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Oral fluoroquinolone use and the risk of acute liver injury: a nationwide cohort study

Nibell, Olof LU ; Svanström, Henrik and Inghammar, Malin LU (2021) In Clinical Infectious Diseases
Abstract
Antibiotics are considered to be among the most frequent causes of drug-related acute liver injury (ALI). Although many ALIs 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 aged 40–85 years.

Results
During a follow-up period of 60... (More)
Antibiotics are considered to be among the most frequent causes of drug-related acute liver injury (ALI). Although many ALIs 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 aged 40–85 years.

Results
During a follow-up period of 60 days, users of oral fluoroquinolones had a >2-fold risk of ALI compared to users of amoxicillin (hazard ratio, 2.32 [95% confidence interval {CI}, 1.01–5.35). The adjusted absolute risk difference for use of fluoroquinolones as compared to amoxicillin was 4.94 (95% CI, .04–16.3) per 1 million episodes.

Conclusions
In this propensity score–matched study, fluoroquinolone treatment was associated with an increased risk of ALI in the first 2 months after starting treatment. (Less)
Please use this url to cite or link to this publication:
author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Clinical Infectious Diseases
article number
ciab825
publisher
Oxford University Press
external identifiers
  • scopus:85134360727
  • pmid:34537834
ISSN
1537-6591
DOI
10.1093/cid/ciab825
language
English
LU publication?
yes
id
2e6c1f8e-eb9e-4540-953b-aa0ea6ff76ec
date added to LUP
2021-10-28 10:23:21
date last changed
2024-04-03 10:26:48
@article{2e6c1f8e-eb9e-4540-953b-aa0ea6ff76ec,
  abstract     = {{Antibiotics are considered to be among the most frequent causes of drug-related acute liver injury (ALI). Although many ALIs 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.<br/><br/>Methods<br/>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 aged 40–85 years.<br/><br/>Results<br/>During a follow-up period of 60 days, users of oral fluoroquinolones had a &gt;2-fold risk of ALI compared to users of amoxicillin (hazard ratio, 2.32 [95% confidence interval {CI}, 1.01–5.35). The adjusted absolute risk difference for use of fluoroquinolones as compared to amoxicillin was 4.94 (95% CI, .04–16.3) per 1 million episodes.<br/><br/>Conclusions<br/>In this propensity score–matched study, fluoroquinolone treatment was associated with an increased risk of ALI in the first 2 months after starting treatment.}},
  author       = {{Nibell, Olof and Svanström, Henrik and Inghammar, Malin}},
  issn         = {{1537-6591}},
  language     = {{eng}},
  month        = {{09}},
  publisher    = {{Oxford University Press}},
  series       = {{Clinical Infectious Diseases}},
  title        = {{Oral fluoroquinolone use and the risk of acute liver injury: a nationwide cohort study}},
  url          = {{http://dx.doi.org/10.1093/cid/ciab825}},
  doi          = {{10.1093/cid/ciab825}},
  year         = {{2021}},
}