[Neurologic side effects of fluoroquinolones. Apropos of 9 cases concerning pefloxacin].
Neurological side-effects were a limiting factor with older quinolones. Although they appear to be less frequent with the newer fluoroquinolones, we observed nine such cases at Amiens University Hospital over a four-year period. The patients were six women and three men, with a mean age of 61 years. They received a mean dose of 800 mg/day of pefloxacin. Four had septic shock, one left ventricular failure, and seven had signs of cholestasis (signs of liver failure were absent). Neurological manifestations occurred between 24 hours and seven days after starting treatment and disappeared within 24 to 48 hours of stopping the drug or reducing the dosage. They included myoclonia (3 cases), convulsions (2 cases, one with concomitant theophylline), delirium and agitation (2 cases, one in a patient on steroids) and confusion (3 cases). Plasma drug levels were determined in six patients and were above normal peak levels (10 micrograms/ml) in five. Pefloxacin was measured in the cerebrospinal fluid in two cases (8.7 and 15.0 micrograms/ml). Neurological manifestations during pefloxacin treatment are probably related to overdose (plasma levels were above normal in 5/6 cases), possibly being favoured by cholestasis (7/9 cases) and/or hemodynamic factors (5/9). Symptoms can resolve when the pefloxacin dosage is reduced.
Andrejak
M
M
Service de Pharmacologie Clinique, Hôpital Sud, CHU d'Amiens.
Schmit
J L
JL
Tondriaux
A
A
Hary
L
L
Debailleux
S
S
Moore
N
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000009:adverse effects; D001927:Brain Diseases / Q000139:chemically induced* / Q000453:epidemiology; D062787:Drug Overdose; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015366:Pefloxacin / Q000008:administration & dosage / Q000009:adverse effects*; D012307:Risk Factors
D000890:Anti-Infective Agents; D015366:Pefloxacin
Effets indésirables neurologiques des fluoroquinolones. A propos de 9 observations concernant la péfloxacine.