Anyone ever have to take the ciprofloxacin antibiotic, or any docs out there with some info? There is a black box warning of possible tendon rupture side effect. I have to take this for 2 weeks. Should I be nervous? Already have lightened my plans over the next few weeks. Last thing I need is a tendon ruptured as a side effect of a minor infection…
J Athl Train. 2014 May-Jun;49(3):422-7. doi: 10.4085/1062-6050-49.2.09. Epub 2014 Apr 24.
Fluoroquinolones and tendinopathy: a guide for athletes and sports clinicians and a systematic review of the literature.
Lewis T1, Cook J.
Author information
Abstract
CONTEXT:
Fluoroquinolone antibiotics have been used for several decades and are effective antimicrobials. Despite their usefulness as antibiotics, a growing body of evidence has accumulated in the peer-reviewed literature that shows fluoroquinolones can cause pathologic lesions in tendon tissue (tendinopathy). These adverse effects can occur within hours of commencing treatment and months after discontinuing the use of these drugs. In some cases, fluoroquinolone usage can lead to complete rupture of the tendon and substantial subsequent disability.
OBJECTIVE:
To discuss the cause, pharmacology, symptoms, and epidemiology of fluoroquinolone-associated tendinopathy and to discuss the clinical implications with respect to athletes and their subsequent physiotherapy.
DATA SOURCES:
We searched MEDLINE, Cumulative Index to Nursing and Allied Health (CINAHL), Allied and Complementary Medicine Database (AMED), and SPORTDiscus databases for available reports of fluoroquinolone-related tendinopathy (tendinitis, tendon pain, or rupture) published from 1966 to 2012. Search terms were fluoroquinolones or quinolones and tendinopathy, adverse effects, and tendon rupture. Included studies were written in or translated into English. Non-English-language and non-English translations of abstracts from reports were not included (n = 1).
STUDY SELECTION:
Eligible studies were any available reports of fluoroquinolone-related tendinopathy (tendinitis, tendon pain, or rupture). Both animal and human histologic studies were included. Any papers not focusing on the tendon-related side effects of fluoroquinolones were excluded (n = 71).
DATA EXTRACTION:
Data collected included any cases of fluoroquinolone-related tendinopathy, the particular tendon affected, type of fluoroquinolone, dosage, and concomitant risk factors. Any data outlining the adverse histologic effects of fluoroquinolones also were collected.
DATA SYNTHESIS:
A total of 175 papers, including 89 case reports and 8 literature reviews, were identified.
CONCLUSIONS:
Fluoroquinolone tendinopathy may not respond well to the current popular eccentric training regimes and may require an alternative, staged treatment approach. Clinicians, athletes, athletic trainers, and their medical support teams should be aware of the need to discuss and possibly discontinue these antibiotics if adverse effects arise.
I can try to get you a copy of the article if you like.
Don’t worry about that… It’s only if you take it loooong term, and even then its very rare. (I’m a doc)
from the above article
“Speed and Latency of Onset of Tendinopathy Symptoms
In a critical review of 98 case reports of fluoroquinolone-associated tendinopathy, symptoms were reported as occurring within 2 hours of taking the medication and as long as 6 months after cessation of treatment, with a median time of onset of 6 days. Eighty-five percent of patients presented within 1 month, and 41% to 50% of patients experienced tendon symptoms after the fluoroquinolone was discontinued. (14)”
You can read the full article here:
http://go.galegroup.com/ps/i.do?id=GALE|A375949530&v=2.1&u=uarizona_main&it=r&p=AONE&sw=w&asid=69e729f5b6bf6db8a75fd7dcec4384e0
Do you have any evidence to backup your statement?
I have yet to see one or hear about it from someone who saw it.
There is a link to the article in my post above. At the bottom of the article, there are recommendations for athletes that are written in non-medical language.
I would recommend that you discuss your concerns with your physician, and see if an alternative (non-quinolone antibiotic) treatment is available for your problem.
Best of luck.
Two years ago I took it for 5 days before reading about the tendon rupture issue, and immediately stopped taking it.
Three months later I severely strained my peroneal brevis tendon (rolled my ankle on a trail run). The timing may or may not have been entirely coincidental. I’ve rolled ankles before, but it had been 7-8 years.
l took it and on day 3 while out for slow jog both Achilles locked up on me. Never took another pill and will never. That was March and l was out until Sept. l talked to several other doctors, drugstore, manufacturer and even FDA. They all said that the doctor that prescribed them was an idiot to give to an athlete.
Be very careful.
If you read the article, it quotes:
“In an evaluation of more than 11 000 patients, rates of 2.4 incidences per 10 000 patient prescriptions for tendinitis and 1.2 per 10 000 for tendon rupture were cited.”
So again. Yes it’s rare. I’m not saying it can’t happen. It might. But then again you might die of liver failure if you take tylenol.
Probably whatever you’re taking the cipro for is more harmful to your body (and your training) then the cipro itself.
Anyone ever have to take the ciprofloxacin antibiotic, or any docs out there with some info? There is a black box warning of possible tendon rupture side effect. I have to take this for 2 weeks. Should I be nervous? Already have lightened my plans over the next few weeks. Last thing I need is a tendon ruptured as a side effect of a minor infection…
If it’s possible to take an alternative to a Fluoroquinolone like Cipro for whatever you have, I would seriously look into that. I was on a pretty long course of Cipro once (~20 days) and didn’t really feel normal until nearly a year later, especially when working out…lots of joint and tendon discomfort, and just a general “off” feeling.
Cipro is a wonderful antibiotic, but it all depends on what you are treating. I prescribe cipro all the time (I work in infectious disease), but I avoid it in many cases. This includes my younger active patients. I’d say it is often overly prescribed by primary care providers. Ask if there are other antibiotics for your infection. One of my colleagues discussed the risk of tendon rupture with a high school athlete and ultimately decided on IV antibiotics. The risk of tendon rupture is very low. If you take cipro and continue training, just be very vigilant to any tendinopathies and pullback/stop ASAP and don’t push through them. Since it is the winter this may be good (unless if you have an upcoming race). None of my patients have complained of tendinopathies, but most of them are inactive/sedentary. Also, one paper that I’ve read showed that the risk for tendon rupture can last for a long period after the completion of cipro (I forgot the exact duration but a few months, I think).
If we’re going to do a journal club, then you should probably also read these paper (doing a quick lit search - there’s actually quite a lot of studies on this subject… I guess that means there’s some controversy)
Eur J Clin Pharmacol. 2007 May;63(5):499-503. Epub 2007 Mar 3.
Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study.
Sode J1, Obel N, Hallas J, Lassen A.
Author information
Abstract
OBJECTIVE:
Several case-control studies have reported that the use of fluoroquinolone increases the risk of rupture of the Achilles tendon. Our aim was to estimate this risk by means of a population-based cohort approach.
SETTING:
Data on Achilles tendon ruptures and fluoroquinolone use were retrieved from three population-based databases that include information on residents of Funen County (population: 470,000) in primary and secondary care during the period 1991-1999. A study cohort of all 28,262 first-time users of fluoroquinolone and all incident cases of Achilles tendon ruptures were identified.
MAIN OUTCOME MEASURES:
The incidence rate of Achilles tendon ruptures among users and non-users of fluoroquinolones and the standardised incidence rate ratio associating fluoroquinolon use with Achilles tendon rupture were the main outcome measures.
RESULTS:
Between 1991 and 2002 the incidence of Achilles tendon rupture increased from 22.1 to 32.6/100,000 person-years. Between 1991 and 1999 the incidence of fluoroquinolone users was 722/100,000 person-years, with no apparent trend over time. Within 90 days of their first use of fluoroquinolone, five individuals had a rupture of the Achilles tendon; the expected number was 1.6, yielding an age- and sex-standardised incidence ratio of 3.1 [(95% confidence interval (95%CI): 1.0-7.3). The 90-day cumulative incidence of Achilles tendon ruptures among fluoroquinolone users was 17.7/100,000 (95%CI: 5.7-41.3), which is an increase of 12.0/100,000 (95%CI: 0.0-35.6) compared to the background population.
CONCLUSION:
Fluoroquinolone use triples the risk of Achilles tendon rupture, but the incidence among users is low.
And another study:
Am J Med. 2012 Dec;125(12):1228.e23-1228.e28. doi: 10.1016/j.amjmed.2012.05.027. Epub 2012 Sep 28.
Impact of age, sex, obesity, and steroid use on quinolone-associated tendon disorders.
Wise BL1, Peloquin C, Choi H, Lane NE, Zhang Y.
Author information
Abstract
BACKGROUND:
Quinolone antibiotics are associated with increased risk of tendinopathy. Identifying at-risk individuals has important clinical implications. We examined whether age, sex, glucocorticoid use, obesity, diabetes, and renal failure/dialysis predispose individuals to the adverse effects of quinolones.
METHODS:
Among 6.4 million patients in The Health Improvement Network (THIN) database, 28,907 cases of Achilles tendonitis and 7685 cases of tendon rupture were identified in a case-crossover study. For each participant, we ascertained whether there was a prescription of a quinolone and comparison antibiotic within 30 days before the diagnosis of tendon disorder (case period) and a prescription of the same medications within 30 days 1 year before disease diagnosis (control period).
RESULTS:
Use of quinolones was strongly associated with an increased risk of Achilles tendonitis (odds ratio , 4.3; 95% confidence interval , 3.2-5.7) and tendon rupture (OR, 2.0; 95% CI, 1.2-3.3). No association was found between the use of other antibiotics and either outcome. The association with Achilles tendonitis was stronger among participants who were aged more than 60 years (OR, 8.3 vs 1.6), who were nonobese (OR, 7.7 vs 2.4), and who used oral glucocorticoids (OR, 9.1 vs 3.2). The association was nonsignificantly stronger in women (OR, 5.0 vs 3.6), diabetic persons (OR, 7.0 vs 4.1), and those in renal failure or receiving dialysis (OR, 20.0 vs 3.9). The effect for tendon rupture was stronger in women, with borderline significance in glucocorticoid users and nonobese persons.
CONCLUSION:
Quinolone-associated tendinopathy is more pronounced among elderly persons, nonobese persons, and individuals with concurrent use of glucocorticoids.
In the second study: “The baseline rate of incident Achilles tendonitis and tendon rupture in the THIN cohort was 92 and 24 per 100,000 person-years, respectively.” which means that even if you’re at 2-4x higher risk, the overall risk is still small (0.3% with cipro).
I agree with you, and the articles you cited above, which both indicate a significantly increased risk of tendinopathy associated with quinolone use (and other risk factors). I agree the risk is small. THe consequences for an athlete may be devastating, so I would advise caution despite the small risk.
I thought the risk of liver failure with acetaminophen (if we are doing a journal club, we should stick to pharmacological/generic drug names) was related to cumulative dose. Also, the person-years evidence of the safety of acetaminophen vs. that of quinolones is on an entirely different magnitude, so I don’t think this is a valid comparison.
My former urologist prescribed it for me a couple of years ago for a “suspected” UTI.
Given that I was a 60 year old male with a history of degenerative Achilles tendinosis, putting me in the cross hairs of the warnings, I declined to take it.
My doc’s unwillingness to discuss it with me or consider alternatives is why he’s now my “former” urologist.
Mark
I don’t think it’s a coincidence that I had an Achilles issue just after taking antibiotic (not sure which one) combined with prednisone for a bad sinus infection. Just a perfect storm with a little too much run training load, combined with the medications. My general practitioner likes to give patients a “boost” with the prednisone.
I now found that just using Nasalcort clears it up for me before it gets to a full blown infection.
I will take a counter to this opinion in the context of a sample of athletes, moreover those with high run volumes. I would avoid it as I have seen enough over the years in the running population.
i take it about once a year as i seem to contract typhoid about yearly. there are lots of studies out there so pubmed is your friend. danger FWIR is 3 weeks after completion and if you’re older and one other thing that didn’t apply to me that i can’t remember.
Thanks everyone, called the doc this morning and he is giving me something else with more typical potential side effects like diarrhea and nausea.
I did take one pill last night, but would think the dosage would not be enough to have any affect.
When he prescribed this yesterday he said “you’re not a marathon runner are you” I said actually I am, then he said" well you should be fine as I have never heard of an actual case of a tendon rupture" …
After reading online last night and the studies and comments on this thread, I’m convinced a tendon issue of some sort is a real threat for any athlete on this stuff… hard to understand how this gets approved…
If I get diarrhea with an antibiotic, I found probiotics to help quite a bit. Also, a doctor wanted to put me on Avelox once (a fluoroquinolone) for a sinus infection and immediately asked for a different class. The tendon rupture were only case reports back then, but I didn’t want to risk it. In cases like this, I recommend discussing the risk/benefits of a drug with your doctor. The FDA puts black box warnings on drugs for a reason. I currently work on a drug with a black box warning. Doctors who are used to using it don’t consider it a big deal, but others are scared to death of it.
Thanks everyone, called the doc this morning and he is giving me something else with more typical potential side effects like diarrhea and nausea.
I did take one pill last night, but would think the dosage would not be enough to have any affect.
When he prescribed this yesterday he said “you’re not a marathon runner are you” I said actually I am, then he said" well you should be fine as I have never heard of an actual case of a tendon rupture" …
After reading online last night and the studies and comments on this thread, I’m convinced a tendon issue of some sort is a real threat for any athlete on this stuff… hard to understand how this gets approved…
That points to a problem I have with people quoting percentages and medicine…if you’re the poor schmuck who has the problem, it’s 100% for you!