Norfloxacin. Lomefloxacin.

Fluoroquinolones. These are DNA gyrase inhibitors. They are derivatives of nalidixic acid basically but they have a greater spectrum against Gram negative aerobes. They do have a number of drug interactions. I would just simply, rather than talking a lot about it, encourage you whichever ones of these products you use, consult the literature so that you are aware of what interactions you have with it. It is suggested that these be given orally two hours before antacids or heavy metals. They are not recommended in people under 18 years of age or in pregnancy or breast feeding because they have caused arthropathy in lab animals but there have also been reports of tendinitis and tendon rupture in patients who have been receiving these drugs.

Major uses are principally for Gram negative infections, chronic otitis media. They have been used in some cystic fibrosis patients because these are about the only drugs that are available that can be given orally that have activity against Pseudomonas. But I would add one caution. We sometimes use ciprofloxacin, for example, in our patients with cystic fibrosis for home therapy. They get resistant to it. I mentioned earlier, you don’t use single entities to treat Pseudomonas. We don’t have anything else that we can treat Pseudomonas with at home orally so we accept the fact that they are going to become resistant to it. We will stop the drug at that point and we will have hopefully knocked it back far enough that the patient will do okay.

Once you’ve stopped the drug and if you come back a month later, that Pseudomonas may be sensitive again and you can use another course. However, this drug should not be used in acute otitis. It should not be used for pneumococcal pneumonia or for anaerobic infections although some of the newer drugs do have coverage of some of those agents.

Norfloxacin is a drug that basically has been used for urinary tract infections. The adverse affects are listed here. I think you probably are fairly familiar with them. I would encourage you to review them if you haven’t recently.

In the interest of time, ciprofloxacin is used parenterally or orally for things like osteomyelitis, pneumonias, skin infections, bacterial diarrhea except for cases of C. diff or pseudomembranous colitis. It can be used in gonorrhea and it is useful in C. jejuni eradication but we really suggest that it be used in multiple antibiotic resistant infections or situations where it represents a significant cost advantage over parenteral therapy. Therein lies the major advantage of these drugs. These drugs can be used orally where you might otherwise have to use IV therapy. So when you can do that, you probably are cost justifiable. To use these as routine drugs for every garden variety infection, I think you are probably incurring increased cost for your patient. There is some activity against Pseudomonas but resistance development is a problem, as I mentioned.

Lomefloxacin and enoxacin are a couple of these products that have been out some years. Lomefloxacin is Maxaquin. It can be useful in UTIs or bronchitis from H. flu and M. cat. It does not interact with theophylline.

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