Tendinitis fluoroquinolones

When taking the fluoroquinolones, report any signs of tendinitis, such as pain or soreness in tiie leg, shoulder, or back of the heel. Periodic applications... 

The answer is a. (Katzung, p 800.) Fluoroquinolones are not recommended in patients less than 18 years old. They have a tendency to damage growing cartilage and cause arthropathy The arthropathy is generally reversible. Tendinitis may occur, and in rare instances in adults, this finding may lead to tendon ruptures. 

Hypersensitivity to fluoroquinolones or the quinolone group tendinitis or tendon rupture associated with quinolone use patients receiving disopyramide and amiodarone or other QTc-prolonging antiarrhythmic drugs reported to cause torsade... 

Tendon rupture/Tendinitis Ruptures of the shoulder, hand, and Achilles tendons that required surgical repair or resulted in prolonged disability have been reported with fluoroquinolone antimicrobials. 

Fluoroquinolones are well tolerated. The most common adverse effects are nausea, vomiting, diarrhoea, headache, insomnia, skin rash and occasionally abnormal liver function tests (with trovafloxacin). Phototoxicity has been particularly reported with pefloxacin, lomefloxacin, sparfloxacin and ofloxacin. Tendinitis is a serious side effect rarely reported in adults. Because of cartilage damage in children it must be used under close supervision. 

Fluoroquinolones may damage growing cartilage and cause an arthropathy. Thus, these drugs are not routinely recommended for patients under 18 years of age. However, the arthropathy is reversible, and there is a growing consensus that fluoroquinolones may be used in children in some cases (eg, for treatment of pseudomonal infections in patients with cystic fibrosis). Tendinitis, a rare complication that has been reported in adults, is potentially more serious because of the risk of tendon rupture. Risk factors for tendonitis include advanced age, renal insufficiency, and concurrent... 

The available data suggest that the incidence of arthro-toxicity in children taking ciprofloxacin is the same as in adults the use of other fluoroquinolones is too rare to obtain clear information about the risks in children (51). In 12 children with sickle cell disease treated successfully for acute osteomyelitis with oral ciprofloxacin, transient bilateral Achilles tendon tendinitis occurred in one 5-year old (52). Another case was reported in a hemodialysis patient with a ciprofloxacin-associated Achilles tendon rupture (53). 

In 42 spontaneous reports of fluoroquinolone-associated tendon disorders, 32 patients had tendinitis, 24 bilaterally, and 10 had a tendon rupture most affected the Achilles tendon (89). The median age was 68 years and there was a male predominance. In 16 cases ofloxacin was implicated, in 13 ciprofloxacin, in eight norfloxacin, and in five pefloxacin. The delay between the start of treatment and the appearance of the first symptoms was 1-510 (median 6) days. Most patients recovered within 2 months after withdrawal, but 26% had not yet recovered at follow-up. 

Ribard P, Audisio F, Kahn MF, De Bandt M, Jorgensen C, Hayem G, Meyer O, Palazzo E. Seven Achilles tendinitis including 3 complicated by rupture during fluoroquinolone therapy. J Rheumatol 1992 19(9) 1479-81. 

In vitro, pefloxacin was more toxic to tendons than ofloxacin, ciprofloxacin, or levofloxacin (3). In rodents, pefloxacin (400 mg/kg for several days) caused oxidative damage to the type I collagen in the Achilles tendon these alterations were identical to those observed in experimental tendinous ischemia and a reperfusion model (4). Oxidative damage was prevented by the co-administration of A-acetylcysteine (150 mg/kg). Several cases of rupture of the Achilles tendon have been reported during or shortly after the use of fluoroquinolones, including five case in which pefloxacin was used (5). 

One of their major classes of drugs, quinolone antibiotics, is associated with serious problems such as the syndrome of hemolysis. In some cases, uremia, coagulopathy, and hyperbilirubinemia were observed for fluoroquinolone antibiotics like temafloxacin. Other adverse reactions have also been reported on the central nervous system with symptoms of headaches, insomnia, and dizziness. Skeletal problems still remain theoretical for quinolones in the prenatal formation, but tendinitis and tendon rupture have occurred in small number of adult patients. " ... 

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