Fluoroquinolone use and urinary tract infection (Q16-02A)

Fluoroquinolone use and urinary tract infection (Q16-02A)

Q16-02A

Overview

What is the issue?
  • Systemic oral fluoroquinolones are among the most widely prescribed class of antibiotics.
  • While adverse effects of fluoroquinolones have been described for many years, between 2016 and 2018 several drug regulatory agencies have advised to restrict the use of fluoroquinolones to second line treatment for uncomplicated UTIs given reports of rare but severe adverse effects such as tendon rupture, aortic aneurysm and retinal detachment.
What was the aim of the study?
  • This study, aimed to determine whether non-fluoroquinolone antibiotics are as effective as fluoroquinolones for the treatment of uncomplicated UTIs in women.
How was the study conducted?
  • Our investigators conducted six population-based cohort studies with health records of over 1.5 million women from six Canadian provinces.
  • Cohorts included women who received an antibiotic treatment for episodes of uncomplicated UTI 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?
  • The proportion of uncomplicated UTIs treated first line with a fluoroquinolone, mostly ciprofloxacin, varied by province and ranged from 22% to 49%. Over the study period, the use of fluoroquinolones decreased in five of the six Canadian provinces.
  • Repeated primary care visits, hospitalization for UTI or the need for a second antibiotic dispensation were less common among women treated with a fluoroquinolone compared to other antibiotics.
  • This benefit must be weighed against the risk of fluoroquinolone antibiotic resistance and rare but severe adverse effects of fluoroquinolones when selecting first line treatment for women with uncomplicated UTIs.
Implications
  • The modest benefit of fluoroquinolone antibiotics should be weighed against risk of rare but severe adverse effects of fluoroquinolones when clinicians are selecting first line treatment for women with uncomplicated UTIs.
Key message
  • Fluoroquinolone antibiotic use was associated with a modest reduction in short-term clinical outcomes compared with other antibiotics among women with uncomplicated urinary tract infections (UTIs).

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
Carolina Moriello MSc
Research Assistant
Audray St-Jean MSc
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
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
Analyst
Zhihai Ma
Alberta
Analyst
Anat Fisher MD, PhD
British Columbia
Analyst
Matthew Dahl BSc
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