Norfloxacin: Side Effects, Contraindications and Dosage
- Fluoroquinolones (1/5): general pharmacology
- Fluoroquinolones (2/5): ciprofloxacin
- Fluoroquinolones (3/5): levofloxacin
- Fluoroquinolones (4/5): ofloxacin
- Fluoroquinolones (5/5): norfloxacin
Review literature: (Simon und Stille, 1997).
Mechanism of Action of Norfloxacin
Norfloxacin is a fluoroquinolone antibiotic, which interferes with the bacterial DNA synthesis via inhibition of the DNA gyrase or topoisomerase II. Fluoroquinolone antibiotics are bactericidal.
Indications for Norfloxacin
Norfloxacin is active against a variety of bacteria:
- Gram-negative pathogens including Pseudomonas, Mycoplasma, Chlamydia,..
- Gram-positive pathogens, but not Pneumococci or Enterococci
- Some anaerobic bacteria
Urologic indications for norfloxacin are urinary tract infections, prostatitis, acute pyelonephritis, epididymitis or perioperative antibiotic prophylaxis for transurethral surgery.
Pharmacokinetics of Norfloxacin
- 40% bioavailability after oral administration.
- Half-life of 3–4 h, 70% renal elimination.
Side Effects of Norfloxacin
- Gastrointestinal side effects: Nausea, vomiting, diarrhea, pseudomembranous colitis
- Neurotoxicity with headache, dizziness, psychosis and seizures.
- Allergy. Rarely serious allergic skin reactions.
- Photosensitization
- Orthopedic side effects: cartilage damage, tendon damage with spontaneous tendon rupture.
- Rarely alterations of the blood count
Interactions with Norfloxacin:
Do not give nitrofurantoin, iron salts, magnesium or aluminum-containing antacids together with norfloxacin. Increased concentrations of theophyllin or ciclosporin due to norfloxacin administration. Norfloxacin increases increases warfarin effect.
Contraindications to Norfloxacin
- Pregnancy, lactation and children
- Severe renal insufficiency
- Patients with tendon damage after fluoroquinolone administration
- Relative contraindication in epilepsy, stroke or psychiatric disorders
Dosage of Norfloxacin
Normal dosage of norfloxacin is 400 mg 1-0-1 p.o. Dose reduction to 400 mg 1-0-0 is necessary in impaired renal function (GFR below 30 ml/min).
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References
- Auquer u.a. 2002 AUQUER, F. ; CORDON, F. ; GORINA, E. ; CABALLERO, J. C. ; ADALID, C. ; BATLLE, J.:
- Single-dose ciprofloxacin versus 3 days of norfloxacin in
uncomplicated urinary tract infections in women.
In: Clin Microbiol Infect
8 (2002), Nr. 1, S. 50–4
- Henry u.a. 2002 HENRY, Jr. ; BETTIS, R. B. ; RIFFER, E. ; HAVERSTOCK, D. C. ; KOWALSKY, S. F. ; MANNING, K. ; HAMED, K. A. ; CHURCH, D. A.:
- Comparison of once-daily extended-release ciprofloxacin and
conventional twice-daily ciprofloxacin for the treatment of uncomplicated
urinary tract infection in women.
In: Clin Ther
24 (2002), Nr. 12, S. 2088–104
- Krcmery und Naber 1999 KRCMERY, S. ; NABER, K. G.:
- Ciprofloxacin once versus twice daily in the treatment of complicated
urinary tract infections. German Ciprofloxacin UTI Study Group.
In: Int J Antimicrob Agents
11 (1999), Nr. 2, S. 133–8
- Martin u.a. 1998 MARTIN, S. J. ; MEYER, J. M. ; CHUCK, S. K. ; JUNG, R. ; MESSICK, C. R. ; PENDLAND, S. L.:
- Levofloxacin and sparfloxacin: new quinolone antibiotics.
In: Ann Pharmacother
32 (1998), Nr. 3, S. 320–36
- Mombelli u.a. 1999 MOMBELLI, G. ; PEZZOLI, R. ; PINOJA-LUTZ, G. ; MONOTTI, R. ; MARONE, C. ; FRANCIOLLI, M.:
- Oral vs. intravenous ciprofloxacin in the initial empirical management
of severe pyelonephritis or complicated urinary tract infections: a
prospective randomized clinical trial.
In: Arch Intern Med
159 (1999), Nr. 1, S. 53–8
- Naber u.a. 1999 NABER, K. G. ; THEURETZBACHER, U. ; MONEVA-KOUCHEVA, G. ; STASS, H.:
- Urinary excretion and bactericidal activity of intravenous
ciprofloxacin compared with oral ciprofloxacin.
In: Eur J Clin Microbiol Infect Dis
18 (1999), Nr. 11, S. 783–9
- Raz u.a. 2000 RAZ, R. ; NABER, K. G. ; RAIZENBERG, C. ; ROHANA, Y. ; UNAMBA-OPARAH, I. ; KORFMAN, G. ; YANIV, I.:
- Ciprofloxacin 250 mg twice daily versus ofloxacin 200 mg twice daily
in the treatment of complicated urinary tract infections in women.
In: Eur J Clin Microbiol Infect Dis
19 (2000), Nr. 5, S. 327–31
- Reid u.a. 2000 REID, G. ; POTTER, P. ; DELANEY, G. ; HSIEH, J. ; NICOSIA, S. ; HAYES, K.:
- Ofloxacin for the treatment of urinary tract infections and biofilms
in spinal cord injury.
In: Int J Antimicrob Agents
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- Simon und Stille 1997 SIMON, C. ; STILLE, W.:
- Antibiotika-Therapie in Klinik und Praxis.
9. Auflage.
Stuttgart New York : Schattauer, 1997
- Talan u.a. 2004 TALAN, D. A. ; KLIMBERG, I. W. ; NICOLLE, L. E. ; SONG, J. ; KOWALSKY, S. F. ; CHURCH, D. A.:
- Once daily, extended release ciprofloxacin for complicated urinary
tract infections and acute uncomplicated pyelonephritis.
In: J Urol
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Deutsche Version: Nebenwirkungen, Kontraindikationen und Dosierung von Norfloxacin
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