Table 4.
US Emergency Department (ED) Visits Among Adults for Adverse Events (AEs) from Oral Antibiotics, by Drug Class and AE Manifestation, 2011–2015
| Oral antibiotic class* | Annualized national estimate | |||
|---|---|---|---|---|
| ED visits for AEs | Rate per 10,000 dispensed prescriptions | |||
| No. | % (95% CI) | Rate (95% CI) | NNH¶ | |
| Sulfonamides | ||||
| Mild allergic reaction† | 23,359 | 69.3 (65.5–73.0) | 13.4 (10.0–16.8) | 746 |
| Moderate-to-severe allergic reaction‡ | 6061 | 18.0 (14.5–21.4) | 3.5 (2.6–4.3) | 2873 |
| Gastrointestinal disturbance§ | 2915 | 8.6 (6.1–11.2) | 1.7 (1.0–2.3) | 5974 |
| Other or unspecified effect | 868 | 2.6 (1.6–3.5) | 0.5 (0.3–0.7) | 20,060 |
| Neurological or psychiatric effect‖ | 522 | 1.5 (1.0–2.1) | 0.3 (0.2–0.4) | 33,363 |
| Penicillins | ||||
| Mild allergic reaction† | 17,436 | 57.5 (52.5–62.6) | 3.4 (2.7–4.0) | 2958 |
| Moderate-to-severe allergic reaction‡ | 6982 | 23.0 (20.5–25.6) | 1.4 (1.1–1.6) | 7385 |
| Gastrointestinal disturbance§ | 4821 | 15.9 (11.6–20.2) | 0.9 (0.5–1.3) | 10,695 |
| Other or unspecified effect | 878 | 2.9 (1.9–3.9) | 0.2 (0.1–0.3) | 58,737 |
| Neurological or psychiatric effect‖ | – | – | – | – |
| Quinolones | ||||
| Mild allergic reaction† | 9847 | 43.2 (38.9–47.5) | 2.9 (2.2–3.6) | 3469 |
| Moderate-to-severe allergic reaction‡ | 5969 | 26.2 (21.6–30.8) | 1.7 (1.3–2.1) | 5723 |
| Gastrointestinal disturbance§ | 4474 | 19.6 (12.8–26.5) | 1.3 (0.7–1.9) | 7635 |
| Other or unspecified effect | 1105 | 4.9 (3.7–6.0) | 0.3 (0.2–0.4) | 30,929 |
| Neurological or psychiatric effect‖ | 1376 | 6.0 (4.2–7.9) | 0.4 (0.3–0.5) | 24,834 |
| Cephalosporins | ||||
| Mild allergic reaction† | 9265 | 59.3 (53.2–65.5) | 3.9 (2.9–4.9) | 2549 |
| Moderate-to-severe allergic reaction‡ | 3382 | 21.7 (17.7–25.7) | 1.4 (1.1–1.8) | 6983 |
| Gastrointestinal disturbance§ | 2296 | 14.7 (9.7–19.7) | 1.0 (0.5–1.4) | 10,286 |
| Other or unspecified effect | 426 | 2.7 (1.5–4.0) | 0.2 (0.1–0.3) | 55,475 |
| Neurological or psychiatric effect‖ | – | – | – | – |
| Lincomycins (clindamycin) | ||||
| Mild allergic reaction† | 6351 | 59.4 (55.1–63.8) | 7.8 (6.2–9.5) | 1275 |
| Moderate-to-severe allergic reaction‡ | 1862 | 17.4 (12.3–22.6) | 2.3 (1.6–3.0) | 4348 |
| Gastrointestinal disturbance§ | 1930 | 18.1 (12.4–23.7) | 2.4 (1.3–3.5) | 4196 |
| Other or unspecified effect | 413 | 3.9 (2.2–5.5) | 0.5 (0.3–0.7) | 19,618 |
| Neurological or psychiatric effect‖ | – | – | – | – |
| Macrolides | ||||
| Mild allergic reaction† | 4499 | 43.8 (38.3–49.2) | 1.1 (0.8–1.5) | 8709 |
| Moderate-to-severe allergic reaction‡ | 2353 | 22.9 (18.8–27.0) | 0.6 (0.5–0.8) | 16,650 |
| Gastrointestinal disturbance§ | 2775 | 27.0 (19.3–34.7) | 0.7 (0.4–1.0) | 14,116 |
| Other or unspecified effect | 426 | 4.1 (2.1–6.2) | 0.1 (0.1–0.2) | 91,956 |
| Neurological or psychiatric effect‖ | – | – | – | – |
| Tetracyclines | ||||
| Mild allergic reaction† | 3516 | 47.6 (39.8–55.4) | 2.0 (1.4–2.7) | 4885 |
| Moderate-to-severe allergic reaction‡ | 1164 | 15.8 (10.2–21.3) | 0.7 (0.4–0.9) | 14,752 |
| Gastrointestinal disturbance§ | 1874 | 25.4 (19.0–31.7) | 1.1 (0.6–1.6) | 9167 |
| Other or unspecified effect | 561 | 7.6 (4.8–10.4) | 0.3 (0.2–0.5) | 30,621 |
| Neurological or psychiatric effect‖ | – | – | – | – |
| Nitroimidazoles (metronidazole) | ||||
| Mild allergic reaction† | 2767 | 44.9 (37.6–52.2) | 3.3 (2.4–4.2) | 3016 |
| Moderate-to-severe allergic reaction‡ | 1219 | 19.8 (14.9–24.7) | 1.5 (1.1–1.9) | 6842 |
| Gastrointestinal disturbance§ | 1742 | 28.3 (20.9–35.7) | 2.1 (1.2–3.0) | 4789 |
| Other or unspecified effect | 271 | 4.4 (2.0–6.8) | 0.3 (0.2–0.5) | 30,840 |
| Neurological or psychiatric effect‖ | – | – | – | – |
| Nitrofurans (nitrofurantoin) | ||||
| Mild allergic reaction† | 2220 | 56.0 (48.6–63.5) | 2.6 (1.9–3.3) | 3825 |
| Moderate-to-severe allergic reaction‡ | 789 | 19.9 (14.5–25.4) | 0.9 (0.6–1.2) | 10,767 |
| Gastrointestinal disturbance§ | 767 | 19.4 (12.7–26.0) | 0.9 (0.5–1.3) | 11,066 |
| Other or unspecified effect | – | – | – | – |
| Neurological or psychiatric effect‖ | – | – | – | – |
Estimates of ED visits for antibiotic AEs are from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project, CDC. Estimates of dispensed prescriptions (from retail and long-term care pharmacies) are from QuintilesIMS National Prescription Audit (2011–2015). Unreliable estimates due to fewer than 20 surveillance cases are indicated by en dash (–) and not shown
CI confidence interval, N/A not applicable, NNH number needed to harm
*Adverse event manifestations were categorized in a mutually exclusive and hierarchical manner based on severity of presentation—for example, visits with both anaphylaxis and diarrhea would be classified as moderate-to-severe allergic reaction
†Includes dermatitis, drug eruption, erythema, flushing, localized or peripheral edema, pruritus, rash, and urticaria
‡Includes anaphylaxis, angioedema, erythema multiforme, exfoliative dermatitis, facial-pharyngeal-genital edema, hyperhidrosis or chills, hypersensitivity vasculitis, allergy-related respiratory compromise (e.g., bronchospasm, dyspnea, hyperventilation, tachypnea, throat tightness, wheezing), serum sickness, and Stevens-Johnson syndrome
§Includes abdominal discomfort, appetite change, constipation, diarrhea, dyspepsia, gastrointestinal irritation (e.g., enteritis, colitis, pancreatitis), gastrointestinal bleeding (e.g., hematemesis, melena), and nausea/vomiting
‖Includes dizziness/syncope, headache, motor impairment (e.g., dystonia, movement disorders, muscle weakness), sensory impairment (e.g., balance/coordination disorders, paresthesia, visual disturbance), and mood disturbance (e.g., anxiety, insomnia, irritability)
¶Number needed to harm calculated as 10,000 multiplied by the reciprocal of the ED visit rate