Fluoroquinolone use for uncomplicated urinary tract infections in women: A retrospective cohort study
Abstract
OBJECTIVES
The United States Food & Drug Administration released an advisory in 2016 that fluoroquinolones be relegated to second line agents for uncomplicated urinary tract infections (UTIs) given reports of rare but serious side effects; similar warnings have followed from Health Canada and the European Medicines Agency. The objective was to determine whether alternative non-fluoroquinolone agents are as effective as fluoroquinolones in the treatment of UTIs.
METHODS
We conducted a retrospective population-based cohort study using administrative health data from 6 Canadian provinces. We identified women (n=1,585,997) receiving antibiotic treatment for episodes of uncomplicated UTIs (n=2,857,243) between January 1 2005 and December 31 3015. Clinical outcomes within 30 days from the initial antibiotic dispensation were compared among patients treated with a fluoroquinolone versus non-fluoroquinolone agents. High-dimensional propensity score adjustments were used to ensure comparable treatment groups and minimize residual confounding.
RESULTS
Fluoroquinolone use for UTI declined over the study period in 5 of 6 provinces, and overall accounted for 22.3-48.5% of treatments. The pooled effect across the provinces indicated that fluoroquinolones were associated with less return outpatient visits (odds ratio (OR) 0.89, 95%CI 0.87-0.92), emergency department visits (OR 0.74, 95%CI 0.61-0.89), hospitalizations (OR 0.83, 95%CI 0.77-0.88), and repeat antibiotic dispensations (OR 0.77,…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 2,857,243 participants or records.
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