Brand and Other Names:Noroxin, Norfloxacin Systemic
- Classes: Fluoroquinolones
Dosing & Uses
Dosage Forms & Strengths
Caused by susceptible strains E.coli
400 mg PO q12hr for 28-42 days
Uncomplicated, caused by E. coli, K. pneumoniae or P. mirabilis: 400 mg PO q12hr for 3 days
Uncomplicated, caused by other susceptible organisms: 400 mg PO q12hr for 7-10 days
Complicated: 400 mg PO q12hr for 10-21 days
800 mg PO single dose
Uncomplicated urethral and cervical gonorrhea caused by Neisseria gonorrhoeae
400 mg PO q12hr for 3 days
CrCl <30 mL/min: Give qDay
Other Indications & Uses
Treatment of infection caused by suscep strains of designated organisms based on culture and suscep if possible
Campylobacter jejuni, Citrobacter spp., Enterobacter spp., Enterococcus faecalis, E. coli, Klebsiella pneumoniae, Legionella pneumophila, Proteus mirabilis, Providencia spp, Pseudomonas aeruginosa, Salmonella spp, Serratia spp., Shigella spp, MSSA, Staphylococcus saprophyticus
<18 years: Safety and efficacy not established
Serious - Use Alternative
Significant - Monitor Closely
Stomach cramps (3%)
Exacerbation of myasthenia gravis
Hypersensitivity reactions: Anaphylactoid reactions, angioedema, dyspnea, vasculitis, urticaria, arthritis, arthralgia, and myalgia
Skin: Toxic epidermal necrolysis, Stevens-Johnson syndrome and erythema multiforme, exfoliative dermatitis, photosensitivity/phototoxicity reactions, leukocytoclastic vasculitis, drug rash with eosinophilia and systemic symptoms (DRESS syndrome)
Gastrointestinal: Pseudomembranous colitis, hepatitis, jaundice (including cholestatic jaundice and elevated liver function tests), pancreatitis (rare), stomatitis
Hepatic: Hepatic failure, including fatal cases
Cardiovascular: On rare occasions, prolonged QTc interval and ventricular arrhythmia including torsades de pointes
Renal: Interstitial nephritis, renal failure
Nervous system/psychiatric: Peripheral neuropathy, Guillain-Barré syndrome, ataxia, paresthesia, hypoesthesia, psychic disturbances (including psychotic reactions and confusion)
Musculoskeletal: Tendinitis, tendon rupture; exacerbation of myasthenia gravis, elevated creatine kinase (CK), muscle spasms
Hematologic: Neutropenia, leukopenia, agranulocytosis, hemolytic anemia (sometimes associated with glucose-6-phosphate dehydrogenase deficiency), thrombocytopenia
Special senses: Hearing loss, tinnitus, diplopia, dysgeusia
Black Box Warnings
Fluoroquinolones are associated with an increased risk of tendinitis and tendon rupture; this risk is further increased in older patients, usually those older than 60 years; in kidney, heart, and lung transplant recipients; and with use of concomitant steroid therapy
May exacerbate muscle weakness in patients with myasthenia gravis; avoid fluoroquinolones with known history of myasthenia gravis
All drugs or conditions that prolong QT interval
In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy
Convulsions, increased intracranial pressure (including pseudotumor cerebri), and toxic psychosis reported with fluoroquinolones
Peripheral neuropathy: Sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias, and weakness reported; peripheral neuropathy may occur rapidly after initiating and may potentially become permanent
Not drug of first choice in pediatrics due to increased incidence of adverse events compared to controls, including arthropathy; no data exist for dose for pediatric patients with renal impairment (ie, CrCl <50 mL/min)
Acute onset of retinal detachment increased 4.5-fold with oral fluoroquinolones in a single case-controlled study - JAMA 2012;307(13):1414-1419; another study disputes these findings (relative risk, 1.29) - JAMA 2013;310(20):2184-2190
Pregnancy & Lactation
Pregnancy Category: C; crosses placenta
Lactation: Small amounts excreted in breast milk, discontinue drug or do not nurse
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Inhibits bacterial DNA gyrase, which in turn inhibits DNA replication and transcription, DNA repair, recombination and transposicion, causing bacterial cell death
Absorption: rapid, up to 40%
Peak Plasma Time: 1-2 hr
Protein Bound: 15%
Enzymes inhibited: CYP1A2
Half-Life: 3-4.5 hr
Excretion: Feces 39%; urine 26-36%
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