Fluoroquinolones Are Associated With Increased Risk of Aortic Aneurysm or Dissection: Systematic Review and...

Area of Science:

• Pharmacovigilance
• Cardiovascular Research
• Infectious Diseases

Background:

• Fluoroquinolone antibiotics are widely used but have potential safety concerns.
• Previous associations noted between fluoroquinolones and collagen disease events.
• Aortic aneurysm (AA) and aortic dissection/rupture (AD/AR) are critical vascular conditions.

Purpose of the Study:

• To investigate the association between fluoroquinolone use and the risk of aortic aneurysm and aortic dissection/rupture (AA/AD/AR).
• To conduct a systematic review and meta-analysis of observational studies evaluating this association.

Main Methods:

• Systematic review and meta-analysis of seven observational studies published until March 2019.
• Included 2,851,646 participants, comparing fluoroquinolone use with non-treatment and beta-lactam antibiotic use.
• Risk of bias assessment and heterogeneity analysis (I² statistic) were performed.

Main Results:

• Fluoroquinolone use was associated with a significantly higher risk of AA/AD/AR compared to non-treatment (OR=2.26, 95% CI 1.93-2.65).
• A higher risk was also observed when compared to beta-lactam antibiotic use (OR=1.56, 95% CI 1.37-1.79).
• These findings remained significant across various study designs and for AD/AR outcomes specifically.

Conclusions:

• Fluoroquinolone use is significantly associated with an increased risk of aortic aneurysm, aortic dissection, and aortic rupture.
• Despite low-certainty evidence (GRADE), the association warrants clinical attention and further investigation.
• Healthcare providers should consider these risks when prescribing fluoroquinolones.