Fluoroquinolone Use Linked to Increased Peripheral Neuropathy Risk

According to the results of a nested case-control study, oral fluoroquinolone exposure appears to be associated with an increased risk of incident peripheral neuropathy.

The aim of the study was to not only determine the association between fluoroquinolone use and the incidence of peripheral neuropathy, but also to evaluate how this risk was affected by medication exposure timing and cumulative dose received. The study authors obtained electronic medical record data from The Health Improvement Network database (United Kingdom) between January 1, 1999, to December 31, 2015. A total of 1,338,900 adults with at least 1 prescription written for an oral fluoroquinolone (34.3%) or oral amoxicillin-clavulanate (65.7%) were included in the cohort.

“Adults with incident peripheral neuropathy were matched (on age, sex, general practice, and calendar time) with up to 4 controls by using incidence density sampling selected from a cohort prescribed oral fluoroquinolone or amoxicillin-clavulanate antibiotics,” the study’s authors explained. They added, “Incidence rate ratios of peripheral neuropathy were calculated for fluoroquinolone and for amoxicillin-clavulanate exposure and compared with nonexposure among patients without diabetes, with sensitivity analyses testing the consistency of the results.”

Data analysis yielded a total of 5357 cases of incident peripheral neuropathy, which were matched to 17,285 control cases; patients with diabetes were excluded from the population. The study authors reported that there was an increased relative incidence of peripheral neuropathy in patients with current oral fluoroquinolone exposure compared to patients not exposed to fluoroquinolones (adjusted incident rate ratio: 1.47; 95% CI: 1.13, 1.92). Conversely, amoxicillin-clavulanate exposure was not significantly associated with an increased risk of peripheral neuropathy (adjusted incident rate ratio: 1.10; 95% CI: 0.86, 1.40).

Results of the study also showed that for each additional day of fluoroquinolone exposure, the patient’s risk of peripheral neuropathy increased by approximately 3%, which continued for up to 180 days after fluoroquinolone exposure. It was noted that no additional risk was observed in patients with increasing amoxicillin-clavulanate exposure.

The study authors also reported that the absolute risk of current oral fluoroquinolone exposure was calculated to be 2.4 per 10,000 patients per year of current fluoroquinolone use (95% CI: 1.8, 3.1). They added, “The number needed to harm for a 10-day course was 152,083 patients (95% CI, 117,742-202,778) and was greatest among men and among patients older than 60 years.”

Based on their findings, the authors concluded that healthcare providers should consider discussing the potential risk of peripheral neuropathy with patients when prescribing fluoroquinolones.

For more information visit jamanetwork.com.