Usage
- This combination is prescribed for bacterial infections such as pneumonia, bronchitis, sinus infections, urinary tract infections, and skin infections. It is also used to prevent antibiotic-associated diarrhea.
- Pharmacological Classification: Levofloxacin is a fluoroquinolone antibiotic; Lactobacillus is a probiotic.
- Mechanism of Action: Levofloxacin inhibits bacterial DNA gyrase and topoisomerase IV, enzymes essential for bacterial DNA replication and repair. Lactobacillus helps restore the normal gut flora, which can be disrupted by antibiotic use.
Alternate Names
- No internationally recognized alternate names exist for this specific combination.
- Brand Names: Brand names vary regionally and include combinations such as NexO and others; Levofloxacin is sold under Levaquin, among others.
How It Works
- Pharmacodynamics: Levofloxacin exerts a bactericidal effect by interfering with bacterial DNA replication. Lactobacillus, a probiotic, helps maintain a healthy gut microbiome, counteracting the adverse effects of antibiotics on gut flora.
- Pharmacokinetics: Levofloxacin is rapidly absorbed orally and achieves peak plasma concentrations within 1-2 hours. It is metabolized to a small extent in the liver and primarily excreted by the kidneys. Lactobacillus colonizes the gut.
- Mode of Action: Levofloxacin inhibits bacterial DNA gyrase and topoisomerase IV. This inhibition disrupts DNA replication and repair in susceptible bacteria. No receptor binding or neurotransmitter modulation is associated with levofloxacin’s action.
- Elimination Pathways: Levofloxacin is mainly eliminated renally, with a small fraction excreted in feces.
Dosage
Standard Dosage
Adults:
- Levofloxacin: 250-750 mg orally or intravenously once daily, depending on the infection.
- Lactobacillus: Dose varies with product; concomitant use usually continues several days beyond the antibiotic course.
Children:
- Levofloxacin: Generally avoided in children except for specific serious infections (e.g., anthrax, plague) due to concerns about musculoskeletal toxicity. If used, dosing is weight-based (8-10 mg/kg twice daily for children 6 months to <5 years and 10mg/kg once daily for children ≥5 years, maximum 750 mg/day).
- Lactobacillus: Use probiotics cautiously in children due to potential sepsis risk. Consult current guidelines.
Special Cases:
- Elderly Patients: Start with lower doses and monitor for adverse events.
- Patients with Renal Impairment: Dose adjustment needed for levofloxacin based on creatinine clearance.
- Patients with Hepatic Dysfunction: Limited dose adjustment guidelines exist. Monitor carefully.
- Patients with Comorbid Conditions: Evaluate potential interactions with other medications.
Clinical Use Cases
Dosing is usually guided by the specific infection being treated (e.g., pneumonia, UTI, skin infection) and follows the standard adult dosing recommendations outlined above.
Dosage Adjustments
- Adjust levofloxacin dosing based on renal function.
Side Effects
Common Side Effects
- Nausea, diarrhea, headache, dizziness, vomiting.
Rare but Serious Side Effects
- Tendonitis, tendon rupture, peripheral neuropathy, Clostridium difficile - associated diarrhea, QT prolongation, seizures, hypersensitivity reactions (including anaphylaxis).
Long-Term Effects
- Peripheral neuropathy may persist even after discontinuation.
Adverse Drug Reactions (ADR)
- Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
Contraindications
- Hypersensitivity to levofloxacin or other quinolones.
- History of tendon disorders related to fluoroquinolone use.
- Myasthenia gravis.
Drug Interactions
- Antacids, calcium, iron, or zinc supplements, sucralfate can reduce levofloxacin absorption.
- NSAIDs can increase the risk of CNS effects like seizures.
- Warfarin: Levofloxacin can enhance the anticoagulant effect.
- Theophylline: Levofloxacin may increase theophylline levels.
Pregnancy and Breastfeeding
- Levofloxacin is generally avoided in pregnancy due to concerns about musculoskeletal toxicity in the developing fetus. If used, consider risks versus benefits.
- Levofloxacin is excreted in breast milk. The decision to breastfeed should be made considering the potential infant risk.
Drug Profile Summary
- Mechanism of Action: Levofloxacin inhibits bacterial DNA gyrase and topoisomerase IV; Lactobacillus restores gut flora.
- Side Effects: Nausea, diarrhea, headache, dizziness, tendon rupture (rare), C. difficile infection.
- Contraindications: Hypersensitivity, tendon disorders related to quinolones, myasthenia gravis.
- Drug Interactions: Antacids, multivitamins, NSAIDs, warfarin.
- Pregnancy & Breastfeeding: Generally avoided in pregnancy; use with caution during lactation.
- Dosage: Levofloxacin 250-750 mg once daily; Lactobacillus dose varies by product.
- Monitoring Parameters: Renal function, signs of tendonitis, QT interval, signs of superinfection.
Popular Combinations
Levofloxacin is sometimes combined with other antibiotics for specific infections. Combining levofloxacin with lactobacillus is primarily done to mitigate the risk of antibiotic-associated diarrhea.
Precautions
- General Precautions: Assess renal function, monitor for tendon pain, avoid excessive sun exposure.
- Specific Populations: Avoid in pregnancy if possible; use cautiously during lactation.
- Lifestyle Considerations: Avoid driving if dizziness occurs.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Lactobacillus + Levofloxacin?
A: Levofloxacin dosing is 250-750 mg once daily, adjusted for renal function. Lactobacillus dosing varies by product.
Q2: What are the common side effects?
A: Nausea, diarrhea, headache, and dizziness.
Q3: What are the serious side effects?
A: Tendon rupture, peripheral neuropathy, C. difficile infection, QT prolongation.
Q4: Can this combination be used in pregnancy?
A: Generally avoided due to potential fetal risk; weigh benefits versus risks if use is considered.
Q5: Can this combination be used during breastfeeding?
A: Use with caution as levofloxacin is present in breast milk.
Q6: What are the major drug interactions?
A: Antacids, minerals (calcium, iron, zinc), NSAIDs, warfarin, theophylline.
Q7: How does levofloxacin work?
A: It inhibits bacterial DNA replication.
Q8: How does Lactobacillus work?
A: It restores healthy gut bacteria, reducing the risk of antibiotic-associated diarrhea.
Q9: Are there any contraindications to this combination?
A: Hypersensitivity to the components, history of tendon disorders with quinolones, and myasthenia gravis.
