I have Marfan syndrome. I understand that antibiotics can increase my risk of aortic dissection. This is why I am asking about antibiotic substitution.
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Antibiotics Can Cause Aneurysms in Marfan Syndrome?
Antibiotics can cause aneurysms in Marfan syndrome patients according to research. I am a long-term cancer survivor who was diagnosed with MS recently. Cancer patients and survivors are often prescribed antibiotics for various reasons. How would MS patients know not to take a medicine prescribed by their doctor?
Antibiotics and aortic aneurysm are related according to the paper linked below. I have also been diagnosed with Marfan Syndrome. Research has shown that as many people with my cancer, multiple myeloma, die from infection as die from the cancer itself.
As you can imagine, during my time as a MM survivor since 1994, antibiotics have been a component of my therapy. I have undergone antibiotics on several occasions. To be honest, I can’t tell you if and when I’ve undergone ciprofloxacin or other fluoroquinolones. Well, I do remember one time when I did have a reaction to cipro.
As a result of that “reaction,” I check the box on all medical forms that ask about allergies.
If you are also a Marfan survivor, you will want to know about the list of antibiotics below that may not increase your risk of aortic aneurysm and dissection.
The exchange was between ChatGPT and me. Wow.
Ask Dr. Nandi: Certain antibiotics may cause aortic aneurysm, FDA warns
Thank you for explaining—that context matters a great deal.
You are correct, but with an important clarification:
The increased aortic dissection risk in Marfan syndrome is not from all antibiotics
The concern is specifically with fluoroquinolone antibiotics, not antibiotics as a whole.
Antibiotics of concern in Marfan syndrome
Fluoroquinolones have been associated with increased risk of:
- Aortic aneurysm expansion
- Aortic dissection or rupture
This risk is higher in people with:
- Marfan syndrome
- Other heritable thoracic aortic diseases
- Known aortic aneurysms
- Hypertension
- Older age
Common fluoroquinolones to avoid
- Ciprofloxacin (Cipro)
- Levofloxacin (Levaquin)
- Moxifloxacin (Avelox)
- Ofloxacin
📌 The FDA specifically warns against using these drugs when alternatives exist in patients like you.
Antibiotics generally considered safer alternatives
Depending on the infection, clinicians often substitute with:
Respiratory infections
- Amoxicillin or amoxicillin-clavulanate
- Doxycycline
- Azithromycin or clarithromycin
- Cephalosporins (e.g., cefdinir, cefuroxime)
Urinary tract infections
- Nitrofurantoin
- Trimethoprim-sulfamethoxazole (if appropriate)
- Fosfomycin
- Cephalosporins
Skin/soft tissue infections
- Cephalexin
- Dicloxacillin
- Clindamycin
- Doxycycline (depending on organism)
These do not carry the same aortic risk signal.
What does not help as a substitute
Unfortunately:
- Supplements, probiotics, or “natural antimicrobials” cannot replace antibiotics for true bacterial infections
- Delaying treatment for infections can increase cardiovascular stress, which itself may raise dissection risk
So the goal is the right antibiotic, not no antibiotic.
Practical guidance for you
1. Make this explicit in your medical record
Ask that your chart state:
“Avoid fluoroquinolones due to Marfan syndrome and aortic dissection risk”
This helps in urgent care and ER settings.
2. Ask this specific question when prescribed antibiotics
“Is this a fluoroquinolone? If so, what non-fluoroquinolone alternative can we use?”
Are you a Marf too? Did you know about the dangers of Fluoroquinolone antibiotics? Scroll down the page and comment or ask a question and I will reply to you ASAP.
thanks,
David Emerson
- Cancer Survivor (and Marf)
- Cancer Coach
- Director PeopleBeatingCancer
Certain antibiotics may cause aortic aneurysm, FDA warns
“The US Food and Drug Administration warned on Thursday that the benefits of fluoroquinolone antibiotics do not outweigh the risks – which include aortic aneurysm – for certain patients, according to the latest research. The research is based on reports of patient problems and on studies published between 2015 and 2018…
Fluoroquinolone antibiotics are often used to treat serious respiratory infections, pneumonia, urinary tract infection, and even plague and exposure to anthrax. They include drugs sold under the names:
- ciprofloxacin (Cipro),
- gemifloxacin (Factive),
- levofloxacin (Levaquin),
- moxifloxacin (Avelox),
- norfloxacin (Noroxin)
- and ofloxacin (Floxin).
The drugs may cause aortic aneurysm, a bulge in an artery that can grow and burst, causing dangerous or fatal bleeding.
Patients most at risk for an aortic aneurysm after taking these antibiotics are the elderly, those with high blood pressure, people who have a history of blockages of the aorta or other blood vessels, and those who have genetic conditions like Marfan syndrome or Ehlers-Danlos…
“Although the risk of aortic aneurysm or dissection is low, we’ve observed that patients are twice as likely to experience an aortic aneurysm or dissection when prescribed a fluoroquinolone drug,” FDA Commissioner Dr. Scott Gottlieb said in a statement. “For patients who have an aortic aneurysm or are known to be at risk of an aortic aneurysm, we do not believe the benefits outweigh this risk, and alternative treatment should be considered…”
In 2016, the FDA said that the drugs may have a disabling side effect on muscles, nerves, joints and the central nervous system and should be restricted for use in some simpler infections…
Antibiotics can cause aneurysms in Marfan syndrome Antibiotics can cause aneurysms in Marfan syndrome
To learn more:
Connective Tissue / Marfan Hub
- Marfan Syndrome – Need to Know
- Marfan Syndrome and Aortic Dilation: How to Reduce Cardiovascular Stress
- Marfan Syndrome and Exercise
To learn more about Marfan syndrome-
- Living a Long Life With Marfan Syndrome
- Ascending Aortic Aneurysm
- Can Supplements Help Support Connective Tissue Health?
- Athletes Living With Marfan Syndrome
- Marfan Bone Health
- Blood Pressure Stabilization
- Aortic Dilation
- Exercise with Marfan Syndrome
- Diet for Marfan Syndrome
- Resveratrol and Aortic Growth
- Cardiovascular toxicity after cancer
- About David Emerson
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