Association of Fluoroquinolones With the Risk of Aortic Aneurysm or Aortic Dissection

Cohort study found an increased rate of aortic aneurysm or aortic dissection for fluoroquinolones vs azithromycin for treatment of pneumonia (HR 2.57, 95%CI 1.36-4.86), but no increased rate vs combined trimethoprim and sulfamethoxazole for UTI.

SPS commentary:

Authors highlight that, in both cohorts, the absolute rate of aortic aneurysm or aortic dissection appeared to be low (<0.1%), and that the increased relative rate observed in the pneumonia cohort may be due to residual confounding or surveillance bias.

Another case control study found that fluoroquinolones were not associated with increased risk of aortic aneurysm/aortic dissection risk vs amoxicillin-clavulanate, ampicillin-sulbactam or extended-spectrum cephalosporins.

An editorial makes suggestions as to why the results of these two studies were discordant, stating that observational studies reflect real-world experience, but for rare outcomes, results are sensitive to design parameters, especially to the choice of appropriate comparison groups. It concludes that fluoroquinolones should be used only for appropriate indications, with careful consideration of well-established adverse effects. While clinicians may choose to avoid use of fluoroquinolones in patients with aortic abnormalities, a strong causal association between fluoroquinolones and aneurysm/aortic dissection remains unproven.


JAMA Internal Medicine

Resource links:


Other study