Tavanic, 500 mg, film-coated tablets, 5 pcs., Sanofi-Aventis Deutschland GmbH buy in Moscow at a low price

Features of the composition and action of Tavanik

The medicine is produced in tablets and solutions for droppers. The composition of the tablet form is presented:

levofloxacin;
crospovidone;
MCC;
sodium stearyl furamate;
hypromellose;
macrogol 800;
food additive E 171 and E 172;
talcum powder

100 ml of Tavanika solution contains levofloxacin, sodium chloride and hydroxide, water, concentrated chlorous acid.

The instructions indicate that the antibiotic affects the production of protein in foreign substances, which provokes the death of pathogenic organisms. Tavanik does not apply:

with Staphylococcus aureus;
certain strains of pneumococcus;
gonococcus, enterococcus;
Salmonella, Shigella, Pseudomonas.

After administration, the active components penetrate almost all internal organs within 2 hours. Residues are excreted by the kidneys after 6-8 hours; in case of renal pathologies, indicators may change.

Interaction

Interactions requiring caution

Contraindications and indications for treatment with Tavanik

The instructions recommend prescribing tablets for therapy:

bronchitis and exacerbations of the chronic form of the disease;
urinary tract infections - ordinary and complicated;
pneumonia, sinusitis, septicemia;
bacterial or chronic prostatitis;
complex forms of tuberculosis;
infectious lesions of the dermis, abdominal cavity or soft tissues.

Tavanic in solution is indicated for patients with pneumonia, tuberculosis, bacteremia, and genitourinary infections.

The drug is contraindicated in case of individual intolerance to the component composition, epilepsy. The medicine is not prescribed to pregnant and lactating women, minor patients, or persons undergoing fluoroquinolone therapy.

The value of levofloxacin (Tavanica) in respiratory infections

In the early 80s of the last century, the first drugs of the fluoroquinolone group appeared in clinical practice, which were characterized by a wide spectrum of antimicrobial activity and favorable tissue pharmacokinetics (concentrations in most tissues exceeded serum levels). The unique mechanism of action of fluoroquinolones on microbial cells (inhibition of DNA gyrase or topoisomerase IV) explained the lack of cross-resistance with other classes of antimicrobial agents. The most well-studied early fluoroquinolones are ciprofloxacin (shows the highest in vitro activity against Enterobacteriaceae and Pseudomonas aeruginosa) and ofloxacin (the highest activity against chlamydia). Fluoroquinolones have taken leading positions in the treatment of various bacterial infections, primarily nosocomial ones, the main pathogens of which are gram-negative bacteria. The disadvantage of early fluoroquinolones is their low natural activity against gram-positive microorganisms, mainly Streptococcus pneumoniae, which did not allow these drugs to be recommended for the treatment of community-acquired respiratory infections. At the end of the 90s, drugs of the fluoroquinolone group appeared in the clinic, fundamentally different in antimicrobial properties from earlier drugs. These differences are characterized primarily by significantly higher natural activity against gram-positive bacteria (pneumococci, staphylococci, enterococci) and atypical microorganisms (chlamydia, mycoplasmas). These drugs were called "new fluoroquinolones" or "respiratory fluoroquinolones." The first of the respiratory fluoroquinolones was levofloxacin, later other drugs appeared (moxifloxacin, gatifloxacin, gemifloxacin). Due to the high activity of the new fluoroquinolones against Gram-positive microbes, including S. pneumoniae, resistant to other antibiotics, they were mainly marketed for the treatment of community-acquired respiratory tract infections, and therefore they are sometimes called “respiratory fluoroquinolones.” It must be borne in mind that, along with increased activity against gram-positive bacteria, all new fluoroquinolones retain, and in some cases exceed, the high activity of earlier fluoroquinolones against gram-negative bacteria. In this regard, in recent years there has been increasing evidence for the use of these drugs not only in the treatment of respiratory infections, but also infections of the skin and soft tissues and urogenital infections. Therefore, the term “respiratory fluoroquinolones” currently does not accurately reflect the clinical significance of these drugs, but denotes their most important place in medicine. This paper will discuss the clinical significance of levofloxacin in respiratory infections. Levofloxacin (Tavanic) is the most well-studied drug among the new fluoroquinolones and has the broadest registered indications (Table 1). Community-acquired respiratory infections include pneumonia, acute bronchitis, exacerbation of chronic bronchitis, sinusitis, acute tonsillopharyngitis. If acute bronchitis and tonsillopharyngitis in adults have a predominantly viral etiology and in most cases do not require antibiotic therapy, then pneumonia, exacerbation of chronic bronchitis and sinusitis are diseases of bacterial etiology (Table 2). Levofloxacin is characterized by high natural activity against all pathogens of community-acquired respiratory infections, and its activity against gram-positive microorganisms is 2-4 times higher than the activity of early fluoroquinolones - ciprofloxacin, ofloxacin and pefloxacin (Table 3). In recent years, widespread resistance of pneumococci to penicillins and macrolides has become a serious problem, which limits the effectiveness of these antibiotics against respiratory infections. In some countries of Europe and the USA, the level of resistance of S. pneumoniae to penicillin and macrolides reaches 30–40% [3], while resistance to levofloxacin is at a minimal level (0.1–1%) [4–5], and it has not been increasing over the past years. Thus, over three seasons of respiratory infections (1999–2000, 2000–2001, 2002), the sensitivity to levofloxacin of S. pneumoniae strains isolated from patients with respiratory infections was studied [6]. There was a low level of pneumococcal resistance to levofloxacin (<2%), and levofloxacin-resistant strains were observed in France before the use of new fluoroquinolones, and their number did not increase after the marketing of levofloxacin. Consistently low resistance of pneumococci to levofloxacin was also noted by other researchers [7–8]. According to the international PROTECT program, in which Russia also participated, there was no noticeable increase in the resistance of the main pathogens of respiratory infections to levofloxacin in different countries, including those in which high resistance of pneumococci to penicillin and macrolides prevailed [8]. Resistance of Haemophilus influenzae and Klebsiella pneumoniae to levofloxacin is also minimal. Resistance to levofloxacin was not observed among chlamydia, mycoplasma and legionella. In Russia, there is also a low level of resistance of pneumococci to levofloxacin (within 1%), and it did not change from 2000 to 2002 [9]. It should be emphasized that levofloxacin (Tavanic) is the first antimicrobial drug recommended by the US Food and Drug Administration (FDA) for the treatment of pneumococcal pneumonia caused by penicillin-resistant strains [10]. In addition to high activity against respiratory pathogens, levofloxacin (Tavanic) is characterized by good tissue pharmacokinetics, in particular, high tissue and intracellular concentrations of the drug are maintained at therapeutic levels (above MIC values) for 24 hours, which explains the single dosing regimen [11]. In patients with severe community-acquired pneumonia and sepsis, it was shown [12] that the average concentrations of levofloxacin (500 mg IV every 24 hours) in the epithelial fluid (11.9 mg/l) were almost identical to the serum concentrations (12.6 mg/l) and exceeded the average MIC values for S. pneumoniae, S. aureus, Klebsiella pneumoniae, Legionella (Table 2) by 6, 48, 92 and 375 times, respectively. Data from a study of bronchopulmonary pharmacokinetics of levofloxacin explain the high effectiveness of the drug in respiratory infections. A large number of controlled clinical studies have shown the high effectiveness of levofloxacin in community-acquired respiratory infections (pneumonia, exacerbation of COPD, sinusitis) at a dose of 500 mg once daily. The most important clinical data were obtained from the following studies. In 108 patients with severe pneumococcal community-acquired pneumonia and bacteremia, the clinical effectiveness of levofloxacin in monotherapy was noted in 98 patients (90.7%), including in 91.7% of patients with pneumonia caused by S. pneumoniae resistant to penicillins and/or macrolides [13]. In a prospective cohort study of community-acquired pneumonia requiring hospitalization, 259 patients received levofloxacin 500 mg per day, 209 patients received combination therapy with ceftriaxone 2 g per day and clarithromycin 1 g per day [14]. With levofloxacin monotherapy, a twofold reduction in mortality was observed compared with combination therapy - 6 and 12% (p = 0.024). The comparative effectiveness of levofloxacin and macrolides in documented legionella pneumonia, which is usually severe and associated with a high likelihood of complications, has been studied [15]. 187 patients received levofloxacin at a dose of 500 mg per day (45 of them in combination with rifampicin), 67 received a parenteral macrolide antibiotic (azithromycin or clarithromycin). The clinical effectiveness of the compared treatment regimens was the same, at the same time, complications of pneumonia were less frequently observed during treatment with levofloxacin (3.4 and 27.2%, p = 0.02), the duration of hospitalization was also shorter with levofloxacin (5.5 and 11 ,3 days, p=0.04). The addition of rifampicin to levofloxacin did not affect the clinical efficacy and course of the disease. A randomized multicenter study in patients with severe community-acquired pneumonia examined the comparative effectiveness of levofloxacin (500 mg every 24 hours) in monotherapy and combination therapy with ceftriaxone (1-2 g every 24 hours) and clarithromycin (500 mg every 12 hours). The clinical effectiveness of mono- and combination therapy was the same – 89.5 and 83.1%. However, in the subgroup of patients with the most severe course of pneumonia, requiring mechanical ventilation, the effectiveness of levofloxacin was higher - 84.2 and 63.2%, respectively [16]. The comparative effectiveness of levofloxacin (Tavanic) and clarithromycin in patients with exacerbation of COPD and the effect of antibiotics on long-term prognosis was studied [17]. 29 patients received levofloxacin orally at a dose of 500 mg per day for 5 days, 20 patients received clarithromycin orally at a dose of 1 g per day for 7 days. The clinical effectiveness of treatment of exacerbation of COPD, assessed after 30 days, was 96.6 and 90% against the background of levofloxacin and clarithromycin, while eradication of the main pathogen - H. influenzae was observed significantly more often against the background of levofloxacin - 100 and 30%, respectively. Over the next 12 months of observation of patients, a new exacerbation of COPD was noted in 53.6% of patients receiving levofloxacin and in 88.9% of patients receiving clarithromycin; Moreover, the average duration of the remission period was significantly longer after treatment with levofloxacin (289±90 and 165±112 days, respectively). The results of the study showed that the more pronounced bacteriological effectiveness of levofloxacin (Tavanica) is accompanied by longer remission in patients with COPD. In 2002–2003 In Russia, a large post-marketing study was conducted on the effectiveness and tolerability of levofloxacin (Tavanic) for community-acquired respiratory infections [18]. The study involved 116 medical institutions from 25 cities in different regions of the country. 1972 patients received levofloxacin, of which 660 were with exacerbation of chronic bronchitis, 625 with community-acquired pneumonia, 532 with acute bacterial sinusitis, 155 with exacerbation of chronic sinusitis. 620 patients were prescribed levofloxacin in case of ineffectiveness of other antibiotics. The average duration of use of levofloxacin was 7 days. The clinical effectiveness of levofloxacin averaged 94.2%, including in patients with pneumonia - 92%, exacerbation of chronic bronchitis - 93%, acute sinusitis - 99%, exacerbation of chronic sinusitis - 92%. Side effects were observed in 34 patients (1.7%), of which in 32 they were mild and did not require discontinuation of the drug. The results of the study confirmed the high effectiveness and good tolerability of levofloxacin in community-acquired respiratory infections. A similar foreign post-marketing study of levofloxacin in 1730 patients with community-acquired pneumonia also documented high clinical efficacy of the drug, amounting to 94%, including 93% in patients with documented pneumococcal pneumonia [19]. The above studies, as well as numerous other studies, indicate the high reliability of levofloxacin in community-acquired respiratory infections. Summarizing these data, we can make the following statements about the high clinical significance of levofloxacin (Tavanica) for respiratory tract infections. • Tavanic is not inferior in effectiveness to b-lactam antibiotics for community-acquired respiratory infections - pneumonia, exacerbation of COPD, acute sinusitis. • Tavanic in monotherapy mode is not inferior in effectiveness to combined regimens (b-lactam + macrolide) for pneumonia of any severity. • Tavanic monotherapy is characterized by higher efficacy compared to the ceftriaxone/macrolide combination in severe community-acquired pneumonia requiring mechanical ventilation. • Tavanic has been shown to be more effective than macrolide antibiotics in community-acquired Legionella pneumonia. • Tavanic has been shown to have an advantage over macrolide antibiotics in exacerbation of COPD both in eradication of Haemophilus influenzae and in the duration of the relapse-free period. These advantages explain the fact that currently levofloxacin (Tavanic) occupies a leading position in the structure of antibiotic prescriptions for community-acquired pneumonia and exacerbation of COPD in the United States and European countries. Currently, levofloxacin is included in foreign and domestic Guidelines for the treatment of community-acquired pneumonia: • Infectious Diseases Society of America (IDSA, 2000 and 2003); • American Thoracic Society (ATS, 2001); • British Thoracic Society (BTS, 2001); • Russian Society of Pulmonologists, Alliance of Clinical Chemotherapists and Microbiologists, IACMAH (2003). Based on the available data, it is possible to determine the place of levofloxacin (Tavanica) for community-acquired respiratory infections in outpatient practice. Community-acquired pneumonia • Non-severe course - outpatients • Tavanic orally 500 mg 1 time per day (has an advantage in elderly patients and patients with concomitant pathologies - diabetes mellitus, heart failure, liver and kidney diseases) • Hospitalized patients - moderate to severe course • Tavanic IV or orally 500 mg 1 time per day (if initial therapy is ineffective or the course is complicated) • Hospitalized patients – severe course • Tavanic IV 500 mg 1–2 times a day (if the need for mechanical ventilation is the drug of choice) Exacerbation of chronic bronchitis • Severe course or frequent exacerbations or severe bronchial obstruction • Tavanic orally 500 mg once a day for 5 days or Acute bacterial sinusitis • Tavanic orally 500 mg once a day for 5 days (with intolerance to b-lactams or moderate to severe ) In conclusion, I would like to note that recommendations for the wider use of levofloxacin (Tavanica) for respiratory infections in outpatient practice and hospital settings are supported by data on the good tolerability and safety of the drug. Currently, levofloxacin (Tavanic) has the most favorable tolerability profile among all registered fluoroquinolones and the minimum incidence of side effects (Table 4). Levofloxacin has virtually no phototoxicity, characteristic of some other fluoroquinolones (most pronounced in lomefloxacin and sparfloxacin). Also, levofloxacin does not show cardiotoxicity (prolongation of the QT interval and associated ventricular arrhythmias), characteristic of grepafloxacin and sparfloxacin, hepatotoxicity, or reactions from the central nervous system.

References 1. Andriole VT. Clin Infect Dis 2005; 41:S113–9. 2. Dalhoff A. Exp Opin Invest Drugs 1999;8(2):123–37. 3. Yakovlev S.V., Yakovlev V.P. Levofloxacin is a new antimicrobial drug from the fluoroquinolone group. – M.: Deepak. – 2006. – 240 p. 4. Sahm DF et al. . 42nd Interscience Conference Antimicrobial Agebts Chemother, San Diego, 2002. 5. Soussy CJ, et al. . 7th Intern Symp New Quinolones, Edinburgh, 2001. In: J Antimicrob Chemother 2001;47:Suppl S1. 6. Soussy CJ, et al. . 14th Eur Congt Clin microbial Inf Dis, Prague, 2004. In: Clin Microbiol Inf 2004;10:Suppl 3. 7. Simoens S, et al. Intern J Antimicrob Ag 2005;26(1):62–68. 8. Felmingham D, et al. . 11th Eur Congress Clin Microb Inf Dis, Istambul, 2001. In: Clin Microb Inf 2001;7:Suppl 1. 9. Grudinina SV, Sidorenko SV, et al. . 43rd Intersci Conf Antimicrob Ag Chemother, Chicago, 2003. 10. Information Letter. JAMA 2000;283:1679. 11. Lee LJ, et al. Pharmacotherapy 1998;180:35–41. 12. Boselli E, Breilh D, Rimmele T, et al. Crit Care Med 2005;33(1):104–9. 13. Kahn J, Bahal N, Wiesinger B, et al. Clin Infect Dis 2004;38(Suppl 1):34–42. 14. Querol-Ribelles JM, Tenias JM, Querol-Borras JM, et al. Int J Antimicrob Ag 2005;25(1):75–83. 15. Garrido R, Parra F, Frances L, et al. Clin Infect Dis 2005;40:800–6. 16. Fogarty C, Siami G, Kohler R, et al. Clin Infect Dis 2004;38(Suppl 1):16–23. 17. Dvoretsky L, Dubrovskaya N, Yakovlev S, et al. [abstract]. 16th European Congress on Clinical Microbiology and Chemotherapy. Nice, France, 1–4 April 2006. 18. Yakovlev S.V., Dvoretsky L.I., Yakovlev V.P. Infections and Antimicrobial Therapy 2003;5(5–6):145–9. 19. Akpunonu B, Michaelis J, Uy C, et al. Clin Infect Dis 2004;38(Suppl 1):5–15. 20. Bertino J, Fish D. Clin Ther 2000;22(7):798–817.

Adverse reactions

During therapeutic procedures, a non-standard response to the drug may occur. Tavanik is capable of provoking:

dyspeptic disorders, discomfort in the epigastric and abdominal areas;
drop in blood pressure, sinus tachycardia;
decreased visual acuity, extraneous noise in the ears;
dermatological rash, obsessive itching, redness;
joint pain, anorexia, drop in blood glucose levels;
exacerbation or development of fungal infection;
breathing problems, changes in sleep patterns, unreasonable anxiety;
confused consciousness.

When injecting the solution, redness and an inflammatory process may form at the needle entry point. Rarely, fever associated with phlebitis is observed.

Clinical diagnosis of pneumonia

Usually the onset of the disease is acute, less often gradual, sometimes the development of pneumonia is preceded by an episode of acute respiratory viral infection or tracheobronchitis. Clinical diagnosis of pneumonia is usually [5] based on such signs as fever to febrile and subfebrile levels, cough (usually with sputum production). Some patients experience chills, chest pain, and shortness of breath. With lobar pneumonia, signs of consolidation of the lung tissue are revealed - shortening of the percussion sound, bronchial breathing, increased vocal tremors. The phenomenon of crepitus is characteristic, although local fine-bubble rales are most often detected on auscultation.

Severe pneumonia is characterized by the following clinical signs [3–5]: • bilateral, multilobar localization or abscess formation; • rapid progression of the process (increase in the infiltration zone by 50% or more within 48 hours of observation); • severe respiratory failure; • severe vascular insufficiency requiring the use of pressor amines; • leukopenia less than 4 or hyperleukocytosis more than 20 × 1000/μl with the number of immature neutrophils more than 10%; • oliguria or manifestations of acute renal failure.

In severe cases of pneumonia, life-threatening manifestations such as infectious-toxic shock, distress syndrome, disseminated intravascular coagulation syndrome, and multiple organ failure are often diagnosed. Severe pneumonia is diagnosed in the presence of 2–3 or more of the listed signs.

Elderly and senile individuals may not have the classic manifestations of pneumonia, but may experience fever, hypothermia, confusion, shortness of breath (or a combination of these symptoms).

When examining the patient, you should carefully record dangerous symptoms: shortness of breath, hypotension, oliguria, severe bradycardia/tachycardia, confusion. Of the possible complications, pleurisy is the most common, and abscess formation is less common. However, we should not forget about more rare and severe complications: meningitis, brain abscess, arthritis, pericarditis, endocarditis, peritonitis, pleural empyema.

Pneumonia of mycoplasma nature is characterized by signs of pharyngo-laryngo-tracheobronchitis at the onset of the disease, myalgia, profuse sweating (even with low subfebrility), an obsessive dry “whooping cough” cough of an unusually low timbre (manifestations of tracheobronchial dyskinesia). The same features (except for myalgia and profuse sweating) are common with chlamydial pneumonia.

Dosages and methods of taking Tavanik

The frequency of use, dose and duration of therapeutic procedures depend on the current disease and its complexity, and the general condition of the body.

Tavanik tablets are taken orally, they can be divided and crushed:

sinusitis, bronchitis, prostatitis, damage to the urinary tract - from 0.25 to 0.5 g daily, therapy lasts 3-14 days, for prostatitis - lasts 28 days;
infectious lesion of the dermis, hypodermis - from 0.25 to 0.5 g up to 2 doses per day, for 7-14 days;
damage to the abdominal part or septicemia - 500 mg of the drug up to 14 procedures per day.

Kidney pathologies require a reduction in standard dosages.

The solution in droppers is administered slowly over 60 minutes. The duration of therapy does not exceed 2 weeks; if it is necessary to increase the treatment period, the patient is transferred to tablets.

special instructions

Hospital-acquired infections caused by Pseudomonas aeruginosa may require combination treatment.

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.

Analogs

If adverse reactions to treatment or signs of intolerance to Tavanik occur, it is replaced with a more suitable medication. The list of analogues is presented:

Zolevoy, Leflokad, Levobact;
Glevo, Levobax, Levocin;
Levoxa, Lebel, Levomak;
Levotor, Levoximed, Levostad;
Levoflox, Levocel, Levofloxacin;
Levoflocin, Leflock, Loxof;
Tigeron, Lexid, Floxium.

Changes in the therapeutic regimen can only be made by the attending physician. Independent selection of analogues is prohibited; an incorrectly selected antibiotic can cause serious harm to health.

Pharmacodynamics

Tavanic® is a synthetic broad-spectrum antibacterial drug from the group of fluoroquinolones, containing levofloxacin, a levorotatory isomer of ofloxacin, as an active substance.

Levofloxacin blocks DNA gyrase 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 of microbial cells.

Levofloxacin is active against most strains of microorganisms both in vitro and in vivo.

In vitro:

Sensitive microorganisms (MIC≤2 mg/ml; inhibition zone ≥17 mm)

Aerobic gram-positive microorganisms: Bacillus anthracis, Corynebacterium diphtheriae, Corynebacterium jeikeium, Enterococcus faecalis, Enterococcus spp, Listeria monocytogenes, Staphylococcus coagulase-negative methi-S/I (coagulase-negative methicillin-sensitive/moderately sensitive), Staphylococcus aureus methi-S, Staphylococcus epi dermidis methi -S, Staphylococcus spp (CNS), Streptococci groups C and G, Streptococcus agalactiae, Streptococcus pneumoniae peni-S/I/R (penicillin-sensitive/moderately sensitive/resistant), Streptococcus pyogenes, Viridans streptococci peni-S/R (penicillin-sensitive /-resistant).

Aerobic gram-negative microorganisms: Acinetobacter baumannii, Acinetobacter spp., Actinobacillus actinomycetemcomitans, Citrobacter freundii, Eikenella corrodens, Enterobacter aerogenes, Enterobacter cloacae, Enterobacter spp., Escherichia coli, Gardnerella vaginalis, Haemophilus ducreyi, Haemophilus influenzae ampi-S/R (ampicil lean-sensitive/ resistant), Haemophilus parainfluenzae, Helicobacter pylori, Klebsiella oxytoca, Klebsiella pneumoniae, Klebsiella spp., Moraxella catarrhalis β+/β- (producing and non-producing beta-lactamases), Morganella morganii, Neisseria gonorrhoeae non PPNG/PPNG, Neisseria meningitidis, Pasteurella canis , Pasteurella dagmatis, Pasteuralla multocida, Pasteurella spp, Proteus mirabilis, Proteus vulgaris, Providencia Rettteri, Providencia Stuartii, Providencia spp, Pseuudomonas aerugin OSA (Hospital infections caused by Pseudomonas Aeruginosa may require combined treatment), Pseudomonas spp, Salmonella spp, serratia marceescens, Serratia spp..

Anaerobic microorganisms: Bacteroides fragilis, Bifidobacterium spp., Clostridium perfringens, Fusobacterium spp., Peptostreptococcus, Propionibacterium spp., Veillonella spp.

Other microorganisms: Bartonella spp., Chlamydia pneumoniae, Chlamydia psittaci, Chlamydia trachomatis, Legionella pneumophila, Legionella spp., Mycobacterium spp., Mycobacterium leprae, Mycobacterium tuberculosis, Mycoplasma hominis, Mycoplasma pneumoniae, Ricketsia spp., Ureaplasma urealyticum.

Moderately sensitive microorganisms (MIC = 4 mg/l; inhibition zone - 16–14 mm):

Aerobic gram-positive microorganisms: Corynebacterium urealyticum, Corynebacterium xerosis, Enterococcus faecium, Staphylococcus epidermidis methi-R (methicillin-resistant), Staphylococcus haemolyticus methi-R.

Aerobic gram-negative microorganisms: Campylobacter jejuni/coli.

Anaerobic microorganisms: Prevotella spp., Porphyromonas spp.

Levofloxacin-resistant microorganisms (MIC≥8 mg/l; inhibition zone <13 mm)

Aerobic gram-positive microorganisms: Staphylococcus aureus methi-R, (methicillin-resistant), Staphylococcus coagulase-negative methi-R (coagulase-negative methicillin-resistant).

Aerobic gram-negative microorganisms: Alcaligenes xylosoxidans.

Anaerobic microorganisms: Bacteroides thetaiotaomicron.

Other microorganisms: Mycobacterium avium.

Resistance

Resistance to levofloxacin develops as a result of a stepwise process of mutations in the genes encoding both type II topoisomerases: DNA gyrase and topoisomerase IV. Other resistance mechanisms, such as the mechanism of influencing the penetration barriers of the microbial cell (a mechanism characteristic of Pseudomonas aeruginosa) and the mechanism of efflux (active removal of the antimicrobial agent from the microbial cell), may also reduce the sensitivity of microorganisms to levofloxacin.

Due to the peculiarities of the mechanism of action of levofloxacin, cross-resistance between levofloxacin and other antimicrobial agents is not usually observed.

Clinical efficacy (effectiveness in clinical studies in the treatment of infections caused by the following microorganisms):

Aerobic gram-positive microorganisms: Enterococcus faecalis, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes.

Aerobic gram-negative microorganisms: Citrobacter freundii, Enterobacter cloacae, Escherichia coli, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella (Branhamella) catarrhalis, Morganella morganii, Proteus mirabilis, Pseudomonas aeruginosa, Serratia marcescens.

Others: Chlamydia pneumoniae; Legionella pneumophila, Mycoplasma pneumoniae.

Reviews

According to doctors, the drug has all the characteristics declared by the manufacturer. If the recommendations from the instructions are followed exactly, the antibiotic is easily tolerated and does not provoke the development of side effects. During therapy, patients should increase the amount of fermented milk products consumed, drink a lot and comply with the requirements for maintaining a sleep-wake schedule.

There are different reviews about Tavanika on the forums; some patients refused treatment procedures due to the risk of developing non-standard responses of the body. People who have undergone a therapeutic course emphasize its effectiveness against many infectious diseases. Following the doctor's recommendations on dosages and duration of treatment allows the body to easily tolerate the antibiotic. Some patients experienced slight dizziness and headaches while taking Tavanic.

Overdose

Symptoms: Based on data obtained from toxicological studies conducted in animals, the most important expected symptoms of an acute overdose of Tavanic® are central nervous system symptoms (impaired consciousness, including confusion, dizziness and convulsions).

During post-marketing use of the drug in overdose, CNS effects have been observed, including confusion, convulsions, hallucinations and tremor.

Nausea and erosions of the gastrointestinal mucosa may develop.

In clinical and pharmacological studies conducted with doses of levofloxacin exceeding therapeutic levels, prolongation of the QT interval was shown.

Treatment: in case of overdose, careful monitoring of the patient is required, including ECG monitoring. Treatment is symptomatic. In case of acute overdose of Tavanic® tablets, gastric lavage and administration of antacids are indicated to protect the gastric mucosa. Levofloxacin is not eliminated by dialysis (hemodialysis, peritoneal dialysis and continuous ambulatory peritoneal dialysis). There is no specific antidote.

Evidence-based criteria for diagnosis

Evidence is provided by X-ray examination [5], in which the detected pathology may be characteristic of certain pathogens. Infiltrative changes can be lobar and multilobar, which is typical for bacterial pneumonia (including pneumococcal, legionella, caused by anaerobes, fungi) and mycobacteriosis, including pulmonary tuberculosis. Diffuse bilateral infiltration is typical for pathogens such as influenza virus, pneumococcus, staphylococcus, legionella. Focal and multifocal infiltration can be homogeneous (pneumococcus, legionella) or inhomogeneous (staphylococcus, viruses, mycoplasma). The combination of infiltrative and interstitial changes is typical for pneumonia of a viral, mycoplasma and pneumocystis nature. Interstitial changes can be miliary (mycobacterium tuberculosis, salmonella, fungi) or reticular (viruses, pneumocystis, mycoplasma, chlamydia). The combination of infiltrative or interstitial changes against the background of lymphadenopathy is quite typical for pulmonary tuberculosis and pneumonia caused by fungi, mycoplasma, chlamydia, measles and varicella viruses. Finally, with pneumonia, radiographic changes may be absent. This happens at the very beginning of the disease, with dehydration, severe neutropenia, as well as with pneumocystis etiology of the disease.

X-ray of the lungs reveals complications such as abscess formation, exudative pleurisy. Computed tomography of the lungs is justified only for differential diagnosis, if a regular X-ray is not very informative, as well as for a more accurate assessment of possible complications. Computed tomography makes it possible to detect early infiltrative and interstitial changes in cases where standard radiography is not yet demonstrative. Cavities, lymphadenopathy, pleural effusion and multifocal changes are clearly identified.

When studying the leukocyte formula, leukocytosis of more than 10 × 1000/μl, a shift of the leukocyte formula to the left (more than 10% of band neutrophils), and toxic granularity of neutrophils are typical. With the so-called In atypical pneumonias (mycoplasma and chlamydial), the leukocyte formula is often unchanged; moderate leukocytosis without neutrophilia is usually observed.

To identify the causative agent, bacteriological examination of sputum is traditionally carried out. Quantitative assessment of microflora is considered necessary, since concentrations of more than 1 million microbial bodies in 1 ml of sputum are diagnostically significant. The most convincing data are from sputum cultures obtained before the start of treatment, as long as the results of bacteriological examination are not distorted by previous ABT.

Determining the sensitivity of microflora isolated from sputum (blood, pleural fluid) to antibiotics can be a good help for the clinician, especially in cases where the initial therapy was ineffective. For the etiological deciphering of chlamydial, mycoplasma, and legionella pneumonia, serotyping is usually used. Specific antibodies to these pathogens are determined using the indirect immunofluorescence reaction (IRIF) or more modern methods - the ELISA test (IgM and IgG antibodies to mycoplasma and chlamydia) and determination of antigen in urine (legionella).

It should be noted that the current classification of pneumonia has led doctors to simplified diagnoses such as “community-acquired pneumonia”, “domestic pneumonia”, etc. It should be borne in mind that such diagnoses do not correspond to the International Classification of Diseases, 10th revision, according to which statistical records are kept. The requirement of Roszdravnadzor for statistical encryption of pneumonia based on etiological principles is legitimate.