Pharmacotherapy

What’s the risk of aortic aneurysm or dissection with fluoroquinolones relative to other antibiotics?

May 2, 2025

Study details: This population-based cohort study analyzed German statutory health insurance data from January 2013 to December 2019. Researchers compared fluoroquinolone (FQ) prescriptions to macrolides and six other broad-spectrum antibiotics using propensity score matching. The study included adults with new antibiotic prescriptions, excluding those with prior antibiotic use, aortic aneurysm or dissection diagnoses, or recent hospitalizations.

Results: FQ use was associated with a significantly higher risk of aortic aneurysm or dissection compared with macrolides (adjusted hazard ratio [aHR], 1.52; 95% confidence interval [CI], 1.33-1.74). This association was consistent across a 90-day risk window and among various FQ agents, with moxifloxacin showing the highest risk (aHR, 2.13; 95% CI, 1.64-2.77). Higher risk for aortic aneurysm or dissection was also observed with FQs relative to these other antibiotic classes:

• tetracyclines: aHR, 1.86; 95% CI, 1.54-2.24
• extended-spectrum penicillins: aHR, 1.45; 95% CI, 1.28-1.65
• cephalosporins: aHR, 1.23; 95% CI, 1.10-1.37
• lincosamides: aHR, 1.73; 95% CI, 1.43-2.11

Clinical impact: Caution is suggested when prescribing FQs, particularly for patients with predisposing factors for aortic aneurysm or dissection. Alternative antibiotics may be preferable to mitigate the risk.

Source:

Wicherski J, et al. (2025, April 26). Pharmacotherapy. Fluoroquinolones and the risk of aortic aneurysm or dissection: A population-based propensity score-matched German cohort study. https://pubmed.ncbi.nlm.nih.gov/40285433/