Fluoroquinolones, aortic aneurysm, and dissection

BACKGROUND AND OBJECTIVE Recently, fluoroquinolones have been found to be associated with tendinopathy and tendon rupture. The mechanism of this phenomenon is thought to involve degradation of collagen and other structural components. As the integrity of the aorta depends upon an intact extracellular matrix, this study was designed to better understand the association between aortic morbidity and fluoroquinolones use.METHODS Data were obtained from the Swedish National Prescribed Drug Register, the National Patient Register of Outpatient and Emergency visits, Statistics Sweden which captures demographic characteristics, and the Swedish Cause of Death Register. From these databases, the use of antibiotics, including fluoroquinolones and amoxicillin, was captured and compared to the first diagnosis of aortic aneurysm or dissection.RESULTS Eligible cases were 560,768 episodes of fluoroquinolone use and 440,504 episodes of amoxicillin use. The incidence of aortic aneurysm or dissection among those using fluoroquinolones was 1.2 per 1,000-person years, compared to 0.7 per person years among those using amoxicillin (HR 1.66). Of the 64 cases of aortic aneurysm, among those treated with fluoroquinolones, 41% occurred in the first 10 days after initiating treatment.CONCLUSION This nationwide Swedish study found that the use of fluoroquinolones was associated with a 66% increase in the rate of aortic aneurysm or dissection, as compared to the use of amoxicillin.