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5.1 Antibacterial: Antileprotic drugs, metronidazole, 4-quinolones

5.1.10 Antileprotic drugs

Dapsone tablets (dermatologist/haematologist/GUM use)


5.1.11 Metronidazole

Metronidazole tablets, suspension
Metronidazole IV infusion
Metronidazole suppositories

5.1.12 Quinolones

Ciprofloxacin tablets, suspension under specific guidelines or only on the advice of a consultant microbiologist.  
Levofloxacin tablets and IV infusion for moderate to severe community acquired pneumonia (for those with a severe allergy towards penicillin).


Levofloxacin is availble on consultant microbiologist advice only. It should be used for severe CAP only when other antibiotics cannot be used. The MHRA has restricted its use following reports of serious hepatotoxicity, cardiac arrhythmias, severe skin reactions and tendon rupture. See the Drug Safety Update September 2012.

Norfloxacin tablets


Ciprofloxacin IV Infusion under specific guidelines or only on the advice of a consultant microbiologist.  


1. Ciprofloxacin and other quinolone antibiotics have a particularly good activity against Gram-negative bacilli, including those normally resistant to other drugs. In order to preserve their usefulness it is intended to reserve these agents for treating acute pyelonephritis, acute prostatitis, epididymitis, pelvic inflammatory disease, and significant infections caused by multiple antibiotic resistant bacteria such as pseudomonas, enterobacter, acinetobacter etc, on the recommendation of a microbiologist.

2. It should be noted that ciprofloxacin has relatively poor activity against such lethal pathogens as beta haemolytic streptococci, anaerobes and streptococcus pneumoniae and it should therefore not be used routinely where these organisms are the likely pathogens (e.g. pneumonia, soft tissue infections).

3. Quinolones are associated with a high-risk for the development of C difficile infection.

4. Due to the extensive oral absorption of ciprofloxacin, IV doses should be reserved for patients where no oral route is available for with microbiologist approval.

5. Oral Levofloxacin has excellent bioavailability so IV should rarely be needed. The other use for Levofloxacin is for confirmed legionella (a Consultant Microbiologist would have been involved with this).

6. Norfloxacin is reserved for use in prophylaxis following an episode of spontaneous bacterial peritonitis.


5.1.13 Urinary-tract Infections

Nitrofurantoin capsules, MR capsules, suspension (see restrictions below).

1. Contrary to MHRA guidance (see link below), the Trust's antimicrobial sub-group advise that nitrofurantoin is contra-indicated in patients with a creatinine clearance of < 40 mL/min. Its antibacterial efficacy depends on renal secretion. Check renal function prior to prescribing, especially in elderly patients.

2. Due to the high cost of nitrofurantoin suspension, its use is restricted to paediatric patients. The immediate release capsules can be opened and the contents dispersed in 10 ml of water. If necessary, this can then be flushed down an enteral feeding tube.

Link to Drug Safety Update on nitrofurantoin.

For link to BNF section: 5.1 Antibacterial drugs