Levofloxacin-Optic, eye drops 0.5% 5 ml

Name: Levofloxacin-Optic, eye drops 0.5% 5 ml
SKU: 338191
Availability: InStock

€4.04

EAN: 4603671003392 SKU: 338191 Categories: Eye Treatment, Infections and inflammations, Medicine

Levofloxacin is the L-isomer of the racemic drug substance ofloxacin. The antibacterial activity of ofloxacin refers mainly to the L-isomer.

As an antibacterial agent of the class of fluoroquinolones, levofloxacin blocks DNA-enzyme (topoisomerase II) and topoisomerase IV, disrupts supercoiling and cross-linking of DNA (deoxyribonucleic acid) breaks, inhibits DNA synthesis and causes deep morphological changes in cytoplasm, cell wall and membranes.

Mechanism of resistance development

Resistance to levofloxacin can develop primarily through two main mechanisms, namely a decrease in intracellular concentration of the drug or changes in the targets of action of the drug.

The changes in the targets – the two bacterial enzymes DNA-gyrase and topoisomerase IV are the result of mutations in the chromosomal genes encoding DNA-gyrase (gyrA and gyrB) and topoisomerase IV (ragC and parE; grlA and grlB in Staphylococcus aureus).

Drug resistance due to low intracellular concentration develops as a result of changes in the porin channel system of the outer cell membrane, which leads to decreased entry of the fluoroquinolone into Gram-negative bacteria, or from efflux pumps.

Efflux-mediated resistance has been described against pneumococci (PmrA), staphylococci (NorA), anaerobic and gram-negative bacteria.

Plasmid-mediated resistance to quinolones (determined on the basis of the qnr gene) has been found against Klebsiella pneumoniae and Escherichia coli.

The development of cross-resistance between fluoroquinolones is possible.

Single mutations may not lead to clinical resistance, but multiple mutations cause clinical resistance to all drugs in the class of fluoroquinolones.

Mutations in the outer membrane porins and efflux systems can have broad substrate specificity, affecting several classes of antibacterial agents and leading to multiple resistance.

The efficacy against Gram-positive aerobes – Enterococcus faecalis, Staphylococcus aureus (methicillin-sensitive strains), Staphylococcus epidermidis (methicillin-sensitive strains), Staphylococcus saprophyticus, Streptococcus pneumoniae (incl. ч. multidrug-resistant strains -MDRSP), Streptococcus pyogenes; gram-negative aerobes – Enterobacter cloacae, Escherichia coli, Haemophilus influenzae, Haemophilus paraintluenzae, Klebsiella pneumoniae, Legionella pneumophila, Moraxella catarrhalis, Proteus mirabilis, Pseudomonas aeruginosa, Serratia marcescens and other microorganisms – Chlamydia pneumoniae, Mycoplasma pneumoniae.

With respect to most (≥90%) strains of the following microorganisms in vitro minimum suppressive concentrations of levofloxacin (2 µg/ml or less) are established, but the effectiveness and safety of clinical use of levofloxacin in therapy of infections caused by these pathogens have not been established in adequate and well-controlled studies: Gram-positive aerobes – Staphylococcus haemolyticus, Streptococcus (group C/F), Streptococcus (group G), Streptococcus agalactiae, Streptococcus milleri, Streptococcus viridans; Gram-negative aerobes -Acinetobacter lwoffii, Acinetobacter baumannii, Bordetella pertussis, Citrobacter (diversus) koseri, Citrobacter freundii, Enterobacter aerogenes, Enterobacter sakazakii, Klebsiella oxytoca, Morganella morganii, Pantoea (Enterobacter) agglomerans, Proteus vulgaris, Providencia rettgeri, Providencia stuartii, Pseudomonas fluorescens; gram-positive anaerobes – Clostridium perfringens.

Sensitive microorganisms: aerobic gram-positive microorganisms – Corynebacterium diphtheriae, Enterococcus spp, including Enterococcus faecalis, Listeria monocytogenes, Staphylococcus spp. (coagulase-negative methicillin-sensitive/leukotoxin-containing/ moderately sensitive strains), including Staphylococcus aureus (methicillin-sensitive strains), Staphylococcus epidermidis (methicillin-sensitive strains), Streptococcus spp. groups C and G, Streptococcus agalactiae, Streptococcus pneumoniae (penicillin-sensitive/moderately sensitive/resistant strains), Streptococcus pyogenes, Streptococcus spp. group viridans (penicillin-sensitive/resistant strains); aerobic gram-negative microorganisms – Acinetobacter spp, including Acinetobacter baumannii, Acinetobacillus actinomycetecomitans, Citrobacter freundii, Eikenella corrodens, Enterobacter spp, including Enterobacter aerogenes, Enterobacter agglomerans, Enterobacter cloacae, Escherichia coli, Gardnerella vaginalis, Haemophilus ducreyi, Haemophilus influenzae (ampicillin sensitive/resistant strains), Haemophilus parainfluenzae, Helicobacter pylori, Klebsiella spp, including Klebsiella oxytoca, Klebsiella pneumoniae, Moraxella catarrhalis (beta-lactamase producing and non-producing strains), Morganella morganii, Neisseria gonorrhoeae (penicillinase producing and non-producing strains), Neisseria meningitidis, Pasteurella spp, including Pasteurella canis, Pasteurella dagmatis, Pasteurella multocida, Proteus vulgaris, Providencia spp. including Providencia rettgeri, Providencia stuartii, Pseudomonas spp, including Pseudomonas aeruginosa, Serratia spp. including Serratia marcescens, Salmonella spp.; anaerobic microorganisms -Bacteroides fragilis, Bifidobacterium spp, Clostridium perfringens, Fusobacteriumspp., Peptostreptococcus spp., Propionibacterium spp., Veilonella spp.; other microorganisms – Bartonella spp, Chlamydia pneumoniae, Chlamydia psittaci, Chlamydia trachomatis, Legionella pneumophila, Legionella spp., Mycobacterium leprae, Mycobacterium tuberculosis, Mycoplasma hominis, Mycoplasma pneumoniae, Rickettsia spp., Ureaplasma urealyticum.

Moderately sensitive microorganisms (MPC more than 4 mg/l): Aerobic Gram-positive microorganisms – Corynebacterium urealyticum, Corynebacterium xerosis, Enterococcus faecium, Staphylococcus epidermidis (methicillin-resistant strains), Staphylococcus haemolyticus (methicillin-resistant strains); aerobic gram-negative microorganisms – Burkhoideria cepacia, Campylobacter jejuni, Campylobacter coli; anaerobic microorganisms – Bacteroides thetaiotaomicron, Bacteroides vulgatus, Bacteroides ovatus, Prevotella spp., Porphyromonas spp.

Resistant microorganisms (MPC more than 8 mg/ml): aerobic gram-positive microorganisms – Corynebacterium jeikeium, Staphylococcus aureus (methicillin-resistant strains), other Staphylococcus spp. (coagulase-negative methicillin-resistant strains); aerobic Gram-negative microorganisms – Alcaligenes xylosoxidane; other microorganisms – Mycobacterium avium.

Minimum inhibitory concentrations of levofloxacin for some microorganisms

Streptococcus

The in vitro activity of levofloxacin is about 2 times higher than that ofloxacin against Enterobacteriaceae, Pseudomonas aeruginosa and gram-positive microorganisms.

When levofloxacin is used in the therapy of chlamydial diseases of the visual organs, concomitant therapy is required.

The degree of sensitivity of microorganisms to levofloxacin can have significant geographical differences.

The maximum concentration of levofloxacin achieved with 0.5% eye drops is more than 100 times greater than the minimum inhibitory concentration (MIC) of levofloxacin for sensitive microorganisms.

Pharmacokinetics:

Levofloxacin persists well in the tear film after instillation into the eye.

The concentration of levofloxacin in tear fluid after a single dose (1 drop) quickly reaches high values and is maintained above the minimum inhibitory concentration for most sensitive ocular pathogens (less than or equal to 2 µg/mL) for at least 6 hours.

In studies on healthy volunteers, the mean concentrations of levofloxacin in the tear film, measured 4 and 6 hours after topical administration, were 17.0 µg/ml and 6.6 µg/ml, respectively. Five of the six volunteers had levofloxacin concentrations of 2 µg/ml or higher 4 hours after instillation. In four of the six volunteers this concentration was maintained 6 hours after instillation.

The mean plasma concentration of levofloxacin 1 hour after administration ranged from 0.86 ng/mL on day 1 to 2.05 ng/mL.

The maximum concentration of levofloxacin in plasma equal to 2.25 ng/ml was detected on the 4th day after two days of using the drug every 2 hours up to 8 times a day.

The maximum concentrations of levofloxacin achieved on day 15 are more than 1000 times lower than those observed after oral administration of standard doses of levofloxacin.

Indications

The treatment of superficial bacterial eye infections caused by sensitive microorganisms in adults and children over 1 year old.
Prevention of complications after surgical and laser operations on the eye.

Active ingredient

Levofloxacin

Composition

Per 1 ml:

Active substance: levofloxacin hemihydrate – 5.12 mg in terms of levofloxacin – 5.00 mg

Auxiliary substances:

Sodium chloride – 9.00 mg,

benzalkonium chloride in terms of dry substance – 0.05 mg,

1 M hydrochloric acid solution or 1 M sodium hydroxide solution – up to pH 6.0-7.0,

Purified water – up to 1.0 ml.

How to take, the dosage

Topically, into the affected eye(s).

The duration of the course of treatment is determined by the severity of the condition and its clinical and bacteriological features. The average duration of a course of therapy is 5 days.

1 to 2 drops in the affected eye(s) every two hours up to 8 times a day during the waking period for the first 2 days, then 4 times a day from days 3 to 5.

If more than one medication is used, the interval between instillations should be at least 15 minutes.

Interaction

No special studies on drug interactions have been conducted. Since the maximum plasma concentration of levofloxacin after topical application in the eye is at least 1000 times lower than after standard oral doses, the interaction with other drugs typical for systemic use is likely to be clinically insignificant.

Special Instructions

The drug should not be injected subconjunctivally and into the anterior chamber of the eye.

The drug should not be used while wearing hydrophilic (soft) contact lenses due to the presence of benzalkonium chloride preservative, which can be absorbed by contact lenses and have adverse effects on the eye tissue and cause discoloration of contact lenses.

To avoid contamination of the drip tip and solution the eyelids and tissues around the eyes should not be touched during the injection.

Long-term treatment with levofloxacin (as well as other antibiotics) causes overgrowth of insensitive microorganisms including fungal flora.

In case of disease course deterioration or no improvement during levofloxacin therapy it is necessary to cancel levofloxacin therapy and switch to therapy with antibacterial agents of other groups with extended ophthalmologic examination including biomicroscopy and fluorescein test.

There are no data on efficacy and safety of levofloxacin in therapy of corneal ulcers.

No formation of corneal precipitates was noted during clinical studies.

Influence on the ability to drive vehicles and mechanisms:

The drug has no significant effect on the ability to drive vehicles and mechanisms. Immediately after instillation temporary blurring of vision is possible.

It is not recommended to drive vehicles and engage in other potentially dangerous activities that require high concentration and speed of psychomotor reactions until the restoration of visual clarity.

Contraindications

Hypersensitivity to levofloxacin or to any of the components of the drug, as well as to other quinolones.

With caution:

Childhood.

Side effects

The incidence of adverse reactions during therapy with levofloxacin was about 10%. Most commonly, the severity of adverse reactions ranged from mild to moderate; adverse reactions were mainly observed in the visual organs. Data on adverse events were obtained during clinical trials and post-registration use.

Immune system disorders:

Rarely (>1/10000, <1/1000): systemic allergic reactions including skin rash.

Very rarely (<1/10000): anaphylactic shock.

Nervous system disorders:

Infrequent (>1/1000, <1/100): headache.

Visual disorders:

Frequent (>1/100, <1/10): burning in the eye, decreased vision, filamentous mucous discharge in the conjunctival cavity.

Infrequent (>1/1000, <1/100): chemosis, conjunctival injection, papillary conjunctivitis, eyelid edema, eyelid erythema, discomfort in the eye, itching in the eye, pain in the eye, “dry” eye syndrome, photophobia.

Respiratory, chest and mediastinal disorders:

Infrequent (>1/1000, <1/100): rhinitis.

Very rare (< 1/10000): pharyngeal edema.

The profile of adverse events when using the drug in the pediatric population is comparable to the adult population.

Overdose

The total amount of levofloxacin contained in one bottle of eye drops is too low to cause toxic reactions even after accidental oral administration. After topical application of an excessive dose of the drug, the eye should be rinsed with clean (tap) water at room temperature.

Pregnancy use

Pregnancy

There are insufficient data on the use of levofloxacin in pregnant women. Results of preclinical studies indicate no direct or indirect adverse effects with respect to toxic effects on reproductive function and intrauterine development.

Potential risk of the drug in humans is unknown. Levofloxacin eye drops may be used during pregnancy if the potential benefit to the mother exceeds the possible risk to the fetus.

Breastfeeding

Levofloxacin enters the breast milk. However, when levofloxacin is used in therapeutic doses, no effects on the infant are expected. Levofloxacin eye drops may be used during breastfeeding if the potential benefit to the mother exceeds any possible risk to the infant.

Fertility

After topical administration, levofloxacin did not cause impairment of fertility in rats at exposures significantly higher than the maximum human dose.

Similarities

Signicef, Tavanic, Oftavix, Flexid, Levolet R, Levofloxacin-Teva, Glevo, Haileflox, Leflobakt, L-Optik Rompharm, Levofloxacin, Korfecin

Additional information

Microorganism	Sensitive, mg/mL	Resistant, mg/mL
	Pseudomonas spp.		≤1	>2
Staphylococcus spp.	≤1	>2
≤1	>2
Streptococcus pneumoniae	≤1	>2
Haemophilus influenzae	≤1	>1
	Moraxella catarrhalis <		≤1	>2

Weight	0.018 kg
Shelf life	2 years.
Conditions of storage	Store in the original package at a temperature not exceeding 25 ° C. Store out of the reach of children.
Manufacturer	Lekko ZAO, Russia
Medication form	eye drops
Brand	Lekko ZAO