Skip to main content

Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study

Abstract

Objective

Several case-control studies have reported that the use of fluoroquinolone increases the risk of rupture of the Achilles tendon. Our aim was to estimate this risk by means of a population-based cohort approach.

Setting

Data on Achilles tendon ruptures and fluoroquinolone use were retrieved from three population-based databases that include information on residents of Funen County (population: 470,000) in primary and secondary care during the period 1991–1999. A study cohort of all 28,262 first-time users of fluoroquinolone and all incident cases of Achilles tendon ruptures were identified.

Main outcome measures

The incidence rate of Achilles tendon ruptures among users and non-users of fluoroquinolones and the standardised incidence rate ratio associating fluoroquinolon use with Achilles tendon rupture were the main outcome measures.

Results

Between 1991 and 2002 the incidence of Achilles tendon rupture increased from 22.1 to 32.6/100,000 person-years. Between 1991 and 1999 the incidence of fluoroquinolone users was 722/100,000 person-years, with no apparent trend over time. Within 90 days of their first use of fluoroquinolone, five individuals had a rupture of the Achilles tendon; the expected number was 1.6, yielding an age- and sex-standardised incidence ratio of 3.1 [(95% confidence interval (95%CI): 1.0–7.3). The 90-day cumulative incidence of Achilles tendon ruptures among fluoroquinolone users was 17.7/100,000 (95%CI: 5.7–41.3), which is an increase of 12.0/100,000 (95%CI: 0.0–35.6) compared to the background population.

Conclusion

Fluoroquinolone use triples the risk of Achilles tendon rupture, but the incidence among users is low.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

Abbreviations

CI:

confidence interval

References

  1. 1.

    Jarvinen TA, Kannus P, Paavola M et al (2001) Achilles tendon injuries. Curr Opin Rheumatol 13(2):150–155

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Jarvinen TA, Kannus P, Maffulli N et al (2005) Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin 10(2):255–266

    PubMed  Article  Google Scholar 

  3. 3.

    Leppilahti J, Puranen J, Orava S (1996) Incidence of Achilles tendon rupture. Acta Orthop Scand 67(3):277–279

    PubMed  CAS  Article  Google Scholar 

  4. 4.

    Maffulli N, Waterston SW, Squair J et al (1999) Changing incidence of Achilles tendon rupture in Scotland: a 15-year study. Clin J Sport Med 9(3):157–160

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Houshian S, Tscherning T, Riegels-Nielsen P (1998) The epidemiology of Achilles tendon rupture in a Danish county. Injury 29(9):651–654

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Levi N (1997) The incidence of Achilles tendon rupture in Copenhagen. Injury 28(4):311–313

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Suchak AA, Bostick G, Reid D et al (2005) The incidence of Achilles tendon ruptures in Edmonton, Canada. Foot Ankle Int 26(11):932–936

    PubMed  Google Scholar 

  8. 8.

    Melhus A (2005) Fluoroquinolones and tendon disorders. Expert Opin Drug Saf 4(2):299–309

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Khaliq Y, Zhanel GG (2003) Fluoroquinolone-associated tendinopathy: a critical review of the literature. Clin Infect Dis 36(11):1404–1410

    PubMed  Article  Google Scholar 

  10. 10.

    van der Linden PD, Sturkenboom MC, Herings RM et al (2002) Fluoroquinolones and risk of Achilles tendon disorders: case-control study. BMJ 324(7349):1306–1307

    PubMed  Article  Google Scholar 

  11. 11.

    van der Linden PD, Sturkenboom MC, Herings RM et al (2003) Increased risk of Achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids. Arch Intern Med 163(15):1801–1807

    PubMed  Article  Google Scholar 

  12. 12.

    van der Linden PD, van de LJ, Nab HW et al (1999) Achilles tendinitis associated with fluoroquinolones. Br J Clin Pharmacol 48(3):433–437

    PubMed  Article  Google Scholar 

  13. 13.

    Shakibaei M, Pfister K, Schwabe R et al (2000) Ultrastructure of Achilles tendons of rats treated with ofloxacin and fed a normal or magnesium-deficient diet. Antimicrob Agents Chemother 44(2):261–266

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Shakibaei M, de Souza P, van Sickle D et al (2001) Biochemical changes in Achilles tendon from juvenile dogs after treatment with ciprofloxacin or feeding a magnesium-deficient diet. Arch Toxicol 75(6):369–374

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Frank L (2000) Epidemiology. When an entire country is a cohort. Science 287(5462):2398–2399

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Gaist D, Sorensen HT, Hallas J (1997) The Danish prescription registries. Dan Med Bull 44(4):445–448

    PubMed  CAS  Google Scholar 

  17. 17.

    Rotmann KJ (2006) Epidemiology – an introduction. Oxford Press, Oxford

    Google Scholar 

  18. 18.

    Maclure M (1991) The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol 133(2):144–153

    PubMed  CAS  Google Scholar 

  19. 19.

    van der Linden PD, Nab HW, Simonian S et al (2001) Fluoroquinolone use and the change in incidence of tendon ruptures in the Netherlands. Pharm World Sci 23(3):89–92

    PubMed  Article  Google Scholar 

  20. 20.

    Goossens H, Ferech M, Vander SR et al (2005) Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 365(9459):579–587

    PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Annmarie Lassen.

Additional information

Grant support: there is no funding.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Sode, J., Obel, N., Hallas, J. et al. Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study. Eur J Clin Pharmacol 63, 499–503 (2007). https://doi.org/10.1007/s00228-007-0265-9

Download citation

Keywords

  • Achilles tendon
  • Antibiotics
  • Cohort study
  • Incidence
  • Quinolone