Clin Infect Dis. 2021 Sep 19:ciab825. doi: 10.1093/cid/ciab825. Online ahead of print.
BACKGROUND: Antibiotics are considered to be among the most frequent causes of drug-related acute liver injuries (ALI). Although many ALI have mild and reversible clinical outcomes there is substantial risk of severe reactions leading to acute liver failure, need for liver transplant, and death. Recent studies have raised concerns of hepatotoxic potential related to the use of fluoroquinolones.
METHODS: This study examined the risk of ALI associated with oral fluoroquinolone treatment compared with amoxicillin (419,930 courses propensity score matched 1:1). The information on drug use was collected from a national, registry-based cohort derived from all Swedish adults ages 40-85 years.
RESULTS: During a follow-up period of 60 days, users of oral fluoroquinolones had an over 2-fold risk of ALI compared to amoxicillin (HR 2.33; 95% CI: 1.01-5.35). The adjusted absolute risk difference for use of fluoroquinolones as compared to amoxicillin was 4.94 (95% CI: 0.04-16.3) per 1 million episodes.
CONCLUSION: In this propensity score matched study, fluoroquinolone treatment was associated with an increased risk of ALI in the first two months after starting treatment.