Quinolones and tendon rupture

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Some abstracts for your perusal!

The first states that one rupture was associated with quinolone use, but

occurred six months after taking the antibiotic. The other article states that

the risk is highest in the elderly who are also taking corticosteroids. I'll do

some research about how one might best avoid blowing out the Achilles Tendon and

let you know...

Quinolones and Tendon Ruptures

We report two cases of tendon rupture associated with ciprofloxacin. One patient

had a complete rupture of an Achilles tendon 6 months after taking the

medication. The other case involved a partial rupture of the subscapularis

tendon. Both ruptures occurred with minimal mechanical stress on the tendons,

suggesting that the fluoroquinolone increased the susceptibility to rupture. We

also review the literature describing the association between fluoroquinolones

and tendon rupture and discuss the mechanisms explaining the heightened risk of

tendon rupture associated with these drugs.

Increased risk of achilles tendon rupture with quinolone antibacterial use,

especially in elderly patients taking oral corticosteroids.

BACKGROUND: In several case reports, the occurrence of Achilles tendon rupture

has been attributed to the use of quinolones, but the epidemiologic evidence for

this association is scanty. METHODS: We conducted a population-based

case-control study in the General Practice Research Database in the United

Kingdom during the period 1988 through 1998. Cases were defined as all persons

who had a first-time recording of an Achilles tendon rupture, and who had at

least 18 months of valid history before the index date. As a control group, we

randomly sampled 50 000 patients with at least 18 months of valid history who

were assigned a random date as index date. RESULTS: We identified 1367 cases

that met the inclusion criteria. The adjusted odds ratio (OR) for Achilles

tendon rupture was 4.3 (95% confidence interval [CI], 2.4-7.8) for current

exposure to quinolones, 2.4 (95% CI, 1.5-3.7) for recent exposure, and 1.4 (95%

CI, 0.9-2.1) for past exposure. The OR of Achilles tendon rupture was 6.4 (95%

CI, 3.0-13.7) in patients aged 60 to 79 years and 20.4 (95% CI, 4.6-90.1) in

patients aged 80 years or older. In persons aged 60 years and older, the OR was

28.4 (95% CI, 7.0-115.3) for current exposure to ofloxacin, while the ORs were

3.6 (95% CI, 1.4-9.1) and 14.2 (95% CI, 1.6-128.6) for ciprofloxacin and

norfloxacin, respectively. Approximately 2% to 6% of all Achilles tendon

ruptures in people older than 60 years can be attributed to quinolones.

CONCLUSIONS: Current exposure to quinolones increased the risk of Achilles

tendon rupture. The risk is highest among elderly patients who were

concomitantly treated with corticosteroids.