[pubmed] Pharmacosafety of Fluoroquinolone and Macrolide Antibiotics in the Clinical Care of Patients with Myasthenia Gr

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Muscle Nerve. 2021 Mar 14. doi: 10.1002/mus.27230. Online ahead of print.

ABSTRACT

INTRODUCTION/AIMS: Anecdotal case reports have suggested a potential association of fluoroquinolones and macrolides with myasthenia gravis (MG) exacerbation, prompting warnings against the use of these drugs in this population. However, large-scale and reliable population-based data that demonstrate this association are lacking. This study aims to examine the association between outpatient treatment with fluoroquinolones or macrolides and MG-related hospitalization.

METHODS: A retrospective cohort study consisting of adult MG patients was conducted using a large de-identified health care claims database. Antibiotic prescription claims were identified, and MG-related hospitalizations were assessed at 15, 30, and 90 days after the date of prescription. We used mixed effects survival regression with log-logistic distribution and independent covariance matrix to estimate odds ratios (ORs) of hospitalization for each potentially exacerbating antibiotic using beta-lactam as the reference and adjusting for covariates.

RESULTS: Among 1,556 MG patients receiving 894 fluoroquinolone prescriptions, 729 macrolide prescriptions, and 1,608 beta-lactam prescriptions during the study period, there was no difference in 15, 30, or 90-day odds of MG-related hospitalization between fluoroquinolone or macrolide users compared to prescribed beta-lactams. However, estimates were higher for fluoroquinolones than macrolides, even after covariate adjustment (adjusted ORs 4.60, 95% confidence interval [CI] 0.55-38.57 for fluoroquinolones and 0.56, 95% CI 0.32-0.97 for macrolides, respectively, at 15 days).

DISCUSSION: Fluoroquinolone and macrolide antibiotics are prescribed frequently to patients with MG. While statistical imprecision precludes a definitive conclusion, elevated ORs for fluoroquinolones raise the possibility of an underpowered association that merits further investigation. This article is protected by copyright. All rights reserved.

PMID:33719062 | DOI:10.1002/mus.27230


Source: https://pubmed.ncbi.nlm.nih.gov/3371906 ... 7&v=2.14.3