How Safe Are Your Antibiotics? New Study Reveals Hidden Risks

A study involving adults in Ontario reveals that some oral antibiotics significantly increase the risk of severe drug rash, which leads to emergency visits and potentially fatal outcomes.

Researchers recommend careful prescribing of antibiotics, especially among adults, noting that while most hospital visits are not fatal, a small percentage result in intensive care or death.

Two classes of commonly prescribed oral antibiotics are associated with the greatest risk of serious drug overdoses that can lead to emergency department visits, hospitalizations, and even death, according to a new study.

Researchers from ICES, Sunnybrook Research Institute and the Department of Medicine at the University of Toronto’s Temerty Faculty of Medicine suggest that doctors should consider using low-risk antibiotics for their patients when appropriate.

Effects of High Frequency Drugs

Serious cutaneous adverse drug reactions (cADRs), or severe drug rash, are a group of slow but potentially life-threatening side effects that affect the skin, often internal organs. Some of these reactions have mortality rates ranging from 20 to 40%. Although many different classes of drugs can cause serious cADRs, antibiotics are among the most commonly reported for these reactions.

Erika Lee, an internist and trainee at ICES and Temerty Medicine’s Eliot Phillipson Clinician-Scientist Training Program, says: “Our goal was to assess the risk of cards in the elderly, tend to receive more antibiotic prescriptions than adults.”

Published in a newspaper JAMAthis case-control study used health care data from the ICES of adults aged 66 or older who received a prescription for at least one oral antibiotic between 2002 and 2022 in Ontario, Canada.

During the study period, 21,758 adults had an ED or hospital visit for a serious cADR after oral antibiotics and were matched with 87,025 controls who did not. reaction.

The Highest Risk for Two Antibiotic Classes

Lee says: “The good news is that many patients who visited the hospital in this way were discharged without being admitted, so that should encourage providers and patients. “However, of those hospitalized for the most severe reaction, twenty percent were treated in the ICU, and five percent of hospitalized patients died, which highlights the need for careful prescribing practices.”

The most frequently prescribed antibiotics were penicillin (29%), followed by cephalosporins (18%), fluoroquinolones (17%), macrolides (15%), nitrofurantoin (9%) and sulfonamides (6%). Antibiotics that were not commonly prescribed were pooled together and accounted for 7% of prescriptions.

Unmeasured Risks of Specific Antibiotics

Key findings include:

• All antibiotics were associated with a greater risk of serious cADRs than macrolides, but sulfonamides (“sulfa drugs”) and cephalosporins were associated with the greatest risk.
• There were 2 cADR-related hospital visits for every 1000 antibiotic prescriptions dispensed.
• About 1 in 8 patients presenting to the ED with antibiotic-related cADRs were hospitalized, either because their reactions were too severe or because of concerns about complications. may appear.
• 20% of hospitalized patients with the most severe types of cADRs were treated in an intensive care unit, and 5% of those patients died.

Recommendations for Clinicians and Patients

“Although rare, these drug-induced changes can be life-threatening. Patients should be aware of rash, fever and other symptoms, which can start weeks after the prescription is started and even after the antibiotics stop,” says David Juurlink, a staff specialist with head of the Division of Clinical Pharmacology and Toxicology at the Sunnybrook Health Sciences Center, senior scientist with ICES and professor of medicine with Temerty Medicine.

He adds: “This is another reason why antibiotics should only be given when they are really needed.

Reference: “Oral Antibiotics and the Risk of Serious Adverse Drug Reactions” by Erika Y. Lee, Tara Gomes, Aaron M. Drucker, Nick Daneman, Ayesha Asaf, Fangyun Wu, Vincent Piguet and David N. Jurlink, 8 August 2024, JAMA.
DOI: 10.1001/jama.2024.11437