Un­der­stand­ing the risks

South Shore Breaker - - Health& Wellness - DR. COLIN MACLEOD HEALTH, NAT­U­RALLY [email protected]­col­in­macleod.com

The Food and Drug As­so­ci­a­tion (FDA) of the United States has re­cently is­sued a warn­ing that tak­ing cer­tain an­tibi­otics in­crease the risk of hav­ing an aor­tic aneurysm. This class of an­tibi­otics, the flu­o­ro­quinolones, have been found to dou­ble a per­son’s risk of hav­ing an aor­tic aneurysm based on four re­cently pub­lished stud­ies and ad­verse events re­port­ing.

“Although the risk of aor­tic aneurysm or dis­sec­tion is low, we’ve ob­served that pa­tients are twice as likely to ex­pe­ri­ence an aor­tic aneurysm or dis­sec­tion when pre­scribed a flu­o­ro­quinolone drug,” said FDA com­mis­sioner Scott Got­tlieb, MD.

An aor­tic aneurysm is a se­ri­ous health con­di­tion which in­volves stretch­ing, en­larg­ing and po­ten­tially tear­ing of the largest artery of the body, the aorta. Aor­tic aneurysms oc­cur in 1.4 per cent of the United States pop­u­la­tion ac­cord­ing to the Aneurysm De­tec­tion and Man­age­ment study from 1997. While many peo­ple with stretch­ing of their aorta will never have any health prob­lems as a re­sult, some can have tear­ing and po­ten­tially fa­tal bleed­ing.

Flu­o­ro­quinolones are a class of broad spec­trum an­tibi­otics, which are of­ten used to treat uri­nary tract in­fec­tions when other drugs can’t be used or have failed to treat the in­fec­tion. Flu­o­ro­quinolone an­tibi­otics are very rarely used in chil­dren be­cause of their po­ten­tial to cause sig­nif­i­cant con­nec­tive tis­sue prob- lems in chil­dren.

There have also been mul­ti­ple warn­ings is­sued by the FDA re­gard­ing flu­o­ro­quinolones over the past decade in­clud­ing about their po­ten­tial to de­crease blood su­gar, elicit men­tal health side ef­fects, pe­riph­eral neu­ropa­thy and dis- abling side ef­fects of the ten­dons, mus­cles, joints, nerves and cen­tral ner­vous sys­tem.

While the FDA main­tains that there is cer­tainly still a place for flu­o­ro­quinolone an­tibi­otics in medicine, their use should be re­stricted in those at in­creased risk of an aor­tic aneurysm.

“For pa­tients who have an aor­tic aneurysm or are known to be at risk of an aor­tic aneurysm, we do not be­lieve the ben­e­fits out­weigh this risk, and al­ter­na­tive treat­ment should be con­sid­ered.”

The peo­ple at higher risk of hav­ing an aor­tic aneurysm in­clude those with a fam­ily his­tory of the con­di­tion, smokers, peo­ple with high blood pres­sure and those with dis­ease of the heart and ves­sels. Mar­fan syn­drome and Eh­lers-dan­los syn­drome are two ge­netic con­di­tions which af­fect con­nec­tive tis­sue health and in­crease the risk of aor­tic aneurysm.

At the time of writ­ing, Health Canada has not re­leased an of­fi­cial warn­ing re­gard­ing the in­creased risk of aor­tic aneurysm with the use of flu­o­ro­quinolone med­i­ca­tions. In July 2018, Health Canada re­leased a warn­ing about the dis­abling ef­fect of flu­o­ro­quinolones on con­nec­tive tis­sues, sim­i­lar to the one re­leased by the FDA in the USA.

More can be learned about this warn­ing from the FDA by vis­it­ing their web­site at fda.gov/ Drugs/drugsafety.

123RF

There have been mul­ti­ple warn­ings is­sued by the FDA re­gard­ing flu­o­ro­quinolones over the past decade in­clud­ing about their po­ten­tial to de­crease blood su­gar, elicit men­tal health side ef­fects, pe­riph­eral neu­ropa­thy and dis­abling side ef­fects of the ten­dons, mus­cles, joints, nerves and cen­tral ner­vous sys­tem.

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