Patients using oral fluoroquinolone have a significantly greater risk of developing aortic aneurysms or dissections, according to a study published in the BMJ.

Björn Pasternak, MD, PhD, senior researcher at the Clinical Epidemiology Unit T2 of the Department of Medicine Solna, at the Karolinska Institutet in Stockholm, and associates conducted a nationwide historical group analysis in Sweden from July 2006 to December 2013 to assess whether the use of fluoroquinolone is associated with an increased risk of aortic aneurysms or dissections.

The investigators defined the initial diagnosis of aortic aneurysms or aortic dissections among the eligible 360,088 patients using fluoroquinolone, as diagnosed at hospital or emergency department admission or death due to these conditions within 60 days from the first treatment.

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Of the cohort, 78% were treated with fluoroquinolone (ciprofloxacin), 20% with norfloxacin, and 2% with another fluoroquinolone. The 360,088 patients were matched with a control group taking amoxicillin.

During the 60 days, 64 aortic aneurysm or dissection cases were reported in the fluoroquinolone cohort, and 40 cases were reported in the control cohort. According to the researchers, fluoroquinolone use was linked to an increase in aortic aneurysms or dissection (hazard ration [HR], 1.66).

In a secondary study from day 61 to 120, fluoroquinolone was associated with increased risks for aortic aneurysms (HR, 1.90) and aortic dissection (HR, 0.93). The most common aneurysm type among participants in the fluoroquinolone group was abdominal (the second most common being thoracic or thoracoabdominal).

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“There was a 66% increased rate of aortic aneurysm or dissection associated with oral fluoroquinolone use, compared with amoxicillin use, within a 60 day risk period from start of treatment,” reported the authors. “Although the absolute risk increase was relatively small, it should be interpreted in the context of the widespread use of fluoroquinolones.”


  1. Pasternak B, Inghammar M, Svanström H. Fluoroquinolone use and risk of aortic aneurysm and dissection: Nationwide cohort study. BMJ. 2018 March 8. doi: 10.1136/bmj.k678