Tendonitis ciprofloxacin

Ciprofloxacin (Cipro, Cipro XR, Proquin XR) [Antibiotic/ Fluoroquinolone] Uses Rx lower resp tract, sinuses, skin skin structure, bone/joints, urinary tract Infxns including prostatitis Action Quinolone antibiotic DNA gyrase Dose Adults. 250-750 mg PO ql2h XR 500-1000 mg PO q24h or 200-400 mg IV ql2h in renal impair Caution [C, /-] Children <18 y Contra Component sensitivity Disp Tabs, susp, inj SE Restlessness, N/V/D, rash, ruptured tendons, T LFTs Interactions T Effects Wf probenecid T effects OF diazepam, theophylline, caffeine, metoprolol, propranolol, phenytoin, warfarin effects W/ antacids, didanosine, Fe salts. Mg, sucralfate, Na bicarbonate,... 

M fortuitum Abscess, sinus tract, ulcer bone, joint, tendon infection Amikacin, cefoxitin, ciprofloxacin, doxycycline, ofloxacin, trimethoprimsulfamethoxazole... 

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). 

Chhajed PN, Plit ML, Hopkins PM, Malouf MA, Glanville AR. Achilles tendon disease in lung transplant recipients association with ciprofloxacin. Eur Respir J 2002 19(3) 469-71. 

Petersen W, Laprell H. Die schleichende Ruptur der Achillessehne nach Ciprofloxacin induzierter Tendopathie. Ein Fallbericht. [Insidious rupture of the Achilles tendon after ciprofloxacin-induced tendopathy. A case report.] Unfallchirurg 1998 101(9) 731-4. 

Malaguti M, Triolo L, Biagini M. Ciprofloxacin-associated AchiUes tendon rnptnre in a hemodialysis patient. J Nephrol 2001 14(5) 431-2. 

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. 

Animal studies show that the propensity to induce tendon lesions varies among fluoroquinolones. Fleroxacin, pefloxacin, levofloxacin, and ofloxacin were the most toxic, while enoxacin, norfloxacin, and ciprofloxacin had little or no effect (92). The structure of the substituent at... 

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

WUliams RJ 3rd, Attia E, Wickiewicz TL, Hannafin JA. The effect of ciprofloxacin on tendon, paratenon, and capsular fibroblast metabolism. Am J Sports Med 2000 28(3) 364-9. 

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). 

Achilles tendon rupture or tendinitis has occurred rarely. Renal disease, hemodialysis, and glucocorticoid use may be predisposing factors. Traditionally, the use of quinolones in children has been contraindicated because they have produced arthropathy in animal jnodels. However, children with cystic fibrosis given ciprofloxacin, norfloxacin, and nalidixic acid have had few, and reversible, joint symptoms. Therefore, the benefits may outweigh the risks in some children. 

Musculoskeletal A 77-year-old man developed symptoms suggestive of flexor tendonitis of both wrists after taking ciprofloxacin for 3 days for a urinary tract infection Although the symptoms... 

Musculoskeletal Two cases of Achilles tendinitis [43, 44 ] and one case of Achilles tendon rupture [45 ] were reported in patients who had taken ciprofloxacin for less than a week and another case of Achilles tendon rupture 1 week after a 1-week course of ciprofloxacin [46 ]. The cases of Achilles tendon rupture occurred during exercise and were not preceded by symptoms of tendinitis. 

Akali AU, Niranjan NS. Management of bilateral Achilles tendon rupture associated with ciprofloxacin a review and case presentation. J Plast Reconstr Aesthet Surg 2008 61(7) 830-A. 

A randomised, placebo-controlled trial using 500 mg ciprofloxacin twice daily for the prevention of postoperative recurrence of Crohn s disease did not show a benefit of the treatment over the disease. The following adverse events were listed diarrhoea, headache, sxm sensitivity, yeast infection, oral candidiasis, difficulty breathing, pharyngeal paraesthesia and tendonitis. Twenty-four percent of subjects (four cases) withdrew due to adverse events [23 ]. These are all expected side effects of ciprofloxacin. Similarly, use of ciprofloxacin 300 mg twice daily in febrile... 

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