Pneumonia with Therapeutic Failure Attributed to Impaired Absorption of Levofloxacin Due to Co-administration with Milk: A Case Report
Abstract
Levofloxacin is a fluoroquinolone antibiotic characterized by high oral bioavailability and is commonly prescribed for a wide range of infections, including community-acquired pneumonia. However, co-administration with calcium-containing products may markedly reduce its gastrointestinal absorption. We report a case of pneumonia in which therapeutic failure was attributed to reduced absorption of levofloxacin due to co-administration with milk. A 53-year-old man with ulcerative colitis treated with mesalazine presented with persistent respiratory symptoms despite oral levofloxacin therapy prescribed for pneumonia. Although his fever had resolved, cough and sputum production persisted, and chest imaging demonstrated radiographic progression. He was admitted and treated with intravenous lascufloxacin, resulting in gradual improvement of the clinical symptoms and radiographic findings. Further history-taking revealed that the patient had been consuming milk concurrently with oral levofloxacin, which likely impaired drug absorption and reduced its therapeutic efficacy. After clinical improvement, he was transitioned to oral therapy and discharged. This case highlights the importance of recognizing food–drug interactions that can lead to apparent antibiotic treatment failure. Adequate patient education regarding appropriate administration of fluoroquinolones is essential to ensure optimal therapeutic outcomes and prevent unnecessary treatment escalation.
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