Fluoroquinolones, a common antibiotic, increase the risk of developing an aneurysm or aortic dissection by 66%, according to a new Swedish national study. These antibiotics are very often prescribed for bacterial sinusitis or urinary tract infections.
A more than doubled risk of developing an aneurysm or aortic dissection during fluoroquinolone treatment, a new Swedish national cohort study published in the BMJ.
A worrying percentage given that these antibiotics represent, for example, 30 million outpatient prescriptions per year in the United States.
360,088 files peeled
Researchers from the Karolinska Institute in Stockholm, Lund University and the Statens Serum Instite in Copenhagen searched the Swedish national health registers (drugs, patients, causes of death) between July 2006 and December 2013 in order to compare the risk of aortic disease in 360,088 people on fluoroquinolones (including 78% ciprofloxacin) versus amoxicillin, within 60 days of starting treatment.
A risk more than doubled
Their work reports a 66% higher risk of developing an aneurysm (dilation) or dissection (rupture) of the aorta. During the 60 days following the initiation of treatment, there were 64 cases of aneurysm or aortic dissection among the 360,088 people treated with fluoroquinolones, compared to 40 cases out of 360,088 individuals treated with amoxicillin.
Study finds a 66% increased rate of aortic aneurysm or dissection associated with oral fluoroquinolone use, compared with amoxicillin use, within a 60 day risk period https://t.co/712B6Bpq9T pic.twitter.com/POFhqizGu4
– The BMJ (@bmj_latest) March 13, 2018
A highly prescribed drug class
In the United States, they represent 30 million outpatient prescriptions per year. In 2016, their potentially dangerous side effects even led the FDA to “approve safety labeling changes to strengthen warnings about their association with disabling and potentially permanent side effects and to limit their use.”
A European assessment
It is a mechanism of non-antimicrobial activity which is at the origin of these serious undesirable effects: the fluoroquinolones would induce an increased activity of particular enzymes: the matrix metalloproteinases.
This leads to the degradation of collagen, which compromises the integrity of the extracellular matrix of the vascular wall.
These results prompt a European assessment of the safety of fluoroquinolones. The researchers say they need more studies to determine if there are differences between the various fluoroquinolones and if in clinical practice their prescription needs to be changed.
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