{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T02:25:59Z","timestamp":1790475959282,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T00:00:00Z","timestamp":1745625600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      To investigate the risk of aortic aneurysm or dissection associated with fluoroquinolone (FQ) prescription compared to macrolides in German routine health care data in order to replicate the recent study (\n                      <jats:italic>Pharmacotherapy<\/jats:italic>\n                      2023;43:883) extending the results by contributing evidence for six additional broad\u2010spectrum antibiotic classes as active comparators.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cohort study in active comparator new user design comparing FQ with macrolides, tetracyclines, penicillins with extended spectrum, penicillins and beta\u2010lactamase inhibitor combinations, second\u2010 and third\u2010generation cephalosporins, sulfonamide and trimethoprim combinations, and lincosamides.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>German statutory health insurance, the \u201cAllgemeine Ortskrankenkasse\u201d (AOK), January 2013 to December 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Adults with at least one new prescription fill for FQ or active comparator antibiotics. New users were defined as individuals without antibiotic prescription fills, aortic aneurysm or dissection diagnoses, and hospitalization within 365\u2009days prior to the cohort entry date. Users of FQ and active comparators were matched by nearest neighbor 1:1 propensity score matching.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Incident inpatient aortic aneurysm or dissection was observed within a 60\u2010day risk window. In sensitivity analyses, an extended risk window of 90\u2009days was applied, and specific FQ agents, dosages, and diagnoses were stratified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>FQ episodes were associated with an increased risk for aortic aneurysm or dissection compared to macrolides (aHR\u2009=\u20091.52 [1.33; 1.74]), which replicates the risk estimate of Garg et\u00a0al. (aHR\u2009=\u20091.34 [1.17; 1.54]). This association was robust in a 90\u2010day risk window and for ciprofloxacin, levofloxacin, and moxifloxacin. Moxifloxacin comprised the greatest risk of aortic aneurysm or dissection compared to macrolides (aHR\u2009=\u20092.13 [1.64; 2.77]). Moreover, we observed similar associations when comparing FQ to tetracyclines, penicillins with extended spectrum, cephalosporins, and lincosamides (aHR\u2009=\u20091.86 [1.54; 2.24], aHR\u2009=\u20091.45 [1.28; 1.65], aHR\u2009=\u20091.23 [1.10; 1.37], and aHR\u2009=\u20091.73 [1.43; 2.11]), respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In a German cohort study, FQ use was associated with a 52% increased risk for aortic aneurysm or dissection within 60\u2009days compared with macrolide use. The risk of FQ\u2010associated aortic aneurysm or dissection compared to macrolides can be replicated in German routine health care data. Extending the analysis, we provided new insights that the effect size may depend on the chosen AC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/phar.70020","type":"journal-article","created":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T03:39:16Z","timestamp":1745638756000},"page":"314-323","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Fluoroquinolones and the risk of aortic aneurysm or dissection: A population\u2010based propensity score\u2010matched German cohort study"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9630-6239","authenticated-orcid":false,"given":"Julia","family":"Wicherski","sequence":"first","affiliation":[{"name":"Federal Institute for Drugs and Medical Devices (BfArM) Research Division, Pharmacoepidemiology  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1682-7913","authenticated-orcid":false,"given":"Jonas","family":"Peltner","sequence":"additional","affiliation":[{"name":"German Centre for Neurodegenerative Diseases (DZNE) Pharmacoepidemiology in Neurodegenerative Disorders  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4161-4407","authenticated-orcid":false,"given":"Cornelia","family":"Becker","sequence":"additional","affiliation":[{"name":"Federal Institute for Drugs and Medical Devices (BfArM) Research Division, Pharmacoepidemiology  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8377-2254","authenticated-orcid":false,"given":"Katrin","family":"Sch\u00fcssel","sequence":"additional","affiliation":[{"name":"Research Institute of AOK (WIdO)  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4464-5351","authenticated-orcid":false,"given":"Gabriela","family":"Br\u00fcckner","sequence":"additional","affiliation":[{"name":"Research Institute of AOK (WIdO)  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Schlotmann","sequence":"additional","affiliation":[{"name":"Research Institute of AOK (WIdO)  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1447-6794","authenticated-orcid":false,"given":"Helmut","family":"Schr\u00f6der","sequence":"additional","affiliation":[{"name":"Research Institute of AOK (WIdO)  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2550-358X","authenticated-orcid":false,"given":"Winfried V.","family":"Kern","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine II University of Freiburg Faculty of Medicine and Medical Centre  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4828-6058","authenticated-orcid":false,"given":"Britta","family":"Haenisch","sequence":"additional","affiliation":[{"name":"Federal Institute for Drugs and Medical Devices (BfArM) Research Division, Pharmacoepidemiology  Bonn Germany"},{"name":"German Centre for Neurodegenerative Diseases (DZNE) Pharmacoepidemiology in Neurodegenerative Disorders  Bonn Germany"},{"name":"Centre for Translational Medicine University of Bonn  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,26]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ardp.201800141"},{"key":"e_1_2_9_3_1","unstructured":"European Medicines Agency.Disabling and potentially permanent side effects lead to suspension or restrictions of quinolone and fluoroquinolone antibiotics. 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