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While the mechanism is not yet understood, the
risk for aortic aneurysm rupture or dissection appears to be approximately
doubled in patients using quinolones.
Therefore, FDA is requiring that warnings be added to the prescribing
information for fluoroquinolones as well as their associated medication guides
which state that they should be avoided in patients who have or are at risk for
aortic aneurysm, including those with peripheral vascular disease,
hypertension, Marfan syndrome, Ehlers-Danlos syndrome, and the elderly.
These new concerns join the growing ranks of
other concerning adverse effects associated with quinolone use:
● Hypoglycemic coma (even in non-diabetics)
● Risk appears to be greatest with
renal impairment, advancing age and/or concurrent use of hypoglycemic
medications
● CNS effects, including attention
disturbances, memory impairment, delirium, nervousness, agitation and
disorientation
● May occur with as little as a
single dose
● Muscle, tendon, joint or nerve
damage
● Peripheral neuropathy
● QT prolongation
As such, providers are reminded that
quinolones should be avoided for the following unless no acceptable
alternatives exist:
● Acute bacterial sinusitis
● Amoxicillin-clavulanate is
preferred by the Infectious Diseases Society of America (IDSA)
● Acute exacerbations of chronic
bronchitis
● High-dose amoxicillin,
amoxicillin-clavulanate and macrolide antibiotics are alternatives
● Uncomplicated urinary tract
infections
● Instead, IDSA recommends
amoxicillin-clavulanate, TMP/SMX or nitrofurantoin
References:
● Food and Drug Administration. Safety Announcement: FDA warns about increased risk of ruptures or
tears in the aorta blood vessel with fluoroquinolone antibiotics in certain
patients. December 10, 2018. Accessed
February 11, 2019.
● Anthony W. Chow, Michael S.
Benninger, Itzhak Brook, Jan L. Brozek, Ellie J. C. Goldstein, Lauri A. Hicks,
George A. Pankey, Mitchel Seleznick, Gregory Volturo, Ellen R. Wald, Thomas M.
File; IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in
Children and Adults, Clinical Infectious Diseases, Volume 54, Issue 8, 15 April
2012, Pages e72–e112, https://doi.org/10.1093/cid/cis370. Accessed February 11, 2019.
● Kalpana Gupta, Thomas M. Hooton,
Kurt G. Naber, Björn Wullt, Richard Colgan, Loren G. Miller, Gregory J. Moran,
Lindsay E. Nicolle, Raul Raz, Anthony J. Schaeffer, David E. Soper;
International Clinical Practice Guidelines for the Treatment of Acute
Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the
Infectious Diseases Society of America and the European Society for
Microbiology and Infectious Diseases, Clinical Infectious Diseases, Volume 52,
Issue 5, 1 March 2011, Pages e103–e120, https://doi.org/10.1093/cid/ciq257. Accessed February 11, 2019.
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