Fluoroquinolone Antibiotics and Tendon Rupture
Saturday, May 23, 2009
Paul Auerbach, M.D.
Outdoor enthusiasts are often stricken with infections for which they might be prescribed antibiotics in the class known as fluoroquinolones, one common member of which is ciprofloxacin (Cipro). They should be aware that a complication of taking a fluoroquinolone for more than a few days is development of tendinitis leading to tendon rupture, notably of the Achilles tendon. The risk is such that the Food and Drug Administration (FDA) requires the makers of such drugs as ciprofloxacin and levofloxacin (Levaquin) to publish a black box warning on the packages alerting users to potentially serious side effects. The full list of drugs affected by the warning include ciprofloxacin (marketed as Cipro and generic ciprofloxacin); ciprofloxacin extended release (marketed as Cipro XR and Proquin XR); gemifloxacin (marketed as Factive); levofloxacin (marketed as Levaquin); moxifloxacin (marketed as Avelox); norfloxacin (marketed as Noroxin); and ofloxacin (marketed as Floxin and generic ofloxacin). As new fluoroquinolones appear on the market, they will undoubtedly be included in the warning program. The warning does not apply to eye and ear drops - only to medications taken orally or by injection.Many patients and health care professionals are not aware of this risk, which is very real, having been officially reported in literally hundreds of patients. Although the drugs are phenomenal in terms of their ability to fight certain bacterial infections, users should be aware of this possible side effect, so that they can discontinue taking the culprit medication and switch to an alternative antibiotic(s) if need be. If tendon pain develops (typically about a week after initiation of therapy) when a person is taking a fluoroquinolone antibiotic, that is the time to make the switch. Simultaneously, anyone affected should diminish or avoid exercise and cease stressing the affected area until such time as the situation is resolved, as would be determined by decreased pain and other signs of inflammation. Most patients can be expected to recover within 10 weeks after discontinuing the antibiotic, but it may take longer.
Fluoroquinolones are widely used to treat infections in adults. They are not commonly prescribed for children because of a risk for eroding cartilage; however, if the medical necessity is important, they can be used in young individuals. The tendon rupture problem is therefore largely a problem of adults, and typically affects the Achilles tendon, with onset of symptoms within the first few weeks after the initiation of antibiotic therapy. Other tendons, including those of the upper extremity, may be involved. It is perhaps the large forces placed upon the Achilles tendon that makes it so prominent in this particular medical situation. Furthermore, the risk of fluoroquinolone-associated tendinitis and tendon rupture appears to be greater in persons older than 60 years of age, in those taking corticosteroid drugs ("steroids"), and in kidney, heart, and lung transplant recipients.
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Tags: fluoroquinolone antibiotic, tendon rupture, fluoroquinolone, wilderness medicine, outdoor medicine, healthline
Labels: fluoroquinolone, tendon rupture
2 Comments:
At Sat May 30, 10:07:00 PM 2009,
mattresses said…
I can attest to the accuracy of this point, although I was lucky enough to avoid serious injury, due probably to the short duration of my antibiotic therapy (10 days). Two years prior I had strained my Achilles. While on the antibiotics it began to hurt during the night. I did at that point notice the warning on the bottle label; however my doctor did not seem to have much knowledge in this area. It is good that you are spreading the word on this ! As you say many are not aware.
At Wed Oct 28, 11:29:00 AM 2009,
Anonymous said…
I have a problem with reoccurring diverticulitis. Around a year ago I had a bout of diverticulitis and my GP prescribed Cipro. At the end of my dosage I started noticing pain in my left knee. The pain went away after a week so I wasn't too concerned. I did read about the black box warning and asked my doctor about it but he assured me I didn't take enough of the medication to cause any permanent damage. Within a month I had another bout with diverticulitis and so my GP sent me to a gastroenterologist. He put me on another round of fluoroquinolones and after a few days of taking the medication I started experiencing pain in my left knee again. I stopped taking the medication immediately but the damage was already done. Since then I have also experienced pain in my right knee and left elbow and right wrist. The pain tends to move from one area to another. I'm just waiting to see where it will appear next. I couldn't understand why I continued to have these problems until I recently read that the poultry industry uses fluoroquinolones in healthy chickens to keep them from getting sick. Every time I eat poultry I get a micro dose of fluoroquinolones which keeps the amount of this antibiotic in my system at a level that is continuing to damage my body. Of course, this is just speculation on my part but what else could be causing the problem? If you have any information I would greatly appreciate it.
Regards,
Davidjhe@yahoo.com
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