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The Annals of Pharmacotherapy Jan 2005To report a case of ofloxacin/levofloxacin-induced rhabdomyolysis and to compare other reported cases from the literature. (Review)
Review
OBJECTIVE
To report a case of ofloxacin/levofloxacin-induced rhabdomyolysis and to compare other reported cases from the literature.
CASE SUMMARY
A 19-year-old male patient developed ofloxacin/levofloxacin-induced rhabdomyolysis during admission for periorbital cellulitis. Symptoms of myalgia, weakness, and swelling of the arms developed after 3 days of treatment with ofloxacin 800 mg/day. Laboratory analysis confirmed the presence of urine myoglobin (381.2 microg/L) and a marked increase in serum myoglobin (590.8 microg/L), along with marked elevations in serum creatine kinase (up to 16 546 IU/L).
DISCUSSION
In addition to ruling out other possible etiologic factors one by one, we assessed the probability of ofloxacin/levofloxacin-induced rhabdomyolysis by observing the close time relationship between drug administration and the development of symptoms/signs, as well as the close time relationship between drug withdrawal and the disappearance of symptoms/signs. An objective causality assessment by use of the Naranjo probability scale revealed that the adverse drug reaction was probable.
CONCLUSIONS
Although ofloxacin/levofloxacin-induced rhabdomyolysis appears to be rare, patients with muscle pain, swelling, or weakness during therapy should be closely monitored for this adverse effect.
Topics: Adult; Anti-Bacterial Agents; Creatine Kinase; Humans; Levofloxacin; Male; Ofloxacin; Rhabdomyolysis
PubMed: 15562138
DOI: 10.1345/aph.1E285 -
American Journal of Therapeutics
Topics: Humans; Levofloxacin; Anti-Bacterial Agents; Ofloxacin; Brain Diseases
PubMed: 36848632
DOI: 10.1097/MJT.0000000000001615 -
The Science of the Total Environment Jun 2022Drug chirality is attracting increasing attention because the enantiomers of the same chiral pharmaceutical usually exhibit different biological activities, metabolic...
Drug chirality is attracting increasing attention because the enantiomers of the same chiral pharmaceutical usually exhibit different biological activities, metabolic pathways, and toxicities. The ubiquitous presence of microplastics (MPs) can enrich organic pollutants commonly found in the environment. However, knowledge about the enrichment of pharmaceutical enantiomers to MPs is relatively limited. We investigated the occurrence of enantioselectivity of ofloxacin (OFL) and levofloxacin (LEV) in the adsorption processes on polyethylene (PE) and the interactions influenced by environmental factors. The results showed that the adsorption efficiency of OFL was generally 3-5% (p < 0.05) higher than that of LEV, indicating the different affinities of the enantiomers to PE, but the adsorption process of OFL and LEV on PE was both well described by pseudo-first-order kinetics and liner isotherm models. The chirality of OFL and LEV was not affected by sizes of PE particles and solution salinity due to the identical physicochemical properties. An examination of pH effect indicated that OFL showed better acid-base adaptability than LEV. Moreover, the differences in enantiomeric enrichment between OFL and LEV on PE were promoted with increasing UV light exposure time and natural organic matter (NOM) concentrations. Using Fourier transform infrared spectroscopy (FTIR), we demonstrated that the constituents of the functional groups in chiral NOM were greatly related to the enantiomer stereoselectivity of OFL, subsequently affecting their adsorption in a chiral environment. The excitation-emission matrix (EEM) spectra confirmed the enantioselective behaviors of chiral pharmaceuticals under UV light due to the different optical activity and humic acid-like and fulvic acid-like molecular structure of the enantiomers. These findings imply that the enantioselectivity of drug enantiomers should be considered in presence of microplastics, leading to a more accurate environmental fate and risks assessments of chiral pharmaceuticals.
Topics: Adsorption; Levofloxacin; Microplastics; Ofloxacin; Pharmaceutical Preparations; Plastics; Polyethylene; Water Pollutants, Chemical
PubMed: 35157859
DOI: 10.1016/j.scitotenv.2022.153765 -
Expert Opinion on Pharmacotherapy Nov 1999Levofloxacin (DR-3355, Daiichi) is a new fluoroquinolone antibiotic which is the active isomer of ofloxacin (DL-8280, Daiichi). By removing the inactive isomer, the in... (Review)
Review
Levofloxacin (DR-3355, Daiichi) is a new fluoroquinolone antibiotic which is the active isomer of ofloxacin (DL-8280, Daiichi). By removing the inactive isomer, the in vitro activity of levofloxacin is 8-128 times higher than that of ofloxacin. This means that bacterial species, which have borderline susceptibility to ofloxacin and other first generation fluoroquinolones (e.g., pneumococci and organisms causing atypical pneumonia), are considerably more sensitive to levofloxacin. The pharmacokinetics of levofloxacin, which is available for both oral and i.v. administration, are characterised by a very high bioavailability, low (30-40%) protein binding, high tissue concentrations and elimination via the kidneys with minimal liver metabolism. As a consequence of the low degree of metabolism, levofloxacin does not interact with other drugs to any major extent. The safety and efficacy of levofloxacin are well documented in lower respiratory tract infections, skin and soft tissue infections, and urinary tract infections. The safety profile seems advantageous and the risks of phototoxicity, CNS toxicity and cardiac reactions (prolongation of QT-time) are low. Serious liver toxicity, leading to the recent withdrawal of trovafloxacin, has not been a problem in levofloxacin studies. Levofloxacin is a valuable addition to the group of fluoroquinolone antibiotics.
Topics: Animals; Anti-Infective Agents; Bacteria; Bacterial Infections; Clinical Trials as Topic; Humans; Levofloxacin; Ofloxacin
PubMed: 11249554
DOI: 10.1517/14656566.1.1.109 -
Environmental Pollution (Barking, Essex... Jan 2023Adsorption and transport of levofloxacin (LEV) and ofloxacin (OFL) enantiomers in a matrix containing goethite and natural organic matter (NOM) were investigated using...
Adsorption and transport of levofloxacin (LEV) and ofloxacin (OFL) enantiomers in a matrix containing goethite and natural organic matter (NOM) were investigated using batch and column experiments. In batch studies, competition and enantioselectivity were observed in the adsorption of LEV and OFL. Enantioselectivity upon adsorption was investigated by comparing changes in the enantiomer fraction (EF) (the ratio of LEV to the sum of LEV and OFL remaining in the solution) after and before adsorption. At pH < 7, there was hardly any selectivity in adsorption of OFL and LEV to goethite. At pH > 7, OFL showed a stronger adsorption than LEV to goethite, and this preference remained when NOM samples of Leonardite humic acid (LHA) and Elliott Soil fulvic acid (ESFA) were added. However, when Suwannee River NOM (SRNOM) was added, the preference was reversed, and LEV was adsorbed more strongly. In single systems, the presence of different types of NOM increased adsorption of LEV and OFL, especially LEV. In column studies, preloaded NOM decreased the transport of LEV and OFL through goethite-coated sand. The EF values in the effluent increased with retention time and reached the largest values (0.59-0.72) at around 1.5 pore volume (PV), and then decreased again, reaching a stable value at 5.0-30.0 PV. Both batch and column experiments showed that, fractionation of LEV and OFL occurred during adsorption and transport in the presence of NOM-goethite complexes, which would eventually affect their environmental fate.
Topics: Levofloxacin; Ofloxacin; Iron Compounds; Adsorption; Humic Substances
PubMed: 36328279
DOI: 10.1016/j.envpol.2022.120542 -
Deutsche Medizinische Wochenschrift... Aug 2019Diagnosed and reported Legionella pneumonias are slightly increasing during recent years. This might at least partially be due to more frequently used diagnostic...
Diagnosed and reported Legionella pneumonias are slightly increasing during recent years. This might at least partially be due to more frequently used diagnostic tests.In severe pneumonia, nucleic acid amplification based methods should supplement the L. pneumophila serogroup-1 urinary antigen test because of their improved spectrum and sensitivity.Recent in vitro data suggest enhanced efficacy of levofloxacin when compared to macrolides. This complements recent clinical cohort data. Thus levofloxacin (750-1000 mg/d) is regarded the treatment of choice for confirmed legionellosis. Second line options are azithromycin or moxifloxacin. Treatment duration of 7 days should be sufficient in most cases.Development of resistance is rare and no routine resistance testing is necessary.
Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Humans; Legionella; Legionellosis; Levofloxacin
PubMed: 31350743
DOI: 10.1055/a-0662-9330 -
Acta Poloniae Pharmaceutica May 2017The commercially available coated tablets containing either racemic form of ofloxacin (Tarivid 200 mg, OfloHexal 200 mg and Ofloxacin-Ratiopharm 200 mg) or only... (Comparative Study)
Comparative Study
The commercially available coated tablets containing either racemic form of ofloxacin (Tarivid 200 mg, OfloHexal 200 mg and Ofloxacin-Ratiopharm 200 mg) or only levofloxacin S-(-)-isomer (Tavanic 250 mg) were examined. The aim of our study was to establish the kinetics of dissolution rate process of ofloxacin optical isomers (S-(-) and R-(+)-ofloxacin) from solid oral dosage forms using flow-through cell method (USP 4 method). The concentrations of analytes (racemic ofloxacin and its enantiomers) in the samples of tablet extracts as well as in dissolution media (0.1 M/L HCl and phosphate buffer pH 6.8) were determined by validated high performance capillary electrophoresis method. The fraction of the average dose of the individual optical isomers of ofloxacin released from the examined tablets was calculated. In the case of the OfloHexal, Ofloxacin-Ratiopharm and Tavanic it was found to be around 100% for both S-(-) and R-(+)-ofloxacin in 0.1 M/L HCI after 30 min of dissolution test. The fraction of the average dose for the Tarivid tablets was approximately 50% at the same time. A similar results were observed for the Ofloxacin-Ratiopharm and Tavanic tablets examined in phosphate buffer (average fraction about 100% after 30 min), while in the case of Tarivid and OfloHexal the averige fraction of the dose determined in a buffer pH 6.8 was 14% and 44%, respectively. There were not found any differences in the kinetics of dissolution of the S-(-)-ofloxacin and R-(+)-ofloxacin isomers within the same formulation. However, statistically significant differences were found in the dissolution of ofloxacin enantiomers between different preparations.
Topics: Anti-Infective Agents; Calibration; Drug Compounding; Drug Liberation; Electrophoresis, Capillary; Isomerism; Kinetics; Levofloxacin; Limit of Detection; Models, Chemical; Models, Statistical; Ofloxacin; Reference Standards; Solubility; Tablets; Technology, Pharmaceutical
PubMed: 29513966
DOI: No ID Found -
Tuberculosis (Edinburgh, Scotland) Mar 2008
Review
Topics: Animals; Antitubercular Agents; Humans; Levofloxacin; Ofloxacin; Treatment Outcome; Tuberculosis
PubMed: 18486047
DOI: 10.1016/S1472-9792(08)70013-1 -
Ecotoxicology and Environmental Safety Jul 2023Excessive antibiotics transferred into the aquatic environment may affect the development of amphibians. Previous studies on the aquatic ecological risk of ofloxacin...
Excessive antibiotics transferred into the aquatic environment may affect the development of amphibians. Previous studies on the aquatic ecological risk of ofloxacin generally ignored its enantiomers. The purpose of this study was to compare the effects and mechanisms of ofloxacin (OFL) and levofloxacin (LEV) on the early development of Rana nigromaculata. After 28-day exposure at environmental levels, we found that LEV exerted more severe inhibitory effects on the development of tadpoles than OFL. According to the enrichment results of differentially expressed genes in the LEV and OFL treatments, LEV and OFL had different effects on the thyroid development of tadpoles. dio2 and trh were affected by the regulation of dexofloxacin instead of LEV. At the protein level, LEV was the main component that affected thyroid development-related protein, while dexofloxacin in OFL had little effect on thyroid development. Furthermore, molecular docking results further confirmed that LEV was a major component affecting thyroid development-related proteins, including DIO and TSH. In summary, OFL and LEV regulated the thyroid axis by differential binding to DIO and TSH proteins, thereby exerting differential effects on the thyroid development of tadpoles. Our research is of great significance for comprehensive assessment of chiral antibiotics aquatic ecological risk.
Topics: Animals; Ofloxacin; Levofloxacin; Larva; Thyroid Gland; Molecular Docking Simulation; Anti-Bacterial Agents; Ranidae; Hypothalamus; Thyrotropin
PubMed: 37178612
DOI: 10.1016/j.ecoenv.2023.114985 -
Progress in Neuro-psychopharmacology &... Jun 2009
Topics: Anti-Infective Agents, Urinary; Catatonia; Female; Humans; Levofloxacin; Middle Aged; Ofloxacin
PubMed: 19332099
DOI: 10.1016/j.pnpbp.2009.03.019