A Case of Levofloxacin-Induced Hepatotoxicity

Levofloxacin-Induced Hepatotoxicity in Patients With Legionnaires' Disease: Implications and Management

Legionnaires' disease (LD), caused by the Legionella bacterium, primarily manifests as pneumonia and could result in a spectrum of clinical severity. As treatment necessitates the use of antibiotics, levofloxacin, a fluoroquinolone, is a commonly preferred option due to its broad-spectrum activity. However, the potential side effects of levofloxacin, including rare instances of hepatotoxicity, introduce a therapeutic challenge. This case report explores the association between levofloxacin and hepatotoxicity and its implications for treating LD.

Brevundimonas diminuta-Induced Lung Abscess in an Immunocompetent Adult: A Rare Case Report

Lung abscesses caused by Brevundimonas diminuta (B. diminuta) are a rare occurrence, particularly in immunocompetent adults. We present the case of a 47-year-old male with a history of COPD, bipolar disorder, and seizure disorder, who presented with a productive cough, worsening shortness of breath, yellow sputum, weight loss, and fatigue over a period of three weeks. Clinical examination revealed decreased breath sounds in the left upper lung zones. Laboratory investigations showed an elevated white cell count, while blood cultures identified B. diminuta. Imaging with computed tomography (CT) confirmed the presence of a 4.2x2.0 cm cavitary lesion consistent with a lung abscess. The patient was successfully treated with a combination of Ampicillin/Sulbactam and Azithromycin, followed by a course of oral Augmentin. Given the size of the abscess and favorable response to antibiotic therapy, invasive procedures were deemed unnecessary. This case underscores the importance of considering unusual pathogens in the etiology of lung abscesses, even in immunocompetent individuals, and highlights the successful management with appropriate antibiotic therapy.

Which patient factors increase the risk of fluoroquinolone-associated reactions?

ABSTRACT

Fluoroquinolones commonly are used to treat a variety of infections in the urinary, gastrointestinal, and respiratory tracts. Clinicians should evaluate patients to ensure that a fluoroquinolone is a safe and effective therapy to treat the infection. This article discusses patient factors that increase the risk for serious adverse drug reactions that can occur with fluoroquinolone use.

Elucidating the Antimycobacterial Mechanism of Action of Ciprofloxacin Using Metabolomics

In the interest of developing more effective and safer anti-tuberculosis drugs, we used a GCxGC-TOF-MS metabolomics research approach to investigate and compare the metabolic profiles of Mtb in the presence and absence of ciprofloxacin. The metabolites that best describe the differences between the compared groups were identified as markers characterizing the changes induced by ciprofloxacin. Malic acid was ranked as the most significantly altered metabolite marker induced by ciprofloxacin, indicative of an inhibition of the tricarboxylic acid (TCA) and glyoxylate cycle of Mtb. The altered fatty acid, myo-inositol, and triacylglycerol metabolism seen in this group supports previous observations of ciprofloxacin action on the Mtb cell wall. Furthermore, the altered pentose phosphate intermediates, glycerol metabolism markers, glucose accumulation, as well as the reduction in the glucogenic amino acids specifically, indicate a flux toward DNA (as well as cell wall) repair, also supporting previous findings of DNA damage caused by ciprofloxacin. This study further provides insights useful for designing network whole-system strategies for the identification of possible modes of action of various drugs and possibly adaptations by Mtb resulting in resistance.

Incidence, clinical features, and risk factors of fluoroquinolone-induced acute liver injury: a case-control study

Background

Fluoroquinolone-related hepatotoxicity is rare but serious and is attracting increasing attention. We explored the incidence, clinical features and risk factors of acute liver injury associated with fluoroquinolone use.

Materials and methods

Based on the Adverse Drug Events Active Surveillance and Assessment System that we developed, we carried out a case-control study by enrolling patients who were hospitalized and received fluoroquinolones to treat or prevent infections at the Chinese People's Liberation Army General Hospital from Jan 2016 to Dec 2017. The incidence of fluoroquinolone-induced acute liver injury was estimated, and logistic regression was used to reveal the risk factors of this adverse reaction.

Results

We found that 17,822 patients received fluoroquinolones, and 13,678 of them met the inclusion criteria. A total of 91 patients developed acute liver injury after receiving the medication, and 369 controls were matched to these patients. The overall incidence of fluoroquinolone-induced acute liver injury in the Chinese population is approximately 6-7 cases per 1,000 individuals annually. Multivariate logistic regression analysis showed that older age slightly decreased the risk of hepatotoxicity (OR, 0.98; 95% CI, 0.96-0.99). The male sex (OR, 2.19; 95% CI, 1.07-4.48), alcohol abuse (OR, 2.91; 95% CI, 1.39-6.11) and hepatitis B carrier status (OR, 2.38; 95% CI, 1.04-5.48) increased the risk of liver injury. Concurrent use of cephalosporins or carbapenems was also associated with an increased risk.

Conclusion

Increased risk of fluoroquinolone-related hepatotoxicity may be associated with youth, the male sex, alcohol abuse, hepatitis B carrier status and the concurrent use of cephalosporins or carbapenems.