Levofloxacin-Associated Mania: A Case Report
Abstract
To the Editor: Fluoroquinolones are a class of broad-spectrum antibiotics used worldwide. Levofloxacin is a thirdgeneration fluorinated quinolone, which is an optically active L-isomer of racemic ofloxacin. It has a broad spectrum of antibacterial activity against both grampositive and gram-negative bacteria through antagonism of topoisomerase IV and DNA gyrase (topoisomerase II), respectively.1 It is commonly used to treat community-acquired pneumonia, gastrointestinal infections, and urinary infections. Common adverse drug reactions seen with quinolones include gastrointestinal disturbances (nausea and diarrhea) and some central nervous system (CNS) side effects (headache, dizziness, and sleep disturbances), whereas tendinopathy, QTc prolongation, retinal detachment, and severe neuropsychiatric complications are uncommon.2,3 Rare neuropsychiatric adverse reactions reported with quinolones include delirium, agitation, confusion, psychosis, and seizures.2,4–7 The safety profile of the quinolones varies; levofloxacin has a good tolerance profile as compared with other fluoroquinolones.8 We report a case of a middle-aged woman treated with levofloxacin after cholecystectomy, who developed mania that resolved after specific treatment. A 45-year-old woman otherwise fit and well with no premorbidity was diagnosed with acute cholecystitis and underwent laparoscopic cholecystectomy. She received oral levofloxacin 500 mg twice a day during the postoperative period and was discharged…
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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