Hospital infections caused by Pseudomonas aeruginosa (Pseudomonas aeruginosa), may require combined treatment.
The prevalence of acquired resistance of the sown strains of microorganisms can vary depending on the geographic region and over time. In this regard, information about drug resistance in a particular country is required. For the treatment of severe infections or in the ineffectiveness of treatment, a microbiological diagnosis should be made, isolating the pathogen and determining its sensitivity to levofloxacin.
Methicillin-resistant golden streptococcus
There is a high likelihood that Methicillin-Resistant Staphylococcus aureus will be resistant to fluoroquinolones, including levofloxacin. therefore levofloxacin It is not recommended for the treatment of established or suspected infections caused by methicillin-resistant Staphylococcus aureus,if the laboratory tests did not confirm the sensitivity of this microorganism to levofloxacin.
Patients who are predisposed to develop seizures
Like other quinolones, levofloxacin should be used with great care in patients with a predisposition to convulsions. Such patients include patients with previous lesions of the central nervous system, such as stroke, severe craniocerebral trauma; patients simultaneously receiving drugs that reduce the threshold of convulsive brain readiness, such as fenbufen and other nonsteroidal anti-inflammatory drugs like it or other drugs that lower the threshold of convulsive readiness, such as theophylline (see section "Interaction with other drugs").
Pseudomembranous disease
Developed during or after levofloxacin treatment, diarrhea, especially severe, persistent and / or with blood, may be a symptom of pseudomembranous colitis caused by Clostridium difficile. In case of suspected development of pseudomembranous colitis, treatment with levofloxacin should be stopped immediately and immediately begin specific antibiotic therapy (vancomycin, teicoplanin or metronidazole inside). Drugs that inhibit the intestinal peristalsis are contraindicated.
Tendonitis
Rarely observed tendonitis in the use of quinolones, including levofloxacin. can lead to the rupture of tendons, including the Achilles tendon. This side effect can develop within 48 hours after the start of treatment and can be bilateral. Older patients are more prone to tendonitis. Risk of rupture of tendons may increase with simultaneous admission glucocorticosteroids. If suspicion of tendonitis should immediately stop the drug Levofloxacin-Teva and begin appropriate treatment affected tendon, for example, providing him with sufficient immobilization (see the sections "Contraindications" and "Side effect").
Hypersensitivity reactions
Levofloxacin can cause serious, potentially fatal, hypersensitivity reactions (angioedema, anaphylactic shock), even with the use of initial doses (see the "Side effect" section). Patients should immediately stop taking the drug and consult a doctor.
Severe bullous reactions
When taking levofloxacin, there were cases of severe bullous skin reactions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis (see section "Side effect"). In case of any reactions from the skin or mucous membranes, the patient should immediately consult a doctor and do not continue treatment until his consultation.
Disturbances from the liver and bile ducts
There have been reports of hepatic necrosis, including the development of fatal liver failure with levofloxacin, mainly in patients with severe underlying diseases, for example, with sepsis (see section "Side effect"). Patients should be warned about the need for discontinuation of treatment and urgent medical attention in case of signs and symptoms of liver damage such as anorexia, jaundice, darkening of urine, pruritus and abdominal pain.
Patients with renal insufficiency
As levofloxacin excreted mainly through the kidneys, in patients with impaired renal function, mandatory monitoring of kidney function is required, as well as correction of the dosing regimen (see section "Method of administration and dose").In the treatment of elderly patients, it should be borne in mind that patients of this group often have impaired renal function (see section "Method of administration and dose").
Prevention of the development of photosensitization reactions
Although photosensitization is very rare in the use of levofloxacin, it is not recommended for patients to be prevented from developing during treatment and to undergo, without special need for strong sunlight or artificial ultraviolet irradiation (for example, to visit the solarium) for 48 hours after the end of treatment with levofloxacin.
Superinfection
As with the use of other antibiotics, the use of levofloxacin, especially for a long time, can lead to increased reproduction of insensitive microorganisms (bacteria and fungi), which can cause changes in microflora, which is normally present in humans. As a result, superinfection may develop. Therefore, during the treatment, it is mandatory to reevaluate the patient's condition, and, if developed during the treatment of superinfection, appropriate measures should be taken.
Lengthening the interval QT
Very rare cases of lengthening of the interval have been reported QT in patients taking fluoroquinolones, including levofloxacin.
When using fluoroquinolones, including levofloxacin, caution should be exercised in patients with known risk factors for lengthening the interval QT: in patients with uncorrected electrolyte disorders (hypokalemia, hypomagnesemia); with the syndrome of congenital lengthening of the interval QT; with diseases of the heart (heart failure, myocardial infarction, bradycardia); with simultaneous [intake of medications that can lengthen the interval QT, such as antiarrhythmic drugs of class IA and III, tricyclic antidepressants, macrolides, neuroleptics.
Elderly patients and female ileal patients may be more sensitive to drugs that extend the interval QT. Therefore, care should be taken to use fluoroquinolones, including levofloxacin (see the sections "With caution", "Method of administration and dose", "Side effect" and "Overdose" "Interaction with other drugs").
Patients with deficiency of glucose-6-phosphate dehydrogenase
Patients with a latent or manifested deficiency of glucose-6-phosphate dehydrogenase have a predisposition to hemolytic reactions in the treatment with quinolones, which should be taken into account when treating levofloxacin.
Hypo-and hyperglycemia (dysglycemia)
As with the use of other quinolones, when levofloxacin was used, cases of hyperglycaemia and hypoglycemia were observed, usually in patients with diabetes mellitus, who received treatment with oral hypoglycemic drugs (eg, glibenclamide) or with insulin preparations. There have been reports of cases of hypoglycemic coma. Patients with diabetes are required to monitor the concentration of glucose in the blood (see section "Side effect").
Peripheral Neuropathy
In patients taking fluoroquinolones, including levofloxacin, sensory and sensory-motor peripheral neuropathy was noted, the onset of which can be rapid. If the patient has symptoms of neuropathy, the use of levofloxacin should be discontinued. This minimizes the possible risk of irreversible changes.
Exacerbation of pseudo-paralytic myasthenia gravis (myasthenia gravis)
Fluoroquinolones, including levofloxacin, are characterized by neuromuscular blocking of activity and may increase muscle weakness in patients with pseudo-paralytic myasthenia gravis. In the postmarketing period, adverse reactions were observed, including pulmonary insufficiency, requiring artificial ventilation, and fatal outcome, which were associated with the use of fluoroquinolones in patients with pseudo-paralytic myasthenia gravis. The use of levofloxacin in patients with established diagnosis of pseudo-paralytic myasthenia is not recommended (see section "Side effect"),
Application in the airborne route of infection with anthrax
The use of levofloxacin in humans, but this indication is based on data but sensitivity to it Bacillus anthracis, obtained in studies in vitro and in experimental studies conducted on animals, as well as on limited data on the use of levofloxacin in humans. The attending physicians should refer to national and / or international documents that reflect the common point of view on the treatment of anthrax.
Psychotic reactions
When using quinolones, including levofloxacin, reported on the development of psychotic reactions, which in very rare cases progressed to the development of suicidal thoughts and behavioral disorders with self-harm (sometimes after taking a single dose of levofloxacin (see the section "Side effect")). With the development of such reactions, treatment with levofloxacin should be discontinued and appropriate therapy prescribed. Caution should be used to prescribe the drug to patients with psychoses or patients who have a history of mental illness.
Visual disturbances
With the development of any visual impairment, an immediate consultation of the ophthalmologist is required (see the "Side effect" section).
Impact on laboratory tests
In patients receiving levofloxacin, the definition of opiates in urine can lead to false positive results, which should be confirmed by more specific methods.
Levofloxacin can inhibit growth Mycobacterium tuberculosis and lead in the future to false-negative results of a bacteriological diagnosis of tuberculosis.