Abstract
IntroductionRecent studies have raised concern that fluoroquinolone use is associated with an increased risk of aortopathy, including aortic aneurysm with and without dissection. We performed a meta-analysis with a comprehensive literature review to further investigate this association.HypothesisIncreased risk aortopathy with use of fluoroquinolone.MethodsThis analysis was conducted per PRISMA guidelines. PubMed, Cochrane library, ClinicalTrials.gov, Embase, web of science and Google Scholar were searched for studies including adult (age > 18 years), patients 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. Data was extracted in predefined tables and meta-analysis was performed using random effects model. Heterogeneity was calculated using Q statistic and I. The main summary estimate was Relative Risk with 95% confidence intervals (CI) as shown in figure.ResultsSeven studies (2 retrospective, 1 longitudinal cohort, 1 nested case control, 1 nationwide cohort, 1 case time control, and 1 case cross-over study) with 59% males were included. Our analysis showed increased combined risk of development of AA and AD with quinolone exposure when compared with controls (relative risk [RR] (95% confidence interval [CI]) = 2.11 (1.62 - 2.75),I=83.700). Individual RR for aortic aneurysm (RR of 2.83 (95% confidence interval [CI]) = 2.02 - 3.95,I=89.150)) and AD (RR of 1.99 (95% confidence interval [CI]) = 1.23-3.06), I=71.33) were also significantly increased.ConclusionCompared to other antibiotics, use of fluoroquinolones was associated with significantly higher risk of aortic aneurysm and dissection combined.