Antidepressant use and antibiotics treatment failure
C.-S. Wu1, W.-L. Huang2, S.-C. Kuo3, S. Wang4, H.-J. Tsai5
1National Health Research Institutes, National Center for Geriatrics and Welfare Research, Zhunan, Taiwan, 2National Taiwan University Hospital, Yunlin Branch, Department of Psychiatry, Yunlin, Taiwan, 3National Health Research Institutes, National Institute of Infectious Diseases and Vaccinology, Miaoli, Taiwan, 4National Health Research Institutes, National Center for Geriatrics and Welfare Research, Miaoli, Taiwan, 5National Health Research Institutes, Institute of Population Health Sciences, Miaoli, Taiwan
Background: Antidepressants may induce antibiotic resistance, yet their impact on antibiotic treatment outcomes in clinical settings remains unexplored. This study investigates the association between antidepressant use and antibiotic treatment failure in urinary tract infections (UTIs) and pneumonia, conditions with distinct pathogen origins.
Aims & Objectives: This study investigates the associations between antidepressant usage and antibiotic treatment failure in patients with urinary tract infections (UTIs) and pneumonia.
Method: This population-based cohort study includes new antibiotic treatments for UTIs (n= 647,514) or pneumonia (n= 532,135). The data was obtained from Taiwan's National Health Insurance (NHI) claims database spanning 2010 to 2021. Antidepressant use was defined as having a prescription for
antidepressants within six months prior to the initial date of antibiotic treatment. Antibiotic treatment failure, defined by specific events within 14 days, includes a different antibiotic prescription, hospitalization, or emergency visits for the same infection. Subgroup analyses examine age, gender, number of comorbidities, and antibiotic types. Antidepressant usage patterns, including timing, duration, and specific antidepressant drugs, are also evaluated.
antidepressants within six months prior to the initial date of antibiotic treatment. Antibiotic treatment failure, defined by specific events within 14 days, includes a different antibiotic prescription, hospitalization, or emergency visits for the same infection. Subgroup analyses examine age, gender, number of comorbidities, and antibiotic types. Antidepressant usage patterns, including timing, duration, and specific antidepressant drugs, are also evaluated.
Results: Antidepressant use has been found to correlate with a higher risk of antibiotic treatment failure (adjusted hazard ratio = 1.06 [1.03, 1.09]) in patients diagnosed with UTIs. This risk appears to be particularly elevated among older adults and those prescribed beta-lactam or aminoglycoside antibacterials. Moreover, prolonged antidepressant use exceeding 30 days and the use of specific antidepressant drugs, such as imipramine, doxepin, citalopram, paroxetine, and polypharmacy, exhibit associations with treatment failure. However, no significant association was observed among patients diagnosed with pneumonia.
Discussion & Conclusions: Antidepressant use correlates with antibiotic treatment failure in UTI patients but not in pneumonia patients. These findings partially provide real-world evidence for the potential impact of antidepressants on antibiotic resistance
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