Hemodialysis for treatment of levofloxacin‐induced neurotoxicity

Abstract

Levofloxacin, a third‐generation fluoroquinolone antibiotic, is rarely associated with neurotoxicity. Patients with advanced kidney disease are particularly vulnerable to this adverse effect. We present two elderly patients with kidney failure who developed levofloxacin‐induced neurotoxicity, which was successfully treated with frequent hemodialysis, resulting in the full resolution of their symptoms. Neurotoxicity is a well‐known side effect of fluoroquinolone antibiotics. Postulated mechanisms include inhibition of the gamma‐aminobutyric acid A receptors and activation of the excitatory N‐methyl‐D‐aspartate receptors. Risk factors include older age, kidney disease, pre‐existing neurological disorders, and drug–drug interactions. While management of levofloxacin‐induced neurotoxicity includes discontinuation of the drug and supportive care, hemodialysis is not recommended, despite available pharmacokinetic data in support of its dialyzability. The successful use of hemodialysis for the treatment of levofloxacin‐induced neurotoxicity observed in our two patients with kidney failure should be further considered for rapid resolution of this rare fluoroquinolone‐related adverse effect in patients with impaired kidney function.

Levofloxacin-Associated Neurotoxicity in a Patient with a High Concentration of Levofloxacin in the Blood and Cerebrospinal Fluid

“…After hemodialysis, the plasma concentration of levofloxacin decreased, the patient’s consciousness level quickly improved, and myoclonus disappeared. This approach is supported by two additional reported cases of levofloxacin-associated neurotoxicity that showed rapid resolution after hemodialysis in patients with impaired renal function [16].…”

Fluoroquinolone-Associated Movement Disorder: A Literature Review

“…A total of 45 reports containing 51 cases who developed MDs secondary to FQNs from 16 countries were reported (Supplementary Material S2) [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ]. The origin was Asian in 19 individuals, North American in 16, European in 14, and Australian in 2.…”

“…The most common indication for antibiotics was urinary tract infection (20/48) [ 40 ]. Additionally, the other indications were cellulitis [ 25 ], bronchitis [ 54 ], community-acquired pneumonia [ 34 , 59 ], diverticulitis [ 47 ], gastroenteritis [ 58 ], generalized edema [ 63 ], gluteal abscess [ 60 ], septic arthritis [ 43 ], legionellosis [ 28 ], meningitis [ 26 ], and tuberculosis [ 55 ].…”

Effect of ciprofloxacin vs levofloxacin on QTc‐interval and dysglycemia in diabetic and non‐diabetic patients

“…Ciprofloxacin is the most potent fluoroquinolone, active against a wide range of bacteria especially, aerobic gram‐negative bacilli 16 . Moreover, levofloxacin is a third‐generation fluoroquinolone 17 . It is a broad‐spectrum antibiotic that has good activity against gram‐positive and gram‐negative aerobes and atypical bacteria 18 .…”

“…16 Moreover, levofloxacin is a third-generation fluoroquinolone. 17 It is a broad-spectrum antibiotic that has good activity against gram-positive and gram-negative aerobes and atypical bacteria. 18 The current study aimed to evaluate the effect of both ciprofloxacin and levofloxacin on both cardiovascular toxicity and dysglycemia and comparing between ciprofloxacin and levofloxacin regarding their risk on QTc prolongation and glucose hemostasis in diabetic and non-diabetic patients.…”