Elsevier

Urology

Volume 113, March 2018, Pages 20-25
Urology

Review Article
Fluoroquinolones and the Risk of Achilles Tendon Disorders: Update on a Neglected Complication

https://doi.org/10.1016/j.urology.2017.10.017Get rights and content

Objective

To evaluate the current evidence and to identify associated risk factors that increase the incidence of this complication. Fluoroquinolone (FQ) has been considered the first-line therapy for uncomplicated urinary infections. FQ has been associated with Achilles tendon disorders, especially during the first month of treatment.

Methods

Data sources searched included PubMed, MEDLINE, and Scopus from January 1988 to June 2017.

Results

A total of 79 articles were used, with ciprofloxacin representing the most common drug.

Conclusion

We found that male gender, advanced age, normal body mass index, chronic renal failure, and concurrent use of corticosteroids increase the risk of Achilles tendon disorders.

Section snippets

Methods

We conducted a computerized search of the relevant scientific literature from 1988 to 2017 using electronic databases, including PubMed, MEDLINE, and Scopus. Searched terms were FQ-related tendinopathy (tendinitis, tendon pain, or rupture). Table 1 lists the keywords used in the search. We included case-control studies, cohort studies, experimental studies, and case reports written in or translated into English, which described disorders of the Achilles tendon and its relation with FQ.

Eligible

Results

The references selected were reviewed by all authors and judged on their contribution to the body of knowledge of this topic. The conduct and validity of any clinical studies were carefully considered, and the outcomes of management protocols were carefully scrutinized.

Case reports mentioning a specific association with the condition that was thought to be relevant to the discussion were included. Only articles that made a significant contribution to the understanding of this condition were

Conclusion

The association between the use of FQ antibiotics and Achilles tendon disorders is well established in the medical literature. We found that male gender, advanced age, normal body mass index, chronic renal failure, and concurrent use of corticosteroids increase the risk of Achilles tendon pathology. Caution should be exercised during the utilization of this antibiotic class in patients with these characteristics.

References (48)

  • G. Corrao et al.

    Evidence of tendinitis provoked by fluoroquinolone treatment: a case-control study

    Drug Saf

    (2006)
  • A.S. Mathis et al.

    Levofloxacin associated Achilles tendon rupture

    Ann Pharmacother

    (2003)
  • P.N. Chajed et al.

    Achilles tendon disease in lung transplant recipients: association with ciprofloxacin

    Eur Respir J

    (2002)
  • A. Pantalone et al.

    Diagnostic failure of ciprofloxacin-induced spontaneous bilateral Achilles tendon rupture: case-report and medical-legal considerations

    Int J Immunopathol Pharmacol

    (2011)
  • A. Durey et al.

    Levofloxacin-induced Achilles tendinitis in a young adult in the absence of predisposing conditions

    Yonsei Med J

    (2010)
  • R.M. Harrell

    Fluoroquinolone-induced tendinopathy: what do we know?

    South Med J

    (1999)
  • W.C. McGarvey et al.

    Partial Achilles tendon ruptures associated with fluoroquinolone antibiotics: a case report and literature review

    Foot Ankle Int

    (1996)
  • T. Movin et al.

    Acute rupture of the Achilles tendon

    Foot Ankle Clin

    (2005)
  • N. Maffulli et al.

    Changing incidence of Achilles tendon rupture in Scotland: a 15-year study

    Clin J Sport Med

    (1999)
  • Y. Yasui et al.

    The risk of Achilles tendon rupture in the patients with Achilles tendinopathy: healthcare database analysis in the United States

    Biomed Res Int

    (2017)
  • N. Maffulli et al.

    ABO blood groups and Achilles tendon rupture in the Grampian region of Scotland

    Clin J Sport Med

    (2000)
  • R.J. Williams et al.

    The effect of ciprofloxacin on tendon, paratenon, and capsular fibroblast metabolism

    Am J Sports Med

    (2000)
  • W.C. Tsai et al.

    Ciprofloxacin up-regulates tendon cells to express matrix metalloproteinase-2 with degradation of type I collagen

    J Orthop Res

    (2011)
  • J. Sode et al.

    Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study

    Eur J Clin Pharmacol

    (2007)
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      It has been recently recommended restricting the use of fluoroquinolones only to complicated infections and patients for whom there is no other appropriate alternative.284 Fluoroquinolone tendon toxicity can be observed with all members of this class of antibiotics regardless of the administration route or the dosage; however the risk is incremented by the concomitant use of corticosteroids; so much that 50% of tendon rupture patients had had recent use of corticosteroids.286–289 Half of ruptures occurred within the first week of FQs administration, and symptoms appear in 85% of cases in less than one month when FQ was administered in association with oral corticosteroid.287

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    Financial Disclosure: The authors declare that they have no relevant financial interests.

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