In one letter for healthcare professionals, the Medicines and Health Products Safety Agency (ANSM) alerted on November 6: fluoroquinolone antibiotics would increase the risk of aneurysm and aortic dissection. In agreement with the European Medicines Agency (EMA) and the laboratories marketing the treatments, the drug policeman believes that “Fluoroquinolones should only be used after careful benefit/risk assessment and consideration of treatment alternatives” in patients at risk. The elderly are particularly affected.
Double the risk
The prescription of these antibiotics, either systemically or inhaled, is used in the treatment of life-threatening bacterial infections. But the ANSM warning is based on several studies, including a Swedish cohort study published last March and a more recent published in september. The results of these two epidemiological reports concluded that the risk of aneurysm or aortic dissection was significantly increased, twice as high with fluoroquinolones.
“Aortic aneurysm and dissection are rare events, with an incidence of approximately 3 to 30 cases per 100,000 people per year”, develops the ANSM. But there are predisposing factors, recalled by the agency: presenting a family history of aneurysm, having already been affected by an aneurysm or an aortic dissection, suffering from Marfan syndrome, Ehlers-Danlos syndrome, Behçet’s, Takayasu’s or giant cell arteritis (Horton’s disease), arterial hypertension or atherosclerosis.
Patients should therefore be well informed of these risks: “They must be warned of the need for immediate treatment by a doctor in an emergency department in the event of a sudden onset of intense abdominal, chest or back pain”. This is then a ruptured aneurysm, requiring emergency surgery.
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