Do Cipro and Levaquin Cause Abdominal Aortic Aneurysms?

Melina Kibbe, MD, of the University of North Carolina Medical Center at Chapel Hill published an article in JAMA Surgery reviewing any possible relationship between taking fluoroquinolones antibiotics such as Cipro or Levaquin and the subsequent development of an abdominal aortic aneurysm.  An aneurysm is a weakening in the wall of a blood vessel that balloons out like the defect on a damaged tire or basketball and has the potential to rupture causing exsanguination and sudden death. Dr Kibbe is also the editor of JAMA Surgery.

The study looked at health insurance company data on antibiotics and aneurysm diagnosis and repair.  They found that 7.5 aneurysms formed per 10,000 fluoroquinolone prescriptions filled at 90 days. This was significantly higher than the 4.6. per 10,000 aneurysms formed after patients took non-fluroquinolone antibiotics.  Patients filling fluroquinolone prescriptions were more likely to undergo repair of aneurysms than those who took other types.

The study used data from IBM MarketScan health insurance claims from 2005 to 2017 in adults aged 18-64.  The study included data on 27,827,254 individuals. The data did not include smoking or hypertensive history or family history of vascular disease. The authors were hoping the FDA would require a warning or caution to high-risk individuals for developing an aneurysm.

We already see an increase in ruptured tendons in patients taking fluroquinolones – especially women who have taken corticosteroids. They are also associated with C difficile colitis, nerve damage, emotional health issues and low blood sugar events. 

Despite these known draw backs to these medications, patients continually demand to have Cipro or Levaquin on hand in case they develop a urine infection or upper respiratory infection or are travelling and concerned about traveler’s diarrhea. 

More research is needed to determine the exact risk of prescribing these medications. Should we be doing scans on patients with hypertension and or smoking history who frequently use these drugs to screen for an abdominal aortic aneurysm?  This is a question that will be addressed by a study soon.  While the research is in process, we need to make sure that our prescribing of these antibiotics is the safest choice for our patients.

Cipro, Levaquin and Tendon Rupture

For many years, fluoroquinolone antibiotics such as Cipro and Levaquin have been integral components of treating bacterial urine infections, travelers’ diarrhea, skin infections and certain pulmonary infections.  Like any chemical or medication, they do not come with a “free lunch.”  There have always been potential side effects and adverse effects possible, in addition to drug to drug interactions with other medications, the prescribing physician needs to take into account before suggesting these products to patients.  In recent months, the use of these antibiotics has come under further critique from individuals developing unexpected tears of tendons and having an increased risk of rupturing a major blood vessel such as the aorta.

The subject of fluoroquinolone antibiotics and tendon rupture was addressed in a recent study of the United Kingdom Clinical Practice Research Datalink and discussed in the on line journal MPR.  They looked at 740,926 users of fluoroquinolone (FQ) antibiotics and tendon ruptures. Of that group, only 3,957 cases of tendon rupture were reported.  This correlated to a risk of 3.73 events per 10,000 person years with an even lower risk for Achilles tendon rupture of 2.91.

When they then looked at which patients with rupture were additionally taking corticosteroids such as prednisone they found the risk increased to 21.2 per 10,000 PY.  The study showed that females were more likely than males to develop a tendon rupture and those over 60 years old as well.

Cipro and Levaquin can certainly remain part of a treatment plan as long as we realize that patients taking steroids, especially women and patients over 60 years of age, are at higher risk than others. That risk, however is extremely small.