Norbactin for cystitis in women and men: how to take?

The active substance of the drug, norfloxacin, belongs to the group of fluorinated quinolones, which have a wide spectrum of antibacterial activity. Its bactericidal activity is manifested in E. coli, which is responsible for the vast majority of bladder inflammations, as well as staphylococci, gonococci, enterobacteria, proteus, and certain strains of ureaplasma. Norbactin for cystitis is one of the preferred drugs, capable of coping with both acute and chronic forms of infection.

Indications Norbactin for cystitis

This drug is prescribed as part of a complex therapy for inflammation of the upper and lower urinary tract. It is active against almost all pathogens of non-specific cystitis, which, due to its anatomy, is the prerogative of the fairer sex. Therefore, doctors often prescribe Norbactin for cystitis in women.

Its spectrum of activity also extends to strains of gonococci; for gonorrheal cystitis, the drug is prescribed to patients of both sexes.

Norbactin is effective in chronic cystitis caused by microorganisms sensitive to it.

Prescription of the drug for prophylactic purposes may be associated with urological operations, manipulations and invasive diagnostics.

Release form

The drug is intended for oral administration and is an elongated tablet, each of which is engraved with the marking "NBT 400", including the letters of the name and dosage - each tablet contains 400 mg of norfloxacin.

In addition, the tablets contain auxiliary ingredients that provide them with the necessary physical and chemical properties:

• strength and homogeneity – microcrystalline cellulose;
• increasing the bioavailability of the active ingredient crosscarmellose sodium;
• emulsifier - sodium lauryl sulfate;
• fillers – corn starch, talc;
• sorbent – colloidal silicon dioxide anhydrous;
• consistency stabilizer – magnesium stearate;
• film formers – hydroxypropyl methylcellulose, macrogol, titanium dioxide.

Pharmacodynamics

The bactericidal action of the active ingredient norfloxacin, like all drugs of this class, is realized by suppressing the enzymatic activity of DNA gyrase and topoisomerase of bacteria, without which the process of DNA replication is impossible, which leads to the death of pathogenic microorganisms sensitive to this action.

Pharmacokinetics

After oral administration, the active ingredient is well and quickly absorbed from the digestive tract into the systemic bloodstream. The maximum serum concentration is determined in the first two hours from the moment of administration. Food in the gastrointestinal tract slows down the absorption of norfloxacin.

About 14% of the dose taken binds to plasma proteins, high concentrations of the active substance are found in the tissues of the genitourinary organs, urine and bile. It is eliminated from the body in approximately equal proportions through the urinary organs and intestines, with about 30% leaving the body unchanged in the urine, sanitizing the urinary tract along the way.

Dosing and administration

Adult patients with uncomplicated acute nonspecific cystitis are prescribed Norbactin for three days, one tablet (400 mg) every 12 hours. It is better to take the medicine in the morning and evening before meals, with a sufficient amount of water. Treatment with Norfloxacin at a dose of 400 mg twice a day for 3 days and Fosfomycin at a single dose of 3.0 g has high clinical and microbiological efficacy in uncomplicated cystitis. [ 2 ]

In cases of chronic cystitis, the drug is prescribed in the same daily dose, but the treatment period can be extended to 12 weeks. In each case, the dose, frequency of administration, and duration of treatment are prescribed individually, depending on the severity of the patient's condition, the identified pathogen, and the response to treatment. If a satisfactory therapeutic effect is achieved during the first month of treatment, the daily dose of the drug can be reduced to a maintenance dose of one tablet. Patients with impaired renal function are prescribed no more than 400 mg per day.

Daily therapy with norfloxacin 200 mg at bedtime is effective in preventing recurrent cystitis. During 1 year of norfloxacin therapy, colonization was rare and superinfection with norfloxacin-resistant organisms was not observed.[ 3 ]

Norbactin is not used in pediatric practice.

Use Norbactin for cystitis during pregnancy

Norfloxacin belongs to the category of drugs that are not recommended for use during pregnancy, since there is a certain risk of adverse effects on the fetus. However, in cases where the clinical benefit outweighs the risk, it can be prescribed to a pregnant woman. It is recommended to refrain from taking the drug during lactation.

Norfloxacin has been shown to be embryotoxic and teratogenic in studies. It significantly reduced the number of viable fetuses, caused growth retardation in viable fetuses, and some visceral and skeletal defects were observed, and these effects were dose-dependent.[ 1 ]

Contraindications

Childhood, pregnancy and lactation, known hypersensitivity to drugs of the quinolone class and any of the auxiliary ingredients, including those manifested as inflammation and subsequent degeneration of tendons up to rupture.

Side effects Norbactin for cystitis

The immune system may react to taking Norbactin in different ways, from banal urticaria to the development of Quincke's edema, Lyell's and Stevens-Johnson syndromes, etc. The drug causes a hypersensitivity reaction to insolation. This should be taken into account by all patients undergoing treatment and avoiding sunlight as much as possible.

From the musculoskeletal system – inflammatory processes in the tendons and joints, muscle and joint pain up to the destruction of myocytes and rupture of tendons.

From the cardiovascular system, hypotension up to loss of consciousness, increased heart rate and heart rhythm disturbances up to the development in rare cases of ventricular fibrillation and flutter or ventricular tachycardia (prolonged QT syndrome on the cardiogram), vasculitis may be observed.

From the hematopoietic system – a decrease in the level of leukocytes, neutrophils, platelets, hemoglobin, the volume of erythrocytes, an increase in the level of eosinophils.

From the central and peripheral nervous system, dizziness, migraines, fainting, drowsiness, mood disorders, confusion up to psychosis, convulsions, hallucinations are most common; in addition, tremors in the limbs, muscle twitching and tics, polyneuropathy, myasthenia, taste disorders.

From the digestive system, there may be abdominal pain of various localizations, including moderate gastralgia, dyspeptic symptoms and loss of appetite, a feeling of bitterness in the mouth, inflammation of the small intestine and pancreas (usually with long-term use).

The urinary organs may react to the intake of norbactin by forming crystalline compounds, kidney inflammation, retention or excessive excretion of urine, hematuria, increased creatinine levels, and in rare cases, acute renal failure may develop.

Skin manifestations may be limited to swelling, itching and rash; in rare cases, stronger and more severe reactions are possible – intra- and subcutaneous hematomas, exanthema, multiple papules and bullae merging into a crust with vascular involvement and hemorrhagic manifestations.

On the part of the liver, inflammation, jaundice, and changes in transaminase activity may develop.

From the organs of vision: increased lacrimation, blurred vision and other disorders.

Hearing organs – noise and ringing in the ears, deafness.

Genitals - candidal colpitis.

Shortness of breath and respiratory dysfunction may develop.

Considering the side effects from the cardiovascular and central nervous system during treatment with norbactin, one should refrain from work associated with the risk of decreased concentration.

Overdose

An acute reaction to an overdose of the drug may manifest as hyperthermia, fever, shortness of breath, prolongation of the QT interval, dyspepsia, affective disorders, psychosis, acute renal failure and other manifestations of adverse reactions, in particular, hematopoiesis disorders.

The antidote is calcium, therefore the patient needs to quickly drink a calcium-containing solution, milk or kefir (yogurt), induce vomiting and wash out the stomach.

Then contact a medical facility for an examination of the safety of vital functions.

Interactions with other drugs

The active ingredient of norbactin blocks the enzymatic activity of CYP1A2, and therefore may affect the effectiveness of drugs that are broken down by this enzyme.

It is not prescribed simultaneously with nitrofurantoin, since in laboratory conditions these drugs reveal incompatibility.

If combined administration with probenecid is necessary, it should be taken into account that the elimination of norfloxacin in the urine will decrease, but the serum concentration will remain at the proper level.

Concomitant administration with theophylline increases the toxicity of norfloxacin (increases serum concentration), therefore, if their combined use is necessary, the level of drugs in the blood plasma should be monitored so as not to miss the opportunity to adjust the dose.

Norbactin promotes the retention of caffeine in the body, which should be taken into account during treatment and one should refrain from drinking coffee and taking caffeine-containing analgesics at the same time.

If concomitant administration with cyclosporine is necessary, its serum level should be monitored in order to adjust the dosage in a timely manner.

When taking norbactin simultaneously with anticoagulants - warfarin derivatives, it is necessary to monitor blood coagulation parameters in order to avoid bleeding resulting from the synergistic action of the drugs.

Oral contraception may be ineffective when combined with antibacterial drugs, so you should take other precautions.

Fenbufen in combination with norbactin increases the risk of developing epileptiform seizures.

If the patient is already taking clozapine or ropinirole and needs to treat cystitis with norbactin, the dose of psychotropic drugs is adjusted.

Incompatible with the centrally acting muscle relaxant tizanidine.

If it is impossible to avoid a combination with glibenclamide, it is necessary to strictly monitor the patient's blood sugar level.

Combination with didanosine should be avoided or an interval of at least two hours should be maintained between doses, since the drugs mutually interfere with absorption from the digestive tract.

Combination with nonsteroidal analgesics increases the risk of seizures and affective disorders. This should be taken into account if this combination cannot be avoided.

Calcium is an antagonist of norfloxacin, so calcium supplements, milk, cottage cheese, and other calcium-containing products are consumed at intervals of two hours after taking norbactin. If the drug has already been taken, the time interval before taking calcium is four hours.

As with calcium, quinolones form insoluble compounds with iron, aluminum, bismuth, magnesium, and zinc in the gastrointestinal tract. Therefore, drugs containing these substances are taken in accordance with the above conditions.

If it is necessary to combine norbactin with antiarrhythmic drugs, macrolide antibiotics, antipsychotics and tricyclic antidepressants, the high risk of synergy in relation to prolongation of the QT interval should be taken into account.

Storage conditions

Store purchased tablets at room temperature, which should not exceed 25℃. The instructions do not say anything about the light regime, but it is not recommended to keep the package in the sun. The place should be inaccessible to children and animals.

If the original packaging is not damaged, the maximum shelf life of the tablets is three years from the date of manufacture, which is indicated on the box.

Analogues

Cystitis of bacterial origin is treated with antibacterial therapy. Usually, broad-spectrum drugs are used. They are prescribed even before the sensitivity test is ready, since the patient's condition is quite painful.

In urology, quinolones, nitrofurans, and the new antibiotic fosfomycin, better known under the trade name monural, are most often used. They are all more or less active against the most common pathogens of cystitis. However, some patients are helped by furadonin or furazolidone, while others are helped by monural or norbactin.

What's the matter? What's better for cystitis? Much depends on the pathogen and whether the disease was detected for the first time or whether it is an exacerbation of long-healed cystitis.

If you have been diagnosed with acute cystitis for the first time, the doctor will often prescribe a drug with the broadest spectrum of action, and in the vast majority of cases it will help to remove acute symptoms. And then a lot depends on the patient. Those who, having gotten rid of the discomfort, decided to stop treatment, have every chance of joining the ranks of chronic urological patients.

In case of recurrent chronic cystitis, the treatment tactics are different, a bacteriological examination of urine is mandatory, the pathogen is identified, its sensitivity to antibacterial drugs is determined. And only then is treatment prescribed.

Therefore, the best medicine for you should be selected by your doctor after conducting laboratory tests.

Fluoroquinolones, including those belonging to earlier generations, are most often the drugs of choice for the treatment of cystitis. They are recommended by the Association of Urologists, since they are active against non-specific and some specific pathogens of cystitis. In addition, they are not as toxic as newer drugs from this group.

Which is better: Norbactin or Nolitsin? These are synonymous drugs with the same active ingredient – Norfloxacin. Even the dosage is absolutely the same. Different manufacturers: Norbactin – India, Nolitsin – Slovenia. There are minor differences in the excipients, which can play a role in the choice if the patient has an established allergy. The therapeutic effect from taking these two drugs should be the same.

Single doses of rufloxacin are as effective as standard 3-day treatment with norfloxacin in uncomplicated cystitis.[ 4 ]

A 3-day regimen with lomefloxacin is more effective than a 10-day regimen with norfloxacin for the treatment of recurrent uncomplicated lower urinary tract infection in women.[ 5 ]

Reviews of the drug are excellent. Women share their impressions, and their cystitis is clearly chronic and recurrent. They note, first of all, the rapid action. Most of the symptoms go away after taking the first pill. Everyone, basically, took it for five days, although for newly diagnosed acute cystitis, three days are enough, according to the instructions. Of the side effects, the most common were complaints of drowsiness, they recommended taking sick leave, because they slept almost all day and night. In addition, women taking norbactin caused candidiasis (a common complication after taking antibiotics) and insomnia. No one had a ruptured tendon.

Many write that it is Norbactin that relieves the symptoms of burning, other drugs simply do not help them. Ladies with recurrent cystitis share that the next exacerbation after Norbactin visits them in five years. In comparison with the more expensive Monural, Norbactin wins in price, but loses in side effects.

Overall, there were no reviews that Norbactin did not help. The most common side effects associated with taking the pills were sleep disorders.