Levofloxacin/methylprednisolone interaction
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Achilles tendon rupture in an elderly patient: case report A 65-year-old woman developed bilateral Achilles tendon rupture while concomitantly receiving levofloxacin and methylprednisolone [routes not stated; time to reaction onset not clearly stated] for pneumonia. The woman received levofloxacin 500 mg/day for 2 weeks and tapered doses of methylprednisolone (16 to 8 mg/day) for 12 days. She had experienced ankle pain a day after treatment initiation, and she presented 2 weeks later because of progressive pain. Haematoma and swelling were noted in her calcaneus area, and there was pain in her Achilles tendon area on palpation and dorsal flexion. The Thompson test was positive on the left, and an ultrasound showed bilateral Achilles tendon rupture. The woman had a lower leg cast for 6 weeks. Levofloxacin and methylprednisolone were already withdrawn prior to her presentation, and her cast was in neutral position on last follow-up. Author comment: On the Naranjo scale, which is used to determine if there is a causal connection between the use of a medicine and a side effect (www.ntvg/nl/naranjo), the above described side effect scored 6 points. This means that a causal connection in this case is ‘probable’. . . Concomitant use of glucocorticoids and fluoroquinolones strongly increases the risk of a tendon rupture. Kok LM, et al. [Bilateral Achilles tendon rupture following levofloxacin and glucocorticoid use]. Nederlands Tijdschrift voor Geneeskunde 156: A4192, No. 13, 803074252 31 Mar 2012 [Dutch; summarised from a translation] - Netherlands
0114-9954/10/1412-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 28 Jul 2012 No. 1412
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