Usage
This combination is prescribed for bacterial infections of the gastrointestinal tract, particularly infectious diarrhea and gastroenteritis caused by a mix of aerobic and anaerobic bacteria. It is also used for amoebiasis, giardiasis, bacterial vaginosis, trichomoniasis, traveler’s diarrhea, dysentery, and urinary tract infections.
It has the following pharmacological classifications:
- Antibiotic: Norfloxacin and Metronidazole.
- Probiotic: Lactobacillus.
Mechanism of Action:
- Norfloxacin: Inhibits bacterial DNA gyrase and topoisomerase IV, enzymes essential for bacterial DNA replication and repair. This hinders bacterial cell division and growth.
- Metronidazole: Disrupts bacterial DNA, inhibiting nucleic acid synthesis, leading to bacterial cell death. It is effective against anaerobic bacteria and some parasites.
- Lactobacillus: Produces lactic acid, which maintains a low pH in the gut and vagina, suppressing the growth of harmful bacteria. It also competes with pathogenic bacteria for nutrients and adhesion sites.
Alternate Names
This combination is commonly known as Norfloxacin + Metronidazole + Lactobacillus. Some brand names include “Fnt,” “Noxagyl DL,” and “Powergyl Oz,” among others. Availability may vary regionally.
How It Works
Pharmacodynamics: The combined effect of Norfloxacin and Metronidazole provides broad-spectrum antibacterial activity against both aerobic and anaerobic bacteria causing gastrointestinal infections. Lactobacillus helps restore the normal gut flora, reducing antibiotic-associated diarrhea.
Pharmacokinetics:
- Norfloxacin: Primarily eliminated through renal excretion.
- Metronidazole: Metabolized in the liver and excreted in urine and feces.
- Lactobacillus: Pharmacokinetics is complex. Survival and colonization in the gut are critical for its efficacy.
Mode of Action: Described in the “Usage” section. Norfloxacin acts by enzyme inhibition (DNA gyrase and topoisomerase IV), Metronidazole by damaging DNA, and Lactobacillus by producing lactic acid and competing with harmful bacteria. Specific receptor binding or neurotransmitter modulation are not relevant to this combination.
Dosage
Dosing information for this specific combination is limited. Doses for the individual components are established, but combining them needs careful consideration and is typically determined case-by-case by a physician. The information below serves as general guidance; consultation with a physician is crucial for tailored dosing recommendations.
Standard Dosage
Adults:
Dosage depends on the infection and patient-specific factors. Norfloxacin is usually prescribed at 400 mg twice daily, Metronidazole at 250-750 mg three times daily. Lactobacillus dosing varies with the strain and formulation.
Children:
Generally avoided in children unless deemed absolutely necessary by a doctor due to potential adverse effects, especially with Norfloxacin.
Special Cases:
- Elderly Patients: Dose adjustments may be necessary due to age-related decline in kidney and liver function.
- Patients with Renal Impairment: Dose reduction may be necessary.
- Patients with Hepatic Dysfunction: Dose reduction may be necessary.
- Patients with Comorbid Conditions: Careful consideration is required, particularly in patients with neurological conditions, seizures, or cardiovascular issues.
Clinical Use Cases
Dosing in these situations is determined case-by-case by a physician:
- Intubation
- Surgical Procedures
- Mechanical Ventilation
- Intensive Care Unit (ICU) Use
- Emergency Situations
Dosage Adjustments
Modifications are based on patient-specific factors. Consultation with a physician is essential for proper adjustments.
Side Effects
Common Side Effects
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Headache
- Dizziness
- Changes in taste
- Allergic skin reactions (rash, itching)
Rare but Serious Side Effects
- Tendonitis or tendon rupture (especially with Norfloxacin)
- Clostridium difficile-associated diarrhea (CDAD)
- Liver damage (with Metronidazole)
- Photosensitivity
- Peripheral neuropathy
- QT interval prolongation
Long-Term Effects
Chronic complications from prolonged use are possible and necessitate monitoring.
Adverse Drug Reactions (ADR)
ADRs requiring immediate intervention include severe allergic reactions, seizures, tendon rupture, C. difficile infection, and liver damage.
Contraindications
- Hypersensitivity to any component
- History of tendon disorders related to quinolone use
- Epilepsy or other seizure disorders
- Myasthenia gravis
- Pregnancy (especially first trimester)
- Breastfeeding (consult physician)
Drug Interactions
- Antacids
- Iron supplements
- Anticoagulants (e.g., warfarin)
- Immunosuppressants
- Anti-seizure medications
- Alcohol
- Dairy products
- Caffeine
- Certain other antibiotics (e.g., macrolides)
Pregnancy and Breastfeeding
This combination should generally be avoided during pregnancy and breastfeeding due to potential risks to the fetus/infant.
Drug Profile Summary
- Mechanism of Action: See “Usage” section.
- Side Effects: See “Side Effects” section.
- Contraindications: See “Contraindications” section.
- Drug Interactions: See “Drug Interactions” section.
- Pregnancy & Breastfeeding: Avoid unless deemed necessary by a physician.
- Dosage: See “Dosage” section.
- Monitoring Parameters: Kidney and liver function, signs of tendon inflammation or rupture, clinical response.
Popular Combinations
This particular combination is not standard clinical practice. Norfloxacin and Metronidazole are sometimes used together, but adding Lactobacillus is less common.
Precautions
- Pre-screening for allergies and relevant medical conditions is essential.
- Exercise caution in patients with kidney or liver disease.
- Avoid driving or operating machinery if dizziness or drowsiness occur.
- Maintain adequate hydration.
- Use cautiously in the elderly and children.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Lactobacillus + Metronidazole + Norfloxacin?
A: See the detailed “Dosage” section above. It’s crucial to consult a physician for individualised dosing.
Q2: What are the primary uses of this drug combination?
A: Primarily used for bacterial gastrointestinal infections, including diarrhea and dysentery, often caused by a mix of aerobic and anaerobic organisms.
Q3: What are the common side effects?
A: Common side effects include nausea, vomiting, diarrhea, abdominal pain, headache, and dizziness.
Q4: Are there any serious side effects I should be aware of?
A: Yes, rare but serious side effects include tendonitis, C. difficile infection, liver damage, and allergic reactions. Seek immediate medical attention if these occur.
Q5: Can this combination be used during pregnancy or breastfeeding?
A: Generally, it’s best to avoid this combination during pregnancy and breastfeeding. Consult a physician for guidance if you have concerns regarding this.
Q6: How do the individual components work together?
A: Norfloxacin and Metronidazole provide broad-spectrum antibacterial action, while Lactobacillus helps maintain beneficial gut flora.
Q7: Are there any drug interactions I should be aware of?
A: Yes, this combination can interact with antacids, iron supplements, anticoagulants, certain antibiotics, and alcohol. Provide a complete medication history to your physician.
Q8: What precautions should be taken while using this drug?
A: Caution is advised for patients with kidney/liver disease, epilepsy, or other seizure disorders. Avoid driving if dizziness occurs. Maintain adequate hydration. Use cautiously in the elderly and children. Do not consume alcohol during and up to 3 days after taking this medication.
Q9: Is this combination safe for children?
A: Use in children is generally avoided unless considered absolutely necessary by a physician.
Q10: Should I avoid any specific foods or drinks while taking this medication?
A: Yes, avoid alcohol, dairy products, and caffeine, as they may interact with the medication or exacerbate side effects. Consult your doctor about specific dietary restrictions.
