Active Ingredients: Norfloxacin
In the past 10 years, 4-fluoroquinolones norfloxacin, ciprofloxacin, fleroxacin, ofloxacin, and levofloxacin have attracted considerable attention as a result of their excellent safety profile and wide spectrum of coverage of enteropathogenic agents.
Thus far, insufficient data exist to recommend lower doses, although one can speculate that these doses might be sufficient.
To date, fluoroquinolones have maintained excellent in vitro activity against most bacterial pathogens associated with TD, although the increasing resistance and in vivo emergence of resistance of C.
Isolation of quinolone-resistant E. Unfortunately, the situation is evolving, and resistant strains are increasingly being isolated, particularly in Asia. Thus far, quinolones remain the drugs of choice when chemoprophylaxis is indicated for, for instance, patients with severe baseline disease.
However, side effects have been observed, such as skin rash, vaginal candidiasis, CNS reactions, phototoxicity, and gastrointestinal complaints; and, very rarely, there have been severe events, including anaphylaxis table 1.
Moreover, confusion might occur with regard to how to manage an illness that occurs despite the patient's receipt of antibiotic prophylaxis.
Quinolones are not approved for prophylaxis in children and pregnant women. Table 1 Prophylactic drugs used to prevent travelers' diarrhea. Table 1 Open in new tab Download slide Prophylactic drugs used to prevent travelers' diarrhea.
Therefore, cyclosporine serum levels should be monitored and appropriate cyclosporine dosage adjustments made when these drugs are used concomitantly. Medications Some quinolones exert an inhibitory effect on the cytochrome P-450 system, thereby reducing theophylline clearance and increasing theophylline blood levels.
Additionally other fluoroquinolones, especially enoxacin, and to a lesser extent ciprofloxacin and pefloxacin, also inhibit the metabolic clearance of theophylline.
As such, these drug interactions involving the fluoroquinolones appear to be drug specific rather than a class effect.
The fluoroquinolones have also been shown to interfere with the metabolism of caffeine and the absorption of levothyroxine. Secondary prophylaxis of variceal bleeding 1.Although it is usually benign, travelers' diarrhea represents a considerable socioeconomic burden for both the traveler and the host country.
Secondary prophylaxis should be started as soon as vasoactive therapy is discontinued.