Quinolones (also called Fluoroquinolones) are a group of synthetic (man-made) antibiotics that are used to treat many different types of bacterial infections. They are called "broad-spectrum" because they can kill a wide variety of bacteria — both Gram-positive and Gram-negative bacteria.

Simple Definition: Quinolones are powerful man-made antibiotics that stop bacteria from copying their DNA, which kills the bacteria.

In Uganda and other community settings, quinolones are commonly prescribed for:

• Typhoid fever (caused by Salmonella typhi)
• Urinary tract infections (UTIs)
• Dysentery (bloody diarrhea, often caused by Shigella)
• Pneumonia
• Gonorrhea (a sexually transmitted infection)
• Wound infections

Because these infections are common in our communities, nurses must understand how to safely administer these drugs and teach patients properly.

Quinolones are divided into four generations based on when they were developed and how broad their bacterial coverage is.

Generation	Examples	Key Features
First Generation	Nalidixic acid, Cinoxacin	Narrow spectrum; mainly Gram-negative; not commonly used today
Second Generation	Ciprofloxacin, Norfloxacin, Ofloxacin	Broader spectrum; good against Gram-negative bacteria; first "fluoroquinolones"
Third Generation	Levofloxacin	Improved Gram-positive coverage; better for respiratory infections
Fourth Generation	Moxifloxacin, Gemifloxacin	Broadest spectrum; covers anaerobes, Gram-positive, and some Gram-negative

🧠 Memory Tip:
Think of generations like upgrading a phone — each new generation gets better and can do more!

• Ciprofloxacin — the most widely used; excellent for UTIs and typhoid
• Levofloxacin — good for pneumonia and respiratory infections
• Moxifloxacin — broad spectrum; good for complicated infections
• Norfloxacin — used for UTIs and gastrointestinal infections
• Ofloxacin — used for eye and ear infections (topical)

Bacteria are living cells that need to make copies of themselves to survive and spread. To do this, they must copy their DNA (their genetic material). This process involves special enzymes (proteins that speed up chemical reactions). Quinolones work by blocking two important bacterial enzymes:

• This enzyme helps bacteria untangle their DNA so it can be copied.
• Without this enzyme, the DNA gets tangled up like a knotted rope.
• Mechanism: Quinolones block DNA gyrase ➔ DNA cannot untangle ➔ bacteria cannot copy themselves ➔ bacteria die.

• This enzyme helps separate the new DNA copies so they can be distributed into new bacterial cells.
• Mechanism: Quinolones block Topoisomerase IV ➔ new DNA copies cannot separate ➔ bacteria cannot divide ➔ bacteria die.

Feature	Explanation
Bactericidal	Quinolones KILL bacteria directly (they don't just stop them from growing)
Target	Only bacterial enzymes — NOT human enzymes (this is why they are safe for humans)
Gram-negative bacteria	Quinolones mainly target DNA gyrase
Gram-positive bacteria	Quinolones mainly target Topoisomerase IV

💡 Analogy:
Imagine a photocopier (the bacteria) trying to make copies of a document (DNA). Quinolones are like someone who jams the photocopier — no more copies can be made, and the "business" (bacteria) shuts down!

Quinolones are broad-spectrum antibiotics, meaning they can kill many different types of bacteria.

Bacteria	Disease Caused
Escherichia coli (E. coli)	UTIs, diarrhea
Salmonella typhi	Typhoid fever
Shigella species	Dysentery (bloody diarrhea)
Pseudomonas aeruginosa	Hospital-acquired infections, wound infections
Neisseria gonorrhoeae	Gonorrhea (STI)
Haemophilus influenzae	Respiratory infections
Legionella species	Atypical pneumonia
Campylobacter species	Gastroenteritis
Klebsiella species	Pneumonia, UTIs

Bacteria	Disease Caused
Streptococcus pneumoniae	Pneumonia, meningitis
Staphylococcus aureus	Skin infections, boils
Enterococcus species	UTIs, abdominal infections

• Mycoplasma pneumoniae
• Chlamydia species
• Mycobacterium tuberculosis (some quinolones are used in TB treatment)

Important Note: Quinolones are NOT effective against viruses, fungi, or parasites. They only kill bacteria!

All quinolones end with the suffix "-floxacin". This makes them easy to identify!

Generic Name	Common Brand Names	Main Uses
Ciprofloxacin	Cipro, Ciprotab, Ciprobay	Typhoid, UTIs, diarrhea, anthrax
Levofloxacin	Levaquin, Tavanic	Pneumonia, sinusitis, complicated infections
Moxifloxacin	Avelox	Respiratory infections, some skin infections
Norfloxacin	Noroxin, Norbactin	UTIs, prostatitis, gastroenteritis
Ofloxacin	Floxin	Eye infections (drops), ear infections
Gemifloxacin	Factive	Community-acquired pneumonia

🧠 Memory Tip:
If the drug name ends in "-floxacin", it is a quinolone!

This table breaks down the specific indications, standard dosages, and unique contraindications for the most commonly prescribed fluoroquinolones. (Note the differences in dosing frequency—some are twice daily, while the newer generations are once daily due to longer half-lives).

Drug Name	Commonest Indications	Standard Dosage	Main Side Effects	Contraindications
Ciprofloxacin (2nd Generation)	Typhoid fever Complicated & uncomplicated UTIs Bacterial diarrhea / dysentery Prostatitis Skin & soft tissue infections Bone & joint infections (osteomyelitis) Anthrax (post-exposure) Gonorrhea (where sensitive) Pseudomonal infections	Oral/IV: Uncomplicated UTI: 250 mg every 12 hours for 3 days Complicated UTI / Typhoid: 500 mg every 12 hours for 7–14 days Severe infection / Anthrax: 750 mg every 12 hours Prostatitis: 500 mg every 12 hours for 28 days Eye/Ear drops: 1–2 drops every 2–4 hours	Nausea, vomiting, diarrhea Abdominal pain, dyspepsia Headache, dizziness, insomnia Photosensitivity (severe sunburn) Tendonitis / tendon rupture (Achilles) Peripheral neuropathy QT prolongation Crystalluria C. difficile superinfection Hypersensitivity reactions	Hypersensitivity to quinolones Pregnancy & breastfeeding Children < 18 years (growing cartilage) History of tendon rupture with quinolones Myasthenia gravis Concurrent tizanidine use Known QT prolongation or uncorrected hypokalemia
Levofloxacin (3rd Generation)	Community-acquired pneumonia Acute bacterial sinusitis Acute exacerbation of chronic bronchitis Complicated & uncomplicated UTIs Pyelonephritis Skin & soft tissue infections Prostatitis	Oral/IV: Uncomplicated UTI: 250 mg once daily for 3 days Complicated UTI / Pyelonephritis: 250–500 mg once daily for 7–10 days Pneumonia / Sinusitis: 500–750 mg once daily for 7–14 days Prostatitis: 500 mg once daily for 28 days	Nausea, diarrhea, constipation Headache, dizziness Insomnia, restlessness Photosensitivity Tendonitis / tendon rupture Peripheral neuropathy QT prolongation Dysglycemia (hypo-/hyperglycemia) Hepatotoxicity C. difficile colitis	Hypersensitivity to quinolones Pregnancy & breastfeeding Children < 18 years History of tendon rupture Myasthenia gravis Known QT prolongation Concurrent use with other QT-prolonging drugs (e.g., amiodarone, sotalol)
Moxifloxacin (4th Generation)	Community-acquired pneumonia Acute bacterial sinusitis Acute exacerbation of chronic bronchitis Complicated intra-abdominal infections Complicated skin & soft tissue infections Plague (Yersinia pestis)	Oral/IV: Standard adult dose: 400 mg once daily Acute sinusitis / Bronchitis: 400 mg once daily for 10 days Pneumonia / Complicated infections: 400 mg once daily for 7–14 days Intra-abdominal: 400 mg once daily for 5–14 days	Nausea, vomiting, diarrhea Dizziness, headache Higher risk of QT prolongation Tendon rupture Peripheral neuropathy Hepatotoxicity (elevated LFTs) Photosensitivity (less than ciprofloxacin) Dysglycemia C. difficile colitis	Hypersensitivity to quinolones Pregnancy & breastfeeding Children < 18 years History of tendon rupture Myasthenia gravis Baseline QT prolongation (highest risk in class) Concurrent antiarrhythmics (Class IA & III) Severe hepatic impairment
Norfloxacin (2nd Generation)	Uncomplicated & complicated UTIs Prostatitis Gastroenteritis / traveler's diarrhea Gonococcal urethritis (where sensitive)	Oral: Uncomplicated UTI: 400 mg every 12 hours for 3 days Complicated UTI: 400 mg every 12 hours for 7–21 days Prostatitis: 400 mg every 12 hours for 28 days Gastroenteritis: 400 mg every 12 hours for 1–3 days	Nausea, vomiting, diarrhea, abdominal cramps Headache, dizziness Photosensitivity Tendonitis / tendon rupture Crystalluria (ensure high fluid intake) Peripheral neuropathy C. difficile colitis	Hypersensitivity to quinolones Pregnancy & breastfeeding Children < 18 years History of tendon rupture Myasthenia gravis QT prolongation Concurrent theophylline (increased toxicity risk)
Ofloxacin (2nd Generation)	Lower respiratory tract infections UTIs & pyelonephritis Prostatitis Skin & soft tissue infections Gonorrhea Bacterial conjunctivitis (eye drops) Otitis externa (ear drops)	Oral/IV: Uncomplicated UTI: 200–400 mg every 12 hours for 3–7 days Lower respiratory / Skin: 400 mg every 12 hours for 10 days Prostatitis: 300 mg every 12 hours for 6 weeks Gonorrhea: 400 mg single dose Eye drops: 1–2 drops every 2–4 hours, then taper Ear drops: 10 drops into affected ear twice daily for 10–14 days	Nausea, diarrhea Insomnia, headache, dizziness Photosensitivity Tendonitis / tendon rupture Peripheral neuropathy QT prolongation Dysglycemia Local irritation (with eye/ear drops) C. difficile colitis	Hypersensitivity to quinolones Pregnancy & breastfeeding Children < 18 years History of tendon rupture Myasthenia gravis QT prolongation Concurrent antiarrhythmics
Gemifloxacin (4th Generation)	Community-acquired pneumonia (CAP) Acute bacterial exacerbation of chronic bronchitis Acute bacterial sinusitis	Oral: Standard adult dose: 320 mg once daily Bronchitis / Sinusitis: 320 mg once daily for 5 days Pneumonia: 320 mg once daily for 5–7 days	Nausea, diarrhea Headache, dizziness Rash (including severe rash in women < 40 years) Photosensitivity Tendon rupture Peripheral neuropathy QT prolongation Dysglycemia C. difficile colitis	Hypersensitivity to quinolones Pregnancy & breastfeeding Children < 18 years History of tendon rupture Myasthenia gravis Known QT prolongation History of rash with other quinolones Concurrent Class IA/III antiarrhythmics

• UTIs: Ciprofloxacin, Levofloxacin, and Norfloxacin are great for UTIs because they are heavily excreted unchanged in the urine. Moxifloxacin is NOT used for UTIs because it is metabolized in the liver and does not concentrate in the urine!
• Respiratory Infections: Levofloxacin, Moxifloxacin, and Gemifloxacin are dubbed the "Respiratory Fluoroquinolones" because they have excellent coverage against Streptococcus pneumoniae (the most common cause of community-acquired pneumonia). Ciprofloxacin is poor against Strep and should not be used as monotherapy for routine pneumonia.
• Pseudomonas: If you suspect Pseudomonas aeruginosa (hospital-acquired infections), Ciprofloxacin is the most potent quinolone.

Case: A 45-year-old female presents to the clinic with dysuria, frequency, and suprapubic pain. Urinalysis confirms an uncomplicated UTI. The pharmacy is out of Ciprofloxacin. A junior doctor writes a prescription for Moxifloxacin 400mg daily. As the nurse reviewing the chart, why should you question this order?

Answer: You must question this order because Moxifloxacin is primarily metabolized by the liver and excreted in feces/bile. It does not reach high enough concentrations in the urine to effectively treat a urinary tract infection. The doctor should switch to Levofloxacin or Norfloxacin instead!

To remember the Respiratory Fluoroquinolones (the ones that effectively kill Streptococcus pneumoniae):

• My = Moxifloxacin
• Lungs = Levofloxacin
• Grow = Gemifloxacin

Common Infections Treated with Quinolones:

• Urinary Tract Infections (UTIs): Very common in women. Symptoms: burning when passing urine, frequent urination, lower abdominal pain. Ciprofloxacin and Norfloxacin are commonly used.
• Typhoid Fever: Caused by Salmonella typhi. Common in areas with poor sanitation. Symptoms: prolonged fever, headache, abdominal pain, rose spots on skin. Ciprofloxacin is the drug of choice in many cases.
• Dysentery (Bloody Diarrhea): Caused by Shigella species. Symptoms: bloody stools, abdominal cramps, fever. Ciprofloxacin is effective.
• Pneumonia: Infection of the lungs. Symptoms: cough, fever, difficulty breathing, chest pain. Levofloxacin and Moxifloxacin are used.
• Gonorrhea: Sexually transmitted infection. Ciprofloxacin was previously used, but resistance is increasing.
• Skin and Soft Tissue Infections: Wounds, abscesses, cellulitis. Ciprofloxacin may be used.
• Bone and Joint Infections: Osteomyelitis (bone infection). Ciprofloxacin is used for chronic cases.
• Eye and Ear Infections: Bacterial conjunctivitis (pink eye) and Otitis externa (swimmer's ear). Ofloxacin eye drops and ear drops.
• Anthrax: A serious bacterial infection that can be used as a biological weapon. Ciprofloxacin is the drug of choice for post-exposure prophylaxis.

Quinolones can be given in several ways:

Route	Examples	Nursing Notes
Oral (by mouth)	Tablets, capsules, suspensions	Most common; absorbed well from the gut
Intravenous (IV)	Infusions in hospital settings	Used for serious infections; infuse slowly
Topical	Eye drops, ear drops	For eye/ear infections only
Otic (ear)	Ofloxacin ear drops	For ear infections

Oral Absorption: Quinolones are well absorbed when taken by mouth. Food may slow absorption slightly, but they can generally be taken with or without food.
EXCEPTION: Avoid taking with dairy products, antacids, or iron supplements (see Drug Interactions).

• A. Absorption: Oral bioavailability is excellent (70–90%). This means most of the drug gets into the bloodstream when taken by mouth. Peak levels in blood occur 1–2 hours after oral administration.
• B. Distribution: Quinolones are widely distributed throughout the body. They penetrate well into: Urine (good for UTIs), Lungs (good for pneumonia), Bones and joints, Prostate gland, Cerebrospinal fluid (to some extent).
• C. Metabolism: Most quinolones are metabolized in the liver. Some are excreted unchanged by the kidneys.
• D. Excretion: Mainly excreted through the kidneys in urine. This is why they are so effective for UTIs — the drug concentrates in the urine! Some are also excreted in bile/feces.
• E. Half-Life: Varies by drug: Ciprofloxacin (~4 hours), Levofloxacin (~6–8 hours), Moxifloxacin (~12 hours). Dosing is usually twice daily for most quinolones.

Quinolones can cause many side effects. Nurses must monitor patients carefully.

Side Effect	What to Watch For
Nausea	Patient feels like vomiting
Vomiting	Actual throwing up
Diarrhea	Loose, watery stools
Abdominal pain	Stomach cramps
Dyspepsia	Indigestion, heartburn
C. difficile infection	Severe watery diarrhea, fever, abdominal pain

💡 Nursing Action: Monitor bowel movements. If patient develops severe diarrhea, notify the doctor immediately — this could be C. difficile, a serious superinfection!

Side Effect	What to Watch For
Headache	Persistent head pain
Dizziness	Feeling lightheaded
Insomnia	Difficulty sleeping
Restlessness	Unable to sit still
Confusion	Disorientation, especially in elderly
Seizures	Convulsions (rare but serious)
Depression	Low mood
Nightmares	Bad dreams

💡 Nursing Action: Monitor mental status. Report any confusion or seizures immediately.

Side Effect	What to Watch For
Tendonitis	Pain, swelling, tenderness in tendons (especially Achilles tendon)
Tendon rupture	Sudden "snap" feeling, inability to move foot, severe pain
Arthralgia	Joint pain
Muscle weakness	Especially dangerous in myasthenia gravis patients

Risk Factors for Tendon Problems: Age over 60 years, taking corticosteroids (like prednisone), kidney disease, diabetes, history of tendon problems.

💡 Nursing Action: Teach patients to STOP the medication and report immediately if they feel tendon pain, swelling, or hear a "pop" sound!

Side Effect	What to Watch For
QT prolongation	Abnormal heart rhythm on ECG
Torsades de Pointes	Life-threatening irregular heartbeat
Palpitations	Feeling heart racing
Hypotension	Low blood pressure

💡 Nursing Action: Monitor heart rate and rhythm. Be extra careful if patient is also taking other QT-prolonging drugs (like amiodarone).

Side Effect	What to Watch For
Photosensitivity	Severe sunburn even with brief sun exposure
Rash	Skin redness, itching
Urticaria (hives)	Raised, itchy welts
Stevens-Johnson syndrome	Severe blistering rash (medical emergency!)
Toxic epidermal necrolysis	Skin peeling off (medical emergency!)

💡 Nursing Action: Teach patients to avoid sun exposure and use protective clothing and sunscreen!

• Elevated liver enzymes (ALT, AST)
• Hepatotoxicity (liver damage)
• Jaundice (yellowing of skin and eyes)

💡 Nursing Action: Monitor liver function tests. Watch for jaundice.

Side Effect	Explanation
Crystalluria	Crystals forming in urine (can block kidneys)
Hypoglycemia	Low blood sugar (especially in diabetics)
Peripheral neuropathy	Numbness, tingling, burning in hands/feet
Aortic aneurysm	Bulging of the main artery (rare but serious)

The FDA (U.S. Food and Drug Administration) has issued the strongest possible warning for quinolones called a "Black Box Warning."

1. Tendinitis and Tendon Rupture: Can happen during treatment or up to several months after. Most commonly affects the Achilles tendon. Risk increased in patients over 60, those on corticosteroids, and those with kidney disease.
2. Peripheral Neuropathy: Nerve damage causing pain, burning, tingling, numbness. Can be permanent!
3. Central Nervous System Effects: Seizures, psychosis, increased intracranial pressure.
4. Exacerbation of Myasthenia Gravis: Can cause life-threatening muscle weakness.

💡 Nursing Action: If a patient experiences ANY of these serious adverse reactions, DISCONTINUE THE MEDICATION IMMEDIATELY and notify the healthcare provider!

Quinolones interact with many other drugs. Nurses must check medication lists carefully!

These contain cations (positive ions) that bind to quinolones in the gut:

Drug/Food	Examples	Action
Antacids	Maalox, Mylanta, Tums	Separate by at least 2 hours
Iron supplements	Ferrous sulfate	Separate by at least 2 hours
Calcium supplements	Calcium carbonate	Separate by at least 2 hours
Zinc supplements	Zinc tablets	Separate by at least 2 hours
Magnesium supplements	Magnesium oxide	Separate by at least 2 hours
Dairy products	Milk, cheese, yogurt	Do not take together

Rule: Give quinolones 2 hours BEFORE or 6 hours AFTER these products!

Drug	Interaction
Corticosteroids (prednisone)	Increased risk of tendon rupture
Warfarin	Increased bleeding risk
Theophylline	Increased theophylline toxicity (nervousness, seizures)
Caffeine	Increased caffeine effects (jitteriness, palpitations)
Phenytoin	Altered phenytoin levels
Amiodarone	Increased QT prolongation risk
Sucralfate	Decreased quinolone absorption

Quinolones can cause hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar). Monitor blood sugar closely in diabetic patients.

Situation	Reason
Known allergy to quinolones	Risk of anaphylaxis
History of tendon rupture with quinolones	High risk of recurrence
Myasthenia gravis	Can worsen muscle weakness

Situation	Reason
Pregnancy	Risk of cartilage damage to fetus
Breastfeeding	Drug passes into breast milk
Children under 18	Risk of cartilage damage in growing bones
Elderly (>60 years)	Increased risk of tendon rupture
Seizure disorders	Can lower seizure threshold
Renal impairment	Drug accumulation; dose adjustment needed
Hepatic impairment	Altered drug metabolism
QT prolongation	Risk of dangerous heart rhythms
Diabetes	Risk of blood sugar changes

• Check allergies — Ask about previous reactions to quinolones
• Obtain culture and sensitivity — Before starting antibiotic (if possible)
• Review medication list — Check for drug interactions
• Assess baseline vital signs and check renal and liver function tests

• Oral: Give with a full glass of water. Can give with food if stomach upset occurs. NEVER give with dairy, antacids, or iron supplements. Ensure patient drinks plenty of fluids (2 liters/day).
• IV Administration: Infuse slowly over 60 minutes (for 500mg) or 90 minutes (for 750mg). Monitor for infusion reactions. Do not mix with other medications in the same IV line.

• Monitor for effectiveness: Decreasing fever, decreasing white blood cell count, improving symptoms, negative culture results.
• Monitor for adverse effects: Tendon pain or swelling, diarrhea (especially watery/bloody), skin rash, mental status changes, heart rhythm changes.
• Monitor intake and output: Ensure adequate urine output (at least 30 mL/hour). Watch for signs of crystalluria.

• A. How to Take the Medication: "Take this medicine with plenty of water. You can take it with food if your stomach hurts. Do NOT take it with milk, yogurt, cheese, or antacids. Wait at least 2 hours before or after."
• B. Fluid Intake: "Drink at least 8 glasses of water every day while taking this medicine. This helps prevent crystals from forming in your urine."
• C. Sun Protection: "This medicine can make your skin very sensitive to the sun. Stay out of direct sunlight. Wear long sleeves, a hat, and use sunscreen. This can happen while taking the medicine AND for several days after."
• D. Tendon Warning: "If you feel pain, swelling, or a 'snap' in your ankle or any tendon, STOP the medicine and come to the clinic immediately! Rest the affected area. Do not exercise while taking this medicine."
• E. Complete the Full Course: "Take ALL the medicine, even if you feel better. If you stop early, the infection may come back stronger."
• F. When to Seek Help: Severe diarrhea, yellowing of skin or eyes, severe skin rash, difficulty breathing, chest pain or irregular heartbeat, severe dizziness or confusion.

What Is Resistance? Bacteria can change (mutate) so that quinolones no longer kill them. This is a growing problem worldwide, including in Uganda.

How Resistance Develops:

• Mutations in target enzymes — Bacteria change their DNA gyrase or topoisomerase IV so the drug cannot bind.
• Efflux pumps — Bacteria develop pumps that push the drug out before it can work.
• Decreased permeability — Bacteria change their cell walls so the drug cannot enter.

How to Prevent Resistance: Only use quinolones when necessary — not for viral infections! Complete the full course of antibiotics. Do not share antibiotics with others. Use narrow-spectrum antibiotics when possible. Practice good hygiene to prevent infections.

💡 Community Teaching:
"Do not buy antibiotics from the shop without a prescription. Using antibiotics when you don't need them makes them stop working when you really need them!"

• Patient: A 25-year-old woman with fever for 7 days, headache, abdominal pain, and constipation.
• Diagnosis: Typhoid fever
• Treatment: Ciprofloxacin 500mg orally twice daily for 14 days
• Nursing Actions: Teach patient to take with water, warn about sun exposure, monitor for tendon pain, ensure completion of full course. Teach family about handwashing and safe water.

• Patient: A 30-year-old pregnant woman with burning urination and frequency.
• Important: Quinolones are contraindicated in pregnancy!
• Alternative: The doctor will likely prescribe a safer antibiotic like amoxicillin or nitrofurantoin.
• Nursing Actions: Do NOT give quinolones to pregnant patients, educate about safe alternatives, encourage plenty of fluids, teach about perineal hygiene.

• Patient: A 65-year-old man on levofloxacin for pneumonia reports pain "above his heel."
• Assessment: Pain over the Achilles tendon.
• Nursing Actions: STOP the medication immediately! Notify the healthcare provider. Rest the affected leg. Do NOT massage or exercise the tendon. Document the adverse reaction.

• F - Fluid intake important (2L/day)
• L - Long QT interval (monitor heart)
• O - Older adults at risk for tendon rupture (>60 years)
• X - Don't give with cations (Ca, Zn, Fe, Mg, Al) or dairy
• A - Avoid in children and pregnancy
• C - Watch for C. difficile diarrhea
• I - Interactions with caffeine, warfarin, theophylline
• N - Neuromuscular blockade (worsens myasthenia gravis)
• S - Sun sensitivity (photosensitivity)

• C - Cartilage damage risk (avoid in children)
• I - Inhibits DNA gyrase
• P - Photosensitivity
• R - Renal excretion (good for UTIs)
• O - Oral and IV routes

• T - Tenderness over tendon
• E - Edema (swelling)
• N - No ability to move the joint
• D - Discomfort with movement
• O - Obvious deformity
• N - Notify doctor immediately!

• Mechanism of action: Inhibits DNA gyrase and topoisomerase IV
• Suffix: All end in "-floxacin"
• Black box warning: Tendon rupture, peripheral neuropathy, CNS effects
• Drug interactions: Antacids, dairy, iron, calcium reduce absorption
• Contraindications: Pregnancy, children <18, myasthenia gravis
• Side effects: Photosensitivity, GI upset, C. difficile, QT prolongation
• Patient teaching: Drink plenty of water, avoid sun, complete full course

• Q1: A patient taking ciprofloxacin reports pain in the Achilles tendon. What is the nurse's best action?
  A: Stop the medication immediately and notify the provider. This could be tendonitis, which can lead to tendon rupture.
• Q2: A patient asks if they can take their ciprofloxacin with their calcium supplement. What should the nurse say?
  A: No. Calcium binds to ciprofloxacin and prevents absorption. Take the antibiotic 2 hours before or 6 hours after the calcium.
• Q3: Why are quinolones contraindicated in children?
  A: They can damage growing cartilage and affect bone development.
• Q4: A patient on levofloxacin develops severe watery diarrhea. What should the nurse suspect?
  A: C. difficile infection. This is a superinfection caused by disruption of normal gut bacteria.

Feature	Details
Class	Fluoroquinolones
Suffix	-floxacin
Action	Bactericidal; inhibits DNA gyrase and topoisomerase IV
Spectrum	Broad (Gram-negative and Gram-positive)
Common drugs	Ciprofloxacin, Levofloxacin, Moxifloxacin, Norfloxacin, Ofloxacin
Routes	Oral, IV, topical (eye/ear drops)
Key side effects	GI upset, photosensitivity, tendon rupture, QT prolongation, C. difficile
Black box warning	Tendon rupture, peripheral neuropathy, CNS effects, myasthenia gravis
Contraindications	Pregnancy, children <18, myasthenia gravis, known allergy
Drug interactions	Antacids, dairy, iron, calcium, magnesium, zinc, corticosteroids, warfarin
Patient teaching	Plenty of fluids, avoid sun, no dairy/antacids with dose, complete full course
Nursing priority	Monitor for tendon pain, diarrhea, rash, mental changes, heart rhythm

• Typhoid fever: very common; spread through contaminated food/water
• Dysentery: bloody diarrhea; spread through poor sanitation
• UTIs: common in women; related to hygiene and water quality
• Pneumonia: especially in children and HIV-positive patients

• Safe water: Boil or treat drinking water to prevent typhoid and dysentery
• Handwashing: Wash hands with soap after using the toilet and before eating
• Proper toilet use: Use latrines to prevent contamination of water sources
• Complete antibiotics: Finish all prescribed medication
• Don't self-medicate: See a healthcare provider before taking antibiotics
• Report side effects: Tell the nurse or doctor if you have tendon pain, severe diarrhea, or skin rash

• Osmosis. (2025). Antibiotics - Fluoroquinolones: Nursing Pharmacology.
• Open RN. (2023). 3.11 Fluoroquinolones – Fundamentals of Nursing Pharmacology.
• RegisteredNurseRN. (2023). Fluoroquinolones (Quinolones) Nursing Antibiotic Pharmacology Review.
• Muntean et al. (2022). Overview of Side-Effects of Antibacterial Fluoroquinolones. PMC.
• Australian Prescriber. Fluoroquinolone antibiotics and adverse events. PMC.