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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Date
2018-04-25Author
Tandan, Meera
Cormican, Martin
Vellinga, Akke
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Recommended Citation
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
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Abstract
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.