Can levofloxacin (a fluoroquinolone antibiotic) cause body pain and hand pain after 22 days of use at a dose of 750mg for chronic cystitis, and will stopping levofloxacin and using diclofenac (a nonsteroidal anti-inflammatory drug (NSAID)) help?

Levofloxacin-Induced Body Pain: Management and Treatment Options

Yes, levofloxacin can cause body pain and hand pain even after 22 days of use at 750mg for chronic cystitis, and stopping levofloxacin immediately is recommended while diclofenac may provide symptomatic relief. 1

Fluoroquinolone-Associated Adverse Effects

Levofloxacin, like other fluoroquinolones, can cause serious side effects including peripheral neuropathy (nerve damage) which may manifest as:

• Pain
• Burning
• Tingling
• Numbness
• Weakness in arms, hands, legs, or feet

The FDA label specifically warns that this nerve damage can occur at any time during treatment and may be permanent. These symptoms require immediate discontinuation of the medication and consultation with a healthcare provider 1.

Management Recommendations

1. Immediate discontinuation of levofloxacin

   • Stop taking levofloxacin at the first sign of peripheral neuropathy symptoms 1
   • The nerve damage may become permanent if the medication is continued

2. Pain management options

   • Diclofenac or other NSAIDs may provide symptomatic relief for the pain
   • However, NSAIDs themselves can occasionally cause urinary symptoms including cystitis 2
   • Consider discussing alternative pain management options with your healthcare provider

3. Alternative antibiotic options for chronic cystitis

   • If continued antibiotic treatment is necessary, alternative options include:
     • Nitrofurantoin 100mg twice daily
     • Trimethoprim-sulfamethoxazole 160/800mg twice daily
     • Fosfomycin 3g single dose 3
   • Culture-directed therapy is essential for complicated UTIs 3

Duration of Treatment for Chronic Cystitis

For chronic or complicated UTIs, the Infectious Diseases Society of America recommends:

• 7 days of antimicrobial treatment for patients with prompt symptom resolution
• 10-14 days for those with delayed response 4

Important Considerations and Monitoring

• Fluoroquinolone side effects can occur even after prolonged use
• Central nervous system effects including anxiety, confusion, and depression may also occur with levofloxacin 1
• Follow-up with a healthcare provider within 48-72 hours of stopping levofloxacin to:
  • Assess clinical response
  • Consider alternative antibiotic options if needed
  • Evaluate for complications 3

Cautions Regarding NSAIDs for Pain Relief

• While diclofenac may help with pain symptoms, be aware that NSAIDs can:
  • Occasionally cause cystitis-like symptoms themselves 2
  • Potentially interact with kidney function
  • Have their own side effect profile

If symptoms persist or worsen after stopping levofloxacin, seek immediate medical attention as this could indicate severe adverse effects requiring further intervention.