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Combined Duo - instructions for use, analogs, reviews and release forms (eye and ear drops) of a hormonal drug with an antibiotic for the treatment of conjunctivitis, blepharitis, otitis in adults, children and pregnancy. Composition

Combined Duo - instructions for use, analogs, reviews and release forms (eye and ear drops) of a hormonal drug with an antibiotic for the treatment of conjunctivitis, blepharitis, otitis in adults, children and pregnancy. Composition

In this article, you can read the instructions for using the drug Combined Duo. Comments of visitors of the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Combinil in their practice are presented. A big request is to actively add their feedback on the hormonal drug to the antibiotic: it helped or did not help the medicine to get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Combinil Duo in the presence of existing structural analogues.Use for the treatment of conjunctivitis, blepharitis, otitis, keratitis in adults, children, as well as during pregnancy and lactation. Composition of the preparation.

 

Combined Duo - a preparation with antibacterial and anti-inflammatory action for topical application in ophthalmology and ENT-practice. The therapeutic effect of the drug Combin Duo is due to the antibacterial action of Ciprofloxacin and the anti-inflammatory effect of dexamethasone.

 

Ciprofloxacin is an antibacterial drug from the group of fluoroquinolones, it has a wide spectrum of action, has a bactericidal effect. The drug inhibits the DNA enzyme enzyme of bacteria, as a result of which DNA replication and the synthesis of bacterial cell proteins are disrupted. Ciprofloxacin acts both on multiplying microorganisms, and on those in rest. It is active against gram-negative microorganisms: Esherichia coli (E. coli), Salmonella spp. (salmonella), Shigella spp. (Shigella), Proteus spp. (proteus) (indole-positive and indole-negative), Morganella morganii, Citrobacter spp., Klebsiella spp. (Klebsiella), Enterobacter spp., Vibrio spp., Campylobacter spp., Hafnia spp., Providencia stuartii, Haemophilus influenzae, Pasteurella multocida, Pseudomonas spp., Gardnerella spp., Legionella pneumophila (Legionella), Neisseria spp., Moraxella catarrhalis, Acinetobacter spp., Brucella spp., Chlamydia spp. (chlamydia); Gram-positive microorganisms: Staphylococcus spp.(Staphylococcus aureus), Streptococcus pyogenes (Streptococcus), Streptococcus agalactiae, Sorynebacterium diphtheriae, Listeria monocytogenes (Listeria).

 

Dexamethasone is a synthetic glucocorticosteroid (GCS), a hormone. With topical application, the therapeutic activity of Dexamethasone is due to anti-inflammatory, antiallergic and antiproliferative action. It reduces the permeability and capillary proliferation, local exudation, cellular infiltration, phagocytic activity, collagen deposition and fibroblast activity, inhibits the formation of scar tissue. Thus, dexamethasone reduces the main symptoms of inflammation.

 

Composition

 

Ciprofloxacin (in the form of hydrochloride) + Dexamethasone + auxiliary substances.

 

Pharmacokinetics

 

When used in ophthalmology, ciprofloxacin penetrates well into various tissues of the eye, with the exception of the lens. The highest concentration is observed in the moisture of the anterior chamber. Systemic reabsorption is observed. However, the drug concentration achieved in the blood is well below the detection limit and is not clinically relevant. Dexamethasone after digestion into the conjunctival sac penetrates well into the epitheliumcornea and conjunctiva; while in the aqueous humor of the eye, therapeutic concentrations are achieved; with inflammation or damage to the mucous membrane, the penetration rate increases.

 

The hydroxypropyl betacyclodextrin, which is part of the preparation as an auxiliary component, contributes to the long-term retention of the active substance on the front surface of the eye, thereby increasing the efficacy and duration of the drug.

 

Indications

 

Infectious and inflammatory diseases of the eye and its appendages:

  • acute and subacute conjunctivitis;
  • keratitis;
  • anterior uveitis;
  • blepharitis and other inflammatory diseases of the eyelids;
  • prevention and treatment of infectious complications after wounds of the eye and its appendages and in operations on the eyeball.

 

Infectious-inflammatory diseases of the ear:

  • acute otitis externa;
  • acute otitis media with a shunt of the tympanic membrane;
  • acute otitis media with granulations and otorei with a shunt of the tympanic membrane.

 

Forms of release

 

Eye and ear drops.

 

Instructions for use and how to use them

 

With infectious and inflammatory diseases, the eye and its appendages are instilled with 1-2 drops into the conjunctival sac every 4-6 hours.The first 24-48 hours of instillation can be made every 2 hours.

 

The course of treatment for acute bacterial conjunctivitis, blepharitis - from 5 to 14 days, with keratitis - 2-4 weeks, for the prevention of inflammatory diseases after surgery with perforation of the eyeball - from 5 days to 1 month.

 

If the drug is used for more than 10 days, the patient's intraocular pressure should be monitored.

 

With infectious-inflammatory diseases of the ear, 4 drops are instilled into the external ear canal of the affected ear 2 times a day for 7 days. Do not change the position of the head for 60 seconds to completely penetrate the canal into the auditory canal.

 

Side effect

  • horny infiltrates;
  • burning, redness, itchy eyes;
  • conjunctivitis;
  • keratitis;
  • periocular edema;
  • the feeling of a foreign body in the eye;
  • photophobia;
  • blurring of vision;
  • dry eyes;
  • swelling of the eyelids;
  • hyperemia of the conjunctiva;
  • glaucoma and optic nerve damage;
  • decreased visual acuity;
  • narrowing of the fields of vision;
  • formation of cataract;
  • secondary infection (fungal and bacterial);
  • thinning of the cornea;
  • perforation of the eyeball;
  • discomfort and pain in the ear;
  • itching in the ear;
  • obstruction of the ear;
  • swelling of the face;
  • slowing healing of wounds;
  • flavor perversions;
  • skin rash.

 

Contraindications

  • herpetic keratitis and other viral lesions of the cornea and conjunctiva;
  • tuberculosis of the eye;
  • fungal lesions of the eyes;
  • viral infections of the ear canal;
  • perforation of the tympanic membrane;
  • children's age till 18 years;
  • pregnancy;
  • lactation period (breastfeeding);
  • hypersensitivity to active substances or to any of the auxiliary ingredients of the drug.

 

Application in pregnancy and lactation

 

Contraindicated the use of the drug Combin Duo during pregnancy and lactation.

 

Use in children

 

Contraindicated in children and adolescents under the age of 18 years.

 

special instructions

 

Prolonged use of eye drops can lead to an increase in intraocular pressure with subsequent damage to the optic nerve, a decrease in acuity and visual fields, as well as the formation of posterior subcapsular cataract. When using the Combinil Duo for more than 10 days, it is necessary to monitor the intraocular pressure.

 

In acute purulent infections of the eyes, corticosteroids may worsen or mask the symptoms of the disease.

 

Prolonged use of the drug may reduce the immune response and lead to the development of secondary infection of the eye.

 

Patients using contact lenses should be removed before instilling the drug and re-dressing only after 20 minutes, since the preservative contained in the preparation may have an adverse effect on the eye tissue.

 

The bottle must be closed after each use. Do not touch the tip of the pipette to the eye.

 

Before applying ear drops, the external auditory canal should be sanitized (rinse and drain the external ear canal).

 

Before instillation of the drug Combin Duo into the external ear canal, it should be warmed to body temperature, held in hands for 1-2 minutes.

 

It is necessary to lie sideways or tilt your head to facilitate burial. To drip into the external ear canal specified number of drops. Allow the drops to drain into the external ear canal, pulling the earlobe down and back. Hold the head in the inverted position for about 2 minutes. You can put in the outer ear canal wool turunda.

 

Impact on the ability to drive vehicles and manage mechanisms

 

After the application of eye drops, it is possible to reduce the clarity of visual perception, so immediately after instillation it is not recommended to drive and engage in activities requiring increased attention and speed of psychomotor reactions.

 

Drug Interactions

 

Systemic absorption with topical use of the Duo Combine is insignificant, so the likelihood of drug interactions is extremely small.

 

Drugs that induce the activity of the isoenzyme CYP 3A4 (barbiturates, phenytoin, carbamazepine, rifampicin), can enhance the metabolism of GCS.

 

Drugs that inhibit the activity of CYP 3A4 (ketoconazole, macrolides), can potentially cause an increase in plasma corticosteroid levels.

 

Dexamethasone is a moderate inducer of CYP3A4. Joint reception with drugs metabolized with CYP3A4 (erythromycin) can increase their clearance, reducing their concentration in the plasma.

 

When ciprofloxacin is combined with other antimicrobial drugs (beta-lactam antibiotics, aminoglycosides, clindamycin, metronidazole), synergy is usually observed; can be successfully used in combination with azlocillin and ceftazidime in infections,caused by Pseudomonas spp .; with mezlocillin and other beta-lactam antibiotics - with streptococcal infections; with isoxazolylpenicillins and Vancomycin - with staphylococcal infections; with Metronidazole and Clindamycin - with anaerobic infections.

 

Analogues of the drug Combinil

 

Structural analogs for the active substance:

  • The Combined Duo.

 

Analogues on the curative effect (funds for the treatment of blepharitis):

  • Diamond green;
  • Wilprafen;
  • Wilprafen solute;
  • Garazon;
  • Hydrocortisone;
  • Gramicidin C;
  • Dexamethasone;
  • Dexon;
  • Demalan cream cosmetic;
  • Innolier;
  • Colbiocin;
  • Cortineff;
  • Levomycetin;
  • Lecrolin;
  • Maxidex;
  • Maxitrol;
  • Okatsin;
  • Ofloxacin;
  • Polynadym;
  • Prenatsid;
  • Sofradex;
  • Sulfacil sodium;
  • Tetracycline ophthalmic ointment 1%;
  • Tebridex;
  • Tebrone;
  • Tobrex;
  • Tobrup;
  • Uniflox;
  • Floxal;
  • Furacilin;
  • Fucitalmic;
  • Tsiprolet;
  • Cipromed;
  • Ciprofloxacin;
  • Tsifran;
  • Chibroxin;
  • Erythromycin;
  • Hermitsed.

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