Levofloxacin-Induced Delirium: Is It a Dangerous Drug in Patients with Renal Dysfunction?

Abstract

The central nervous system (CNS) toxicity of fluoroquinolones is well known but usually occurs benign. In the literature, there are a few number of severe CNS toxicity cases related to fluoroquinolones. Levofloxacin is a third-generation fluorinated quinolone antibiotic, is the active levo stereoisomer of ofloxacin, and has one of the most favorable adverse reaction profiles. We describe a case of delirium associated with levofloxacin in a 55-year-old man who was hospitalized in our medical clinic for pneumonia.

Hemodialysis for treatment of levofloxacin‐induced neurotoxicity

“…Similar to our two cases, most previous reports establish advanced age and impaired kidney function as risk factors for levofloxacin‐induced neurotoxicity …”

“…10,14,15 A 55 year old man with pneumonia and acute kidney injury developed acute delirium after receiving a 500 mg daily intravenous dose of levofloxacin for 10 days with resolution of symptoms 48 hours after discontinuing the medication. 15 A 42-year-old woman endured acute delirium with psychosis after 2 days of treatment with oral levofloxacin 500 mg daily for sinusitis. Her psychosis improved with supportive care and drug discontinuation.…”

“…19 Similar to our two cases, most previous reports establish advanced age and impaired kidney function as risk factors for levofloxacin-induced neurotoxicity. 8,10,11,15,16 The management of severe toxicity of fluoroquinolones is symptomatic and supportive, with a focus on drug discontinuation, treatment of seizures if they develop with intravenous benzodiazepines, and monitoring for QTinterval prolongation and torsade de pointes. While the prescribing information for levofloxacin states that in case of an acute over dose, the drug is not efficiently removed by hemodialysis or peritoneal dialysis, 4 , there are pharmacokinetic studies demonstrating that levofloxacin is dialyzable.…”

Pheochromocytoma Characterizing Both Fever and Acute Renal Failure

“…It has one of the most adverse reaction profiles. [3] Levofloxacin is a dangerous drug in patients with renal dysfunction. In this report, pheochromocytoma crisis with nonoliguric acute renal failure was preoperatively controlled by the treatment of α 1 -adrenergic receptor blocking agent.…”

Effect of Danofloxacin on Reactive Oxygen Species Production, Lipid Peroxidation and Antioxidant Enzyme Activities in Kidney Tubular Epithelial Cell Line, LLC‐PK1

“…Most FQs and their metabolites are excreted from kidney by glomerular filtration and tubular secretion . Nephrotoxicity such as crystalluria, interstitial nephritis and acute renal failure has also been reported during therapy with FQs , but the mechanism is still unknown. Previous studies have demonstrated that oxidative stress plays an important factor in the FQs‐induced adverse effects, such as neurotoxic effects and chondrotoxicity .…”