Commonly prescribed fluoroquinolone antibiotics can cause life-threatening blood vessel complications. Drugs such as ciprofloxacin (Cipro) and levofloxacin (Levaquin) can trigger aortic dissection and aortic aneurysm. With aortic dissection, a tear in the inner layer of this large blood vessel allows blood to run between the lining and the outer covering. This pushes the layers further apart. In an aortic aneurysm, the blood vessel develops a weak spot and puffs up like a balloon. Needless to say, both conditions are extremely dangerous. If the aorta leaks blood or bursts, it is a catastrophe.
Do Fluoroquinolone Antibiotics Threaten Those With Pre-existing Aortic Disease?
Doctors already knew about these complications, although it took decades to recognize them. They wondered, however, if some people might be at especially high risk for aorta damage from fluoroquinolone antibiotics.
A new study from Taiwan shows that people who already have aortic disease are indeed more susceptible to these dangers (Journal of the American College of Cardiology, April 20, 2021). Taiwan is an especially good setting for answering such questions because it has a medical insurance database that covers nearly every citizen in the country. Using these records, the investigators identified 31,570 adults who had survived aortic aneurysm or aortic dissection between 2001 and 2013. They analyzed whether they were more likely than other people to suffer further aortic damage if given fluoroquinolone antibiotics. For comparison, they examined the use of amoxicillin, a completely different type of antibiotic, in these individuals as well.
Such high-risk patients were more likely to die if they took a fluoroquinolone. In addition, they were significantly more likely to die from aortic complications. Amoxicillin, on the other hand, was not associated with bad outcomes.
The investigators conclude
“FQs should not be used by high-risk patients unless no other treatment options are available.”
An accompanying editorial in the Journal of the American College of Cardiology also urges physicians to avoid prescribing such drugs in patients at risk for aortic complications. The writer likened it to pouring gasoline on a fire.