norfloxacin (redirected from Janacin)

norfloxacin /nor·flox·a·cin/ (nor-flok´sah-sin) a broad-spectrum antibacterial effective against a wide range of aerobic gram-negative and gram-positive organisms.

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nor·flox·a·cin (nôr-flks-sn)

n.

An oral antibiotic of the fluoroquinolone class.

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norfloxacin

[nôrflok′səsin]

an oral antibacterial drug.

indications It is prescribed for the treatment of bacterial urinary tract infections, sexually transmitted gonorrhea, and proctitis.

contraindications Hypersensitivity to quinolones or pregnancy or lactation prohibits its use. It should be used with caution in patients younger than 18 years because of arthropathy. Concomitant use of nitrofurantoin drugs is not recommended, and concomitant use of corticosteroids can increase the risk of arthropathy in the elderly.

adverse effects Typical side effects include nausea, dizziness, and headache. Severe hypersensitivity reactions, tendon rupture, and numerous other effects have been reported with relatively low incidence.

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norfloxacin (nôrflok´ssēn),

n brand name: Noroxin;
drug class: fluoroquinolone antiinfective;
action: a broad-spectrum bactericidal agent that inhibits the enzyme DNA gyrase needed for replication of DNA;
uses: adult urinary tract infections.

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norfloxacin

a fluoroquinolone antibiotic, used particularly in urinary tract infection.

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antibiotic 

1. Pertaining to the ability to destroy or inhibit other living organisms.

2. A substance derived from a mould or bacterium, or produced synthetically, that destroys (bactericidal) or inhibits the growth (bacteriostatic) of other microorganisms and is thus used to treat infections. Some substances have a narrow spectrum of activity whereas others act against a wide range of both gram-positive and gram-negative organisms (broad-spectrum antibiotics). Antibiotics can be classified into several groups according to their mode of action on or within bacteria: (1) Drugs inhibiting bacterial cell wall synthesis, such as bacitracin, vancomycin and the β-lactams based agents (e.g. penicillin, cephalosporins (e.g. ceftazidime, ceftriaxone, cefuroxime). (2) Drugs affecting the bacterial cytoplasmic membrane, such as polymyxin B sulfate and gramicidin. (3) Drugs inhibiting bacterial protein synthesis, such as aminoglycosides (e.g. amikacin sulfate, framycetin sulfate, gentamicin, neomycin sulfate and tobramycin), tetracyclines, macrolides (e.g. erythromycin and azithromycin) and chloramphenicol. (4) Drugs inhibiting the intermediate metabolism of bacteria, such as sulfonamides (e.g. sulfacetamide sodium) and trimethoprim. (5) Drugs inhibiting bacterial DNA synthesis, such as nalixidic acid and fluoroquinolones (e.g. ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin and ofloxacin). (6) Other antibiotics such as fusidic acid, the diamidines, such as propamidine isethionate and dibrompropamidine. Syn. antibacterial. See antiinflammatory drug; fusidic acid.

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norfloxacin

Chibroxin, Noroxin, Utinor (UK)

Pharmacologic class: Fluoroquinolone

Therapeutic class: Anti-infective

Pregnancy risk category C

Action

Inhibits bacterial DNA synthesis by blocking DNA gyrase in susceptible gram-negative and gram-positive aerobic and anaerobic bacteria

Availability

Ophthalmic solution: 0.3% in 5-ml bottle

Tablets: 400 mg

⊘Indications and dosages

➣ Urinary tract infections (UTIs) caused by Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis

Adults: 400 mg P.O. q 12 hours for 3 days

➣ UTIs caused by all organisms except E. coli, K. pneumoniae, and P. mirabilis

Adults: 400 mg P.O. q 12 hours for 7 to 10 days. For complicated UTIs, may give for up to 21 days.

➣ Gonorrhea

Adults: 800 mg P.O. as a single dose

➣ Prostatitis caused by E. coli

Adults: 400 mg P.O. q 12 hours for 28 days

➣ Conjunctivitis caused by susceptible organisms

Adults and children ages 1 and older: One or two drops of ophthalmic solution instilled into affected eye(s) q.i.d. for up to 7 days. Depending on infection severity, first-day dosage may be one or two drops q 2 hours while awake.

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to drug
• History of tendinitis or tendon rupture with fluoroquinolone use

Precautions

Use cautiously in:
• CNS diseases or disorders, renal impairment, cirrhosis, bradycardia, acute myocardial ischemia
• elderly patients
• pregnant or breastfeeding patients (safety not established except in postexposure inhalation or cutaneous anthrax).
• children younger than age 18 (except with ophthalmic solution).

Administration

• Give with glass of water 1 hour before or 2 hours after a meal.
• Don't give antacids within 2 hours of norfloxacin.

Route	Onset	Peak	Duration
P.O.	Rapid	2-3 hr	12 hr
Ophthalmic	Unknown	Unknown	Unknown

Adverse reactions

CNS: dizziness, light-headedness, drowsiness, headache, asthenia, insomnia, agitation, confusion, acute psychoses, hallucinations, tremors, increased intracranial pressure, seizures

CV: vasodilation, QT prolongation, arrhythmias

EENT: eye burning and discomfort, conjunctival hyperemia, corneal deposits, photophobia (all with ophthalmic use)

GI: nausea, diarrhea, abdominal pain, pancreatitis, pseudomembranous colitis

GU: interstitial cystitis, vaginitis

Hematologic: leukopenia

Hepatic: hepatitis

Metabolic: hyperglycemia, hypoglycemia

Musculoskeletal: tendinitis, tendon rupture

Skin: rash, hyperhidrosis, photosensitivity, phototoxicity, Stevens-Johnson syndrome

Other: altered taste, hypersensitivity reactions including anaphylaxis

Interactions

Drug-drug. Antacids, bismuth, iron salts, subsalicylate, sucralfate, zinc salts: decreased norfloxacin absorption

Antineoplastics: decreased norfloxacin blood level

Cimetidine: interference with norfloxacin elimination

Corticosteroids: increased risk of tendon rupture

Nitrofurantoin: antagonism of norfloxacin's antibacterial effects in GU tract

Other fluoroquinolones: increased risk of nephrotoxicity

Probenecid: decreased renal elimination of norfloxacin

Theophylline: increased theophylline blood level, greater risk of toxicity

Warfarin: increased anticoagulant effect

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, eosinophils, lactate dehydrogenase, platelets: increased levels

Hemoglobin, hematocrit: decreased values

Drug-food. Caffeine: decreased hepatic metabolism of caffeine

Milk or yogurt (consumed alone): impaired drug absorption

Tube feedings: impaired drug absorption

Drug-herbs. Dong quai, St. John's wort: phototoxicity

Fennel: decreased drug absorption

Drug-behaviors. Sun exposure: phototoxicity

Patient monitoring

• Monitor vital signs and cardiovascular status.
• Check fluid intake and output. Keep patient well-hydrated.
• Assess patient's response to therapy. Obtain specimens for repeat culture and sensitivity tests if he relapses or doesn't improve.
• Monitor renal function.

Patient teaching

• Tell patient to take on empty stomach with full glass of water, 1 hour before or 2 hours after a meal.
• If patient needs antacid for GI upset, instruct him not to take it within 2 hours of norfloxacin.
☞ Advise patient to promptly report rash, severe GI problems, or weakness.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Teach patient ways to counteract photosensitivity, such as by wearing sunglasses and avoiding excessive exposure to bright light.
• Teach patient how to use eye drops. Caution him not to touch dropper tip to any surface (including eye).
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.

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norfloxacin

Antibiotics A broad-spectrum–gram-negative bacilli, staphylococci–fluoroquinolone with limited activity against streptococci and anaerobes. See Fluoroquinolone.