Antibiotic Overprescription Is Associated with Worse CKD Outcomes

A recent study in JAMA Open Network looked at the relationship between fluoroquinolone — an antibiotic — dosage and adverse side effects in patients with CKD. The researchers found that higher doses of fluoroquinolone correlated with an increased risk of adverse side effects.

In the United States, chronic kidney disease (CKD) is one of the leading causes of death. According to the CDC, approximately 1 in 7 people have CKD. CKD risk factors include diabetes, hypertension, glomerulonephritis, polycystic kidney disease, kidney cancer, lupus nephritis, obesity, heart disease, and family history.

A 2020 publication states, “the fluoroquinolones are a family of broad spectrum, systemic antibacterial agents that have been used widely as therapy of respiratory and urinary tract infections. Fluoroquinolones are active against a wide range of aerobic gram-positive and gram-negative organisms.”

Common fluoroquinolones include ciprofloxacin, delafloxacin, gemifloxacin, levofloxacin, moxifloxacin, norfloxacin, and ofloxacin. They are often prescribed for bacterial bronchitis, pneumonia, sinusitis, septicemia and intraabdominal infections, joint and bone infections, soft tissue and skin infections, pelvic inflammatory disease, and many more.

The researchers from this study found that 1.2% of patients treated with high-dose fluoroquinolones had a hospital visit associated with nervous system and psychiatric disorders, hypoglycemia, or a collagen-associated event. Meanwhile, the rate for patients treated with a low fluoroquinolone dose was 0.9%.

“A higher vs lower fluoroquinolone dose was associated with a slightly higher 14-day risk of a hospital visit with nervous system and/or psychiatric disorders, hypoglycemia, or a collagen-associated event. Altered mental status was the most common adverse event,” stated the investigators in the article.

In addition to the side effects outlined in this study, fluoroquinolones can cause other side effects. As stated in an article from the Australian Prescriber, tendinopathy, aortopathy, neuropathy, arrhythmia, hypoglycemia, and hyperglycemia can occur in patients treated with this medication.

Researchers highlight that, while fluoroquinolones may pose a risk to some patients with CKD, it is essential to consider prescriptions on a case-by-case basis. They believe that, in some instances, the benefits may outweigh the potential risk.

“The findings of this cohort study suggest that fluoroquinolones should be prescribed cautiously and at lower doses among older adults with advanced CKD. All patients should be advised to watch for signs of altered mental status with fluoroquinolone use,” recommended clinicians in the article.