{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T08:19:39Z","timestamp":1770970779694,"version":"3.50.1"},"reference-count":18,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009780","name":"Region Sk\u00e5ne","doi-asserted-by":"publisher","award":["2022-1573"],"award-info":[{"award-number":["2022-1573"]}],"id":[{"id":"10.13039\/501100009780","id-type":"DOI","asserted-by":"publisher"}]},{"name":"ALF"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,12,5]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to investigate whether oral fluoroquinolone use is associated with an increased risk of aortic and mitral valve regurgitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A nationwide cohort study based on linked healthcare register data encompassing patient characteristics, prescription data and cases of aortic and mitral valve regurgitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Sweden, 2006\u20132018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Study participants were adults aged 18\u201375 years. 794 588 courses of fluoroquinolones (88% ciprofloxacin) propensity score-matched (1:1) to an equal number of courses of penicillin V.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Aortic or mitral valve regurgitation leading to ED visit, hospitalisation or death. Cox regression was used to estimate HRs for the first incident of valve regurgitation within 120 days of treatment initiation. Subgroup and supplementary analyses included sex, age, first episode, surgery or death only, 356-day follow-up and analysis using amoxicillin as comparator drug.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 29 (incidence rate 0.5 per 1000 person-years) cases in the fluoroquinolone group compared with 43 (0.7 per 1000 person-years) cases in the penicillin V group during the main (1\u201330\u2009days) follow-up period; corresponding to a HR 0.70 (95% CI 0.43 to 1.11). Analyses of subsequent time periods yielded results consistent with the main period: HR 1.06 (0.63\u20131.78) for days 31\u201360 and 0.90 (0.59\u20131.36)\u2009days 61\u2013120. No significant differences were found in any of the subgroup- or supplementary analyses. The absolute risk difference was \u221217 (95% CI \u221233 to 6)\u2009cases of valve regurgitation per 1 000 000 courses of fluoroquinolones.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In a nationwide cohort study, there was no statistical support for an increase in the risk of mitral or aortic valve regurgitation associated with oral fluoroquinolone use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-096783","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T15:27:20Z","timestamp":1770737240000},"page":"e096783","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Oral fluoroquinolone use and the risk of aortic and mitral valve regurgitation: a nationwide cohort study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1676-0322","authenticated-orcid":false,"given":"Olof","family":"Nibell","sequence":"first","affiliation":[{"name":"Division of Infection Medicine, Lund University, Lund, Sweden"},{"name":"Department of Infectious Diseases, Sk\u00e5ne University Hospital Lund, Lund, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonas","family":"Bj\u00f6rk","sequence":"additional","affiliation":[{"name":"Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden"},{"name":"Clinical Studies Sweden, Forum South, Sk\u00e5ne University Hospital Lund, Lund, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malin","family":"Inghammar","sequence":"additional","affiliation":[{"name":"Division of Infection Medicine, Lund University, Lund, Sweden"},{"name":"Department of Infectious Diseases, Sk\u00e5ne University Hospital Lund, Lund, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"2026021223252914000_16.2.e096783.1","unstructured":"Antibiotic resistance & patient safety portal: CDC. n.d. Available: https:\/\/arpsp.cdc.gov\/profile\/antibiotic-use\/all-classes?class-select-community=class214"},{"key":"2026021223252914000_16.2.e096783.2","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.k678","article-title":"Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study","volume":"360","author":"Pasternak","year":"2018","journal-title":"BMJ"},{"key":"2026021223252914000_16.2.e096783.3","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-010077","article-title":"Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study","volume":"5","author":"Daneman","year":"2015","journal-title":"BMJ Open"},{"key":"2026021223252914000_16.2.e096783.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.07.035"},{"key":"2026021223252914000_16.2.e096783.5","unstructured":"Agency EM . Systemic and inhaled fluoroquinolones: risk of heart valve regurgitation\/incompetence: EMA. 2020. Available: https:\/\/www.ema.europa.eu\/en\/medicines\/dhpc\/systemic-inhaled-fluoroquinolones-risk-heart-valve-regurgitationincompetence"},{"key":"2026021223252914000_16.2.e096783.6","unstructured":"Administration UFaD . FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients 2018, Available: https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-warns-about-increased-risk-ruptures-or-tears-aorta-blood-vessel-fluoroquinolone-antibiotics [Accessed 21 Dec 2018]."},{"key":"2026021223252914000_16.2.e096783.7","doi-asserted-by":"crossref","first-page":"2899","DOI":"10.1093\/eurheartj\/ehab374","article-title":"Oral fluoroquinolones and risk of aortic or mitral regurgitation: a nationwide nested case-control study","volume":"42","author":"Strange","year":"2021","journal-title":"Eur Heart J"},{"key":"2026021223252914000_16.2.e096783.8","unstructured":"Parsons LS . 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