Norfloxacin Dosage

This dosage information may not include all the information needed to use Norfloxacin safely and effectively. See additional information for Norfloxacin.

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for Urinary Tract Infection

Uncomplicated:
Due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis: 400 mg orally every 12 hours for 3 days
Due to other organisms: 400 mg orally every 12 hours for 7 to 10 days

Complicated: 400 mg orally every 12 hours for 10 to 21 days

Usual Adult Dose for Cystitis

Due to E coli, K pneumoniae, or P mirabilis: 400 mg orally every 12 hours for 3 days
Due to other organisms: 400 mg orally every 12 hours for 7 to 10 days

Usual Adult Dose for Prostatitis

Acute or chronic: 400 mg orally every 12 hours for 28 days

Usual Adult Dose for Gonococcal Infection - Uncomplicated

800 mg orally one time

Due to high rates of resistance, the Centers for Disease Control and Prevention do not recommend fluoroquinolones for treatment of gonococcal infections in the United States. Ceftriaxone or oral cefixime is recommended as first-line treatment of gonorrhea in the United States. Antimicrobial susceptibility patterns should be monitored.

Doxycycline therapy for 7 days (if not pregnant) or single-dose azithromycin is also recommended for possible coexisting chlamydial infection.

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Campylobacter Gastroenteritis

(Not approved by FDA)

400 mg orally every 12 hours for 3 days
Immunocompromised patients may require therapy for 7 to 14 days.

Usual Adult Dose for Epididymitis - Non-Specific

(Not approved by FDA)

Nonsexually transmitted: 400 mg orally every 12 hours for 14 days

Usual Adult Dose for Pyelonephritis

(Not approved by FDA)

Mild infections: 400 mg orally every 12 hours for 14 days

Usual Adult Dose for Salmonella Enteric Fever

(Not approved by FDA)

400 mg orally every 12 hours for 7 to 14 days

Usual Adult Dose for Salmonella Gastroenteritis

(Not approved by FDA)

400 mg orally every 12 hours for 5 days; however, most cases are self-limiting and prudent withholding of antibiotic therapy does not appear to slow recovery
Immunocompromised patients may require therapy for 14 days.

Usual Adult Dose for Shigellosis

(Not approved by FDA)

400 mg orally every 12 hours for 5 days
Immunocompromised patients may require therapy for 7 to 10 days.

Usual Adult Dose for Traveler's Diarrhea

(Not approved by FDA)

400 mg orally every 12 hours for 3 days; however, most cases are self-limiting and prudent withholding of antibiotic therapy does not appear to slow recovery
Immunocompromised patients may require therapy for 7 to 14 days.

Renal Dose Adjustments

CrCl 30 mL/min or less: 400 mg orally once a day

Liver Dose Adjustments

No adjustment recommended.

Precautions

Fluoroquinolones, including norfloxacin, have been associated with an increased risk of tendonitis and tendon rupture in all ages. The risk is further increased in older patients usually over 60 years of age, in kidney, heart, or lung transplant recipients, and with the use of concomitant corticosteroids. Independent risk factors include strenuous physical activity, renal failure, and previous tendon disorders such as rheumatoid arthritis; however, cases have been reported in patients with no known risk factors. Tendon rupture may occur during or up to several months after completion of therapy. Patients should be advised to discontinue norfloxacin, rest and avoid exercise, and contact their healthcare provider if they experience tendon pain, swelling, inflammation, or rupture. Norfloxacin is contraindicated in patients with a history of tendinitis or tendon rupture associated with the use of any quinolone, including norfloxacin.

Fluoroquinolones, including norfloxacin, have neuromuscular blocking activity and may exacerbate muscle weakness in patients with myasthenia gravis. Patients should contact their healthcare provider at once if worsening muscle weakness or breathing problems develop. Norfloxacin should be avoided in patients with a known history of myasthenia gravis.

Convulsions have been reported with norfloxacin. Convulsions, increased intracranial pressure (including pseudotumor cerebri), and toxic psychosis have been reported with fluoroquinolones. Fluoroquinolones may also cause central nervous system (CNS) stimulation, resulting in tremors, restlessness/agitation, nervousness/anxiety, lightheadedness, confusion, hallucinations, paranoia, depression, nightmares, insomnia, and rarely, suicidal thoughts or acts. Norfloxacin should be discontinued and appropriate measures taken if these reactions occur. Norfloxacin should be used with caution in patients with a known or suspected CNS disorder or other risk factors that may predispose them to seizures or lower the seizure threshold (e.g., severe cerebral arteriosclerosis, epilepsy, certain drug therapy). Patients should be advised to avoid driving or engaging in other tasks requiring mental alertness and coordination until they know how the drug affects them.

Serious and occasionally fatal hypersensitivity and/or anaphylactic reactions have been reported; some following the first dose. The drug should be discontinued immediately at the first appearance of a skin rash, jaundice, or other signs of hypersensitivity. Severe, acute hypersensitivity reactions may require treatment with epinephrine and other resuscitative measures including oxygen, intravenous fluids, antihistamines, corticosteroids, cardiovascular support, and airway management as clinically indicated.

Norfloxacin has been associated with rare cases of sensory or sensorimotor axonal polyneuropathy resulting in paresthesias, hypoesthesias, dysesthesias, and weakness. To prevent development of an irreversible condition, norfloxacin should be discontinued if symptoms of neuropathy occur or if deficits in light touch, pain, temperature, position sense, vibratory sensation, and/or motor strength are observed.

Prolongation of the QTc interval and torsades de pointes have been reported in some patients receiving norfloxacin. Generally, drugs that prolong the QT interval are not recommended for use in patients with ongoing proarrhythmic conditions. The risk of arrhythmia may be reduced by avoiding use of norfloxacin in the presence of hypokalemia, significant bradycardia, or concurrent treatment with Class IA or Class III antiarrhythmic agents. Patients should be advised to contact their physician if they experience syncope, irregular heartbeats, or palpitations.

Patients should be advised to avoid excessive exposure to sunlight or artificial ultraviolet light during and for several days after treatment. The drug should be discontinued if photosensitivity or signs of phototoxicity (e.g., sunburn, redness, burning, itching, rash, blistering) occur.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following quinolone therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

As a precaution against crystalluria, the recommended daily dosage of norfloxacin should not be exceeded and patients should be well hydrated to prevent concentrated urine.

Renal, hepatic, and hematopoietic function should be monitored periodically during prolonged therapy.

Dosage adjustments are recommended for renally impaired patients. Caution and monitoring is recommended for elderly patients, who may be at a greater risk of adverse reactions due to declining renal function.

Norfloxacin is not effective for the treatment of syphilis, although it may mask or delay its symptoms when used to treat gonorrhea. All gonorrhea patients should undergo serologic testing for syphilis at the time of diagnosis and 3 months after treatment.

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

Data not available

Other Comments

The manufacturer's Medication Guide should be dispensed with each new and refill prescription.

Norfloxacin should be taken at least 1 hour before or at least 2 hours after a meal, milk, and/or other dairy products. Patients should be advised to drink plenty of fluids.

Iron-, zinc-, aluminum-, or magnesium-containing compounds (e.g., antacids, sucralfate, mineral supplements, buffered didanosine) should be administered either 2 hours before or 2 hours after norfloxacin.

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