of pathogens. In addition to gram+ and gram-microorganisms, it effectively prevents DNA reproduction of atypical bacteria and anaerobes: Mycoplasma spp., Legionella spp. and chlamydia. Drug-resistant strains are formed very slowly, which allows it to be successfully used as an alternative to macrolides and beta-lactam antibiotics in respiratory diseases (pneumonia, bronchitis, sinusitis), soft tissue and skin infections.

Advantages:

• Wider spectrum of antimicrobial activity compared to levofloxacin.
• The absence of a photosensitizing effect (allergic reactions do not occur when exposed to ultraviolet light, which is typical for previous generations of fluoroquinolones).
• There is no cross-resistance with other classes of antibiotics when prescribing complex antibiotic therapy.

There are no reliable data on the safety of Moxifloxacin ® in children. Therefore, its appointment is not recommended. It can be used only for health reasons, strictly under medical supervision, provided that the weight of the child exceeds 33 kilograms (dose adjustment with a lower body weight is not possible).

Flaws:

• Not effective in the treatment of urinary tract infections.
• There is not enough information about the toxicity of the drug to judge its 100% safety.
• Contraindications, in addition to pregnancy, lactation and epilepsy, are also intestinal disorders (diarrhea). In addition, quite often there are side effects from the gastrointestinal tract.
• The absorption of the active substance is negatively affected by the simultaneous intake of multivitamin and mineral complexes, which are usually used to maintain immunity during antibiotic therapy.

Only the attending physician can choose the original or analogue of levofloxacin ® 500 mg, taking into account laboratory analysis. Usually Moxifloxacin ® is used when the disease is provoked by an anaerobic pathogen, and other means are ineffective. Given the lack of information about the toxicity of the drug, it is unacceptable to prescribe it to yourself. The cost of 5 tablets of 400 mg is quite high: from 975 rubles. Up to 2 packs may be required per course of treatment.

Eye drops with fluoroquinolones

The original drug is Levofloxacin ® eye drops with an active ingredient concentration of 0.5%. Produced in 1 ml dropper tubes, the minimum price in pharmacies is 53 rubles per package with 2 ml of solution.

It is used in the antibiotic therapy of superficial ophthalmic infections caused by various types of staphylococci, streptococci, neisseria, pseudomonads, chlamydia and other microorganisms. They are also used as a prophylactic after surgery.

Strict contraindications are pregnancy, lactation, individual intolerance to certain components and age up to a year. Side effects can be manifested by burning in the eyes, blurred vision, the appearance of mucous cords. Less commonly - headache, swelling, dryness of the cornea. Despite the mode of application (up to 8 times a day), an overdose is extremely unlikely. It is not recommended to wear hydrophilic contact lenses during treatment.

Analogues of drops are the following medicines:

• . It is a 0.3% solution of Ofloxacin ® in 5 ml vials worth 170 rubles. It is used for blepharitis, conjunctivitis, keratitis, chlamydial infection and as a prophylaxis after surgery. Contraindicated in pregnant and lactating women, as well as persons with hypersensitivity to the components of the drug.
• - drops based on levofloxacin (0.5%, 5 ml). The list of indications, contraindications and side effects is the same as that of the original remedy. The price of one bottle is 230 rubles.
• Oftaquix ® . French analogue costing from 220 rubles per 5 ml bottle.
• . It is a 0.3% solution in containers of 5 ml (it costs about 270 rubles). Instructions for use are fully consistent with Floksal.
• - eye drops, the active ingredient of which is ciprofloxacin (3 mg per ml, 5 ml per vial). Indicated for uveitis, blepharitis, conjunctivitis, dacryocystitis, as well as for the prevention of postoperative complications. Not used for the treatment of pregnant and lactating women, children under one year of age, prone to allergies to the components of the composition of persons. Price - from 130 rubles.
• ciloxane ® . An analogue of the previous drug, prescribed for corneal ulcers and conjunctivitis of bacterial origin. During pregnancy and lactation, it is used with caution, contraindicated in children under 12 years of age. There is no information about the availability in Russian pharmacies.
• Uniflox ® - a remedy based on ofloxacin (5 ml of a 0.3% solution costs 115-135 rubles) with the same list of indications and contraindications.

All of these medicines can only be used as directed by an ophthalmologist and in strict accordance with the instructions.

Manufacturer of Levofloxacin ®

Initially, the drug, as mentioned above, was discovered and patented by the Japanese company Daichii, which produced it from 1987 until the expiration of the patent. Currently, the drug in the form of tablets, eye drops and infusion solution is produced worldwide by both large corporations and small pharmaceutical factories. Products of Belarusian, Israeli and Russian companies are represented on the domestic market.

Which brand of levofloxacin ® tablets is better?

This antibiotic has been used in clinical practice for a long time in different countries, so its quality and effectiveness can be judged by the numerous reviews of both doctors and patients:

• In Israel, Teva ® Pharmaceutical Plant produces 500 mg film-coated tablets in packs of 7 and 14. The price of 400 or 700 rubles is quite low for such a high-quality antimicrobial agent.
• The Belarusian concern Belmedpreparaty ® produces 250 mg capsules, 500 mg tablets, intravenous solution and eye drops. It is considered a fairly good generic, although it is rarely found in pharmacies in the Russian Federation.
• Russian companies "Vertex" ® , "Nizhpharm" ® , "Tevanik" ® and others also offer good drugs. Prices vary over a fairly wide range.

A doctor will help you choose a specific drug, but judging by the price / quality combination, Israeli products are still the best option. However, even cheaper drugs have the desired therapeutic effect, but before using them, you should always consult with a specialist.

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

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

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

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

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

• golden and saprophytic staphylococcus aureus;
• the causative agent of anthrax;
• streptococcus;
• legionella;
• meningococcus;
• yersinia;
• gonococcus;
• hemophilic bacillus;
• moraxella.

E. coli, enterococci, pneumococci and some strains of Proteus have moderate sensitivity. Resistant to the action of the antibiotic Ciprofloxacin are mycoplasmas and ureaplasmas, listeria and other, infrequent bacteria.

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

The advantage of the antibiotic Ciprofloxacin is a wide choice of forms of release. So, for the treatment of bacterial eye infections to reduce the risk of systemic side effects, the drug is prescribed in the form of eye drops. In severe diseases, injections of Ciprofloxacin are necessary, or rather, infusions, the standard dosage is 100 mg - 200 mg / 100 ml. After normalization of the patient's condition, the patient is transferred to tablets (they are available with a concentration of the active ingredient of 250 and 500 mg). Accordingly, the price of the drug also differs.

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

The antibiotic Ciprofloxacin is prescribed for children from 5 years of age and adults to treat such diseases:

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

In the form of eye drops, the antibiotic Ciprofloxacin is prescribed for infections of the mucous membrane of the organs of vision. According to experts, cases of development of resistance of the bacterial flora to the action of the drug have not been identified to date. But fluoroquinolones are classified as unsafe drugs, so they are not considered as first-line drugs for the treatment of uncomplicated bacterial infections.

Ciprofloxacin intramuscularly and in the form of eye drops and tablets

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

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

With plasma proteins, the active component of the drug binds only 15-20%. Basically, the antibiotic is concentrated in the organs of the small pelvis and abdominal cavity, saliva, lymphoid tissue of the nasopharynx, and lungs. Ciprofloxacin is also found in synovial fluid, bone and cartilage tissue.

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

The exact amount of medication prescribed, as well as the duration of treatment, depends on many factors. First of all, it is the condition of the patient. The standard recommendation regarding the use of any antibacterial agent is to continue taking it for at least three days after the temperature has returned to normal. This applies to both oral forms and the use of Ciprofloxacin intramuscularly.

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

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

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

Important

The severe course of the infection is an indication for increasing the daily dosage for an adult to 1.5 g.

Important

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

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

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

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

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

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

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

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

Also, contraindications to taking the medicine are hypersensitivity not only to Ciprofloxacin, but also to other medicines from the fluoroquinolone group.

The use of an antibiotic should be carried out under strict medical supervision in violation of the excretory function of the kidneys, severe diseases of the central nervous system. If the use of Ciprofloxacin is started after an operation under general anesthesia, monitor the pulse and blood pressure.

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

The patient is warned about such possible side effects:

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

Ciprofloxacin is part of many drugs.

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

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

If we talk about analogues of this antibiotic, we should also mention other antibacterial agents from the group of fluoroquinolones. So, patients are often interested in the doctor, Ofloxacin or Ciprofloxacin, which is better? Or can it be replaced with more modern Norfloxacin or Moxifloxacin?

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

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

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

Natalia, 50 years old

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

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

Modern antibiotics for the treatment of cystitis, such as Ofloxacin and Levofloxacin, are considered universal drugs that can suppress the activity of most bacteria.

Their appointment does not require a preliminary laboratory study of pathogens and determination of their sensitivity to these drugs, which allows you to start treatment in a timely manner.

Ofloxacin - description of the drug

Ofloxacin (Ofloxacin) - a synthetic antibacterial drug obtained as a result of improving nalidixic acid, belongs to the class of fluoroquinolones, named similarly to the main active ingredient. The use of Ofloxacin for cystitis is due to the fact that it:

• Directly acts on the pelvic organs - the target of treatment, while not deposited in the liver;
• Has a low level of microbial resistance;
• It has a wide spectrum of action against gram-negative and gram-positive bacteria, some types of protozoa;
• Due to the possibility of simultaneous administration with others, it is widely used as part of complex therapy for diseases of the urinary tract;
• It is widely used in the period of first aid as a catalyst for the development of protective blocks of the body.

Important! Ofloxacin has practically no effect on lacto- and bifidobacteria, as a result of which it occupies one of the leading positions in the sparing treatment of bacterial infectious diseases of the urinary tract.

With an uncomplicated course of the disease, the drug is prescribed in a short course (from 3 to 5 days), in the case of a chronic form of cystitis, the treatment is extended up to 10 days.

The dosage is selected individually and on average ranges from 200 to 800 mg of the drug per day, designed for several doses. A single dose, if necessary, can be 400 mg.

2 hours after taking the drug, it is maximally concentrated in the blood, producing a therapeutic effect, and is excreted from the body within a day. Young age (up to 18 years), pregnancy and lactation are contraindications for taking Ofloxacin.

Levofloxacin - description of the drug

Levofloxacin - a drug designed to combat atypical bacteria, obtained as a result of serious pharmacological developments, the isomer of ofloxacin is an effective drug in the latest generation of fluoroquinolones, ideal for systemic treatment.

The main active ingredient is levofloxacin hemihydrate, which:

• Blocks the formation of DNA of pathogenic bacteria, inhibits their reproduction;
• Prevents the penetration of pathogens into the mucous membrane of the bladder;
• Quickly relieves acute inflammation;
• Resistance develops slowly and does not overlap with other antibiotics.

The drug is bioavailable, quickly and completely absorbed by the body, due to which it penetrates well into organs, tissues and mucous membranes.

Take up to 2 times a day, completely swallowing the tablets and drinking plenty of water. The dosage is determined by the severity of the disease and varies from 250 mg to 500 mg for 3-14 days.

Important! Clinical studies of the effect of the drug on women during pregnancy and lactation, as well as children, are not sufficient, so its use should be determined by the degree of risk for this group of patients.

Levofloxacin or Ofloxacin. What is more effective for cystitis?

Both drugs belong to an important group of fluoroquinolones and are actively used in therapeutic practice for the treatment of cystitis. In the presence of identical mechanisms of action on atypical pathogens, Levofloxacin belongs to antibiotics of the III (new) generation, which are characterized by higher clinical activity and a minimal set of side effects.

When the drug is absorbed inside, Levofloxacin with cystitis behaves 2 times more actively against pathogenic microbes than Ofloxacin, which is an important advantage in the choice of treatment.

If the therapeutic course with one of the drugs is ineffective, the doctor diagnoses a complicated bladder infection and sends the patient for a urological examination to identify possible pathologies and prescribes a new treatment that is adequate to the patient's condition.

According to the latest medical statistics, the spread of prostatitis and its forms has recently begun to increase. The reasons for this situation can be called a lot of factors, among which, the main place is occupied by the unsatisfactory attitude of a man to his health, poor ecology, poor-quality food, etc.

Therefore, it is not surprising how seriously pharmacologists have to work to offer patients the latest and most effective drugs for the treatment of prostatitis. Among them, there is also Levofloxacin - an antibiotic of the latest generation, with a wide spectrum of action.

This type of drug, like Amoxiclav, belongs to antibiotics with a wide spectrum of action and is ideal for the systemic treatment of various diseases, including prostatitis (acute, chronic, bacterial).

The release form of the drug is tablets or solutions for injection. Any form of the drug is quickly absorbed into the blood, affects the body at the cellular level, and the directed action of the drug allows you to effectively kill entire colonies of harmful microorganisms. For people suffering from infectious and bacterial diseases, it will be much cheaper to purchase such a medication than to buy other synonyms and an antibiotic substitute, which also have side effects and contraindications.

Levofloxacin analogues have the following properties:

• They have a wide and active spectrum of effects on the body.
• Able to quickly penetrate into the tissues of the prostate.
• Show a high degree of activity and directional action.

It's important to know

Before taking the medicine, you should read all the information that the instructions for taking the drug offer you. Like any other antibiotic, domestic or imported, Levofloxacin can cause side effects and individual intolerance.

Today you can choose not only Levofloxacin, analogues of this drug, similar in composition, action and form of release, are presented on the market in large quantities.

Tavanik- the same effective antibiotic that is prescribed for a variety of diseases. Characterized by a high degree of drug activity and impact on groups of harmful microorganisms, its use allows you to get positive results of treatment in the shortest possible time of therapy. The price of the product depends on the form of release: tablets can be bought from 600 rubles, an injection solution will cost you 1620 rubles.

Ciprofloxacin refers to active antibiotics with a wide spectrum of action. It is used to treat infectious diseases of internal organs and tissues, in particular, the genitourinary system. The drug is produced in various forms, for example, these are eye drops, suspensions and solutions for injections, tablets and capsules. The cost of an antibiotic is low, from 18 rubles, and any pharmacy can offer you this drug.

Along with the Russian analogues discussed above, there are also foreign analogues of Levofloxacin on the market that can defeat any infectious disease.

Elefloks, produced by an Indian pharmaceutical company, is actively used to treat various forms of prostatitis, inhibits the activity of harmful microorganisms. It is used in systemic treatment, in which the disease is quickly treatable.

Glevo- a product of Indian pharmacology, with a wide spectrum of action, excellent for the treatment of all forms of prostatitis.

Levofloxacin belongs to the group of fluoroquinols. To the same group with the active substance levofloxacin belong:

• Glevo.
• Elefloks.
• Ciprofloxacin.

All antibiotics of this group are very effective in the treatment of prostatitis. Therefore, your choice of a drug can only be influenced by your individual intolerance to the components of one of them, the severity of the disease, in which it is necessary to use complex treatment, in which not all antibiotics may be compatible with other drugs. All drugs have detailed instructions, after reading which you will find out what side effect can be expected, what contraindication in your case may affect the choice of remedy.

Tavanic or Levofloxacin which is better?

As we have already noted, both of these drugs belong to the group of fluoroquinols, with the active ingredient - levofloxacin, which quickly penetrates into the blood, then it is taken by the plasma and distributed to all tissues of the body.

The drug Levofloxacin has an active effect on various areas of tissues affected by harmful microorganisms, and it acts directly at the cellular level, which speeds up treatment and gives positive results. With prostatitis, different groups of bacteria can be present in the body that affect the organ and cause disease: anaerobic gram-positive and gram-negative, simple microorganisms and chlamydia. With all these "pests" the drug fights very effectively.

Tavanic is an antibiotic of the latest generation with high rates of effectiveness in the treatment of diseases of various internal organs, bone tissue.

The active substance in the drug is levofloxacin, the auxiliary ones are crospovidone, cellulose, titanium dioxide, macrogol 8000, iron oxide red and yellow. When taking the drug, its concentration in the blood lasts for a rather long period.

The antibacterial drug gives the fastest and most positive results in the treatment of various forms of prostatitis, ranging from mild to chronic, as it affects tissue cells, their membranes and walls. It is especially effective in complex treatment, because. its active and active component, levofloxacin, interacts well with other drugs.

note

If we compare Tavanic or Levofloxacin, which is better, then the first drug has fewer side effects and has a faster action and the spectrum of its effects is much wider.

Comparing the cost of drugs, it can be noted that you can buy Levofloxacin at a price of 77 rubles, and Tavanic - from 590 rubles.

Most often, when the doctor has prescribed a course of treatment with this drug, the patient is prescribed 2 doses.

The average daily dose of the drug at each dose is from 500 ml to 1 g, depending on the form of the disease, the prostate gland is in. If injections are prescribed, then the daily dose of liquid is from 250 to 500 ml, depending on the severity of the disease. The medicine is taken regardless of the meal, because. mucosa quickly absorbs the substances of the drug.

It's important to know

With mild forms of prostatitis, as well as with diseases that affect the bronchi, the course of treatment can be from 14 to 28 days. In this case, the daily dose is from 500 ml to 1 g.

To decide whether Tavanic or Levofloxacin is better, the attending physician will help you, who will select the optimal antimicrobial drug for effective therapy.

Levofloxacin or Ciprofloxacin: a comparative evaluation of drugs

The drug has a wide spectrum of action, inhibits the vital activity of various microorganisms, quickly penetrates into the bloodstream, is distributed throughout the tissues of the body, and any infection is amenable to such therapy.

The doctor prescribes the drug, which calculates the daily dose of the drug.

The course of treatment can be from 1 to 4 weeks, depending on the degree of the disease.

If we consider Levofloxacin and Ciprofloxacin, the difference lies in the fact that the first is more effective, it can interact with other drugs, while Ciprofloxacin, under the influence of other drugs, can reduce its concentration and activity, which delays the course of treatment.

Both medicines, Levofloxacin and Ciprofloxacin, are antibiotics that should only be taken on the advice of a doctor, who considers each clinical case on an individual basis.

The main difference between the two antibiotics is the active substance: in the first preparation it is levofloxacin, and in the second it is ofloxacin. Under the action of Ofloxacin, not all groups of bacteria can be destroyed, since microorganisms have a different degree of sensitivity to ofloxacin, so the treatment of prostatitis may be different due to the causes of the disease and the effectiveness of treatment may also differ.

Levofloxacin Astrapharm: description of the drug and its distinctive features

Distinctive features from Levofloxacin

Levofloxacin Astrapharm is able to inhibit the activity of gram-positive and gram-negative microbes, while Levofloxacin acts on all groups of bacteria.

Most often, Levofloxacin Astrapharm is used to effectively treat bacterial chronic prostatitis.

In therapy with Levofloxacin, a positive trend is observed already in the middle of treatment, and this occurs regardless of the form of the disease.

If we talk about Levofloxacin Astrapharm blister, then it is more effective in the treatment of mild and moderate forms of prostatitis.

Regardless of what choice you make in the treatment of prostatitis, you must remember that only a systemic, well-chosen treatment can give positive dynamics and results.