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Title: Fluoroquinolones Plus Corticosteroids Increases Risk of Achilles Tendon Disorders In Those Over 60

URL: http://bmj.com/cgi/content/full/324/7349/1306

BMJ 2002;324:1306-1307. "Fluoroquinolones and risk of Achilles tendon disorders: case-control study"
06/06/2002 08:05:00 AM
By Harvey McConnell

Patients 60 and older who are prescribed fluoroquinolones and corticosteroids have an increased risk of developing Achilles tendon disorders. Dr P D van der Linden and colleagues at the Erasmus University Medical Center. Rotterdam, The Netherlands previously found, in a small study, an association between tendinitis and fluoroquinolones. The clinicians used a large British family doctor database to carry out this nested case-control study examining the association between these drugs and Achilles tendon disorders. The base cohort consisted of all patients aged 18 years or over who had received a fluoroquinolone. The cohort included 46,776 users of fluoroquinolones over a six year period, of whom 704 had Achilles tendinitis and 38 had Achilles tendon rupture. The researchers found that the adjusted relative risk of Achilles tendon disorders with current use of fluoroquinolones was 1.9. The risk for recent and past use was similar to that for no use. The relative risk with current use was 3.2 among patients aged 60 and over and 0.9 among patients aged under 60. Among patients aged 60 and older, the concurrent use of corticosteroids and fluoroquinolones increased the risk to 6.2. The clinicians said their results indicate an adverse effect is relatively rare, with an overall excess risk of 3.2 cases per 1000 patient years. The effect seems restricted to people aged 60 or over, and within this group concomitant use of corticosteroids increased the risk substantially. The proportion of Achilles tendon disorders among patients with both risk factors that is attributable to their interaction was 87 percent. "Although the mechanism is unknown, the sudden onset of some tendinopathies, occasionally after a single dose of a fluoroquinolone, suggests a direct toxic effect on collagen fibres," they conclude.

http://bmj.com/cgi/content/full/324/7349/1306

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