Quinolone-Related Achilles Tendon Rupture Risk High in Elderly on Corticosteroids

NEW YORK (Reuters Health) Aug 11 - Current or past treatment with quinolones is tied to an increased risk of Achilles tendon rupture, especially in elderly patients who are also taking oral corticosteroids, new research suggests.

Despite numerous case reports linking quinolone use with tendon rupture, the epidemiologic evidence supporting this association is limited.

To clarify the issue, Dr. Bruno H. Ch. Stricker, from Erasmus Medical Centre in Rotterdam, the Netherlands, and colleagues conducted a case-control study of 1367 patients with Achilles tendon rupture and 50,000 randomly selected controls. The patients were diagnosed between 1988 and 1998 and all had at least 18 months of history data prior to their diagnosis.

The researchers' findings are published in the August 11/25th issue of the Archives of Internal Medicine.

Exposure to quinolones was tied to an increased rupture risk, but the magnitude of this risk depended on when the treatment was given. For example, past exposure to quinolones was associated with an odds ratio for tendon rupture of 1.40, while current exposure was linked to a 4.3 odds ratio.

The risks of quinolone exposure were magnified for patients 60 years of age or older. Current users in their 60s and 70s had an odds ratio of 6.4 of sustaining a tendon rupture, while current users in their 80s and 90s had an odds ratio of 20.4.

In terms of specific quinolones, ofloxacin use was tied to the highest risk of rupture, followed by norfloxacin use and ciprofloxacin use, the investigators note. Lastly, patients who were also exposed to oral corticosteroids, either currently or recently, were much more likely to sustain a tendon rupture than patients only exposed to quinolones.

The researchers calculate that 2% to 6% of Achilles tendon ruptures among patients older than 60 years are due to quinolone use, indicating a rather low absolute risk. "Nevertheless, prescribers should be aware of this risk and try to avoid the combination with oral corticosteroids, or should prescribe alternative antimicrobial agents if possible," the authors state.

Arch Intern Med 2003;163:1801-1807.