Researchers reported that a new analysis of U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) data from 2018 to 2023 showed that while oral and intravenous fluoroquinolone antibiotics carry a lower risk of anaphylaxis compared to amoxicillin, moxifloxacin demonstrated the highest risk within its class.
These findings will be presented at the upcoming American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress (Abstract 008).
The researchers, from Penn State College of Medicine, analyzed 53,176 adverse reactions reported to FAERS, identifying 553 cases of anaphylaxis associated with fluoroquinolone use. The investigation focused specifically on oral and intravenous formulations of levofloxacin, ciprofloxacin, and moxifloxacin.
"Among the fluoroquinolones, moxifloxacin was associated with a higher signal for reported anaphylaxis," the researchers reported, documenting a reporting odds ratio (ROR) of 7.49 (95% confidence interval [CI] = 6.29–8.92) compared to all other medications in the database.
The investigation found that fluoroquinolone-associated anaphylaxis predominantly affected women, who comprised 60.5% of cases. The mean age of affected patients was 55 years.
When compared to the broader medication database, fluoroquinolones as a class showed a disproportionally higher rate of anaphylaxis, with an ROR of 4.55 (95% CI = 4.18–4.95). However, this risk was substantially lower than that associated with amoxicillin, which demonstrated an ROR of 27.63 (95% CI = 25.97–29.39).
Current guidelines recommend challenging patients who require fluoroquinolone treatment with an alternative drug within the same class when hypersensitivity occurs. This disproportionality analysis provides new evidence that could influence the selection of alternative fluoroquinolones in patients with previous reactions.
Tyler Miluski, DO, and Taha Al-Shaikhly, MBChB, conducted the research in response to increasing reports of fluoroquinolone hypersensitivity reactions. Their analysis revealed that moxifloxacin not only carried the highest risk compared to all medications but also demonstrated an elevated risk within its own class, with an ROR of 1.87 (95% CI = 1.53–2.28) compared to other fluoroquinolones.
The analysis found that among fluoroquinolones, moxifloxacin was associated with a higher signal for reported anaphylaxis, while the fluoroquinolone class overall showed lower reporting rates compared to amoxicillin.