Mechanism of Action:

Fluoroquinolones are a synthetic antibacterial medication that work by inhibiting the bacterial DNA replication. They are bacteriocidal due to the action they take against the DNA of the bacterial cell wall. Many fluoroquinolones are broad spectrum and effective against a wide variety of both gram-positive and gram-negative bacteria.

Nursing Considerations:

Administration: oral, IV.   rapid onset of action.  Take with plenty of water and food. Avoid taking diary with med as absorption will be delayed. Take oral fluoroquinolones with a full glass of water two hours before or after meals to enhance absorption and prevent crystalluria.

Fluoroquinolones are safe to use in pediatrics but only used for complicated UTIs and pyelonephritis,

Dose adjustments are required for renal insufficiency.

Pregnancy: There is limited data on safety in pregnancy.

Drug Interactions: There are numerous drug interactions. Ensure that a complete medication profile is obtained. Some of the meds that interact with fluoroquinolones are:

• Anticoagulants
• Bronchodilators
• Tizanidines (risk of hypotension and sedation)
• Theophylline use with asthmatics (risk of increased theophylline levels and toxicity)
• Antacids – ensure a 4 hour window before and 2 hour after to avoid slowing absorption.
• NSAIDs (increased risk of seizures)

High Alert Med:  Black Box Warnings are the strongest warnings issued by the Federal Drug Association (FDA) (equivalent to “Safety Warnings” by Health Canada) and signify that the medical studies have indicated that the drug carries a significant risk of serious or life-threatening adverse effects.

Fluoroquinolones, including, have been associated with disabling and potentially irreversible serious adverse reactions, including:

• Tendinitis and tendon rupture
• Peripheral neuropathy
• Central nervous system effects such as seizures or suicidal thoughts
• Exacerbation of muscle weakness in clients with myasthenia gravis

In clients who experience any of these serious adverse reactions, discontinue the medication immediately, and avoid the use of fluoroquinolones.

Client Teaching:

• Avoid direct and indirect sunlight due to the photosensitivity that can be experienced while on these medications.
• Ensure dosages are spaced evenly throughout the day and that fluid balance is maintained.  It is important to maintain an intake of 1500mL-2000mL per day while taking the medication.
• The client should be advised that medications containing calcium, aluminum, iron, or zinc may impair absorption and should be avoided.
• Side effects of fluoroquinolones increase drowsiness.  Additionally, the client should be cautioned to monitor for episodes of fainting or decreased heart rate and report any history of prolonged QT syndrome.
• Report right away peripheral neuropathy, increased tendon pain, jaundice, rash, or mood changes.^[2]

Flouroquinolones Medication Card

Now let’s take a closer look at the medication card for levofloxacin (Daily Med, 2019; UpToDate, 2021). Because information about medication is constantly changing, nurses should always consult evidence-based resources to review recommendations before administering specific medication.

To support your learning, editable and printable drug cards for all the antimicrobials are available. Chapter 12 Antimicrobials Medication Cards

References