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I am grateful to our expert panelist Dr. Dave Khan who provided the response to your inquiry. Isolated arthralgias would be very unusual for azithromycin. Even serum sickness-like reactions (SSLR) to azithromycin would be exceedingly rare with only a single case report with a very questionable case attributed to azithromycin in a boy who presented with uveitis. Assuming this was many years ago, it is certainly possible that if indeed they were drug-related, she could tolerate them again.

I do Nitric Oxide (Inomax)- FDA think any diagnostic testing would be of value and simply treating the patient and monitoring for adverse effects would be appropriate. Since azithromycin is rarely associated with severe drug reactions, this would be the first choice for treatment if it were indicated in the future. As an aside, in regards to patients with fluoroquinolone allergy, while a history of anaphylaxis increases the likelihood of true allergy, some patients may still be shown to be not allergic through drug challenge even with histories of anaphylaxis.

Even those with confirmed fluoroquinolone allergy may tolerate another quinolone as degree of cross-reactivity is variable. Biuk D, Jukic T, Vukojevic N, Kalauz M. Nitric Oxide (Inomax)- FDA sickness and uveitis. Elkayam O, Yaron M, Caspi D.

Minocycline-induced autoimmune syndromes: an overview. Shapiro LE, Knowles SR, Shear NH. Comparative Nitric Oxide (Inomax)- FDA of tetracycline, minocycline, and doxycycline.

Blanca-Lopez N, Ariza A, Dona I, Mayorga C, Montanez MI, Garcia-Campos J, et al. Hypersensitivity reactions to fluoroquinolones: analysis of the factors involved.

Pongracic, MD, FAAAAIWeb design by Reason One. October 17, 2008 Drug Assessments 1 CommentAcute bacterial sinusitis is a common, usually self-limited condition often associated with allergies and environmental irritants, as well as co-infection with viruses and fungi. Acute bacterial sinusitis is 200 times less common than viral rhinosinusitis. Symptoms and signs suggesting bacterial, as opposed to viral sinusitis include purulent nasal discharge in combination with facial pain and maxillary toothache, facial swelling and tenderness.

Most diagnoses are based on history and physical examination as opposed to laboratory cultures and sinus xrays, which girl growth considered unreliable. Category: Levofloxacin is a fluoroquinolone class, broad-spectrum antibacterial agent.

It is the L- isomer Nitric Oxide (Inomax)- FDA the racemate, ofloxacin. Mechanism of Action: Levofloxacin exerts its action by inhibiting the bacterial topoisomerases II (DNA gyrase) and topoisomerases IV, which interferes with DNA replication, transcription, repair, Nitric Oxide (Inomax)- FDA recombination.

Assessment principles: Double blind randomized controlled trials comparing levofloxacin to other fluoroquinolones or other classes of antibacterial agents in adult patients with Nitric Oxide (Inomax)- FDA bacterial sinusitis will be critically appraised.

Based on three DBRCTs in 1045 randomized adult patients with acute bacterial sinusitis lasting for 7 to 28 days, oral levofloxacin 500mg daily for 10-14 days was not significantly different from a single dose of oral azithromycin 2000mg (Murray et al 2005), oral cefdinir 600mg daily for 10 days (Henry et al 2004), or oral Nitric Oxide (Inomax)- FDA, 1000mg daily for 10-14 days (Lasko et al 1998) in terms Nitric Oxide (Inomax)- FDA clinical response (as defined by the individual trial) and total withdrawals.

One trial (Murray et Nitric Oxide (Inomax)- FDA reported on mortality and serious girls smoking. Total mortality, non-fatal serious adverse events and withdrawals due to adverse events were not significantly different between levofloxacin and azithromycin.

None of the trials reported on bacteriological response. Murray et al and Henry et al did not report on total adverse events.

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