Compared with other classes of antibiotics, fluoroquinolones have been associated with increased risk of aortic aneurysm and dissection in high-risk patients. However, a study recently published in JAMA Surgery found that fluoroquinolones should be used with caution in all adults.
Researchers compared prescription fills for fluoroquinolone or other classes of antibiotics - such as amoxicillin-clavulanate, azithromycin, cephalexin, and others - and analysed the 90-day incidence of aortic aneurysm and dissection. Interaction terms were used to assess potential effects across sex, age, and comorbidity status (diabetes, hypertension, and hyperlipidaemia).
Of the 47,596,545 prescription fills analysed, fluoroquinolone accounted for 9,053,961 fills. The results show an increased rate of aortic aneurysms within 90 days after fluoroquinolone use compared with alternative antibiotic use. When stratified by age, an increased incidence of aneurysms was observed in adults 35 years or older.
No differences were seen after stratifying for common comorbidities and sex, suggesting a risk of this drug class among both healthy and unhealthy individuals.
Further studies will be needed to elucidate the mechanisms of fluoroquinolone-associated aneurysm development, the authors say. For now, they think the current warnings regarding fluoroquinolones may need to be expanded to include younger adults.