Quantification of the risk of liver injury associated with flucloxacillin: a UK population-based cohort study.


Wing, K; Bhaskaran, K; Pealing, L; Root, A; Smeeth, L; van Staa, TP; Klungel, OH; Reynolds, RF; Douglas, I; (2017) Quantification of the risk of liver injury associated with flucloxacillin: a UK population-based cohort study. The Journal of antimicrobial chemotherapy, 72 (9). pp. 2636-2646. ISSN 0305-7453 DOI: https://doi.org/10.1093/jac/dkx183

This is the latest version of this item. Earlier version may have full text manuscript

[img]
Preview
Text - Accepted Version
License:

Download (932kB) | Preview
[img]
Preview
Text - Accepted Version
License:

Download (1MB) | Preview

Abstract

Flucloxacillin is an established cause of liver injury. Despite this, there are a lack of published data on both the strength of association after adjusting for potential confounders, and the absolute incidence among different subgroups of patients. To assess the relative and absolute risks of liver injury following exposure to flucloxacillin and identify subgroups at potentially increased risk. A cohort study between 1 January 2000 and 1 January 2012 using the UK Clinical Practice Research Datalink, including 1 046 699 people with a first prescription for flucloxacillin (861 962) or oxytetracycline (184 737). Absolute risks of experiencing both symptom-defined (jaundice) and laboratory-confirmed liver injury within 1-45 and 46-90 days of antibiotic initiation were estimated. Multivariable logistic regression was used to estimate 1-45 day relative effects. There were 183 symptom-defined cases (160 prescribed flucloxacillin) and 108 laboratory-confirmed cases (102 flucloxacillin). The 1-45 day adjusted risk ratio for laboratory-confirmed injury was 5.22 (95% CI 1.64-16.62) comparing flucloxacillin with oxytetracycline use. The 1-45 day risk of laboratory-confirmed liver injury was 8.47 per 100 000 people prescribed flucloxacillin (95% CI 6.64-10.65). People who received consecutive flucloxacillin prescriptions had a 1-45 day risk of jaundice of 39.00 per 100 000 (95% CI 26.85-54.77), while those aged >70 receiving consecutive prescriptions had a risk of 110.57 per 100 000 (95% CI 70.86-164.48). The short-term risk of laboratory-confirmed liver injury was >5-fold higher after a flucloxacillin prescription than an oxytetracycline prescription. The risk of flucloxacillin-induced liver injury is particularly high within those aged >70 and those who receive multiple flucloxacillin prescriptions. The stratified risk estimates from this study could help guide clinical care.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology
Research Centre: EHR Research Group
PubMed ID: 28859440
URI: http://researchonline.lshtm.ac.uk/id/eprint/4328557

Available Versions of this Item

Statistics


Download activity - last 12 months
Downloads since deposit
46Downloads
63Hits
Accesses by country - last 12 months
Accesses by referrer - last 12 months
Impact and interest
Additional statistics for this record are available via IRStats2

Actions (login required)

Edit Item Edit Item