Fluoroquinolones and tendon inflammation/ruptures

Fluoroquinolones and tendon inflammation/ruptures

Tendonitis and tendon rupture, particularly of the Achilles tendon, may occur during treatment with fluoroquinolones. These side effects can occur within 48 hours of treatment starting, but also several months after it has ended.

Key words: Fluoroquinolones; moxifloxacin; ciprofloxacin; levofloxacin; tendon rupture; Achilles tendon

Incident data


Year: 2018

Age: 70

Sex: Female

Medicinal product: Moxifloxacin

Indication: Pneumonia acquired in the out-patient setting

ADR: Ruptured tendon

After two days of moxifloxacin treatment, the patient hit her hip against a gardening implement, causing severe hip pain. Moxifloxacin was subsequently stopped on the sixth day of treatment. An MRI revealed ruptured tendons at the tuber ischiadicum with perifocal haematoma, but no infection or abscess, and with little intra-articular effusion.

Year: 2022

Age: 73

Sex: Male

Medicinal product: Ciprofloxacin

Indication: Pyelitis

ADR: Inflammation and rupture of Achilles tendon in both legs

The patient experienced difficulty walking on the third day of treatment and was unable to walk the next day. Ciprofloxacin was stopped. An X-ray revealed nothing conspicuous. Tendonitis was diagnosed and the patient received physiotherapy. Both Achilles tendons ruptured during the subsequent course, necessitating surgery.

The patient was taking prednisone as an immunosuppressant following a kidney transplant. Other concomitant medication: Tacrolimus, doxazosin, lisinopril, dutasteride, tamsulosin, lercanidipine, atorvastatin, acetylsalicylic acid, sodium hydrogen carbonate, sulfonated copolymer and mycophenolate.

Year: 2020

Age: 25

Sex: Female

Medicinal product: Levofloxacin

Indication: Infection of the left ear

ADR: Tendonitis of the tibialis posterior and Achilles tendons

Five days after beginning treatment, the patient experienced inflammation of the right tibialis posterior tendon and Achilles tendon, which subsequently spread to her left leg. Treatment was stopped on the eighth day. The patient required several months of physiotherapy and could still walk only a limited distance five months later.

Summary and recommendation

In view of the risk of persistent or even permanently debilitating side effects, fluoroquinolones should not be used as first-line treatment in uncomplicated infections.