Adverse events of fluoroquinolones vs. other antimicrobials prescribed in primary care: A systematic review and meta-analysis of randomized controlled trials
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Tandan, M., Cormican, M., & Vellinga, A. (2018). Adverse events of fluoroquinolones vs. other antimicrobials prescribed in primary care: A systematic review and meta-analysis of randomized controlled trials. International Journal of Antimicrobial Agents. doi: https://doi.org/10.1016/j.ijantimicag.2018.04.014
Background Fluoroquinolones (FQs) are second line antimicrobial agents. Once the decision to prescribe an antimicrobial is made, its choice should be based on both the benefits and harms. This systematic review quantifies the occurrence of common adverse events (AEs) related to FQs in relation to any other antimicrobial for any indication in primary care. Methods We searched randomized controlled trials from Embase, PubMed, Cochrane Central Register of Controlled Trials and CINHAL. FQs had to be administered orally, for any indication, to adults and in primary care. Data were extracted independently in standard forms in Covidence . Pooled estimates of the intervention effects for AEs were determined by the Peto odds ratios (ORs) and 95% confidence intervals in Revman. Results Of the 39 studies selected, the most commonly reported AEs were nausea, vomiting, diarrhoea, headache, dizziness, and rash. A meta-analysis of 28 studies reporting AEs showed central nervous system (CNS) (OR 1.40 (1.12-1.75) p=0.003, heterogeneity (I2 ) = 0%) and gastrointestinal (GI) related AEs (OR 1.20 (1.06-1.36) p=0.005, I2=80%) were significantly associated with FQs use compared to other antimicrobials. Compared to FQs, co-amoxiclav 2 showed significantly more total AEs (OR 0.70 (0.54-0.90) p=0.006, I2=78%) and GI-related AEs (OR 0.69(0.52-0.91) p=0.008, I2=94%). Withdrawal and/or discontinuation due to drugrelated AEs were higher for FQs (OR 1.19 (1.00-1.42) p=0.05, I2=5%). Sensitivity analyses did not change these results. Conclusion FQs are associated with more CNS and GI-related AEs compared to other types of antimicrobial. This information is relevant to support decision making in relation to antimicrobial prescribing.
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