Reviewed by Michael Payne, MD, London Health Sciences Centre
The US FDA boxed warnings on the use of fluoroquinolones were updated in 2016 and included a warning of potential increased risk of suicidal thoughts. However, this large population-based cohort study found the use of outpatient oral fluoroquinolones for pneumonia or urinary tract infections was not associated with an increased risk of admission to hospital or an emergency department for suicidality. However, the absolute risk was low in this cohort and suicidal thoughts or completed suicide, that did not result in hospital presentation, were not assessed. Fluoroquinolones are associated with many adverse drug events limiting the indications for their use; however, this study does not support an association with risk of suicidal thoughts. The study included 2,756,268 adults (≥18 years) who initiated an oral fluoroquinolone or comparator antibiotic (2003 to 2015). Comparator antibiotics were azithromycin in the pneumonia cohort and trimethoprim-sulfamethoxazole in the UTI cohort. Participants were matched 1:1 within each cohort on a propensity score, calculated from a multivariable logistic regression model. The primary outcome was hospital admission or emergency department visit for suicidal ideation or self-harm within 60 days after treatment. The adjusted hazard ratios for fluoroquinolones were 1.01 (0.76 to 1.36) versus azithromycin in the pneumonia cohort and 1.03 (0.91 to 1.17) versus trimethoprim-sulfamethoxazole in the UTI cohort.
Reference: Wang, et al. Association between initiation of fluoroquinolones and hospital admission or emergency department visit for suicidality: population based cohort study. BMJ 2022;379:e069931 http://dx.doi.org/10.1136/ bmj-2021-069931.