{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T17:33:50Z","timestamp":1776447230368,"version":"3.51.2"},"reference-count":39,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T00:00:00Z","timestamp":1616716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction\/Aims<\/jats:title><jats:p>Anecdotal case reports have suggested a potential association of fluoroquinolones and macrolides with myasthenia gravis (MG) exacerbation, prompting warnings against the use of these drugs in this population. However, large\u2010scale and reliable population\u2010based data that demonstrate this association are lacking. This study aims to examine the association between outpatient treatment with fluoroquinolones or macrolides and MG\u2010related hospitalization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study consisting of adult MG patients was conducted using a large de\u2010identified healthcare claims database. Antibiotic prescription claims were identified, and MG\u2010related hospitalizations were assessed at 15, 30, and 90\u2009days after the date of prescription. We used mixed effects survival regression with log\u2010logistic distribution and independent covariance matrix to estimate odds ratios (ORs) of hospitalization for each potentially exacerbating antibiotic using beta\u2010lactam as the reference and adjusting for covariates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 1556 MG patients receiving 894 fluoroquinolone prescriptions, 729 macrolide prescriptions, and 1608 beta\u2010lactam prescriptions during the study period, there was no difference in 15, 30, or 90\u2010day odds of MG\u2010related hospitalization between fluoroquinolone or macrolide users compared to prescribed beta\u2010lactams. However, estimates were higher for fluoroquinolones than macrolides, even after covariate adjustment (adjusted OR [aOR] 4.60, 95% confidence interval [CI] 0.55\u201038.57 for fluoroquinolones and OR 0.56, 95% CI 0.32\u20100.97 for macrolides, respectively, at 15\u2009days).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Fluoroquinolone and macrolide antibiotics are prescribed frequently to patients with MG. While statistical imprecision precludes a definitive conclusion, elevated ORs for fluoroquinolones raise the possibility of an underpowered association that merits further investigation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mus.27230","type":"journal-article","created":{"date-parts":[[2021,3,15]],"date-time":"2021-03-15T01:45:00Z","timestamp":1615772700000},"page":"156-162","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Pharmacosafety of fluoroquinolone and macrolide antibiotics in the clinical care of patients with myasthenia gravis"],"prefix":"10.1002","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3589-764X","authenticated-orcid":false,"given":"Thanh Phuong","family":"Pham Nguyen","sequence":"first","affiliation":[{"name":"Department of Neurology University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"},{"name":"Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, Department of Neurology University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"},{"name":"Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"},{"name":"Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles E.","family":"Leonard","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"},{"name":"Center for Pharmacoepidemiology Research and Training, Department 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