Fluoroquinolones

Fluoroquinolones

Ray Masters RN

Elizabeth Mathes RN 

 

Overview

·         Antibacterial spectrum includes bactericidal action on both gram+ and gram- organisms

·         Effective against some gram+ organisms (Streptococcus pneumonia, Haemophilus influenzaep, aeruginosa, Salmonella, and Shigella).

Mechanism of Action

·         Interferes with the enzyme DNA gyrase, which is needed to synthesize DNA.

·         Contains a bactericidal action.

Indications

·         Urinary tract infections

·         Bone infections

·         Joint infections

·         Bronchitis

·         Pneumonia

·         Gastroenteritis

·         Gonorrhea

Examples

·         ciprofloxacin HCL (Cipro)

·         levofloxacin (Levaquin)

·         lomefloxacin (Mazaquin)

·         moxifloxacin (Avelox)

·         norfloxacin (Noroxin)

·         ofloxacin (Floxin)

·         chloramphenicol (Chloromycetin)

·         quinupristin (Synercid)

Routes

·         PO, IM, IV

Considerations

·         Fluid intake should be at least 2000ml/day

·         Antacids and iron preparations decrease absorption of fluoroquinolones such as levofloxacinj

·         Levofloxacin can increase the effects of theophylline and caffeine.

·         Levofloxacin can increase the effects of oral hypoglycemic.

·         When levofloxacin is taken with NSAIDs, CNS reactions such as seizures may occur.

Nursing Interventions

·         Obtain specimen from infected site for culture and sensitivity before initiating antibacterial therepy.

·         Monitor I&O. Urine output should be at least 750ml/day.

·         Client fluid intake should be >2000ml/day to prevent crystalluria.

·         Monitor BUN and serum creatinine. Elevated values may indicate renal dysfunction.

·         Administer levofloxacin 2 hours before or after antacids of iron products. If GI upset occurs, may be taken with food.

·         For IV levofloxacin dilute in an appropriate amount of solution and infuse over 60 minutes.

·         Monitor for signs and symptoms of superinfection (mouth ulcers, furry black tongue, anal or genital discharge/itching.)

·         Monitor serum theophylline.

·         Monitor blood glucose.

Client Teaching

·         Drink at least 6 to 8 glasses of fluid daily.

·         Avoid caffeinated products.

·         Avoid operating hazardous machinery or operating a motor vehicle while taking drug or until stability has occurred.

·         Use sunglasses, sun block, and protective clothing when in the sun.

Side Effects

·         Drug related dizziness

·         Photosensitivity

·         Nausea

·         Vomiting

·         Diarrhea/flatulence

·         Abdominal cramps

·         Tinnitus

·         Rash

·         Tendon rupture (rare)

References

Kee, J.L., Hayes, E.R., & McCuistion, L.E. (2012). Pharmacology: A nursing process approach. St. Louis: Elsevier Saunders.