If you suspect you are experiencing a fluoroquinolone-related issue with a tendon, do the following immediately:. For some medical conditions, taking fluoroquinolone-class antibiotics may be your only choice. Some kinds of infections will not respond to other drugs, and you may be allergic to the alternatives, which include penicillin and sulfas. Should this apply to you, it would be advisable to reduce or even eliminate all physical activities that could contribute to a tendon rupture.
Be aware that even if you stop taking these antibiotics, you may still be susceptible to tendon ruptures as long as six to eight months. It is therefore essential that you are vigilant to any possible tendon pain that occurs, as it could be a sign of fluoroquinolone-caused tendonitis.
Even with the risk of tendon rupture rising only from 1 in , to 1 in 25,, the FDA considers these numbers to merit their serious announcement. As of July 26, , makers of fluoroquinolones have been advised of their need to create new Medication Guides for their products. In addition, the FDA has recommended the need to amend the prescribing information for these antibiotics. If you think you have antibiotics-related tendinitis or a tendon injury, visit an orthopedist.
Article written by: Rob Williams, MD. Telephone: Call Us Now! Click to call. Coastal Orthopedics Blog. What are the signs of a tendon rupture? If you have been diagnosed with a bacterial infection often in the kidney, sinus, or lungs and you have been taking Cipro, Levaquin, or any other of this type of broad-spectrum antibiotic, your chances of developing tendonitis or tendon ruptures increases if you are also: Over the age of 60 Suffering from rheumatoid arthritis Taking corticosteroids for inflammation, particularly for asthma A heart, lung, or kidney transplant recipient What should I do if I take Fluoroquinolones and develop tendon problems?
Analyses with conditional logistic regression analyses with matching on GP practice gave similar results but lower precision data not shown. The absolute overall risk of Achilles tendon ruptures was 5. Given the population-attributable risk percentage of 2. Rupture of the Achilles tendon is a serious condition that may lead to significant morbidity and often requires surgical treatment.
In our study, use of quinolones was independently associated with an increased risk of Achilles tendon rupture. This effect was demonstrated only in persons aged 60 years or older, and within this group concomitant use of corticosteroids increased the risk substantially. These findings confirm the results from case series, case reports, and one case-control study that suggested that age greater than 60 years and concurrent corticosteroid use were risk factors for quinolone-induced tendon disorders.
Among the individual quinolones, the highest risk of Achilles tendon rupture was found for users of ofloxacin. Although the CIs of the risk estimates overlapped those of the other quinolones, this finding is consistent with data from previous studies, 30 case series, 6 case reports, 7 , 8 and animal toxicity testing, 31 which showed that ofloxacin and pefloxacin which is not marketed in the United Kingdom were associated with a higher risk of tendon disorders than other quinolones.
In our study, oral corticosteroid use was not only an important independent risk factor but, in combination with current exposure to quinolones, also strongly increased the risk of Achilles tendon rupture in patients older than 60 years.
Other independent risk factors for Achilles tendon rupture were osteoarthrosis, inflammatory joint diseases, and gout. Furthermore, patients who received dialysis or who underwent a renal transplant were at higher risk of developing Achilles tendon rupture, which is consistent with the literature. The incidence of Achilles tendon rupture varies among different studies but seems to have increased in the past few decades and shows a bimodal age distribution.
These tendon ruptures are mostly because of sport activity. The second peak occurs between 70 and 80 years of age, and these tendon ruptures are mostly not sport related. In a study with prescription event monitoring, the incidence of tendon rupture was estimated as 2. The most important risk factor for the development of Achilles tendon rupture is probably sporting, in particular the recreational sports that demand sudden acceleration and jumping.
The mechanism of Achilles tendon rupture induced by quinolones is not well understood, although it is known that quinolones exhibit a pronounced affinity for connective tissues. A Japanese group succeeded in producing quinolone-induced tendinitis in juvenile rats after high doses of pefloxacin and ofloxacin, but not in adult rats. Some potential limitations should be considered in the interpretation of our results.
Selection bias is unlikely, since our study was population based and cases of Achilles tendon rupture will ultimately come to the attention of the GP. Controls were randomly selected from the study base, and the index dates were also randomly assigned. We cannot exclude the possibility that some of the Achilles tendon ruptures were misclassified despite extensive review of the computerized patient records.
As the review was blinded to exposure to quinolones, however, any misclassification was unbiased and thus would lead to a conservative estimate rather than to an overestimation of the risk of Achilles tendon rupture due to quinolones. Prescription data in the General Practice Research Database are automatically registered when the GP writes a prescription. These data are considered complete, which means that misclassification of quinolone use was unlikely. Recall bias can be excluded, since data on drug use were recorded before the onset of disease.
During the s, there has been an increase in case reports implicating that quinolones may cause tendon disorders. As a consequence, diagnostic suspicion bias might partly explain the observed increase in relative risk, if physicians diagnose Achilles tendon disorders more readily in patients currently using quinolones.
However, adjustment for calendar year did not change the relative risk, so we assume that diagnostic bias did not play a major role. Confounding by indication is unlikely, since none of the indications for use of quinolones are known risk factors for Achilles tendon rupture, and adjustment for potential risk factors such as history of musculoskeletal disorders, gout, lipid disorders, and kidney transplantation did not change the estimate considerably.
In conclusion, our data confirm that exposure to quinolones increases the risk of Achilles tendon disorders, in particular in elderly patients who concomitantly use oral corticosteroids. Given the low incidence of Achilles tendon rupture, these absolute risks are modest.
Nevertheless, prescribers should be aware of this risk and try to avoid the combination with oral corticosteroids, or should prescribe alternative antimicrobial agents if possible. Corresponding author: Bruno H. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Table 1. View Large Download. Rev Rhum Mal Osteoartic. Arthropathies et tendinopathie achilleenne induites par la pefloxacine: a propos d'une observation.
N Engl J Med. Seven Achilles tendinitis including 3 complicated by rupture during fluoroquinolone therapy. J Rheumatol. Fluoroquinolone induced tendinopathy: report of 6 cases. Lietman PS Fluoroquinolone toxicities: an update.
Moellering RC Jr The place of quinolones in everyday clinical practice. Hooper DC Expanding uses of fluoroquinolones: opportunities and challenges. Ann Intern Med. Popul Trends. Jick H A database worth saving. Tendon disorders attributed to fluoroquinolones: a study of spontaneous reports in the period to Arthritis Rheum.
Oslo, Norway World Health Organization;. Cronin ME Musculoskeletal manifestations of systemic lupus erythematosus. Rheum Dis Clin North Am. Electron microscopic investigation of the effects of diabetes mellitus on the Achilles tendon. J Foot Ankle Surg. Am J Kidney Dis. Mahler FFritschy D Partial and complete ruptures of the Achilles tendon and local corticosteroid injections.
The study , published in Annals of Family Medicine , used a case series analysis in which patients served as their own control. The study team categorized antibiotics into three groups: first- and second-generation fluoroquinolones, third-generation fluoroquinolones, and nonfluoroquinolones.
Analysis was based on patients with Achilles tendon rupture who had received antibiotic prescriptions. Sex and recent corticosteroid use did not appear to affect the results. To do that, researchers focused on more than a million Medicare fee-for-service beneficiaries, reviewing inpatient and outpatient, prescription-medication records.
Information about use of seven oral antibiotics—fluoroquinolones ciprofloxacin, levofloxacin, moxifloxacin and amoxicillin, amoxicillin-clavulanate, azithromycin and cephalexin—was extracted.
The study team also looked at all tendon ruptures combined, and three types of tendon ruptures by anatomic site, Achilles tendon rupture, rupture of rotator cuff, and other tendon ruptures that occurred in —
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