Fluoroquinolone Use Is Associated with Excess Risk for Aortic Aneurysm or Dissection

Fluoroquinolones are associated with tendinopathy and tendon rupture (NEJM JW Gen Med Jan 1 2013 and Am J Med 2012; 125:1228.e23). The presumed mechanism is stimulation of matrix metalloproteinase activity, which results in degradation of collagen and extracellular matrix structural components. Because excessive metalloproteinase activity also is involved in the pathophysiology of aortic aneurysm, Swedish researchers performed a registry-based study to explore a possible association between fluoroquinolone use and aortic aneurysm or dissection. About 306,000 fluoroquinolone treatment episodes (78% ciprofloxacin) were propensity score–matched to the same number of amoxicillin treatment episodes in middle-aged or older adults (age, ≥50).

Within 60 days of the date that a prescription was filled, rates of aortic aneurysm or dissection were 1.2 cases per 1000 person-years for fluoroquinolone and 0.7 cases per 1000 person-years for amoxicillin — a significant difference. The estimated absolute difference was 82 cases of aortic aneurysm or dissection by 60 days per 1 million treatment episodes.