I’d like to bring attention to a study done by Doctors Andrew W Gottschalk and John W Bachman of the Mayo Clinic Department of Family Medicine. The case study involves an elderly man given Levaquin for a presumed brochitis who developed complete tendon ruptures of both of his Achilles heels. This drug’s side-effect was directly responsible for his subsequent physical and psychologic decline and unfortunate death.
The doctors found that with Achilles tendon rupture, as with hip fracture in the elderly, ‘the best offense is a good defense’. Steroid co-medication is a known risk factor for tendinopathy, and thus should be avoided when placing a patient on levofloxacin, or indeed on any fluoroquinolone. Patients currently on corticosteroid treatment should receive trials with other antibiotics before levofloxacin is considered. Doses should be adjusted accordingly in patients with decreased creatinine clearance. All patients should be educated as to possible side-effects of treatment. The development of tendonitis is an indication for discontinuing therapy, and informing patients of the possibility of tendon distress may prevent severe complications. Levofloxacin is an expensive, commonly used antibiotic. Although this fluoroquinolone is often appropriate therapy under certain circumstances, their case reminds us that levofloxacin therapy has associated risks, which in their patient catalyzed a downward spiral resulting in death.
The following is a brief summary, or read the case study in full here:
An active senior, a farmer, came to the Mayo Clinic because his “feet [weren’t] working”. One month earlier, the patient was diagnosed with bronchitis at an outside clinic and was treated with a seven-day course of levofloxacin 500 mg by mouth, taken once a day. His heel pain began over the first four days of fluoroquinolone treatment. On the seventh day of treatment, upon dismounting his tractor, he noticed sudden, severe pain in both of his heels and a compromised ability to get around independently.
He had no history of tendinopathy. But MRIs of his ankles showed complete rupture of both Achilles tendons. He was fitted with casts for his heels and discharged from the hospital one day after admission. Five weeks after hospital admission, the patient’s casts were removed and he was fitted with controlled ankle motion (CAM) boots. Nine weeks after hospitalization, the patient was instructed to stop wearing the CAM boots and began wearing his own tennis shoes.
At his initial presentation to the outpatient care center on the day of admission, the patient’s primary care physician noted, “History of depression and anxiety: He is not anxious and depression is currently not a problem. He looks much brighter.” However, at the meeting with his orthopedic surgeon nine weeks after hospital discharge, both the patient and family members noted decreased energy levels and general lack of enthusiasm. There was concern that these symptoms were fueled by his immobility.
Ten weeks after diagnosis, the patient presented to the Emergency Department with a 22-pound weight loss over the prior two months as well as generalized lethargy. He was hospitalized for evaluation where he was hydrated and his antihypertensive regimen was modified. He was discharged with blood pressures well within the normal range and with close follow-up with his primary care physician. The patient was readmitted for inpatient care the following day with hospital-acquired pneumonia. He subsequently developed kidney failure, sepsis, heart failure, and a myocardial infarction. After consultation with the patient and his family, care was withdrawn and comfort care measures were initiated until the patient passed away 11 weeks after the initial diagnosis of bilateral complete Achilles tendon rupture.
In the study, the doctors show that tendon rupture can be deadly. Physiologically, their patient could not perform the farm chores his body had become accustomed to and could no longer actively prepare his own meals. Psychologically, his mobility had allowed him to interact with his family, friends, and coworkers on the farm. Immobility led to social isolation which led to a recurrence of his depression. This, coupled with his rapid deconditioning, resulted in disaster.
Source: Journal of Medical Case Reports, Death following bilateral complete Achilles tendon rupture in a patient on fluoroquinolone therapy, by Drs. Andrew W Gottschalk and John W Bachman, available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2631494
As always, we at LevaquinBlog hope you educate yourself before taking any medicine, especially one with serious known risks such as Levaquin.
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