Antimicrobials
Norfloxacin

Norfloxacin

High
Moderate
See below under General Info

Spectrum of Activity

Dosing

General Information

Hospital Formulary Status No

In-Hospital Cost will be updated

PharmaCare Formulary Status Yes (PO solid)

Special Authority None

PharmaCare Coverage 400mg PO - $1.1808/tab

Outpatient Cost 400mg PO - $1.18-1.40/tab

Prophylaxis of spontaneous bacterial peritonitis

Uncomplicated UTI

Monitor QTc in patients with increased risk

Gastritis (PO)

  • mild and transient GI upset
  • sx: anorexia, nausea, vomiting, and abdominal discomfort

Increase in liver enzymes (PO)

  • mild elevations in hepatic transaminases
  • liver failure is rare

Peripheral neuropathy (PO)

  • sx: pain, burning, tingling, numbness, weakness, or a change in sensation to light, touch, pain, temperature, or the sense of body position
  • onset: rapid, often within a few days
  • can occur at any time during treatment and last for months to years after discontinuation or be permanent
  • higher risk for men and patients >60 years old
  • risk can increase by ~3% with each day of exposure and persist for 180 days
  • treatment: discontinue offending agent and provide symptomatic care

QT interval prolongation (PO)

  • caused by inhibition of cardiac KCHN2 potassium voltage-gated channels
  • may lead to torsades de pointes
  • avoid fluoroquinolone use for patients taking other QT-prolonging drugs and patients with long QT syndromes or other significant risk factors for arrhythmia

Tendinopathy (PO)

  • includes tendon rupture and achilles tendinopathy
  • usually occurs early in treatment (~8 days after initiation)
  • higher risk for patients >60 years old, nonobese, using oral glucocorticoids and with kidney, heart, or lung transplants
  • advise patient to avoid exercise, contact their physician for evaluation, transition to non-fluoroquinolone antibiotic when appropriate and discontinue drug if any sign of tendinopathy develops (pain, swelling)

Arthropathy (PO)

  • usually reversible
  • involves cartilage erosions and noninflammatory effusions in weight-bearing joints
  • children: 9-22%

Dysglycemia (PO)

  • associated with hypoglycemia and hyperglycemia in diabetic and nondiabetic patients
  • higher risk for older adults and patients with diabetes mellitus

Phototoxicity (PO)

  • low risk
  • sunscreen containing UVA blockers may offer some protection

Hypersensitivity reactions (PO)

  • more common: delayed-onset maculopapular rash
  • less common: immediate reactions (urticaria, pruritus, angioedema, wheezing and anaphylaxis), acute interstitial nephritis (associated with eosinophiluria but not crystalluria)

Other QTc prolonging agents.

Divalent cations - Decreased absoprtion.

Methadone - Increased seizures.

Thyroid replacement - Decreases T.

Warfarin - Increased INR.

Antimicrobial class: Fluoroquinolone

Pregnancy category: C

Average serum half life: 4.0 hr

Biliary penetration: Therapeutic

CSF penetration: Poor

Urine penetration: Therapeutic