Comparative Effectiveness Of Fluoroquinolone Antibiotic Use In Uncomplicated Acute Exacerbations Of COPD: A Multi-Cohort Study

Abstract

Purpose

Fluoroquinolone antibiotics are associated with rare, but severe adverse events. They are frequently used for the treatment of acute exacerbations of COPD (AECOPD). While their effectiveness in severe exacerbations requiring hospitalisation has been well documented, the potential benefit in the ambulatory setting is less clear, especially in uncomplicated patients with COPD.

Patients and characteristics

We carried out a retrospective cohort study using health care databases from six Canadian provinces in subjects visiting their physician for uncomplicated COPD. Subjects dispensed either a quinolone or other antibiotics were compared using inverse probability of treatment weights with high dimensional propensity scores on 30-day outcomes, including repeat visits, hospitalisation for AECOPD and subsequent antibiotic prescription. Results from each province were combined by random effects meta-analysis.

Results

We identified 286,866 AECOPD events among 203,642 unique individuals. The frequency of fluoroquinolone use, mostly levofloxacin and moxifloxacin, varied by province and ranged from 8% to 32% of AECOPD antibiotic prescriptions. The risk of a repeat ambulatory care visit was increased among patients who were dispensed a fluoroquinolone compared with other antibiotics (OR 1.32, 95% CI 1.27–1.36). The risk of a hospitalisation for AECOPD was also higher with fluoroquinolones (OR 1.52, 95% CI 1.33–1.74). There was no difference in subsequent antibiotic prescriptions (OR 1.00, 95% CI 0.94–1.07).

Conclusion

There is no apparent benefit in short-term outcomes with fluoroquinolones as compared to other antibiotics for the ambulatory treatment of AECOPD in uncomplicated patients. These findings support current recommendations that fluoroquinolones be reserved for AECOPD in patients with recurrent exacerbations, significant co-morbidity or requiring hospitalisation.

Journal

Journal ID (nlm-ta): Int J Chron Obstruct Pulmon Dis

Journal ID (iso-abbrev): Int J Chron Obstruct Pulmon Dis

Journal ID (publisher-id): COPD

Journal ID (pmc): copd

Title: International Journal of Chronic Obstructive Pulmonary Disease

Publisher: Dove

ISSN (Print): 1176-9106

ISSN (Electronic): 1178-2005

Publication date (Electronic): 18 December 2019

Publication date Collection: 2019

Volume: 14

Pages: 2939-2946

Affiliations

[1 ]Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital , Montreal, Quebec, Canada

[2 ]Manitoba Centre for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg, Manitoba, Canada

[3 ]Institute for Clinical Evaluative Sciences , Toronto, Ontario, Canada

[4 ]Sunnybrook Research Institute , Toronto, Ontario, Canada

[5 ]Division of Infectious Diseases, Sunnybrook Health Sciences Centre , Toronto, Ontario, Canada

[6 ]Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada

[7 ]Health Quality Council , Saskatoon, Saskatchewan, Canada

[8 ]Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan , Saskatoon, Saskatchewan, Canada

[9 ]College of Pharmacy, Dalhousie University , Halifax, Nova Scotia, Canada

[10 ]Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia , Vancouver, British Columbia, Canada

[11 ]Department of Medicine, Cumming School of Medicine, University of Calgary , Calgary, Alberta, Canada

[12 ]School of Pharmacy, Memorial University of Newfoundland , St John’s, Newfoundland and Labrador, Canada

[13 ]College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg, Manitoba, Canada

Author notes

Correspondence: Shawn Bugden School of Pharmacy, Memorial University of Newfoundland , 300 Prince Philip Drive, St John’s, Newfoundland and LabradorA1B 3V6, CanadaTel [phone]Fax [phone] Email [e-mail]

Article

Publisher ID: 226324

DOI: 10.2147/COPD.S226324

PMC ID: 6927224

Copyright statement: © 2019 Ernst et al.

License:

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Page count

Figures: 4, Tables: 2, References: 24, Pages: 8

Categories

Subject: Original Research