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Norfloxacin Prescribing Update

Norfloxacin prescribing for urinary tract infections (UTIs)

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Avoid prescribing norfloxacin for the empirical treatment of uncomplicated UTIs

Norfloxacin resistance continues to increase, and we are in danger of losing a valuable weapon in our antibiotic arsenal.

Almost 80% of all prescriptions for norfloxacin are generated in primary care. This means GPs are in the ideal position to assess use of norfloxacin and to address increasing resistance. To ensure the longevity of this medicine, it is important we are restrained in our prescribing.

The best way that general practice can have some influence over this, is to avoid using norfloxacin for the empirical treatment of uncomplicated UTIs.

Appropriate prescribing for uncomplicated UTIs

Approximately 50% of women will have a UTI in their lifetime; most of these will be classified as uncomplicated.

For these women, treatment should always start with either trimethoprim or nitrofurantoin.

Norfloxacin would only be appropriate in these women if the initial treatment with trimethoprim or nitrofurantoin fails, and use of norfloxacin is supported by laboratory culture and sensitivity data.

Complicated vs uncomplicated UTI

Uncomplicated UTI
Classic presentation:

  • Dysuria, frequency, urgency
  • Occurs in women with a normal, unobstructed genitourinary tract
  • Most frequent in young sexually active women

Complicated UTI
All UTIs in

  • Men
  • Children
  • Pregnant women

All people with

  • Suspected pyelonephritis
  • Failed antibiotic treatment/recurrent UTI
  • Catheter in-situ and symptoms of UTI
  • Hospital-acquired infection
  • Quinolones report
  • Abnormal genitourinary tract/recent instrumentation
  • Renal impairment

This report provides an overview of your current prescribing of norfloxacin. This information is complementary to the 2010 quinolone report.

Summary of your total use of norfloxacin

Your total number of norfloxacin prescriptions xx
The average for all GPs 28

Norfloxacin as a % of your antibiotics for UTIs* xx%
The average for all GPs 39%

Prescribing for uncomplicated UTIs

This data shows that the use of antibiotics for UTIs in women aged 20-60 years is changing – national data shows the use of norfloxacin is reducing, and is being replaced by trimethoprim and nitrofurantoin.

# This only includes data for women aged 20-60 years. Most women in this age group presenting with UTI, will have an uncomplicated infection, and they may be treated empirically with trimethoprim or nitrofurantoin.
National#

Notes:
Time period: 1 January 2010 to 31 December 2010.
Data is assigned to you based on the recorded NZMC number for prescriptions.
Data has been excluded where the NZMC number was not recorded.