Levofloxacin (brand name is Levaquin) is in the fluoroquinolone class of antibiotics and has broad-spectrum antimicrobial activity, typically used to treat numerous bacterial infections, causing pneumonia, acute bacterial sinusitis, anthrax, cellulitis, endocarditis, gastroenteritis, tuberculosis, bacterial meningitis, genitourinary infections, such as chronic prostatitis and pelvic inflammatory disease, periodontal disease, and Yersinia pestis, the causative organism of the plague. Some serious side-effects have occurred and its use has subsequently been limited due to reports of tendon inflammation and rupture, seizures, psychosis and permanent peripheral nerve damage. Nevertheless, levofloxacin has been trialed safely and effectively in the following rheumatoid arthritis studies, although its mechanism of action on disease amelioration remains to be fully understood.

Antibiotics for the treatment of rheumatoid arthritis. Int J Gen Med. 2013 Dec 27;7:43-7. doi: 10.2147/IJGM.S56957.

A Turkish researcher reviewed the efficacy of different antibiotics in the treatment of rheumatoid arthritis (RA), used successfully, as early the 1930s, with the introduction of sulfasalazine and, shortly after, tetracycline. Levofloxacin and macrolide antibiotics have also been studied and shown to be effective for RA based on reports of the possible implication of periodontal bacteria in RA.

Rheumatoid arthritis is linked to oral bacteria: etiological association. Mod Rheumatol. 2009;19(5):453-6. doi: 10.1007/s10165-009-0194-9. Epub 2009 June 24.

A prolific researcher of infectious causes for rheumatoid arthritis (RA) and its treatment with antibiotic therapy, at the Division of Rheumatology of Nazilli State Hospital, in Nazilli, Turkey, reviewed the evidence of periodontitis and the role of causative organisms that are directly associated with the etiopathogenesis of RA. Additionally, this researcher states that findings of anerobic bacteria, such as, Porphyromonas gingivalis, Tannerella forsythensis, and Prevotella intermedia that have been identified in RA synovial fluid can be treated with antibiotics, such as ornidazole, levofloxacin, and clarithromycin that have been shown to be effective in RA.

Levofloxacin treatment in patients with rheumatoid arthritis receiving methotrexate. South Med J. 2007 Feb;100(2):135-9.

The aim of this 6-month, double-blind, placebo-controlled, randomized trial was to determine the safety, effectiveness, and tolerability of the antibiotic, levofloxacin (500mg daily), an antimicrobial used to treat infections caused by anaerobic bacteria, such as periodontitis, in 76 rheumatoid arthritis (RA) patients. All patients had active disease in spite of at least 6 months of treatment with methotrexate and levothyroxine was added to their medication protocol. The researchers were looking for improvements in tender and swollen joint counts, as well as American College of Rheumatology (ACR) criteria for improvement (ACR20, ACR50, ACR70), and patient and physician global assessments. Patients taking levofloxacin for 6 months, in addition to methotrexate, had significant improvements in signs and symptoms of RA, the antibiotic was well tolerated and found to be safe with no toxic effects at the dosage used.

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