Alatrofloxacin-induced seizures during slow intravenous infusion

OBJECTIVE: To report a case of seizures associated with slow infusion (1-2 h) of alatrofloxacin, the prodrug of trovafloxacin. CASE SUMMARY: A 37-year-old Asian man was admitted to the hospital for a di stal pancreatectomy and drainage of a pseudocyst. Postoperative complicatio ns developed, which included peritonitis and pneumonia, requiring intensive care admission. cultures from peritoneal drainage fluid and sputum isolate d Klebsiella pneumoniae and Pseudomonas aeruginosa, respectively. He was tr eated with multiple courses of antibiotics, including intravenous gentamici n, metronidazole, vancomycin, meropenem, and ceftazidime. After three weeks , the patient still had sepsis and began therapy with alatrofloxacin in add ition to ceftazidime acid vancomycin. Alatrofloxacin infusion was administe red according to product information instructions. Fifteen minutes after th e first dose was started, the patient developed generalized clonus. On rech allenge, infusing at half the initial rate, the seizure recurred; consequen tly, the infusion was discontinued and replaced with intravenous ciprofloxa cin and metronidazole. The patient remained seizure free thereafter. DISCUSSION: Fluoroquinolones have been implicated in central nervous system adverse effects, including seizures, which have been reported with other f luoroquinolones but not with alatrofloxacin ortrovafloxacin. In these repor ts. the patients often had preexisting risk factors such as increased age a nd electrolyte imbalances. The only apparent predisposition in this patient was mild hyponatremia. CONCLUSIONS: Alatrofloxacin may cause seizures even during slow infusion. T his case highlights the need for caution when commencing parenteral fluoroq uinolone therapy, particularly with a new agent.