Fluoroquinolones may precipitate psychiatric disorders, hypoglycemia in elderly CKD patients: JAMA

According to a study published in the Journal of American Medical Association, among older patients with advanced CKD who were prescribed a fluoroquinolone at a higher-than-recommended dose were significantly more likely to experience the composite outcome of a hospital visit with nervous system and/or psychiatric disorders, hypoglycemia, or a collagen-associated event. Although risk was low, older adults with advanced chronic kidney disease (CKD) should be prescribed fluoroquinolones with caution and at low doses.

This population-based cohort study (January 1, 2008 to March 17, 2020) conducted in Ontario, Canada, used pooled health data to assess the efficacy of novel fluoroquinolone antibiotics. identified the user. Participants included adults with advanced CKD aged 66 years or older. Data analysis was conducted from 1 January to 30 April 2021. A new formulation of high-dose fluoroquinolone compared to low-dose fluoroquinolone. The primary endpoint was his 14-day risk of hospital visits with neurological and/or psychiatric disorders, hypoglycemia, or collagen-related events. Secondary endpoints included hospitalization for sepsis, retinal detachment, or other tendon disorders, all-cause hospitalization, all-cause mortality, and sudden cardiac death.

The major highlights of this study:

1. Of the 11917 patients included in the analysis, 5482 (46.0%) received high-dose fluoroquinolones and 6435 (54.0%) received low-dose fluoroquinolones.

2. After weighting, the primary composite outcome - hospital visit for nervous system and/or psychiatric disorders, hypoglycemia, or collagen-related events - was 68 out of 5482 (1.2%) patients treated with higher doses of fluoroquinolones.

3. 47 out of 5516 patients (0.9%) were treated with low-dose fluoroquinolones.

4. Risk of sepsis, retinal detachment, all-cause hospitalization, all-cause mortality, and sudden cardiac death did not differ significantly between groups.

Taken together, these results suggest that elderly patients with advanced chronic kidney disease who are prescribed fluoroquinolones at doses have significantly higher likelihood of facing higher Hypoglycemia, or collagen-related events, although the absolute risk for these events was less than 2%, concluded the Authors.

Reference: 

Muanda, F. T., Sood, M. M., Weir, M. A., Sontrop, J. M., Ahmadi, F., Yoo, E., Kim, R. B., Silverman, M. S., Knoll, G. A., & Garg, A. X. (2022). Association of Higher-Dose Fluoroquinolone Therapy With Serious Adverse Events in Older Adults With Advanced Chronic Kidney Disease. In JAMA Network Open (Vol. 5, Issue 8, p. e2224892). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2022.24892