Гиперчувствительность к левофлоксацину и другим фторхинолонам, эпилепсия, поражение сухожилий при ранее проводившемся лечении хинолонами, беременность, период лактации, детский и подростковый возраст (до 18 лет).
Антибактериальный препарат группы фторхинолонов широкого спектра действия. Левофлоксацин блокирует ДНК-гиразу (топоизомеразу II) и топоизомеразу IV, нарушает суперспирализацию и сшивку разрывов ДНК, подавляет синтез ДНК, вызывает глубокие морфологические изменения в цитоплазме, клеточной стенке и мембранах микроорганизмов. Препарат активен в отношении аэробных грамположительных микроорганизмов: Corynebacterium diphtheriae, Enterococcus spp. (в т.ч. Enterococcus faecalis), Listeria monocytogenes, Staphylococcus spp. (коагулаза-отрицательные, в т.ч. метициллин-чувствительные/метициллин-умеренно чувствительные штаммы), Staphylococcus aureus (метициллин-чувствительные штаммы), Staphylococcus epidermidis (метициллин-чувствительные штаммы), Streptococcus spp. группы С и G, Streptococcus agalactiae, Streptococcus pneumoniae (пенициллин-чувствительные/умеренно-чувствительные/резистентные штаммы), Streptococcus pyogenes, Streptococcus viridans (пенициллин-умеренно-чувствительные/резистентные штаммы); аэробных грамотрицательных микроорганизмов: Acinetobacter spp. (в т.ч. Acinetobacter baumannii), Actinobacillus actinomycetemcomitans, Citrobacter freundii, Eikenella corrodens, Enterobacter spp. (в т.ч. Enterobacter aerogenes, Enterobacter agglomerans, Enterobacter cloacae), Escherichia coli, Gardnerella vaginalis, Haemophilus ducreyi, Haemophilus influenzae (ампициллин-чувствительные/резистентные штаммы), Haemophilus parainfluenzae, Helicobacter pylori, Klebsiella spp. (в т.ч. Klebsiella oxytoca, Klebsiella pneumoniae), Moraxella catarrhalis (продуцирующие и непродуцирующие β-лактамазы), Morganella morganii, Neisseria gonorrhoeae (продуцирующие и непродуцирующие пенициллиназу), Neisseria meningitidis, Pasteurella spp. (в т.ч. Pasteurella conis, Pasteurella dagmatis, Pasteurella multocida), Proteus mirabilis, Proteus vulgaris, Providencia spp. (в т.ч. Providencia rettgeri, Providencia stuartii), Pseudomonas spp. (в т.ч. Pseudomonas aeruginosa), Salmonella spp., Serratia spp. (в т.ч. Serratia marcescens); анаэробных микроорганизмов: Bacteroides fragilis, Bifidobacterium spp., Clostridium perfringens, Fusobacterium spp., Peptostreptococcus spp., Propionibacterium spp., Veilonella spp.; других микроорганизмов: Bartonella spp., Chlamydia pneumoniae, Chlamydia psittaci, Chlamydia trachomatis, Legionella pneumophila, Legionella spp., Mycobacterium spp. (в т.ч. Mycobacterium leprae, Mycobacterium tuberculosis), Mycoplasma hominis, Mycoplasma pneumoniae, Rickettsia spp., Ureaplasma urealyticum.
Показания к применению
Бактериальные инфекции, чувствительные к левофлоксацину, у взрослых:- острый синусит; - обострение хронического бронхита; - внебольничная пневмония; - неосложненные инфекции мочевыводящих путей; - осложненные инфекции мочевыводящих путей (включая пиелонефрит); - хронический бактериальный простатит; - инфекции кожных покровов и мягких тканей; - септицемия/бактериемия, связанные с указанными выше показаниями; - инфекции брюшной полости; - для комплексного лечения лекарственно-устойчивых форм туберкулеза.
Противопоказания
Гиперчувствительность к левофлоксацину и другим фторхинолонам, эпилепсия, поражение сухожилий при ранее проводившемся лечении хинолонами, беременность, период лактации, детский и подростковый возраст (до 18 лет).
Применение при беременности и в период грудного вскармливания
Применение препарата противопоказано при беременности и в период лактации.
Способ применения и дозы
Препарат принимают внутрь один или два раза в день. Таблетки следует проглатывать целиком, не разжевывая и запивая достаточным количеством жидкости (от 0.5 до 1 стакана). Препарат можно принимать перед едой или между приемами пищи. Дозы определяются характером и тяжестью инфекции, а также чувствительностью предполагаемого возбудителя. Больным с нормальной или умеренно сниженной функцией почек (клиренс креатина > 50 мл/мин) рекомендуется следующий режим дозирования препарата: Синусит: по 500 мг 1 раз в день - 10-14 дней. Обострение хронического бронхита: по 250 мг или по 500 мг 1 в день - 7-10 дней. Внебольничная пневмония: по 500 мг 1-2 раза в день - 7-14 дней. Неосложненные инфекции мочевыводящих путей: по 250 мг 1 раз в день - 3 дня. Простатит - по 500 мг 1 раз в день - 28 дней. Осложненные инфекции мочевыводящих путей, включая пиелонефрит - по 250 мг 1 раз в день - 7-10 дней. Инфекции кожи и мягких тканей: по 250-500 мг 1-2 раза в день - 7-14 дней. Интраабдоминальная инфекция: по 500 мг 1 раз в день - 7-14 дней (в комбинации с антибактериальными препаратами, действующими на анаэробную флору). Режим дозирования больных с нарушенной функцией почек: Клиренс креатина 250 мг/24ч 500мг/24ч 500 мг/12чпервая доза: 250мг первая доза: 500мг первая доза: 500мг50 – 20 мл/мин затем: по 125мг/24ч затем: по 250мг/24ч затем: по 250мг/12ч19 – 10 мл/мин затем: по 125мг/48ч затем: по 125мг/24ч затем: по 125мг/12ч<10 мл/мин (включаягемодиализ и ПАПД) затем: по 125мг/48ч затем: по 125мг/24ч затем: по 125мг/24чПосле гемодиализа или постоянного амбулаторного перитонеального диализа (ПАПД) не требуется введение дополнительных доз. При нарушении функции печени не требуется специального подбора доз, поскольку левофлоксацин метаболизируется в печени лишь в крайне незначительной мере. Для пациентов пожилого возраста не требуется изменения режима дозирования, за исключением случаев низкого клиренса креатинина. Как и при применении других антибиотиков, лечение препаратом Глево таблетки, покрытые пленочной оболочкой, 250мг и 500мг рекомендуется продолжать не менее 48-78 часов после нормализации температуры тела или после достоверной эрадикации возбудителя. Если пропущен прием препарата, следует как можно скорее принять таблетку, пока не приблизилось время очередного приема. Далее продолжать принимать препарат по схеме.
Побочное действие
Указанные ниже побочные эффекты представлены в соответствии со следующими градациями частоты их возникновения: очень частые (≥1/10), частые (≥ 1/100, <1/10); нечастые (≥1/1000, <1/100); редкие (≥1/10000, <1/1000; очень редкие (<1/10000) (включая отдельные сообщения), неизвестная частота (по имеющимся данным определить частоту встречаемости не представляется возможным). Данные из клинических исследований левофлоксацина Нарушения со стороны сердцаРедкие: синусовая тахикардияНеизвестная частота: удлинение интервала Q-ТНарушения со стороны крови и лимфатической системыНечастые: лейкопения (уменьшение количества лейкоцитов в периферической крови), эозинофилия (увеличение количества эозинофилов в периферической крови). Редкие: нейтропения (уменьшение количества нейтрофилов в периферической крови), тромбоцитопения (уменьшение количества тромбоцитов в периферической крови). Неизвестная частота: панцитопения (уменьшение количества всех форменных элементов в периферической крови), агранулоцитоз (отсутствие или резкое уменьшение количества гранулоцитов в периферической крови), гемолитическая анемия. Нарушения со стороны нервной системыЧастые: головная боль, головокружениеНечастые: сонливость, тремор, дисгевзия (извращение вкуса). Редкие: парестезия, судорогиНеизвестная частота: периферическая сенсорная нейропатия, периферическая сенсомоторная нейропатия, дискинезия, экстрапирамидные расстройства, потеря вкусовых ощущений, паромсия (расстройство ощущение запаха, особенно субъективное ощущение запаха, объективно отсутствующего), включая потерю обоняния. Нарушения со стороны органов зренияОчень редкие: нарушение зрения, такие как расплывчатость видимого изображения. Нарушения со стороны органов слуха и лабиринтные нарушенияНечастые: вертиго (чувство отклонения или кружения или собственного тела или окружающих предметов). Редкие: звон в ушахНеизвестная частота: снижение слухаНарушения со стороны дыхательной системы, органов грудной клетки и средостенияНечастые: одышкаНеизвестная частота: бронхоспазм, аллергический пневмонит. Нарушения со стороны желудочно-кишечного трактаЧастые: диарея, рвота, тошнотаНечастые: боли в животе, диспепсия. Неизвестная частота: геморрагическая диарея, которая в очень редких случаях может быть признаком энтероколита, включая псевдомембранозный колит. Нарушения со стороны почек и мочевыводящих путейНечастые: повышенная концентрация креатинина в сыворотке крови. Редкие: острая почечная недостаточность (например, вследствие развития интерстициального нефрита). Нарушения со стороны кожи и подкожных тканейНечастые: сыпь, зуд, крапивницаНеизвестная частота: токсический эпидермальный некролиз, синдром Стивенса-Джонсона, экссудативная многоформная эритема, реакции фотосенсибилизации (повышенной чувствительности к солнечному и ультрафиолетовому излучению), лейкоцитокластический васкулит). Реакции со стороны кожи и слизистых оболочек могут иногда развиваться даже после приема первой дозы препарата. Нарушения со стороны скелетно-мышечной системы и соединительной ткани Нечастые: артралгия, миалгия. Редкие: поражение сухожилий, включая тендинит (например, ахиллова сухожилия), мышечная слабость, которая может быть особенно опасна у пациентов с псевдопаралитичеой миастенией (myasthenia gravis). Неизвестная частота: рабдомиолиз, разрыв сухожилия (например, ахиллова сухожилия). Этот побочный эффект может наблюдаться в течение 48 часов после начала лечения и может носить двухсторонний характер. Нарушения со стороны обмена веществ и питания Нечастые: анорексияРедкие: гипогликемия, особенно у пациентов с сахарным диабетом (возможные признаки гипогликемии: «волчий» аппетит, нервозность, испарина, дрожь). Инфекционные и паразитарные заболевания Нечастые: грибковые инфекции, развитие резистентности патогенных микроорганизмов. Нарушения со стороны сосудов Редкие: снижение артериального давления. Общие расстройства Нечастые: астенияРедкие: пирексия (повышение температуры тела). Нарушения со стороны иммунной системы Редкие: ангионевротический отек Неизвестная частота: анафилактический шок, анафилактоидный шок. Анафилактические и анафилактоидные реакции могут иногда развиваться даже после приема первой дозы препарата. Нарушения со стороны печени и желчевыводящих путей Частые: повышение активности «печеночных» ферментов в крови (например, аланинаминотрансферазы (АлАТ), аспартатаминотрансферазы (АсАТ)). Нечастые: повышение концентрации билирубина в крови. Неизвестная частота: тяжелая печеночная недостаточность, включая случаи развития острой печеночной недостаточности, особенно у пациентов с тяжелым основным заболеванием (например, при сепсисе); гепатит. Нарушения психикиЧастые: бессоницаНечастые: чувство беспокойства, спутанность сознания. Редкие: психические нарушения (например, с галлюцинациями), депрессия, ажитация (возбуждение), нарушение сна, ночные кошмары. Неизвестная частота: нарушения психики с нарушениями поведения с причинением себе вреда, включая суицидальные мысли и суицидальные попытки. Другие возможные нежелательные эффекты, относящиеся ко всем фторхинолонам Очень редкие: приступы порфирии (очень редкой болезни обмена веществ) у больных, уже страдающих этим заболеванием.
Передозировка
Симптомы: тошнота, эрозивные поражения слизистой оболочки ЖКТ, удлинение интервала QT, спутанность сознания, головокружение, судороги. Лечение: проводят симптоматическую терапию, диализ не эффективен.
Особые указания
Хотя левофлоксацин более растворим, чем другие хинолоны, пациентам следует проводить адекватную гидратацию организма. Во время лечения необходимо избегать солнечного и искусственного УФ-облучения во избежание повреждения кожных покровов (фотосенсибилизация). При появлении признаков тендинита, псевдомембранозного колита левофлоксацин немедленно отменяют и назначают соответствующую терапию. Следует иметь в виду, что у больных с поражением головного мозга в анамнезе (инсульт, тяжелая травма) возможно развитие судорог, при недостаточности глюкозо-6-фосфатдегидрогеназы повышается риск развития гемолиза. Влияние на способность к вождению автотранспорта и управлению механизмамиВ период лечения необходимо соблюдать осторожность при вождении автотранспорта и занятии другими потенциально опасными видами деятельности, требующими повышенной концентрации внимания и быстроты психомоторных реакций.
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Enterococcus faecalis), Listeria monocytogenes, Staphylococcus spp. (коагулаза-отрицательные, в т.ч. метициллин-чувствительные/метициллин-умеренно чувствительные штаммы), Staphylococcus aureus (метициллин-чувствительные штаммы), Staphylococcus epidermidis (метициллин-чувствительные штаммы), Streptococcus spp. группы С и G, Streptococcus agalactiae, Streptococcus pneumoniae (пенициллин-чувствительные/умеренно-чувствительные/резистентные штаммы), Streptococcus pyogenes, Streptococcus viridans (пенициллин-умеренно-чувствительные/резистентные штаммы); аэробных грамотрицательных микроорганизмов: Acinetobacter spp. (в т.ч. Acinetobacter baumannii), Actinobacillus actinomycetemcomitans, Citrobacter freundii, Eikenella corrodens, Enterobacter spp. (в т.ч. 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Таблетки следует проглатывать целиком, не разжевывая и запивая достаточным количеством жидкости (от 0.5 до 1 стакана). Препарат можно принимать перед едой или между приемами пищи. Дозы определяются характером и тяжестью инфекции, а также чувствительностью предполагаемого возбудителя. Больным с нормальной или умеренно сниженной функцией почек (клиренс креатина \u003e 50 мл/мин) рекомендуется следующий режим дозирования препарата: Синусит: по 500 мг 1 раз в день - 10-14 дней. Обострение хронического бронхита: по 250 мг или по 500 мг 1 в день - 7-10 дней. Внебольничная пневмония: по 500 мг 1-2 раза в день - 7-14 дней. Неосложненные инфекции мочевыводящих путей: по 250 мг 1 раз в день - 3 дня. Простатит - по 500 мг 1 раз в день - 28 дней. Осложненные инфекции мочевыводящих путей, включая пиелонефрит - по 250 мг 1 раз в день - 7-10 дней. Инфекции кожи и мягких тканей: по 250-500 мг 1-2 раза в день - 7-14 дней. Интраабдоминальная инфекция: по 500 мг 1 раз в день - 7-14 дней (в комбинации с антибактериальными препаратами, действующими на анаэробную флору). Режим дозирования больных с нарушенной функцией почек: Клиренс креатина 250 мг/24ч 500мг/24ч 500 мг/12чпервая доза: 250мг первая доза: 500мг первая доза: 500мг50 – 20 мл/мин затем: по 125мг/24ч затем: по 250мг/24ч затем: по 250мг/12ч19 – 10 мл/мин затем: по 125мг/48ч затем: по 125мг/24ч затем: по 125мг/12ч\u003c10 мл/мин (включаягемодиализ и ПАПД) затем: по 125мг/48ч затем: по 125мг/24ч затем: по 125мг/24чПосле гемодиализа или постоянного амбулаторного перитонеального диализа (ПАПД) не требуется введение дополнительных доз. При нарушении функции печени не требуется специального подбора доз, поскольку левофлоксацин метаболизируется в печени лишь в крайне незначительной мере. Для пациентов пожилого возраста не требуется изменения режима дозирования, за исключением случаев низкого клиренса креатинина. Как и при применении других антибиотиков, лечение препаратом Глево таблетки, покрытые пленочной оболочкой, 250мг и 500мг рекомендуется продолжать не менее 48-78 часов после нормализации температуры тела или после достоверной эрадикации возбудителя. Если пропущен прием препарата, следует как можно скорее принять таблетку, пока не приблизилось время очередного приема. Далее продолжать принимать препарат по схеме."}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Указанные ниже побочные эффекты представлены в соответствии со следующими градациями частоты их возникновения: очень частые (≥1/10), частые (≥ 1/100, \u003c1/10); нечастые (≥1/1000, \u003c1/100); редкие (≥1/10000, \u003c1/1000; очень редкие (\u003c1/10000) (включая отдельные сообщения), неизвестная частота (по имеющимся данным определить частоту встречаемости не представляется возможным). Данные из клинических исследований левофлоксацина Нарушения со стороны сердцаРедкие: синусовая тахикардияНеизвестная частота: удлинение интервала Q-ТНарушения со стороны крови и лимфатической системыНечастые: лейкопения (уменьшение количества лейкоцитов в периферической крови), эозинофилия (увеличение количества эозинофилов в периферической крови). Редкие: нейтропения (уменьшение количества нейтрофилов в периферической крови), тромбоцитопения (уменьшение количества тромбоцитов в периферической крови). Неизвестная частота: панцитопения (уменьшение количества всех форменных элементов в периферической крови), агранулоцитоз (отсутствие или резкое уменьшение количества гранулоцитов в периферической крови), гемолитическая анемия. Нарушения со стороны нервной системыЧастые: головная боль, головокружениеНечастые: сонливость, тремор, дисгевзия (извращение вкуса). Редкие: парестезия, судорогиНеизвестная частота: периферическая сенсорная нейропатия, периферическая сенсомоторная нейропатия, дискинезия, экстрапирамидные расстройства, потеря вкусовых ощущений, паромсия (расстройство ощущение запаха, особенно субъективное ощущение запаха, объективно отсутствующего), включая потерю обоняния. Нарушения со стороны органов зренияОчень редкие: нарушение зрения, такие как расплывчатость видимого изображения. Нарушения со стороны органов слуха и лабиринтные нарушенияНечастые: вертиго (чувство отклонения или кружения или собственного тела или окружающих предметов). Редкие: звон в ушахНеизвестная частота: снижение слухаНарушения со стороны дыхательной системы, органов грудной клетки и средостенияНечастые: одышкаНеизвестная частота: бронхоспазм, аллергический пневмонит. Нарушения со стороны желудочно-кишечного трактаЧастые: диарея, рвота, тошнотаНечастые: боли в животе, диспепсия. Неизвестная частота: геморрагическая диарея, которая в очень редких случаях может быть признаком энтероколита, включая псевдомембранозный колит. Нарушения со стороны почек и мочевыводящих путейНечастые: повышенная концентрация креатинина в сыворотке крови. Редкие: острая почечная недостаточность (например, вследствие развития интерстициального нефрита). Нарушения со стороны кожи и подкожных тканейНечастые: сыпь, зуд, крапивницаНеизвестная частота: токсический эпидермальный некролиз, синдром Стивенса-Джонсона, экссудативная многоформная эритема, реакции фотосенсибилизации (повышенной чувствительности к солнечному и ультрафиолетовому излучению), лейкоцитокластический васкулит). Реакции со стороны кожи и слизистых оболочек могут иногда развиваться даже после приема первой дозы препарата. Нарушения со стороны скелетно-мышечной системы и соединительной ткани Нечастые: артралгия, миалгия. Редкие: поражение сухожилий, включая тендинит (например, ахиллова сухожилия), мышечная слабость, которая может быть особенно опасна у пациентов с псевдопаралитичеой миастенией (myasthenia gravis). Неизвестная частота: рабдомиолиз, разрыв сухожилия (например, ахиллова сухожилия). Этот побочный эффект может наблюдаться в течение 48 часов после начала лечения и может носить двухсторонний характер. Нарушения со стороны обмена веществ и питания Нечастые: анорексияРедкие: гипогликемия, особенно у пациентов с сахарным диабетом (возможные признаки гипогликемии: «волчий» аппетит, нервозность, испарина, дрожь). Инфекционные и паразитарные заболевания Нечастые: грибковые инфекции, развитие резистентности патогенных микроорганизмов. Нарушения со стороны сосудов Редкие: снижение артериального давления. Общие расстройства Нечастые: астенияРедкие: пирексия (повышение температуры тела). Нарушения со стороны иммунной системы Редкие: ангионевротический отек Неизвестная частота: анафилактический шок, анафилактоидный шок. Анафилактические и анафилактоидные реакции могут иногда развиваться даже после приема первой дозы препарата. Нарушения со стороны печени и желчевыводящих путей Частые: повышение активности «печеночных» ферментов в крови (например, аланинаминотрансферазы (АлАТ), аспартатаминотрансферазы (АсАТ)). Нечастые: повышение концентрации билирубина в крови. Неизвестная частота: тяжелая печеночная недостаточность, включая случаи развития острой печеночной недостаточности, особенно у пациентов с тяжелым основным заболеванием (например, при сепсисе); гепатит. Нарушения психикиЧастые: бессоницаНечастые: чувство беспокойства, спутанность сознания. Редкие: психические нарушения (например, с галлюцинациями), депрессия, ажитация (возбуждение), нарушение сна, ночные кошмары. Неизвестная частота: нарушения психики с нарушениями поведения с причинением себе вреда, включая суицидальные мысли и суицидальные попытки. Другие возможные нежелательные эффекты, относящиеся ко всем фторхинолонам Очень редкие: приступы порфирии (очень редкой болезни обмена веществ) у больных, уже страдающих этим заболеванием."}}]},{"id":8,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Симптомы: тошнота, эрозивные поражения слизистой оболочки ЖКТ, удлинение интервала QT, спутанность сознания, головокружение, судороги. Лечение: проводят симптоматическую терапию, диализ не эффективен."}}]},{"id":9,"name":"Особые указания","slug":"cautions","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Хотя левофлоксацин более растворим, чем другие хинолоны, пациентам следует проводить адекватную гидратацию организма. Во время лечения необходимо избегать солнечного и искусственного УФ-облучения во избежание повреждения кожных покровов (фотосенсибилизация). При появлении признаков тендинита, псевдомембранозного колита левофлоксацин немедленно отменяют и назначают соответствующую терапию. Следует иметь в виду, что у больных с поражением головного мозга в анамнезе (инсульт, тяжелая травма) возможно развитие судорог, при недостаточности глюкозо-6-фосфатдегидрогеназы повышается риск развития гемолиза. Влияние на способность к вождению автотранспорта и управлению механизмамиВ период лечения необходимо соблюдать осторожность при вождении автотранспорта и занятии другими потенциально опасными видами деятельности, требующими повышенной концентрации внимания и быстроты психомоторных реакций."}}]}],"source":{"title":"36.6","url":"https://366.ru"}},"description_toggle":false,"short_description":"Антибактериальный препарат группы фторхинолонов широкого спектра действия. 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