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The use of fluoroquinolones and the risk of tendon damage

Antibiotics from the fluoroquinolone group are often used to treat infections and are prescribed by both general practitioners and narrow specialists and surgeons. The occurrence of tendon damage due to the use of fluoroquinolones has been established, however, the risk of this type of undesirable effects when using "new" fluoroquinolones is not yet fully established.

The systematic review of Canadian researchers was aimed at evaluating observational study data that established the relationship between the use of fluoroquinolones and the development of tendinopathy, as well as identifying risk factors for this complication of fluoroquinolones.

The search for observational studies which examined the development of tendon lesions with fluoroquinolones was carried out in the MEDLINE, EMBASE and Cochrane Controlled Research Register databases until May 2013. Of the 560 abstracts examined, 16 studies were identified who met the inclusion criteria included in the meta-analysis. Eight studies were considered high quality studies and five studies specifically examined Achilles tendon ruptures. In addition, three studies have examined Achilles tendon injuries and 3 other tendon injuries (including ruptures of any tendon) were considered an estimated result.

The results of these studies indicate that people receiving fluoroquinolones constitute a group at increased risk of rupture of the Achilles tendon, in particular in the month following the use of the drugs (odds ratio varying from 1.1 to 7.1). A study has shown that an increased risk of tendon rupture has been observed in patients over the age of 60. In 5 studies, it was found that patients taking fluoroquinolones and oral glucocorticoids have an increased risk of developing tendon damage compared to those receiving fluoroquinolones only. In 4 studies, the differences in risk of this adverse event depending on the drug were studied. Thus, according to 3 studies when using ofloxacin, the greatest risk of tendon damage has been found.

A limitation of this meta-analysis was the fact that only observational studies were included in the systematic review.

Thus, combined data from observational studies have shown an increased risk of developing tendon damage, including tears and tendonitis, under the influence of fluoroquinolones. Although this complication is relatively rare, the concomitant use of glucocorticoids increases the risk of damage to tendons, which varies depending on the drug used and is greatest when using ofloxacin.