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Antimicrobial therapy: general principles

A wide variety of antimicrobial agents is available to treat established infections caused by bacteria, fungi, viruses, or parasites. This section will cover the general principles of antimicrobial therapy and will also include illustrative clinical problems to emphasize proper decision-making in using antimicrobials.

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Norfloxacin is administered orally. The drug should be given with a glass of water at least 1 hour before or at least 2 hours after a meal or ingestion of milk or other dairy products.

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Antacids containing magnesium hydroxide or aluminum hydroxide may decrease absorption of oral norfloxacin, and the drugs probably should not be administered concomitantly. Patients should be instructed not to ingest antacids concomitantly with or within 2 hours of a norfloxacin dose. The mechanism of this interaction has not been fully elucidated to date, but studies using ciprofloxacin indicate that antacids containing magnesium and aluminum ions may bind to, and form insoluble complexes with, quinolones in the GI tract. 

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Adverse effects have occurred in about 7% of patients receiving a single 800-mg oral dose of norfloxacin for the treatment of uncomplicated gonorrhea. Dizziness, nausea, and abdominal cramping are the adverse effects reported most frequently in patients receiving this single-dose regimen, and these effects have been reported in 2-3.5% of patients.

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Norfloxacin also has been used in adults for the treatment of various GI infections caused by susceptible organisms. Because only low serum concentrations of norfloxacin are attained after oral administration of usual dosages, use of the drug is generally limited to genitourinary or GI tract infections. Prior to initiation of norfloxacin therapy, appropriate specimens should be obtained for identification of the causative organism and in vitro susceptibility tests.

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Levofloxacin (Levaquin) is indicated for the treatment of uncomplicated skin infections caused by S. aureus and S. pyogenes. Two large clinical trials in Japan demonstrated levofloxacin’s effects against various skin pathogens, the majority of which were methicillin-sensitive S. aureus or coagulase-negative staphylococci.