Possible gatifloxacin-induced seizure

To report a case of seizure activity following gatifloxacin administration during treatment of urosepsis in an intensive care unit.

An 86-year-old African American male nursing home resident with a history of hypertension and cerebrovascular accident with aphasia was initiated on gatifloxacin therapy for treatment of urosepsis. After 2 intravenous doses (400 mg followed 24 h later with 200 mg), he developed 2 generalized seizures lasting <2 minutes each. Gatifloxacin was discontinued, and the patient was switched to ceftazidime. Phenytoin was initiated, and no recurrent seizures were witnessed.

Fluoroquinolones have been shown to induce seizures or decrease seizure threshold. The majority of reports include older-generation fluoroquinolones such as ofloxacin. The incidence of seizures associated with fluoroquinolones varies among the individual agents and is relatively rare. Risk factors include increased age, compromised renal function, history of seizures, and coadministration with theophylline or nonsteroidal antiinflammatory drugs. Application of an objective causality scale indicates the seizures in our patient were possibly associated with gatifloxacin.

This case of gatifloxacin-induced seizures may reflect a class-effect phenomenon versus an effect caused by an individual fluoroquinolone. Caution is warranted when using these agents in patients at risk for drug-induced seizures.