{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T06:40:08Z","timestamp":1793947208149,"version":"4.8.0"},"reference-count":54,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T00:00:00Z","timestamp":1689033600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Study Objective<\/jats:title><jats:p>To investigate risk of aortic aneurysm or dissection in patients using oral fluoroquinolones compared to those using macrolides in real\u2010world clinical practice among a large US general population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study design.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Source<\/jats:title><jats:p>MarketScan commercial and Medicare supplemental databases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>Adults patients with at least one prescription fill for fluoroquinolone or macrolide antibiotics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>Fluoroquinolone or macrolide antibiotics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements and Main Results<\/jats:title><jats:p>The primary outcome was estimated incidence of aortic aneurysm or dissection associated with the use of fluoroquinolones compared with macrolides during a 60\u2010day follow\u2010up period in a 1:1 propensity score\u2010matched cohort. We identified 3,174,620 patients (1,587,310 in each group) after 1:1 propensity score matching. Crude incidence of aortic aneurysm or dissection was 1.9 cases per 1000 person\u2010years among fluoroquinolone users and 1.2 cases per 1000 person\u2010years among macrolide users. In multivariable Cox regression, compared with macrolides, the use of fluoroquinolones was associated with an increased risk of aortic aneurysm or dissection (aHR: 1.34; 95% CI: 1.17\u20131.54). The association was primarily driven by a high incidence of aortic aneurysm cases (95.8%). Results of sensitivity (e.g., fluoroquinolone exposure ranging from 7 to 14\u2009days (aHR: 1.47; 95% CI: 1.26\u20131.71)) and subgroup analyses (e.g., ciprofloxacin (aHR: 1.26; 95% CI: 1.07\u20131.49) and levofloxacin (aHR: 1.44; 95% CI: 1.19\u20131.52)) remained consistent with main findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Fluoroquinolone use was associated with a 34% increased risk of aortic aneurysm or dissection compared with macrolide use among a general US population.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2841","type":"journal-article","created":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T01:12:24Z","timestamp":1688001144000},"page":"883-893","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Oral fluoroquinolones and risk of aortic aneurysm or dissection: A nationwide <scp>population\u2010based<\/scp> propensity score\u2010matched cohort study"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2479-555X","authenticated-orcid":false,"given":"Mahek","family":"Garg","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veena","family":"Venugopalan","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy and Translational Research, College of Pharmacy University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0411-2160","authenticated-orcid":false,"given":"Scott M.","family":"Vouri","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vakaramoko","family":"Diaby","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole M.","family":"Iovine","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Global Medicine, College of Medicine University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3299-8111","authenticated-orcid":false,"given":"Haesuk","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,11]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199102073240606"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-021-06467-z"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.5018"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.5651"},{"key":"e_1_2_7_6_1","unstructured":"Information for Healthcare Professionals: Fluoroquinolone Antimicrobial Drugs [ciprofloxacin (marketed as Cipro and generic ciprofloxacin) ciprofloxacin extended\u2010release (marketed as Cipro XR and Proquin XR) gemifloxacin (marketed as Factive) levofloxacin (marketed as Levaquin) moxifloxacin (marketed as Avelox) norfloxacin (marketed as Noroxin) and ofloxacin (marketed as Floxin)]. Accessed December 04 2020.http:\/\/wayback.archive\u2010it.org\/7993\/20170112032310\/http:\/\/www.fda.gov\/Drugs\/DrugSafety\/PostmarketDrugSafetyInformationforPatientsandProviders\/ucm126085.htm"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-007-0265-9"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.383"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40264-013-0089-8"},{"key":"e_1_2_7_10_1","unstructured":"FDA drug safety communication: FDA requires label changes to warn of risk for possibly permanent nerve damage from antibacterial fluoroquinolone drugs taken by mouth or by injection. Accessed December 04 2020.http:\/\/wayback.archive\u2010it.org\/7993\/20170112031629\/http:\/\/www.fda.gov\/Drugs\/DrugSafety\/ucm365050.htm"},{"key":"e_1_2_7_11_1","unstructured":"FDA drug safety communication: FDA updates warnings for oral and injectables fluoroquinolone antibiotics due to disabling side effects. Accessed November 20 2020.https:\/\/www.fda.gov\/drugs\/drug\u2010safety\u2010and\u2010availability\/fda\u2010drug\u2010safety\u2010communication\u2010fda\u2010updates\u2010warnings\u2010oral\u2010and\u2010injectable\u2010fluoroquinolone\u2010antibiotics"},{"key":"e_1_2_7_12_1","unstructured":"FDA Drug Safety Communication: FDA Warns about Increased Risk of Ruptures or Tears in the Aorta Blood Vessel with Fluoroquinolone Antibiotics in Certain Patients. Accessed November 20 2020https:\/\/www.fda.gov\/drugs\/drug\u2010safety\u2010and\u2010availability\/fda\u2010warns\u2010about\u2010increased\u2010risk\u2010ruptures\u2010or\u2010tears\u2010aorta\u2010blood\u2010vessel\u2010fluoroquinolone\u2010antibiotics"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1401430"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.5389"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.06.067"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-77"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k678"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2011.05.027"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.26.6.w678"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.17.2037"},{"key":"e_1_2_7_21_1","unstructured":"Centers for Disease Control and Prevention.Outpatient antibiotic prescriptions \u2013 United States. Accessed December 04 2020.https:\/\/www.cdc.gov\/antibiotic\u2010use\/community\/programs\u2010measurement\/state\u2010local\u2010activities\/outpatient\u2010antibiotic\u2010prescriptions\u2010US\u20102017.html"},{"key":"e_1_2_7_22_1","unstructured":"FDA.Generic. Accessed December 04 2020.https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2008\/021721s020_020635s57_020634s52_lbl.pdf"},{"key":"e_1_2_7_23_1","unstructured":"FDA.Generic. Accessed December 04 2020.https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2016\/019537s086lbl.pdf"},{"key":"e_1_2_7_24_1","unstructured":"FDA.ZDL. Accessed December 04 2020.https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2013\/050710s039 050711s036 050784s023lbl.pdf"},{"key":"e_1_2_7_25_1","unstructured":"PatelPH HashmiMF.Macrolides. In:StatPearls ed.StatPearls Publishing;2023."},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/17.Supplement_1.S192"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1086\/375078"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-022-02488-x"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.08.025"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a010245"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1532\/hsf.1415"},{"key":"e_1_2_7_32_1","first-page":"1388","article-title":"Prevalence and risk factors of aortic aneurysm in patients with chronic obstructive pulmonary disease","volume":"10","author":"Ando K","year":"2014","journal-title":"J Thorac Dis"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.3109\/15412555.2010.528085"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2013.06.016"},{"key":"e_1_2_7_35_1","first-page":"322","article-title":"Association of chronic obstructive pulmonary, coronary artery, or peripheral artery disease with abdominal aortic aneurysm rupture","volume":"4","author":"Takagi H","year":"2017","journal-title":"Int Angiol"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2018.08.043"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.16338"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-016-3372-0"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2009.01.006"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.4414\/smw.2017.14489"},{"key":"e_1_2_7_41_1","first-page":"227","article-title":"Aneurysms of the ascending aorta","volume":"13","author":"Lavall D","year":"2012","journal-title":"Dtsch Arztebl Int"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2015.02.037"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir1043"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.7326\/M15-1840"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2020.6165"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.23518"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.21196"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2009.10.009"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00428-006-0194-5"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cca.2011.09.029"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1186\/471-2415-3-10"},{"key":"e_1_2_7_52_1","doi-asserted-by":"publisher","DOI":"10.3109\/15376516.2010.529183"},{"key":"e_1_2_7_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2020.09.069"},{"key":"e_1_2_7_54_1","unstructured":"Highlights of prescribing information. Accessed December 04 2020.https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2008\/021721s020_020635s57_020634s52_lbl.pdf"},{"key":"e_1_2_7_55_1","unstructured":"Highlights of prescribing information. Accessed December 04 2020.https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2017\/050733s043lbl.pdf"}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.2841","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T13:07:21Z","timestamp":1761052041000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/phar.2841"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,11]]},"references-count":54,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1002\/phar.2841"],"URL":"https:\/\/doi.org\/10.1002\/phar.2841","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"value":"0277-0008","type":"print"},{"value":"1875-9114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,11]]},"assertion":[{"value":"2023-01-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}