Summary about Disease
Quinolone-associated tendon rupture is a rare but serious adverse event linked to the use of quinolone antibiotics. These antibiotics, while effective against certain bacterial infections, can sometimes damage tendons, leading to pain, inflammation, and potentially rupture, most commonly affecting the Achilles tendon.
Symptoms
Pain in the affected tendon area (most often Achilles tendon)
Stiffness in the affected tendon area
Swelling or inflammation around the tendon
Difficulty walking or bearing weight
A snapping or popping sensation at the time of rupture
Inability to plantar flex the foot (point toes downward) in complete Achilles tendon rupture
Causes
Quinolone antibiotics are believed to cause tendon damage through several mechanisms. They can disrupt collagen production, increase matrix metalloproteinase activity (enzymes that break down connective tissue), and lead to oxidative stress within tendon cells, weakening the tendon and predisposing it to rupture. Risk factors include:
Age over 60
Use of corticosteroids
Pre-existing tendon disease
Renal insufficiency
Diabetes
Participation in strenuous physical activity
Medicine Used
Quinolones implicated include:
Ciprofloxacin
Levofloxacin
Moxifloxacin
Ofloxacin
Norfloxacin While these medications can cause tendon rupture, it's important to remember that they are beneficial for treating certain infections, and the risk of tendon rupture is relatively low.
Is Communicable
No, quinolone-associated tendon rupture is not a communicable disease. It is an adverse reaction to a medication, not an infectious process.
Precautions
Inform your doctor about any pre-existing tendon problems, steroid use, kidney problems, or diabetes before starting quinolone antibiotics.
Report any tendon pain or stiffness to your doctor immediately while taking quinolones.
Avoid strenuous physical activity while taking quinolones.
Consider alternative antibiotics if you have risk factors for tendon rupture.
If tendon pain develops, discontinue the quinolone and rest the affected limb.
How long does an outbreak last?
This is not an outbreak situation, so the question is not applicable. Tendon damage can occur at any point while taking the antibiotic or even after the antibiotic course is complete, and recovery depends on the severity of the damage and the treatment received.
How is it diagnosed?
Physical examination: A doctor will examine the affected area for pain, swelling, and range of motion. They may perform specific tests to assess tendon integrity, such as the Thompson test for Achilles tendon rupture.
Imaging studies:
Ultrasound: Can visualize tendon swelling, inflammation, and partial tears.
MRI: Provides a more detailed image of the tendon and surrounding tissues, allowing for better assessment of the extent of the injury and detection of complete ruptures.
Medical History: Thorough review of medications and patient history.
Timeline of Symptoms
9. Timeline of symptoms
Tendon pain can develop at any point during quinolone treatment or even weeks to months after finishing the antibiotic.
Initial symptoms may include mild aches or stiffness in the tendon.
Symptoms can worsen over time, leading to more severe pain, swelling, and difficulty walking.
Rupture can occur suddenly, often with a snapping or popping sensation, or it may develop gradually over time.
Important Considerations
Prompt diagnosis and treatment are essential to prevent long-term complications.
Treatment options range from conservative measures like rest, ice, compression, and elevation (RICE) and immobilization to surgical repair in cases of complete rupture.
Patients who experience quinolone-associated tendon problems should avoid quinolones in the future.
Physicians should carefully weigh the risks and benefits of quinolone use, especially in patients with risk factors for tendon rupture.
Alternatives to quinolones should be considered whenever appropriate.