Which antibiotics Cause Pain?

Fluoroquinolones are antibiotics that are effective against both gram-negative and gram-positive bacteria. They are commonly used to treat a wide range of illnesses, including respiratory and urinary tract infections, as well as sexually transmitted infections. It is also routinely utilized in competitive sports for a variety of illnesses. Ciprofloxacin (Cipro), levofloxacin (Levaquin), norfloxacin (Noroxin), gemifloxacin (Factive), moxifloxacin (Avelox), and ofloxacin are examples of fluoroquinolone antibiotics.

How and why do these drugs damage tendons in particular?

Over the last three decades, there has been conclusive evidence that fluoroquinolones are associated with the development or worsening of tendinopathy, and in some cases, tendon rupture. These antibiotics have a strong affinity for connective tissue, such as cartilage, tendons, and bone.  When compared to other antibiotics, the usage of fluoroquinolone antibiotics is connected with a 3.8-fold increase in tendinopathies. The specific mechanism by which fluoroquinolones damage tendon integrity is yet unknown, however some possibilities exist. Tendons are mostly made of type 1 collagen, with proteins and tendon cells mixed in. Collagen is produced by tendon cells. Fluoroquinolone antibiotics, particularly ciprofloxacin, have been demonstrated to promote the development of matrix metalloproteinase, a degrading enzyme that is critical in the response to injury and the preservation of tendon health. This increase in metalloproteinase causes tendon tissue degeneration by inhibiting collagen production. A more recent MRI-based investigation in healthy males given ciprofloxacin revealed a decrease in glycosaminoglycan (GAG) concentration within the Achilles tendon, which is likewise indicative of biochemical tendon breakdown.

Which tendons are most affected?

The Achilles tendon is the most commonly afflicted tendon, accounting for up to 90% of cases, and this is assumed to be due to its weight-bearing function. The patellar tendon, thumb and finger flexors, and shoulder tendons are among the other tendons that have been reported.

What are the risk factors involved?

There are a number of risk factors listed below that appear to enhance the possibility of developing tendinopathy or even tendon rupture following fluoroquinolone use. These are some examples:

  • Age > 60
  • Renal disease
  • Corticosteroid use eg. Inhalers
  • Physical activity level

What are the likely symptoms?

Symptoms will often include localized tendon pain that worsens with movement and may appear quickly, within 2 hours of taking the antibiotics. On average, symptoms will appear after a week, however, some people may present considerably later. The majority of the time, patients will fail to realize the link between their prior usage of antibiotics and current discomfort, and as a result, this ailment is most likely underreported.

Is this condition handled differently?

In this group, treatment may need to be less aggressive in the beginning. Heavy loading is the gold standard treatment for tendinopathies, but in the acute stage, it may aggravate the condition while the antibiotics stay in the body. Fluoroquinolones should be avoided whenever possible in an athlete population.