High Rate of Coadministration of Di- or Tri-valent Cation-Containing Compounds With Oral Fluoroquinolones: Risk Factors and Potential Implications

Abstract

Coadministration of fluoroquinolones with DTCCs is extremely common and significantly associated with polypharmacy.

Risk Factors for Infection or Colonization with CTX-M Extended-Spectrum-β-Lactamase-Positive Escherichia coli

“…Data were abstracted from the Pennsylvania Integrated Clinical and Administrative Research Database (PICARD), which includes demographic, laboratory, pharmacy, and billing information and has been used successfully in prior studies of antibiotic utilization and resistance (2,12,21). The following data were collected for all subjects: baseline demographics, inpatient or outpatient status in relation to the culture date, origin at the time of hospital admission for inpatients (i.e., physician referral, transfer from another facility, or admission through the Emergency Department), hospital location at the time of infection (i.e., intensive care unit or medical floor), prior admission to UPHS in the 30 days prior to the culture date, time of onset of nosocomial infection (date of the first positive culture Ն48 h from the date of admission), health care-associated infection (date of the first positive culture Ն48 h from the date of admission or admission as a transfer from another institution), and culture site (i.e., blood, urine, respiratory tract, or wound).…”

“…Cases and controls were characterized by potential risk factors, including demographic variables, comorbid conditions, and prior antibiotic use. Continuous variables were compared using the Student t test or Wilcoxon rank-sum test, and categorical variables were compared using the 2 or Fisher exact test. Bivariable analyses were then performed to determine the association between potential risk factors and isolation of CTX-M-positive E. coli, focusing on prior antibiotic use as the primary risk factor of interest.…”

Quinolones

“…decreased the risk): location in an intensive care unit (OR, 0.51; 95% CI, 0.30-0.87; p = 0.013) and longer duration of levofloxacin therapy (OR, 0.92; 95% CI, 0.88-0.97; p = 0.001). Extrapolating these results to all oral levofloxacin recipients at the institution, one in every three doses would be complicated by deleterious coadministration with at least one multivalent cation-containing agent [4].…”

“…Since quinolones are often administered orally, absorptive interactions may compromise the efficacy of antimicrobial therapy. Due to their breadth of activity, agents of this class find substantial use in the critically ill and elderly, many of whom receive potentially interacting medications [1][2][3][4]. Because the elderly have an increased sensitivity to drug-induced toxicity and experience more adverse drug reactions, they may also exhibit an increased incidence and severity of drug-drug interactions.…”

Coadministration of oral levofloxacin with agents that impair its absorption: potential impact on emergence of resistance

“…calcium, aluminium, zinc, magnesium, iron) is known to inhibit oral FQ absorption [8]. In a prior study from our institution, it was estimated that approximately one in three (2488 of 7871; 32%) oral FQ doses were administered within 2 h of at least one DTCC [9]. Despite the potential clinical implications of such drug-drug interactions, their impact on the emergence of FQ resistance has not been evaluated.…”