Fluoroquinolone-Associated Tendinopathy: A Critical Review of the Literature

With the expanded use of fluoroquinolones for the treatment of community-acquired respiratory infections and reports of tendon injury linked to the use of these agents, we reviewed the literature to investigate the frequency and strength of this association. Ninety-eight case reports were available...

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Bibliographic Details
Published in:Clinical infectious diseases 2003-06, Vol.36 (11), p.1404-1410
Main Authors: Khaliq, Yasmin, Zhanel, George G.
Format: Article
Language:English
Subjects:
Achilles tendon
Adult
Aged
Anti-Infective Agents - adverse effects
Antibacterial agents
Antibiotics. Antiinfectious agents. Antiparasitic agents
Biological and medical sciences
Ciprofloxacin - adverse effects
Corticosteroids
Dialysis
Dosage
Fluoroquinolones
Humans
Major Articles
Medical sciences
Middle Aged
Pefloxacin - adverse effects
Pharmacology. Drug treatments
Physical trauma
Risk Factors
Tendinopathy
Tendinopathy - chemically induced
Tendon injuries
Tendon Injuries - chemically induced
Tendon Injuries - physiopathology
Tendons
Traumatic ruptures
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Summary:With the expanded use of fluoroquinolones for the treatment of community-acquired respiratory infections and reports of tendon injury linked to the use of these agents, we reviewed the literature to investigate the frequency and strength of this association. Ninety-eight case reports were available for review. The incidence of tendon injury associated with fluoroquinolone use is low in a healthy population but increases in patients who have renal dysfunction, who are undergoing hemodialysis, or who have received renal transplants. Pefloxacin and ciprofloxacin were most frequently implicated, but tendon injury was reported with most fluoroquinolones. The median duration of fluoroquinolone treatment before the onset of tendon injury was 8 days, although symptoms occurred as early as 2 hours after the first dose and as late as 6 months after treatment was stopped. Up to one-half of patients experienced tendon rupture, and almost one-third received long-term corticosteroid therapy. 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.
ISSN:1058-4838
1537-6591
DOI:10.1086/375078