Some antibiotics, used to treat life-threatening bacterial infections, are not without danger.
An increased risk of occurrence of aneurysm and aortic dissections after treatment with fluoroquinolnes (ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin, flumequine and ofloxacin) has just been clearly identified. “Thus, in patients at risk of developing aneurysm and aortic dissection, fluoroquinolones should only be used after careful benefit/risk assessment and after consideration of treatment alternatives,” says the ANSM.
The aorta is the largest artery in the body. When it ruptures, it is called an aortic aneurysm. Without care, patients have no chance of getting out of it.
“Patients should be informed of the risk of aortic aneurysm and dissection. They should 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, thoracic or back pain”, continues the drug agency.
Treat bacterial infections
Quinolones and fluoroquinolones are antibiotics administered systemically (injectable or oral form) or by inhalation. They are used to treat bacterial infections which can be life-threatening.
Predisposing factors for occurrence of aortic aneurysm and dissection include family history of aneurysm, pre-existing aortic aneurysm or dissection, Marfan syndrome, Ehlers-Danlos vascular syndrome , Takayasu’s arteritis, giant cell arteritis (or Horton’s disease), Behçet’s disease, arterial hypertension and atherosclerosis.
Many healthcare professionals involved
Many healthcare professionals are concerned by these new recommendations: general practitioners, cardiologists, internal medicine doctors, infectiologists, pulmonologists, ENT specialists, pediatricians, gastroenterologists, dermatologists, gynecologists, nephrologists, urologists, resuscitators, geriatricians, radiologists, emergency physicians, pharmacists. pharmacies and hospital pharmacists.
Two studies motivated ANSM’s decision
In March and July, two studies motivated the ANSM’s decision. The first, published in the BMJ, compared the adverse events associated with 360,088 fluoroquinolone prescriptions (ciprofloxacin in 78% of cases) with those associated with 360,088 amoxicillin prescriptions. Result: during the 60 days following the taking of the antibiotic, the rate of aneurysm or aortic dissection increased by 66% with fluoroquinolones.
The second, published in the JAMA, further reported that “Ciprofloxacin significantly increased the incidence of aortic dissection and rupture in a mouse model of moderate and sporadic aortic aneurysm and dissection. In these mice, ciprofloxacin decreased the expression and lysyl oxidase activity and increased elastic fiber fragmentation and cell injury, which may contribute to increased susceptibility to stress-induced aortic destruction.”
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