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Consider adverse drug events before prescribing antibiotics

Common antibiotic-associated adverse drug events can be avoided with more judicious prescribing and therefore, should be considered when initiating or discontinuing therapy in hospitalized patients, according to data published in JAMA Internal Medicine.

“Unnecessary use of antibiotics is particularly concerning because antibiotics may be associated with a number of [adverse drug events (ADEs)] ... Estimates of the incidence of antibiotic-associated ADEs in hospitalized patients are generally unavailable,” Pranita D. Tamma, MD, MHS, from the division of pediatric infectious diseases at the Johns Hopkins University School of Medicine and colleagues wrote. “A comparative analysis of the incidence of ADEs across all classes of antibiotics has yet to be performed.”

Researchers examined the incidence of antibiotic-associated ADEs for adult inpatients aged 18 years and older receiving at least 24 hours of any parenteral or oral antibiotic therapy admitted to four general medicine services at Johns Hopkins Hospital between September 2013 and June 2014. They evaluated the medical records of 1,488 patients for 30 days after antibiotic initiation for the development of gastrointestinal, dermatologic, musculoskeletal, hematologic, hepatobiliary, renal, cardiac and neurologic antibiotic-associated-ADEs. For 90 days after antibiotic initiation, they also watched for development of Clostridium difficile infection or incident multidrug-resistant organism infection.

In total, 298 (20%) patients experienced at least one antibiotic-associated ADE. Fifty-six (20%) nonclinically indicated antibiotic regimens were linked to an ADE, including seven cases of C. difficile infection. Analysis showed that every additional 10 days of antibiotic therapy increased the risk for ADEs by 3%. Gastrointestinal, renal and hematologic abnormalities were the most common ADEs, accounting for 78 (42%), 45 (24%) and 28 (15%) 30-day ADEs, respectively. Notably, researchers observed significant differences between the incidence of ADEs associated with specific antibiotics.

“The frequency of antibiotic-associated ADEs may not be recognized by clinicians because ADEs have varied manifestations, clinicians may be unaware of the risks associated with specific antibiotic agents, or because they may occur after patients are discharged from the hospital,” Tamma and colleagues wrote. “Our findings provide quantitative data about the risk of ADEs that clinicians should consider when weighing decisions to initiate or discontinue antibiotic therapy and lend further credence to the importance of antibiotic stewardship to optimize patient safety.” – by Savannah Demko

Disclosures: The researchers report no relevant financial disclosures.