J Michael Paterson, of the Institute for Clinical Evaluative Sciences in Toronto, and colleagues conducted a population-based, nested, case-control study involving 144 patients aged ≥66 years with no history of liver disease who were admitted to the hospital for acute liver injury within 30 days of receiving a prescription for moxifloxacin, levofloxacin, ciprofloxacin, cefuroxime axetil, or clarithromycin. Ten age- and sex-matched controls who had received an antibiotic but were not admitted to hospital were selected for each case.
The researchers found that the majority of hospitalized patients (61.1%) died in the hospital. Compared with clarithromycin, use of moxifloxacin or levofloxacin correlated with an increase in the risk of acute liver injury (adjusted odds ratio, 2.2 and 1.85, respectively). No increased risk was seen for ciprofloxacin or cefuroxime axetil.
“Relative to the use of clarithromycin, the use of moxifloxacin and levofloxacin was associated with an increase (about two-fold) in the risk of admission to hospital for acute liver injury among the patients in our cohort,” the authors write. “Although our results require confirmation in other settings, they suggest that both moxifloxacin and levofloxacin be considered for regulatory warnings regarding acute liver injury.”
One author disclosed financial ties to the pharmaceutical industry.