Cohort studyindependent cross-checkabstract checked★ key study I-ABX-123 standard review

UK study finds no aortic risk from fluoroquinolones after fair comparison

Association Between Fluoroquinolone Use and Hospitalization With Aortic Aneurysm or Aortic Dissection.

Overview

Brown JP et al.. JAMA Cardiol 2023 · PMID 37585175 · DOI 10.1001/jamacardio.2023.2418

Compared with other antibiotics, fluoroquinolones were not linked to aortic aneurysm or dissection.

Does the study support the specific claim? No · Methodological quality: high

Study explained simply

What did the researchers want to find out?: Test aortic risk with fair comparisons
How was the study done?: Cohort + case-crossover
How many people, animals or samples were studied?: Over 3.5 million adults
What was actually found?: No association after adjustment
How large was the observed effect?: HR 1.03 (0.91-1.17)
What do the results mean in everyday life?: Earlier alarms may reflect sicker patients
What are the study's limitations?: Observational
What does it say about Elawady's specific claim?: Contradicts the aortic part
Do the results apply to Germany and Europe?: High
What can explicitly not be concluded from this study?: Risk in people with existing aneurysm

Is fluoroquinolone use associated with aortic aneurysm or dissection after addressing confounding?

Study design: Cohort study – Cohort and case-crossover studies in two UK primary-care databases
Population: Adults prescribed fluoroquinolones or cephalosporins; cases hospitalised with AA/AD
Country: UK
Period: April 1997-December 2019
Sample size: Cohort 3,134,121 (Aurum) + 452,086 (GOLD); case-crossover 84,841 + 10,357 cases
Inclusion and exclusion criteria: CPRD Aurum and GOLD linked to hospital data

Exposure / intervention: Systemic fluoroquinolone
Comparator: Cephalosporin; trimethoprim; co-amoxiclav; non-use
Endpoints: Hospitalisation with aortic aneurysm or dissection
Statistical methods: IPTW Cox; conditional logistic case-crossover; fixed-effect pooling

Results: Crude HR 1.28 (95% CI 1.13-1.44) vs cephalosporins; adjusted HR 1.03 (0.91-1.17). Case-crossover: vs cephalosporin OR 1.05 (0.87-1.27), vs trimethoprim 0.89 (0.75-1.06), vs co-amoxiclav 0.98 (0.82-1.18); association only vs non-use.
Absolute risks: not reported
Authors' conclusion: Estimates of association may be affected by confounding; when accounted for, no association was evident.

Orienting tool: ROBINS-E
Type of assessment: simplified assessment (abstract only)
Full formal assessment: no
Overall risk of bias: low
Rationale: Active-comparator and self-controlled designs address confounding by indication.

Association disappears after adjustment; CIs exclude effects as large as earlier reports (upper 1.17).

Strong contradicting evidence for the aortic element.

Some earlier studies found associations.

High (UK).

The aortic risk is uncertain and may be due to confounding.

Multidimensional assessment
Multidimensional assessment
Authenticity of the source	verified
Methodological quality	high
Risk of bias	low
Precision of results	moderate
Directness	direct
Reproducibility	replicated
Consistency with the overall evidence	mixed
Regional transferability	high
Adequacy of the interpretation (by the archive)	not applicable

Risk in high-risk subgroups (e.g. known aneurysm).