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Fluoroquinolones 'double kidney disease risk'

Patients on fluoroquinolones have double the risk of acute kidney disease, compared with those that do not take the antibiotics, claim researchers who recommended the drugs were prescribed ‘vigilantly’.

 

The study

US and Canadian researchers followed a cohort of 1,292 men aged 40 to 85 years and hospitalised for acute kidney injury over nine years, and compared their use of antibiotics with 12,651 matched controls admitted to hospital for other causes. The most commonly used fluoroquinolones were ciprofloxacin (44.5%) and levofloxacin (43.9%) while respiratory and genitourinary infections were the most common indications (45.6% and 27% respectively). Amoxicillin and azyithromycin were selected as control drugs.

The findings
Patients currently taking fluoroquinolones had an adjusted relative risk of 2.18 for acute kidney injury, compared with those not taking the drugs. Recent use did not increase the ajdusted relative risk of kidney injury (0.87) or past use (0.86). When fluoroquinolones were used at the same time with renin-angiotensin-system blockers, the relative risk of acute kidney injury increased four-fold, compared with those not taking the drugs (4.46). The case-time-control analysis confirmed that the risk of acute kidney injury with oral fluoroquinolones use doubled, compared with controls. No increased risk of acute kidney injury was found with amoxicillin or azyithromycin.

What this means for GPs

The authors said: ‘The twofold differential in risk between current and both recent and past fluoroquinolone use suggests that acute kidney injury is an acute adverse effect of fluoroquinolones’ and recommended ‘vigilant prescribing’ of the drugs.

CMAJ 2013, online 3 Jun

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