Antibiotic Ciprofloxacin (“Cipro”) Damages Connective Tissue
Node Smith, ND
There has been a recent recirculation of information warning against the use of ciprofloxacin, and other antibiotics of the fluoroquinolone class.1 The warnings are specific to the association these drugs have with disrupting the healthy function of connective tissue, potentially causing tendon rupture and retinal detachment. Inflammation of tendons (tendonitis) is also a risk factor of taking these drugs. A number of journals have published studies about these side effects, and the drugs do have a black box warning.
Known risks of Ciprofloxacin
Ciprofloxacin has historically been used as a first line antibiotic for many types of infections, but has been recommended against in recent years. It is still sometimes used, however, and both patients and doctors should be aware of the risks involved in its use.
In addition to tendon rupture and retinal detachment, other connective tissue types may be involved. A key tissue that is concerning is the aorta. Two retrospective studies have shown an association between fluoroquinolone use and cardiovascular complications. Patients having taken fluoroquinolones had an elevated risk for aneurysms and dissections than patients who had not taken these antibiotics.
Two studies have shown an association between fluoroquinolone use and cardiovascular complications
Aneurysms result from the loss of integrity between the layers of tissue comprising the vessel wall, forming a balloon-like space in the vessel that weakens its integrity. Though connective tissue certainly plays a role in the integrity of vessels like the aorta, there are a lot of factors that play into the formation of an aneurysm.
To clarify the association between fluoroquinolone use and increased risk of aortic disease, researchers used a mouse model of human aortic aneurysms and dissections (ADD).
Results warn against use of these medications in individuals who have questionable cardiovascular status
The findings were drastic. In mice with normal, unstressed aortas, treatment with ciprofloxacin showed no significant negative impact. However, in aortas with moderate stress, treated with cipro, 79 percent of the mice developed ADD – 67 percent had aortic dissections, and 15 percent had fatal ruptures. The findings were similar across males and females.
These results warn against the use of these medications in individuals who have questionable cardiovascular status, or are known to be at risk for vascular damage.
- LeMaire SA, Zhang L, Luo W, et al. Effect of Ciprofloxacin on Susceptibility to Aortic Dissection and Rupture in Mice. JAMA Surg. Published online July 25, 2018. doi:10.1001/jamasurg.2018.1804
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Node Smith, ND, is a naturopathic physician in Portland, OR and associate editor for NDNR. He has been instrumental in maintaining a firm connection to the philosophy and heritage of naturopathic medicine among the next generation of docs. He helped found the first multi-generational experiential retreat, which brings elders, alumni, and students together for a weekend camp-out where naturopathic medicine and medical philosophy are experienced in nature. Four years ago he helped found the non-profit, Association for Naturopathic ReVitalization (ANR), for which he serves as the board chairman. ANR has a mission to inspire health practitioners to embody the naturopathic principles through experiential education. Node also has a firm belief that the next era of naturopathic medicine will see a resurgence of in-patient facilities which use fasting, earthing, hydrotherapy and homeopathy to bring people back from chronic diseases of modern living; he is involved in numerous conversations and projects to bring about this vision.