The Association between the Risk of Aortic Aneurysm/Aortic Dissection and the Use of Fluroquinolones: A Systematic Review and Meta-Analysis

Abstract

This study aimed to investigate the association between the risk of aortic aneurysm (AA)/aortic dissection (AD) and the use of fluoroquinolones (FQs). PubMed, Embase, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Web of Science and Scopus were searched for relevant articles to 21st February 2021. Studies that compared the risk of AA/AD in patients who did and did not receive FQs or other comparators were included. The pooled results of nine studies with 11 study cohorts showed that the use of FQs increased the risk of AA/AD by 69% (pooled risk ratio (RR) = 1.69 (95% CI = 1.08, 2.64)). This significant association remained unchanged using leave-one-out sensitivity test analysis. Similar results were found for AA (pooled RR = 1.58 (1.21, 2.07)) but no significant association was observed for AD (pooled RR = 1.23 (0.93, 1.62)). Stratified by the comparators, the use of FQs was associated with a significantly higher risk of AA/AD compared to azithromycin (pooled RR = 2.31 (1.54, 3.47)) and amoxicillin (pooled RR = 1.57 (1.39, 1.78)). In contrast, FQ was not associated with a higher risk of AA/AD, when compared with amoxicillin/clavulanic acid or ampicillin/sulbactam (pooled RR = 1.18 (0.81, 1.73)), sulfamethoxazole–trimethoprim (pooled RR = 0.89 (0.65, 1.22)) and other antibiotics (pooled RR = 1.14 (0.90, 1.46)). In conclusion, FQs were associated with an increased risk of AA or AD, although the level of evidence was not robust. However, FQs did not exhibit a higher risk of AA or AD compared with other broad-spectrum antibiotics. Further studies are warranted to clarify the role of FQs in the development of AA or AD.

Overview of Tendinopathy, Peripheral Neuropathy, Aortic Aneurysm, and Hypoglycemia Caused by Fluoroquinolones

“…[28][29][30][31][32] Several systematic metaanalyses found that the risk of aortic aneurysm and aortic dissection is significantly higher among the users of FQs. [33][34][35][36][37][38] Moreover, a retrospective cohort study of Taiwan National Health Insurance Research Database determined that the risk of all-cause mortality, aortic death, and later aortic surgery was found to be higher among the patients with aortic aneurysm or aortic dissection, who are exposed to systemic FQs. 39 Similarly, another retrospective cohort study of Taiwan National Health Insurance Research Database revealed that the mortality was increased in patients who took FQs to treat UTIs compared to the users of cephalosporins, 40 and a nested case-control study of Korea National Health Insurance data stressed on higher incidence of aortic aneurysm or aortic dissection among the users of systemic FQs.…”

Newer, Older, and Alternative Agents for the Eradication of Helicobacter pylori Infection: A Narrative Review

“…Neither of the studies referred to H. pylori eradication and no case presentation is known. Clinically, one can hardly believe that 7–14 days of FQ treatment could change the aortic architecture [ 52 ]. Instead, during the decades of infection, H. pylori itself could promote the development of vascular complications (coronary heart disease, stroke, etc.)…”

Fluoroquinolones and Risk of Aortic Aneurysm or Dissection in Patients With Congenital Aortic Disease and Marfan Syndrome

“…31 A 2021 meta-analysis stated that the risk of AA/AD with fluoroquinolone use was similar to that with other broad-spectrum antibiotics. 32 The authors have affected the results, such as computed tomography, blood pressure, body mass index, tobacco use, congenital collagen disorders, ongoing infection, and family history of aortic disease. 31 Future studies should attempt to control for as many potential confounders as possible.…”