Fluoroquinolones and the risk of tendon injury: a systematic review and meta-analysis
Two pages on PainSci cite Alves 2019: 1. Achilles Tendinitis Treatment Science 2. A pill that trashes tendons
PainSci notes on Alves 2019:
This meta-analysis substantiates and confirms the existence of a well-known phenomenon, a serious side effect of the fluoroquinolone class of antibiotics: they cause a 2.5× greater risk of Achilles tendinitis than the average healthy person, and a 4× greater risk of Achilles tendon rupture, worse in older patients and when mixed with corticosteroids.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
PURPOSE: Tendinopathy is a known adverse reaction associated to fluoroquinolones, but a meta-analysis was not yet published. The aim of this study was to conduct a systematic review and a meta-analysis of the scientific evidence evaluating the risk of tendon injury associated with fluoroquinolones.
METHODS: A literature search was conducted to identify observational studies which reported results on the risk of Achilles tendon rupture (ATR), risk of Achilles tendinitis (AT), or risk of any tendon disorders (ATD). A meta-analysis was performed by pooling odds ratios (ORs) with their 95% confidence intervals (CIs).
RESULTS: Fifteen studies were included in the meta-analysis. Treatment with fluoroquinolones was associated with an increased risk of ATR (OR 2.52 (95% CI 1.81-3.52), p<0.001, I2=76.7%), an increased risk of AT (OR 3.95 (95% CI 3.11-5.01), p<0.001, I2=0%), and increased risk of ATD (OR 1.98 (95% CI 1.62-2.43), p<0.001, I2=84.5%). The initial risk estimates remained statistically significant among patients aged ≥60 years old. Risk estimates did not significantly change after depending on the concomitant use of corticosteroids or studies methodological quality assessment. The analysis according to the type of fluoroquinolones was only possible for ATR, which were ofloxacin and norfloxacin were found to increase the risk of this outcome, but not ciprofloxacin and levofloxacin.
CONCLUSIONS: The results of this meta-analysis confirm the risk of tendon injuries associated with fluoroquinolones. Older age and concomitant use of corticosteroids seem to be additional risk factors for tendinopathy.
related content
- “Fluoroquinolone antibiotics: must now only be prescribed when other commonly recommended antibiotics are inappropriate,” {Medicines and Healthcare products Regulatory Agency}, Gov.uk.
- “Fluoroquinolone toxicity symptoms in a patient presenting with low back pain,” Strauchman et al, Clin Pract, 2012.
- “Drug-Induced Tendon Disorders,” Knobloch, Adv Exp Med Biol, 2016.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial. Kirwan 2024 Br J Sports Med.
- Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Hohenschurz-Schmidt 2024 Eur J Pain.
- Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes. Aasdahl 2021 BMC Musculoskelet Disord.
- Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. Moore 2023 J Pain.
- Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis: a systematic review and individual participant data meta-analysis. Holden 2023 The Lancet Rheumatology.