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Transcript
Indications
1. Uncomplicated cystitis – treatment of initial and recurrent.
2. Recurrent cystitis – prophylaxis.
3. Vesicoureteral reflux – prophylaxis.
4. UTI due to susceptible enterococci including VRE.
Comments
Nitrofurantoin is not indicated for pyelonephritis or systemic infections. Nitrofurantoin is contraindicated in children less
than one month of age. Nitrofurantoin is not useful in patients with creatinine clearance <30 mL/minute due to impaired
concentration in urine. Prolonged use may produce pulmonary fibrosis or neuropathy. Duration of therapy for cystitis is
usually 7-10 days.
NORFLOXACIN
Usual Dose
Adult: 200-400 mg BID PO (UWHC cost/day $3.55-7.10).
Indications
1. Non-febrile traveler’s diarrhea – prophylaxis and treatment. Duration of treatment is usually 72 hours.
2. Neisseria gonorrhoeae infection (800 mg as a single dose). Oral alternative for penicillinase-producing organisms.
3. Uncomplicated urinary tract infections (200 mg Q12H PO).
4. Prophylaxis for SBP in patients with GI bleeding as alternative to ceftriaxone.
Comments
Dose adjustment required for renal impairment. See renal dosing guideline on uconnect.
Norfloxacin is not effective for systemic infections. Use for noninvasive urinary tract infections or enteric infections only.
Also, norfloxacin does not elevate theophylline blood levels as ciprofloxacin does. Use of quinolones is generally
contraindicated in children <18 years of age or pregnant women because of cartilage damage seen in animal models. In
special circumstances, such as multiply resistant organisms, use in children may be justified. Pediatric Infectious Disease
consultation should be obtained before prescribing in children.
Drug Interactions
Antacids, sucralfate (due to its aluminum content) and other cations, including zinc, iron and the buffering agent in
didanosine significantly decrease the bioavailability of norfloxacin. Episodes of hypo- and hyperglycemia have been
reported when fluoroquinolones are administered concomitantly with sulfonylureas.
NYSTATIN
Usual Dose
Adult: 500,000 units/5 mL two to four times daily swish and swallow (UWHC cost/day $1.30-2.60).
Pediatric:** 200,000 units/2 mL – 500,000 units/5 mL PO (not swallowed) Q6H.
Indications
1. Oropharyngeal candidiasis
Comments
Esophagitis requires treatment with fluconazole or alternative antifungal agent. Nystatin powder (1/8 tsp in water) may be
used as an alternative to the suspension if a product without a sweetener is desired.