Fluoroquinolones and the Risk of Aortopathy: A Systematic Review and Meta-Analysis

WMJ. 2020 Sep;119(3):185-189.


Introduction: Recent studies have raised concerns that fluoroquinolone use is associated with an increased risk of aortopathy, including aortic aneurysm with and without dissection.

Objective: We performed a meta-analysis with a comprehensive literature review to further investigate this association.

Methods: This analysis was conducted per PRISMA guidelines. PubMed, Cochrane Library, ClinicalTrials.gov, Embase, Web of Science, and Google Scholar were searched for studies that included adult patients (age >18 years) 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. Heterogeneity was calculated using Q statistic I2 .

Results: A total of 6 studies-comprised of 59% males-were included in our analysis, which showed an increased combined risk of development of aortic aneurysm and aortic dissection with quinolone exposure when compared with controls (relative risk [RR] = 2.11; 95% CI, 1.62 - 2.75; I2 = 83.700). Individual relative risk for aortic aneurysm (RR = 2.83; 95% CI, 2.02 - 3.95, I2 = 89.150) and aortic dissection (RR = 1.99; 95% CI, 1.23 - 3.06; I22 = 71.33) also were significantly increased.

Conclusion: Compared to other antibiotics, the use of fluoroquinolones was associated with a significantly higher risk of aortic aneurysm and dissection combined.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / adverse effects
  • Aortic Aneurysm* / chemically induced
  • Aortic Aneurysm* / drug therapy
  • Aortic Aneurysm* / epidemiology
  • Aortic Dissection* / chemically induced
  • Aortic Dissection* / drug therapy
  • Aortic Dissection* / epidemiology
  • Female
  • Fluoroquinolones / adverse effects
  • Humans
  • Male


  • Anti-Bacterial Agents
  • Fluoroquinolones