According to the Centers for Disease Control and Prevention, of the 269.4 million antibiotic prescriptions in 2015, the antibiotic class known as fluoroquinolones was prescribed 32.5 million times. Fluoroquinolones are broad-spectrum antibacterial drugs used for various infections, including respiratory and urinary tract infections. This drug class includes ciprofloxacin, gemifloxacin, levofloxacin, moxifloxacin, norfloxacin, and ofloxacin. Fluoroquinolones have long carried a boxed warning for the risk of tendonitis, tendon rupture peripheral neuropathy, central nervous system effects, and exacerbation of myasthenia gravis. In 2018, the Food and Drug Administration (FDA) issued a Drug Safety Communication warning that fluoroquinolone use could increase the incidence of aortic aneurysm. Fluoroquinolones' labeling was changed to include this risk and providers were recommended to avoid prescribing these drugs to people with a history of or risk factors for aortic aneurysm. (See Drug Watch, April 2019). A recent study now supports broadening that precaution to all adults, not just those at high risk.

In the January 6 JAMA Surgery, Newton and colleagues report on their study assessing aortic aneurysm and dissection risks in a heterogeneous U.S. population 90 days after fluoroquinolone use.1 The researchers reviewed nearly 48 million filled prescriptions for antibiotics between 2005 and 2017; 19% were for fluoroquinolones and 81% were for comparator antibiotics. Patient records examined were for adults ages 18 to 64 years; those with previous aortic aneurysm or dissection, recent antibiotic exposure, and recent hospitalization were excluded. Cox regression was used to estimate the association between fluoroquinolone filled prescriptions and 90-day aneurysm incidence. After weighting for demographic characteristics and comorbidities, and when compared with other antibiotics, fluoroquinolone filled prescriptions were associated with an increased 90-day incidence of abdominal aortic aneurysm, iliac artery aneurysm, and other abdominal aneurysm, and adults were more likely to undergo aneurysm repair. When stratified by age, all adults age 35 years or older appeared to be at increased risk.

Although the FDA has not yet addressed these findings, NPs may wish to be cautious with all adults who require antibiotics, not just those at risk for aortic aneurysm, and reserve fluoroquinolones for times when other drug classes would not be effective or appropriate.

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