{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T15:53:51Z","timestamp":1774540431360,"version":"3.50.1"},"reference-count":36,"publisher":"BMJ","license":[{"start":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T00:00:00Z","timestamp":1664841600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2022,8,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the association between initiation of fluoroquinolones and hospital admission or emergency department visit for suicidality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population based cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>IBM MarketScan database, USA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>2\u2009756\u2009268 adults (\u226518 years) who initiated an oral fluoroquinolone (ciprofloxacin, levofloxacin, moxifloxacin, gemifloxacin, ofloxacin, gatifloxacin, norfloxacin, lomefloxacin, besifloxacin) or comparator antibiotic (January 2003 to September 2015) and had at least six months of continuous health plan enrollment and a diagnosis of pneumonia or urinary tract infection (UTI) three days or less before the drug initiation date. Comparator antibiotics were azithromycin in the pneumonia cohort and trimethoprim-sulfamethoxazole in the UTI cohort. Participants were matched 1:1 within each cohort on a propensity score, calculated from a multivariable logistic regression model that included 57 baseline covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcomes measure<\/jats:title>\n                    <jats:p>Primary outcome was hospital admission or emergency department visit for suicidal ideation or self-harm within 60 days after treatment initiation. Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The pneumonia cohort included 551\u2009042 individuals, and the UTI cohort included 2\u2009205\u2009526 individuals. During the 60 day follow-up, 181 events were observed in the pneumonia cohort and 966 in the UTI cohort. The adjusted hazard ratios for fluoroquinolones were 1.01 (95% confidence interval 0.76 to 1.36) versus azithromycin in the pneumonia cohort and 1.03 (0.91 to 1.17) versus trimethoprim-sulfamethoxazole in the UTI cohort. Results were consistent across sensitivity analyses and subgroups of sex, age, or history of mental illnesses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Initiation of fluoroquinolones was not associated with a substantially increased risk of admission to hospital or emergency department visits for suicidality compared with azithromycin or trimethoprim-sulfamethoxazole.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2021-069931","type":"journal-article","created":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T06:50:12Z","timestamp":1664866212000},"page":"e069931","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Association between initiation of fluoroquinolones and hospital admission or emergency department visit for suicidality: population based cohort study"],"prefix":"10.1136","volume":"379","author":[{"given":"Junyi","family":"Wang","sequence":"first","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA 02120, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua J","family":"Gagne","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA 02120, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sushama","family":"Kattinakere-Sreedhara","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA 02120, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A","family":"Fischer","sequence":"additional","affiliation":[{"name":"Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3336-5412","authenticated-orcid":false,"given":"Katsiaryna","family":"Bykov","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA 02120, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,10,4]]},"reference":[{"key":"2025110101535480000_379.oct04_4.e069931.1","unstructured":"Cowling T Farrah K . Fluoroquinolones for the Treatment of Other Respiratory Tract Infections: A Review of Clinical Effectiveness. Cost-Effectiveness, and Guidelines, 2019."},{"key":"2025110101535480000_379.oct04_4.e069931.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2019.10.016"},{"key":"2025110101535480000_379.oct04_4.e069931.3","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.080358"},{"key":"2025110101535480000_379.oct04_4.e069931.4","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ076"},{"key":"2025110101535480000_379.oct04_4.e069931.5","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.2013.796362"},{"key":"2025110101535480000_379.oct04_4.e069931.6","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics8030104"},{"key":"2025110101535480000_379.oct04_4.e069931.7","unstructured":"US Food and Drug Administration. FDA Drug Safety Communication: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects. https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-drug-safety-communication-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics. Published 26 July 2016. 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Suicidal Ideation, Suicide Attempt, or Self-Inflicted Harm: Pediatric Emergency Department Visits, 2010-2014 and 2016. https:\/\/www.hcup-us.ahrq.gov\/reports\/ataglance\/findingsataglance.jsp. Published 5 November 2019. 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