Comparison of the effectiveness of Glev and Tavanik
Tavanik is more effective than Glev - this means that the ability of the medicinal substance to provide the maximum possible effect is different.
For example, if the therapeutic effect of Tavanik is more pronounced, then with Glev it is impossible to achieve this effect even in large doses.
Also, the speed of therapy is an indicator of the speed of therapeutic action in Tavanik and Glev, as well as bioavailability - the amount of a medicinal substance reaching the place of its action in the body. The higher the bioavailability, the less it will be lost during absorption and use by the body.
Comparison of safety of Glev and Tavanik
The safety of a drug includes many factors.
At the same time, Glev’s is quite similar to Tavanik’s. It is important where the drug is metabolized: drugs are excreted from the body either unchanged or in the form of products of their biochemical transformations. Metabolism occurs spontaneously, but most often involves major organs such as the liver, kidneys, lungs, skin, brain and others. When assessing metabolism in Glev, as well as in Tavanik, we look at which organ is the metabolizing organ and how critical the effect on it is.
The risk-benefit ratio is when the prescription of a drug is undesirable, but justified under certain conditions and circumstances, with the obligatory observance of caution in use. At the same time, Glev does not have any risks when used, just like Tavanik.
Also, when calculating safety, it is taken into account whether only allergic reactions occur or possible dysfunction of the main organs. In other matters, as well as the reversibility of the consequences of using Glev and Tavanik.
Tavanik film-coated tablets 500 mg 10 pcs. in Moscow
Hospital-acquired infections caused by Pseudomonas aeruginosa (Pseudomonas aeruginosa),
may require combination treatment.
Risk of developing resistance.
The prevalence of acquired resistance in cultured strains of microorganisms may vary by geographic region and over time. In this regard, information on drug resistance in a specific country is required. For the treatment of severe infections or if treatment is ineffective, a microbiological diagnosis must be established with the isolation of the pathogen and determination of its sensitivity to levofloxacin.
Methicillin-resistant streptococcus aureus.
There is a high likelihood that methicillin-resistant Staphylococcus aureus will be resistant to fluoroquinolones, including levofloxacin. Therefore, levofloxacin is not recommended for the treatment of known or suspected infections caused by methicillin-resistant Staphylococcus aureus if laboratory tests have not confirmed the sensitivity of this microorganism to levofloxacin.
Disability and potential irreversible serious adverse reactions associated with fluoroquinolones.
The use of fluoroquinolones, incl. levofloxacin has been associated with disability and the development of irreversible serious adverse reactions from various body systems that can develop simultaneously in the same patient. Adverse reactions caused by fluoroquinolones include tendinitis, tendon rupture, arthralgia, myalgia, peripheral neuropathy, and nervous system side effects (hallucinations, anxiety, depression, insomnia, headaches, and confusion). These reactions may develop from several hours to several weeks after starting levofloxacin therapy. The development of these adverse reactions was observed in patients of any age or without the presence of previous risk factors. If the first signs or symptoms of any serious adverse reactions occur, use of levofloxacin should be discontinued immediately. The use of fluoroquinolones should be avoided, incl. levofloxacin, in patients who have experienced any of these serious adverse reactions.
Patients predisposed to developing seizures.
Like other quinolones, levofloxacin should be used with great caution in patients with a predisposition to seizures. Such patients include patients with previous CNS lesions, such as stroke, severe TBI; patients concomitantly receiving drugs that lower the seizure threshold of the brain, such as fenbufen and other similar NSAIDs, or other drugs that lower the seizure threshold, such as theophylline (see “Interactions”). If seizures develop, treatment with levofloxacin should be discontinued.
Pseudomembranous colitis.
Diarrhea that develops during or after treatment with levofloxacin, especially severe, persistent and/or bloody, may be symptoms of pseudomembranous colitis caused by Clostridium difficile. If pseudomembranous colitis is suspected, treatment with levofloxacin should be stopped immediately and specific antibiotic therapy (vancomycin, teicoplanin or oral metronidazole) should be started immediately. Drugs that inhibit intestinal motility are contraindicated.
Tendinitis and tendon rupture.
Tendinitis has been reported rarely with quinolones, including levofloxacin, and can sometimes lead to rupture of tendons, including the Achilles tendon, and may be bilateral. This side effect may occur within 48 hours of starting treatment or several months after completion of fluoroquinolone therapy. Elderly patients are more prone to developing tendonitis; in patients taking fluoroquinolones, the risk of tendon rupture may increase with concomitant use of corticosteroids. In addition, post-transplant patients have an increased risk of developing tendonitis, so it is recommended to be careful when prescribing fluoroquinolones to this category of patients. In patients with impaired renal function, the daily dose should be adjusted based on creatinine clearance. Patients should be advised to remain calm at the first sign of tendonitis or tendon rupture and to contact their healthcare provider. If you suspect the development of tendonitis or tendon rupture, you should immediately stop treatment with Tavanic® and begin appropriate treatment of the affected tendon, for example, providing it with sufficient immobilization (see “Contraindications” and “Side effects”).
Hypersensitivity reactions.
Levofloxacin may cause serious, potentially fatal hypersensitivity reactions (angioedema, anaphylactic shock), even with initial doses (see "Side Effects"). Patients should immediately stop taking the drug and consult a doctor. If they develop, patients should immediately stop taking the drug and immediately consult a doctor.
Severe bullous reactions.
Cases of severe bullous skin reactions such as Stevens-Johnson syndrome or toxic epidermal necrolysis have been observed while taking levofloxacin (see "Side effects"). In case of development of any reactions from the skin or mucous membranes, the patient should immediately consult a doctor and not continue treatment until his consultation.
From the liver and bile ducts.
Cases of hepatic necrosis, including fatal liver failure, have been reported with the use of levofloxacin, mainly in patients with severe underlying diseases, such as sepsis (see "Side effects"). Patients should be warned to stop treatment and seek immediate medical attention if signs and symptoms of liver damage occur, such as anorexia, jaundice, dark urine, itching and abdominal pain.
Patients with impaired renal function.
Since levofloxacin is excreted mainly through the kidneys, patients with impaired renal function require mandatory monitoring of renal function, as well as adjustment of the dosage regimen (see “Dosage and Administration”). When treating elderly patients, it should be borne in mind that patients in this group often have impaired renal function (see “Dosage and Administration”).
Preventing the development of photosensitivity reactions.
Although photosensitivity occurs very rarely with the use of levofloxacin, to prevent its development, patients are not recommended to be unnecessarily exposed to strong solar or artificial UV irradiation (for example, visiting a solarium) during treatment and for 48 hours after treatment with levofloxacin.
Superinfection.
As with the use of other antibiotics, the use of levofloxacin, especially for a long time, can lead to increased proliferation of microorganisms that are insensitive to it (bacteria and fungi), which can cause changes in the microflora that is normally present in humans. As a result, superinfection may develop. Therefore, during treatment, it is imperative to re-evaluate the patient’s condition, and if superinfection develops during treatment, appropriate measures should be taken.
Prolongation of the QT interval.
Very rare cases of QT prolongation have been reported in patients taking fluoroquinolones, including levofloxacin.
When using fluoroquinolones, including levofloxacin, caution should be exercised in patients with known risk factors for prolongation of the QT interval: in patients with uncorrected electrolyte disturbances (with hypokalemia, hypomagnesemia); c congenital long QT syndrome; with heart disease (heart failure, myocardial infarction, bradycardia); while taking drugs that can prolong the QT interval, such as class IA and III antiarrhythmic drugs, tricyclic antidepressants, macrolides, antipsychotics.
Elderly and female patients may be more sensitive to drugs that prolong the QT interval. Therefore, fluoroquinolones, including levofloxacin, should be used with caution (see Precautions, Dosage and Administration, Side Effects and Overdose, Interactions).
Patients with glucose-6-phosphate dehydrogenase deficiency.
Patients with latent or manifest glucose-6-phosphate dehydrogenase deficiency are predisposed to hemolytic reactions when treated with quinolones, which should be taken into account when treated with levofloxacin.
Hypo- and hyperlycemia (dysglycemia).
As with the use of other quinolones, cases of hyperglycemia and hypoglycemia have been observed with the use of levofloxacin, usually in patients with diabetes mellitus receiving concomitant treatment with oral hypoglycemic drugs (for example, glibenclamide) or insulin preparations. Cases of hypoglycemic coma have been reported. In patients with diabetes mellitus, monitoring of blood glucose concentrations is required (see “Side Effects”).
Peripheral neuropathy
. Sensory and sensorimotor peripheral neuropathy, which may have a rapid onset, has been reported in patients taking fluoroquinolones, including levofloxacin. If the patient develops symptoms of neuropathy, levofloxacin should be discontinued. This minimizes the risk of developing irreversible changes. Patients should be informed to report any symptoms of neuropathy to their healthcare provider. Fluoroquinolones should not be prescribed to patients with a history of peripheral neuropathy.
Exacerbation of pseudoparalytic myasthenia gravis (myasthenia gravis).
Fluoroquinolones, including levofloxacin, have neuromuscular blocking activity and may increase muscle weakness in patients with myasthenia gravis. Post-marketing adverse reactions, including pulmonary failure requiring mechanical ventilation and death, have been associated with the use of fluoroquinolones in patients with myasthenia gravis. The use of levofloxacin in a patient with an established diagnosis of pseudoparalytic myasthenia gravis is not recommended (see section "Side effects").
Application for airborne anthrax infection.
The use of levofloxacin in humans for this indication is based on susceptibility data from Bacillus anthracis obtained from in vitro and experimental animal studies, as well as limited data from the use of levofloxacin in humans. Treating physicians should refer to national and/or international documents that reflect the collectively developed point of view on the treatment of anthrax.
Psychotic reactions.
Psychotic reactions, including suicidal ideation/attempts, have been reported in patients taking fluoroquinolones, including levofloxacin, sometimes after a single dose. If such reactions develop, treatment with levofloxacin should be discontinued and appropriate therapy should be prescribed. The drug should be prescribed with caution to patients with psychosis or patients with a history of mental illness (see Precautions).
Visual impairment.
If any visual impairment develops, immediate consultation with an ophthalmologist is necessary (see “Side effects”).
Effect on laboratory tests.
In patients taking levofloxacin, the determination of opiates in urine may lead to false-positive results, which should be confirmed by more specific methods.
Levofloxacin may inhibit the growth of Mycobacterium tuberculosis
and subsequently lead to false negative results of the bacteriological diagnosis of tuberculosis.
Impact on the ability to drive vehicles or engage in other potentially hazardous activities.
Side effects of Tavanic®, such as dizziness or vertigo, drowsiness and visual disturbances (see section “Side effects”), may reduce psychomotor reactions and the ability to concentrate. This may pose a risk in situations where these abilities are of particular importance (for example, when driving a car, when servicing machinery, when performing work in an unstable position).
Comparison of addiction between Glev and Tavanik
Like safety, addiction also involves many factors that must be considered when evaluating a drug.
So, the totality of the values of such parameters as “o syndrome” in Glev is quite similar to the similar values in Tavanik. Withdrawal syndrome is a pathological condition that occurs after the cessation of intake of addictive or dependent substances into the body. And resistance is understood as initial immunity to a drug; in this it differs from addiction, when immunity to a drug develops over a certain period of time. The presence of resistance can only be stated if an attempt has been made to increase the dose of the drug to the maximum possible. At the same time, Glev’s meaning of the “syndrome is satisfactory”, however, the same as Tavanik’s.
Instructions for use TAVANIC
When prescribing the drug to elderly patients, it should be borne in mind that patients in this group often have impaired renal function.
In patients with previous brain damage (including stroke or severe brain injury), the use of Tavanic may provoke seizures.
In severe pneumonia caused by pneumococcus, the use of Tavanic may not be effective enough.
Hospital-acquired infections caused by Pseudomonas aeruginosa may require combination therapy.
Severe allergic reactions may sometimes be preceded by milder skin manifestations. However, these reactions can develop after the first dose - a few minutes or hours after using the drug.
To avoid the development of photosensitivity, patients should avoid exposure to the sun or UV exposure (for example, exposure to the sun at high altitudes or visiting a solarium).
If pseudomembranous colitis is suspected, Tavanik should be discontinued immediately and appropriate treatment should be initiated. In such cases, drugs that inhibit intestinal motility should not be used.
In elderly patients, when using the drug Tavanic, the likelihood of developing tendinitis increases. The use of corticosteroids appears to increase the risk of tendon rupture. If tendonitis is suspected, Tavanik should be immediately discontinued and appropriate treatment should be initiated, ensuring a state of rest in the affected area.
Tavanic should be taken at least 2 hours before or 2 hours after taking sucralfate, magnesium- or aluminum-containing antacids, as well as iron salts.
With the simultaneous use of vitamin K antagonists, control of the blood coagulation system is necessary.
Tavanic should be prescribed with caution simultaneously with probenecid and cimetidine, which block tubular secretion. This applies primarily to patients with impaired renal function.
During treatment you should avoid drinking alcohol.
Experience with other quinolones suggests that they can cause exacerbation of porphyria. A similar effect cannot be excluded when using the drug Tavanic.
When using fluoroquinolones in patients with glucose-6-phosphate dehydrogenase deficiency, hemolysis of erythrocytes is possible. Considering this, treatment with Tavanik in this category of patients should be carried out with extreme caution.
The recommended duration of administration should be strictly adhered to, which should be at least 60 minutes for 100 ml of infusion solution. Experience with the use of levofloxacin shows that increased heart rate and a transient drop in blood pressure may occur during infusion. In rare cases, vascular collapse may occur. If a significant drop in blood pressure is observed during the infusion, the administration is stopped immediately.
Elderly patients with normal renal function do not require dosage adjustment.
Use in pediatrics
Tavanic is contraindicated for the treatment of children and adolescents due to the likelihood of damage to articular cartilage.
Impact on the ability to drive vehicles and operate machinery
Tavanic can cause dizziness or stiffness, drowsiness, visual disturbances, and also reduce the ability to concentrate and the speed of psychomotor reactions. This should be taken into account if it is necessary to use the drug in persons whose activities involve driving a car, servicing machines and mechanisms, or performing work in an unstable position.
Comparison of side effects of Glev and Tavanik
Side effects or adverse events are any adverse medical event that occurs in a subject after administration of a drug.
Glev's state of adverse events is almost the same as Tavanik's. They both have few side effects. This implies that the frequency of their occurrence is low, that is, the indicator of how many cases of an undesirable effect of treatment are possible and registered is low. The undesirable effect on the body, the strength of influence and the toxic effect of Glev is similar to Tavanik: how quickly the body recovers after taking it and whether it recovers at all.
Application of Tavanic in urology
Tavanic blocks DNA gyrase (topoisomerase II) and topoisomerase IV, disrupts supercoiling and cross-linking of DNA breaks, inhibits DNA synthesis, and causes profound morphological changes in the cytoplasm, cell wall and membranes. Tavanic, like other fluoroquinolones, has a pronounced post-antibiotic effect - the continuation of the antimicrobial effect after removal of the drug from the environment, the duration of which depends on the type of microorganism and the value of the previously effective concentration [5]. Tavanik is characterized by a high degree of bioavailability and resistance to transformation in the body. It penetrates well into various organs and tissues; in the tissues of the genitourinary system, the concentration of Tavanic when used in therapeutic doses corresponds to or exceeds the concentration in the blood serum [3,4]. The drug is excreted primarily in the urine (70%), which creates high concentrations sufficient to suppress microflora sensitive to it for a long time [5]. Long-term circulation of the drug in the body in therapeutic concentrations allows it to be used once a day [5]. As a rule, Tavanic is well tolerated by patients. Side effects (3–10% of cases) include nausea, vomiting, diarrhea, constipation, headache, phototoxicity, hypersensitivity reactions, prolongation of the QT interval on the ECG, tendinitis. Contraindications to taking the drug include hypersensitivity, age under 18 years, pregnancy, breastfeeding, epilepsy, glucose-6-phosphate dehydrogenase deficiency [5]. Tavanic is used in urological practice to treat diseases such as uncomplicated and complicated urinary tract infections (UTIs), bacterial prostatitis, nonspecific urethritis and some types of specific urethritis (caused by sexually transmitted infections), as well as orchitis and epididymitis. Uncomplicated urinary tract infections Acute uncomplicated UTI is an episode of acute infection of the lower (urethritis, cystitis) or upper (pyelonephritis) urinary tract in patients in the absence of any disturbances in the outflow of urine from the kidneys and bladder, structural changes in the organs of the urinary system and serious background diseases that can aggravate its course or lead to ineffectiveness of the therapy. Recurrent uncomplicated UTI is the occurrence of more than two episodes of UTI within 6 months or three episodes within 1 year. Asymptomatic bacteriuria - the presence of two consecutive (with an interval of 1 week) positive results of bacteriological examination of urine, in which the same strain of the UTI pathogen was identified; There are no clinical manifestations of the disease [2]. Uncomplicated UTIs are more common in women. Every second woman in the world experiences an episode of UTI at least once in her life, of which 25–40% of women experience a recurrence of the disease within the next 6–12 months. Treatment of acute uncomplicated UTIs can be done on an outpatient basis; Hospitalization is necessary only in serious cases. Richard G. A. et. al. studied the efficacy and safety of Tavanic 250 mg once daily compared with ciprofloxacin 500 mg twice daily for 10 days in the treatment of 385 patients with urinary tract infection in a randomized, double-blind, multicenter trial. Before starting treatment, all patients underwent urine culture, according to which an increase in pathogenic microflora was detected in all patients and the microbial number was 105 microbial bodies in 1 ml of urine. Clinical recovery was observed in 92% of patients treated with Tavanic and in 88% of patients treated with ciprofloxacin. Side effects were noted in 4 and 3% of patients, respectively. The authors conclude that the effectiveness and safety of Tavanic therapy is comparable to those using ciprofloxacin, and in some cases even exceeds them [7,8]. Treatment regimens for patients with acute uncomplicated urinary tract infections are presented below. Acute uncomplicated cystitis: Tavanic 250–500 mg orally once a day for 3–5 days. Acute uncomplicated mild pyelonephritis: Tavanic orally 250–500 mg once a day for 7–14 days. If there is no improvement or worsening of the patient's condition, hospitalization is indicated for additional examination, identification of complicating factors, drainage of the urinary tract and possible surgical treatment. Hospitalization is also indicated for initial moderate and severe acute uncomplicated pyelonephritis, the presence of symptoms of intoxication, and urosepsis [2]. Acute uncomplicated pyelonephritis of moderate and severe course: Tavanic 500 mg intravenously once a day for 3–5 days, then 500 mg orally once a day (total course of treatment – 2–3 weeks). Uncomplicated UTIs (other than sexually transmitted diseases) are very rare in young, healthy men aged 15 to 50 years. Typically, UTIs in men are complicated and are caused by urological abnormalities, bladder outlet obstruction, instrumental interventions and urinary tract drainage [2]. Nonspecific urethritis in young men: Tavanic 250–500 mg orally once a day for 7 days. In case of exacerbation of recurrent uncomplicated UTI, it is possible to use Tavanik according to the schemes given above. However, long-term use of the drug as maintenance therapy is often unjustified due to the high risk of developing dysbiosis. Complicated urinary tract infections A complicated UTI is a UTI that develops against the background of structural or anatomical abnormalities of the genitourinary organs, as well as concomitant diseases that reduce the body's defenses and increase the risk of ascending infection or treatment failure. Complicated UTI is characterized by the presence of one or more of the following factors: • the presence of an indwelling bladder catheter, catheter-stent, drainage, intermittent catheterization of the bladder; • presence of residual urine; • obstructive uropathy (infravesical obstruction, neurogenic bladder, stones, urinary tract tumors, etc.); • vesicoureteral reflux and other functional anomalies; • reconstructive surgeries on the urinary tract; • chemical or radiation damage to the urothelium; • peri- and postoperative UTI; • renal failure, diabetes mellitus, kidney transplantation, immunodeficiency states [2]. Treatment tactics depend on the severity of the disease and the ability to eliminate complicating factors. Otherwise, the UTI may not be completely cured. Treatment of complicated UTI often requires hospitalization of the patient. In this case, it is advisable to carry out antibacterial therapy under the control of bacteriological examination of urine. Of the antibacterial agents, the most effective are fluoroquinolones, which are excreted primarily by the kidneys, have a wide spectrum of antimicrobial action and reach high concentrations both in the urine and in the tissues of the genitourinary system. Y. Kawada, Y. Aso et. al. compared the effectiveness of Tavanic therapy at a dosage of 250 mg twice daily (135 patients) and ofloxacin at a dosage of 200 mg twice daily (126 patients) in the treatment of patients with complicated urinary infection. A positive clinical effect was obtained in 83.7% of patients in the Tavanic therapy group and in 79.4% of patients in the ofloxacin therapy group. From a statistical point of view, there were no differences in the effectiveness of treatment between the two groups described above. Side effects were noted in 4.9% of patients in the ofloxacin group. In the Tavanika group, no such effects were noted, which, according to the authors, indicates better tolerability of the drug [6]. Despite the fact that, according to various studies, the effectiveness of the drug is close to that of other quinolones, the obvious advantages of Tavanik are the low level of side effects, good tolerability and the possibility of a single daily dose. In the presence of kidney or bladder stones, eradication of the pathogen can help inhibit their growth. If complete stone removal is not possible, the patient requires long-term antimicrobial therapy. The addition of infection against the background of obstruction of the upper urinary tract is extremely dangerous and requires emergency drainage. Active antimicrobial therapy can be started only after the obstruction has been eliminated due to the high risk of developing bacteriotoxic shock. Treatment of asymptomatic bacteriuria in patients with permanent catheters or drainages in the urinary tract, as well as intermittent catheterization of the bladder, is not recommended, because leads to the selection of resistant strains of microorganisms and is ineffective for the treatment of microorganisms included in the biofilm film. If clinical manifestations are present, such patients are prescribed 7–10-day courses of broad-spectrum antibiotics. The presence of diabetes mellitus or immunodeficiency is an indication for treatment of even asymptomatic bacteriuria. At the Urology Clinic of the MMA named after I.M. Sechenov Tavanic was prescribed to 114 patients with uncomplicated infections and 86 patients with complicated urinary tract infections (acute obstructive pyelonephritis) aged 19 to 63 years (average age 41 years). Among patients with uncomplicated infections, 76 patients had acute cystitis, and 38 had acute non-obstructive pyelonephritis. The drug was prescribed to patients at a dosage of 500 mg per day for 10 days for uncomplicated infections and 14 days for complicated ones. Treatment results were assessed based on subjective assessment of the effectiveness and safety of treatment by patients and physicians, as well as analysis of objective indicators: monitoring of blood and urine tests, ultrasound monitoring. Lack of clinical treatment effect was defined as persistence or worsening of clinical manifestations after 2 days of treatment. As a result of the analysis of data obtained during the study, a positive clinical and laboratory effect from treatment was achieved in 91% of patients with uncomplicated infections and in 82% with complicated infections. During a control bacteriological study performed 2 weeks after treatment, in patients with a good clinical effect of antibiotic therapy, no growth of the pathogen was detected. Side effects of using Tavanik were noted in 3% of patients. The most common adverse reactions were nausea and diarrhea. It should be noted that the above phenomena had an extremely low degree of severity. None of the patients required special treatment due to the above adverse reactions, and none of them left the study. Thus, fluoroquinolones currently retain their leading place in the treatment of urinary tract infections. In terms of clinical effectiveness, these drugs are comparable to aminoglycosides and new generation cephalosporins, and in some cases (for mixed infections) superior to them. The effect of the drugs is predominantly pathogenetic in nature, and is aimed at eliminating inflammatory agents from the body. For complicated UTIs (except for cases of resistance), Tavanic is used according to the following regimen: Tavanic intravenously 500 mg once a day for 7–14 days. If indicated, the duration of treatment can be increased to 3 weeks. UTI in renal failure or kidney transplantation: Tavanic orally 250–500 mg once a day for 10–14 days. When using Tavanic in patients with renal failure, it should be taken into account that with a decrease in glomerular filtration <20 ml/min. dose adjustment or increasing the intervals between doses of the drug is required. Treatment of UTI in patients with a kidney transplant lasts at least 10–14 days [2]. Bacterial prostatitis Prostatitis is an inflammation of the prostate gland, which can be acute or chronic (symptoms persist for >3 months) [2]. Today, the treatment of chronic prostatitis cannot be imagined without antibiotics and antimicrobial drugs, among which the most preferred are fluoroquinolones, characterized by a wide spectrum of antimicrobial action, high bactericidal activity and good pharmacokinetics. Fluoroquinolones, unlike non-fluorinated quinolones, have a large volume of distribution, create high concentrations in organs and tissues, and penetrate into cells. Treatment of prostatitis should be comprehensive: in addition to antimicrobial therapy, it is necessary to adequately drain the excretory ducts of the prostate acini (for chronic prostatitis, prostate massage is performed), as well as the use of various physical methods (physiotherapy) in order to improve blood flow and provide a more active anti-inflammatory effect. When choosing an antibacterial agent, one should take into account the spectrum of its antimicrobial activity, as well as its ability to penetrate prostate tissue. Fluoroquinolones have good interstitial penetration, a wide spectrum of antimicrobial activity and are the drugs of choice for the treatment of prostatitis. The possibility of single use makes the use of Tavanik preferable. At the Urology Clinic of the I.M. Sechenov Moscow Medical Academy, the effectiveness of Tavanik was assessed in 96 patients with chronic bacterial prostatitis. To confirm the diagnosis of chronic prostatitis, all patients underwent microscopy of prostate secretions. In rare cases (about 10%), when it was not possible to obtain prostate juice, a spermogram was performed. Most patients underwent urethral scraping examination using PCR. Refusal to perform urethral scraping in a number of patients was associated with a negative result of this test before contacting our clinic. The material for bacteriological culture was sperm collected in the morning on the day of the study in a sterile jar. This analysis was not performed on all patients. The selection criterion for this study was a long history of treatment for chronic prostatitis, which could be the cause of multiple antibiotic resistance of the pathogen. The criterion for exclusion from the study was multidrug-resistant flora identified during bacteriological examination. The pathogens identified during bacteriological examination in patients of the main and control groups were sensitive to most drugs, including fluoroquinolones. The effectiveness of the drug was assessed 1 month after the start of treatment. The control examination included a microscopic examination of prostate secretions, a bacteriological examination of sperm, and a PCR examination of scrapings from the urethra. After treatment of patients with chronic bacterial prostatitis, complaints were completely absent in 79 (82.3%) patients. In 3 patients there was a decrease in clinical symptoms. In 14 patients, complaints persisted, but only 5 out of 14 had signs of inflammation during a control microscopic examination of prostate secretions. The percentage of patients in whom pathogens were not identified during the control examination was 89.6. The clinical effectiveness of the use of Tavanik in patients with chronic bacterial prostatitis was 85.4%, the microbiological effectiveness was 89.6%. Treatment regimens: Acute bacterial prostatitis: Tavanic 500 mg intravenously once a day for 2–4 weeks, then orally 500 mg once a day for 2 weeks. Chronic bacterial prostatitis: Tavanic orally 500 mg 1 time/day. within 4 weeks. Epididymitis and orchitis Epididymitis is inflammation of the epididymis. Orchitis is inflammation of the testicle. Orchiepididymitis is a combined inflammation of the testicle and its epididymis. When choosing an antibiotic for the treatment of epididymitis and orchiepididymitis in young sexually active men, it is necessary to remember that in 2/3 of cases the disease can be caused by chlamydial infection. In elderly patients with benign prostatic hyperplasia and urinary disorders, uropathogenic microorganisms may be the causative agents. Fluoroquinolones are the drugs of choice due to their wide spectrum of antimicrobial activity and good interstitial penetration [2]. Depending on the severity of the inflammatory process, fluoroquinolones are used orally or parenterally. Orchitis, epididymitis, mild orchiepididymitis: Tavanic orally 500 mg once a day for 2 weeks. Orchitis, epididymitis, orchiepididymitis of moderate and severe course: Tavanic intravenously 500 mg once a day for 1 week, then orally 500 mg once a day for 1 week. Sexually transmitted diseases A special place in the recommendations of the WHO, CDC, and European recommendations for the management of patients with STDs is occupied by fluoroquinolones, which have a bactericidal effect, a wide spectrum of antimicrobial activity, high efficiency, and good tolerability with long-term use. An important factor in the treatment of a number of STDs is the effect of fluoroquinolones on microorganisms that are resistant to drugs of other classes, high activity against microorganisms with intracellular localization, and a long-term post-antibiotic effect [1]. Chlamydial, mycoplasma and ureaplasma urethritis: Tavanic 500 mg 1 time per day for 7–10 days. Thus, due to its unique qualities, Tavanik is the drug of choice for the treatment of a wide range of urological diseases. Literature 1. Kubanova A.A., Kisina V.I., et al. Rational pharmacotherapy of skin diseases and sexually transmitted infections. M.: Litterra, 2005. 2. Lopatkin N.A., Perepanova T.S., et al. Rational pharmacotherapy in urology. M.: Litterra, 2006. 3. Laurent O.B., Pushkar D.Yu., Tevlin K.P. Levofloxacin in the treatment of urinary tract infections // Russian Medical Journal. 2001;9(16–17). 4. Padeiskaya E.N., Yakovlev V.P. Antimicrobial drugs of the fluoroquinolone group in clinical practice. M.: Logata, 1998. 5. Yakovlev V.P., Yakovlev S.V., et al. Rational antimicrobial pharmacotherapy. M.: Litterra, 2003. 6. Kawada Y., Aso Y., et al. Comparative study of DR-3355 and Ofloxacin in complicated urinary tract infections. 31st Intersci Conf Antimicrob Agents Chemother. Chicago, Sept–Oct 1991 In: Programm and Abstracts, 1991: abs. 884. 7. Richard G., DeAbate C., et al. Short-course levofloxacin (250 mg qd) vs ofloxacin (200 mg bid) in uncomplicated UTI: a double-blind, randomized trial. 6th Int. Symp. on new Quinolones. Denver (Nov 1998) In: Abstracts, 1998: abs 126. 8. Richard GA, Klimberg IN, et al. Levofloxacin versus ciprofloxacin versus lomefloxacin in acute pyelonephritis. Urology. 52(1). 51–5. 1998.
