Tendon Injury and Fluoroquinolone Use: A Systematic Review

  title={Tendon Injury and Fluoroquinolone Use: A Systematic Review},
  author={Anne L Stephenson and Wei Wu and Daniel Jos{\'e} D{\'i}az Cort{\'e}s and Paula A. Rochon},
  journal={Drug Safety},
BackgroundFluoroquinolone antibiotics are commonly used to treat infections and are prescribed by general practitioners, medical specialists and surgeons. Tendon injury has been associated with the use of these medications but the risk associated with newer fluoroquinolones has not been established.ObjectivesThe aim of this systematic review was to evaluate the evidence from observational studies to determine the strength of the association between fluoroquinolone use and tendinopathy, and to… 

Fluoroquinolones and the risk of tendon injury: a systematic review and meta-analysis

A systematic review and meta-analysis of the scientific evidence evaluating the risk of tendon injury associated with fluoroquinolones confirmed that older age and concomitant use of corticosteroids seem to be additional risk factors for tendinopathy.

Fluoroquinolone-mediated Achilles rupture: a case report and review of the literature.

  • Adam M. BudnyAlexis N Ley
  • Medicine
    The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
  • 2015
This work presents a case of levofloxacin-mediated Achilles rupture that was complicated by the presence of an infected hematoma and abscess and subsequent long-term postoperative follow-up data, with a review of the literature.

Do fluoroquinolones increase aortic aneurysm or dissection incidence and mortality? A systematic review and meta-analysis

FQs were associated with an increased incidence of AAD in the general population and a higher risk of adverse outcomes in patients with preexisting AAD, and the association was significant when compared with amoxicillin, azithromycin, doxycycline, or no antibiotics.

Anabolic steroids and tendons: A review of their mechanical, structural, and biologic effects

Future studies investigating the use of AAS as a possible treatment for tendon injury/pathology are supported by reports suggesting that AAS may counteract the irreparable structural/functional changes that occur in the musculotendinous unit following rotator cuff tears, as well as studies suggesting that the purported deleterious effects on tendon may be transient.

Genuine open‐mindedness

  • P. Hanrahan
  • Medicine, Biology
    Internal medicine journal
  • 2015
A systematic review of fluoroquinolones and tendon injury found that the risk of tendonitis and rupture is particularly pronounced among patients greater than 60years of age, patients who are non-obese and patients who use oral glucocorticoids.

Tendinopathy after ofloxacin ear drops

An unusual case of fluoroquinoloneinduced tendinopathy considering the route of administration of a 58-year-old man, with no relevant medical history, who experienced a first episode of tend inopathy in 2002 after taking five pills of ofloxacin 200 mg associated with corticosteroids for otitis.

The Association between the Risk of Aortic Aneurysm/Aortic Dissection and the Use of Fluroquinolones: A Systematic Review and Meta-Analysis

FQs were associated with an increased risk of aortic aneurysm (AA) or AD, although the level of evidence was not robust, and FQs did not exhibit a higher risk of AA or AD compared with other broad-spectrum antibiotics.

Triceps Ruptures After Fluoroquinolone Antibiotics: A Report of 2 Cases

The sports medicine team should be aware of this risk of fluoroquinolone-induced tendinopathy to athletes and consider it when choosing antibiotics to treat athletes.



Fluoroquinolone-associated tendinopathy: a critical review of the literature.

  • Y. KhaliqG. Zhanel
  • Medicine, Biology
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 2003
Tendon injury associated with fluoroquinolone use is significant, and risk factors such as renal disease or concurrent corticosteroid use must be considered when these agents are prescribed.

Musculoskeletal injury associated with fluoroquinolone antibiotics.

Achilles tendinitis associated with fluoroquinolones.

The results suggest that some fluoroquinolones may increase the risk of Achilles tendinitis, and that this risk increase is highest for ofloxacin.

Evidence of Tendinitis Provoked by Fluoroquinolone Treatment

Clinicians should be aware of this adverse effect, and the increased risk for fluoroquinolone-associated tendinitis in elderly patients with corticosteroid use must be considered when these agents are prescribed.

Tendon disorders attributed to fluoroquinolones: a study on 42 spontaneous reports in the period 1988 to 1998.

Reports suggest that fluoroquinolone-associated tendon disorders are more common in patients over 60 years of age, and ofloxacin was implicated most frequently relative to the number of filled prescriptions in the Netherlands.

Interventions for treating acute and chronic Achilles tendinitis.

There is insufficient evidence from randomised controlled trials to determine which method of treatment is the most appropriate for the treatment of acute or chronic Achilles tendinitis.

Fluoroquinolones and risk of Achilles tendon disorders: case-control study

A nested case-control study among users of fluoroquinolones in a large UK general practice database to study the association with Achilles tendon disorders.

Tendinous disorders attributed to statins: a study on ninety-six spontaneous reports in the period 1990-2005 and review of the literature.

It is suggested that prescribers should be aware of tendinous complications related to statins, particularly in risky situations, including physical exertion and association with medications known to increase the toxicity of statins.

Achilles tendon disease in lung transplant recipients: association with ciprofloxacin

It is concluded that lung transplant recipients receiving ciprofloxacin are at significant risk of developing Achilles tendon disease, and the association between cipROfloxACin and Achilles tendon Disease appears to be idiosyncratic rather than dose-related.

Increased risk of achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids.

Current exposure to quinolones increased the risk of Achilles tendon rupture, and the risk is highest among elderly patients who were concomitantly treated with corticosteroids.