Active substance: Norfloxacin
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Contraindications As noted above, under licensed use, norfloxacin is also now considered to be contraindicated for the treatment of certain sexually transmitted diseases by some experts due to bacterial resistance. Patients taking any of these drugs concomitantly with norfloxacin should be carefully monitored.
Pregnancy Norfloxacin has been reported to rapidly cross the blood-placenta and blood-milk barrier, and is extensively distributed into the fetal tissues. For this reason norfloxacin and other fluoroquinolones are contraindicated during pregnancy due to the risk of spontaneous abortions and birth defects.
The manufacturer only recommends use of norfloxacin during pregnancy when benefit outweighs risk. Ciprofloxacin is being licensed for the treatment of Complicated Urinary Tract Infections and Pyelonephritis due to Escherichia coli and Inhalational Anthrax post-exposure and levofloxacin was recently licensed for the treatment of Inhalational Anthrax post-exposure.
However, the Fluoroquinolones are licensed to treat lower respiratory infections in children with cystic fibrosis in the UK.
In selected cases with highly resistant organisms isolated or when the diagnosis is uncertain, infectious diseases or urology consultation should be considered.
If you decide the patient has catheter-acquired urinary tract infection, what therapies should you initiate immediately?
A urine culture must be obtained prior to initiation of antimicrobial therapy in every case to confirm the diagnosis and direct antimicrobial therapy.
Do not treat asymptomatic bacteriuria. Treatment of asymptomatic bacteriuria in residents with indwelling catheters has been identified as a frequent cause of inappropriate antimicrobial use. Prophylactic antimicrobial therapy should be initiated only for bacteriuric patients prior to an invasive urologic procedure.
When symptomatic infection is diagnosed, reassess the indications for an indwelling catheter and discontinue the catheter, whenever possible.They have been supplying medications of my medications with them for quite some time now.
Patients with moderate or severe clinical presentations should have empiric antimicrobial therapy initiated pending urine culture results.
When empiric antimicrobial therapy is initiated, considerations relevant to selection of the antimicrobial regimen include: Review recent prior urine cultures from the patient, recent or current antimicrobial therapy, and consider the prevalence of resistance to potential infecting organisms in the facility for known or suspected susceptibilities of the likely infecting pathogens.
Review patient tolerance and renal function.