No increased Achilles tendon rupture risk with 3rd-gen fluoroquinolones
An analysis of administrative claims data in Japan found that newer, third-generation fluoroquinolones were not associated with an increased risk of Achilles tendon rupture, Japanese researchers reported this week in the Annals of Family Medicine.
Using data from patients enrolled in Japan's National Health Insurance and Elderly Health Insurance programs from April 2012 to March 2017, the study examined patients who had experienced Achilles tendon rupture after receiving an antibiotic prescription. Antibiotics were categorized into three groups: first- and second-generation fluoroquinolones, third-generation fluoroquinolones, and non-fluoroquinolones. The researchers then estimated the incidence rate ratio (IRR) of Achilles tendon rupture during the antibiotic exposure period relative to the non-exposure period.
Among the 504 patients analyzed, the risk was not significantly elevated during exposure to third-generation fluoroquinolones (IRR, 1.05; 95% confidence interval [CI], 0.33 to 3.37) and non-fluoroquinolones (IRR, 1.08; 95% CI, 0.80 to 1.47). In contrast, increased risk of Achilles tendon rupture tripled during exposure to first- and second-generation fluoroquinolones (IRR, 2.94; 95% CI, 1.90 to 4.54). The findings were similar when researchers analyzed subgroups stratified by sex and recent corticosteroid use.
The findings are noteworthy because several studies have found that Achilles tendon rupture is one of the adverse effects associated with fluoroquinolone use, but that association has not previously been investigated with third-generation fluoroquinolones. The authors say the findings suggest third-generation fluoroquinolones may be a safer option for patients who have an elevated risk of Achilles tendon rupture, such as athletes.
May 10 Ann Fam Med study
Decline seen in US antibiotic use since 1999, but progress has slowed
Overall short-term antibiotic use in the United States fell over the past 20 years, but progress stalled over the last decade, researchers from Johns Hopkins University School of Medicine reported today in Open Forum Infectious Diseases.
The researchers used data from National Health and Nutrition Examination Surveys (NHANES), which ask participants about medications taken over the past 30 days and have been collected and released in 2-year intervals since 1999, to identify trends in short-term non-topical antibiotic use from 1999 to 2018. They calculated the prevalence of antibiotic use overall and by subgroups of interest for the years 1999 to 2002, 2007 to 2010, and 2015 to 2018. They also calculated antibiotic use by class and examined factors associated with antibiotic use during 2015-2018.
The analysis found that the overall prevalence of past 30-day short-term non-topical antibiotic use adjusted for age, sex, race/ethnicity, poverty status, time of year of the interview, and insurance fell from 4.9% (95% CI, 3.9% to 5.0%) during 1999-2002 to 3.0% (95% CI, 2.6% to 3.0%) in 2015-2018, with the largest decline observed among children 0 to 1 years. Declines were also observed in age categories 6 to 11, 12 to 17, and 18 to 39 years. Short-term antibiotic use for all antibiotics (topical and non-topical) followed the same trend. The investigators noted significant declines in penicillins and cephalosporins.
From 2007-2010 to 2015-2018, however, there was no significant change in antibiotic use (adjusted prevalence ratio [aPR], 1.0; 95% CI, 0.8 to 1.2). Age was significantly associated with antibiotic use during this period, with children age 0 to 1 year having significantly higher antibiotic use than all other age-groups. Being non-Hispanic Black was negatively associated with antibiotic use compared with being non-Hispanic White (aPR, 0.6; 95% CI, 0.4 to 0.8).
"Overall, these data suggest that, despite the push for antimicrobial stewardship and reducing unnecessary antimicrobial prescriptions, the progress of reduction over the past decade may be slower than desired," the study authors wrote. "Further investigation should be conducted for the most recent years to verify if these finding hold across data sources, as this would imply that the US has not met the goals established in 2014 to reduce antibiotic use."
May 13 Open Forum Infect Dis abstract