Usage
This combination medication is prescribed for various bacterial infections, including respiratory tract infections (e.g., pneumonia, bronchitis, sinusitis), urinary tract infections (e.g., cystitis, pyelonephritis), skin and soft tissue infections, typhoid fever, gastrointestinal infections, otitis media, and certain sexually transmitted infections. It’s also used post-operatively to prevent infections and restore gut flora balance disrupted by antibiotic therapy.
Pharmacological Classification:
- Cefixime: Cephalosporin antibiotic
- Ofloxacin: Fluoroquinolone antibiotic
- Lactobacillus: Probiotic
Mechanism of Action:
Cefixime inhibits bacterial cell wall synthesis, leading to bacterial cell death. Ofloxacin inhibits bacterial DNA gyrase and topoisomerase IV, enzymes essential for bacterial DNA replication and repair. Lactobacillus helps restore the normal gut flora.
Alternate Names
No internationally recognized alternate names exist for this specific combination. However, it is marketed under various brand names such as Cenact O, Astecef O, Cefizoid-OF, and others.
How It Works
Pharmacodynamics: Cefixime disrupts bacterial cell wall synthesis. Ofloxacin inhibits DNA gyrase and topoisomerase IV, thereby blocking bacterial DNA replication. Lactobacillus replenishes beneficial gut bacteria, preventing antibiotic-associated diarrhea and promoting gut health.
Pharmacokinetics:
- Cefixime: Absorption is approximately 40-50%, unaffected by food. Primarily excreted in the urine.
- Ofloxacin: Well-absorbed orally. Metabolized in the liver and excreted in urine and feces.
- Lactobacillus: Not systemically absorbed. Excreted in feces.
Mode of Action: Cefixime binds to penicillin-binding proteins (PBPs), disrupting peptidoglycan synthesis and weakening the cell wall. Ofloxacin inhibits bacterial DNA gyrase and topoisomerase IV, essential for DNA replication and repair, leading to bacterial cell death. Lactobacillus produces lactic acid, lowering gut pH which inhibits pathogen growth, and competes with harmful bacteria for resources.
Elimination Pathways:
Cefixime primarily through renal excretion. Ofloxacin through both renal and hepatic pathways. Lactobacillus through fecal excretion.
Dosage
Standard Dosage
Adults:
The usual dose is 200 mg Cefixime + 200 mg Ofloxacin + Lactobacillus (e.g., 60 million spores or 2.5 million spores depending on the formulation) twice daily. This is the recommended dosage for adults.
Children:
Cefixime is 8mg/kg/day, administered once daily or in two divided doses every 12 hours, not to exceed 400mg/day. Ofloxacin is generally avoided in children due to the risk of adverse effects on developing cartilage. Lactobacillus can be used safely in children, but the specific dose varies with the formulation. Consult a pediatrician before administering this combination to children. Children over 45kg or older than 12 years may receive the adult dose.
Special Cases:
- Elderly Patients: Dose adjustments may be necessary based on renal function.
- Patients with Renal Impairment: Dose reduction is needed based on creatinine clearance.
- Patients with Hepatic Dysfunction: Use cautiously. Dosage adjustment might be required.
- Patients with Comorbid Conditions: Carefully monitor patients with colitis, seizures, or myasthenia gravis.
Clinical Use Cases
Dosing should be individualized based on patient-specific factors and infection severity. Consultation with an infectious disease specialist is advisable in complex cases.
- Intubation/Surgical Procedures/Mechanical Ventilation/ICU Use/Emergency Situations: Dosage is generally consistent with standard recommendations, with careful monitoring and potential adjustments based on organ function and patient status.
Dosage Adjustments
Modifications are necessary for patients with renal or hepatic impairment, or those with specific comorbid conditions. Dosage needs to be adjusted based on creatinine clearance in renal impairment.
Side Effects
Common Side Effects
Nausea, vomiting, diarrhea, abdominal pain, indigestion, flatulence, headache, dizziness, insomnia, itching.
Rare but Serious Side Effects
Severe allergic reactions (anaphylaxis), Clostridium difficile - associated diarrhea, tendonitis, tendon rupture, seizures, peripheral neuropathy, QT interval prolongation.
Long-Term Effects
Potential for Clostridium difficile - associated diarrhea, antibiotic resistance, and effects on gut microbiome with prolonged use.
Adverse Drug Reactions (ADR)
Any sign of hypersensitivity, severe diarrhea, tendon pain or inflammation, or neurological symptoms requires immediate medical attention.
Contraindications
Hypersensitivity to Cefixime, Ofloxacin, or other quinolones/cephalosporins. Severe renal or hepatic impairment. Myasthenia gravis. Pregnancy (Ofloxacin is contraindicated, Cefixime should be used cautiously). Tendonitis.
Drug Interactions
Antacids, sucralfate, cimetidine, probenecid, warfarin, theophylline, NSAIDs, some antidiabetic agents, cyclosporine, multivitamins containing iron or zinc.
Pregnancy and Breastfeeding
Ofloxacin is contraindicated during pregnancy and breastfeeding. Cefixime should be used with caution only if potential benefit outweighs the risk. Lactobacillus is generally considered safe during pregnancy and breastfeeding.
Drug Profile Summary
- Mechanism of Action: Cefixime: inhibits cell wall synthesis; Ofloxacin: inhibits DNA gyrase/topoisomerase IV; Lactobacillus: restores gut flora.
- Side Effects: Common: Nausea, vomiting, diarrhea, headache. Serious: Allergic reactions, tendon rupture, C.difficile infection.
- Contraindications: Hypersensitivity, severe renal/hepatic impairment, myasthenia gravis, pregnancy (Ofloxacin).
- Drug Interactions: Antacids, warfarin, probenecid, theophylline.
- Pregnancy & Breastfeeding: Ofloxacin is contraindicated. Cefixime use cautiously if benefits outweigh risks.
- Dosage: Adults: 200 mg Cefixime + 200 mg Ofloxacin + Lactobacillus twice daily. Pediatric: 8 mg/kg/day cefixime. Adjustments needed for renal/hepatic impairment.
- Monitoring Parameters: Renal function, liver function, signs of hypersensitivity, tendon function, complete blood counts.
Popular Combinations
This specific combination is itself a popular combination used for bacterial infections requiring broad-spectrum coverage and gut flora protection.
Precautions
- General Precautions: Renal and hepatic function evaluation, monitoring for allergic reactions.
- Specific Populations: Pregnant Women: Avoid Ofloxacin, use Cefixime cautiously. Breastfeeding Mothers: Avoid Ofloxacin, consider risks/benefits with Cefixime. Children & Elderly: Dosage adjustments as described above.
- Lifestyle Considerations: Avoid alcohol, adequate hydration.
FAQs
Q1: What is the recommended dosage for Cefixime + Lactobacillus + Ofloxacin?
A: Adults: 200 mg Cefixime + 200 mg Ofloxacin + Lactobacillus (e.g. 60 million spores) twice daily. Pediatric dosing should be determined by a pediatrician based on weight and clinical condition.
Q2: What infections does this combination treat?
A: Respiratory tract, urinary tract, skin and soft tissue, gastrointestinal, typhoid fever, and some sexually transmitted infections.
Q3: What are the common side effects?
A: Nausea, vomiting, diarrhea, headache, dizziness.
Q4: Are there any serious side effects?
A: Yes, though rare: Allergic reactions, C. difficile infection, tendon rupture, seizures, peripheral neuropathy.
Q5: What are the contraindications?
A: Hypersensitivity, severe renal or hepatic impairment, myasthenia gravis, pregnancy (Ofloxacin), tendonitis.
Q6: Can I take this medication with antacids?
A: No, antacids and other medications can interact with Cefixime and Ofloxacin. Consult a physician.
Q7: Can pregnant or breastfeeding women take this combination?
A: Ofloxacin is contraindicated during pregnancy and breastfeeding. Cefixime should be used with caution and only if the benefits outweigh the risks.
Q8: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember. If it’s almost time for your next dose, skip the missed dose and return to your regular schedule.
Q9: Can I stop taking the medication once I feel better?
A: No, complete the full course of treatment prescribed by your doctor, even if symptoms improve, to prevent antibiotic resistance.
Q10: What should I discuss with my doctor before taking this medication?
A: Allergies, medical history (especially liver or kidney problems, seizures), concomitant medications, pregnancy or breastfeeding status.
