Abstract
Levofloxacin is a fluoroquinolone antibiotic commonly used to treat a wide range of bacterial infections. It is normally well tolerated with the most common side effect being gastrointestinal distress. Severe side effects including neuropsychiatric symptoms are rare but have been observed even in patients who lack risk factors or are otherwise healthy. Healthcare providers should be aware of these effects and consider transitioning to other antibiotics in patients who develop psychosis or other neuropsychiatric symptoms after initiating this medication. Symptoms rapidly improve after discontinuation of the drug, so prompt recognition can reduce morbidity and mortality. We report a case of levofloxacin-induced psychosis in a young healthy female patient.
Highlights
While commonly used for their favorable characteristics and their activity against a range of bacteria, fluoroquinolones can have severe side effects
We describe a case of levofloxacin induced psychosis in a 23-year-old female being treated for bilateral submandibular abscesses
A 23-year-old African American female with a history of recurrent submandibular abscesses and a submental abscess currently being treated with levofloxacin and metronidazole presented to the hospital emergency department with anxiety, paranoia, visual hallucinations, and psychosis
Summary
While commonly used for their favorable characteristics and their activity against a range of bacteria, fluoroquinolones can have severe side effects. A 23-year-old African American female with a history of recurrent submandibular abscesses and a submental abscess currently being treated with levofloxacin and metronidazole presented to the hospital emergency department with anxiety, paranoia, visual hallucinations, and psychosis. She had first been diagnosed with a dental abscess approximately one month prior and was prescribed clindamycin due to allergies to antibiotics including amoxicillin, ampicillin, and penicillin. Due to issues with medication non-adherence the patient subsequently developed bilateral submandibular abscesses and a submental abscess requiring repeat incision and drainage and transition to alternative antibiotics She had been recently discharged from the hospital four days prior following repeat incision and drainage with the prescriptions for levofloxacin and metronidazole, which she had been taking as instructed. She was transitioned to oral cefdinir and discharged to home with instructions to follow up with her surgeon and with psychiatry
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