Antibiotic exposure and drug-induced intracranial hypertension: a systematic review and meta-analysis

Drug-induced intracranial hypertension (DIH) is a rare condition that has been associated with several risk factors, including exposure to certain medications. Herein, we synthesised the literature-pooled quantitative risk of developing DIH with antibiotics use.

Medline, Embase, and Cochrane Library were searched (inception to June 2024). We included observational or randomised studies reporting the incidence of antibiotic-related DIH, or the comparative odds of DIH between antibiotic users and non-users. Risk of bias was assessed via the ROBINS-E tool. Non-pairwise and pairwise meta-analyses (with random effects) were conducted to determine the pooled incidence of antibiotic-related DIH and the comparative odds of DIH among antibiotic users and non-users, respectively.

We identified 10 studies (all observational studies). Overall, tetracycline class antibiotics were significantly associated with DIH in both least- (3.96, 95%CI [1.33, 11.78], p = 0.013, I²: 98.7%) and most-adjusted (2.40, 95%CI [1.87, 3.06], p < 0.0001, I²: 19.0%) analyses. Likewise, quinolone class antibiotics were significantly associated with DIH in both least- (2.54, 95%CI [1.57, 4.10], p < 0.0005, I²: 78%) and most-adjusted (2.70, 95%CI [1.54, 4.75], p < 0.001, I²: 83.2%) analyses. Sensitivity analyses with the leave-one-out method or omission of "serious" risk of bias studies yielded consistent findings.

Despite unclear pathophysiology, low certainty evidence supports that tetracycline and quinolone class antibiotics are associated with DIH. Dose-response studies are needed to support causality.