Features of the composition and action of Tavanik
The medicine is produced in tablets and solutions for droppers. The composition of the tablet form is presented:
- levofloxacin;
- crospovidone;
- MCC;
- sodium stearyl furamate;
- hypromellose;
- macrogol 800;
- food additive E 171 and E 172;
- talcum powder
100 ml of Tavanika solution contains levofloxacin, sodium chloride and hydroxide, water, concentrated chlorous acid.
The instructions indicate that the antibiotic affects the production of protein in foreign substances, which provokes the death of pathogenic organisms. Tavanik does not apply:
- with Staphylococcus aureus;
- certain strains of pneumococcus;
- gonococcus, enterococcus;
- Salmonella, Shigella, Pseudomonas.
After administration, the active components penetrate almost all internal organs within 2 hours. Residues are excreted by the kidneys after 6-8 hours; in case of renal pathologies, indicators may change.
Interaction
Interactions requiring caution
With preparations containing magnesium, aluminum, iron and zinc, didanosine. Medicines containing divalent or trivalent cations, such as zinc or iron salts (medicines for the treatment of anemia), magnesium- and/or aluminum-containing drugs (such as antacids), didanosine (only dosage forms containing aluminum or magnesium as a buffer), It is recommended to take at least 2 hours before or 2 hours after taking Tavanic® tablets.
Calcium salts have a minimal effect on the absorption of levofloxacin when taken orally
With sucralfate. The effect of Tavanic® is significantly weakened by the simultaneous use of sucralfate (a drug for protecting the gastric mucosa).
For patients receiving levofloxacin and sucralfate, it is recommended that sucralfate be taken 2 hours after taking levofloxacin.
With theophylline, fenbufen or similar drugs from the NSAID group that reduce the threshold of convulsive readiness of the brain. No pharmacokinetic interaction of levofloxacin with theophylline was detected.
However, with the simultaneous use of quinolones and theophylline, NSAIDs and other drugs that reduce the threshold of convulsive readiness of the brain, a pronounced decrease in the threshold of convulsive readiness of the brain is possible.
The concentration of levofloxacin while taking fenbufen increases only by 13%.
With indirect anticoagulants (vitamin K antagonists) In patients treated with levofloxacin in combination with indirect anticoagulants (for example, warfarin), an increase in PT/INR and/or the development of bleeding was observed, incl. and heavy. Therefore, with the simultaneous use of indirect anticoagulants and levofloxacin, regular monitoring of blood coagulation parameters is necessary.
With probenecid and cimetidine. With the simultaneous use of drugs that interfere with renal tubular secretion, such as probenecid and cimetidine, and levofloxacin, caution should be exercised, especially in patients with renal failure.
The elimination (renal clearance) of levofloxacin is slowed down by cimetidine by 24% and probenecid by 34%. This is unlikely to be of clinical significance if renal function is normal.
With cyclosporine. Levofloxacin increased the half-life of cyclosporine by 33%. Since this increase is clinically insignificant, no dose adjustment of cyclosporine is required when used concomitantly with levofloxacin.
With GCS. Concomitant use of corticosteroids increases the risk of tendon rupture.
With drugs that prolong the QT interval. Levofloxacin, like other fluoroquinolones, should be used with caution in patients receiving drugs that prolong the QT interval (for example, class IA and III antiarrhythmic drugs, tricyclic antidepressants, macrolides, antipsychotics).
Other. Clinical and pharmacological studies conducted to study the possible pharmacokinetic interactions of levofloxacin with digoxin, glibenclamide, ranitidine and warfarin showed that the pharmacokinetics of levofloxacin when used simultaneously with these drugs does not change sufficiently to be of clinical significance.
Contraindications and indications for treatment with Tavanik
The instructions recommend prescribing tablets for therapy:
- bronchitis and exacerbations of the chronic form of the disease;
- urinary tract infections - ordinary and complicated;
- pneumonia, sinusitis, septicemia;
- bacterial or chronic prostatitis;
- complex forms of tuberculosis;
- infectious lesions of the dermis, abdominal cavity or soft tissues.
Tavanic in solution is indicated for patients with pneumonia, tuberculosis, bacteremia, and genitourinary infections.
The drug is contraindicated in case of individual intolerance to the component composition, epilepsy. The medicine is not prescribed to pregnant and lactating women, minor patients, or persons undergoing fluoroquinolone therapy.
Evidence-based criteria for diagnosis
Evidence is provided by X-ray examination [5], in which the detected pathology may be characteristic of certain pathogens. Infiltrative changes can be lobar and multilobar, which is typical for bacterial pneumonia (including pneumococcal, legionella, caused by anaerobes, fungi) and mycobacteriosis, including pulmonary tuberculosis. Diffuse bilateral infiltration is typical for pathogens such as influenza virus, pneumococcus, staphylococcus, legionella. Focal and multifocal infiltration can be homogeneous (pneumococcus, legionella) or inhomogeneous (staphylococcus, viruses, mycoplasma). The combination of infiltrative and interstitial changes is typical for pneumonia of a viral, mycoplasma and pneumocystis nature. Interstitial changes can be miliary (mycobacterium tuberculosis, salmonella, fungi) or reticular (viruses, pneumocystis, mycoplasma, chlamydia). The combination of infiltrative or interstitial changes against the background of lymphadenopathy is quite typical for pulmonary tuberculosis and pneumonia caused by fungi, mycoplasma, chlamydia, measles and varicella viruses. Finally, with pneumonia, radiographic changes may be absent. This happens at the very beginning of the disease, with dehydration, severe neutropenia, as well as with pneumocystis etiology of the disease.
X-ray of the lungs reveals complications such as abscess formation, exudative pleurisy. Computed tomography of the lungs is justified only for differential diagnosis, if a regular X-ray is not very informative, as well as for a more accurate assessment of possible complications. Computed tomography makes it possible to detect early infiltrative and interstitial changes in cases where standard radiography is not yet demonstrative. Cavities, lymphadenopathy, pleural effusion and multifocal changes are clearly identified.
When studying the leukocyte formula, leukocytosis of more than 10 × 1000/μl, a shift of the leukocyte formula to the left (more than 10% of band neutrophils), and toxic granularity of neutrophils are typical. With the so-called In atypical pneumonias (mycoplasma and chlamydial), the leukocyte formula is often unchanged; moderate leukocytosis without neutrophilia is usually observed.
To identify the causative agent, bacteriological examination of sputum is traditionally carried out. Quantitative assessment of microflora is considered necessary, since concentrations of more than 1 million microbial bodies in 1 ml of sputum are diagnostically significant. The most convincing data are from sputum cultures obtained before the start of treatment, as long as the results of bacteriological examination are not distorted by previous ABT.
Determining the sensitivity of microflora isolated from sputum (blood, pleural fluid) to antibiotics can be a good help for the clinician, especially in cases where the initial therapy was ineffective. For the etiological deciphering of chlamydial, mycoplasma, and legionella pneumonia, serotyping is usually used. Specific antibodies to these pathogens are determined using the indirect immunofluorescence reaction (IRIF) or more modern methods - the ELISA test (IgM and IgG antibodies to mycoplasma and chlamydia) and determination of antigen in urine (legionella).
It should be noted that the current classification of pneumonia has led doctors to simplified diagnoses such as “community-acquired pneumonia”, “domestic pneumonia”, etc. It should be borne in mind that such diagnoses do not correspond to the International Classification of Diseases, 10th revision, according to which statistical records are kept. The requirement of Roszdravnadzor for statistical encryption of pneumonia based on etiological principles is legitimate.
Adverse reactions
During therapeutic procedures, a non-standard response to the drug may occur. Tavanik is capable of provoking:
- dyspeptic disorders, discomfort in the epigastric and abdominal areas;
- drop in blood pressure, sinus tachycardia;
- decreased visual acuity, extraneous noise in the ears;
- dermatological rash, obsessive itching, redness;
- joint pain, anorexia, drop in blood glucose levels;
- exacerbation or development of fungal infection;
- breathing problems, changes in sleep patterns, unreasonable anxiety;
- confused consciousness.
When injecting the solution, redness and an inflammatory process may form at the needle entry point. Rarely, fever associated with phlebitis is observed.
Clinical diagnosis of pneumonia
Usually the onset of the disease is acute, less often gradual, sometimes the development of pneumonia is preceded by an episode of acute respiratory viral infection or tracheobronchitis. Clinical diagnosis of pneumonia is usually [5] based on such signs as fever to febrile and subfebrile levels, cough (usually with sputum production). Some patients experience chills, chest pain, and shortness of breath. With lobar pneumonia, signs of consolidation of the lung tissue are revealed - shortening of the percussion sound, bronchial breathing, increased vocal tremors. The phenomenon of crepitus is characteristic, although local fine-bubble rales are most often detected on auscultation.
Severe pneumonia is characterized by the following clinical signs [3–5]: • bilateral, multilobar localization or abscess formation; • rapid progression of the process (increase in the infiltration zone by 50% or more within 48 hours of observation); • severe respiratory failure; • severe vascular insufficiency requiring the use of pressor amines; • leukopenia less than 4 or hyperleukocytosis more than 20 × 1000/μl with the number of immature neutrophils more than 10%; • oliguria or manifestations of acute renal failure.
In severe cases of pneumonia, life-threatening manifestations such as infectious-toxic shock, distress syndrome, disseminated intravascular coagulation syndrome, and multiple organ failure are often diagnosed. Severe pneumonia is diagnosed in the presence of 2–3 or more of the listed signs.
Elderly and senile individuals may not have the classic manifestations of pneumonia, but may experience fever, hypothermia, confusion, shortness of breath (or a combination of these symptoms).
When examining the patient, you should carefully record dangerous symptoms: shortness of breath, hypotension, oliguria, severe bradycardia/tachycardia, confusion. Of the possible complications, pleurisy is the most common, and abscess formation is less common. However, we should not forget about more rare and severe complications: meningitis, brain abscess, arthritis, pericarditis, endocarditis, peritonitis, pleural empyema.
Pneumonia of mycoplasma nature is characterized by signs of pharyngo-laryngo-tracheobronchitis at the onset of the disease, myalgia, profuse sweating (even with low subfebrility), an obsessive dry “whooping cough” cough of an unusually low timbre (manifestations of tracheobronchial dyskinesia). The same features (except for myalgia and profuse sweating) are common with chlamydial pneumonia.
Dosages and methods of taking Tavanik
The frequency of use, dose and duration of therapeutic procedures depend on the current disease and its complexity, and the general condition of the body.
Tavanik tablets are taken orally, they can be divided and crushed:
- sinusitis, bronchitis, prostatitis, damage to the urinary tract - from 0.25 to 0.5 g daily, therapy lasts 3-14 days, for prostatitis - lasts 28 days;
- infectious lesion of the dermis, hypodermis - from 0.25 to 0.5 g up to 2 doses per day, for 7-14 days;
- damage to the abdominal part or septicemia - 500 mg of the drug up to 14 procedures per day.
Kidney pathologies require a reduction in standard dosages.
The solution in droppers is administered slowly over 60 minutes. The duration of therapy does not exceed 2 weeks; if it is necessary to increase the treatment period, the patient is transferred to tablets.
special instructions
Hospital-acquired infections caused by Pseudomonas aeruginosa may require combination treatment.
The prevalence of acquired resistance in cultured strains of microorganisms may vary by geographic region and over time. In this regard, information on drug resistance in a specific country is required. For the treatment of severe infections or if treatment is ineffective, a microbiological diagnosis must be established with the isolation of the pathogen and determination of its sensitivity to levofloxacin.
Methicillin-resistant streptococcus aureus.
Analogs
If adverse reactions to treatment or signs of intolerance to Tavanik occur, it is replaced with a more suitable medication. The list of analogues is presented:
- Zolevoy, Leflokad, Levobact;
- Glevo, Levobax, Levocin;
- Levoxa, Lebel, Levomak;
- Levotor, Levoximed, Levostad;
- Levoflox, Levocel, Levofloxacin;
- Levoflocin, Leflock, Loxof;
- Tigeron, Lexid, Floxium.
Changes in the therapeutic regimen can only be made by the attending physician. Independent selection of analogues is prohibited; an incorrectly selected antibiotic can cause serious harm to health.
Pharmacodynamics
Tavanic® is a synthetic broad-spectrum antibacterial drug from the group of fluoroquinolones, containing levofloxacin, a levorotatory isomer of ofloxacin, as an active substance.
Levofloxacin blocks DNA gyrase and topoisomerase IV, disrupts supercoiling and cross-linking of DNA breaks, inhibits DNA synthesis, and causes profound morphological changes in the cytoplasm, cell wall and membranes of microbial cells.
Levofloxacin is active against most strains of microorganisms both in vitro and in vivo.
In vitro:
Sensitive microorganisms (MIC≤2 mg/ml; inhibition zone ≥17 mm)
Aerobic gram-positive microorganisms: Bacillus anthracis, Corynebacterium diphtheriae, Corynebacterium jeikeium, Enterococcus faecalis, Enterococcus spp, Listeria monocytogenes, Staphylococcus coagulase-negative methi-S/I (coagulase-negative methicillin-sensitive/moderately sensitive), Staphylococcus aureus methi-S, Staphylococcus epi dermidis methi -S, Staphylococcus spp (CNS), Streptococci groups C and G, Streptococcus agalactiae, Streptococcus pneumoniae peni-S/I/R (penicillin-sensitive/moderately sensitive/resistant), Streptococcus pyogenes, Viridans streptococci peni-S/R (penicillin-sensitive /-resistant).
Aerobic gram-negative microorganisms: Acinetobacter baumannii, Acinetobacter spp., Actinobacillus actinomycetemcomitans, Citrobacter freundii, Eikenella corrodens, Enterobacter aerogenes, Enterobacter cloacae, Enterobacter spp., Escherichia coli, Gardnerella vaginalis, Haemophilus ducreyi, Haemophilus influenzae ampi-S/R (ampicil lean-sensitive/ resistant), Haemophilus parainfluenzae, Helicobacter pylori, Klebsiella oxytoca, Klebsiella pneumoniae, Klebsiella spp., Moraxella catarrhalis β+/β- (producing and non-producing beta-lactamases), Morganella morganii, Neisseria gonorrhoeae non PPNG/PPNG, Neisseria meningitidis, Pasteurella canis , Pasteurella dagmatis, Pasteuralla multocida, Pasteurella spp, Proteus mirabilis, Proteus vulgaris, Providencia Rettteri, Providencia Stuartii, Providencia spp, Pseuudomonas aerugin OSA (Hospital infections caused by Pseudomonas Aeruginosa may require combined treatment), Pseudomonas spp, Salmonella spp, serratia marceescens, Serratia spp..
Anaerobic microorganisms: Bacteroides fragilis, Bifidobacterium spp., Clostridium perfringens, Fusobacterium spp., Peptostreptococcus, Propionibacterium spp., Veillonella spp.
Other microorganisms: Bartonella spp., Chlamydia pneumoniae, Chlamydia psittaci, Chlamydia trachomatis, Legionella pneumophila, Legionella spp., Mycobacterium spp., Mycobacterium leprae, Mycobacterium tuberculosis, Mycoplasma hominis, Mycoplasma pneumoniae, Ricketsia spp., Ureaplasma urealyticum.
Moderately sensitive microorganisms (MIC = 4 mg/l; inhibition zone - 16–14 mm):
Aerobic gram-positive microorganisms: Corynebacterium urealyticum, Corynebacterium xerosis, Enterococcus faecium, Staphylococcus epidermidis methi-R (methicillin-resistant), Staphylococcus haemolyticus methi-R.
Aerobic gram-negative microorganisms: Campylobacter jejuni/coli.
Anaerobic microorganisms: Prevotella spp., Porphyromonas spp.
Levofloxacin-resistant microorganisms (MIC≥8 mg/l; inhibition zone <13 mm)
Aerobic gram-positive microorganisms: Staphylococcus aureus methi-R, (methicillin-resistant), Staphylococcus coagulase-negative methi-R (coagulase-negative methicillin-resistant).
Aerobic gram-negative microorganisms: Alcaligenes xylosoxidans.
Anaerobic microorganisms: Bacteroides thetaiotaomicron.
Other microorganisms: Mycobacterium avium.
Resistance
Resistance to levofloxacin develops as a result of a stepwise process of mutations in the genes encoding both type II topoisomerases: DNA gyrase and topoisomerase IV. Other resistance mechanisms, such as the mechanism of influencing the penetration barriers of the microbial cell (a mechanism characteristic of Pseudomonas aeruginosa) and the mechanism of efflux (active removal of the antimicrobial agent from the microbial cell), may also reduce the sensitivity of microorganisms to levofloxacin.
Due to the peculiarities of the mechanism of action of levofloxacin, cross-resistance between levofloxacin and other antimicrobial agents is not usually observed.
Clinical efficacy (effectiveness in clinical studies in the treatment of infections caused by the following microorganisms):
Aerobic gram-positive microorganisms: Enterococcus faecalis, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes.
Aerobic gram-negative microorganisms: Citrobacter freundii, Enterobacter cloacae, Escherichia coli, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella (Branhamella) catarrhalis, Morganella morganii, Proteus mirabilis, Pseudomonas aeruginosa, Serratia marcescens.
Others: Chlamydia pneumoniae; Legionella pneumophila, Mycoplasma pneumoniae.
Reviews
According to doctors, the drug has all the characteristics declared by the manufacturer. If the recommendations from the instructions are followed exactly, the antibiotic is easily tolerated and does not provoke the development of side effects. During therapy, patients should increase the amount of fermented milk products consumed, drink a lot and comply with the requirements for maintaining a sleep-wake schedule.
There are different reviews about Tavanika on the forums; some patients refused treatment procedures due to the risk of developing non-standard responses of the body. People who have undergone a therapeutic course emphasize its effectiveness against many infectious diseases. Following the doctor's recommendations on dosages and duration of treatment allows the body to easily tolerate the antibiotic. Some patients experienced slight dizziness and headaches while taking Tavanic.
Overdose
Symptoms: Based on data obtained from toxicological studies conducted in animals, the most important expected symptoms of an acute overdose of Tavanic® are central nervous system symptoms (impaired consciousness, including confusion, dizziness and convulsions).
During post-marketing use of the drug in overdose, CNS effects have been observed, including confusion, convulsions, hallucinations and tremor.
Nausea and erosions of the gastrointestinal mucosa may develop.
In clinical and pharmacological studies conducted with doses of levofloxacin exceeding therapeutic levels, prolongation of the QT interval was shown.
Treatment: in case of overdose, careful monitoring of the patient is required, including ECG monitoring. Treatment is symptomatic. In case of acute overdose of Tavanic® tablets, gastric lavage and administration of antacids are indicated to protect the gastric mucosa. Levofloxacin is not eliminated by dialysis (hemodialysis, peritoneal dialysis and continuous ambulatory peritoneal dialysis). There is no specific antidote.
