1463. Comparative Evaluation of Adverse Tendon Events between Recipients of Fluoroquinolones and Ceftriaxone/Azithromycin among Veterans Affairs Patients with Community Acquired Bacterial Pneumonia
Session: Poster Abstract Session: Respiratory Infections: CAP
Friday, October 5, 2018
Room: S Poster Hall
  • Patel FQvsCTXAZ Poster IDweek 2018 tpl.pdf (245.8 kB)
  • Background: Fluoroquinolones (FQs) are used commonly for patients (pts) with community acquired bacterial pneumonia (CABP). A recent FDA Drug Safety Communication strengthened labeling regarding tendinopathy/tendon rupture for FQs. The data prompting this change lacked a comparator group of pts using other antibiotics, like ceftriaxone/azithromycin (CTX-AZ) for similar indications. The objectives of this study were to compare the incidence of adverse tendon events (TE) between FQ and CTX-AZ among pts with CABP and determine if FQ treatment is independently associated with TE.

    Methods: A retrospective cohort study was performed among pts in the Upstate New York Veterans’ Healthcare Administration. Inclusion criteria: 1) age ≥ 18 years, 2) diagnosis of CABP (ICD9 code with manual confirmation) from 1/2014 to 12/2015, 3) receipt of IV/oral FQ or CTX-AZ ≥ 1 day, and 4) treatment initiated as inpatient. Data were collected from pt’s medical records. Occurrence of TE was defined using a natural word search algorithm of pts’ clinical progress notes within 90 days of starting FQ or CTX-AZ therapy. Search terms were: tendinopathy, tendon pain, tendon rupture, tendinitis, and Achilles heel pain/tear/torn/rupture. Classification and regression tree (CART) was used to identify breakpoints in continuous variables associated with TE.

    Results: There were 379 FQ and 274 CTX-AZ recipients. Mean ± standard deviation (SD) ages for FQ and CTX-AZ recipients were, 73.0 ± 12.7 vs 72.8 ± 12.7 years, respectively. Mean (SD) APACHE-II was significantly higher for FQ than CTX-AZ recipients, 10.2 ± 5.1 versus 8.5 ± 3.6, respectively (p<0.001). Residence in the intensive care unit at start of therapy did not differ (FQ: 11.6% vs CTX-AZ: 10.2%, p=0.58). The incidence of TE did not differ between groups (FQ: 9/379 [2.4%] vs CTX-AZ: 4/274 [1.5%], p=0.57). In multivariate analyses (Figure), treatment was not independently associated with TE (aOR: 1.78, 95% confidence interval: 0.51-6.21, p=0.37) after adjustment for treatment duration, APACHE-II, age ≥52 years and BMI ≥27.5.

    Conclusion: Incidence of TE did not significantly differ between FQ and CTX-AZ recipients. After adjustment, FQ treatment was not independently associated with an increased risk of TE.

    Nimish Patel, PharmD, PhD1, Jeffrey Clark, PharmD1, Nicholas Stornelli, Pharm.D.1, Gina Belfiore, Pharm.D.1 and Thomas P. Lodise, PharmD, PhD2, (1)Albany College of Pharmacy & Health Sciences, Albany, NY, (2)Albany College of Pharmacy, Albany, NY


    N. Patel, None

    J. Clark, None

    N. Stornelli, None

    G. Belfiore, None

    T. P. Lodise, paratek: Consultant and Scientific Advisor , Consulting fee .

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