Levofloxacin and rhabdomyolysis in a renal transplant patient

Korzets, Asher; Gafter, U.; Dicker, Dror; Herman, Michal; Ori, Yaacov

doi:10.1093/ndt/gfl396

Cited by 18 publications

(30 citation statements)

References 6 publications

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“…There have been several other case reports of levofloxacin causing rhabdomyolysis in nondialysis 3,4 or renal transplant recipients. 5 Some of these cases were much more severe than ours, resulting in some of the poor outcomes of rhabdomyolysis, such as acute renal failure, anuria, metabolic acidosis, fatal hyperkalemia and compartment syndromes. 6 However, to our knowledge, this is the first case of levofloxacin-induced rhabdomyolysis in a hemodialysis patient.…”

Section: Discussionmentioning

confidence: 59%

Levofloxacin‐induced rhabdomyolysis in a hemodialysis patient

Gupta

Guron

Harris

et al. 2011

Hemodialysis International

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Section: Discussionmentioning

confidence: 59%

Levofloxacin‐induced rhabdomyolysis in a hemodialysis patient

Gupta

Guron

Harris

et al. 2011

Hemodialysis International

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“…Acute rhabdomyolysis has been previously reported in patients under hemodialysis [9] or after renal transplantation [10]. Petitjeans et al described in 2003 a case of an elderly patient with severe rhabdomyolysis, suffering from acute renal failure [8].…”

Section: Discussionmentioning

confidence: 99%

Acute Rhabdomyolysis Associated with Coadministration of Levofloxacin and Simvastatin in a Patient with Normal Renal Function

Paparoupa

Pietrzak

Gillissen

2014

Case Reports in Medicine

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We report a rare case of severe acute rhabdomyolysis in association with coadministration of levofloxacin and simvastatin in a patient with normal renal function. A 70-year-old Caucasian male was treated due to community acquired pneumonia with levofloxacin in a dosage of 500 mg once and then twice a day. On the 8th day of hospitalization the patient presented with acute severe rhabdomyolysis requiring an intensive care support. After discontinuation of levofloxacin and concomitant medication with simvastatin 80 mg/day, clinical and laboratory effects were totally reversible. Up to now, levofloxacin has been reported to induce rhabdomyolysis mainly in patients with impaired renal function, as the medication has a predominant renal elimination. In our case renal function remained normal during the severe clinical course. According to a recent case report rhabdomyolysis was observed due to interaction of simvastatin and ciprofloxacin. To our best knowledge this is the first case of interaction between simvastatin and levofloxacin to be reported. This case emphasizes the need of close monitoring of creatine kinase in patients under more than one potentially myotoxic medication especially when patients develop muscle weakness.

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“…Exclusion criteria include: 1) patient unable to provide informed consent; 2) greater than 5 days post-transplantation; 3) BK virus nephropathy with a previous transplant; 4) history of allergic reaction to any quinolone antibiotic; 5) history of quinolone-associated tendonitis or tendon rupture; 6) corrected QT interval ≥450 ms; 7) taking medication known to prolong the QT interval, such as class IA antiarrhythmic drugs (for example quinidine, procainamide, disopyramide), class III antiarrhythmic drugs (for example amiodarone, sotalol), azole antifungals (for example fluconazole) or macrolide antibiotics (for example erythromycin); 8) pregnant or breastfeeding, since the safety of levofloxacin in these settings is not established; 9) require quinolone antibiotic for >14 days (for example for UTI prophylaxis); 10) received a multiorgan transplant (for example kidney-pancreas); 11) currently enrolled in another interventional trial; 12) previously enrolled in this study; 13) history of rhabdomyolysis [22]; and 14) significant allergic reactions to ≥3classes of antibiotics, since these patients may have no other option other than quinolones for treatment of common post-transplant infection.…”

Section: Methodsmentioning

confidence: 99%

Quinolone prophylaxis for the prevention of BK virus infection in kidney transplantation: study protocol for a randomized controlled trial

Humar

Gill

Johnston

et al. 2013

Trials

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BackgroundBK virus infection has emerged as a major complication in kidney transplantation leading to a significant reduction in graft survival. There are currently no proven strategies to prevent or treat BK virus infection. Quinolone antibiotics, such as levofloxacin, have demonstrated activity against BK virus. We hypothesize that administration of a quinolone antibiotic, when given early post-transplantation, will prevent the establishment of BK viral replication in the urine and thus prevent systemic BK virus infection.Methods/designThe aim of this pilot trial is to assess the efficacy, safety and feasibility of a 3-month course of levofloxacin in the kidney transplant population. This is a multicenter, randomized, double-blind, placebo-controlled trial with two parallel arms conducted in 11 Canadian kidney transplant centers. A total of 154 patients with end-stage renal disease undergoing kidney transplantation will be randomized to receive a 3-month course of levofloxacin or placebo starting in the early post-transplant period. Levofloxacin will be administered at 500 mg po daily with dose adjustments based on kidney function. The primary outcome will be the time to occurrence of BK viruria within the first year post-transplantation. Secondary outcomes include BK viremia, measures of safety (adverse events, resistant infections,Clostridium difficile-associated diarrhea), measures of feasibility (proportion of transplanted patients recruited into the trial), proportion of patients adherent to the protocol, patient drop-out and loss to follow-up,and use of quinolone antibiotics outside of the trial protocol.DiscussionResults from this pilot study will provide vital information to design and conduct a large, multicenter trial to determine if quinolone therapy decreases clinically meaningful outcomes in kidney transplantation. If levofloxacin significantly reduces BK viruria and urine viral loads in kidney transplantation, it will provide important justification to progress to the larger trial. If the full trial shows that levofloxacin significantly reduces BK infection and improves outcomes, its use in kidney transplantation will be strongly endorsed given the lack of proven therapies for this condition.Trial registrationThis trial was funded by the Canadian Institutes of Health Research (grant number:222493) and is registered at ClinicalTrials.gov ( NCT01353339).

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Levofloxacin and rhabdomyolysis in a renal transplant patient

Cited by 18 publications

References 6 publications

Levofloxacin‐induced rhabdomyolysis in a hemodialysis patient

Levofloxacin‐induced rhabdomyolysis in a hemodialysis patient

Acute Rhabdomyolysis Associated with Coadministration of Levofloxacin and Simvastatin in a Patient with Normal Renal Function

Quinolone prophylaxis for the prevention of BK virus infection in kidney transplantation: study protocol for a randomized controlled trial

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