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2017 ; 12
(9
): e0183813
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Risk of gastrointestinal perforation in patients taking oral fluoroquinolone
therapy: An analysis of nationally representative cohort
#MMPMID28873440
Hsu SC
; Chang SS
; Lee MG
; Lee SH
; Tsai YW
; Lin SC
; Chen ST
; Weng YC
; Porta L
; Wu JY
; Lee CC
PLoS One
2017[]; 12
(9
): e0183813
PMID28873440
show ga
BACKGROUND: Fluoroquinolone is a commonly prescribed antimicrobial agent, and up
to 20% of its users registers adverse gastroenterological symptoms. We aimed to
evaluate the association between use of fluoroquinolone and gastrointestinal
tract perforation. METHODS: We conducted a nested case-control study on a
national health insurance claims database between 1998 and 2011. The use of
fluoroquinolones was classified into current (< 60 days), past (61-365 days prior
to the index date) and any prior year use of fluoroquinolones. We used the
conditional logistic regression model to estimate rate ratios (RRs), adjusting or
matching by a disease risk score (DRS). RESULTS: We identified a cohort of 17,510
individuals diagnosed with gastrointestinal perforation and matched them to
1,751,000 controls. Current use of fluoroquinolone was associated with the
greatest increase in risk of gastrointestinal perforations after DRS score
adjustment (RR, 1.90; 95% CI, 1.62-2.22). The risk of gastrointestinal
perforation was attenuated for past (RR, 1.33; 95% CI, 1.20-1.47) and any prior
year use (RR, 1.46; 95% CI, 1.34-1.59). To gain insights into whether the
observed association can be explained by unmeasured confounder, we compared the
risk of gastrointestinal perforation between fluoroquinolone and macrolide. Use
of macrolide, an active comparator, was not associated with a significant
increased risk of gastrointestinal perforation (RR, 1.11, 95%CI, 0.15-7.99).
Sensitivity analysis focusing on perforation requiring in-hospital procedures
also demonstrated an increased risk associated with current use. To mitigate
selection bias, we have also excluded people who have never used fluoroquinolone
before or people with infectious colitis, enteritis or gastroenteritis. In both
of the analysis, a higher risk of gastrointestinal perforation was still
associated with the use of fluoroquinolone. CONCLUSIONS: We found that use of
fluoroquinolones was associated with a non-negligible increased risk of
gastrointestinal perforation, and physicians should be aware of this possible
association.