The safety profile of levofloxacine use for older adults

ABSTRACT Introduction And Aim: Levofloxacin is an antibiotic that commonly used for infection diseases such as lower respiratory and urinary tract infections. Although it is stated that it is safe in terms of side effect profile, there are reports such as QT interval prolongation, tendinopathy and achilles tendon rupture, delirium and apathy in the literature. There are concerns about the safety of levofloxacin therapy in geriatric patients with multiple comorbidities, such as diabetes, cardiovascular disease. This retrospective study aims to investigate the safety of the use of levofloxacin in geriatric cases. Material and Method: Between January 2015-December 2017, 92 patients who were over 60 years of age and who had received levofloxacin therapy from the Geriatrics Clinic were retrospectively studied. Demographic data, medications, comorbidities, tendinopathy, delirium, laboratory results, ECG and apathy scores were analyzed. Results: 92 patients were included in the study. The rates of change in QT and QTc interval, heart rate of patients were examined. Statistically significant prolongations were observed in QT (p=0,009) and QTc (p<0,001) values on the third days. No fatal arrhythmia was found in any of the patients. No statistically significant difference was found in heart rate on the third and seventh days (p = 0.253). On the seventh day, there was no statistically significant difference in QT and QTc interval. Statistically significant decrease in delirium rates of the patients was found (p <0.001). No new apathy, delirium and tendinopathy were detected in any of the patients. Conclusion: Fluoroquinolones are a class of drugs commonly used for the treatment of various infectious diseases. They are popular agents with broad spectrum and rapid bactericidal effect. Levofloxacin is well tolerated in geriatric cases as our study supports; QTc interval prolongation is not clinically significant and it can be used safely in geriatric cases in terms of tendinopathy, cardiovascular and CNS side effects. It is also important that oral bioavailability of levofloxacin is high, as it provides ease of use in geriatric practice. Key words: Levofloxacin, aged 60 years and over, QTc interval prolongation, tendinopathy, apathy, delirium, seizure, cardiovascular safety