Are Fluoroquinolones Truly Associated with Increased Risk of Aortic Dissection?
BACKGROUND AND PURPOSE:
Recent observational studies have reported an association between fluoroquinolone and increased risk of aortic aneurysm or aortic dissection (AA/AD) | FDA has released a Drug Safety Communication addressing this risk
However, previous studies did not consider the role of coexisting infections nor the effects of fluoroquinolones vs other antibiotics
Dong et al. (JAMA Intern Med)
Estimated the risk of AA/AD associated with infections
Assessed the comparative risk of AA/AD associated with fluoroquinolones vs other antibiotics with similar indication profiles
Nested case-control study (January 1, 2009, to November 30, 2015)
Nationwide population-based health insurance claims database
Infections and antibiotic use within a 60-day risk window before the occurrence of AA/AD
Every incident case of AA/AD was matched with 10 control individuals based on age, sex, and follow-up duration using risk-set sampling
Conditional logistic regression was used to estimate the odds ratios (ORs) comparing infections for which fluoroquinolones are commonly used vs no infection within a 60-day risk window before outcome occurrence | Adjustments made for baseline confounders and concomitant antibiotic use
Fluoroquinolones were compared to other antibiotics with similar indication profiles within patients with indicated infections
28,948 cases | 289,480 matched controls
71.37% male | Mean (SD) age 67.41 (15.03) years
There was an association between AA/AD and ‘any indication’ infection
OR 1.73 (95% CI, 1.66 to 1.81)
However, fluoroquinolones were not associated with an increased AA/AD risk in patients with indicated infections when compared with
Combined amoxicillin-clavulanate or combined ampicillin-sulbactam
OR 1.01 (95% CI, 0.82 to 1.24)
OR 0.88 (95% CI, 0.70 to 1.11)
Findings did not differ based on subgroup analysis
Although fluoroquinolone use was associated with AA/AD, this association was no longer apparent when fluoroquinolones where compared to other antibiotics used for the same indication
A recent study by Gopalakrishnan et al. (JAMA Intern Med, 2020) reached similar conclusions
Risk of AA/AD was slightly increased with fluoroquinolone use in pneumonia, compared to other antibiotics, but there was no association for patients with urinary tract infections
The results of these studies confirm the importance of adjusting for pre-existing infections when assessing antibiotic safety
The authors conclude
This study’s results emphasize the importance of considering coexisting infections while examining the safety of antibiotics using real-world data
Concern about AA/AD should not preclude patients with indicated infections from necessary treatment with fluoroquinolones
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan