title: Musculoskeletal complications of fluoroquinolones: guidelines and precautions for usage in the athletic population.
abstract: Fluoroquinolone antibiotics are associated with a wide spectrum of musculoskeletal complications that involve not only tendon but also cartilage, bone, and muscle. Insights into the pathoetiology of fluoroquinolone toxicity on musculoskeletal tissues have been evolving over recent years. Although the pathoetiology is certainly multifactorial, alterations in cell signaling proteins and direct toxic effects on musculoskeletal tissues have been strongly implicated. Increasing age and concomitant systemic corticosteroid use appear to significantly increase the risk of adverse events. The purpose of this article is to review the musculoskeletal complications associated with use of fluoroquinolone antibiotics by adults; identify risk factors associated with fluoroquinolone toxicity; explore the possible pathoetiology of fluoroquinolone toxicity on tendon, cartilage, bone, and muscle; and offer recommendations regarding evaluation and treatment of fluoroquinolone-associated musculoskeletal complications. In addition, this review will provide recommendations regarding fluoroquinolone use in athletes and return to play after fluoroquinolone exposure.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, MN 55905, USA.
authors.forename: Mederic M
authors.initials: MM
authors.lastname: Hall
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Finnoff
authors.forename: Jay
authors.initials: J
authors.lastname: Smith
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001842:Bone and Bones / Q000187:drug effects; D002356:Cartilage / Q000187:drug effects / Q000502:physiology; D024841:Fluoroquinolones / Q000009:adverse effects*; D006801:Humans; D018482:Muscle, Skeletal / Q000187:drug effects; D009141:Musculoskeletal System / Q000187:drug effects*; D052256:Tendinopathy / Q000139:chemically induced; D013710:Tendons / Q000187:drug effects / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones