Tendon Rupture

Muscle weakness, loss of muscle mass, tendon rupture, osteoporosis, aseptic necrosis of femoral and humoral heads, spontaneous fractures... 

Fluoroquinolones Tendonitis, Achilles tendon rupture, contraindicated... 

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. 

Un, acute exacerbation of chronic bronchitis prophylaxis in transurethral procedures Action Quinolone antibiotic -1- DNA gyrase. Dose 400 mg/d PO X w/ renal insuff, avoid antacids Caution [C, —] Interactions w/ cation-containing products Contra Quinolone all gy, children <18 y,T QT interval, X Disp Tabs SE NA/ /D, abd pain, photosens, Szs, HA, dizziness, tendon rupture, periph al neuropathy, pseudomembranous cohtis, anaphylaxis Interactions t Effects W/ cimetidine, probenecid T effects OF cyclosporine, warfarin, caffeine X effects W/ antacids EMS Monitor ECG for TqT int val, esp in pts taking class lA/III antiarrhythmics monitor ECG and BP for signs of h5 povolemia and electrol5rte disturbances (hypokalemia) d/t D T risk of photosensitivity Rxns OD May cause NA /D, confusion and Szs symptomatic and supportive... 

Confusion, hallucinations, restlessness, seizures, tremors, rapid heartbeat, shortness of breath, abdominal pain, darkurine, fatigue, loss of appetite, nausea, vomiting, jaundice, pain at injection site, stomach cramps, diarrhea, tendon rupture, increased sensitivity of skin to sunlight... 

Fluoroquinolones Tendonitis, Achilles tendon rupture, contraindicated in patients less than 18 years old because of effects on cartilage development... 

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... 

Tendons can be injured by glucocorticoids and can rupture (276). Ten cases of Achilles tendon rupture were seen in a single clinic over a 10-year period (SEDA-17, 448). The risk seems to be greater if local (for example intra-articular) injections are used. 

A 69-year-old man with newly diagnosed giant cell arteritis was given prednisone 30 mg bd, and 2 weeks later developed severe pain along his Achilles tendons bilaterally 1 week later the left tendon ruptured (278). Despite immobilization his pain worsened. The prednisone was gradually tapered and the symptoms abated, with complete recovery. 

Halpern AA, Horowitz BG, Nagel DA. Tendon ruptures associated with corticosteroid therapy. West J Med 1977 127(5) 378-82. 

Bunch TJ, Welsh GA, Miller DV, Swaroop VS. Acute spontaneous Achilles tendon rupture in a patient with giant cell arteritis. Ann Clin Lab Sci 2003 33 326-8. 

Immunological Anaphylaxis, hypersensitivity Musculoskeletal Tendon rupture... 

Musculoskeletal Tendon rupture (rare), arthropathy (animal studies)... 

Musculoskeletal. Proximal myopathy and tendon rupture may occur. Osteoporosis develops insidiously leading to fractures of vertebrae, ribs, femora and feet. Pain and restriction of movement may occur months in advance of radiographic changes. A biphosphonate, with or without vitamin D, is useful for prevention and treatment. Growth in children is impaired. A vascular necrosis of bone (femoral heads) is a serious complication (at higher doses) it appears to be due to restriction of blood flow through bone capillaries. 

Ciprofloxacin can be associated with partial or complete tendinitis. Of 72 lung transplant recipients who received ciprofloxacin, 20 had Achilles tendon involvement (tendinitis 15, rupture 5) (49). Tendon rupture occurred at a lower dosage of ciprofloxacin than tendinitis and the mean recovery duration was significantly longer. 

Achilles tendon rupture without any sudden pain occurred in a 45-year-old female runner who developed bilateral tendinopathy of the Achilles tendon after repeated treatment with ciprofloxacin histological analysis showed cystic changes with focal necrosis (50). 

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). 

Tendinopathy and partial or complete tendon rupture as adverse events of fluoroquinolones have been reported during or shortly after the use of fluoroquinolones (80-84). Pefloxacin and ofloxacin have been implicated, as has ciprofloxacin (85,86). In six patients taking fluoroquinolones risk factors included renal insufficiency, glucocorticoid therapy, secondary hyperparathyroidism, advanced age, and diabetes mellitus (87). Cases have also been reported among immunocompromised renal transplant recipients (88). 

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. 

West MB, Gow P. Ciprofloxacin, bilateral Achilles tendonitis and unilateral tendon rupture—a case report. NZ Med J 1998 111(1058) 18-19. 

Casparian JM, Luchi M, Moffat RE, Hinthorn D. Quinolones and tendon ruptures. South Med J 2000 93(5) 488-91. 

Old age, renal dysfunction, and concomitant corticosteroid therapy are predisposing risk factors (30,31). Tendon rupture occurred in less than four per million prescriptions (9). 

Rare side effects cartilage toxicity, tendon rupture, and Q prolongation. An increase in QT prolongation and torsade de pointes has been associated with the use of fluoroquinolones, particularly the newer generations. 

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