Case report from King's Mill Hospital - UK
Ciprofloxacine induce tendinitis
Introduction
Tendinopathy after fluoroquinolone is a well recognized but an uncommon adverse effect. Fluoroquinolone is commonly used antibiotic in diabetic patient because of its broad antibacterial activity, relative safety in renal impairment, and good soft tissue penetration. We report a patient with diabetic foot ulcer who has been prescribed ciprofloxacin for a period of 6 weeks.
Case report
Our patient is 62-year-old male with type 2 diabetes for – years. He has been following up in the diabetes fool clinic for a right sided diabetic foot ulcer.
Ciprofloxacin was started on him 6-weeks ago. His uric acid was normal and the rheumatological screen was negative. His serum creatinin was ---. On the fourth week of treatment the patient developed tendinitis involving semimembranosus tendon at the right knee joint and subsequently flexor tendon at the elbow (triceps epicondyle). He was not on any other drug that is known to cause tendinitis. ((His symptoms improved with the discontinuation of the antibiotic)). We concluded that this tendinitis is most likely related to the ciprofloxacin.
Discussion
Tendinitis is a rare adverse reaction described after drugs use. Fluoroquinolones especially pefloxacine, were the most incriminated (2). Fluoroquinolones are relatively safe, effective broad spectrum antibiotics. As their use becomes more frequent, so will the adverse side effects. Risk factors for the development of fluoroquinolone-induced tendinopathy are age, renal failure, corticosteroid use, diabetes mellitus, hyperparathyroidism, rheumatic disease, gout, participation in sports, and previous tendinopathy from fluoroquinolones (1, 5, 6, 7, 8, 9, 10).
The incidence of fluoroquinolone-induced tendon injury in an otherwise healthy population is not well established, but reports suggest that it is low, ranging from 0.14% to 0.4% (11, 12, 13). The incident of tendinitis is slightly more common in male (1.9 to 1-male female ratio) and the age over 60 years is associated with high risk. (5, 6, 7, 8, 10).
The median duration of fluoroquinolone treatment before the onset of tendon injury can be as early as 2 hours after the first dose and as late as 6 months after treatment was stopped (3).
