An Umbrella Literature Review on Aortopathy and Fluoroquinolone Use

Abstract

 Background: Aortic dissection and aortic rupture are critical vascular events often predisposed by aneurysmal dilation of the aorta. The use of fluoroquinolone has been associated with aortic dissection and aortic rupture, necessitating a careful clinical review before use. Despite black box warnings, fluoroquinolones continue to be one of the commonly prescribed antibiotics.   Critical care providers, specifically those who work in close association with high-volume aortic centers, can play an active role in antibiotic stewardship in the use of fluoroquinolones in patients with a known or predisposition to aortopathy.

Aim: This paper provides a brief review of the potential effects of fluoroquinolones on the development of aortic aneurysm, dissection, and or rupture and the cautions to be exercised when using fluoroquinolones, especially in people who are predisposed to developing aortopathies.

Methods: A rapid umbrella review was conducted on the effects of fluoroquinolones on aortopathy and the potential for acute aortic events associated with their use. The PICO (Population, Intervention, Comparator, Outcome) strategy coined the research question. It is as follows:  In patients with known aortopathy or a known risk of aortopathy, what are the risks of an acute aortic event from taking fluoroquinolones compared to other antibiotics? A meta-analysis was done with selected studies utilizing a random effects model (utilizing Statsdirect software), which showed a pooled effect that favored the association of fluoroquinolones with aortopathy.

Findings:  Meta-analysis results showed a pooled effect that favored the association of fluoroquinolones with aortopathy.

Discussion: Fluoroquinolone use potentiates the risk of developing aortic aneurysm and aortic dissection. Despite published evidence and warnings from manufacturers and regulatory bodies, fluoroquinolone use continues to be a covert contributor to the development of aortopathy.

Conclusion: The literature reports multiple instances of fluoroquinolone-induced aortopathy. As such, fluoroquinolones should be reserved for use in situations where their benefits clearly outweigh the risks.