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Antibacterial agents (antibiotics)

Study supports link between fluoroquinolones and aortic aneurysm

A study has shown that fluoroquinolone use is associated with a 66% increased risk of aortic aneurysm, comparted to amoxicillin.

Fluoroquinolone antibiotics are associated with an increased risk of aortic aneurysm or dissection, a study shows.

The findings, published in the BMJ, found a 66% increased risk of aortic aneurysm or dissection in people who received the class of antibiotics during the 60-day period after treatment initiation, compared with those who received amoxicillin.

The study used nationwide registry data from Sweden to compare 360,088 episodes of fluoroquinolone use (78% ciprofloxacin) matched to an equal number of amoxicillin use episodes.

Within 60 days of the first prescription being filled, the rate of aortic aneurysm or dissection was 1.2 vs 0.7 cases per 1000 person-years, respectively.

In secondary analyses, the researchers found no significant relationship between fluoroquinolone use and aortic aneurysm or dissection 61–120 days of initiation. And 41% of events in fluoroquinolone-treated patients occurred in the first 10 days.

They also found that most of the association was driven by the risk of aneurysm, which was raised by 90% in the initial 60-day period.

The results add to a growing body of evidence linking fluoroquinolones to aortic aneurysms. However, the authors note that the absolute risk still remained small, equating to an addition 82 incidents per million treatment episodes.

It is thought that fluoroquinolones have a damaging effects on the extracellular matrix in the vascular wall. They carry a boxed warning regarding these mechanisms and, in 2016, the European Medicines Agency launched a safety assessment of the drug class following two reports from the UK linking them to aortic aneurysm.

The research team, led by Björn Pasternak from the Karolinska Institutet in Stockholm, concluded that their findings lend support to this purported association.

However, they added: “Before these results are used to guide clinical decision making, the collective body of data on this safety issue should be scrutinised by drug regulatory authorities and weighed, together with other safety issues with this drug class.”

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2018.20204533

Readers' comments (1)

  • Fluoroquinolone antibiotics, or FQs, cause HORRIFIC devastation of every sort imaginable from head to toe, body and mind. The thing is, that with this class of drugs, the adverse reaction doesn't stop when the patient discontinues the drugs. Sadly, the victims tend to suffer a syndrome with a whole bunch of HORRIBLE "symptoms" that set in either all at once or in rapid succession and which will then continue for years upon years. I am pretty sure that these studies are measuring the increased likelihood of ruptures during the time that the person is taking the drugs, not a tracking of everyone who took them across time to see if they had one or a review of everyone who had one to see if FQs were in their medical histories. "The researchers were then able to compare the risk of aortic aneurysm or dissection among more than 360,000 treatment episodes of fluoroquinolones with the risk among the same number of treatment episodes of amoxicillin, another type of antibiotic." Again, I believe that by treatment episodes they are referring just to the time they are taking an FQ or perhaps also a short period afterward. The real number could be more like 20 times as likely, or 50 times as likely. All we know is it's much much higher than this. Also, it's not like most drugs that have one or two quirky ways they mess with people. FQs kill victims in dozens of ways from plummeting blood pressure to soaring blood sugar, from collapsed lung to intracranial pressure, from muscle wasting to suicide, we are dropping like flies. Of course, in 99% or more of the cases, the cause of death listed is the disease or condition the doctors suspected and not the combination of toxic chemicals the doctors prescribed and the pharmacists dispensed. Dr. Charles Bennett of the University of South Carolina has estimated that FQs have killed roughly 300,000 Americans and millions globally. The number of Americans who have been sickened and maimed is in the tens of millions, the vast majority of whom are misdiagnosed, meaning not only that we do without treatment we need and suffer through additional toxic reactions as we take more drugs we don't need, but that we are padding the numbers of all sorts of different conditions such as lupus, fibro, ALS, Parkinson's and so on. Not only are we boosting their numbers, but we are skewing their research and messing up their hopes for establishing efficacious best practices. This is a serious crisis of almost unimaginable scope and scale, the thalidomide story of our generation. You will be hearing a lot more about this soon...

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