Fluoroquinolones and tendon disorders

Melhus, Åsa

doi:10.1517/14740338.4.2.299

Cited by 47 publications

(36 citation statements)

References 58 publications

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“…The use of fluroquinolone antibiotics have been associated with Achilles tendon rupture through an unknown mechanism (Melhus, 2005;Yu and Giuffre, 2005). In other cases, repeated microtrauma has also been postulated as a cause; however, the only well-established mechanism is the contribution of poor tendon vascularity to degenerative changes (Smith, 1965;Pufe et al, 2005).…”

Section: Implications For Tendon Rupturementioning

confidence: 99%

The arterial anatomy of the Achilles tendon: Anatomical study and clinical implications

et al. 2009

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The Achilles tendon is the most frequently ruptured tendon in the lower limb and accounts for almost 20% of all large tendon injuries. Despite numerous published studies describing its blood supply, there has been no uniformity in describing its topography. The current study comprises a detailed anatomical study of both the intrinsic and extrinsic arterial supply of the Achilles tendon, providing the detail sought from studies calling for improved planning of surgical procedures where damage to the vascularity of the Achilles tendon is likely. A dissection, microdissection, histological, and angiographic study was undertaken on 20 cadaveric lower limbs from 16 fresh and four embalmed cadavers. The Achilles tendon is supplied by two arteries, the posterior tibial and peroneal arteries. Three vascular territories were identified, with the midsection supplied by the peroneal artery, and the proximal and distal sections supplied by the posterior tibial artery. The midsection of the Achilles tendon was markedly more hypovascular that the rest of the tendon. The Achilles tendon is at highest risk of rupture and surgical complications at its midsection. Individuals with particularly poor supply of the midsection may be at increased risk of tendon rupture, and approaches to the tendon operatively should consider the route of supply by the peroneal artery to this susceptible part of the tendon.

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Section: Implications For Tendon Rupturementioning

confidence: 99%

The arterial anatomy of the Achilles tendon: Anatomical study and clinical implications

et al. 2009

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“…Otro evento similar es la tendinopatía que puede evolucionar a la rotura de tendón, principalmente el de Aquiles 9 . Su frecuencia de aparición es baja 10 y se ha observado principalmente en pacientes mayores de 60 años, asociado al uso de corticosteroides y falla renal y hepática 11,12 . Este evento ocurre generalmente en el primer mes de tratamiento, aunque puede aparecer hasta varios meses de suspendido el medicamento 13 .…”

Section: Sistema Músculo-esqueléticounclassified

Seguridad de las fluoroquinolonas: riesgos habitualmente olvidados para el clínico

Pavez

et al. 2017

Rev. chil. infectol.

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Safety of fluoroquinolones: risks usually forgotten for the clinicianQuinolones are a group of widely used antimicrobials. Although they are considered safe for patients, knowledge of the safety profile is necessary so that professionals become aware of what is necessary to monitor. At the musculoskeletal level, quinolones have the potential to damage cartilage, causing even tendon rupture in infrequent cases. Hypoglycemia / hyperglycemia has been observed at the endocrine level, thus, careful monitoring of glycemia in patients with quinolone is recommended in diabetic patients. At the cardiovascular level, arrhythmias induced by these antimicrobials are rare but severe. At the level of the nervous system, the appearance of alterations of the central nervous system and the peripheral neuropathy are emphasized. When assessing the safety of quinolones, it is important to consider potential interactions with other substances (medical products). In children it is preferred not to use fluoroquinolones because of the potential risk of cartilage damage and growth, effects that do not seem to be so dramatic in the face of new evidence. Despite optimism, the safety of the treatment of these antimicrobials should be evaluated in every pediatric patient.Key words: Fluoroquinolonas, safety, pharmaco surveillance, pediatrics. Palabras clave: Fluoroquinolonas, seguridad, farmacovigilancia, pediatría. IntroducciónL as quinolonas son un grupo de antimicrobianos que ha presentado un aumento progresivo de consumo ambulatorio a través de los años 1 . Gracias a la farmacovigilancia se han detectado reacciones adversas graves que han obligado a retirar del mercado varias fluoroquinolonas 2 . Por ejemplo, grepafloxacina experimentó un retiro voluntario por el efecto de prolongación del intervalo QT, complicación que exponía a los pacientes a riesgo de arritmias ventriculares graves, como la torsión de puntas 3 . Otro ejemplo fue el retiro de gatifloxacina, por alteraciones en los valores de glicemia 4 . El reporte de las reacciones adversas a medicamento a la autoridad regulatoria es un factor clave para la detección oportuna de eventos adversos en nuestra población. Si bien el grupo de las quinolonas es considerado seguro para los pacientes, el conocimiento del perfil de seguridad es necesario para que los profesionales estén en conocimiento de lo que es necesario reportar. Los efectos adversos más frecuentes de las quinolonas son los gastrointestinales (náuseas, vó-mitos, diarrea), las alergias y las reacciones neurológicas (mareo, cefalea, ansiedad) 5 . En los últimos años algunas agencias sanitarias de países desarrollados han emitido alertas de seguridad por reacciones adversas a este grupo de medicamentos y, a pesar de que estos eventos son incluidos en los folletos de información al profesional, son desconocidos para los médicos clínicos.El objetivo de la presente revisión es dar a conocer reacciones adversas de las fluoroquinolonas que han adquirido relevancia clínica en los últimos años, con la intención de que sean detectad...

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“…There is limited evidence that oral corticosteroids and local steroid injections are risk factors for Achilles tendon ruptures [ 23 , 24 ]. The use of fl uoroquinolones is also associated with Achilles tendinopathy and tendon ruptures [ 25 ], and the administration of fl uoroquinolones should be carefully considered, especially in patients undergoing corticosteroid treatment [ 26 ]. Achilles tendon rupture can also be associated with systemic diseases such as gout, lupus erythematosus, and rheumatoid arthritis.…”

Section: Etiologymentioning

confidence: 99%

Achilles Tendon Lesions in Soccer Players

Karlsson

Olsson

Helander

2015

Football Traumatology

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The Achilles tendon is the thickest and strongest tendon in the human body and needs to resist forces of up to 9 kN (approximately 12 times the weight of the body) during running [ 1 ]. For optimal function, the tendon must be capable of resisting high tensile forces with limited elongation and at the same time storing elastic energy when activated. Despite its strength, it is susceptible to both overuse injury and acute injury, such as a complete rupture.Functional defi cits are commonly described after an Achilles tendon rupture [ 2 -5 ], and several studies have shown that only approximately 50 % of the patients return to previous activity level and sports [ 2 , 6 , 7 ]. Accordingly, an Achilles tendon rupture might be career-ending for the professional athlete [ 8 ].A large number of medical reports have been published in the fi eld of Achilles tendon rupture, but there is still a lack of consensus in terms of the best treatment. EpidemiologyThe annual incidence of Achilles tendon ruptures in the population is increasing with a peak incidence of 37 per 100,000 persons [ 9 -11 ]. A bimodal age distribution has been reported with the highest incidence in the 30-39-year age group [ 9 , 12 ]. A study by Houshian et al. [ 9 ] showed that 73 % of the injuries were sports-related and the peak of sports-related injuries occurred in the 30-49-year age group. There is a second nonsports-related peak in incidence occurring at a mean age of 53 years [ 10 ]. Epidemiological studies generally show much a higher incidence of Achilles tendon ruptures in men, and the ratio between men and women is between 3:1 and 18:1, in general approximately 10:1 [ 9 , 13 ].A recently published study of the UEFA Champions League injury showed that Achilles tendon disorders (tendinopathies and ruptures) accounted for 2.5 % of all injuries and 3.8 % of layoff times in male professional football players [ 14 ]. In this cohort of 203 football players, only 4 % were classifi ed as partial or total ruptures. EtiologyThe etiology of Achilles tendon ruptures is regarded as multifactorial, and many factors have been proposed, but the pathology still remains unclear.

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Fluoroquinolones and tendon disorders

Cited by 47 publications

References 58 publications

The arterial anatomy of the Achilles tendon: Anatomical study and clinical implications

The arterial anatomy of the Achilles tendon: Anatomical study and clinical implications

Seguridad de las fluoroquinolonas: riesgos habitualmente olvidados para el clínico

Achilles Tendon Lesions in Soccer Players

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