Among patients on receiving hemodialysis (HD), treatment with fluoroquinolone may be linked with an augmented risk of sudden cardiac death (SCD) when compared to treatment with an amoxicillin-based antibiotic, according to a study published in JAMA Cardiology.
“Respiratory fluoroquinolone antibiotics are some of the most common medications with QT interval–prolonging potential prescribed to patients with hemodialysis-dependent kidney failure—individuals who have a very high risk of SCD. To date, there have been no large-scale, population-specific studies evaluating the cardiac safety of respiratory fluoroquinolones in the hemodialysis population,” the researchers wrote.
Thus retrospective cohort study assessed safety via an active comparator new-user design. The researchers analyzed administrative claims data from a US-wide kidney failure registry from January 1, 2007, to December 31, 2016. In total, the study consisted of 264,968 Medicare beneficiaries receiving in-center HD. The primary endpoint was defined as sudden cardiac death within 5 days of outpatient initiation of a study antibiotic. Data analysis was conducted from January 4 to August 16, 2021.
According to the results, respiratory fluoroquinolone vs amoxicillin-based antibiotic treatment was associated with a higher relative and absolute 5-day risk of SCD (weighted HR=1.95; 95% CI, 1.57-2.41; and weighted RD per 100 000 treatment episodes, 44.0; 95% CI, 31.0-59.2). However, the researchers noted that respiratory fluoroquinolone vs amoxicillin-based antibiotic treatment was not associated with the 5-day risk of fracture.
“In this study, compared with amoxicillin-based antibiotic treatment, respiratory fluoroquinolone treatment was associated with a higher short-term risk of SCD among patients with hemodialysis-dependent kidney failure,” the researchers concluded.
Study suggests that, among patients receiving hemodialysis, treatment with a respiratory fluoroquinolone may be associated with an increased risk of sudden cardiac death more than treatment with an amoxicillin-based antibiotic https://t.co/V3CrP8pTpm
— JAMA Cardiology (@JAMACardio) October 20, 2021
“This finding suggests that decisions between the use of respiratory fluoroquinolones and amoxicillin-based antibiotics should be individualized, with prescribers considering both the clinical benefits and potential cardiac risks.”
Quinolones associated with more sudden death in dialysis patients vs amoxicillin https://t.co/ZEjkfiU5rf
— Swapnil Hiremath, MD (@hswapnil) October 21, 2021