Infectivology Xagena

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Xagena Newsletter

Neurological safety of fluoroquinolones versus therapeutic alternatives

Fluoroquinolones, one of the most commonly prescribed antibiotic classes, have been implicated in cases of central nervous system ( CNS ) and peripheral nervous system ( PNS ) adverse events, which highlights the need for epidemiologic studies of the neurological safety of fluoroquinolones.

The aim of the study was to evaluate the safety of fluoroquinolones with regard to risk of diagnosed neurological dysfunction.

Researchers have conducted a propensity score-matched inception cohort study using claims data from a commercially insured population.
The study included adults prescribed an oral fluoroquinolone or comparator antibiotic between January 2000 and September 2015 for acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, uncomplicated urinary tract infection, or acute bronchitis.

The outcomes were CNS dysfunction, and four separate but complementary PNS dysfunction outcomes.
Cox proportional hazards models were estimated after matching on propensity scores fitted using the variables age, sex, epilepsy, hereditary peripheral neuropathy, renal dysfunction, diabetes, Gabapentinoid use, statin use, Isoniazid use, and chemotherapy use.

The cohort contained 976 568 individuals exposed to a fluoroquinolone antibiotic matched 1:1 with a comparator.
Matching produced balance ( standardized mean difference less than 0.1 ) on all variables included in the propensity score.

The hazard ratio ( HR ) associated with fluoroquinolone exposure was 1.08 ( 95% confidence interval 1.05-1.11 ) for central nervous system dysfunction, and 1.09 ( 95% CI 1.07-1.11 ) for the most commonly occurring peripheral nervous system dysfunction outcome.

In conclusion, fluoroquinolone antibiotic use was associated with the development of neurological dysfunction versus comparator antibiotic use in the adult population. ( Xagena )

Ellis DE et al, Pharmacoepidemiol Drug Saf 2021; 30: 797-805