It's Topic Tuesday! - Antibiotics and Your Aorta: What Patients and Caregivers Should Know

Antibiotics are some of the most commonly prescribed medications, and when they are needed, they can be lifesaving. But if you have an aortic aneurysm, a history of aortic disease, or certain conditions that increase your risk, there is one group of antibiotics you should know about.

The goal isn't to be afraid of antibiotics, but to ensure your healthcare team knows your full medical history so they can choose the safest and most appropriate treatment for you.

First: Antibiotics Don't Treat Every Infection

It is easy to think that an antibiotic might help whenever we are sick, but antibiotics only work against bacterial infections.

The common cold and influenza, or the flu, are caused by viruses, so antibiotics will not make these illnesses go away faster. Many sore throats, sinus infections, and cases of bronchitis are also viral.

Taking an antibiotic when it isn't needed can cause side effects and contribute to antibiotic resistance, which makes bacterial infections harder to treat in the future.

When an antibiotic is necessary, your healthcare provider will decide which medication is appropriate based on the type of infection, your medical history, allergies, medications, and other risk factors.

The Antibiotics Aortic Patients Should Know About

One class of antibiotics, called fluoroquinolones, has received special attention in people with or at increased risk for aortic disease.

Common fluoroquinolones include:

• Ciprofloxacin, commonly known as Cipro

• Levofloxacin, commonly known as Levaquin

• Moxifloxacin

• Ofloxacin

In 2018, the U.S. Food and Drug Administration (FDA) issued a safety warning after studies found an association between systemic fluoroquinolone use and an increased occurrence of rare but serious aortic aneurysms and dissections.

An aortic aneurysm is an abnormal enlargement or bulging of part of the aorta. An aortic dissection occurs when a tear develops within the wall of the aorta, allowing blood to travel between its layers.

Both can become medical emergencies.

Who Is Considered at Higher Risk?

The FDA advises healthcare professionals to avoid prescribing fluoroquinolones to people who have an aortic aneurysm or are at increased risk for one when other treatment options are available.

That includes people with:

• A known aortic aneurysm

• A history of aneurysms or certain blood vessel diseases

• High blood pressure

• Certain genetic conditions affecting the blood vessels, including Marfan syndrome and Ehlers-Danlos syndrome

• Older age

If any of these apply to you, make sure the person prescribing an antibiotic knows about your aortic history.

Something as simple as saying, “I have a history of aortic disease. Is this antibiotic appropriate for me?” can start an important conversation.

Does This Mean Fluoroquinolones Can Never Be Used?

No.

There are situations in which a fluoroquinolone may be the best, or sometimes the only appropriate, antibiotic for a particular bacterial infection.

The FDA warning does not tell patients to automatically refuse these medications. Instead, it encourages healthcare professionals to consider other treatment options for people at higher risk when alternatives are available.

If you are already taking ciprofloxacin, levofloxacin, or another fluoroquinolone, do not stop taking it on your own. Contact the healthcare professional who prescribed it if you are concerned about your aortic history or want to discuss possible alternatives.

Stopping an antibiotic without medical guidance can allow an infection to worsen or return.

Know the Warning Signs

Aortic aneurysms can exist without causing symptoms. However, a dissection or rupture can cause sudden, severe symptoms and requires immediate medical attention.

While taking a fluoroquinolone, or at any time, seek emergency care for sudden, severe, and persistent pain in the chest, back, or abdomen, particularly if you have a known aneurysm or other risk factors for aortic disease.

Do not wait to see whether severe symptoms improve.

What About Antibiotics and Warfarin?

There is another medication issue worth remembering for some members of the aortic community.

People who have undergone certain heart or aortic procedures, particularly those with some types of mechanical heart valves, may take the anticoagulant warfarin, also known as Coumadin or Jantoven.

Many medications, including some antibiotics, can change how warfarin works and may cause your INR to rise or fall.

INR is a blood test used to measure how long it takes your blood to clot and helps your healthcare team determine whether your warfarin dose is appropriate.

If you take warfarin and are prescribed an antibiotic:

• Tell the prescribing healthcare professional that you take warfarin.

• Make sure your anticoagulation clinic or the clinician managing your warfarin knows about the new medication.

• Ask whether you need your INR checked more frequently while taking the antibiotic.

Never adjust your warfarin dose on your own unless your healthcare team instructs you to do so.

A Simple Habit That Can Make a Difference

If you live with aortic disease, there is a lot of medical information to keep track of. You don't need to memorize the names of every antibiotic.

Instead, remember one simple step: Tell every healthcare professional who treats you that you have a history of aortic disease.

That includes urgent care clinicians, emergency room teams, dentists, pharmacists, and other healthcare professionals who may not routinely see your cardiology records.

You can also keep an updated medication list and important medical conditions stored on your phone or carried in your wallet so that information is available when you need it.

The Bottom Line

Antibiotics are essential medications when bacterial infections need treatment. For most antibiotics, having aortic disease does not automatically create a special concern.

However, fluoroquinolone antibiotics such as ciprofloxacin and levofloxacin carry an FDA warning regarding aortic aneurysm and dissection, particularly in people who already have an aneurysm or other risk factors.

If you have aortic disease, don't be afraid to ask questions when a new medication is prescribed: What is this antibiotic treating? Is it a fluoroquinolone? Does my aortic history affect which antibiotic is safest for me?

And if you take warfarin, remember to ask whether a new antibiotic means your INR should be checked.

Being informed doesn't mean avoiding medications you need. It means making sure you and your healthcare team have all the information necessary to choose your treatment safely.

That's all for today. Remember to Think Aorta!

Zach