{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T22:31:17Z","timestamp":1792276277701,"version":"4.4.0"},"reference-count":16,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2019,6,12]],"date-time":"2019-06-12T00:00:00Z","timestamp":1560297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Neurotoxicity is a rare and intolerable adverse effect associated with levofloxacin therapy, whose diagnosis has mostly been reported based on medical history rather than quantitative measures in the blood. We report a 68-year-old man with levofloxacin-associated encephalopathy and myoclonus with high levels of levofloxacin in the blood and cerebrospinal fluid. After hemodialysis, these decreased, and his symptoms rapidly improved. An electroencephalogram was also normal. This case showed the concentration of levofloxacin to be clearly related to levofloxacin-associated neurotoxicity. Therefore, an estimation of its concentration may contribute to accurate diagnosis.<\/jats:p>","DOI":"10.3390\/antibiotics8020078","type":"journal-article","created":{"date-parts":[[2019,6,12]],"date-time":"2019-06-12T10:55:19Z","timestamp":1560336919000},"page":"78","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Levofloxacin-Associated Neurotoxicity in a Patient with a High Concentration of Levofloxacin in the Blood and Cerebrospinal Fluid"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6183-8910","authenticated-orcid":false,"given":"Masashi","family":"Nishikubo","sequence":"first","affiliation":[{"name":"Department of General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo 6500047, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maki","family":"Kanamori","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo 6500047, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Nishioka","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo 6500047, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2769","DOI":"10.2165\/00003495-200363240-00008","article-title":"Levofloxacin: A review of its use in the treatment of bacterial infections in the United States","volume":"63","author":"Croom","year":"2003","journal-title":"Drugs"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1111\/j.1365-2125.2011.03991.x","article-title":"Neurotoxic effects associated with antibiotic use: Management considerations","volume":"72","author":"Grill","year":"2011","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.genhosppsych.2007.11.003","article-title":"Levofloxacin-induced delirium with psychotic features","volume":"30","author":"Kiangkitiwan","year":"2008","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"634","DOI":"10.3109\/0886022X.2012.660855","article-title":"Levofloxacin-induced delirium: is it a dangerous drug in patients with renal dysfunction?","volume":"34","author":"Kocyigit","year":"2012","journal-title":"Ren. Fail."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.mjafi.2012.10.001","article-title":"Levofloxacin induced delirium with psychotic features in a young patient","volume":"69","author":"Raj","year":"2013","journal-title":"Med. J. Armed Forces India"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1177\/1060028013507050","article-title":"Orofacial dyskinesia associated with the use of levofloxacin","volume":"48","author":"Host","year":"2014","journal-title":"Ann. Pharmacother."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s40734-015-0021-8","article-title":"Reversible craniocervical dystonia associated with levofloxacin","volume":"2","author":"Lizarraga","year":"2015","journal-title":"J. Clin. Mov. Disord."},{"key":"ref_8","first-page":"FD01","article-title":"A rare instance of levofloxacin induced myoclonus","volume":"11","author":"Kunder","year":"2017","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1038\/clpt.1981.154","article-title":"A method for estimating the probability of adverse drug reactions","volume":"30","author":"Naranjo","year":"1981","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1177\/0091270004264643","article-title":"Measuring the effects of supratherapeutic doses of levofloxacin on healthy volunteers using four methods of QT correction and periodic and continuous ECG recordings","volume":"44","author":"Noel","year":"2004","journal-title":"J. Clin. Pharmacol."},{"key":"ref_11","first-page":"1","article-title":"Phase I study of levofloxacin healthy and elderly volunteers","volume":"57","author":"Shiba","year":"2009","journal-title":"Jpn. J. Chemother."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e109","DOI":"10.1086\/323406","article-title":"Cerebrospinal fluid penetration of levofloxacin in patients with spontaneous acute bacterial meningitis","volume":"33","author":"Scotton","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"101","DOI":"10.2165\/00003088-199732020-00002","article-title":"The clinical pharmacokinetics of levofloxacin","volume":"3","author":"Fish","year":"1997","journal-title":"Clin. Pharmacokinet."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1159\/000239301","article-title":"Levofloxacin, an optical isomer of ofloxacin, has attenuated epileptogenic activity in mice and inhibitory potency in GABA receptor binding","volume":"40","author":"Akahane","year":"1994","journal-title":"Chemotherapy"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1212\/WNL.0000000000002455","article-title":"Antibiotic-associated encephalopathy","volume":"86","author":"Bhattacharyya","year":"2016","journal-title":"Neurology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"E40","DOI":"10.1111\/hdi.12687","article-title":"Hemodialysis for treatment of levofloxacin-induced neurotoxicity","volume":"23","author":"Idrees","year":"2019","journal-title":"Hemodial. Int."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/8\/2\/78\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:57:57Z","timestamp":1760187477000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/8\/2\/78"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,12]]},"references-count":16,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,6]]}},"alternative-id":["antibiotics8020078"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics8020078","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,12]]}}}