From the Guidelines
Levaquin (levofloxacin) is generally contraindicated in patients with abdominal aortic aneurysm (AAA) due to the increased risk of aortic dissection or rupture, as suggested by recent guidelines 1. Patients with AAA should avoid fluoroquinolone antibiotics like Levaquin, as they can degrade collagen and other connective tissue components that maintain aortic wall integrity, potentially leading to life-threatening complications. The most recent guidelines from the European Society of Cardiology (2024) recommend that fluoroquinolones be considered only if there is a compelling clinical indication and no other reasonable alternative, with a Class IIb and Level B recommendation 1. Key points to consider include:
- Avoiding fluoroquinolones in patients with AAA whenever possible
- Considering alternative antibiotic classes for patients with AAA who require antibiotic treatment
- Carefully evaluating the risks and benefits of fluoroquinolone use in situations where they may be the only effective option
- Monitoring patients with AAA closely if fluoroquinolone use is necessary
- Recognizing the cumulative risk of collagen degradation with repeated fluoroquinolone use, even if previous use did not result in complications, as highlighted by the association between fluoroquinolone use and increased risk of aortic aneurysm and dissection 1.
From the Research
Levaquin and AAA Interaction
- Levaquin, a fluoroquinolone antibiotic, has been associated with an increased risk of aortic aneurysm or dissection 2.
- A study found that levofloxacin, a type of fluoroquinolone, is associated with aortic dissection 2.
- However, another study found that fluoroquinolones, including levofloxacin, were not linked to aortic aneurysm or dissection 3.
- There is no direct evidence that Levaquin is contraindicated with Abdominal Aortic Aneurysm (AAA), but caution should be exercised when prescribing fluoroquinolones to patients with AAA due to the potential risk of aortic aneurysm or dissection.
Management of AAA
- The management of AAA involves risk factor reduction, surveillance by ultrasound, and elective aneurysm repair when the aneurysm diameter reaches 5.5 cm 4.
- The Society for Vascular Surgery practice guidelines recommend endovascular repair as the preferred method of treatment for ruptured aneurysms and suggest that elective EVAR be limited to hospitals with a documented mortality and conversion rate to open surgical repair of 2% or less 5.
- Antibiotic prophylaxis is recommended for patients with an aortic prosthesis before certain procedures, but not for patients with AAA unless the potential for infection exists or the patient is immunocompromised 5.
Treatment of Infected Aortic Aneurysm
- Treatment of infected aortic aneurysm without aortic resection is possible, and endovascular aneurysm repair (EVAR) with aggressive antibiotic treatment is a viable option 6.
- EVAR with aggressive antibiotic treatment has been shown to be beneficial for patients with infected aortic aneurysm, with a lower hospital mortality rate compared to antibiotic treatment alone 6.