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From Southern Medical Journal Fluoroquinolone-Induced Tendinopathy: What Do We Know?Richard M. Harrell, MD, Department of Emergency Medicine, Louisiana State University School of Medicine, Shreveport.
AbstractFluoroquinolones are relatively safe, effective antibiotics. As their use becomes more frequent, so will the adverse side effects. I highlight a rare but debilitating adverse reaction -- fluoroquinolone-induced tendinopathy. Case reports and letters from 1987 to 1998 were identified by using Grateful Med and PubMed Internet accesses to the National Library of Medicine. Articles were reviewed for clinical practicality. There are few articles on fluoroquinolone-induced tendinopathy in the US literature targeting primary care physicians. This entity has been described in many case reports, but little has been done to isolate the causative agents. Incidence of this side effect is difficult to estimate, since no prospective studies are available for review or calculation of risk. Fluoroquinolone-induced tendinopathy appears more commonly in tendons under high stress. The cause is probably multifactorial. Risk factors for the development of fluoroquinolone-induced tendinopathy are age, renal failure, corticosteroid use, and previous tendinopathy from fluoroquinolones. [South Med J 92(6):622-625, 1999. © 1999 Southern Medical Association]
IntroductionFluoroquinolones are synthetic antibiotics that inhibit bacterial DNA gyrase, which is necessary for the synthesis of bacterial DNA.[1] Fluoroquinolones have in vitro activity against a wide range of gram-negative and gram-positive organisms and have been shown to be relatively safe. Pharmaceutical companies are developing fluoroquinolones with longer half-lives for once daily dosing. For these reasons, these drugs are being used more often than ever before. Fluoroquinolone-induced tendinopathy is well described in France and, to a much lesser extent, by US rheumatologic and orthopaedic journals, but there is scant information in primary care literature. Fluoroquinolone-induced tendinopathy is underreported, both in the literature and to the Food and Drug Administration (FDA). With greater penetration of managed care into our practices, primary care physicians in the United States are more apt to see and be expected to treat this medication complication. The following is a presentation of a case of fluoroquinolone-induced tendinitis and a current literature review of tendinopathy associated with fluoroquinolones.
Reprint requests to Richard M. Harrell, MD, 1455 E Bert Kouns Industrial Loop, Shreveport, LA 71105.
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