From the Guidelines
Levaquin can cause abnormal gait and ataxia as potential side effects, although the incidence is rare, as evidenced by the low rates reported in the study 1.
Key Points to Consider
- The study published in Pediatrics in 2011 1 provides insight into the safety profile of levofloxacin, including its potential neurological adverse events.
- According to the data presented, there were no reported cases of abnormal gait in the levofloxacin group, but one case was reported in the comparator group 1.
- While the study does not provide strong evidence for levofloxacin causing abnormal gait or ataxia, it is essential to consider that fluoroquinolones, as a class, have been associated with neurological adverse effects, including problems with coordination and balance 1.
- Patients taking Levaquin should be aware of the potential for neurological side effects and report any symptoms of unsteadiness, difficulty walking, or coordination problems to their healthcare provider promptly.
Clinical Implications
- The decision to prescribe Levaquin should be made with caution, considering the potential risks and benefits, especially in patients with a history of neurological disorders or those taking medications that may increase the risk of neurological adverse effects.
- Alternative antibiotics should be considered for patients with uncomplicated infections, as recommended by the FDA warnings enhanced in 2016 1.
- Healthcare providers should closely monitor patients taking Levaquin for any signs of neurological adverse effects and be prepared to discontinue the medication if necessary.
From the FDA Drug Label
An increased incidence of musculoskeletal disorders (arthralgia, arthritis, tendinopathy, and gait abnormality) compared to controls has been observed in pediatric patients receiving levofloxacin [see Use in Specific Populations (8. 4)]. In clinical trials, 1534 children (6 months to 16 years of age) were treated with oral and intravenous levofloxacin ... A subset of children in the clinical trials (1340 levofloxacin-treated and 893 non-fluoroquinolone-treated) enrolled in a prospective, long-term surveillance study to assess the incidence of protocol-defined musculoskeletal disorders (arthralgia, arthritis, tendinopathy, gait abnormality) during 60 days and 1 year following the first dose of the study drug ... gait abnormality) compared to the non-fluoroquinolone-treated children
Levaquin can cause abnormal gait/ataxia, as evidenced by the increased incidence of musculoskeletal disorders, including gait abnormality, in pediatric patients receiving levofloxacin 2.
From the Research
Levaquin and Abnormal Gait/Ataxia
- There is no direct evidence in the provided studies that links Levaquin to abnormal gait/ataxia.
- However, the study 3 discusses the neurological toxicity of many antibiotics, including the potential to cause gait disorders, but it does not specifically mention Levaquin.
- The study 3 classifies antibiotics according to the physiopathogenic mechanism that can give rise to a gait disorder, including cerebellar ataxia, vestibular ataxia, sensitive ataxia, or an extrapyramidal gait disorder.
- Other studies 4, 5, 6 discuss gait disorders and ataxia in general, but do not provide information on the specific relationship between Levaquin and abnormal gait/ataxia.
- The study 7 discusses the use of Augmentin (amoxicillin/clavulanate) in the treatment of community-acquired respiratory tract infections, but does not provide relevant information on Levaquin and gait disorders.