University of Wisconsin–Madison Medical College of Wisconsin

Fluoroquinolones and the Risk of Aortopathy: A Systematic Review and Meta-Analysis

Azka Latif, MD, MBBS; Muhammad Junaid Ahsan, MD, MBBS; Vikas Kapoor, MD, MBBS; Noman Lateef, MD, MBBS; Saad Ullah Malik, MD, MBBS; Apurva D. Patel, MD; Behram Ahmed Khan, MD, MBBS; Marvin Bittner, MD, MSC; Mark Holmberg, MD

WMJ. 2020;119(3):185-189.

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Introduction: Recent studies have raised concerns that fluoroquinolone use is associated with an increased risk of aortopathy, including aortic aneurysm with and without dissection.

Objective: We performed a meta-analysis with a comprehensive literature review to further investigate this association.

Methods: This analysis was conducted per PRISMA guidelines. PubMed, Cochrane Library,, Embase, Web of Science, and Google Scholar were searched for studies that included adult patients (age >18 years) exposed to fluoroquinolones or control antibiotics (amoxicillin/any other antibiotic) for urinary tract infection or pneumonia with a primary outcome of aortic aneurysm or dissection. Heterogeneity was calculated using Q statistic I2.

Results: A total of 6 studies—comprised of 59% males—were included in our analysis, which showed an increased combined risk of development of aortic aneurysm and aortic dissection with quinolone exposure when compared with controls (relative risk [RR] = 2.11; 95% CI, 1.62 - 2.75; I2 = 83.700). Individual relative risk for aortic aneurysm (RR = 2.83; 95% CI, 2.02 - 3.95, I2 = 89.150) and aortic dissection (RR = 1.99; 95% CI, 1.23 - 3.06; I2 = 71.33) also were significantly increased.

Conclusion: Compared to other antibiotics, the use of fluoroquinolones was associated with a significantly higher risk of aortic aneurysm and dissection combined.

Author Affiliations: CHI Health Creighton University, Omaha, NE (Latif, Ahsan, Kapoor, Lateef, Malik, Patel, Khan, Bittner, Holmberg).
Corresponding Author: Azka Latif, MD, MBBS, 7500 Mercy Rd, 68124, Omaha, NE; phone 402.651.4961; email
Funding/Support: None declared.
Financial Disclosures: None declared.
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