Levofloxacin

Abstract

S LevofloxacinRefractory distributive shock: case report A male neonate developed refractory distributive shock during treatment with levofloxacin for Stenotrophomonas maltophila pneumonia [route of administration not stated; duration of treatment to reaction onset not clearly stated].The boy, who was born at 28 weeks' gestation and had a birth weight of 650g, developed findings consistent with pneumonia at week 4. He was receiving mechanical ventilation. At this point, he was on day 11 of meropenem treatment for Klebsiella pneumoniae and weighed 1163g. Analysis of endotracheal tube aspirate repeatedly revealed S. maltophilia. Following antibiotic-resistance profiling, he started receiving cotrimoxazole. However, he had an unsatisfactory response with the development of respiratory failure and septic shock. Twenty-four hours later, he started receiving levofloxacin 8.5 mg/kg every 12 hours with signs of improvement in the first 48 hours. However, he developed progressive haemodynamic failure with a decrease in BP to 30mm Hg.The boy received increased vasoactive drug support with dopamine, epinephrine, norepinephrine, hydrocortisone and dobutamine. However, his mean arterial pressure remained at 25-30mm Hg and he developed oligoanuria, tachycardia, generalised oedema, hyperlactacidaemia and metabolic acidosis. As he had a pinkish colour and his central-peripheral temperature gradient was < 1 degree, a form of distributive shock was suspected. As he had respiratory improvement, but haemodynamic compromise, an adverse reaction to levofloxacin was suspected. Levofloxacin was discontinued and, over the next 12 hours, his mean arterial pressure and urine output returned to normal. He was weaned off vasoactive drugs. He subsequently received cotrimoxazole and completely recovered.Author comment: "Our patient suffered refractory distributive shock, probably related to levofloxacin administration."Leante-Castellanos JL, et al. Refractory shock secondary to treatment with levofloxacin in an extremely low birth weight infant affected by Stenotrophomonas maltophilia pneumonia. Case Reports in Perinatal Medicine