DSEN Abstract
Fluoroquinolone Use for Acute Bacterial Sinusitis

A study conducted by the Canadian Network for Observational Drug Effect Studies (CNODES)

Summary and Key Messages

Fluoroquinolone antibiotic use was not associated with better clinical outcomes compared with other antibiotics among patients treated for acute bacterial sinusitis.
Although a relatively small proportion of acute bacterial sinusitis events were treated with fluoroquinolones, guidelines suggest limiting their use to second-line treatment only.

Project Lead & Team

This research was funded by CIHR – Drug Safety and Effectiveness Network and conducted by CNODES.

For more information, please contact info@cnodes.ca.

What is the issue?

Oral fluoroquinolones are among the most widely prescribed class of antibiotics and are associated with rare but severe adverse effects such as tendon rupture, aortic aneurysm, and retinal detachment.
Guidelines suggest limiting their use to second-line treatment only, though their use has extended to milder infections, such as acute bacterial sinusitis, with limited evidence of superiority to first-line antibiotics.

What was the aim of the study?

This study, conducted by CNODES, aimed to compare the clinical outcomes for acute bacterial sinusitis initially treated with fluoroquinolones compared with other antibiotics.

How was the study conducted?

We conducted a multi-site population-based cohort study using administrative health data from 6 Canadian provinces.
The study cohorts included over 1.5 million mostly adult patients who received an antibiotic treatment for an incident episode of acute bacterial sinusitis between 2005 and 2015.
Clinical outcomes within 30 days of the initial antibiotic dispensation were compared between patients treated with a fluoroquinolone and those treated with other antibiotics. Results were combined across studies using a statistical approach called meta-analysis.

What did the study find?

Fluoroquinolones were not commonly used in the first-line treatment of acute bacterial sinusitis. Their use represented between 2% to 11% of antibiotic dispensations and declined in all provinces over the study period.
Fluoroquinolones were more likely to be prescribed as second-line treatment.
Compared with other antibiotics, fluoroquinolones were not associated with better clinical outcomes. There was a 26% higher risk of repeated primary care visits following fluoroquinolone use compared with other antibiotics.
There was no difference between fluoroquinolones and other antibiotics in the need for a second antibiotic dispensation within 30 days.