Could antibiotics cause weakness?

[Jeromekjerome]

My mum has been taking 20mg of Leflunomide as well as the reduced 25mg of Pred for about a month and has just started a second cause of antibiotics to clear up a water infection.

She felt exhausted after walking a couple of hundred yards yesterday and when she sat down had no energy at all.

When she stands up from a car journey she feels light-headed for a minute. She has noticed that she is definitely not as energetic as she was.

Also the muscles around her jaw joint have become slightly slack or weakened, the joint was making a crunching sound when she tried to eat.

We haven't got a clue if these new symptoms are due to the antibiotics, a reduction in the steroids, the Leflunomide or the recent type 2 diabetes diagnosis.

Despite the visual loss she has been fine in all other ways since the Pred started up until now.

Does anyone have experiences like this with Leflunomide or antibiotics?

[PMRpro Ambassador]

What antibiotic is it?

She is unwell - a UTI can lead to quite unpleasant systemic symptoms, especially in older patients. Remind me - how old is your mum?

[Jeromekjerome in reply to PMRpro]

She is 75. The antibiotics are Nitrofurantoi, she just told me she thinks the symptoms may have started before the new pills.

[PMRpro Ambassador in reply to Jeromekjerome]

Leflonomide does list unusual tiredness and dizziness as an adverse effect. Nitrofurantoin is a horrible antibiotic, luckily it often works well in just a few days so the courses are usually quite short.

You and she need to assess whether the fatigue is simply too much for her to accept. To be honest, I have no idea whether leflunomide helps reduce pred in GCA - it doesn't always in PMR and I don't think I have come across anyone with GCA who takes it. I'm a bit confused about them using it in a GCA patients who already has total loss of vision - I don't see why they can't reduce the dose anyway as the usual risk is of a flare threatening vision.

[SnazzyD in reply to Jeromekjerome]

I have seen elderly people suffer with Nitrofurantoin.

Have a read of these regarding caution in the elderly with it

bnf.nice.org.uk/drug/nitrof...

medscape.com/viewarticle/80...

Make sure she’s not dehydrated especially if it’s hot where you are.

[SnazzyD]

The jaw joint could be from weakened muscles from Pred and she’s got Temporomandibular joint dysfunction. I had that from three months in. I had to reduce salads and eat more cooked veg, plus avoid heavily chewy things until it recovered as my muscles got stronger with reducing dose.

mayoclinic.org/diseases-con...