Norfloxacin

INTRODUCTION

Indications

Treatment of the following bacterial infections: Urinary tract and gynecologic infections, including cystitis, gonorrhea, and prostatitis.

Action

Inhibits bacterial DNA synthesis by inhibiting DNA gyrase enzyme. Therapeutic Effects: Death of susceptible bacteria. Spectrum: Active against gram-positive pathogens, including Staphylococcus aureus, S. epidermidis, Streptococcus agalactiae, Enterococcus faecalis. Gram-negative spectrum notable for activity against Escherichia coli, Klebsiella pneumoniae, Enterobacter aerogenes, Proteus mirabilis, Proteus vulgaris.

Adverse Reactions/Side Effects

CNS: SEIZURES, dizziness, drowsiness, headache, insomnia, agitation, confusion. CV: ARRHYTHMIAS, QTc prolongation. GI: HEPTATOXICITY, PSEUDOMEMBRANOUS COLITIS, abdominal pain, diarrhea, nausea. GU: vaginitis. Derm: photosensitivity, rash. Endo: hyperglycemia, hypoglycemia. MS: tendinitis, tendon rupture. Neuro: peripheral neuropathy. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for seizures; notify physician immediately if patient develops or increases seizure activity.

• Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, angioedema, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stools, and other severe or prolonged GI problems (nausea, vomiting, heartburn). Notify physician or nursing staff immediately of these signs.

• Be alert for signs of hepatotoxicity, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician.

• Assess any tendon pain or joint pain. Tendinopathy and rupture can occur, especially in large, weightbearing tendons (Achilles, patellar tendons). Risk of tendon damage is greater in patients >65 yrs old, transplant recipients (i.e., kidney, heart, lung), patients with pre-existing tendon damage, and patients taking corticosteroids concurrently.

• Monitor signs of peripheral neuropathy (numbness, tingling). Perform objective tests (nerve conduction, monofilaments) to document any neuropathic changes.

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Be alert for confusion, agitation, or other alterations in mental status. Notify the physician promptly if these symptoms develop.

• Monitor signs of hypoglycemia (weakness, malaise, irritability, fatigue) or hyperglycemia (drowsiness, fruity breath, increased urination, unusual thirst). Patients with diabetes mellitus should check blood glucose levels frequently.

Interventions

• If tendon symptoms occur, notify the physician and protect the affected ...