Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 1;9(7):581-588.
doi: 10.1530/EOR-23-0181.

Achilles tendon complications of fluoroquinolone treatment: a molecule-stratified systematic review and meta-analysis

Alessandro Sangiorgio  1 , Martina Sirone  1 , Federico Maria Adravanti  1   2 , Enrique Adrian Testa  1   3 , Martin Riegger  1   3 , Giuseppe Filardo  1   2
Affiliations

Achilles tendon complications of fluoroquinolone treatment: a molecule-stratified systematic review and meta-analysis

Alessandro Sangiorgio et al. EFORT Open Rev. .

Abstract

Purpose: The association between fluoroquinolone intake and Achilles tendinopathy (AT) or Achilles tendon rupture (ATR) is widely documented. However, it is not clear whether different molecules have the same effect on these complications. The purpose of this study was to document Achilles tendon complications for the most prescribed fluoroquinolones molecules.

Methods: A literature search was performed on Pubmed, Cochrane, Embase, and Web of Science databases up to April 2023. Inclusion criteria: studies of any level of evidence, written in English, documenting the prevalence of AT/ATR after fluoroquinolone consumption and stratifying the results for each type of molecule. The Downs and Black's 'Checklist for Measuring Quality' was used to evaluate the risk of bias.

Results: Twelve studies investigating 439,299 patients were included (59.7% women, 40.3% men, mean age: 53.0 ± 15.6 years). The expected risk of AT/ATR was 0.17% (95% CI: 0.15-0.19, standard error (s.e.): 0.24) for levofloxacin, 0.17% (95% CI: 0.16-0.19, s.e.: 0.20) for ciprofloxacin, 1.40% (95% CI: 0.88-2.03, s.e.: 2.51) for ofloxacin, and 0.31% (95% CI: 0.23-0.40, s.e.: 0.77) for the other molecules. The comparison between groups documented a significantly higher AT/ATR rate in the ofloxacin group (P < 0.0001 for each comparison). Levofloxacin and ciprofloxacin showed the same risk (P = n.s.). The included studies showed an overall good quality.

Conclusion: Ofloxacin demonstrated a significantly higher rate of AT/ATR complications in the adult population, while levofloxacin and ciprofloxacin showed a safer profile compared to all the other molecules. More data are needed to identify other patient and treatment-related factors influencing the risk of musculoskeletal complications.

Keywords: Achilles tendinopathy; Achilles tendon rupture; ciprofloxacin; fluoroquinolones; levofloxacin; ofloxacin.

PubMed Disclaimer

Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the study reported.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. Out of 981 studies, 12 were included in the systematic review and meta-analysis.
Figure 2
Figure 2
Forest plot on the relative risk of Achilles tendon damage stratified for each molecule.
Figure 3
Figure 3
Comparison between groups.
Figure 4
Figure 4
Downs and Black’s risk of bias of the included articles (14, 20, 21, 22, 23, 24, 25, 27, 28, 29, 30).
See this image and copyright information in PMC

References

    1. Tsai WC & Yang YM. Fluoroquinolone-associated tendinopathy. Chang Gung Medical Journal 201134461–467. - PubMed
    1. Asplund CA & Best TM. Achilles tendon disorders. BMJ 2013346f1262. (10.1136/bmj.f1262) - DOI - PubMed
    1. Shimatsu K Subramaniam S Sim H & Aronowitz P. Ciprofloxacin-induced tendinopathy of the gluteal tendons. Journal of General Internal Medicine 2014291559–1562. (10.1007/s11606-014-2960-4) - DOI - PMC - PubMed
    1. Muzi F Gravante G Tati E & Tati G. Fluoroquinolones-induced tendinitis and tendon rupture in kidney transplant recipients: 2 cases and a review of the literature. Transplantation Proceedings 2007391673–1675. (10.1016/j.transproceed.2007.01.077) - DOI - PubMed
    1. Godoy-Santos AL Bruschini H Cury J Srougi M de Cesar-Netto C Fonseca LF & Maffulli N. Fluoroquinolones and the risk of Achilles tendon disorders: update on a neglected complication. Urology 201811320–25. (10.1016/j.urology.2017.10.017) - DOI - PubMed

LinkOut - more resources