16 Dec Fluoroquinolone use for acute bacterial sinusitis (Q16-02B)
Fluoroquinolone use for acute bacterial sinusitis (Q16-02B)
Overview
What is the issue?
- Oral fluoroquinolones are among the most widely prescribed class of antibiotics and are associated with rare but severe adverse effects such as tendon rupture, aortic aneurysm, and retinal detachment.
- Guidelines suggest limiting their use to second-line treatment only, though their use has extended to milder infections, such as acute bacterial sinusitis, with limited evidence of superiority to first-line antibiotics.
What was the aim of the study?
- This study aimed to compare the clinical outcomes for acute bacterial sinusitis initially treated with fluoroquinolones compared with other antibiotics.
How was the study conducted?
- We conducted a multi-site population-based cohort study using administrative health data from 6 Canadian provinces.
- The study cohorts included over 1.5 million mostly adult patients who received an antibiotic treatment for an incident episode of acute bacterial sinusitis between 2005 and 2015.
- Clinical outcomes within 30 days of the initial antibiotic dispensation were compared between patients treated with a fluoroquinolone and those treated with other antibiotics. Results were combined across studies using a statistical approach called meta-analysis.
What did the study find?
- Fluoroquinolones were not commonly used in the first-line treatment of acute bacterial sinusitis. Their use represented between 2% to 11% of antibiotic dispensations and declined in all provinces over the study period.
- Fluoroquinolones were more likely to be prescribed as second-line treatment.
- Compared with other antibiotics, fluoroquinolones were not associated with better clinical outcomes. There was a 26% higher risk of repeated primary care visits following fluoroquinolone use compared with other antibiotics.
- There was no difference between fluoroquinolones and other antibiotics in the need for a second antibiotic dispensation within 30 days.
Implications
- Although a relatively small proportion of acute bacterial sinusitis events were treated with fluoroquinolones, guidelines suggest limiting their use to second-line treatment only.
Key message
- Fluoroquinolone antibiotic use was not associated with better clinical outcomes compared with other antibiotics among patients treated for acute bacterial sinusitis.
Manuscripts
St-Jean A, Chateau D, Dahl M, Ernst P, Daneman N, Sketris IS, Zhang J, Marra F, Quail J, Bugden S, for the Canadian Network for Observational Drug Effect Studies (CNODES) Investigators. Regional Variation in the Potentially Inappropriate First Line Use of Fluoroquinolones in Canada as a Key to Antibiotic Stewardship? A Drug Utilization Review Study. BMC Infectious Diseases. 2021 Aug 3;21(1):733.
Ernst P, Dahl M, Chateau D, Daneman N, Quail J, Sketris IS, Fisher A, Zhang J, Bugden S for the Canadian Network for Observational Drug Effect Studies (CNODES) Investigators. Comparative effectiveness of fluoroquinolone antibiotic use in uncomplicated acute exacerbations of COPD: A multi-cohort study. International Journal of Chronic Obstructive Pulmonary Disease. 2019 Dec 18, 14: 2939—2946
Daneman N, Chateau D, Dahl M, Zhang J, Fisher A, Sketris IS, Quail J, Lalji F, Ernst P, Bugden S; for the Canadian Network for Observational Drug Effect Studies (CNODES) Investigators. Fluoroquinolone Use for Uncomplicated Urinary Tract Infections in Women: A Retrospective Cohort Study. Clinical Microbiology and Infection.2020 May;26(5):613-618.