Fluoroquinolone Use and Risk of Pneumothorax in Adults Hospitalized With Community Acquired Pneumonia: A Retrospective Cohort Study
Abstract
Objectives: The objective of this study is to examine the relationship between fluoroquinolone exposure and pneumothorax risk in patients hospitalized with pneumonia.
Methods: This retrospective cohort study used the TriNetX US Collaborative Network. We defined two mutually exclusive cohorts of hospitalized adults based on exposure to antibiotic classes commonly used to treat community acquired pneumonia: fluoroquinolone (ciprofloxacin, moxifloxacin, levofloxacin, and ofloxacin) versus nonfluoroquinolone (amoxicillin, azithromycin, ceftriaxone, and doxycycline). Patients with connective tissue disorders were excluded. The primary outcome was the occurrence of pneumothorax within 60 days. We used Cox proportional hazards regression to estimate hazard ratios (HRs) adjusted for demographics, comorbidities, and markers of illness severity.
Results: Among 1 140 106 eligible patients, 86 814 (7.6%) received fluoroquinolones. Fluoroquinolones as a class were not associated with risk of pneumothorax (HR 1.29, 0.95-1.76, Q = 0.21). Among individual fluoroquinolones, Ciprofloxacin alone was associated with an increased risk of pneumothorax (HR 2.26, 95% CI 1.38-3.69, Q < 0.01). Pooled nonfluoroquinolone antibiotics were associated with a modestly reduced hazard of pneumothorax (HR 0.79, 95% CI 0.69-0.91, Q < 0.01), although this effect was not consistent across individual agents.
Conclusions: Exposure to fluoroquinolones does not appear to impact the risk of pneumothorax in…
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: 140 participants or records.
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