Clinical Scorecard: How COVID-19 Restrictions Affect Causal Effect Estimates: Fluoroquinolone Use and Tendon Rupture
At a Glance
Category
Detail
Condition
Tendon rupture
Key Mechanisms
The study examined whether pandemic-related changes in health-seeking behaviour and treatment decisions, together with measurement errors, could affect estimates of the effect of fluoroquinolones versus cephalosporins on tendon rupture.
Target Population
Adults aged 18 years or older receiving a first systemic fluoroquinolone or cephalosporin prescription in UK primary care between 1 January 2006 and 31 March 2023, meeting the study’s linkage and prior-registration or practice-data-quality requirements.
Care Setting
CPRD Aurum UK primary care records linked to Hospital Episode Statistics and Office for National Statistics death records.
Key Highlights
The study replicated a published cohort study estimating tendon rupture risk after fluoroquinolone versus cephalosporin prescribing.
Four analyses varied the periods used for exposure and outcome ascertainment.
The pandemic period began on 16 March 2020; the post-pandemic period began on 17 April 2022.
Tendon rupture was identified from diagnostic records using prespecified CPRD and HES codelists.
The supplied source excerpt does not specify follow-up censoring events; remove this highlight unless verified from the full methods.
Guideline-Based Recommendations
Diagnosis
Management
Monitoring & Follow-up
Risks
The authors state that pandemic-related changes in health-seeking behaviour and EHR recording could introduce bias into causal-effect estimates.
The article describes tendon rupture as a well-established adverse drug reaction to fluoroquinolones.
Patient & Prescribing Data
Adults aged 18 years or older receiving a first systemic fluoroquinolone or cephalosporin prescription between 1 January 2006 and 31 March 2023, with required HES/ONS linkage and at least 1 year of prior practice registration or practice data deemed research quality; those with a tendon rupture diagnosis in the preceding year were excluded.
The exposed cohort received a first systemic prescription for ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin, or ofloxacin. The comparison cohort received a first systemic cephalosporin prescription; people with fluoroquinolone exposure in the preceding 60 days were excluded.
