An elderly patient with fluoroquinolone-associated achilles tendinitis.
BACKGROUND
Due to their broad-spectrum activity and oral bioavailability, fluoroquinolone antibiotics are commonly prescribed to adults aged >60 years for many common community-acquired infections. The association between fluoroquinolone use and Achilles tendinitis is well established but sometimes missed in clinical practice. Older patients and patients with renal dysfunction are at particularly increased risk for this complication.


METHODS
We present a case of Achilles tendinitis in a 77-year-old patient with renal dysfunction and a urinary tract infection (UTI) treated with ciprofloxacin 250 mg PO QD. Tendinitis developed within several days of the start of treatment and improved within 2 days of treatment cessation, without the need for intervention. The likelihood of ciprofloxacin having caused this reaction was probable (Naranjo score, 7). Early diagnosis and treatment cessation might have prevented tendon rupture, and the tendinitis resolved completely with subsequent physical therapy.


CONCLUSIONS
Based on this outcome in this patient with UTI, fluoroquinolones should be used with caution, particularly in patients with risk factors predisposing to tendinitis, including advanced age and renal dysfunction.
Damuth
Emily
E
University of Michigan Medical School, University of Michigan Health System, Ann Arbor, Michigan, USA.
Heidelbaugh
Joel
J
Malani
Preeti N
PN
Cinti
Sandro K
SK
D000368:Aged; D000890:Anti-Infective Agents / Q000009:adverse effects* / Q000737:chemistry / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000009:adverse effects* / Q000737:chemistry / Q000627:therapeutic use; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000188:drug therapy; D008297:Male; D012307:Risk Factors; D052256:Tendinopathy / Q000139:chemically induced*; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy
D000890:Anti-Infective Agents; D002939:Ciprofloxacin