The drug Abaktal ® is used as a monotherapy or as a combination therapy with other antimicrobial agents.
With mixed infections, with perforated processes in the abdominal cavity, with bacterial infections of the gastrointestinal tract with severe course, the drug Abaktal® is combined with drugs active against anaerobes (metronidazole, clindamycin).
During treatment, patients should receive a large amount of fluid (to prevent crystalluria).
Photosensitivity
Due to the possible appearance of a photosensitivity reaction during treatment, the Abaktal® preparation should not be exposed to UV radiation and prolonged exposure to direct sunlight. If there are any changes on the skin, treatment should be discontinued. Avoid direct sunlight for 4 days after discontinuation of therapy, otherwise it is recommended to use protective clothing or a protective cream (with a high level of UV protection).
Liver failure
For patients with severe liver disease, dose adjustment is required in proportion to the degree of damage (see section "Method of administration and dose").
Musculoskeletal system
Tendinitis, which occurs during treatment with pefloxacin, can lead to rupture of the tendon (for example, the Achilles tendon). Sometimes bilateral bilateral tendonitis may occur within 48 hours after initiation of treatment with Abaktal®, as well as several months after discontinuation of treatment with the drug.
The risk factors for the development of tendonitis against the background of fluoroquinolone therapy include: age over 60 years, renal failure, dialysis, concomitant therapy with glucocorticosteroids, dyslipidemia. In case of initial signs of tendonitis treatment with pefloxacin should be discontinued, the load on the affected limb should be eliminated and the doctor should be consulted.
To reduce the risk of tendonopathy:
- It is recommended to treat elderly patients after a careful assessment of the relationship between benefit and risk. The risk can be reduced through the use of half doses of the drug;
- the use of pefloxacin in patients with tendinitis in a history is contraindicated, it is recommended to avoid the use in patients receiving glucocorticosteroids or engaged in intensive physical exercises.
The risk of rupture is higher in patients who started walking after prolonged compliance with bed rest.
With the beginning of pefloxacin therapy, it is recommended to monitor pain and swelling in the Achilles tendon, especially in patients at risk. If these symptoms are identified, pefloxacin should be discontinued,Eliminate the burden on the affected tendons and support them with a suitable orthosis or orthopedic footwear, even if the lesion is one-sided. You should seek advice from a specialist.
Disglycemia
In patients with diabetes mellitus, taking oral hypoglycemic agents (for example, glibenclamide) or insulin, the use of pefloxacin increases the risk of hypo- / hyperglycemia. Such patients need monitoring of blood glucose concentration.
Disturbances from the nervous system
In patients receiving fluoroquinolones, including pefloxacin, sensory and sensory-motor peripheral neuropathy was noted, the onset of which can be rapid. When a patient develops symptoms of neuropathy, pefloxacin should be discontinued (minimizing the possible risk of irreversible changes). Pefloxacin should be used with caution in patients with pseudo-paralytic myasthenia gravis (myasthenia gravis).
Pefloxacin should be used with caution in elderly patients with impaired cerebral circulation, organic changes in the brain or stroke.
Pefloxacin should be used with caution in patients who have a history of seizures and conditions predisposing to their development in patients with porphyria.
Disturbances on the part of the organ of sight
If visual acuity decreases or other effects from the visual organ are observed, the ophthalmologist should be consulted immediately.
Gastrointestinal tract
Diarrhea (especially in cases of severe, persistent and / or blooded impurities) during or after application of the drug Abaktal® may be a symptom of the disease caused by Clostridium difficile, the most severe form of which is pseudomembranous colitis. If there is a suspicion of pseudomembranous colitis, the use of Abaktal® should be stopped immediately and symptomatic treatment should be given (eg, vancomycin inside). In this condition, drugs that reduce peristalsis are contraindicated.
Heart Disease
It was reported on the lengthening of the interval QT in patients who received fluoroquinolones. Although pefloxacin can be attributed to a group of fluoroquinolones characterized by very low potential, or lacking sufficient information to assess their potential ability to elicit an interval QT, caution should be exercised while using pefloxacin with drugs that can lengthen the interval QT (for example, antiarrhythmic drugs IA and III classes; antipsychotic drugs (pimozide, haloperidol, phenothiazine derivatives); tricyclic antidepressants, some antimicrobials (erythromycin, sparfloxacin, moxifloxacin, antimalarial drugs, macrolides); some antihistamines (astemizole), as the risk of developing life-threatening arrhythmias increases.
Deficiency of glucose-6-phosphate dehydrogenase
The development of hemolytic reactions with the use of fluoroquinolones in patients with deficiency of glucose-6-phosphate dehydrogenase was reported. Although pefloxacin was not reported for hemolysis, antibiotic use in such patients should be avoided and an alternative treatment option should be avoided, if available.
Sustainability
As with other antibiotics, the use of pefloxacin, especially prolonged, can lead to the propagation of insensitive microorganisms. Repeated evaluation of the patient's condition is mandatory.If a secondary infection develops during treatment, appropriate measures should be taken.
Impact on laboratory tests
There may be false-positive results in determining opioids in urine. It may be necessary to confirm positive results using more specific methods.
Pefloxacin does not affect the tests that determine the level of glucose in the urine.
Hypersensitivity
Hypersensitivity and allergic reactions, including anaphylactic reactions, can be a consequence of the use of pefloxacin and can be life-threatening.
When developing a hypersensitivity reaction, it is necessary to cancel pefloxacin and begin appropriate therapy.
Special precautions for the destruction of unused medicinal product
There is no need for special precautions for the destruction of the unused drug Abaktal®.