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Overview of Side-Effects of Antibacterial Fluoroquinolones: New Drugs versus Old Drugs, a Step Forward in the Safety Profile? Pharmaceutics 2023; 15:pharmaceutics15030804. [PMID: 36986665 PMCID: PMC10056716 DOI: 10.3390/pharmaceutics15030804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 03/05/2023] Open
Abstract
Antibacterial fluoroquinolones (FQs) are frequently used in treating infections. However, the value of FQs is debatable due to their association with severe adverse effects (AEs). The Food and Drug Administration (FDA) issued safety warnings concerning their side-effects in 2008, followed by the European Medicine Agency (EMA) and regulatory authorities from other countries. Severe AEs associated with some FQs have been reported, leading to their withdrawal from the market. New systemic FQs have been recently approved. The FDA and EMA approved delafloxacin. Additionally, lascufloxacin, levonadifloxacin, nemonoxacin, sitafloxacin, and zabofloxacin were approved in their origin countries. The relevant AEs of FQs and their mechanisms of occurrence have been approached. New systemic FQs present potent antibacterial activity against many resistant bacteria (including resistance to FQs). Generally, in clinical studies, the new FQs were well-tolerated with mild or moderate AEs. All the new FQs approved in the origin countries require more clinical studies to meet FDA or EMA requirements. Post-marketing surveillance will confirm or infirm the known safety profile of these new antibacterial drugs. The main AEs of the FQs class were addressed, highlighting the existing data for the recently approved ones. In addition, the general management of AEs when they occur and the rational use and caution of modern FQs were outlined.
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Chen C, Patterson B, Simpson R, Li Y, Chen Z, Lv Q, Guo D, Li X, Fu W, Guo B. Do fluoroquinolones increase aortic aneurysm or dissection incidence and mortality? A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:949538. [PMID: 36017083 PMCID: PMC9396038 DOI: 10.3389/fcvm.2022.949538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The aim of this study was to determine the association between fluoroquinolones (FQs) use, the risk of de novo aortic aneurysm or dissection (AAD), and the prognosis of patients with pre-existing AAD. Materials and methods We searched PubMed, EMBASE, CENTRAL, Scopus, and Web of Science on 31 March 2022. Observational studies that evaluated the association of FQs with AAD risk in the general population or FQs with the prognosis of patients with preexisting AAD and presented adjusted effect estimates were included. Two reviewers assessed study eligibility, extracted data, and assessed the risk of bias and certainty of evidence using GRADE. Results Of the 13 included studies, 11 focused on the association of FQs with de novo AAD incidence, and only one study investigated the association of FQs with the patient with AAD prognosis. FQ use was associated with an increased risk of de novo AAD within 30 days (RR: 1.42; 95% CI: 1.11–1.81; very low certainty) and 60 days (RR: 1.44; 95% CI: 1.26–1.64; low certainty). Specifically, the association was significant when compared with amoxicillin, azithromycin, doxycycline, or no antibiotic use. Furthermore, patients with preexisting AAD exposure to FQ had an increased risk of all-cause mortality (RR: 1.61; 95% CI: 1.50–1.73; moderate certainty) and aortic-specific mortality (RR: 1.80; 95% CI: 1.50–2.15; moderate certainty), compared to the non-exposed FQ group within a 60-day risk period. Conclusion FQs were associated with an increased incidence of AAD in the general population and a higher risk of adverse outcomes in patients with preexisting AAD. Nevertheless, the results may be affected by unmeasured confounding factors. This should be considered by physicians contemplating using FQs in patients with aortic dilation and those at high risk of AAD. Systematic Review Registration [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021230171].
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Affiliation(s)
- Can Chen
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Benjamin Patterson
- Department of Vascular Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Ruan Simpson
- Department of Pathology, Portsmouth Hospitals NHS Trust, United Kingdom
| | - Yanli Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhangzhang Chen
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qianzhou Lv
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiaoyu Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Xiaoyu Li,
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Weiguo Fu,
| | - Baolei Guo
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
- Baolei Guo,
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Systemic quinolones and risk of retinal detachment III: a nested case-control study using a US electronic health records database. Eur J Clin Pharmacol 2022; 78:1019-1028. [PMID: 35290480 PMCID: PMC9107393 DOI: 10.1007/s00228-021-03260-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022]
Abstract
Background Quinolones are popular antibiotics that are known for their potency, broad coverage, and reasonable safety. Concerns have been raised about a possible association between quinolones and retinal detachment (RD). Methods We conducted a nested case–control study using electronic health records (EHR) from the Health Facts® Database. The initial cohort included all patients who were admitted between 2000 and 2016, with no history of eye disease, and had a minimum medical history of one year. Eligible cases comprised inpatients who were first admitted with a primary diagnosis of RD between 2010 and 2015. Each eligible case was matched without replacement to five unique controls by sex, race, age, and period-at-risk. We used conditional logistic regression to calculate RD risk, adjusting for exposure to other medications, and major risk factors. Results We identified 772 cases and 3860 controls. Whereas our primary analysis of all subjects revealed no quinolone-associated RD risk, elevated but non-significant risks were noted in African Americans (ciprofloxacin and levofloxacin), those aged 56–70 years old (moxifloxacin), and women (ciprofloxacin). Conclusion Our study did not identify an elevated RD risk within 30 days following systemic administration of quinolone antibiotics. Suggestions of increased risk observed in some population subgroups warrant further investigation. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-021-03260-4.
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Leonova MV. Collagen-associated side effects of fluoroquinolones: aneurysm and aortic dissection (systematic review). CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.1.201380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Well known for fluoroquinolones cause the development of collagen-associated side effects tendopathies with the risk of tendon rupture and retinal detachment, which is associated with the damaging effect and degradation of type I and type III collagen. The aorta is also rich in collagen type I and type III up to 8090%, which has the potential to play a role in the development of aortopathies in cases of fluoroquinolone use. Since 2015, the first publications of research results on the collagen-associated effect of fluoroquinolones on the development of aneurysm and aortic dissection, often called aortopathy, began to appear. A systematic review of observational studies and 5 meta-analyzes of the development of a novel side effect of fluoroquinolones is presented. An absolute incidence of this side effect of 1.1% and a twofold increased relative risk of developing aneurysm/aortic dissection (RR 2.042.23), aortic aneurysm (RR 1.742.83), and aortic dissection (RR 1.882.79). When analyzing age subgroups, an increase in the risk of aneurysm/aortic dissection was noted already from the age of 35 years and was more significant in elderly patients (over 65 years). Analisys of the course duration of fluoroquinolone use (314 days or 14 days) was carried out in two studies and showed an increase in the risk of aneurysm/aortic dissection with increasing duration of fluoroquinolone therapy (RR 1.72 versus RR 1.92). The risk of developing a fluoroquinolone-associated aortopathy was highest during the first 30 days after the course use of fluoroquinolones, with a slight decrease within 6090 days after the course. The signal was confirmed by the FDA pharmacovigilance system (USA) during the analysis of cases of aneurysm/aortic dissection against the background of fluoroquinolones use. International regulatory authorities (FDA and EMA) have announced official documents warning of an increased incidence of rare but serious cases of aortic dissection or ruptured aortic aneurysm with oral fluoroquinolones. Fluoroquinolones should not be given to patients at increased risk unless other treatment options are available. The increased risk category includes patients with a history of aortic or other blood vessel aneurysm, high blood pressure, and the elderly.
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Abstract
Fluoroquinolones are broad-spectrum antibiotics with good oral bioavailability. They are used for the treatment of a wide variety of infections, but there are restrictions on prescribing these drugs. Epidemiological studies have reported an increased risk of rare adverse effects. These include tendinopathy and tendon rupture, peripheral neuropathy and aortic aneurysm. Safe prescribing of fluroquinolones requires recognition of patients with risk factors for toxicity. Prompt drug discontinuation is recommended in the event of an adverse reaction. Practising antimicrobial stewardship by prescribing fluoroquinolones only when alternative drugs are unavailable is also key to limiting adverse events and antibiotic resistance.
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Affiliation(s)
- Diva Baggio
- Malignant Haematology and Stem Cell Transplantation Service, Alfred Health.,General Medicine Unit, Alfred Health.,Central Clinical School, Monash University.,Melbourne
| | - Michelle R Ananda-Rajah
- Malignant Haematology and Stem Cell Transplantation Service, Alfred Health.,General Medicine Unit, Alfred Health.,Central Clinical School, Monash University.,Melbourne
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Taher MK, Alami A, Gravel CA, Tsui D, Bjerre LM, Momoli F, Mattison D, Krewski D. Systemic quinolones and risk of retinal detachment I: analysis of data from the US FDA adverse event reporting system. Expert Opin Drug Saf 2021; 21:269-276. [PMID: 34641748 DOI: 10.1080/14740338.2022.1993187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Quinolones comprise a class of antibiotics that are globally preferred for treating a wide range of bacterial infections due to their potency, broad coverage, favorable pharmacologic profile, and mostly mild to moderate adverse reactions. Spontaneous reports on adverse drug events (ADE) and data from some pharmacoepidemiologic studies have raised concerns regarding quinolones and risk of retinal detachment (RD). This study examined ADE reports submitted to FDA adverse event reporting system (FAERS) for evidence on quinolone-associated RD risk. RESEARCH DESIGN AND METHODS We identified all RD reports in FAERS between 2010-2019. We compared ADE signals between quinolones and selected medications that were previously associated with RD, and with reference medications not known to cause RD. For signal detection, we used two techniques: the proportional reporting ratio (PRR) and multi-item gamma Poisson shrinker (MGPS), which are known for their higher sensitivity and specificity for ADE signal detection, respectively. RESULTS Moxifloxacin showed a positive and significant PRR signal for RD [PRR: 2.54 (1.60, 4.04)], and a marginally significant EBGM signal [EBGM: 2.21 (1.41, 3.02)]. CONCLUSION Moxifloxacin is the only quinolone showing a positive disproportionality signal for RD. Further epidemiologic research is needed to clarify the association between moxifloxacin and RD risk.
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Affiliation(s)
- Mohamed Kadry Taher
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Risk Sciences International, Ottawa, ON, Canada
| | | | - Christopher A Gravel
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Derek Tsui
- Risk Sciences International, Ottawa, ON, Canada
| | - Lise M Bjerre
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,Institut Du Savoir Montfort, Ottawa, ON, Canada
| | - Franco Momoli
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Risk Sciences International, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Donald Mattison
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Risk Sciences International, Ottawa, ON, Canada
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Risk Sciences International, Ottawa, ON, Canada
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Barberán J, Barberán LC, de la Cuerda A. [Safety in the selection of oral antibiotic treatment in community infections, beyond COVID-19]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2021; 34:289-297. [PMID: 34319057 PMCID: PMC8329570 DOI: 10.37201/req/087.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Los antibióticos orales son uno de los fármacos más utilizados en la comunidad. Sus efectos adversos son generalmente poco frecuentes y leves, e incluyen toxicidad e interacciones medicamentosas. El mecanismo de producción es variado y no siempre bien conocido. El conocimiento de los efectos adversos con relevancia clínica puede permitir hacer un uso más juicioso de los antibióticos basados en el principio primero no hacer daño, primun non nocere. En esta revisión exploramos los principales efectos adversos de los antibióticos orales con énfasis en los β-lactámicos, macrólidos y fluoroquinolonas.
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Affiliation(s)
- J Barberán
- José Barberán, Servicio de Medicina Interna - Enfermedades infecciosas Hospital Universitario HM Montepríncipe. Universidad San Pablo CEU, Madrid, Spain.
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The Association between the Risk of Aortic Aneurysm/Aortic Dissection and the Use of Fluroquinolones: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2021; 10:antibiotics10060697. [PMID: 34200836 PMCID: PMC8230555 DOI: 10.3390/antibiotics10060697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/30/2021] [Accepted: 06/04/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to investigate the association between the risk of aortic aneurysm (AA)/aortic dissection (AD) and the use of fluoroquinolones (FQs). PubMed, Embase, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Web of Science and Scopus were searched for relevant articles to 21st February 2021. Studies that compared the risk of AA/AD in patients who did and did not receive FQs or other comparators were included. The pooled results of nine studies with 11 study cohorts showed that the use of FQs increased the risk of AA/AD by 69% (pooled risk ratio (RR) = 1.69 (95% CI = 1.08, 2.64)). This significant association remained unchanged using leave-one-out sensitivity test analysis. Similar results were found for AA (pooled RR = 1.58 (1.21, 2.07)) but no significant association was observed for AD (pooled RR = 1.23 (0.93, 1.62)). Stratified by the comparators, the use of FQs was associated with a significantly higher risk of AA/AD compared to azithromycin (pooled RR = 2.31 (1.54, 3.47)) and amoxicillin (pooled RR = 1.57 (1.39, 1.78)). In contrast, FQ was not associated with a higher risk of AA/AD, when compared with amoxicillin/clavulanic acid or ampicillin/sulbactam (pooled RR = 1.18 (0.81, 1.73)), sulfamethoxazole–trimethoprim (pooled RR = 0.89 (0.65, 1.22)) and other antibiotics (pooled RR = 1.14 (0.90, 1.46)). In conclusion, FQs were associated with an increased risk of AA or AD, although the level of evidence was not robust. However, FQs did not exhibit a higher risk of AA or AD compared with other broad-spectrum antibiotics. Further studies are warranted to clarify the role of FQs in the development of AA or AD.
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Yu X, Jiang DS, Wang J, Wang R, Chen T, Wang K, Cao S, Wei X. Fluoroquinolone Use and the Risk of Collagen-Associated Adverse Events: A Systematic Review and Meta-Analysis. Drug Saf 2020; 42:1025-1033. [PMID: 31077091 DOI: 10.1007/s40264-019-00828-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION It has been suggested that fluoroquinolone antibiotics increase the risk of developing collagen-associated adverse events such as aortic dissection and aortic aneurysm. These are life-threatening emergencies that need to be prevented. OBJECTIVES We performed this systematic review to clarify the association between fluoroquinolones and three collagen-associated adverse events: aortic aneurysm or aortic dissection, retinal detachment, and tendon disorders. METHODS We searched PubMed, Embase, and Scopus for observational studies up to January 2019. Cohort and case-control studies were included if they reported data on the risk of collagen-related adverse events associated with fluoroquinolone exposure versus no exposure. We assessed the quality of the included studies using the Newcastle-Ottawa Scale. Effect statistics were pooled using random-effects models. Sensitivity and subgroup analyses were performed to identify any source of heterogeneity. RESULTS After screening 2729 citations, we included 22 observational studies (12 cohort studies and ten case-control studies) with 19,207,552 participants. Current use of fluoroquinolones was significantly associated with aortic aneurysm and aortic dissection (odds ratio [OR] 2.20; 95% confidence interval [CI] 1.92-2.52), tendon disorders (OR 1.89; 95% CI 1.53-2.33), and retinal detachment (sensitivity analysis, OR 1.25; 95% CI 1.01-1.53). Past fluoroquinolone use (> 30 and ≤ 365 days) was associated with retinal detachment (OR 1.27; 95% CI 1.09-1.47). CONCLUSIONS Fluoroquinolone use incurs a risk of developing three collagen-associated diseases (aortic aneurysm or aortic dissection, retinal detachment, and tendon disorders). Patients at an increased risk of collagen-associated diseases should not use fluoroquinolones unless no other options are available.
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Affiliation(s)
- Xinyu Yu
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ding-Sheng Jiang
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China.,NHC Key Laboratory of Organ Transplantation, Wuhan, China.,Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Jing Wang
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Rui Wang
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Taiqiang Chen
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Kan Wang
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shiyi Cao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Xiang Wei
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China. .,NHC Key Laboratory of Organ Transplantation, Wuhan, China. .,Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China.
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Stahlmann R, Lode H. Calculated initial parenteral treatment of bacterial infections: Safety and tolerabilty. GMS INFECTIOUS DISEASES 2020; 8:Doc16. [PMID: 32373441 PMCID: PMC7186799 DOI: 10.3205/id000060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This is the fourth chapter of the guideline "Calculated initial parenteral treatment of bacterial infections in adults - update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. Safety and tolerability of antimicrobial agents will be discussed in this chapter. Toxic, allergic and biological effects can be differentiated on the basis of their pathogenesis. The question of differences in the tolerability of specific antibiotics is of particular importance. However, due to limitations of the available data, it cannot be answered for most agents with the desired accuracy. For an assessment of rare side effects, results from the postmarketing surveillance have to be used.
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Affiliation(s)
- Ralf Stahlmann
- Institut für Klinische Pharmakologie und Toxikologie, Charité – Universitätsmedizin Berlin, Germany
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11
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Oral Fluoroquinolones and Risk of Mitral and Aortic Regurgitation. J Am Coll Cardiol 2019; 74:1444-1450. [DOI: 10.1016/j.jacc.2019.07.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/20/2019] [Accepted: 07/02/2019] [Indexed: 12/20/2022]
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12
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Baek YH, Park SJ, Jeong S, Oh IS, Jeong HE, Park KH, Shin JY. Signal Detection Between Fluoroquinolone Use and the Risk of Rhegmatogenous Retinal Detachment: Sequence Symmetry Analysis Using Nationwide South Korean Healthcare Database Between 2004 and 2015. Clin Drug Investig 2018; 38:1179-1188. [PMID: 30276555 DOI: 10.1007/s40261-018-0708-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVES The association between fluoroquinolone and rhegmatogenous retinal detachment (RRD) has been controversial as a result of inconsistent findings. We set out to detect a possible association of fluoroquinolone use and risk of RRD, using sequence symmetry analysis (SSA). METHODS We conducted an SSA, case-only design, using a Korean nationwide healthcare database between 2004 and 2015. Exposure was defined as new fluoroquinolone use and outcome as an incident RRD, defined by a diagnosis of RRD (ICD-10: "H33.0") or surgery for RRD. Pairs of exposure and RRD within a 1-year time-window were included. The sequence ratio (SR) was calculated by the ratio of the number of patients prescribed with exposure first and diagnosed with RRD second divided by the number of patients diagnosed with RRD first and prescribed with exposure second. SR was adjusted (aSR) for underlying trends and 95% confidence intervals (CIs) were calculated. In order to observe whether the estimated ratio stabilized over time, we did repeated time-sequential analyses with the cumulative data starting from the 3-year period 2004-2006 to 2015. RESULTS Fluoroquinolone use had a greater association with RRD as compared with other antibiotics [fluoroquinolone: 5234 pairs; aSR = 1.70 (95% CI 1.61-1.80), first-generation cephalosporin: 4139 pairs; aSR = 1.39 (95% CI 1.31-1.80), second-generation cephalosporin: 5914 pairs; aSR = 1.31 (95% CI 1.24-1.38), third-generation cephalosporin: 3650 pairs; aSR = 0.88 (95% CI 0.83-0.95), extended-spectrum penicillin: 4823 pairs; aSR = 1.29 (95% CI 1.31-1.47), macrolides: 4115 pairs; aSR = 1.31 (95% CI 1.24-1.39)]. Time-sequential analyses supported the association between fluoroquinolone and RRD. CONCLUSIONS Our detection suggests a possible association between fluoroquinolone use and RRD. However, possible overestimation and reverse causality bias may have influenced our findings due to the limitation of an SSA design.
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Affiliation(s)
- Yeon-Hee Baek
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sohyun Jeong
- School of Pharmacy, Gachon University, Incheon, South Korea
| | - In-Sun Oh
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Han Eol Jeong
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.
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Forooghian F. The importance of validation in ophthalmic medical claims database research. Can J Ophthalmol 2017; 52:143-144. [PMID: 28457280 DOI: 10.1016/j.jcjo.2016.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
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14
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Alves C, Penedones A, Mendes D, Batel Marques F. A systematic review and meta-analysis of the association between systemic fluoroquinolones and retinal detachment. Acta Ophthalmol 2016; 94:e251-9. [PMID: 26846201 DOI: 10.1111/aos.12931] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 10/17/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE Several pharmacoepidemiologic studies have been carried out evaluating the risk of retinal detachment associated with systemic fluoroquinolones. This meta-analysis aims to investigate such association, in the light of the best scientific evidence available. METHODS A literature search was conducted to identify relevant studies evaluating the risk for retinal detachment associated with systemic fluoroquinolones. A meta-analysis was performed to pool rate ratios (RRs). Meta-regressions were conducted aiming to evaluate the influence of time interval between fluoroquinolones use and retinal detachment diagnosis or treatment risk estimates. RESULTS Ten observational studies from seven publications were included. Overall, fluoroquinolones were not associated with an increased risk for retinal detachment [RR 1.47 (95% CI 0.95-2.27): p = 0.09; I(2) = 92.8%]. When the analysis was stratified according to different study designs, the result was statistically significant for retrospective cohort studies [RR 1.87 (95% CI 1.36-2.58); p < 0.001; I(2) = 0.0%] and for past users of fluoroquinolones, based on data from case-control studies [RR 1.07 (95% CI 1.01-1.12); p = 0.01; I(2) = 0.0%]. According to meta-regressions, the risk for retinal detachment did not vary due to different time intervals between fluoroquinolones prescription and retinal detachment occurrence. No statistically significant results were identified among studies evaluating only rhegmatogenous retinal detachments, as well as among studies that evaluated patients not requiring a prior ophthalmologist visit to be included. CONCLUSIONS In light of the current available evidence, systemic fluoroquinolones do not seem to be associated with retinal detachment.
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Affiliation(s)
- Carlos Alves
- Central Portugal Regional Pharmacovigilance Unit (UFC); Centre for Health Technology Assessment and Drug Research (CHAD); AIBILI - Association for Innovation and Biomedical Research on Light and Image; Coimbra Portugal
- School of Pharmacy; University of Coimbra; Coimbra Portugal
| | - Ana Penedones
- Central Portugal Regional Pharmacovigilance Unit (UFC); Centre for Health Technology Assessment and Drug Research (CHAD); AIBILI - Association for Innovation and Biomedical Research on Light and Image; Coimbra Portugal
- School of Pharmacy; University of Coimbra; Coimbra Portugal
| | - Diogo Mendes
- Central Portugal Regional Pharmacovigilance Unit (UFC); Centre for Health Technology Assessment and Drug Research (CHAD); AIBILI - Association for Innovation and Biomedical Research on Light and Image; Coimbra Portugal
- School of Pharmacy; University of Coimbra; Coimbra Portugal
| | - Francisco Batel Marques
- Central Portugal Regional Pharmacovigilance Unit (UFC); Centre for Health Technology Assessment and Drug Research (CHAD); AIBILI - Association for Innovation and Biomedical Research on Light and Image; Coimbra Portugal
- School of Pharmacy; University of Coimbra; Coimbra Portugal
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15
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He Y, Wong ICK, Li X, Anand S, Leung WK, Siu CW, Chan EW. The association between non-vitamin K antagonist oral anticoagulants and gastrointestinal bleeding: a meta-analysis of observational studies. Br J Clin Pharmacol 2016; 82:285-300. [PMID: 26889922 DOI: 10.1111/bcp.12911] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/12/2016] [Accepted: 02/14/2016] [Indexed: 12/21/2022] Open
Abstract
Particular concerns have been raised regarding the association between non-vitamin K antagonist oral anticoagulants (NOACs) and the risk of gastrointestinal bleeding (GIB); however, current findings are still inconclusive. We conducted a systematic review with a meta-analysis to examine the association between NOACs and GIB in real-life settings. We performed a systematic search of PubMed, EMBASE and CINAHL Plus up to September 2015. Observational studies that evaluated exposure to NOACs reporting GIB outcomes were included. The inverse variance method using the random-effects model was used to calculate the pooled estimates. Eight cohort studies were included in the primary meta-analysis, enrolling 1442 GIB cases among 106 626 dabigatran users (49 486 patient-years), and 184 GIB cases among 10 713 rivaroxaban users (4046 patient-years). The pooled incidence rates of GIB were 4.50 [95% confidence interval (CI) 3.17, 5.84] and 7.18 (95% CI 2.42, 12.0) per 100 patient-years among dabigatran and rivaroxaban users, respectively. The summary risk ratio (RR) was 1.21 (95% CI 1.05, 1.39) for dabigatran compared with warfarin, and 1.09 (95% CI 0.92, 1.30) for rivaroxaban. Subgroup analyses showed a dose-related effect of dabigatran, with a significantly higher risk of GIB for 150 mg b.i.d. (RR = 1.51, 95% CI 1.34, 1.70) but not for 75 mg b.i.d. or 110 mg b.i.d.. In addition, the use of proton pump inhibitors (PPIs)/histamine H2-receptor antagonists (H2RAs) influenced the association in dabigatran users, whereas this effect was modest among rivaroxaban users. In conclusion, our meta-analysis suggested a slightly higher risk of GIB with dabigatran use compared with warfarin, whereas no significant difference was found between rivaroxaban and warfarin for GIB risk.
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Affiliation(s)
- Ying He
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong.,Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Shweta Anand
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Wai K Leung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Chung Wah Siu
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
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16
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Abstract
Observational studies have been recognised to be essential for investigating the safety profile of medications. Numerous observational studies have been conducted on the platform of large population databases, which provide adequate sample size and follow-up length to detect infrequent and/or delayed clinical outcomes. Cohort and case-control are well-accepted traditional methodologies for hypothesis testing, while within-individual study designs are developing and evolving, addressing previous known methodological limitations to reduce confounding and bias. Respective examples of observational studies of different study designs using medical databases are shown. Methodology characteristics, study assumptions, strengths and weaknesses of each method are discussed in this review.
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18
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Farioli A, Hemmingsson T, Kriebel D. Vascular risk factors and rhegmatogenous retinal detachment: a follow-up of a national cohort of Swedish men. Br J Ophthalmol 2015; 100:907-913. [DOI: 10.1136/bjophthalmol-2015-307560] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/28/2015] [Accepted: 10/01/2015] [Indexed: 12/31/2022]
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