Fluoroquinolone Induced Movement Disorders: Case Report and Literature Review

Year 2018, Volume: 4 Issue: 1, 53 - 63, 01.01.2018

Duane Bates Jenny Edwards Justin Chow Michael Fisher Aaron Switzer Christine Morris

https://doi.org/10.5455/umj.20180207122003

Abstract

Background: Movement disorders are a very rare adverse effect of fluoroquinolones. The mechanism involves inhibition of GABA-A-receptors as well as activation of the excitatory NMDA receptors. This is thought to induce a hyperexcitable neuronal state. A literature review suggests this is a class effect and occurs shortly after initiation and resolves within a few days of discontinuation. Case Presentation: A 62-year-old man with Campylobacter jejuni was treated with levofloxacin. The patient had normal liver enzymes and serum creatinine. Two hours after the initial dose of levofloxacin it was noted that the patient neck would shake and turn to the left and his right arm would abduct at the shoulder and flex at the elbow. The movements would occur every 1 to 2 minutes. There was muscle fasciculations in the bicep and forearm of the right arm briefly after the neck movement. The patient was given diphenhydramine 25 mg IV x 1 dose and within 20 minutes there was a reduction in the abnormal movements. Within 24 hours the movement disorder had completely resolved. Conclusion: The case presented and literature review summarizes the data on fluoroquinolone induced movement disorders.

Keywords

Fluoroquinolone, levofloxacin, movement disorder, motor dysfunction

References

• Stahlmann R, Lode. Safety considerations of fluoro quinolones in the elderly: an update. Drugs Aging, 27(3), 2010, 193-209.
• Grill MF, Maganti RK. Neurotoxic effects associated with antibiotic use: management considerations. Br J Clin Pharmacol, 72(3), 2011, 381-93.
• Lode H. Potential interactions of the extended-spectrum fluoroquinolones with CNS. Drug Saf, 21(2), 1999, 123-35.
• Lau A, Chan LN. Electrolytes, other minerals and trace elements. In: Lee M. Basic skills in interpreting laboratory data. 5th edition. (Bethesda (MD): American Society Health- System Pharmacists. 2013) 119-149.
• Micromedex® 2.0, (electronic version). Truven Health Analytics, Greenwood Village, Colorado, USA. Available at: http://micromedexsolutions.com(cited: Oct/ 24/2016).
• Beaulieu I, Nadeau C. Myoclonus and convulsions. In: Neron A, editor. Care Beyond Cure: Management of Pain and Other Symptoms. 4th edition. (Montreal (QC): l’Association des pharmaciens des établissements de santé du Québec (A.P.É.S.) and the Canadian Society of Hospital Pharmacists (CSHP), 2009) 285-96.
• Allos BM, Lovine NM, Blaser MJ. Campylobacter jejuni and related species. In: Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th edition. (Philadelphia, PA : Elsevier/Saunders, 2015) 2485-93.
• Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, Janecek E, Domecq C, Greenblatt DJ. Clin Pharmacol Ther, 30(2), 1981, 239-45.
• Addalla A, Ramly S, Boers P, Casserly L. Ciprofloxacin- associated choreoathetosis in a hemodialysis patient. BMJ Case Rep, 2013 Apr 18;2013.pii: bcr2013009293.
• Cheung YF, Wong WWY, Tang KW, Chan JHM, Li PCK. Ciprofloxacin-induced palatal tremor. Mov Disord, 22(7), 2007, 1038-43.
• Marinella MA. Myoclonus and generalized seizures associated with gatifloxacin treatment. Arch Intern Med, 161(18), 2001, 2261-62.
• Yasuda H, Yoshida A, Masuda Y, Fukayama, Kita Y, Inamatsu T. Levofloxacin-induced neurological adverse effects such as convulsions, involuntary movement (tremor, myoclonus and chorea like). Visual hallucination in two elderly patients. Nihon Ronen Igakkai Zasshi, 36(3), 1999, 213-17.
• Sharma DD, Aggarwal A, Sharma RC, Kumar R. A probable association of acute dystonia with gemifloxacin administration. Indian J Med Sci, 63(12), 2009, 557-60.
• MacLeod W. Case report: severe neurological reaction to ciprofloxacin. Can Fam Physician. 2001 47(march), 2001, 553-55.
• Mittal SO, Machado DG, Jabbari B. Orofacial dyskinesia after moxifloxacin treatment-case with normal hepato renal function and review of literature. Clin Neuropharmacol, 35(6), 2012, 292-4.
• Thomas RJ, Reagan DR. Association of a Tourette-like syndrome with ofloxacin. Ann Pharmacother, 30(2), 1996, 138-41.
• Kim SH, Jeong SH, Kim JW, Lee SH, Kim JM. A case of hemiballism as a rare side effect of ciprofloxacin in a patient with liver cirrhosis. Chemotherapy, 55(4), 2009, 207-10.
• Lee CH, Cheung RTF, Chan TM. Ciprofloxacin-induced oral facial dyskinesia in a patient with normal liver and renal function. Hosp Med, 61(2), 2000, 142-43.
• Post B, Koelman JHTM. Tijssen AJ. Prospinal myoclonus after treatment with ciprofloxacin. Mov Disord, 19(5), 2004, 595-97.
• Azar S, Ramjiani A, Van Gerpen JA. Ciprofloxacin–induced chorea. Mov Disord, 20(4), 2005, 513-14.
• Schwartz MT, Calveert JF. Potential neurological toxicity related to ciprofloxacin. DICP, 24(2), 1990, 138-40.
• Striano P, Zara F, Coppola A, Ciampa C, Pezella M, Striano S. Epileptic myoclonus as ciprofloxacin associated adverse effect. Mov Disord, 22(11), 2007, 1675-76.
• Mohan N, Menon K, Rao PG. Oral gatifloxacin-induced ataxia. Am J Health-Syst Pharm, 59(19), 2002, 1894.
• Host BD, Sloan W. Orofacial dyskinesia associated with the use of levofloxacin. Ann Pharmacother, 48(1), 2014, 142-44.
• Pastor P, Moitinho E, Elizalde I, Cirera I, Tolosa E. Reversible oral-facial dyskinesia in a patient receiving ciprofloxacin hydrochloride. J Neurol, 243(8), 1996, 616-17.
• DeBleecker JL, Vervaet VL. Reversible orofacial dyskinesia after ofloxacin treatment. Mov Disord, 19(6), 2004, 731-32.
• Murray CK, Wortmann GW. Trovafloxacin-induced weakness due to a demyelinating polyneuropathy. South Med J, 93(5), 2000, 514-5.
• Farrington J, Stoudemire A, Tierney J. The role of ciprofloxacin in a patient with delirium due to multiple etiologies. Gen Hosp Psychiatry, 17(1), 1995, 47-53.
• Sousa J, Alves G, Fortuna A, Falcao A. Third and forth generation fluoroquinolone antibacterials: a systematic review of safety and toxicity profiles. Curr Drug Saf, 9(2), 2014, 89-105.
• Iigin S, Can OD, Atli O, Ucel UI, Sener E, Guven I, Ciprofloxacin-induced neurotoxicity: evaluation of possible underlying mechanisms. Toxicol Mech Methods, 25(5), 2015, 374-81.
• Nau R, Sorgel F, Eiffert H. Penetration of drugs through the blood-cerebrospinal fluid/blood-brain barrier for treatment of central nervous system infections. Clin Microbiol Rev, 23(4), 2010, 858-83.
• Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis, 39(9), 2004, 1267-84.
• Tunkel AR. Initial therapy and prognosis of bacterial meningitis in adults. UpToDate online [internet database]. Version 22.0. Waltham (MA): UpToDate Inc; [updated 2015 Oct 7; cited 2016 Oct 21]. Available from http.uptodate online.com. Subscription required to access content.
• Leonard JM. Central nervous system tuberculosis. In: UpToDate online [internet database]. Version 22. Waltham (MA): UpToDate Inc; [updated 2015 Oct 7; cited 2016 Oct 21]. Available from http.uptodateonline.com. Subscription required to access content.
• Lexicomp [database on the Internet]. Hudson (OH): Wolters Kluwer Clinical Drug Information; © 1978–2016 [updated daily; cited 2016 Oct 25]. Available from: http://online. lexi.com [subscription required to access content]
• Davey PG, Charter M, Kelly S, Varma TRK, Jacobson I, Freeman A et al. Ciprofloxacin and sparfloxacin penetration into human brain tissue and their activity as antagonists of GABAA receptor of the rat vagus nerve. Antimicrob Agents Chemother, 38(6), 1994, 1356-62.
• Leone M, Sampol-Manos E, Santelli D, Grabowski, Alliez B, Durand A et al. Brain tissue penetration of ciprofloxacin following the single intravenous dose. J Antimicrob Chemother, 50(4), 2002, 607-09.