Physicians have been warned to avoid prescribing fusidic acid antiobiotics to patients who are on cholesterol-lowering statin medications.
Kenneth Beazley (80) of Ballybrasil, Cobh, Co Cork, died on January 19th last at Cork University Hospital (CUH) after being prescribed a bacteriostatic antibiotic fusidic acid in conjunction with his regular statin medication.
Cork City Coroner’s Court heard Mr Beazley suffered from a complex medical history having undergone bypass surgery. He also had hypertension, diabetes mellitus, heart disease and degenerative joint disease. He had two joint replacements arising out of his arthritis.
His GP, Dr Peter Morahan, told coroner Dr Myra Cullinane that the late Mr Beazley had been a patient of his from 1977. He said he had treated Mr Beazley for a variety of conditions over the years at his Cobh-based surgery.
In November 2014, the doctor noticed a bloody discharge coming from Mr Beazley’s right knee. Mr Beazley went to the surgery on a daily basis from December 1st to 4th, as there was a discharge from the knee.
Dr Morahan consulted with consultant orthopaedic surgeon Dr Richard Creedon who recommended Mr Beazley take a fusidic acid antibiotic in tablet form.
A two-week prescription was written and a subsequent two-week prescription for the same drug was dispensed later that month. Dr Morahan said he was not aware of any problems with prescribing fuisdic acid antibiotics to a patient on statins and that it was a long-established antiobiotic that seemed appropriate to deal with the infection. The acid was developed 40 years ago and specifically works by preventing bacterial replication. It is now primarily used in drug “cocktails” to target anti biotic resistant strains.
On December 22nd, Mr Beazley attended the surgery where the doctor found there was a slight elevation in his INR levels in his blood test. Mr Beazley presented at a level of 3.4, but it wasn’t a cause of major concern as normal levels are in the 2.0 to 3.0 range.
However, in the weeks that followed, Mr Beazley’s INR levels in his blood tests rose from 6.8 to 7.9. He was admitted to the Bon Secours Hospital in Cork on the January 9th. His condition continued to deteriorate and he died at CUH 10 days later.
Consultant orthopaedic surgeon Dr Richard Creedon, who is a specialist in arthroscopic knee surgery, said he had seen Mr Beazley on a few occasions. He told Dr Cullinane that on December 4th Dr Morahan contacted him about pus which was being discharged from the pensioner’s knee. A CT scan was to be organised and a recommendation was made that Mr Beazley be put on a course of fusidic acid antibiotics.
Dr Creedon said he had never come across any problem with that antibiotic and statin medications. He described the pensioner as a “handsome and debonair man” before offering his condolences to the family at their tragic loss.
Dr John McCarthy, a physician at the Bon Secours Hospital, said Mr Beazley was admitted to the facility in January of this year with decreasing mobility issues and muscle weakness. He said a consultant onsite put forward the possibility of problems with the prescribing of fuisidic acid antibiotics and station medication when Mr Beazley’s condition started to deteriorate.
Mr Beasley was transferred to CUH for renal replacement therapy on January 16th. He died of cardiac arrest three days later.
Dr Margaret Bolster, who carried out the autopsy on Mr Beazley, said Mr Beazley had a number of serious aliments including severe heart disease. She noted an extensive breakdown of his skeletal muscle. She said his cause of death was almost certainly the combination of statin drugs and fusidic antibiotics.
However, Dr Bolster described such cases as being extremely rare having only ever come across two instances in all her years as a pathologist.
A verdict of medical misadventure was recorded in the case.
Dr Cullinane said she previously issued a warning about the usage of statin medication and fusidic acid at an inquest in 2008. She asked that the matter be again raised with the Irish Pharmaceutical Health Care Association and the Health Products Regulatory Authority.
Dr Cullinane offered her condolences to the family for their “devastating tragedy.”