Fluoroquinolones and Aortic Aneurysm Risk: More Support for an Association

By Christine Judge

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

An association between fluoroquinolone antibiotics and increased risk for aortic aneurysm, the subject of a 2018 FDA safety warning, is supported in a JAMA Surgery study. Some recent studies have called this association into question.

Researchers examined 90-day incidence of aortic aneurysm after prescription fills for fluoroquinolones (~9 million) compared with comparator antibiotics (~39 million) in commercially insured U.S. adults through age 64.

Overall incidence of aneurysm was low (7.5 cases per 10,000 fluoroquinolone fills vs. 4.6 for comparator antibiotics). Fluoroquinolones were associated with a 20% increased risk for aortic aneurysm overall, including elevated risks for abdominal aortic aneurysms, iliac aneurysms, and other abdominal aneurysms — but not for aortic dissection or thoracic aortic aneurysm.

The association was observed among adults aged 35 and older and did not vary markedly by sex or comorbidity status.

Editorialists conclude: "We wholeheartedly agree with the authors that fluoroquinolone use 'should be pursued with caution in all adults, not just in high-risk individuals,' and we encourage the FDA to broaden their warning recommendations."