Fluoroquinolone use and chronic obstructive pulmonary disease (Q16-02C)

Fluoroquinolone use and chronic obstructive pulmonary disease (Q16-02C)

Q16-02C

Overview

What is the issue?
  • Systemic oral fluoroquinolones are a class of antibiotics frequently used for the treatment of acute exacerbations of COPD. Their use has been associated with rare but severe adverse effects such as tendon rupture, aortic aneurysm and retinal detachment.
  • While the effectiveness of fluoroquinolone antibiotics in severe exacerbations of COPD requiring hospitalization is known, their potential benefit in uncomplicated exacerbations is unclear.
What was the aim of the study?
  • This study, aimed to determine whether the use of fluoroquinolones in patients with uncomplicated acute exacerbations of COPD is effective.
How was the study conducted?
  • Our investigators conducted six population-based cohort studies with health records of over 200,000 patients with COPD aged 66 years and older from six Canadian provinces.
  • The cohorts included patients who received an antibiotic treatment for episodes of uncomplicated acute exacerbations of COPD between 2005 and 2015.
  • Clinical outcomes within 30 days of the initial antibiotic dispensation were compared among patients treated with a fluoroquinolone versus other antibiotics. Results were combined across studies using a statistical approach called meta-analysis.
What did the study find?
  • Fluoroquinolone use, mostly levofloxacin and moxifloxacin, varied by province and ranged from 8% to 32% of antibiotic dispensations for the first line treatment of uncomplicated acute exacerbations of COPD.
  • 30-day primary care visits and hospitalizations for COPD were more frequent among patients who received a fluoroquinolone compared to other antibiotics. There was no difference in the need for a second antibiotic dispensation.
  • These findings support the current recommendations to limit the use of fluoroquinolones for severe exacerbations of COPD, especially given the rare but severe adverse effects associated with this class of antibiotics.
Implications
  • These findings support current recommendations that fluoroquinolone antibiotics should be reserved for treatment of severe exacerbations of COPD, especially given the rare but severe adverse effects associated with this class of antibiotics.
Key message
  • There is no apparent benefit in short-term clinical outcomes with fluoroquinolones compared with other antibiotics for the treatment of uncomplicated acute exacerbations of chronic obstructive pulmonary disease (COPD).

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.

Presentations

Project Team

Methods Lead
Dan Chateau PhD
Steering Committee Liaison
Pierre Ernst MD, MSc, FRCPC
Lead Analyst
Matthew Dahl BSc
Research Assistant
Audray St-Jean MSc
Site Investigator
Ingrid Sketris Pharm D, MPA(HSA)
Atlantic
Site Investigator
Hala Tamim PhD
Atlantic
Site Investigator
Nick Daneman MD, FRCPC, MSc
Ontario
Site Investigator
Mikhael Laskine
Quebec
Site Investigator
Jacqueline Quail PhD
Saskatchewan
Site Investigator
Jianguo (James) Zhang MSc
Alberta
Site Investigator
Fawziah Lalji BSC(PHARM), PHARMD, FCSHP
British Columbia
Site Investigator
Shawn C. Bugden BSc (Pharm), MSc, PharmD
Manitoba
Analyst
Yan Wang MSc
Atlantic
Analyst
Steve Doucette MSc
Atlantic
Analyst
Vicki Ling
Ontario
Analyst
Fangyun Wu MSc
Ontario
Analyst
Yu Lan Jin BA, MA
Quebec
Analyst
Nianping Hu PhD
Saskatchewan
Analyst
Zhihai Ma
Alberta
Analyst
Anat Fisher MD, PhD
British Columbia
Analyst
Matthew Dahl BSc
Manitoba