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Fluoroquinolones increased risk for acute liver injury in older patients
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Patients taking moxifloxacin or levofloxacin were at greater risk for hospitalization for acute liver injury than those prescribed clarithromycin in a recent study.
Researchers evaluated 144 patients aged 66 years and older admitted to an Ontario, Canada, hospital for acute liver injury, along with 1,409 matched controls. All patients had received a prescription for clarithromycin or fluoroquinolones including moxifloxacin, levofloxacin, ciprofloxacin or cefuroxime axetil within 30 days of admission. Controls had received one of the incorporated medications but had not been admitted for liver injury. Using patients who received clarithromycin as a reference group, investigators assessed potential associations between use of the medications and development of liver injury.
The crude incidence rates for admission due to liver injury were 7.98 per 100,000 exposures of moxifloxacin and 8.62 per 100,000 exposures for levofloxacin, compared with 3.95 per 100,000 exposures to clarithromycin. Incidence rates were lower among patients who received cefuroxime axetil (6.44 per 100,000 exposures) and ciprofloxacin (6.37 per 100,000 exposures).
Researchers observed associations between risk for acute liver injury and use of moxifloxacin (adjusted OR=2.20, 1.21-3.98) or levofloxacin (aOR=1.85, 1.01-3.39) via multivariate analysis. These associations both strengthened after excluding residents of long-term care facilities, with an aOR of 2.74 for moxifloxacin (1.42-5.29) and 2.29 for levofloxacin (1.17-4.46). No association was found between liver injury risk and ciprofloxacin (aOR=1.56, 0.95-2.58) or cefuroxime axetil (aOR=1.43, 0.72-2.83) (95% CI for all).
“Our findings make an important contribution to an evidence base that is currently limited to case reports and registries of drug-induced liver injury,” the researchers wrote. “Although our results require confirmation in other settings, they suggest that both moxifloxacin and levofloxacin be considered for regulatory warnings regarding acute liver injury.”