Fluoroquinolones and Cardiovascular Risk: A Systematic Review, Meta-analysis and Network Meta-analysis

Gorelik, Einat; Masarwa, Reem; Perlman, Amichai; Rotshild, Victoria; Abbasi, Momen; Muszkat, Mordechai; Matok, Ilan

doi:10.1007/s40264-018-0751-2

Cited by 89 publications

(75 citation statements)

References 27 publications

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“…Among 496 cases, 490 cases received antibiotics with nearly 1/5 receiving combined antibiotic therapy. Fluoroquinolone, previously reported with cardiovascular risks of QTc prolongation, [15] were not statistically associated with acute CVEs in our study. In addition, only 3 cases had macrolides and 6 cases had anti-fungal agents, so they were not included into statistical analysis.…”

Section: Resultscontrasting

confidence: 46%

“…Traditional risk factors of CVDs might have warning effects, including previous history, hypertension, diabetes, hyperlipidemia and hyperuricemia. In addition, serious side effects of some drugs are chief culprits of CVEs, such as theophylline [14] and widely-concerned uoroquinolones [15]. Relationship between inhaled long-acting bronchodilators and CVDs is still highly debated, for their pharmacological mechanisms are contradictory to therapeutics of cardiac remodeling and heart failure.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors of acute cardiovascular events following acute exacerbation period for patients with COPD: a nested case-control study

Lhamo

Zhang

et al. 2020

Preprint

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Background For patients with chronic obstructive pulmonary disease (COPD), the incidence of acute cardiovascular events (CVEs) increases during acute exacerbation (AE) period, causing increased inpatient mortality. Thus, we try to identify risk factors of acute CVEs in patients with AECOPD via a nested case-control study.Methods A total of 496 cases hospitalized for AECOPD were included into analysis, and followed-up for 6 months after discharge. Acute CVEs in the AE period were defined as the new or worsening acute coronary syndrome (ACS), arrhythmia, left ventricular disfunction (LVD). Risk factors were selected from several variables, including baseline characteristics and treatments in the stable period as well as symptoms, laboratory tests, complications and treatments in the AE period. Results Thirty cases (6.05%) had acute CVEs, including 2 with ACS, 13 with LVD, 19 with arrhythmia, and 4 deaths, with significantly increased mortality risk (P=0.001, OR=5.81). Moreover, patients who have had CVEs were inclined to have re-exacerbation within 3 months. Multivariate analysis showed that previous LVD history (P=0.004, OR=5.06), 20% increase in heart rate (HR) (P=0.003, OR= 10.19), electrolyte disturbance (P=0.01, OR= 4.24) and diuretics (P=0.002, OR = 6.37) were independent risk factors. In addition, usage of theophylline, fluoroquinolone and inhaled beta agonists in the AE period were not statistically associated with acute CVEs. Conclusions Our study preliminarily indicated that patients hospitalized for AECOPD with previous LVD history or increased HR need close observation and diuretics should be cautiously used with electrolyte monitoring. These findings needs to be confirmed in a large cohort.

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Section: Resultscontrasting

confidence: 46%

Section: Introductionmentioning

confidence: 99%

Risk factors of acute cardiovascular events following acute exacerbation period for patients with COPD: a nested case-control study

Lhamo

Zhang

et al. 2020

Preprint

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“…In the same study treatment failure was evident in the presence of gyrA mutations conferring high-level resistance such as D94G. Even if dysglycaemia has not been an issue for levofloxacin as for gatifloxacin, and there may be less problems than for moxifloxacin with regard to QT-prolongation and drug-drug interactions (192), less is known about tolerability and safety of higher than recommended doses of levofloxacin (70,193). A randomised ongoing dose-ranging study (OptiQ trial; NCT01918397) evaluating the contribution of levofloxacin to MDR-TB treatment, will present data on correlations of levofloxacin dose increments (11,14,17 and 20 mg/kg) and potential favourable treatment outcome without increased risk of toxicity (194).…”

Section: Is Re-evaluation Of Breakpoints For M Tuberculosis Accordinmentioning

confidence: 87%

Towards individualised treatment of tuberculosis

Niward

2019

Linköping University Medical Dissertations

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Each year, around 10 million of individuals develop active tuberculosis (TB). Worldwide, TB is the leading cause of death from an infectious agent surpassing both malaria and HIV. Current treatment regimens are long and therefore encompass a risk of nonadherence and development of acquired drug-resistance, reflected in the increase of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB. Indeed, this calls for prudent use of existing TB drugs and improvement of TB treatment strategies. The aim of this thesis was to investigate the current drug susceptibility testing (DST) breakpoints for Mycobacterium tuberculosis (M. tuberculosis), the pharmacokinetics and pharmacodynamics (PK/PD) of TB treatment and to explore the role of therapeutic drug monitoring (TDM) for optimising TB treatment. LIST OF SCIENTIFIC PAPERS This thesis is based on the following publications, referred to in the text by their Roman numerals.

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“…Das WIdO hat mit Unterstützung von Prof. Dr. Winfried V. Kern vom Zentrum Infektionsmedizin am Universitätsklinikum Freiburg eine Schätzung vorgenommen, wie viele Patienten in Deutschland einem Risiko für bestimmte Fluorchinolon-assoziierte Nebenwirkungen ausgesetzt waren. Basierend auf verschiedenen epidemiologischen Untersuchungen kann ein zusätzliches Risiko im Vergleich zur Behandlung mit besser verträglichen Antibiotika für ausgewählte unerwünschte Arzneimittelwirkungen und schädigende Wirkungen ermittelt werden (Gorelik et al 2018;Morales et al 2019;Pasternak et al 2018;Persson et al 2019;Tandan et al 2018). Aufgrund solcher Schätzungen und der Meldung möglicherweise anhaltender Nebenwirkungen im Bereich des Nervensystems und des Bewegungsapparates wurde die Anwendung der Fluorchinolone jetzt nochmals eingeschränkt.…”

Section: Risiko Für Die Fluorchinolon-patientenunclassified

Fluorchinolon-Antibiotika: Risikoreiche Verordnungen in Deutschland

Schröder¹,

Zawinell²,

Dollen³

et al. 2020

MVF

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Etwa fünf Prozent der GKV-Versicherten haben im Jahr 2018 ein Fluorchinolon-Antibiotikum verordnet bekommen. Damit gehören diese in Deutschland zu den häufig verordneten Antibiotika, obwohl sie ein erhöhtes Risiko für ungewöhnlich schwerwiegende, teils irreversible Nebenwirkungen haben. Einige der zusätzlichen Risiken dieser als Reserve-Antibiotika eingestuften Arzneimittel können auf der Grundlage von Studienergebnissen hochgerechnet werden. Schätzungsweise 3,3 Millionen Patienten wurden in Deutschland im Jahr 2018 im Rahmen von 3,5 Millionen Behandlungsfällen mit Fluorchinolonen behandelt. Es ist davon auszugehen, dass mehr als 40.000 dieser Patienten von Nebenwirkungen wie einer Schädigung des Nervensystems oder der Hauptschlagader oder einem Sehnenriss betroffen waren und sich 140 Todesfälle ereigneten. Diese Zahlen sind besonders alarmierend, weil für viele Erkrankungen gut wirksame und risikoärmere Antibiotika zur Verfügung stehen oder ein Antibiotikaeinsatz gänzlich vermieden werden kann. Zudem sind die Gefahren dieser Wirkstoffklasse den pharmazeutischen Herstellern bereits seit Jahren bekannt. Eine Auswertung der Daten aller mit Fluorchinolonen behandelten AOK-Patienten zeigt, dass im Verordnungsjahr 2018 bei 8,5 Prozent immer noch eine der nun offiziell eingeschränkten Diagnosen vorliegt. Dies ist gegenüber dem Jahr 2006 ein deutlicher Rückgang. Dennoch ist es aufgrund der Erkenntnislage und der resultierenden Empfehlungen als letzte Therapieoption erstrebenswert, dass Fluorchinolone bei diesen Diagnosen künftig deutlich zurückhaltender verordnet werden.

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Fluoroquinolones and Cardiovascular Risk: A Systematic Review, Meta-analysis and Network Meta-analysis

Cited by 89 publications

References 27 publications

Risk factors of acute cardiovascular events following acute exacerbation period for patients with COPD: a nested case-control study

Risk factors of acute cardiovascular events following acute exacerbation period for patients with COPD: a nested case-control study

Towards individualised treatment of tuberculosis

Fluorchinolon-Antibiotika: Risikoreiche Verordnungen in Deutschland

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