Moxifloxacin-Induced Clostridium Difficile Diarrhea

Abstract

Mirtazapine in suicidal Huntington's disease TO THE EDITOR: Huntington's disease (HD) is a progressive neurodegenerative disorder, whose major progressive clinical features are chorea, dementia, and psychiatric disturbances such as depression or psychotic episodes. Depression is said to be frequent in HD, and, in various studies, prevalence has varied from 9% to 44%. 1 We report the case of a woman whose severe depression and suicidal ideations secondary to HD were successfully treated with mirtazapine. Case Report. A 32-year-old woman with HD (42 cytosine-adenine-guanine repeats) of 6 years' duration was hospitalized due to a suicide attempt by jumping out of the window from the second floor. Before this suicide attempt, she had been treated with olanzapine (for the choreatic movement disorder) and riluzole. The woman developed a severe depressive episode at home, not adequately realized by her husband. The patient had known about the positive genetic test results for HD for 2 years, and the depression seemed to be unrelated neither to this fact nor to any other exogenic reason. Besides fracturing both calcaneus and lumbar vertebral body III, the patient presented in a depressive stupor. She was oriented and able to follow commands and speak, but did not answer with more than a word; her thoughts monotonously revolved around suicide. After admission, she was treated with mirtazapine 30 mg/d, which had to be increased to 90 mg/d in the next week. However, due to this medication the mood improved significantly in the next few weeks, and the patient started to speak after 5 days of treatment; suicidal thoughts disappeared after 2 weeks of treatment. We reduced mirtazapine to 60 mg/d after 2 months and to 30 mg/d after 9 months. The woman is seen in our outpatient clinic every month and has remained in a stable mood for >1 year. Discussion. Depression in HD often precedes the onset of neurologic symptoms and responds to antidepressant medication, but may not be interpreted as a merely psychological response to the development of the disease. 2 Thus, depression seems to result from neuropathologic changes. It was hypothesized that the neuronal loss in the medial anterior caudate is responsible for both the neurologic and emotional symptoms. 1 In his original paper, George Huntington 3 himself drew attention to "that form of insanity which leads to suicide." In fact, several studies 1,4-6 have supported this statement by showing high suicide rates in HD. Six percent of deaths among affected persons result from suicide, and 28% of patients with HD attempted suicide at least once. 4 Factors that increase the risk of suicide are having no offspring, being unmarried, having a family history of suicide, living alone, endogenous depression, and having no contact with others who have HD. 5 Today, there are only case reports available on the treatment of depression from HD, and, moreover, there is no treatment recommendation for suicidal HD patients. Mirtazapine, a noradrenergic and specific serotonergic antidepressant, was s...

Risk factors and mortality associated with Clostridium difficile-associated diarrhoea at a VA hospital

“…What was unexpected was the relatively high rate of association of CDAD with the fluoroquinolones, particularly levofloxacin and a relatively newer penicillinase-resistant penicillin, piperacillin/tazobactam. Although rarely shown to be associated with C. difficile infection, both fluoroquinolones and piperacillin/tazobactam have been suggested as being potential risk factors in past case reports [8][9][10][11][12][13][14][15].…”

Do fluoroquinolones predispose patients to Clostridium difficile associated disease? A review of the evidence

“…22-16.74) was highest compared to levofloxacin (AHR 2.52 95% CI 1.68-3.79) and ciprofloxacin (AHR 3.74 95% CI 2.81-4.97). The conclusions from these studies 20,21 in dependently demonstrated a strong association between the newer classes of quinolones (levofloxacin 20,22 gatiflox acin 23 and moxifloxacin 9,24 ) and CDAD. Similarly, in a case-control study done in a Veterans Administration hospital, 30 patients with CDAD were identified over a 6 month period.…”

“…Various studies have sought to identify the precise strain of C. difficile responsible for the CDAD epidemic. Recently, two major studies have identified a more virulent strain of C. difficile, referred to most commonly as either the BI or NAP1 strain 8,9 which has a 15-20 times enhanced capacity to produce toxins. The strain is characterized in various ways and is referred to as toxin type 3, North American pulsed-field gel electrophoresis type 1, restriction endonuclease analysis group BI and PCR ribotype 027.…”

Antimicrobial Therapy for Acute Colonic Diverticulitis

“…However, the potential association of fluoroquinolone use with epidemics of C. difficile-associated disease has been the subject of several recent reports [59][60][61][62][63][64]. In the past, C. difficile-associated disease was linked epidemiologically to a variety of antibiotics, including clindamycin, cephalosporins, and ampicillin and ampicillin/sulbactam.…”