Grand mal seizures as a complication of treatment with pefloxacin in patients with cirrhosis. A report of three cases

In this paper, three cases of grand mal seizures are reported as a complication of pefloxacin at usual doses (400 mg twice a day) in patients with cirrhosis. Grand mal seizures occurred from 12 h to 8 days after the onset of pefloxacin treatment. In 1 case, seizures recurred after inadvertent rechallenge with the drug. Elevated pefloxacin serum levels were demonstrated in 2 cases. Brain computed tomography in all 3 cases and cerebrospinal fluid examination showed normal results. No etiology other than pefloxacin overdose was found. After pefloxacin withdrawal, no recurrence of seizures were observed. Therefore, when pefloxacin treatment is indicated for cirrhotic patients, a reduced dosage and/or careful monitoring of pefloxacin serum levels should be recommended.