The results of a large observational study suggest fluoroquinolone antibiotics are associated with an increased short-term risk of aortic aneurysm.

The study, published yesterday in JAMA Surgery, found that aortic aneurysm incidence within 90 days of filling a fluoroquinolone prescription was 20% higher in adults 35 and over compared with other antibiotics.

In particular, there was a 31% higher incidence of abdominal aortic aneurysm and a 61% higher incidence of iliac artery aneurysm after fluoroquinolone use. Overall incidence of aneurysm in the cohort of more than 27 million Americans was low.

The Food and Drug Administration (FDA) added to its black box warnings on fluoroquinolones in 2018 to advise that people with a history of aortic aneurysm—a balloon-like bulge in the aorta that can cause life-threatening internal bleeding if it ruptures—or blockages of other blood vessels, or high blood pressure should consider alternative antibiotics. The warning was based on an FDA review of studies showing fluoroquinolones were associated with an increased risk of aortic aneurysm or dissection (a tear or separation in the lining of the aorta).

“For patients who have an aortic aneurysm or are known to be at risk of an aortic aneurysm, we do not believe the benefits outweigh this risk, and alternative treatment should be considered,” the FDA wrote.

Image by Gerd Altmann from Pixabay

But the authors of the study say these findings indicate that fluoroquinolones, which are one of the most commonly prescribed antibiotic classes in the United States and are used for a variety of bacterial infections, should be used with caution not just in high-risk groups but in all adults 35 and over.

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