When treating diseases of a bacterial nature, the doctor usually prescribes antibiotics. These drugs have a huge number of varieties. Of course, it is impossible to know all types of antiseptic pharmaceutical products, but some drugs against bacterial infections are of particular interest.
One of the modern antibiotics that is presented on our drug market is Zivox. Instructions for use of this drug indicate that it is an antimicrobial agent of synthetic origin. It belongs to a special group - oxazolidinones. The main active ingredient is linezolid.
Next, we will consider the following information: the effect of the Zivox drug, instructions for use, analogues, side effects and contraindications.
In what form is it produced?
This drug is available in two dosage forms:
- In the form of granules, painted in white or yellowish color and having the aroma of an orange. A solution for oral administration is prepared from them with the expectation that 100 mg of linezolid will be contained in 5 ml of the finished suspension. The granules are placed in a 150 ml stacked container. Also in the package there is a measuring spoon with divisions (2.5 and 5 ml of suspension).
- In the form of tablets containing 600 mg of linezolid. The package contains one blister with 10 tablets inside.
- An infusion solution containing 2 mg linezolid / 1 ml, in packs of 100, 200, 300 ml.
What is the pharmacological effect of the drug?
The active substance linezolid has the ability to penetrate bacterial cells, bind to their ribosomes and inhibit protein synthesis. As a result, microorganisms die.
What microorganisms does the drug help against?
The drug "Zivox", the instructions for use of which accompanies each package of medicine, effectively affects the following microorganisms:
- gram-positive aerobic bacteria: enterococci, corynebacter, staphylococci, streptococci;
- gram-negative aerobic bacteria of the genus pasteurella;
- gram-positive anaerobic bacteria: clostridium and peptostreptococcus;
- Gram-negative anaerobic bacteria of the genera Prevotella, bacteroides, chlamydia.
Mozexella, Legionella, Mycoplasma bacteria are moderately sensitive to linezolid.
There are also microorganisms that are resistant to linezolid, which is part of the Zivox drug.
Instructions for use indicate the following resistant strains: hemophilic bacteria, as well as the genera Enterobacteriacea, Nizer and pseudomonas.
What diseases is this medicine indicated for?
Zivox antibiotic is prescribed for the following diseases:
- Infectious and inflammatory ailments that are caused by bacteria that are sensitive to this drug.
- In cases of hospital or community-acquired pneumonia.
- With infectious lesions of the skin and soft tissues of the human body.
- In the presence of diseases caused by enterococci, which are resistant to vancomycin.
Also, the Zivox antibiotic can be used as a component of a combination therapy for an infection caused by gram-negative bacteria.
Pharmacokinetics
Linezolid is characterized by a fairly rapid absorption from the digestive tract into the blood, regardless of the form of release of the drug. Already after 2 hours after taking the drug, its concentration in plasma reaches its maximum values. Linezolid is characterized by complete bioavailability, and its distribution over organs and tissues occurs rather quickly. Regardless of what the concentration of the antibiotic in the blood is, 31% binds to plasma proteins.
In the human body, linezolid is metabolized through oxidation to two products that do not have an antimicrobial effect. They are excreted by the kidneys (about 50%) and the intestines (up to 6%). Up to 35% of a non-metabolized antibiotic is excreted in urine.
Stable pharmacokinetics, which is characterized by the drug "Zivox." Instructions for use note the absence of dependence of this drug criterion on the age of the patient. In this regard, older people do not need to adjust the dosage of this pharmaceutical product.
Drug dosage
The drug "Zivox" can be prescribed by a doctor to a patient for oral use or in the form of intravenous infusion. Moreover, the patient can be transferred from one type of drug administration to another without loss of treatment effectiveness.
The dosage of the drug, the duration of the course is prescribed by the attending physician, and these circumstances of therapy are determined by the following factors:
- what kind of bacteria the disease was caused by;
- localization of infection;
- the severity of the disease;
- clinical effect of therapy.
When streptococcal pneumonia of community-acquired and hospital type in adults and children over 12 years of age, 600 mg of Zivox is prescribed. The instruction indicates that a dose of the drug must be taken every 12 hours, and the duration of the course is 10-14 days.
For infections of the skin or soft tissues, complicated or uncomplicated, caused by staphylococci, streptococci and enterococci resistant to vancomycin, including diabetic foot syndrome (without osteomyelitis), a dose of Zivox 600 mg is prescribed. The instruction also says that the interval between doses of the drug should be 12 hours. The course of therapy lasts 10-14 days, but can last up to 28 days as prescribed by the doctor.
If the patient has renal failure, then he does not need to adjust the dose of the drug. During the hemodialysis procedure, linezolid is removed over a period of 3 hours. In connection with this circumstance, the drug should be taken after an event to cleanse the blood. Patients who are diagnosed with liver failure also do not need to adjust the dosage.
Patients under 12 years of age are prescribed only the infusion form of the Zivox drug. Instructions for use in infants and children indicate that linezolid should be taken at a dose of 10 mg / kg of the child’s weight with a frequency of every 8 hours. The course of treatment is from 10 to 14 days. This dosage of the drug is relevant for therapy in the case of community-acquired and hospital pneumonia, infections of soft tissues and skin, as well as for the fight against enterococcal infections.
The protective shell made of foil is removed immediately before the infusion procedure. Check the bag for leaks, squeezing it for 1 minute. Leaky packaging is unsuitable due to non-sterility. The infusion solution is administered over a period of 30-120 minutes.
Application features
There are some features of taking the drug "Zivox". The instruction indicates that if the infection is caused by gram-negative bacteria, it is necessary to connect additional drugs with activity against this group of microorganisms.
When taking linezolid in some patients, reversible myelosuppression may occur. Depending on the duration of therapy, it is characterized by anemia, leukopenia, thrombocytopenia or pancytopenia. Based on these data, monitoring of blood indices in patients at risk of bleeding should be carried out. Also, these measures are appropriate if the patient had a history of myelosuppression or he is taking drugs that reduce the level of hemoglobin and platelets or their activity. Evaluation of blood counts is also necessary for a long period of treatment (more than 14 days).
In some patients, taking linezopide may be accompanied by a risk of developing
colitis of a pseudomembranous nature of different types of severity.
Diarrhea is common in people taking antibiotics quite often. The extent of this side effect can vary from mild to severe. When taking the Zivox drug, whether it is a tablet or suspension, the normal intestinal microflora are inhibited and the clostridium bacteria are overgrown. In the process of its activity, this microorganism releases toxins of groups A and B, and they provoke diarrhea. Elevated levels of these components can cause death in patients. All patients with this type of diarrhea need careful monitoring by doctors for a period of 2 months.
In some cases, visual impairment is observed during treatment with Zivox. Instructions for use in children and adults indicate a possible change in the perception of colors, sharpness of focus, field defects, fog. In these cases, the patient needs an urgent consultation with an oculist. If this medicine is taken by the patient for a long time period (more than 3 months), then it is imperative to carry out eye control. With the onset and development of phenomena such as peripheral or optic neuropathy, the question is raised about stopping treatment with the drug if its benefits are less than the damage to health.
There have also been cases of lactic acidosis when taking Zivox. It manifests itself in the form of nausea, vomiting, unjustified acidosis or a decrease in carbonate anions. This phenomenon should be carefully monitored by a medical professional.
If the patient has a need to take serotonin reuptake inhibitors together with Zivox, then he should be taken under medical control in order to detect the serotonin syndrome: cognitive failure, hyperreflexia, hyperpyrexia and impaired coordination. In the presence of the described phenomena, treatment is discontinued with one or both drugs. In this case, there is a discoloration of the tooth enamel, which is removed by professional cleaning.
There is another caveat for taking the drug Zivox. Instructions for use (tablets or granules for the preparation of a suspension - it doesn’t matter) reads: when treating linezolid, it is not recommended to drive a vehicle, operate special equipment, and carry a risk to life and health.
What side effects does the drug have?
Adverse reactions that can occur in a patient while taking the Zivox 600 mg pharmaceutical agent are classified according to the frequency of manifestation: from very frequent (10%) to very rare (0.01%).
Usually, as side effects in the treatment with Zivox, the instructions for use, whether it is a solution or tablets, refers to mild or moderate symptoms. The following symptoms differ in particular frequency:
- nausea;
- diarrhea;
- headaches.
Adult patients may also experience constipation, vomiting, pain in the abdomen, flatulence, as well as candidiasis of the oral cavity.
To infrequently encountered side effects from the use of Zivox, the instructions for use (for children over 12 years of age and adults) call changes in the color of the tongue.
Based on laboratory studies, it can be argued that during treatment with this antibiotic, thrombocytopenia is often detected. Not so regularly observed increase in blood triglycerides, abnormal activation of liver enzymes ALT, AST, alkaline phosphatase, LDH, as well as lipases and amylases. Also recorded an increase in the concentration of total bilirubin, creatine and prolactin.
The nervous system of the patient can also respond to taking the drug with linezolid. This is often expressed in dizziness and migraines, as well as in convulsions. More rare manifestations of the side effect of the drug are cases of perversion of taste.
Changes in the normal functioning of the central nervous system can cause Zivox (tablets). The instruction indicates a fairly common insomnia in patients during the course of treatment with this pharmaceutical drug.
On the functioning of the genitourinary system, therapy with the use of Zivox can be reflected in the form of vaginal candidiasis.
Often there are skin manifestations of linezolid treatment in the form of a rash.
Other side effects include febrile events and opportunistic fungal infections, which are rare.
Also, in the study of the drug "Zivox" there were cases of increased blood pressure, itching and dyspepsia.
When linezolid treatment of adolescent patients from 12 to 17 years, the following undesirable manifestations are often found:
- diarrhea, vomiting, nausea, abdominal pain;
- vertigo, migraine;
- rash;
- infectious diseases of the upper respiratory tract, cough, pharyngitis;
- fever;
- pain, the localization of which is difficult to describe.
The following phenomena may also occur, characterized by a lower frequency:
- eosinophilia;
- increase in triglycerides, ALT, creatine and lipase;
- itching
A clinical study revealed additional side effects that characterize Zivox (solution and tablets). These include:
- reversible myelosuppression;
- optic neuropathy;
- anaphylaxis;
- angioneurotic edema;
- lactic acidosis;
- peripheral neuropathy;
- discoloration of tooth enamel;
- chills;
- fatigue;
- serotonin syndrome.
How is Zivox combined with other medicines?
When combined with cytochrome isoenzymes, there is no change in the activity of the latter.
If simultaneously treated with linezolid and monoamine oxidase inhibitors, then the effect of the latter is enhanced. Based on this circumstance, the dosage of adrenergic agonists and dopaminomimetics should be reduced.
When taking Zivox together with antidepressants that inhibit the uptake of serotonin,
serotonin syndrome may occur
.In the case of simultaneous administration with Aztreonam or Gentamicin, the pharmacokinetics of linezolid was not observed.
Joint administration with "Rifampicin" entails a decrease in the maximum concentration of "Zivox" - up to 32%.
Contraindications
The drug is unacceptable for use by patients with hypersensitivity to the main or additional components that make up its composition.
If the patient takes phenelzine or isocarboxazide, then he cannot take linezolid during this therapy and 2 weeks after it.
If it is not possible to control blood pressure, then Zivox is unacceptable for the treatment of patients with the following diseases:
- unstable hypertension;
- thyrotoxicosis;
- pheochromocytoma;
- as well as in conjunction with adrenomimetics and dopaminomimetics.
If it is impossible to closely monitor patients with a risk of serotonin syndrome, Zivox cannot be prescribed in the following circumstances:
- the presence of a carcinoid disease;
- taking drugs that inhibit the reuptake of serotonin, tricyclic antidepressants, triptans, Miperedin and Buspirone.
The tablet form of "Zivox" is contraindicated in children under 12 years of age due to the inability to select an adequate dosage.
The drug is indicated for treatment if the expected benefit outweighs the risk in the following cases:
- renal and liver failure;
- systemic infections;
- pregnancy and lactation.
Can an overdose of the drug occur?
In clinical studies, as well as with the further use of the drug "Zivox" in a hospital or community-acquired use of cases of overdose were not detected. In the event of a similar situation, symptomatic therapy is recommended.
Storage and Vacation
The drug "Zivox" is sold in a pharmacy by prescription.
It should be stored in a place limited from moisture and sunlight at an air temperature of not more than 30˚C, to limit the access of children.
Analogs
In the case of unacceptability of treatment with Zivox, its analogues may be prescribed for reasons of similarity of effects of exposure to the main active substance:
- For pneumonia and bronchitis - “Doxycycline hydrochloride”, “Bronchorus”, “Arlet”.
- In case of bacterial infections - “Levomycetin 0.25 g”, “Vancomabol”, “Lifaxon”.
- For skin infections - “Benzatin benzylpenicillin”, “Sulfadimethoxin”.
- For non-healing wounds - "Tsifaleksin sodium salt", "Lifusol."
Only the attending physician should prescribe a drug from this list, since each medication has its own indications, especially the reception and contraindications.