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氟喹诺酮类药物的不良反应:一项在印度南部三级医疗机构进行的回顾性队列研究。

Adverse Effects of Fluoroquinolones: A Retrospective Cohort Study in a South Indian Tertiary Healthcare Facility.

作者信息

Mathews Benitta, Thalody Ashley Ann, Miraj Sonal Sekhar, Kunhikatta Vijayanarayana, Rao Mahadev, Saravu Kavitha

机构信息

Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.

Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.

出版信息

Antibiotics (Basel). 2019 Jul 27;8(3):104. doi: 10.3390/antibiotics8030104.

Abstract

The Food and Drug Administration (FDA) safety review revealed that the use of fluoroquinolones (FQs) is linked with disabling and potentially permanent serious adverse effects. These adverse effects compromise the tendons, muscles, joints, nerves, and central nervous system of the human body. The purpose of the study was to investigate the incidence and risk factors for adverse drug reactions (ADRs) caused by FQs in comparison with other antibiotics used. A retrospective cohort study was conducted over seven months in Kasturba Medical College Hospital, Manipal, India. Patients who were prescribed with FQs were selected as the study cohort (SC; = 482), and those without FQs were the reference cohort (RC; = 318). The results showed that 8.5% (41) of patients developed ADRs in the SC, whereas 4.1% (13) of patients developed ADRs in the RC. With oral and parenteral routes of administration, almost a similar number of ADRs were observed. Levofloxacin caused the highest number of ADRs reported, especially with the 750-mg dose. Based on a multiple logistic regression model, FQ use (odds ratio (OR): 2.27; 95% confidence interval (CI): 1.18-4.39; = 0.015) and concomitant steroid use (OR: 3.19; 95% CI: 1.31-7.79; = 0.011) were identified as independent risk factors for the development of ADRs among antibiotics users, whereas age was found to be protective (OR: 0.98; 95% CI: 0.97-1.00; = 0.047). The study found a higher incidence of ADRs related to FQs compared to other antibiotics. The study concludes a harmful association between FQ use and the development of ADRs. Moreover, FQs are not safe compared to other antibiotics. Hence, the use of FQs should be limited to the conditions where no other alternatives are available.

摘要

美国食品药品监督管理局(FDA)的安全审查显示,氟喹诺酮类药物(FQs)的使用与致残性且可能永久性的严重不良反应有关。这些不良反应会损害人体的肌腱、肌肉、关节、神经和中枢神经系统。本研究的目的是调查与其他使用的抗生素相比,FQs引起药物不良反应(ADRs)的发生率及危险因素。在印度马尼帕尔卡斯图巴医学院医院进行了一项为期七个月的回顾性队列研究。被开具FQs处方的患者被选为研究队列(SC;n = 482),未使用FQs的患者为对照队列(RC;n = 318)。结果显示,SC中有8.5%(41例)的患者发生了ADRs,而RC中有4.1%(13例)的患者发生了ADRs。在口服和肠外给药途径中,观察到的ADRs数量几乎相似。左氧氟沙星报告的ADRs数量最多,尤其是750毫克剂量时。基于多因素逻辑回归模型,使用FQs(比值比(OR):2.27;95%置信区间(CI):1.18 - 4.39;P = 0.015)和同时使用类固醇(OR:3.19;95%CI:1.31 - 7.79;P = 0.011)被确定为抗生素使用者发生ADRs的独立危险因素,而年龄具有保护作用(OR:0.98;95%CI:0.97 - 1.00;P = 0.047)。该研究发现,与其他抗生素相比,FQs相关ADRs的发生率更高。该研究得出结论,使用FQs与发生ADRs之间存在有害关联。此外,与其他抗生素相比,FQs不安全。因此,FQs的使用应仅限于没有其他替代药物的情况。

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