Risk of Tendon Injury in Patients Treated With Fluoroquinolone (FQ) Versus Non-Fluoroquinolone Antibiotics for Community-Acquired Pneumonia (CAP)-Reference-Cited by-同舟云学术

Risk of Tendon Injury in Patients Treated With Fluoroquinolone (FQ) Versus Non-Fluoroquinolone Antibiotics for Community-Acquired Pneumonia (CAP)

Published:2023-11-09 Issue: Volume: Page:
ISSN:1060-0280
Container-title:Annals of Pharmacotherapy
language:en
Short-container-title:Ann Pharmacother

Author:

Fleming Virginia H.¹^ORCID,Xu Jianing²,Chen Xianyan²,Hall Daniel²,Southwood Robin L.¹

Affiliation:

1. College of Pharmacy, University of Georgia, Athens, GA, USA

2. Department of Statistics, University of Georgia, Athens, GA, USA

Abstract

Background: Fluoroquinolones (FQs) are associated with increased risk of tendon injury but comparative risk versus other antibiotic options for the same indication has yet to be evaluated. Objective: Describe the incidence (relative risk) of any tendon injury in patients receiving FQ compared with other (non-FQs) antibiotics for treatment of community-acquired pneumonia (CAP). Methods: A retrospective propensity score weighted cohort study was performed to evaluate the association between FQ antibiotics and tendon injury risk at 2 time points (within 1 month and within 6 months of use) compared with non-FQ regimens for treatment of CAP. The evaluation was performed using the CCAE (MarketScan Commercial Claims and Encounters) and COB (Medicare Supplemental and Coordination of Benefits) databases from 2014 to 2020. Patients with ICD (International Classification of Diseases) 9/10 coding for outpatient pneumonia who were >18 years and without history of tendon injury were included. Patients with history of tendon injury, who received multiple antibiotic therapies for recurrent pneumonia, or who received both FQ and non-FQ regimens during the study period were excluded. Propensity score weighting was used to adjust for selection bias due to contributing risk factors, including demographics (age, sex), comorbidities (diabetes mellitus, chronic kidney disease), and concurrent medications (corticosteroids). Results: At 1 month, the odds of tendon injury were estimated to be significantly higher (41.9%) in patients receiving FQs compared with those receiving a non-FQ-based regimen (odds ratio [OR] = 1.419, 95% confidence interval [CI] = [1.188-1.698]). The odds of tendon injury were also estimated to be higher (OR = 1.067, 95% CI = [0.975-1.173]) in the FQ population within 180 days, but this effect was not statistically significant. The most frequent sites of tendon injuries were rotator cuff, shoulder, and patellar tendon. Conclusions and Relevance: Prescribers should recognize the risk of tendon injury within 1 month of FQ use when considering treatment regimens for CAP and use alternative options with lower risk whenever possible.

Publisher

SAGE Publications

Subject

Pharmacology (medical)

Link

http://journals.sagepub.com/doi/pdf/10.1177/10600280231210275

Reference30 articles.

1. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

2. US Food and Drug Administration. Information for healthcare professionals: fluoroquinolone antimicrobial drugs [ciprofloxacin (marketed as Cipro and generic ciprofloxacin), ciprofloxacin extended-release (marketed as Cipro XR and Proquin XR), gemifloxacin (marketed as Factive), levofloxacin (marketed as Levaquin), moxifloxacin (marketed as Avelox), norfloxacin (marketed as Noroxin), and ofloxacin (marketed as Floxin)]. Drugs, Drug Safety and Availability Postmarket Drug Safety Information for Patients and Providers Web site. Accessed May 14, 2023. http://wayback.archive-it.org/7993/20161022101528/http:/www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm126085.htm

3. Food and Drug Administration. Information for Healthcare Professionals: “FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together.”. Drugs, Drug Safety and Availability Postmarket Drug Safety Information for Patients and Providers Web site. Accessed May 14, 2023. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics

4. Oral fluoroquinolones and risk of aortic aneurysm or dissection: A nationwide population‐based propensity score‐matched cohort study

5. Measuring Outpatient Antibiotic Prescribing. Updated 2021. Accessed September 26, 2023. https://www.cdc.gov/antibiotic-use/data/outpatient-prescribing/index.html