Abstract
BACKGROUND/OBJECTIVES: 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. SUBJECTS/METHODS: 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. RESULTS: 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, I(2): 98.7%) and most-adjusted (2.40, 95%CI [1.87, 3.06], p < 0.0001, I(2): 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, I(2): 78%) and most-adjusted (2.70, 95%CI [1.54, 4.75], p < 0.001, I(2): 83.2%) analyses. Sensitivity analyses with the leave-one-out method or omission of "serious" risk of bias studies yielded consistent findings. CONCLUSIONS: 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.