Usage
This combination medication is prescribed for various bacterial and parasitic infections, particularly those affecting the gastrointestinal tract. These include:
- Diarrhea and dysentery caused by susceptible bacteria or parasites
- Amoebiasis (infection with Entamoeba histolytica)
- Giardiasis (infection with Giardia lamblia)
- Bacterial vaginosis
- Pelvic inflammatory disease
- Gastroenteritis
- Other mixed bacterial infections, where the Lactobacillus component aids in restoring gut flora disrupted by antibiotics
Pharmacological Classification:
- Ofloxacin: Fluoroquinolone antibiotic
- Metronidazole: Nitroimidazole antibiotic, antiprotozoal
- Lactic acid bacillus: Probiotic
Mechanism of Action:
Ofloxacin inhibits bacterial DNA gyrase and topoisomerase IV, enzymes crucial for DNA replication and cell division. Metronidazole disrupts DNA synthesis and damages cell membranes in anaerobic bacteria and protozoa. Lactic acid bacillus helps restore healthy gut flora.
Alternate Names
No widely recognized alternate names exist for this specific combination. However, the individual components have several synonyms. Brand names vary depending on the manufacturer. Some examples include “Norfagyl Plus,” “OFLARGE M SUSP,” and “Neoxy-MT.”
How It Works
Pharmacodynamics: Ofloxacin and metronidazole exhibit bactericidal and antiparasitic actions by disrupting DNA function and cell wall integrity. Lactic acid bacillus exerts probiotic effects by competing with pathogenic organisms and potentially bolstering local immune function.
Pharmacokinetics:
- Absorption: Ofloxacin is well-absorbed orally. Metronidazole absorption is also good. Lactobacillus is ingested in spore form and colonizes the GI tract.
- Metabolism: Ofloxacin is minimally metabolized. Metronidazole undergoes some hepatic metabolism.
- Elimination: Ofloxacin is primarily excreted renally. Metronidazole is excreted in urine and feces.
Mode of Action: Ofloxacin inhibits DNA gyrase and topoisomerase IV. Metronidazole creates cytotoxic metabolites that damage bacterial/parasitic DNA.
Receptor Binding, Enzyme Inhibition, Neurotransmitter Modulation: Ofloxacin targets DNA gyrase and topoisomerase IV. Metronidazole’s metabolites disrupt DNA. No known direct neurotransmitter effects.
Elimination Pathways: Primarily renal excretion for Ofloxacin; both renal and hepatic routes for metronidazole.
Dosage
Dosage and duration are determined by the specific infection, severity, and patient factors. Always consult current clinical guidelines and individual patient considerations.
Standard Dosage
Special Cases:
- Elderly Patients: Exercise caution, particularly with high doses or renal impairment.
- Patients with Renal Impairment: Dosage adjustments may be required.
- Patients with Hepatic Dysfunction: Caution is advised; dose adjustments may be needed.
- Patients with Comorbid Conditions: Consider underlying medical conditions like epilepsy, heart problems, or CNS disorders when prescribing.
Clinical Use Cases
Dosage recommendations are condition specific. Consult product information and guidelines for clinical use cases such as surgical prophylaxis.
Dosage Adjustments
Modifications are essential for renal/hepatic impairment, CNS disorders, and potential drug interactions. Always consider patient-specific factors.
Side Effects
Common Side Effects:
Nausea, vomiting, diarrhea, abdominal pain, headache, dizziness, photosensitivity.
Rare but Serious Side Effects:
Peripheral neuropathy, seizures, tendon rupture, severe allergic reactions (anaphylaxis), Clostridium difficile-associated diarrhea. QT interval prolongation (rarely with metronidazole + ofloxacin combination).
Long-Term Effects:
Peripheral neuropathy can be a chronic complication.
Adverse Drug Reactions (ADR):
Severe skin reactions (Stevens-Johnson syndrome), hepatotoxicity, QT prolongation (rarely).
Contraindications
Hypersensitivity to quinolones or nitroimidazoles, myasthenia gravis, tendon disorders, epilepsy, pregnancy (especially first trimester), breastfeeding (unless benefits outweigh risks), children and adolescents (some formulations).
Drug Interactions
Antacids, calcium, magnesium, iron supplements, warfarin, theophylline, NSAIDs, some antidepressants, antiarrhythmics. Alcohol can induce a disulfiram-like reaction with metronidazole.
Pregnancy and Breastfeeding
Generally contraindicated during pregnancy, especially the first trimester. Ofloxacin and metronidazole can be excreted in breast milk. Consult guidelines for managing potential neonatal risks if use is unavoidable.
Drug Profile Summary
Refer to the information provided above for details on mechanism of action, side effects, contraindications, drug interactions, and dosage.
Monitoring Parameters: Renal and liver function, complete blood count (CBC), ECG (especially if co-prescribing drugs that prolong the QT interval). Monitor for signs of tendonitis or peripheral neuropathy.
Popular Combinations
This combination itself is a common clinical combination. The inclusion of Lactobacillus is intended to mitigate antibiotic-associated diarrhea.
Precautions
Screen for contraindications and drug interactions. Avoid alcohol with metronidazole. Advise patients about photosensitivity. Monitor for tendonitis and neuropathy. Use caution in elderly patients and those with renal or hepatic impairment. Avoid use in pregnancy and breastfeeding if possible.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Lactic acid bacillus + Metronidazole + Ofloxacin?
A: Dosage varies with age, weight, and the condition being treated. Consult prescribing information or up-to-date resources for precise dosages.
Q2: What are the most common side effects?
A: Nausea, vomiting, diarrhea, headache, dizziness, and photosensitivity are frequently reported.
Q3: Is this combination safe in pregnancy?
A: Generally contraindicated, especially in the first trimester, due to potential fetal risks.
Q4: Can I drink alcohol while taking this medication?
A: Avoid alcohol with metronidazole due to the risk of a disulfiram-like reaction (flushing, headache, nausea, vomiting).
Q5: Are there any drug interactions I should be aware of?
A: Yes, interactions exist with antacids, metal ions (calcium, magnesium, iron), some antibiotics, warfarin, theophylline, and others. Consult a comprehensive drug interaction resource.
Q6: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember. If it is near the time of your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose to catch up.
Q7: Can I take this combination with dairy products?
A: Dairy products can interfere with the absorption of ofloxacin. Take the medication separated from dairy products by at least two hours.
Q8: What should I do if I experience severe side effects?
A: Discontinue use immediately and consult a physician.
Q9: How long should the treatment last?
A: The duration depends on the infection being treated. Always complete the full course prescribed by your doctor, even if symptoms improve earlier.
