NORTIROS TZ TAB

• Norfloxacin covers the common bacterial causes of infective diarrhoea including Shigella, Salmonella and enterotoxigenic Escherichia coli.
• Tinidazole covers Entamoeba histolytica, Giardia and anaerobic organisms that norfloxacin does not reach.
• Empirical cover across both groups is useful in mixed or undiagnosed infective diarrhoea, which is common in Indian practice.
• Tinidazole has a longer half-life than metronidazole, allowing shorter courses and once- or twice-daily dosing.
• Norfloxacin achieves high concentrations in the gut lumen and urinary tract.

Not everyone gets these. Most are mild and settle as the course finishes.

• Tinidazole causes a disulfiram-like reaction with alcohol. The patient must avoid alcohol during treatment and for at least three days after the last dose.
• Fluoroquinolones can cause tendon damage and rupture, peripheral neuropathy and central nervous system effects, which may be irreversible. Stop at the first sign of tendon pain or new numbness.
• Tendon risk is much higher in the elderly, in patients on corticosteroids, and in transplant recipients.
• Contraindicated in children and adolescents, in pregnancy — particularly the first trimester — and in breastfeeding.
• Contraindicated in known hypersensitivity to quinolones or nitroimidazoles, in a history of tendon disorder with a quinolone, and in myasthenia gravis.
• Separate from antacids, calcium, iron and zinc by at least two hours, as these prevent norfloxacin absorption.
• Rehydration is the priority in acute diarrhoea; antibiotics are an adjunct and are not needed in most cases.
• Avoid excessive sun exposure, and use with caution alongside warfarin, whose effect tinidazole potentiates.