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Psychosomatics. 2018 May - Jun;59(3):259-266. doi: 10.1016/j.psym.2017.11.001. Epub 2017 Nov 10.

Fluoroquinolone-Related Neuropsychiatric Events in Hospitalized Veterans.

Author information

1
Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo School of Medicine and Biomedical Sciences, Infectious Diseases, Buffalo, NY; Department of Infectious Diseases, VA Western New York Healthcare System, Buffalo VA Medical Center, Buffalo, NY.
2
Department of pharmacy, VA Western New York Healthcare System, Buffalo VA Medical Center, Pharmacy, Buffalo, NY. Electronic address: kari.mergenhagen@va.gov.
3
Department of pharmacy, VA Western New York Healthcare System, Buffalo VA Medical Center, Pharmacy, Buffalo, NY; Department of Defense, Landstuhl Regional Medical Center, Pharmacy, Landstuhl, Germany.
4
Department of pharmacy, VA Western New York Healthcare System, Buffalo VA Medical Center, Pharmacy, Buffalo, NY; Department of Pharmacy, Buffalo General Medical Center, Pharmacy, Buffalo, NY.
5
Department of pharmacy, VA Western New York Healthcare System, Buffalo VA Medical Center, Pharmacy, Buffalo, NY.
6
Department of Pharmacy, D'Youville College, School of Pharmacy, Buffalo, NY.
7
Department of pharmacy, VA Western New York Healthcare System, Buffalo VA Medical Center, Pharmacy, Buffalo, NY; Department of Pharmacy, Erie County Medical Center, Pharmacy, Buffalo, NY.
8
Department of pharmacy, VA Western New York Healthcare System, Buffalo VA Medical Center, Pharmacy, Buffalo, NY; Department of pharmacy practice, University at Buffalo-The State University of New York, School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY.
9
Department of Pharmacy, Erie County Medical Center, Pharmacy, Buffalo, NY.

Abstract

OBJECTIVE:

To measure the incidence and risk factors for fluoroquinolone (ciprofloxacin, moxifloxacin, and levofloxacin)-associated psychosis or delirium in a veteran population.

METHODS:

A retrospective study was conducted in the Western New York Veterans Affairs Health System (2005-2013). Participants were hospitalized veterans receiving a fluoroquinolone for at least 48 hours (n = 631). Cases of delirium or psychosis were defined by the Diagnostic and Statistical Manual of Mental Disorders-IV criteria, and the Naranjo scale (score ≥ 1) was used to determine the probability of the adverse drug reaction being related to fluoroquinolones. A bivariate analysis of covariates followed by a multivariate logistic regression was used to determine predisposing factors to the development of delirium/psychosis.

RESULTS:

The mean age of the population was 71.5 years (range: 22-95). Fluoroquinolone-associated delirium/psychosis occurred in 3.7% of the inpatients studied (n = 23). The median Naranjo score was 3 indicating a possible association. Psychosis/delirium occurred in 3.6% of ciprofloxacin-treated patients (n = 14/391), 4.5% of patients-treated with moxifloxacin (n = 9/200), and 0% of those receiving levofloxacin (n = 0/40); p = 0.4. Significant risk factors for development of delirium/psychosis in patients receiving a fluoroquinolone in the multivariate logistical regression included typical antipsychotic use (OR, 5.4; 95% CI: 1.4-16.7) and age. A 10-year increase in age was associated with a 1.8-fold greater odds of a neuropsychiatric event.

CONCLUSIONS:

Fluoroquinolones may be more commonly associated with delirium/psychosis than originally reported in this veteran population. Caution should be used when prescribing a fluoroquinolone for patients on typical antipsychotics and those of advanced age.

KEYWORDS:

Adverse Drug Events; Antibiotics; Drug Safety; Fluoroquinolones; Infectious Diseases; Medication Safety

PMID:
29275962
DOI:
10.1016/j.psym.2017.11.001

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