Ciprofloxacin-Induced Hepatotoxicity Resolved with Levofloxacin: A Case Report and a Review of the Literature

Abstract

Objective

To report a case of elevated hepatic transaminases in a patient receiving ciprofloxacin that resolved upon discontinuation and initiation of levofloxacin.

Summary

A 45-year-old white woman was initiated on ciprofloxacin and gentamicin after a blood culture revealed gram-negative rods. On day 2 of antibiotic therapy, the patient's aspartate aminotransferase (AST) and alanine aminotransferase (ALT) increased to 2,352 units/L and 783 units/L, respectively, and remained elevated for the following 4 days. Baseline AST and ALT were within normal limits. On day 5 of therapy, ciprofloxacin was discontinued and levofloxacin was initiated. On the following day, the hepatic transaminases decreased (AST, 192 units/L; ALT, 582 units/L) and continued to normalize prior to hospital discharge. On a subsequent admission later in the month, levofloxacin was again administered for treatment of a gram-positive bacteremia, with no subsequent elevation of hepatic transaminases.

Discussion

An objective causality assessment revealed that the adverse drug reaction (ADR) was probable. Although reports of this ADR have been noted, there is no previously documented occurrence of resolution of elevated hepatic transaminases on therapeutic modification to another fluoroquinolone.

Conclusion

Ciprofloxacin may significantly elevate hepatic transaminases. The clinician should be aware of the unique ADR profiles of the different fluoroquinolones because hepatotoxicity may not be a class effect.