Refractory shock secondary to treatment with levofloxacin in an extremely low birth weight infant affected by Stenotrophomonas maltophilia pneumonia

Abstract

Stenotrophomonas maltophilia is an important but rare cause of late onset neonatal sepsis in extremely low birth weight (ELBW) infants. These infections are difficult to treat due to the multiple drug resistance profile of the organism. One class of antibiotics available for use is the quinolones, such as ciprofloxacin and levofloxacin. However, the limited experience and known toxicity of levofloxacin raises further concerns regarding its use in this patient population. We present a case of refractory shock in an ELBW infant following the use of levofloxacin to treat S. maltophilia infection. The use of levofloxacin in ELBW infants may be associated with major hemodynamic compromise and, accordingly, we recommend caution for its use in this patient population.

Levofloxacin Use in the Neonate: A Case Series

“…7 Since then, approved indications have expanded to include some pediatric indications, and there is growing use of fluo-roquinolones in neonates, particularly ciprofloxacin. [8][9][10][11] Although literature describing the use of levofloxacin in the neonatal patient is limited to case reports, 12 there are circumstances when this medication is required because of the resistance pattern of the organism, clinical deterioration with first-line treatment, medication shortages, or other factors that preclude the use of alternative antibiotics, such as the risk of kernicterus with trimethoprim-sulfamethoxazole (TMP-SMX), for example.…”