Usage
Cefixime + Lactobacillus + Ornidazole is a combination medication primarily prescribed for bacterial and parasitic infections, especially those affecting the gastrointestinal tract. It is also effective against infections of the urinary tract, respiratory tract (including tonsillitis, pharyngitis, and bronchitis), and some sexually transmitted diseases. This combination is sometimes used as a prophylactic measure against post-operative infections.
Pharmacological Classification:
- Cefixime: Third-generation cephalosporin antibiotic
- Lactobacillus: Probiotic
- Ornidazole: Antiprotozoal, antibacterial (specifically against anaerobes)
Mechanism of Action: This triple-drug combination works synergistically to combat infections and maintain gut health: Cefixime disrupts bacterial cell wall synthesis, Ornidazole damages microbial DNA and cell structures, and Lactobacillus helps restore the balance of healthy gut flora.
Alternate Names
There are no internationally recognized non-proprietary names for this combination product. A variety of brand names exist depending on the manufacturer and region. Some examples of brand names offering this specific combination include: Caftyca-OZ LB, Cefmed OZ, Fimial-OZ among many others.
How It Works
Pharmacodynamics:
- Cefixime: Binds to penicillin-binding proteins (PBPs) in bacterial cell walls, inhibiting cell wall synthesis and causing bacterial cell death.
- Ornidazole: Forms reactive radicals within microbial cells, damaging DNA, proteins, and membranes, leading to cell death. It is effective against anaerobic bacteria and certain protozoa.
- Lactobacillus: Produces lactic acid, which creates an acidic gut environment. This inhibits the growth of harmful bacteria and promotes the restoration of normal gut flora, often disrupted by antibiotic use.
Pharmacokinetics:
- Cefixime: Absorbed orally, peak serum concentrations reached in 2-6 hours. Excreted primarily via the kidneys.
- Ornidazole: Well-absorbed orally, metabolized in the liver, excreted primarily in urine.
- Lactobacillus: Not systemically absorbed. Exerts its effect locally in the gut.
Elimination Pathways:
- Cefixime: Primarily renal excretion.
- Ornidazole: Primarily renal excretion, some hepatic metabolism.
- Lactobacillus: Remains in the gastrointestinal tract.
Dosage
Dosage information can vary depending on the specific product and manufacturer. Always consult the product’s prescribing information.
Standard Dosage
Adults:
- Cefixime: 200-400 mg per day, either as a single dose or divided into two doses.
- Ornidazole: Dosage varies based on the infection being treated (typically 500-1500 mg per day).
- Lactobacillus: Dosage varies based on the specific strain and product formulation.
Children:
Cefixime is generally not recommended for children under 10 years old in certain conditions. Cefixime dosing in children is weight-based at 8 mg/kg/day, with a maximum of 400mg. Ornidazole and lactobacillus dosing needs specific pediatric guidelines, which should be verified through appropriate pediatric resources.
Special Cases:
- Elderly Patients: May require dosage adjustments based on kidney function.
- Patients with Renal Impairment: Cefixime dose reduction is necessary. Ornidazole and Lactobacillus use in renal impairment necessitates dose adjustments or close monitoring.
- Patients with Hepatic Dysfunction: Cefixime dosage adjustments may be required. Ornidazole use should be done cautiously in patients with liver diseases.
- Patients with Comorbid Conditions: Patients with conditions like diabetes or cardiovascular disease may require careful monitoring.
Clinical Use Cases
Dosage for clinical use cases (intubation, surgical procedures, mechanical ventilation, ICU use, emergency situations) should be determined on a case-by-case basis by the treating physician considering the patient’s condition and infection severity.
Dosage Adjustments
Dose modifications should be considered based on renal or hepatic dysfunction, metabolic disorders, or other factors affecting drug metabolism. Consult specific product information.
Side Effects
Common Side Effects:
Nausea, vomiting, diarrhea, stomach pain, headache, dizziness, indigestion, flatulence, loss of appetite, skin rash.
Rare but Serious Side Effects:
Severe allergic reactions (anaphylaxis), pseudomembranous colitis (C. difficile infection), Stevens-Johnson syndrome.
Long-Term Effects:
With prolonged use, some antibiotics can lead to antibiotic resistance.
Adverse Drug Reactions (ADR):
Any signs of allergic reaction (rash, itching, swelling, difficulty breathing) or severe gastrointestinal issues should be treated as a serious ADR.
Contraindications
Hypersensitivity to cephalosporins, penicillins, or nitroimidazoles. Patients with a history of seizures or other neurological disorders should be monitored closely.
Drug Interactions
Cefixime can interact with warfarin, probenecid, and other medications. Ornidazole can interact with anticoagulants and alcohol. Inform your doctor about all medications being taken.
Pregnancy and Breastfeeding
Use during pregnancy and breastfeeding should be done cautiously and only when the potential benefit outweighs the risks. It’s unknown whether this combination is excreted in breast milk. Consult a physician.
Drug Profile Summary
- Mechanism of Action: Cefixime inhibits cell wall synthesis; Ornidazole damages microbial DNA; Lactobacillus promotes healthy gut flora.
- Side Effects: Nausea, vomiting, diarrhea, headache, dizziness, allergic reactions.
- Contraindications: Hypersensitivity, certain neurological conditions.
- Drug Interactions: Anticoagulants, alcohol, probenecid.
- Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks.
- Dosage: Varies depending on infection and patient factors. Refer to prescribing information.
- Monitoring Parameters: Renal function, liver function tests, complete blood count, signs of superinfection.
Popular Combinations
This combination itself is popular. It can be further combined with other agents like Saccharomyces boulardii (another probiotic) for enhanced gut flora support.
Precautions
Screen for allergies, assess organ function. Caution in pregnancy and breastfeeding, children, and elderly. Avoid alcohol while taking ornidazole. Monitor for signs of superinfection.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cefixime + Lactobacillus + Ornidazole?
A: The dosage depends on the specific infection and patient factors. Adult doses generally range from 200-400 mg cefixime, 500-1500 mg ornidazole, and Lactobacillus varies by formulation. Always consult product information for detailed dosage.
Q2: How should this combination be administered?
A: This combination is usually taken orally as a tablet, capsule, or suspension.
Q3: Can this combination be used in children?
A: Cefixime is not generally recommended in children under 10, especially for certain indications. Pediatric dosages are calculated by weight, with Ornidazole and Lactobacillus considerations needing verified pediatric references.
Q4: What are the common side effects?
A: Common side effects include nausea, vomiting, diarrhea, and headache.
Q5: What are the major contraindications?
A: Contraindications include hypersensitivity to cephalosporins, penicillins, or nitroimidazoles.
Q6: Are there any significant drug interactions?
A: Yes, this medication can interact with certain anticoagulants (warfarin), probenecid, and alcohol.
Q7: Can this combination be used during pregnancy and breastfeeding?
A: It should be used with caution during pregnancy and breastfeeding, only if the benefits outweigh potential risks. It is not established if it is present in breastmilk. Consult a physician before use.
Q8: What should patients be advised regarding lifestyle?
A: Patients should avoid alcohol while on ornidazole. Maintain adequate hydration to mitigate gastrointestinal side effects. Inform the doctor of any new or worsening symptoms.
Q9: What monitoring parameters are important during therapy?
A: Monitor renal and liver function, as well as complete blood count, and be vigilant for signs of superinfection like C. difficile-associated diarrhea.
Q10: What is the role of Lactobacillus in this combination?
A: Lactobacillus helps maintain or restore the balance of healthy bacteria in the gut, which can be disrupted by antibiotic use. This helps prevent antibiotic-associated diarrhea and promotes gut health.
