Common antibiotics pose a rare risk of severe liver injury in older patients

The commonly used broad-spectrum antibiotics moxifloxacin and levofloxacin are associated with an increased risk of severe liver injury in older people, according to a new study published in CMAJ (Canadian Medical Association Journal).

Moxifloxacin and levofloxacin are commonly prescribed "fluoroquinolone" often used for bacterial infections such as respiratory infections, and others. However, both the European Medicines Agency and Health Canada have issued warnings about the risk of liver injury from moxifloxacin, although there are few published studies on the safety of fluoroquinolones, especially related to .

Researchers from the Institute for Clinical Evaluative Sciences (ICES), Toronto; the University of Toronto and McMaster University, Hamilton, Ont., examined the risk of acute liver injury in patients taking moxifloxacin compared with those taking other antibiotics commonly used to treat . They looked at 9 years of data from Ontario to identify people aged 66 years or older with no history of liver disease who were admitted to hospital for liver injury within 30 days after receiving a prescription for these antibiotics. Excluding patients admitted for previous or recent hospitalization, 144 patients were admitted for acute liver injury, with the median time from the dispensing of the antibiotic to admission to hospital being 9 days. Eighty-eight (61.1%) of patients died during their index admission to hospital for liver injury.

"Compared with clarithromycin, moxifloxacin was associated with a more than 2-fold increased risk of admission to hospital for acute liver injury," writes Dr. David Juurlink, ICES, with coauthors. "Levofloxacin was also associated with a statistically significant but lower risk of hepatotoxicity than…moxifloxacin."

The authors note that, although these cases are serious, they are relatively rare, with about 6 cases for every 100 000 patients treated with the antibiotics.

The authors believe their findings are an important contribution to the evidence regarding the risks of these antibiotics. "Despite recent regulatory warnings regarding the hepatic safety of moxifloxacin, there is a lack of controlled studies supporting the notion that moxifloxacin presents a particular risk relative to other broad-spectrum antibiotic agents and, in particular, to other fluoroquinolones," write the authors.

They conclude: "Although our results require confirmation in other settings, the findings suggest that both moxifloxacin and levofloxacin be considered for regulatory warnings regarding acute ."

More information: Paper online: www.cmaj.ca/lookup/doi/10.1503/cmaj.111823

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

New system targets germs in donated blood plasma

12 hours ago

(HealthDay)—A new system designed to eliminate germs in donated blood plasma and reduce the risk of transmitting a plasma-borne infection has been approved by the U.S. Food and Drug Administration.

Judge halts Alzheimer's drug swap until July

Dec 16, 2014

A federal judge has ordered an Irish drug manufacturer to halt its plans to discontinue its widely used Alzheimer's medication, allegedly in an effort to drive patients to a newer patented drug.

India court blocks Bayer generic drug appeal

Dec 13, 2014

An Indian court has rejected German drug giant Bayer's bid to block a generic version of its blockbuster cancer treatment Nexavar by a local drugmaker, a move hailed by activists on Saturday.

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.