Review ArticleFluoroquinolones and the Risk of Achilles Tendon Disorders: Update on a Neglected Complication
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)
Choosing optimal antimicrobial therapies
Med Clin North Am
(2012)- et al.
Ciprofloxacin and tenosynovitis
Lancet
(1988) - et al.
Epidemiologic investigation of 1394 feet: coincidence of hindfoot malalignment and Achilles tendon disorders
Foot Ankle Surg
(2012) - et al.
Levofloxacin-induced bilateral Achilles tendon rupture: a case report and review of the literature
J Orthop Sci
(2004) - et al.
Management of bilateral Achilles tendon rupture associated with ciprofloxacin: a review and case presentation
J Plast Reconstr Aesthet Surg
(2008) - et al.
Ciprofloxacin-mediated inhibition of tenocyte migration and down-regulation of focal adhesion kinase phosphorylation
Eur J Pharmacol
(2009) - et al.
Fluoroquinolone-associated tendinopathy
Chang Gung Med J
(2011) - et al.
Norfloxacin-induced rheumatoid disease
N Z Med J
(1983) - et al.
Fluoroquinolones and risk of Achilles tendon disorders: case-control study
BMJ
(2002) - et al.
Achilles tendinitis associated with fluoroquinolones
Br J Clin Pharmacol
(1999)
Evidence of tendinitis provoked by fluoroquinolone treatment: a case-control study
Drug Saf
Levofloxacin associated Achilles tendon rupture
Ann Pharmacother
Achilles tendon disease in lung transplant recipients: association with ciprofloxacin
Eur Respir J
Diagnostic failure of ciprofloxacin-induced spontaneous bilateral Achilles tendon rupture: case-report and medical-legal considerations
Int J Immunopathol Pharmacol
Levofloxacin-induced Achilles tendinitis in a young adult in the absence of predisposing conditions
Yonsei Med J
Fluoroquinolone-induced tendinopathy: what do we know?
South Med J
Partial Achilles tendon ruptures associated with fluoroquinolone antibiotics: a case report and literature review
Foot Ankle Int
Acute rupture of the Achilles tendon
Foot Ankle Clin
Changing incidence of Achilles tendon rupture in Scotland: a 15-year study
Clin J Sport Med
The risk of Achilles tendon rupture in the patients with Achilles tendinopathy: healthcare database analysis in the United States
Biomed Res Int
ABO blood groups and Achilles tendon rupture in the Grampian region of Scotland
Clin J Sport Med
The effect of ciprofloxacin on tendon, paratenon, and capsular fibroblast metabolism
Am J Sports Med
Ciprofloxacin up-regulates tendon cells to express matrix metalloproteinase-2 with degradation of type I collagen
J Orthop Res
Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study
Eur J Clin Pharmacol
Cited by (21)
Achilles Tendon Rupture
2024, Clinics in Podiatric Medicine and SurgeryCurrent understanding of the diagnosis and management of the tendinopathy: An update from the lab to the clinical practice
2022, Disease-a-MonthCitation Excerpt :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
Novel medicinal and synthetic chemistry strategies against antimicrobial resistance
2022, Emerging Nanomaterials and Nano-based Drug Delivery Approaches to Combat Antimicrobial ResistanceThe use of host factors in microbial forensics
2019, Microbial ForensicsMiscellaneous antibacterial drugs
2019, Side Effects of Drugs AnnualCitation Excerpt :Bilateral involvement occurred in 27% of cases. Male sex, advanced age, normal body mass index, chronic renal failure, and concurrent corticosteroids were associated with an increased risk [14R]. A meta-analysis evaluated the risk for fetal malformations and pregnancy complications following exposure to fluoroquinolones during pregnancy.
Achilles tendon disorders: An overview of diagnosis and conservative treatment
2023, Journal of the American Academy of Physician Assistants
Financial Disclosure: The authors declare that they have no relevant financial interests.