Modern treatment of infectious processes is not conceivable without the use of antibacterial drugs. The ever-increasing resistance of microorganisms leads to the search for new drugs or the use of combinations of old, well-established antibiotics. The uncontrolled administration of broad-spectrum antibiotics is not in favor of the rational use of antibacterial drugs , instead of an initial assessment of the sensitivity of flora to drugs of this group. The Remedia drug, possessing significant pharmacokinetic and pharmacodynamic advantages in the series of fluoroquinolones, is increasingly used to treat infectious diseases of various etiologies.
Clinical and pharmacological characteristics
The medicine "Remedia", or "Levofloxacin" (international nonproprietary name), is an antibacterial drug from a number of fluoroquinolones intended for enteric and parenteral routes of administration.
By its nature, Remedia (instructions for use provides just such information) is monofluoroquinolone, an isomer of ofloxacin and, in comparison with other drugs, has significant pharmacokinetic advantages:
- oral bioavailability is 100%, while the degree of relationship with plasma proteins reaches 40%;
- the maximum content of the drug in serum is observed 1-2 hours after ingestion and is comparable to that after intravenous administration;
- "Remedia" is characterized by an increased volume of distribution in the body, due to intensive penetration into the tissue;
- has a long half-life from the body, which leads only to a single dose of the drug per day.
Considering that the significant therapeutic effect of fluoroquinolones is determined by the rapid increase in the therapeutic concentration of the drug in the blood, the above pharmacokinetic parameters create favorable conditions for the complete elimination of microorganisms.
By its type of action on the growth and reproduction of bacteria, Remedi has a bactericidal effect, affecting not only the active forms of pathogenic bacteria, but also vegetative and inactive ones.
The metabolism of a small amount of the drug occurs in hepatocytes by oxidation or deacetylation. At the same time, about 5% of the drug is excreted by the kidneys in the form of metabolites, and the rest is excreted by glomerular filtration and tubular secretion. It should be noted that after oral administration, a significant part of the drug (about 70%) is excreted from the body within 24 hours with urine, and about 80% of the dose is eliminated after 48 hours. The proportion of the excreted drug through the gastrointestinal tract is small and amounts to only about 4%.
When using the drug in a dose of more than 1000 mg per day (twice taking tablets of 500 mg), there is a slight chance of a cumulative effect.
Mechanism of action
The mechanism of action of the drug is based on the inhibition of a specific enzyme called DNA gyrase, which is involved in the replication of genetic material, stitching the positive turns of the DNA helix into negative ones. As a result of inhibition of this enzyme, DNA replication and cell division are disrupted , and cell death occurs.
"Remedia": instructions for use and indications
To date, the main indications for the appointment of the drug are bacterial etiology infectious processes caused by antibiotic-sensitive strains of microorganisms in people over 18 years of age.
The drug "Remedia" has proven itself in the treatment of respiratory bacterial infections of the upper and lower respiratory tract, such as acute bronchitis, sinusitis, and inflammatory diseases of the lung tissue. This is primarily due to the excellent penetration of the drug into the epithelium of the bronchi and lungs, where even after the first dose of the drug an effective concentration is created.
Also, the drug is successfully used to treat urinary tract infections (pyelonephritis, cystitis, urethritis, etc.), biliary tract infections, prostatitis, skin infections, intraperitoneal infections and septic conditions.
In order to treat infectious diseases of the respiratory tract, “Remedia” is prescribed (depending on the severity of the disease) 1-2 times a day, 500 mg in tablet or injection form.
For the treatment of urinary tract infections, a dose of 250 mg once a day is sufficient, and in severe cases, the daily dose may be 500 mg (Remedia 500). The instructions for use say that a double dose of 250 mg can be replaced with a single dose of 500 mg, depending on the severity of the disease.
For the treatment of infectious diseases of the skin and mucous membranes, Remedia is prescribed in a dosage of 250 mg twice a day.
Contraindications
An absolute contraindication to taking the drug is hypersensitivity and the presence of allergic reactions in the history of drugs of the fluoroquinolone group.
There are no unambiguous data regarding the administration of the drug during pregnancy, since controlled studies to study the teratogenic or embryotoxic effect have not been conducted.
In view of this, the appointment of "Remedy" should be avoided by pregnant women, except in cases where the potential risk of prescribing the drug is lower than the benefit from it.
In the case of the use of the drug in patients suffering from porphyria, an exacerbation of the disease may occur.
With extreme caution, the infusion solution should be used in patients with previous lesions of the central nervous system (strokes, heart attacks, traumatic brain injuries), due to the high probability of the development of convulsive conditions.
There are no specific instructions for patients working with complex mechanisms in production or driving vehicles, however, the possibility of developing side effects from the central nervous system in the form of drowsiness, confusion, etc. should be taken into account. In view of this, you should refrain from this kind of work.
Side effects
One of the most significant side effects that develop while taking fluoroquinolones is a violation of the development of cartilage due to damage to the pineal gland chondrocytes and the tissue itself. In view of this, the drug is contraindicated in persons under 18 years of age and pregnant. It should be noted that in patients older than 18 years of age, against the background of prolonged use of the drug, the appearance of arthralgia or impaired joint function was not observed. Other side effects include the following.
From the gastrointestinal tract - nausea, vomiting, decreased appetite, the appearance of discomfort in the epigastric region, the occurrence of gastrointestinal bleeding and the development of gastroenteritis; increased plasma aminotransferases.
From the central nervous system - the development of symptoms of encephalopathy, headache, dizziness, loss of consciousness, sleep disorders and frequent changes in mood, the appearance of paresthesias, hallucinations and delusions.
On the part of the immune system - the development of allergic reactions in the form of skin rashes, itching, and with increased insolation, photodermatitis can develop.
From the urinary system - the development of crystalluria.
On the part of the respiratory system, the appearance of bronchospasm is likely, and on the part of the circulatory system, a sharp decrease in blood pressure, the development of hypoglycemia, and reactions from the cellular link of hemostasis (in the form of thrombocytopenia, etc.) are likely.
Interaction with other drugs
The drugs of the fluoroquinolone group are not prescribed together with antacids, since this significantly reduces the absorption and bioavailability of antibiotics. The simultaneous use of Remedia with iron preparations, as well as with drugs that affect the functional activity of the central nervous system, is not recommended. In addition, there is evidence regarding the effects of probenecid and cimetidine on the elimination of the drug from the body (these substances can reduce the elimination of the antibiotic).
There is no unambiguous indication of drug interactions with levofloxacin. Due to the low metabolism of the drug in the liver tissue and the lack of interaction with the enzymes of the cytochrome P450 group, Remedia does not change the activity of the latter, however, despite this, like other representatives of the fluoroquinolone group, this drug should not be combined with theophylline drugs and indirect anticoagulants, due to a possible increase in the concentration of the latter in the blood.
The use of the drug during breastfeeding
To date, there is no information regarding the ability of the drug to penetrate into breast milk. If there is a need for antibiotic therapy during breastfeeding, it is recommended to stop the latter for a while (the duration depends on the severity of the infection process and the expected duration of antibiotic therapy). If necessary, in order to maintain lactation, periodic decantation is performed or lactation is completely stopped by medical means.
In extreme cases, breastfeeding and antibiotic therapy are possible when assessing risks for the baby and mother.
Release form and dosage
Remedia is available in two forms: for enteral and parenteral administration. For oral administration, there is a tablet form containing 250 or 500 mg of the drug (respectively under the trade names "Remedia 250" and "Remedia 500"). For parenteral administration , an infusion solution is available.
Remedia tablets are taken 1-2 times a day before meals or in between meals, without chewing, drinking plenty of water. If it becomes necessary to divide the dose in half, the tablet can be broken into two parts by the label.
For parenteral administration, an injection solution with an active substance concentration of 500 mg / 100 ml solution is available (Remedia 500). In the case of an intravenous injection, the drug is administered no faster than within 1 hour.
After the infusion of the drug, a further transition to the tablet form is recommended. The estimated duration directly depends on the severity of the infectious process and the sensitivity of the pathogenic microflora to the antibiotic. Therapy (regardless of the form of administration) is recommended to continue for 3-4 days after normalization of body temperature. Self-treatment and early termination of the drug is not recommended, due to the high risk of adverse reactions and the likely development of microflora resistance to the drug.
special instructions
Before starting therapy using Remedia, the instructions for use require a sample to be tested for the sensitivity of the strain of microorganisms to this drug. However, in view of a wide spectrum of action, treatment can be started without a test, with the subsequent determination of the most effective drug.
When prescribing Remedia medicine, special attention should be paid to analyzes aimed at assessing renal blood flow, since the bulk of the drug is excreted through the kidneys. In case of impaired function of the latter, the dosage of the drug must be adjusted in accordance with the clearance of endogenous creatinine.
Infusion forms of the drug are strictly prohibited to mix with solutions for injection, which have an alkaline reaction (sodium bicarbonate), as well as with heparin. For the purpose of dilution, the Remedia infusion solution is compatible with isotonic sodium chloride solution , isotonic glucose solution and Ringer's solution.
While taking Remedia, alcohol should be avoided, since it helps to enhance the toxic effect of levofloxacin on the central nervous system and a more pronounced manifestation of side effects.
If it is decided to use Remedi on its own, the instructions for use, analogues, should be studied carefully, since it is the completeness of the information and reliance on sufficient knowledge about the drug that will help to avoid gross errors.
Storage and distribution conditions from pharmacies
The drug does not require special storage conditions. Its safety is ensured at an ambient temperature of not more than 25 degrees Celsius. From the pharmacies Remedia (antibiotic) is available on prescription.
When buying a drug, it is imperative to pay attention to the integrity and safety of the packaging, date of manufacture and shelf life. Must be present in the box with the medicine "Remedy" instructions for use. The tablets should be in good quality packaging. You can check the tactile sensations from her (no matter how strange it may seem). This is due to the fact that counterfeiters and fakes are increasingly appearing on the pharmaceutical market, which in the best case are not able to provide the proper antibacterial effect when taken orally, and in the worst, cause serious side effects. Therefore, when purchasing the drug, do not be lazy to ask the pharmacist about the availability of a quality certificate confirming the origin of the Remedia drug (tablets). Instructions for use (according to the prescription of the purchased drug) should contain information about the origin of the drug.
Overdose
In case of an overdose, a specific antidote does not exist. Symptoms when the dose is exceeded is mainly due to the influence of the latter on the functional activity of the central nervous system. At the same time, confusion, drowsiness, dizziness, as well as symptoms of nervous system excitation in the form of psychoses, epileptic seizures, etc. are observed.
Treatment is aimed at the speedy removal of the drug from the body. Given the high bioavailability and distribution of the drug throughout the body, hemodialysis detoxification methods are ineffective. It is necessary to stop the drug from entering the body and carry out symptomatic treatment.
In view of the significant elimination of Remedia by filtration in the renal glomeruli, an effective method of detoxification is the use of water-salt infusion solutions and loop-type diuretics.
Reviews about the drug
In general, there are positive reviews about the drug due to its high effectiveness for the treatment of infectious diseases of various etiologies. As the instructions for use say about Remedia, reviews of the drug are left not only by patients, but also by the attending physicians, who note its high effectiveness, up to the treatment of nosocomial and nosocomial infections.
Negative reviews and dissatisfaction with the drug are left mainly by patients. This is due to the development of side effects or improper use of Remedia. The instruction, however, gives quite comprehensive information for this drug. Negative reviews are due to the use of the drug in those cases when it is ineffective due to the mismatch of the spectrum of antibacterial action of the microbial infection. It should be noted that critical opinions are often left by patients who are self-medicating and accepting “Remedia” on their own or on the recommendation of friends or acquaintances (the instructions are often ignored, which is not recommended). Negative reviews from medical specialists are practically not observed. This is due to the correct and rational use of the drug (information about "Remedia 500", the instruction contains enough information for the correct purpose of the drug).
Analogues of the drug "Remedia"
For the Remedia drug, the instruction describes the analogs as follows: since this drug is a fluoroquinolone antibiotic levofloxacin, almost all drugs of a similar composition can be considered full-fledged analogues. Among these, it should be noted primarily “Levofloxacin”, “Zolev”, “Lebed”, “Levoksimed” and many others. For “Remedia” (tablets), the instructions for use analogs are offered in the form of such drugs as “Leflock”, “Phloxium” and others.
Conclusion
The active ingredient of Remedia is the antibiotic levofloxacin. It is an excellent broad-spectrum antibacterial drug with a bactericidal effect. Due to the low incidence of adverse reactions and the lack of antibiotic resistance of various bacterial strains, “Remedia” is successfully used in clinical practice. Instructions for use give quite comprehensive information regarding the activity of the drug.