Usage
Lactobacillus + Ofloxacin + Ornidazole is a combination medication primarily prescribed for mixed bacterial and parasitic infections, particularly those involving anaerobic bacteria. It is commonly used to treat gastrointestinal infections (infectious diarrhea, dysentery, traveler’s diarrhea), gynecological infections (bacterial vaginosis, pelvic inflammatory disease), and certain respiratory and urinary tract infections.
Pharmacological Classification:
- Ofloxacin: Fluoroquinolone antibiotic
- Ornidazole: Nitroimidazole antibiotic, antiprotozoal
- Lactobacillus: Probiotic
Mechanism of Action:
Ofloxacin inhibits bacterial DNA gyrase and topoisomerase IV, essential enzymes for bacterial DNA replication and repair. Ornidazole disrupts DNA synthesis and causes DNA strand breakage in susceptible anaerobic bacteria and protozoa. Lactobacillus, a probiotic, helps restore the balance of normal gut flora, which may be disrupted by the antibiotics.
Alternate Names
This combination medication may be referred to simply as Ofloxacin + Ornidazole + Lactobacillus. Brand names may vary regionally. One example found in the sources is Oflarge OZ+.
How It Works
Pharmacodynamics:
Ofloxacin and Ornidazole have bactericidal and antiprotozoal activity, respectively. Ofloxacin primarily targets gram-negative bacteria, while Ornidazole is effective against anaerobic bacteria and certain protozoa (e.g., Trichomonas vaginalis, Entamoeba histolytica). Lactobacillus helps prevent or treat antibiotic-associated diarrhea.
Pharmacokinetics:
- Absorption: Ofloxacin and Ornidazole are well-absorbed orally.
- Metabolism: Ofloxacin is primarily excreted unchanged in urine, with minor hepatic metabolism. Ornidazole undergoes hepatic metabolism, forming active and inactive metabolites.
- Elimination: Ofloxacin and its metabolites are primarily excreted renally. Ornidazole and its metabolites are excreted in urine and feces.
- Mode of Action: As explained before Ofloxacin acts on DNA gyrase and topoisomerase IV; Ornidazole damages bacterial/protozoal DNA.
Receptor binding, enzyme inhibition, or neurotransmitter modulation: This drug interacts with DNA related enzymes and inhibits their activity.
Dosage
Standard Dosage
Adults:
One tablet (Ofloxacin 200mg + Ornidazole 500mg + Lactobacillus 60-120 million spores) twice daily for 5-10 days, but it may be adjusted according to the specific infection.
Children:
Dosage in children needs to be determined by a pediatrician and is based on weight or age. Safety and efficacy in children have not been extensively studied.
Special Cases:
- Elderly Patients: Dosage adjustment may be needed based on renal function.
- Patients with Renal Impairment: Dose reduction may be necessary.
- Patients with Hepatic Dysfunction: Caution is advised, and dose adjustment might be required.
- Patients with Comorbid Conditions: Dosage adjustments should be considered for patients with certain conditions like epilepsy or glucose-6-phosphate dehydrogenase deficiency.
Clinical Use Cases
Dosage in specific clinical settings should be individualized based on the infection severity and patient’s condition. Consult local or international guidelines for specific recommendations in cases like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Dose modifications should be based on renal/hepatic function, other metabolic disorders, or genetic polymorphisms affecting drug metabolism. Consultation with an infectious disease specialist is recommended.
Side Effects
Common Side Effects:
Nausea, vomiting, diarrhea, abdominal pain, dizziness, headache.
Rare but Serious Side Effects:
- Tendinitis, tendon rupture (especially Achilles tendon)
- Peripheral neuropathy
- Seizures
- Clostridium difficile-associated diarrhea (pseudomembranous colitis)
- Allergic reactions (rash, itching, swelling, severe skin reactions)
Long-Term Effects:
Peripheral neuropathy can be persistent.
Adverse Drug Reactions (ADR):
Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
Contraindications
- Hypersensitivity to fluoroquinolones or nitroimidazoles
- Epilepsy or conditions that lower the seizure threshold
- History of tendinitis or tendon rupture with quinolone use
- Children and adolescents (due to risk of cartilage damage)
- Pregnancy and breastfeeding (Ofloxacin)
- Patients with glucose-6-phosphate dehydrogenase deficiency.
Drug Interactions
- Antacids, iron supplements, sucralfate, multivitamins containing zinc or magnesium can reduce the absorption of Ofloxacin.
- Warfarin and other anticoagulants: Ofloxacin may enhance the anticoagulant effect.
- Theophylline: Ofloxacin may increase theophylline levels.
- Non-steroidal anti-inflammatory drugs (NSAIDs): Increased risk of seizures when combined with Ofloxacin.
- Alcohol should be avoided with Ornidazole.
Pregnancy and Breastfeeding
Ofloxacin is contraindicated during pregnancy and breastfeeding. Ornidazole should be used with caution. Limited data is available.
Drug Profile Summary
See information given above.
Popular Combinations
The combination of Ofloxacin and Ornidazole itself is frequently used. Lactobacillus is added to minimize gastrointestinal side effects.
Precautions
See above sections for detailed information.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Lactobacillus + Ofloxacin + Ornidazole?
A: Standard adult dosage is one tablet twice daily. Dosage adjustments are necessary for renal/hepatic impairment, elderly patients, and other specific conditions. Pediatric dosing must be determined by a pediatrician.
Q2: What are the most common side effects?
A: Common side effects include nausea, vomiting, diarrhea, abdominal pain, dizziness, and headache.
Q3: What are the serious side effects to watch out for?
A: Serious side effects include tendon rupture, peripheral neuropathy, seizures, C. difficile infection, and severe allergic reactions.
Q4: Can this medication be used in pregnant or breastfeeding women?
A: Ofloxacin is contraindicated in pregnancy and breastfeeding. Ornidazole use should be carefully evaluated.
Q5: What are the main drug interactions?
A: Interactions occur with antacids, metal ions, warfarin, theophylline, NSAIDs.
Q6: What is the role of Lactobacillus in this combination?
A: Lactobacillus helps to prevent or treat antibiotic-associated diarrhea by restoring healthy gut flora.
Q7: What infections is this medication typically used for?
A: This combination is prescribed for mixed bacterial and parasitic infections, commonly involving anaerobic bacteria. These include gastrointestinal infections, gynecological infections, some respiratory infections, and some urinary tract infections.
Q8: Can I stop taking the medication if I feel better before completing the course?
A: No, it’s crucial to complete the entire prescribed course even if symptoms improve to prevent the development of antibiotic resistance.
Q9: Are there any dietary restrictions while taking this medication?
A: Avoid alcohol while taking Ornidazole. Dairy products, antacids, and supplements containing minerals should be taken separately from Ofloxacin.
Q10: What should I do if I experience side effects?
A: Contact your healthcare provider immediately if you experience any side effects, especially serious ones like tendon pain, numbness, tingling, seizures, or severe allergic reactions.
