Fluoroquinolones are a type of antibiotic that help to treat various bacterial infections. They work by targeting specific enzymes in bacteria called DNA gyrase and topoisomerase IV. These enzymes play a crucial role in DNA replication. When fluoroquinolones inhibit these enzymes, it leads to the death of bacteria, thus making the drug effective in controlling infections (Duman et al., 2025). However, while these medications are useful, they are also linked to a notable risk—tendon injuries.
The connection between fluoroquinolones and tendon injuries is concerning. Research suggests that these antibiotics may disrupt the normal process of collagen synthesis and affect the health of tendon cells. Collagen is a vital protein that provides structure and strength to tendons. When fluoroquinolones interfere with collagen production and tendon cellular balance, it increases the risk of tendon damage, resulting in injuries (Bisaccia et al., 2019). This effect could lead to various injuries, including tendonitis or even tendon ruptures, which can be painful and debilitating.
Certain individuals may be more susceptible to these tendon injuries when taking fluoroquinolones. Age is a significant risk factor; older adults often have weaker tendons, making them more prone to injury. Additionally, the concurrent use of corticosteroids, which are often prescribed for inflammation, can further increase this risk (Lewis and Cook, 2014). Some underlying health conditions, such as diabetes or kidney disease, also contribute to vulnerability during fluoroquinolone therapy (Alves et al., 2019). The presence of these risk factors can heighten the possibility of tendon injuries in those using these antibiotics.
The prevalence of reported tendon injuries related to fluoroquinolone use is notable. Data from the FDA’s adverse event reports indicate that many patients have experienced tendon problems following treatment with these antibiotics (Arabyat et al., 2015). A study conducted by Shu et al. (2022) highlighted an alarming trend where fluoroquinolone-associated tendon injuries are frequently documented, pointing to an urgent need for awareness among healthcare providers and patients alike.
Any athlete or individual undergoing physical therapy must be particularly cautious when prescribed fluoroquinolones. The demanding nature of athletic training or rehabilitation puts stress on the tendons, making these individuals even more prone to injuries while on these medications (Baggio and Ananda-Rajah, 2021). The potential for tendon damage can not only hinder recovery from injury but also reduce performance and overall quality of life for those engaged in sports or exercise.
In summary, fluoroquinolones are powerful antibiotics that effectively treat infections, but their link to tendon injuries is an important health consideration. Understanding how these antibiotics work and their impact on tendon health is crucial, especially for those at greater risk. Thus, it is vital for healthcare providers to be aware of these risks when prescribing fluoroquinolones and to consider potential alternatives or preventive measures for vulnerable patients., Fluoroquinolones are important antibiotics used to treat many infections. However, their use has been linked to serious tendon injuries, especially in the Achilles tendon and other areas. Studies, such as those by Godoy-Santos et al. (2018) and Baik et al. (2020), show that people taking fluoroquinolones have a higher chance of experiencing tendon ruptures. This increased risk makes it critical for health professionals to understand the significance of these potential injuries when deciding to prescribe fluoroquinolone medications.
Doctors must be aware of the specific risks associated with fluoroquinolones to protect their patients. Certain groups of patients are more vulnerable to tendon ruptures, such as older adults, those with a history of tendon issues, and individuals taking steroids. According to Barberán et al. (2023), understanding these risk factors is essential. Physicians should take extra care when prescribing fluoroquinolones to these at-risk populations. Open discussions with patients about the benefits and risks of the medication can help them make informed decisions about their treatment.
To promote safe prescribing practices, a few recommendations should be followed. First, healthcare providers should avoid prescribing fluoroquinolones to patients known to have risk factors for tendon injuries, such as a previous history of tendinopathy or those who are over the age of 60. Furthermore, monitoring patients for early signs of tendon pain or discomfort is crucial, as seen in the work of Lewis and Cook (2014). If a patient begins to report any tendon symptoms, the healthcare provider should consider discontinuing the fluoroquinolone and exploring alternative treatment options. Regular follow-ups can help catch these issues early, leading to better outcomes.
Despite the concerns regarding tendon injuries, fluoroquinolones remain valuable tools in the treatment of serious bacterial infections. However, more research is necessary to fully understand how fluoroquinolones cause tendon damage. Investigating the biological mechanisms behind fluoroquinolone-induced tendon injuries is essential for developing preventive measures. Duman et al. (2025) and Bisaccia et al. (2019) emphasize the need for further studies that could clarify these processes. By understanding how these medications harm tendons, healthcare professionals can create more effective guidelines and treatment protocols.
It is vital to strike a balance between the therapeutic benefits of fluoroquinolones and the risks of tendon injuries. Individualized patient care strategies should guide prescribing decisions, ensuring that each patient receives safe and effective treatment that aligns with their specific health needs and risk factors. Ongoing education and awareness among healthcare providers will play an important role in minimizing the risks associated with fluoroquinolone use while maintaining access to these essential medications.
Citations:
Duman, E., Müller-Deubert, S., Pattappa, G., Stratos, I., Sieber, S.A., Clausen-Schaumann, H., Sarafian, V., Shukunami, C., Rudert, M. and Docheva, D., 2025. Fluoroquinolone-mediated tendinopathy and tendon rupture. Pharmaceuticals, 18(2), p.184. https://pmc.ncbi.nlm.nih.gov/articles/PMC11858458/
Bisaccia, D.R., Aicale, R., Tarantino, D., Peretti, G.M. and Maffulli, N., 2019. Biological and chemical changes in fluoroquinolone-associated tendinopathies: a systematic review. British medical bulletin, 130(1), pp.39-49. https://academic.oup.com/bmb/advance-article-pdf/doi/10.1093/bmb/ldz006/28850032/ldz006.pdf
Lewis, T. and Cook, J., 2014. Fluoroquinolones and tendinopathy: a guide for athletes and sports clinicians and a systematic review of the literature. Journal of athletic training, 49(3), pp.422-427. https://meridian.allenpress.com/jat/article-abstract/49/3/422/191343
Alves, C., Mendes, D. and Marques, F.B., 2019. Fluoroquinolones and the risk of tendon injury: a systematic review and meta-analysis. European journal of clinical pharmacology, 75(10), pp.1431-1443. https://link.springer.com/article/10.1007/s00228-019-02713-1
Arabyat, R.M., Raisch, D.W., McKoy, J.M. and Bennett, C.L., 2015. Fluoroquinolone-associated tendon-rupture: a summary of reports in the Food and Drug Administration’s adverse event reporting system. Expert opinion on drug safety, 14(11), pp.1653-1660. https://www.tandfonline.com/doi/abs/10.1517/14740338.2015.1085968
Shu, Y., Zhang, Q., He, X., Liu, Y., Wu, P. and Chen, L., 2022. Fluoroquinolone-associated suspected tendonitis and tendon rupture: a pharmacovigilance analysis from 2016 to 2021 based on the FAERS database. Frontiers in Pharmacology, 13, p.990241. https://www.frontiersin.org/articles/10.3389/fphar.2022.990241/full
Baggio, D. and Ananda-Rajah, M.R., 2021. Fluoroquinolone antibiotics and adverse events. Australian prescriber, 44(5), p.161. https://pmc.ncbi.nlm.nih.gov/articles/PMC8542490/
Godoy-Santos, A.L., Bruschini, H., Cury, J., Srougi, M., de Cesar-Netto, C., Fonseca, L.F. and Maffulli, N., 2018. Fluoroquinolones and the risk of Achilles tendon disorders: update on a neglected complication. Urology, 113, pp.20-25. https://www.sciencedirect.com/science/article/pii/S0090429517311007
Barberán, J., de la Cuerda, A., González, M.I.T., Aparicio, A.L., Vinuesa, C.M., Sánchez, A.R. and Barberán, L.C., 2023. Safety of fluoroquinolones. Revista Española de Quimioterapia, 37(2), p.127. https://pmc.ncbi.nlm.nih.gov/articles/PMC10945095/
Baik, S., Lau, J., Huser, V. and McDonald, C.J., 2020. Association between tendon ruptures and use of fluoroquinolone, and other oral antibiotics: a 10-year retrospective study of 1 million US senior Medicare beneficiaries. BMJ open, 10(12), p.e034844. https://bmjopen.bmj.com/content/10/12/e034844.abstract
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