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Fluoroquinolones

3 min read

Fluoroquinolones

Key Points

  • Fluoroquinolones are broad-spectrum synthetic antibacterial agents used for selected respiratory, skin, and urinary infections.
  • They are bactericidal through inhibition of bacterial DNA replication.
  • Oral absorption is reduced by antacids and mineral products containing calcium, aluminum, iron, or zinc.
  • Maintain hydration and administer oral doses with a full glass of water to reduce crystalluria risk.
  • Boxed warning reactions include tendinitis/tendon rupture, peripheral neuropathy, CNS effects, and worsening weakness in myasthenia gravis.
  • Discontinue immediately and notify the provider if serious warning symptoms occur.

Mechanism of Action

Fluoroquinolones are synthetic antibacterials that inhibit bacterial DNA replication, causing bactericidal activity against susceptible organisms.

Clinical Use

  • Respiratory infections such as pneumonia.
  • Complicated skin infections.
  • Complicated urinary tract infections.

Fluoroquinolone use is generally contraindicated in children except selected high-risk indications (for example complicated UTI, pyelonephritis, plague, or post-anthrax exposure). Use cautiously during pregnancy.

Nursing Considerations

  • Check allergy history before first dose.
  • Oral administration: give with a full glass of water and separate from meals, antacids, and mineral-containing products by at least 2 hours.
  • Encourage daily fluid intake (about 1500 to 2000 mL/day unless contraindicated).
  • IV levofloxacin infusion guidance: doses up to 500 mg over 60 minutes; 750 mg over 90 minutes.
  • Anticipate dosage adjustment in renal or hepatic impairment.
  • Use caution in clients with seizure history.
  • Monitor infection response (WBC trend, fever trend, infection site, culture results when available).

Side Effects and Adverse Effects

  • Common: GI upset, drowsiness.
  • Additional monitoring: hypersensitivity, photosensitivity, hypoglycemia, rash, C. diff-associated diarrhea, fainting, decreased heart rate, prolonged QT risk, mood changes.
  • Boxed warning serious reactions: tendinitis/tendon rupture, peripheral neuropathy, CNS effects, and exacerbation of myasthenia gravis weakness.

Boxed Warning Response

Stop fluoroquinolone therapy immediately and notify the provider if tendon pain, tendon rupture symptoms, peripheral neuropathy, jaundice, CNS effects, or worsening muscle weakness occur.

Health Teaching

  • Avoid direct and indirect sunlight; use sunscreen and protective clothing.
  • Space doses evenly and avoid missed doses.
  • Do not take calcium, aluminum, iron, or zinc products within 2 hours of oral dose timing.
  • Report tendon pain (especially Achilles region), numbness/tingling, severe mood changes, syncope, bradycardia symptoms, jaundice, or rash promptly.
  • Report severe diarrhea or signs of superinfection immediately.

Self-Check

  1. Which new symptom in a patient taking levofloxacin requires immediate discontinuation and provider notification?
  2. Why should antacids or iron-containing products be separated from oral fluoroquinolone doses?
  3. What monitoring priorities are most important in an older adult receiving fluoroquinolone therapy for pneumonia?

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