QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Gallagher, J. C Articles by Rose, C. Search for Related Content PubMed PubMed Citation Articles by Gallagher, J. C Articles by Rose, C.

Severe Pseudomembranous Colitis After Moxifloxacin Use: A Case Series

Clinical Assistant Professor, Clinical Specialist, Infectious Diseases, School of Pharmacy, Temple University, Philadelphia, PA

Jennifer K Du, PharmD

Clinical Pharmacist, Sutter Infusion & Pharmacy Services, Emeryville, CA

Christina Rose, PharmD BCPS

Clinical Assistant Professor, Clinical Specialist, Critical Care, School of Pharmacy, Temple University

Reprints: Dr. Gallagher, School of Pharmacy, Temple University, 3307 N. Broad St., Philadelphia, PA 19140, fax 215/707-8326, Jason.gallagher{at}temple.edu

OBJECTIVE: To describe the illnesses of 4 patients who developed severe pseudomembranous colitis after receiving moxifloxacin.

CASE SUMMARY: Four patients received moxifloxacin for pulmonary infections prior to developing positive Clostridium difficile toxin assays; all 4 later died from complications associated with C. difficile–associated disease (CDAD). Three patients developed CDAD while outpatients, although all of them had recent hospitalizations and their disease was presumed to be hospital related. All patients presented with diffuse abdominal pain, fever, and diarrhea. The patients were all treated surgically with total abdominal colectomies and medically with metronidazole.

DISCUSSION: Recent reports have highlighted the connection between fluoroquinolones and CDAD, in contrast to historical studies and assumptions. Evidence in the literature about differences in the propensity of various fluoroquinolones to cause CDAD is conflicting. The Naranjo probability scale revealed a probable relationship between moxifloxacin and CDAD for 3 patients, and a possible relationship for 1 patient.

CONCLUSIONS: Our cases highlight the need for vigilance in monitoring patients for signs of CDAD when using any antibiotic, including moxifloxacin. Patients with suspected severe CDAD need to be managed aggressively to avoid poor outcomes.

Key Words: Clostridium difficile, fluoroquinolone, moxifloxacin, pseudomembranous colitis

Published Online, December 9, 2008. www.theannals.com, DOI 10.1345/aph.1L335