Yaşlılarda Levofloksasin Kullanımının Güvenliliği

Yıl 2021, Cilt: 4 Sayı: 2, 45 - 51, 31.08.2021

Kenan Sakar , Ali Ekrem Aydın , Özge Dokuzlar , Suleyman Emre Kocyıgıt

https://doi.org/10.47141/geriatrik.984996

Öz

Amaç: Levofloksasin en sık reçete edilen antibakteriyel ajanlardan biridir. Geriatri pratiğinde önemli olan birçok enfeksiyonun tedavisinde kullanılmaktadır. Bu çalışmada yaşlı hastalarda birçok avantaj sağlayan levofloksasinin güvenilirliğini araştırmayı amaçladık.

Gereç ve Yöntemler: Geriatri polikliniğine başvuran ve herhangi bir nedenle levofloksasin tedavisi alan 92 yaşlı hastanın tıbbi kayıtları retrospektif olarak incelendi. Demografik özellikler, ilaçlar ile tedavinin başlangıcında ve üçüncü gününde elektrokardiyografi parametreleri, Apati Değerlendirme Ölçeği puanı ve Konfüzyon Değerlendirme Ölçeği ile değerlendirilen deliryum varlığı kaydedildi. Ayrıca yedinci günde verilerine ulaşılabilen verileri kaydedildi. Tüm hastalar veya bakım verenler tedaviden sonraki 90 gün içinde tendinit veya tendon rüptürü açısından sorgulandı.

Bulgular: Hastaların yaş ortalaması 80,75±7,01 yıl ve %57,6'sı kadındı. Başlangıç ve üçüncü gün QT (p:0,008) ve QTc (p<0,001) değerleri arasında anlamlı fark varken, 7. günde fark yoktu (p>0,05). Deliryum ve Apati Değerlendirme Ölçeği puanları tedavi süresince iyileşme gösterdi (p>0,05). Hiçbir hasta nöbet geçirmedi. Tedavi sırasında veya tedaviden sonraki 3 ay içinde tendinit ve tendon yırtılması tespit edilmedi.

Sonuç: Bu sonuçlar ışığında, yaşlı erişkinlerde ek risk faktörlerine dikkat edilerek levofloksasin kullanımı güvenli görünmektedir.

Anahtar Kelimeler

Apati, Deliryum, Levofloksasin, QTc, Yaşlı

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

yok

Safety of Levofloxacin in Older Adults

Öz

Aim: Levofloxacin is one of the most prescribed antibacterial agents. They are used for the treatment of many infections, which are of paramount importance for geriatric practice. In this study, we aimed to investigate the safety of levofloxacin, which provides many advantages in older patients.

Material and Methods: The medical records of 92 older patients admitted to the geriatric clinic and treated with levofloxacin for any reason were retrospectively reviewed. Demographic characteristics, drugs, electrocardiography parameters, Apathy Evaluation Scale score, and delirium evaluated by Confusion Assessment Method were recorded on the baseline and the third day. We also recorded 21 patients’ seventh-day data, which can be available. All the patients or caregivers were questioned about tendinitis or tendon rupture within 90 days after treatment at the outpatient controls.

Results: The mean age of the patients was 80.75±7.01 years, and 57.6% were female. There was a significant difference between baseline and third day QT (p:0.008) and QTc (p<0.001) values, but on the 7th day, not (p>0.05). Delirium and Apathy Evaluation Scale scores improved during the treatment (p>0.05). No patient had a seizure. Tendinitis and tendon rupture were not detected during or within the three months after the treatment.

Conclusion: In the light of these results, the use of levofloxacin seems to be safe in older adults, with caution on additional risk factors.

Anahtar Kelimeler

Apathy, Delirium, Levofloxacin, Older adult, QTc

Proje Numarası

yok

Kaynakça

• 1. Liu X, Ma J, Huang L, et al. Fluoroquinolones increase the risk of serious arrhythmias: A systematic review and meta-analysis. Medicine (Baltimore). 2017; 96(44):e8273.
• 2. Bidell MR, Lodise TP. Fluoroquinolone-Associated Tendinopathy: Does Levofloxacin Pose the Greatest Risk? Pharmacotherapy. 2016; 36(6):679–93.
• 3. Yoshikawa TT, Livesley NJ, Chow AW. Infected Pressure Ulcers in Elderly Individuals. Clin Infect Dis. 2002; 35(11):1390–6.
• 4. Ates Bulut E, Soysal P, Isik AT. Frequency and coincidence of geriatric syndromes according to age groups: Single-center experience in Turkey between 2013 and 2017. Clin Interv Aging. 2018;13:1899–905.
• 5. Gao CH, Yu LS, Zeng S, et al. Personalized therapeutics for levofloxacin: A focus on pharmacokinetic concerns. Ther Clin Risk Manag. 2014; 10:217–27.
• 6. Noreddin AM, Elkhatib WF. Levofloxacin in the treatment of community-acquired pneumonia. Expert Rev Anti Infect Ther. 2010; 8(5):505–14.
• 7. Kuula LSM, Viljemaa KM, Backman JT, et al. Fluoroquinolone-related adverse events resulting in health service use and costs: A systematic review. PLoS One. 2019; 14(4):e0216029.
• 8. Liu HH. Safety profile of the fluoroquinolones: Focus on levofloxacin. Drug Saf. 2010; 33(5):353–69.
• 9. Shi S, Klotz U. Age-related changes in pharmacokinetics. Curr Drug Metab. 2011; 12(7):601–10.
• 10. Hooper,DC. Fluoroquinolones. https://www.uptodate.com/contents/fluoroquinolones?search=levofloxacin%20drug%20information&source=search_result&selectedTitle=1~145&usage_type=default&display_rank=1#H2783446913. Accessed June 3, 2019.
• 11. Bazett HC. An analysis of the time-relations of electrocardiograms. Heart. 1920; 7:353–70.
• 12. Straus SMJM, Kors JA, De Bruin ML, et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol. 2006; 47(2):362–7.
• 13. Vandael E, Vandenberk B, Vandenberghe J, et al. Risk factors for QTc-prolongation: systematic review of the evidence. Int J Clin Pharm. 2017; 39(1):16–25.
• 14. Marin RS, Biedrzycki RC, Firinciogullari S. Reliability and validity of the apathy evaluation scale. Psychiatry Res. 1991; 38(2):143–62.
• 15. Gulseren S, Atun C, Erol A, et al. Apati değerlendirme ölçeği Türkçe formunun geçerlilik ve güvenilirlik çalışması. Nöropsikiatri Arşivi. 2001; 38(3):142–50.
• 16. Inouye SK, Van Dyck CH, Alessi CA, et al. Clarifying confusion: The confusion assessment method: A new method for detection of delirium. Ann Intern Med. 1990; 113(12):941–8.
• 17. Tsai WC, Yang YM. Fluoroquinolone-associated Tendinopathy. Chang Gung Med J. 2011; 34(5):461–7.
• 18. Faulkner CM, Cox HL, Williamson JC. Unique Aspects of Antimicrobial Use in Older Adults. Clin Infect Dis. 2005; 40(7):997–1004.
• 19. Mehrzad R, Barza M. Weighing the adverse cardiac effects of fluoroquinolones: A risk perspective. J Clin Pharmacol. 2015; 55(11):1198–206.
• 20. Amankwa K, Krishnan SC, Tisdale JE. Torsades de pointes associated with fluoroquinolones: Importance of concomitant risk factors. Clin Pharmacol Ther. 2004; 75(3):242–7.
• 21. Gervasoni C, Cattaneo D, Falvella FS, et al. Levofloxacin-induced seizures in a patient without predisposing risk factors: the impact of pharmacogenetics. Eur J Clin Pharmacol. 2013; 69(8):1611–3.
• 22. Armstrong MJ, Fox SH, Marras C. Improvement of apathy after levofloxacin treatment: An N-of-1 study. Neurologist. 2012; 18(3):146–8.
• 23. Chhajed PN, Plit ML, Hopkins PM, et al. Achilles tendon disease in lung transplant recipients: Association with ciprofloxacin. Eur Respir J. 2002; 19(3):469–71.
• 24. Carbon C. Comparison of side effects of levofloxacin versus other fluoroquinolones. Chemotherapy. 2001; 47 Suppl 3:9–14.
• 25. Godoy-Santos AL, Bruschini H, Cury J, et al. Fluoroquinolones and the Risk of Achilles Tendon Disorders: Update on a Neglected Complication. Urology. 2018; 113:20–5.
• 26. Mathis AS, Chan V, Gryszkiewicz M, Adamson RT, et al. Levofloxacin associated Achilles tendon rupture. Ann Pharmacother. 2003; 37(7–8):1014–7.