Use of fluoroquinolones and the risk of spontaneous cervical artery dissection

Background and purpose Because of their potential to alter the integrity of collagen and other components of the extracellular matrix, fluoroquinolone antibiotics might be involved in the pathogenesis of spontaneous cervical artery dissection (sCeAD). Methods In the setting of a single-centre case-control study, whether fluoroquinolone use in the 30-day period before the index event is associated with sCeAD (cases) in comparison with a group of age- and sex-matched patients who suffered a first-ever acute cerebral infarction from a cause other than CeAD (non-CeAD IS, controls) was assessed. Results Overall, 284 cases (mean age 43.2 +/- 10.4 years; 58.5% men) and 568 controls qualified for the analysis. Thirty (10.6%) patients in the sCeAD group and 16 (2.8%) in the non-CeAD IS group were fluoroquinolone users (P <= 0.001). The use of these antibiotics was associated with a more than two-fold increased risk of sCeAD [odds ratio (OR) 2.31; 95% confidence interval (CI) 1.00-5.30] after adjusting for confounders. The risk was more substantial in the subgroup of patients with dissection involving the carotid artery (OR 2.78; 95% CI 1.14-6.78), in females (OR 4.58; 95% CI 1.04-20.1) and compared to that conferred by other antibiotics (OR 2.42; 95% CI 1.02-5.75). Conclusions Fluoroquinolones may represent a novel contributing factor involved in the pathogenesis of sCeAD.