Ciprofloxacin: risk for the aorta? : An antibiotic could damage not only the tendons, but also the main artery

Antibiotics can save lives. But many of these medications also have side effects – unwanted side effects that can sometimes seriously endanger the health of patients. An increasingly criticized remedy in recent years has been the broad-spectrum antibiotic ciprofloxacin from the group of fluoroquinolones.

The drug is known to affect the normal functioning of connective tissue, leading to retinal detachment, tendinitis, and even tendon tears. can drive. It's now also in the brochure. However, the possible consequences go far beyond that.

A first suspicion

Retrospective clinical studies have suggested that ciprofloxacin, through its action on the connective tissue, may also endanger the health of the body's most important blood vessel. Because: "The main artery is also built partly from stable connective tissue, the so-called extracellular matrix," says Scott LeMaire of Baylor College of Medicine in Houston.

In investigations, patients who had taken the antibiotic were more likely to suffer aneurysmal aortic dissection and tears – life-threatening fissures in the vessel wall. But was it really a causal relationship?

Tears in the main artery

This was studied by LeMaire and his colleagues in experiments with mice. They administered ciprofloxacin or a fictitious rodent drug with healthy or slightly pre-damaged aorta over a four-week period. The result: In healthy animals, the administration of antibiotics does not seem to have a negative effect on vascular health.

The situation was different in mice with pre-existing aortic disease: 79% had aneurysms – dangerous vesicles of the vascular wall. 67% of the animals underwent slit of the aortic wall, a so-called aortic dissection and 15% even a fatal rupture of the main artery. In contrast, only ciprofloxacin accounted for 45% of aneurysms and 24% of aortic dissections in this group. None of the animals suffered a fatal rupture of the aorta.

Destructive Mechanisms

Other experiments have shown the mechanisms underlying these side effects. Thus, the antibiotic apparently causes deterioration of the elastic fibers of the extracellular matrix. In addition, among other things, the activity of the enzyme lysyl oxidase has been stopped, which is responsible for the stability of this connective tissue structure.

In addition, scientists found that cellular processes increased, resulting in cell death. For example, what are called matrix metalloproteinases have been too active – substances that break down connective tissue. These effects of ciprofloxacin were then confirmed in human aortic cell studies

Attention Required

"Our study confirms the concerns badociated with ciprofloxacin and suggests that this antibiotic or agent of the same clbad may be present at Pre-existing patients how aortic dilatation should be used with the utmost care, "says LeMaire.Required recommendations should be published as soon as possible.

Due to the high potential for side effects of ciprofloxacin, institutions such as the US Food and Drug Administration (FDA) also warn against reckless use of the drug.In the United States, the drug should only be used in patients with severe infections – or if, for example, there is no substitution treatment.

The European Medicines Agency s (EMA) is also working on a re-evaluation of fluoroquinolones. However, a fundamental ban is unlikely. According to experts, ciprofloxacin and Co are essential drugs for certain diseases. (JAMA Surgery, 2018, doi: 10.1001 / jamasurg.2018.1804)