Pharmacotherapy. 2023 Sep 12. doi: 10.1002/phar.2877. Online ahead of print.
INTRODUCTION: An understanding of how frequently individual fluoroquinolone (FQ) adverse events of interest (FQAEIs) occur within specific infection types is imperative to coordinate appropriate use of FQ and potential avoidance in certain disease states and/or patient populations.
OBJECTIVES: Study objectives were to i) quantify the incidence of three concerning FQAEI (i.e., adverse tendon event (TE), Clostridioides difficile infection (CDI), and aortic aneurysm/dissection (AAD)), ii) identify the patient-level factors that predict these events, and iii) develop clinical risk scores to estimate the predicted probabilities of each FQAEI based on patient-level covariates available on clinical presentation.
METHODS: A retrospective cohort study was performed among hospitalized patients with community-acquired pneumonia receiving care in the Upstate New York Veterans' Healthcare Administration from 2011-2016. The outcomes of interest for this study were the occurrence of TE, CDI, and AAD. We also evaluated a composite of these three outcomes, FQAEI.
RESULTS: The study population consisted of 1,071 patients. The overall incidence of FQAEI, TE, AAD, and CDI were 6.5%, 1.8%, 4.5%, and 0.3%, respectively. For each outcome evaluated, the probability of the event of interest was predicted by the presence of certain comorbidities, previous health care exposure, choice of specific FQ antibiotic, or therapy duration. Concomitant steroids, pneumonia in preceding 180 days, and creatinine clearance <30 mL/min predicted FQAEI.
CONCLUSIONS: Individual frequencies of three important FQAEIs were quantified and risk scores were developed to estimate the probabilities of experiencing these events to help clinicians individualize treatment decisions for patients and reduce the potential risks of select FQAEIs.