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

Abstract

Pierre Ernst,1 Matthew Dahl,2 Dan Chateau,2 Nick Daneman,3–6 Jacqueline Quail,7,8 Ingrid S Sketris,9 Anat Fisher,10 Jianguo Zhang,11 Shawn Bugden12,13 On behalf of the Canadian Network for Observational Drug Effect Studies (CNODES) Investigators1Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada; 2Manitoba 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; 3Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; 4Sunnybrook Research Institute, Toronto, Ontario, Canada; 5Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; 6Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; 7Health Quality Council, Saskatoon, Saskatchewan, Canada; 8Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; 9College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada; 10Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada; 11Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; 12School of Pharmacy, Memorial University of Newfoundland, St John’s, Newfoundland and Labrador, Canada; 13College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, CanadaCorrespondence: Shawn BugdenSchool of Pharmacy, Memorial University of Newfoundland, 300 Prince Philip Drive, St John’s, Newfoundland and Labrador A1B 3V6, CanadaTel [phone]Fax [phone]Email [email protected]: 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.Keywords: chronic obstructive pulmonary disease, fluoroquinolones, comparative effectiveness

Keywords

• chronic obstructive pulmonary disease
• fluoroquinolones
• comparative effectiveness