Usage
- This combination medication is primarily prescribed for bacterial infections, especially those of the gastrointestinal tract, such as infectious diarrhea (including traveler’s diarrhea) and dysentery. The Lactobacillus component is included to help prevent or mitigate antibiotic-associated diarrhea, a common side effect of Ofloxacin. It is also sometimes used in combination with other antibiotics, for enhanced effectiveness against certain bacteria.
- Pharmacological Classification: Antibiotic/Probiotic combination.
- Mechanism of Action: Ofloxacin, a fluoroquinolone antibiotic, inhibits bacterial DNA gyrase and topoisomerase IV. These enzymes are crucial for bacterial DNA replication and repair, thus disrupting bacterial growth and leading to cell death. Lactobacillus, a probiotic, helps restore the normal gut flora, which may be disrupted by antibiotic use.
Alternate Names
- Ofloxacin + Lactobacillus
- Ofloxacin and Lactobacillus combination
- Ofloxacin/Lactobacillus
- Brand Names: Several brand names exist depending on the manufacturer and specific formulation, some include “Oflarge OZ+” and “Oford LB”.
How It Works
- Pharmacodynamics: Ofloxacin exerts its bactericidal effect by inhibiting DNA gyrase and topoisomerase IV, leading to impaired DNA replication and ultimately cell death.
- Pharmacokinetics: Ofloxacin is well-absorbed orally and widely distributed in the body. It is metabolized in the liver and excreted primarily through the kidneys. The Lactobacillus component primarily resides in the gut.
- Mode of Action: Ofloxacin targets bacterial DNA gyrase and topoisomerase IV, inhibiting DNA replication. Lactobacillus, competes with harmful bacteria for resources.
- Elimination Pathways: Ofloxacin is primarily eliminated via renal excretion, with some hepatic metabolism.
Dosage
Standard Dosage
Adults:
- A common dosage is one tablet containing 200 mg of Ofloxacin and 60 million spores (or CFU) of Lactobacillus, taken twice daily. This can be administered with or without food. Treatment duration typically ranges from 5 to 10 days but varies with infection severity.
Children:
- This combination is generally not recommended for children under 12 years of age unless specifically prescribed by a doctor. Dosing is adjusted based on the child’s age and weight.
Special Cases:
- Elderly Patients: Dose adjustments may be needed due to age-related decline in renal function.
- Patients with Renal Impairment: Dose reduction is necessary if creatinine clearance is less than 50 mL/min. Contraindicated if creatinine clearance is less than 30 mL/min.
- Patients with Hepatic Dysfunction: Caution should be exercised, and liver function tests should be monitored.
- Patients with Comorbid Conditions: Careful consideration is needed for underlying conditions.
Clinical Use Cases
The primary clinical use case is infectious diarrhea, but it might be used in other infections where Ofloxacin is indicated, with Lactobacillus to prevent antibiotic-associated diarrhea. Specific dosing for clinical settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations should be decided on a case-by-case basis under direct supervision of a qualified medical professional.
Dosage Adjustments
Dosage adjustments may be required for renal or hepatic impairment.
Side Effects
Common Side Effects
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Headache
- Dizziness
Rare but Serious Side Effects
- Tendon damage (tendinitis, tendon rupture)
- Peripheral neuropathy (nerve damage)
- Photosensitivity (sun sensitivity)
- Seizures (rare)
- QT prolongation (changes to heart rhythm)
Long-Term Effects
- Potential for Clostridium difficile infection with prolonged use.
- Possible antibiotic resistance with inappropriate or prolonged use.
Adverse Drug Reactions (ADR)
- Hypersensitivity reactions (allergic reactions)
- Stevens-Johnson syndrome (a severe skin reaction)
Contraindications
- Hypersensitivity to Ofloxacin, Lactobacillus, or other quinolones.
- Myasthenia gravis (a neuromuscular disorder)
- History of tendon disorders related to quinolone use.
- Epilepsy or other seizure disorders.
- Prolonged QT interval.
Drug Interactions
- Antacids, iron supplements, sucralfate, and multivitamins can decrease Ofloxacin absorption.
- NSAIDs can increase the risk of seizures.
- Anticoagulants may have enhanced effects when used with Ofloxacin.
- Some antibiotics may reduce the efficacy of Lactobacillus.
- Drugs metabolized by certain liver enzymes (CYP450) can interact with Ofloxacin.
Pregnancy and Breastfeeding
- Ofloxacin is generally avoided during pregnancy and breastfeeding due to potential risks to the fetus or infant.
- The safety of Lactobacillus during pregnancy and breastfeeding isn’t fully established, though generally considered safe in food.
Drug Profile Summary
- Mechanism of Action: Ofloxacin: DNA gyrase/topoisomerase IV inhibitor; Lactobacillus: Restores gut flora.
- Side Effects: Nausea, vomiting, diarrhea, headache, dizziness, photosensitivity, tendinitis, peripheral neuropathy (rare), seizures (rare).
- Contraindications: Hypersensitivity, myasthenia gravis, tendon disorders, epilepsy, prolonged QT interval.
- Drug Interactions: Antacids, iron, sucralfate, NSAIDs, anticoagulants, other antibiotics.
- Pregnancy & Breastfeeding: Generally avoided.
- Dosage: Adults: 200 mg Ofloxacin/60 million spores Lactobacillus twice daily. Pediatric and special cases require adjusted doses.
- Monitoring Parameters: Renal function, liver function tests, signs of tendinitis or peripheral neuropathy, gastrointestinal effects.
Popular Combinations
- Lactobacillus is frequently combined with antibiotics like Ofloxacin to prevent antibiotic-associated diarrhea.
- Ornidazole is sometimes added for specific infections.
Precautions
- Assess allergies, renal/hepatic function, and history of tendon disorders.
- Monitor for adverse reactions, especially tendinitis, peripheral neuropathy, and CNS effects.
- Avoid prolonged sun exposure.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Lactobacillus + Ofloxacin?
A: The standard adult dose is 200 mg of Ofloxacin and 60 million spores of Lactobacillus, twice daily. Pediatric and special populations require adjusted dosing.
Q2: What are the common side effects?
A: Common side effects include nausea, vomiting, diarrhea, abdominal pain, headache, and dizziness.
Q3: Who should not take this medication?
A: Individuals with hypersensitivity to the components, myasthenia gravis, a history of tendon disorders with quinolone use, epilepsy, or a prolonged QT interval should not take this medication. Pregnant and breastfeeding women are generally advised against its use.
Q4: Are there any drug interactions I should be aware of?
A: Yes, this medication can interact with antacids, iron supplements, sucralfate, NSAIDs, anticoagulants, and some other antibiotics. Discuss all medications and supplements you are taking with your doctor.
Q5: Can I take this medication if I have kidney or liver problems?
A: Caution is advised. Dosage adjustments are usually needed for renal impairment, and careful monitoring is necessary for hepatic dysfunction.
Q6: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it is close to the next dose. Do not double the dose.
Q7: Can I stop taking the medication once I feel better?
A: No, complete the full course of treatment prescribed by your doctor, even if you feel better. Stopping prematurely can lead to incomplete eradication of the infection and increase the risk of antibiotic resistance.
Q8: What should I do if I experience side effects?
A: Contact your physician if side effects occur. While some are mild and transient, others can be serious.
Q9: Can this drug impact my ability to drive or operate machinery?
A: This medication can cause dizziness or lightheadedness in some people. Use caution when driving or operating machinery until you know how it affects you.
Q10: Should I take any dietary precautions with this drug?
A: Maintain a balanced diet and adequate hydration while taking this medication. Avoid taking it at the same time as antacids, iron supplements, or multivitamins, as these can decrease Ofloxacin absorption.
