Norfloxacin: Uses
Norfloxacin is used in adults for the treatment of complicated and uncomplicated urinary tract infections and prostatitis caused by susceptible organisms and for the treatment of uncomplicated gonorrhea.
Norfloxacin also has been used in adults for the treatment of various GI infections caused by susceptible organisms. Because only low serum concentrations of norfloxacin are attained after oral administration of usual dosages, use of the drug is generally limited to genitourinary or GI tract infections. Prior to initiation of norfloxacin therapy, appropriate specimens should be obtained for identification of the causative organism and in vitro susceptibility tests.
Norfloxacin may be initiated, however, before obtaining the results of these tests. If clinical response to norfloxacin therapy is unsatisfactory, additional specimens should be obtained and susceptibility tests repeated.
Urinary Tract Infections and Prostatitis
Uncomplicated Urinary Tract Infections
Oral norfloxacin is used in adults for the treatment of uncomplicated urinary tract infections (UTIs) caused by susceptible Citrobacter freundii, Enterobacter aerogenes, E. cloacae, Escherichia coli, Klebsiella pneumoniae, Morganella morganii, Proteus mirabilis, P. vulgaris, Providencia rettgeri, Pseudomonas aeruginosa, or Serratia marcescens. The drug is also used orally in adults for the treatment of uncomplicated UTIs caused by susceptible Staphylococcus aureus, S. epidermidis, S. saprophyticus, or Enterococcus faecalis (formerly Streptococcus faecalis).
Some clinicians suggest that norfloxacin be reserved for the treatment of complicated UTIs, especially those caused by multidrug-resistant bacteria, and that the drug generally not be used in the treatment of uncomplicated UTIs (e.g., acute cystitis) unless more commonly employed urinary anti-infectives are contraindicated or not tolerated. In controlled studies in men and women with uncomplicated UTIs, 7-10 days of oral norfloxacin therapy was at least as effective as 7-10 days of oral co-trimoxazole therapy, but norfloxacin was generally associated with fewer adverse effects than co-trimoxazole.
Oral norfloxacin has also been at least as effective as oral amoxicillin when used in men and women, including geriatric individuals, for the treatment of uncomplicated UTIs caused by susceptible organisms. Limited data indicate that 3 days of norfloxacin therapy may be as effective as 7-10 days of therapy for the treatment of uncomplicated UTIs caused by susceptible organisms; however, further study is needed to establish the relative rate of relapse and recurrence of infection with these regimens.
Complicated Urinary Tract Infections
Oral norfloxacin is used in adults for the treatment of complicated UTIs caused by susceptible E. coli, K. pneumoniae, P. mirabilis, Ps. aeruginosa, S. marcescens, or E. faecalis. Oral norfloxacin has generally been effective when used in adults with chronic bacteriuria or complicated UTIs caused by susceptible organisms, including by Ps. aeruginosa. In a limited number of patients, oral norfloxacin therapy appeared to be as effective as parenteral anti-infective therapy for the treatment of nonbacteremic, nosocomial UTIs. However, further study is needed to compare the relative efficacy of oral norfloxacin and parenteral anti-infectives usually used in the treatment of complicated UTIs. Some clinicians suggest that norfloxacin may be particularly useful for the treatment of UTIs caused by organisms resistant to other anti-infectives (e.g., b-lactam antibiotics, aminoglycosides) and for the treatment of chronic or complicated UTIs if parenteral anti-infective therapy is not warranted.
Prostatitis
Oral norfloxacin is used for the treatment of prostatitis caused by E. coli.
Gonorrhea and Associated Infections
Oral norfloxacin is used for the treatment of uncomplicated gonorrhea in adults. Oral norfloxacin is one of several single-dose alternative regimens recommended by the US Centers for Disease Control and Prevention (CDC) for the treatment of uncomplicated cervical, urethral, or rectal gonorrhea in adults and adolescents.
The CDC and many clinicians currently recommend that uncomplicated gonorrhea in adults and adolescents be treated with a single IM dose of ceftriaxone, a single oral dose of cefixime, or a single oral dose of certain fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin) given in conjunction with an anti-infective regimen effective for presumptive treatment of chlamydia.
The CDC states that, although a single 800-mg oral dose of norfloxacin appears to be effective for the treatment of uncomplicated gonorrhea, clinical experience with the regimen is limited and it does not appear to offer any advantage over the currently recommended single-dose ciprofloxacin, ofloxacin, or levofloxacin regimens.
Treatment failures have been reported in some patients receiving single doses of norfloxacin for the treatment of uncomplicated gonorrhea. In addition, the fact that strains of N. gonorrhoeae with decreased susceptibility to fluoroquinolones have been reported in several areas in the US (e.g., Hawaii, Ohio) and elsewhere (e.g., Southeast Asia, Australia, Africa, Great Britain) should be considered.
The CDC states that fluoroquinolones should not be used for the treatment of gonococcal infections acquired in Asia or the Pacific islands (including Hawaii) and may be inadvisable for infections acquired in other areas where N. gonorrhoeae with quinolone resistance have been reported (including California). Results of several studies in men and women with uncomplicated gonorrhea indicate that oral norfloxacin (a single 800-mg dose or two 600-mg doses given 4 hours apart) may be as effective as IM spectinomycin (a single 2-g dose) for the treatment of gonorrhea caused by penicillinase- or nonpenicillinase-producing N. gonorrhoeae.
Although oral norfloxacin has also been effective when used in a limited number of adults with pharyngeal gonococcal infections, efficacy of the drug in these infections has not been clearly established. For additional information on current recommendations for the treatment of gonorrhea and associated infections.
GI Infections
Norfloxacin has been effective when used in adults for the treatment of gastroenteritis caused by susceptible strains of enterotoxigenic E. coli, Aeromonas hydrophila, Plesiomonas shigelloides, Salmonella, Shigella boydii, Sh. dysenteriae, Sh. flexneri, Sh. sonnei, Vibrio cholerae, or V. parahaemolyticus. Although some strains of Helicobacter pylori (formerly Campylobacter pylori or C. pyloridis) are susceptible to norfloxacin in vitro, the drug has been ineffective in eradicating the organism in vivo and has had little effect on symptoms of gastritis when used in a limited number of patients with nonulcerative dyspepsia.
Cholera
Norfloxacin has been effective when used in the treatment of cholera. Although tetracyclines generally are the anti-infectives of choice for the treatment of cholera in conjunction with fluid and electrolyte replacement therapy, when the infection is caused by strains of V. cholerae resistant to tetracyclines, alternative agents include co-trimoxazole, fluoroquinolones, or furazolidone. In one study in adults with severe cholera and dehydration, norfloxacin was more effective than co-trimoxazole in reducing stool output and decreasing the duration of diarrhea, fluid requirements, and excretion of vibrio.
Shigella Infections
Oral norfloxacin is used for the treatment of shigellosis caused by susceptible Shigella. Anti-infective therapy generally is indicated in addition to fluid and electrolyte replacement for the treatment of severe cases of shigellosis since anti-infectives appear to shorten the duration of diarrhea and period of fecal excretion of Shigella. A fluoroquinolone (e.g., ciprofloxacin, norfloxacin, ofloxacin) or ceftriaxone are considered drugs of choice for the treatment of shigellosis when the susceptibility of the isolate is unknown; azithromycin also has been recommended and co-trimoxazole or ampicillin may be effective if the strain is known to be susceptible to these drugs. In one controlled study in adults with acute shigellosis, a single 800-mg oral dose of norfloxacin was as effective as 5 days of co-trimoxazole therapy.
Travelers’ Diarrhea
Norfloxacin has been effective when used for short-term treatment of travelers’ diarrhea or for the prevention of travelers’ diarrhea in adults traveling for relatively short periods of time to high-risk areas. The principal cause of travelers’ diarrhea is infection with enterotoxigenic E. coli, but other infectious agents (e.g., Shigella, Salmonella, Campylobacter spp, Vibrio parahaemolyticus) also have been associated with the disease.
Treatment of travelers’ diarrhea depends on the severity of the illness. In individuals with mild to moderate disease, replacement therapy with oral fluids and electrolytes may be sufficient, although therapy with nonspecific or antimotility agents (e.g., bismuth subsalicylate, loperamide) may be useful for temporary relief of associated symptoms (e.g., abdominal cramps and diarrhea).
Travelers who develop diarrhea with at least 3 loose stools in an 8-hour period, especially if associated with nausea, vomiting, abdominal cramps, fever, or bloody stools, may benefit from short-term treatment with an anti-infective agent. Therapy with an effective anti-infective agent can reduce a typical 3- to 5-day illness to 1-1. days. When use of an anti-infective agent is indicated for treatment of travelers’ diarrhea, ciprofloxacin, levofloxacin, norfloxacin, or ofloxacin generally is used. Some clinicians suggest that azithromycin can be used as an alternative agent in children and pregnant women and may be a drug of choice for travelers in areas with a high prevalence of Campylobacter resistant to fluoroquinolones (e.g., Thailand).
Co-trimoxazole also can be used for the treatment of travelers’ diarrhea and is considered an alternative for use in pregnant women and in children who cannot receive quinolones; however, resistance to co-trimoxazole has been reported in many areas. Efficacy of anti-infective therapy may depend on the etiologic agent and its susceptibility to anti-infectives. Nausea and vomiting without diarrhea should not be treated with anti-infectives.
Travelers should consult a physician, rather than attempt self-medication, if the diarrhea is severe or fails to respond to several days of therapy, the stools contain blood and/or mucus, fever with shaking chills occurs, or dehydration and persistent diarrhea develop. Because travelers’ diarrhea is a relatively nonthreatening illness that is usually mild and self-limiting and can be effectively treated and because of the risks of widespread use of prophylactic anti-infectives (i.e., potential adverse drug reactions, selection of resistant organisms and increased susceptibility to infections caused by these or other organisms), the CDC and most experts recommend that anti-infectives not be used prophylactically by most individuals traveling to areas of risk.
In addition, although controlled studies have indicated that various anti-infectives when taken prophylactically have been 52-95% effective in preventing travelers’ diarrhea in several developing areas of the world, efficacy depends on resistance patterns of pathogenic bacteria in each travel area, and such information seldom is available. While fluoroquinolone resistance for bacteria causing travelers’ diarrhea currently is least common, this could change as use of these drugs increases worldwide.
The CDC states that although use of anti-infectives for prophylaxis of travelers’ diarrhea in certain high-risk groups, such as travelers with immunosuppression or immunodeficiency, may seem reasonable, currently there are no specific data to support such prevention in these populations.Anti-infectives that have been used for prophylaxis of travelers’ diarrhea are not effective in preventing diarrhea caused by viral or parasitic infections, and use of such prophylaxis may give a false sense of security to the traveler about the risk associated with consuming certain local foods and beverages. The principal preventive measure is prudent dietary practices. If prophylaxis is used, ciprofloxacin, levofloxacin, norfloxacin, or ofloxacin can be given for a maximum of 3 weeks.
| Dosage forms of Norfloxacin: | |||
|---|---|---|---|
| Co Norfloxacin 400 mg Tablet | Novo-Norfloxacin 400 mg Tablet | Pms-Norfloxacin 400 mg Tablet | Apo-Norflox 400 mg Tablet |
| Noroxin 400 mg tablet | |||
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Therapeutic classes of Norfloxacin:
Anti-Bacterial Agents, Anti-Infectives, Enzyme Inhibitors, Nucleic Acid Synthesis Inhibitors, Quinolones
Delivery
Australia, Canada, Mexico, New Zealand, USA, Europe [Belgium, France, Norway, Holland, Ireland, Spain, Switzerland, Great Britain (UK), Italy] and etc.