Unexpected outcome (positive or negative) including adverse drug reactions
A rare case of ciprofloxacin-induced bilateral rupture of the Achilles tendon
Knowsley PCT, Physiotherapy Department, Whiston Hospital, Warrington Road, Merseyside, L35 5DR, UK
Correspondence to:
Trevor G Lewis, trevor{at}tlewis10.fsnet.co.uk
Fluoroquinolone antibiotics have been widely used for over 25 years. Their key adverse effect is tendinopathy. A 76-year-old woman developed bilateral Achilles tendinopathy on the fourth day of fluoroquinolone use. Her doctor advised her to complete the course; however, she went on to sustain bilateral tendoachilles rupture. The patient undertook self-referral to a Primary Care Musculoskeletal Assessment Service, where bilateral Achilles tendon rupture was confirmed by ultrasonography. Surgical repair of both tendons was undertaken. Several months postoperatively the patient was discharged. Fluoroquinolone-related tendinopathy can occur within hours of commencing the medication or up to 6 months post cessation. The incidence of Achilles tendon disorders significantly outweighs pathology in other tendons. Men are up to four times more susceptible than women, hence bilateral rupture in a 76-year-old woman is rare. Patients prescribed fluoroquinolones presenting with tendinopathy require consideration of dose reduction or cessation of fluoroquinolone therapy.
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