Tavanic 250 mg pills 10 pcs

Levofloxacin

Pills

1 tablet contains: Active substance: levofloxacin hemihydrate 256.23 mg, which corresponds to the content of levofloxacin 250 mg. Auxiliary substances: hypromellose - 5.4 mg, crospovidone - 7 mg, microcrystalline cellulose - 33.87 mg, sodium stearyl fumarate - 5 mg. 5.433 mg, macrogol 8000 - 0.288 mg, titanium dioxide (E171) - 1.358 mg, talc - 0.407 mg, iron red oxide (E172) - 0.007 mg, iron yellow oxide (E172) - 0.007 mg.

Synthetic antimicrobial drug from the group of fluoroquinolones, levorotatory isomer ofloxacin. has a broad spectrum of antimicrobial action. Levofloxacin blocks dna-gyrase (topoisomerase ii) and topoisomerase iv, disrupts superspiration and cross-linking of dna gaps, inhibits dna synthesis, causes profound morphological changes in the cytoplasm, cell wall and membranes of microbial cells. microorganisms both in vitro and in vivo. in vitro sensitive (μP ≤2 mg / ml; inhibition zone ≤17 mm) aerobic gram-positive microorganisms: bacillus anthratis, corynebacterium diphtheriae, corynebact erium jeikeium, enterococcus spp. (including enterococcus faecalis), listeria monocytogenes, staphylococcus spp. (coagulase-negative, methicillin-sensitive / methicillin-moderately sensitive strains), staphylococcus aureus (methicillin-sensitive strains), staphylococcus epidermidis (methicillin-sensitive strains), staphylococcus spp. (coagulase-negative), streptococcus spp. groups c and g (including streptococcus agalactiae, streptococcus pneumoniae (penicillin-sensitive / moderately sensitive / resistant strains), streptococcus pyogenes, streptococcus viridans (penicillin-sensitive / resistant strains); isp, actinobacillus actinimycetemcomitans, citrobacter freundii, eikenella corrodens, ispobacter sv., isobacter sv. helicobacter pylori, klebsiella spp. (including klebsiella oxytoca, klebsiella pneumoniae), moraxella catarrhalis (strains producing and producing no β-lactamase), morganella morganii, neisseria gonnorrhoeae (strains producing and producing no penicillinase), neisseria meningitidis, pasteurella spp. (including pasteurella canis, pasteurella dagmatis, pasteurella multocida), proteus mirabilis, proteus vulgaris, providencia spp. (including providencia rettgeri, providencia stuartii), pseudomonas spp. (nosocomial infections caused by pseudomonas aeruginosa may require combined treatment), salmonella spp., serratia spp. (serratia marcescens); anaerobic microorganisms: bacteroides fragilis, bifidobacterium spp., clostridium perfringens, fusobacterium spp., peptostreptococcus spp., propionibacterum spp., veilonella spp .; other microorganisms: bartonella spp., chlamydia pneumoniae, chlamydia psittaci, chlamydia trachomatis, legionella pneumophila, legionella spp., mycobacterium spp. . (Including mycobacterium leprae, mycobacterium tuberculosis), mycoplasma hominis, mycoplasma pneumoniae, rickettsia spp, ureaplasma urealyticum.levofloksatsin moderately active (MIC = 4 mg / L; 16-14 mm zone of inhibition) against aerobic gram-positive organisms: corynebacterium urealiticum, corynebacterium xerosis, enterococcus faecium, staphylococcus epidermidis (methicillin-resistant strains),staphylococcus haemolyticus (methicillin-resistant strains); aerobic gram-negative microorganisms: campilobacter jejuni, campilobacter coli; anaerobic microorganisms: prevotella spp., porphyromonas spp. for levofolksacin resistant (≥ 8 mg / l; zone of inhibition ≤ 13 mm), aerobic gram-positive microorganisms: staphylococcus aureus (methicillin-resistant strains), staphylococcus spp. (coagulase-negative methicillin-resistant strains); aerobic gram-negative microorganisms: alcaligenes xylosoxidans; anaerobic microorganisms: bacteroides thetaiotaomicron; other microorganisms: mycobacterium avium. clinical efficacy in clinical studies the drug was effective in treating infections caused by the microorganisms listed below , haemophilus influenzae, haemophilus parainfluenzae, klebsiella pneumoniae, moraxela (branhamella) catarrhalis, morganella morganii, proteus mirabilis, pseudomonas aeruginosa, serratia marcescens. other: chaphaus, weparashan, weparashanas, wepango, pediatrics, juvenile levofloxacin develops as a result of a phased process of gene mutations encoding both type ii topoisomerases: dna-gyrase and topoisomerase iv. other mechanisms of resistance, such as the mechanism of influence on the penetration barriers of a microbial cell (a mechanism characteristic of pseudomonas aeruginosa) and the mechanism of efflux (active removal of an antimicrobial agent from a microbial cell), can also reduce the sensitivity of microorganisms to levofloxacin. no cross-resistance between levofloxacin and other antimicrobial agents is observed.

AbsorptionAfter ingestion, levofloxacin is rapidly and almost completely absorbed from the gastrointestinal tract. Food intake has little effect on its absorption. Absolute bioavailability when administered is 99-100%. After a single dose of levofloxacin in a dose of 500 mg Cmax in plasma is reached within 1-2 hours and is 5.2 ± 1.2 mcg / ml. The pharmacokinetics of levofloxacin is linear in the dose range from 50 to 1000 mg.Css of levofloxacin in plasma while taking 500mg of levofloxacin 1 or 2 times / day is achieved within 48 hours. ml, and Cmin of levofloxacin (concentration before taking the next dose) in PL kite was 0.5 ± 0.2 micrograms / ml.Na 10th day ingestion Tavanik drug in a dose of 500 mg of 2 times / day levofloxacin Cmax in plasma was 7.8 ± 1.1 pg / ml,and Cmin of levofloxacin (concentration before taking the next dose) in plasma was 3.0 + 0.9 mcg / ml. DistributionPlasma protein binding is 30-40%. After a single dose and repeated administration of levofloxacin in a dose of 500 mg of Vd, levofloxacin averages 100 l, which indicates good penetration of levofloxacin into the organs and tissues of the human body. After a single oral administration of levofloxacin at a dose of 500 mg Cmax of levofloxacin in the bronchial mucosa and epithelial lining fluid was achieved within 1-4 hours and amounted to 8.3 mcg / g and 10.8 mcg / ml, respectively, with the coefficients of penetration into the mucous membrane of the bronchi and the fluid of the epithelial lining compared with plasma concentrations of 1.1-1.8 and 0.8-3.0, respectively. After 5 days of taking levofloxacin orally in a dose of 500 mg, the average concentrations of levofloxacin through 4 hours after the last administration of the drug in the epithelial lining fluid was 9.94 mcg / ml and in alveolar macrophages — 97.9 mcg / ml.Cmax in the lung tissue after ingestion of levofloxacin orally at a dose of 500 mg was approximately 11.3 mcg / g and was reached after 4-6 hours after taking the drug with penetration coefficients of 2-5 compared to plasma concentration. After 3 days of taking levofloxacin at a dose of 500 mg 1 time or 2 times / day, Cmax of levofloxacin in the alveolar fluid was reached 2-4 hours after taking the drug and was 4.0 and 6.7 mcg / ml, respectively, with the penetration coefficient compared to the plasma concentrations of the components 1. Levofloxacin penetrates well into the cortical and spongy bone tissue, both in proximal and distal femur with penetration coefficient (Bone tissue / plasma) 0.1-3. Cmax of levofloxacin in the cancellous spongy bone of the proximal femur after ingestion of the drug at a dose of 500 mg was approximately 15.1 mcg / g (2 hours after taking the drug). Levofloxacin does not penetrate into the spinal fluid. After ingestion of levofloxacin at a dose of 500 mg 1 time / day for 3 days, the average concentration of levofloxacin in the tissue of the prostate gland was 8.7 mcg / g, the average concentration ratio of the prostate gland / plasma was 1.84. The average concentration in the urine after 8-12 hours after ingestion Three doses of 150, 300 and 600 mg of levofloxacin were 44 mcg / ml, 91 mcg / ml and 162 mcg / ml, respectively. Metabolism is slightly metabolized in Levofloxacin (5% of the dose taken). Its metabolites are demethyl levofloxacin and levofloxacin N-oxide, which are excreted by the kidneys.Levofloxacin is stereochemically stable and does not undergo chiral transformations. Withdrawal After ingestion, levofloxacin is relatively slowly excreted from the plasma (T1 / 2 - 6-8 h). Excreted mainly in the urine (more than 85% of the dose). The total clearance of levofloxacin after a single dose of 500 mg was 175 ± 29.2 ml / min. There are no significant differences in the pharmacokinetics of levofloxacin when it is in / in the introduction and ingestion, which confirms that the ingestion and in / in the introduction are interchangeable. Pharmacokinetics in Special groups of patients. The pharmacokinetics of levofloxacin in men and women do not differ. The pharmacokinetics in elderly patients does not differ from that in young patients, with the exception of differences in pharmacokinetics associated with differences in CC. In renal failure, the pharmacokinetics of levofloxacin is altered. As renal function decreases, renal clearance and renal clearance decrease, and T1 / 2 increases. Pharmacokinetics in renal failure after a single dose of Tavanic 500 mgKK (ml / min) <20 20-49 50-80 Kidney clearance (ml / min) 13 26 57Т1 / 2 (h) 35 27 9

Bacterial infections caused by microorganisms sensitive to levofloxacin in adults: - acute sinusitis; - exacerbation of chronic bronchitis; - community-acquired pneumonia; - uncomplicated infections of the urinary tract; - complicated infections of the urinary tract (including pyelonephritis) - chronic bacterial prostatitis; and soft tissues; - for complex treatment of drug-resistant forms of tuberculosis; - prevention and treatment of anthrax in the airborne route of infection. When using the drug Ta Vanik should take into account the official national recommendations on the proper use of antibacterial drugs, as well as the sensitivity of microorganisms in a particular country.

- epilepsy; - pseudo-paralytic myasthenia (myastenia gravis); - tendon lesions associated with a history of fluoroquinolones; - children and adolescents under 18 years of age (due to incomplete growth of the skeleton, since the risk of damage to cartilage growth points cannot be completely eliminated ); - pregnancy (the risk of damage to the cartilage growth points of the fetus cannot be completely excluded); - breastfeeding period (the risk of damage to the cartilage growth points of the bones in the child cannot be completely ruled out); - hypersensitivity to levofloxacin or to other quinolo s, as well as any of the excipients of the drug.

The drug should be stored out of the reach of children at a temperature not higher than 25 ° C.

The drug is contraindicated for use in pregnancy and in lactating women.

Dosage and administration

The drug is taken orally 250 or 500 mg 1 or 2 times / day. Tablets should be taken without chewing and drinking a sufficient amount of liquid (0.5 to 1 cup). If necessary, pills can be broken down along the separation groove. The preparation can be taken before meals or at any time between meals, since food intake does not affect the absorption of the drug. The drug should be taken at least 2 hours before or 2 hours after taking antacids containing magnesium and / or aluminum, zinc, iron salts or sucralfate. Considering that the bioavailability of levofloxacin when using the drug Tavanic pills equal to 99-100%, in the case of transferring a patient from iv administration of the drug to pills, the treatment should be continued in the same dose that was used for IV infusion. The dosage regimen is determined by the nature and severity of the infection, as well as nature of the suspected pathogen. The duration of treatment varies depending on the course of the disease. Patients with normal renal function (CK> 50 ml / min) are recommended the following dosing regimen and duration of treatment. Acute sinusitis: 2 tab. 250 mg or 1 tab. 500 mg 1 time / day (respectively, 500 mg of levofloxacin) - 10-14 days. Exacerbation of chronic bronchitis: 2 tab. 250 mg or 1 tab. 500 mg 1 time / day (respectively, 500 mg of levofloxacin) - 7-10 days. Community-acquired pneumonia: 2 tab. 250 mg or 1 tab. 500 mg 1-2 times / day (respectively, 500-1000 mg of levofloxacin) - 7-14 days. Uncomplicated urinary tract infections: 1 tab. 250 mg 1 time / day (respectively, 250 mg of levofloxacin) - 3 days. Complicated urinary tract infections: 2 tab. 250 mg 1 time / day (250 mg of levofloxacin, respectively) or 1 tab. 500 mg 1 time / day (respectively, 500 mg of levofloxacin) - 7-14 days. Pyelonephritis: 2 tab. 250 mg 1 time / day or 1 tab. 500 mg 1 time / day (respectively, 500 mg of levofloxacin) - 7-10 days. Chronic bacterial prostatitis: 2 tab. 250 mg or 1 tab. 500 mg 1 time / day (respectively, 500 mg of levofloxacin) - 28 days. Infections of the skin and soft tissues: 2 tab. 250 mg or 1 tab. 500 mg 1-2 times / day (respectively, 500-1000 mg of levofloxacin) - 7-14 days. As part of complex therapy for drug-resistant forms of tuberculosis: 1 tab.500 mg 1-2 times / day (respectively, 500-1000 mg of levofloxacin) - up to 3 months. Prevention and treatment of anthrax with an airborne route of infection: 2 tab. 250 mg or 1 tab. 500 mg (respectively, 500 mg of levofloxacin) 1 time / day - up to 8 weeks. Patients with impaired renal function (CK ≤ 50 ml / min) require correction of the dosing regimen depending on the CC value, since Levofloxacin is preferentially excreted by the kidneys. QC Recommended dose> 50 ml / min 250 mg / 24 h 500 mg / 24 h 500 mg / 12 h 50-20 ml / min first dose 250 mg then 125 mg / 24 h first dose 500 mg then 250 mg / 24 h the first dose of 500 mg / mg 250 mg / 12 h19-10 ml / min the first dose of 250 mg / 125 mg / 48 h the first dose 500 mg / 125 mg / 24 h the first dose 500 mg / 125 mg / 12 h <10 ml / min (including hemodialysis and CAPD *) first dose of 250 mgs, then 125 mg / 48 h first dose of 500 mgs, then 125 mg / 24 hours, first dose of 500 mgs, then 125 mg / 24 hours * After hemodialysis or permanent outpatient peritoneal dialysis, It does not require correction of the dosing regimen, since levofloxacin is only slightly metabolized in the liver. Elderly patients do not need to adjust the dosing regimen, except for cases of a decrease in QA to 50 ml / min and lower. It is necessary to take a pill as soon as possible and continue to take Tavanic according to the recommended dosing regimen.

From the side of the cardiovascular system: rarely - sinus tachycardia, palpitations, decrease in blood pressure; unknown frequency (post-marketing data) - prolongation of the QT interval, ventricular arrhythmias, ventricular tachycardia, ventricular tachycardia of the pirouette type, which can lead to cardiac arrest. rarely - neutropenia, thrombocytopenia; frequency unknown (post-marketing data) - pancytopenia, agranulocytosis, hemolytic anemia. On the nervous system: often - headache, dizziness; infrequently - drowsiness, tremor, dysgeusia (taste perversion); rarely - paresthesia, convulsions; unknown frequency (post-marketing data) - peripheral sensory neuropathy, peripheral sensory-motor neuropathy, dyskinesia, extrapyramidal disorders, loss of taste, parosmia (sense of smell disorder, especially the subjective sense of smell, which is objectively absent), including loss of smell, fainting,benign intracranial hypertension. Mental disorders: often - insomnia; infrequently - anxiety, confusion; rarely, mental disorders (hallucinations, paranoia), depression, agitation (agitation), sleep disorders, nightmares; frequency is unknown (post-marketing data) - mental disorders with behavioral disorders with self-harm, including suicidal thoughts and suicidal attempts. On the part of the organ of vision: very rarely - visual disturbances such as blurring of the visible image; frequency unknown (post-marketing data) - transient loss of vision, uveitis. On the part of the organ of hearing and labyrinth disturbances: infrequently - vertigo (feeling of deviation or whirling or own body or surrounding objects); rarely tinnitus; frequency unknown (post-marketing data) - hearing loss, hearing loss. On the part of the respiratory system: infrequently - shortness of breath; unknown frequency (postmarketing data) - bronchospasm, allergic pneumonitis. From the digestive system: often - diarrhea, vomiting, nausea; infrequently - abdominal pain, dyspepsia, flatulence, constipation; unknown frequency (post-marketing data) - hemorrhagic diarrhea, which in very rare cases can be a sign of enterocolitis, including pseudomembranous colitis, pancreatitis, stomatitis. From the side of the liver and biliary tract: often - increased activity of ALT, AST, AlcF, GGT; infrequently - an increase in the concentration of bilirubin in the blood; unknown frequency (post-marketing data) - severe liver failure, including cases of acute liver failure (sometimes fatal), especially in patients with severe underlying disease (for example, sepsis); hepatitis, jaundice. From the urinary tract: infrequently - an increase in serum creatinine concentration; rarely, acute renal failure (for example, due to the development of interstitial nephritis). On the side of the skin and subcutaneous tissues: rarely - rash, itching, urticaria, hyperhidrosis; unknown frequency (postmarketing data) - toxic epidermal necrolysis, Stevens-Johnson syndrome, exudative erythema multiforme, photosensitivity reactions (increased sensitivity to solar and UV radiation), leukocytoclastic vasculitis.Reactions from the skin and mucous membranes can sometimes develop even after the first dose of the drug is injected. On the immune system: infrequently - urticaria; rarely, angioedema; frequency unknown (post-marketing data) - anaphylactic shock, anaphylactoid shock. Anaphylactic and anaphylactoid reactions can sometimes develop even after taking the first dose of the drug. On the part of the musculoskeletal system: infrequently - arthralgia, myalgia; rarely - affection of tendons, including tendonitis (for example, Achilles tendon), muscle weakness, which can be especially dangerous in patients with pseudoparalytic myasthenia (myasthenia gravis); unknown frequency (postmarketing data) - rhabdomyolysis, tendon rupture (for example, Achilles tendon; this side effect can be observed within 48 hours after the start of treatment and can be bilateral), ligament rupture, muscle rupture, arthritis. Metabolism: infrequent - anorexia; rarely, hypoglycemia, especially in patients with diabetes mellitus (possible symptoms of hypoglycemia: wolf appetite, nervousness, perspiration, tremors); frequency is unknown - hyperglycemia, hypoglycemic coma. Infectious and parasitic diseases: infrequently - fungal infections, development of resistance of pathogenic microorganisms. General reactions: infrequently - asthenia; rarely - pyrexia (fever); frequency is unknown - pain (including pain in the back, chest, limbs). Other possible adverse effects that apply to all fluoroquinolones. Very rarely - attacks of porphyria in patients already suffering from this disease.

Symptoms: Based on the data obtained in animal studies, the most important expected symptoms of an acute overdose of the drug Tavanic are symptoms of the central nervous system (impaired consciousness, including confusion, dizziness and convulsions). With post-marketing use of the drug in overdose, effects from the CNS were observed, including confusion, convulsions, hallucinations and tremors. Nausea and erosion of the gastrointestinal mucosa are possible. In clinical and pharmacological studies conducted with doses of levofloxacin exceeding therapeutic, prolongation of the QT interval was shown. Treatment: conducting symptomatic therapy, careful monitoring of the patient, including ECG monitoring. In the case of an acute overdose of pills of the drug Tavanic, gastric lavage and the introduction of antacids to protect the gastric mucosa are indicated.Levofloxacin is not cleared by dialysis (hemodialysis, peritoneal dialysis, and permanent peritoneal dialysis). There is no specific antidote.

Combinations that require caution must be followed. Preparations containing divalent or trivalent cations, such as zinc and iron salts, antacid agents containing magnesium and / or aluminum, didanosine (only dosage forms containing aluminum or magnesium as a buffer) are recommended to take at least 2 hours before or 2 hours after taking the pills Tavanic. Calcium salts have a minimal effect on the absorption of levofloxacin when it is ingested. The effect of the drug Tavanic is significantly weakened while taking Sukralfat. Patients receiving levofloxacin and sucralfate are advised to take sucralfate 2 hours after taking levofloxacin. No pharmacokinetic interaction of levofloxacin with theophylline was detected. The concentration of levofloxacin with simultaneous use of fenbufen increases only by 13%. However, while quinolone and theophylline, NSAIDs and other drugs that reduce the threshold of brain convulsive readiness are given, a marked decrease in the threshold of convulsive readiness of the brain is possible. An increase in prothrombin time was observed in patients who received levofloxacin in combination with indirect anticoagulants (for example, warfarin). INR and / or bleeding, incl. and heavy. Therefore, with the simultaneous use of indirect anticoagulants and levofloxacin, regular monitoring of blood coagulation parameters is necessary. With simultaneous use of levofloxacin and drugs that disturb renal tubular secretion of levofloxacin, such as probenecid and cimetidine, caution should be exercised especially in patients with renal insufficiency. Withdrawal (renal clearance) of levofloxacin is slowed by the action of cimetidine by 24% and probenecid by 34%. It is unlikely that this may have clinical significance in normal renal function. Levofloxacin increased T1 / 2 of cyclosporine by 33%. Since this increase is clinically insignificant,dose adjustment of cyclosporine with its simultaneous use with levofloxacin is not required. Simultaneous use of GCS increases the risk of tendon rupture. Levofloxacin, like other fluoroquinolones, should be used with caution in patients receiving drugs, extending the QT interval (for example, anti-arrhythmic drugs class IA and III tricyclic antidepressants, macrolides, neuroleptics). Other combinations Clinical and pharmacological studies conducted to study the possible pharmacokinetic interaction of levoflo xacin with digoxin, glibenclamide, ranitidine and warfarin showed that the pharmacokinetics of levofloxacin, when used simultaneously with these drugs, does not change sufficiently to have clinical significance.

Hospital infections caused by Pseudomonas aeruginosa (Pseudomonas aeruginosa) may require combined treatment. The prevalence of acquired resistance of strains of microorganisms sown may vary depending on the geographic region and over time. In this regard, information on drug resistance in a particular country is required. For the treatment of severe infections or treatment failure, a microbiological diagnosis should be made with the release of the pathogen and its sensitivity to levofloxacin. There is a high probability that methicillin-resistant strains of Staphylococcus aureus will be resistant to fluoroquinolones, including levofloxacin. Therefore, levofloxacin is not recommended for the treatment of established or suspected infections caused by methicillin-resistant strains of Staphylococcus aureus, if laboratory studies have not confirmed the sensitivity of this microorganism to levofloxacin. As with other quinolones, levofloxacin should be used with great caution in patients with a predisposition : in patients with previous CNS lesions, such as stroke, severe traumatic brain injury; in patients simultaneously receiving drugs that reduce the threshold of convulsive readiness of the brain, such as fenbufen and other similar NSAIDs, as well as other drugs that lower the threshold of convulsive readiness, such as theophylline. Diarrhea developed during or after treatment with levofloxacin, especially severe, persistent and / or blood may be a symptom of pseudomembranous colitis caused by Clostridium difficile.If pseudomembranous colitis is suspected, treatment with levofloxacin should be stopped immediately and specific antibiotic therapy should start immediately (vancomycin, teicoplanin or metronidazole orally). Drugs that inhibit intestinal peristalsis are contraindicated. Rarely observed tendonitis when using quinolones, including levofloxacin, can lead to tendon rupture, including the Achilles tendon. This side effect may develop within 48 hours after the start of treatment and may be bilateral. Elderly patients are more prone to tendinitis. The risk of tendon rupture may increase with simultaneous use of GCS. If you suspect tendonitis, you should immediately discontinue treatment with Tavanic and begin appropriate treatment of the affected tendon, for example, by ensuring sufficient immobilization. Levofloxacin can cause serious, potentially fatal hypersensitivity reactions (angioedema, anaphylactic shock), even when using the drug in initial doses. Patients should immediately stop taking the drug and consult a doctor. When using levofloxacin, there have been cases of severe bullous skin reactions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis. In the event of any reactions from the skin or mucous membranes, the patient should immediately consult a doctor and not continue treatment before consulting a specialist. He reported cases of necrosis of the liver, including the development of fatal liver failure, when using levofloxacin, mainly in patients with severe major diseases (such as sepsis). The patient should be warned about the need to stop treatment and urgent treatment to the doctor in case of signs and symptoms of liver damage, such as anorexia, jaundice, dark urine, pruritus, abdominal pain. Levofloxacin is excreted mainly by the kidneys, patients with impaired renal function require mandatory monitoring of renal function, as well as correction of the dosage regimen. In the treatment of elderly patients, it should be borne in mind that patients in this group often suffer from impaired renal function. Although photosensitization is very rare when using levofloxacin,to prevent its development, patients are not recommended during treatment and within 48 hours after the end of treatment with levofloxacin to be exposed without particular need to strong solar or artificial ultraviolet radiation (for example, to go to a tanning bed). As with other antibiotics, use of levofloxacin, especially for long periods time, can lead to increased reproduction of microorganisms (bacteria and fungi) that are insensitive to it, which can cause changes in the microflora, which normally tstvuet a person, as a result may develop superinfection. Therefore, in the course of treatment, it is imperative that the patient’s condition be re-evaluated, and if superinfection develops during treatment, appropriate measures should be taken. Very rare cases of prolongation of the QT interval have been reported in patients receiving fluoroquinolones, including levofloxacin. When using fluoroquinolones, including levofloxacin, care should be taken in patients with known risk factors for lengthening the QT interval: in patients with uncorrected electrolyte disturbances (with hypokalemia, hypomagnesemia); with syndrome of congenital lengthening of the QT interval, with heart disease (heart failure, myocardial infarction, bradycardia), while taking medicines that can prolong the QT interval, such as class IA and III antiarrhythmic drugs, tricyclic antidepressants, macrolides, neuroleptics. Elderly and female patients may be more sensitive to drugs that prolong the QT interval. Therefore, fluoroquinolones, including levofloxacin, should be used with caution in patients. Patients with latent or manifested glucose-6-phosphate dehydrogenase deficiency are prone to hemolytic reactions when treated with quinolones, which should be taken into account when treating with levofloxacin. As with other quinolones, cases of hyperglycemia and hypoglycemia have been observed in the use of levofloxacin, usually in patients with diabetes mellitus who are simultaneously treated with oral hypo likemicheskimi agents (e.g. glibenclamide) or insulin. Cases of hypoglycemic coma have been reported.Patients with diabetes require careful monitoring of blood glucose concentrations. Patients receiving fluoroquinolones, including levofloxacin, have had sensory and sensory-motor peripheral neuropathy, the onset of which can be rapid. If the patient has symptoms of neuropathy, the use of levofloxacin should be discontinued. This minimizes the possible risk of irreversible changes. Fluoroquinolones, including levofloxacin, are characterized by blocking neuromuscular activity and