Fluoroquinolone-Induced Tendinopathy: Also Occurring with Levofloxacin

Fleisch, Felix; Hartmann, Karsten; Kühn, Manfred

doi:10.1007/s150100070050

Cited by 30 publications

(17 citation statements)

References 5 publications

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“…Data include the implicated fluoroquinolone, dose and duration of therapy when the tendon injury occurred, the tendon involved, time to onset of injury, the intervention(s) taken, time to recovery, and potential predisposing factors. The following text summarizes these 60 cases presented in table 1 and, when available, includes details from grouped data from case series [36][37][38][39][40], for a denominator of 98 cases. A comparison with the retrospective studies is presented in the discussion.…”

Section: Resultsmentioning

confidence: 99%

“…Thirty-nine cases (44.3%) were bilateral. Other sites included the triceps epicondyle (2 cases), flexor tendon sheath (finger; 2 cases), thumb (3 cases), patellar (1 case), supraspinal tendon (1 case), quadriceps (1 case), subscapularis terrea (1 case), and rotator cuff (1 case) [6,20,[29][30][31][32][33]40]. Eighty-two patients (83.7%) experienced tendinitis.…”

Section: Resultsmentioning

confidence: 99%

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Fluoroquinolone-Associated Tendinopathy: A Critical Review of the Literature

Khaliq

Zhanel

2003

Clinical Infectious Diseases

303

254

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With the expanded use of fluoroquinolones for the treatment of community-acquired respiratory infections and reports of tendon injury linked to the use of these agents, we reviewed the literature to investigate the frequency and strength of this association. Ninety-eight case reports were available for review. The incidence of tendon injury associated with fluoroquinolone use is low in a healthy population but increases in patients who have renal dysfunction, who are undergoing hemodialysis, or who have received renal transplants. Pefloxacin and ciprofloxacin were most frequently implicated, but tendon injury was reported with most fluoroquinolones. The median duration of fluoroquinolone treatment before the onset of tendon injury was 8 days, although symptoms occurred as early as 2 hours after the first dose and as late as 6 months after treatment was stopped. Up to one-half of patients experienced tendon rupture, and almost one-third received long-term corticosteroid therapy. Tendon injury associated with fluoroquinolone use is significant, and risk factors such as renal disease or concurrent corticosteroid use must be considered when these agents are prescribed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Fluoroquinolone-Associated Tendinopathy: A Critical Review of the Literature

Khaliq

Zhanel

2003

Clinical Infectious Diseases

303

254

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“…80,81 Tendonitis and tendon rupture are class effects and, as such, have been reported with levofloxacin. 82 Such events probably affect Ͻ1 in 5000 patients receiving fluoroquinolones, 83 and the adjusted relative risk compared with the incidence in the general population is ∼3.7%. 84 The overall incidence is calculated at 3 cases per 1000 patient-years.…”

Section: Tendonitis and Tendon Rupturementioning

confidence: 99%

Efficacy and safety of levofloxacin in the context of other contemporary fluoroquinolones: a review

Ball

2003

Current Therapeutic Research

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Background: In recent years, fluoroquinolone research has focused on achieving several goals, including (1) enhanced potency against gram-positive cocci, notably Streptococcus pneumoniae, and anaerobes, while (2) maintaining potency against gram-negative pathogens, (3) optimizing pharmacokinetics and pharmacodynamics (PK/PD), and (4) minimizing potential adverse drug reactions through recognition and avoidance of structural configurations that have characterized earlier, reactive compounds.Objective: This review examines the efficacy and safety of fluoroquinolones and the specific clinical evidence regarding levofloxacin.Methods: Using published literature collected over time by the author, a review was conducted, focusing on the efficacy and safety profile of levofloxacin and other fluoroquinolones.Results: The newer fluoroquinolones have fulfilled many of the research goals described above. Levofloxacin has improved anti-gram-positive potency, PK/PD properties, a proven clinical trial record (particularly for communityacquired pneumonia [CAP]), and an excellent safety profile-in the context of the treatment of Ͼ250 million patients worldwide in the past decade. It is licensed for management of drug-resistant S pneumoniae infections in the United States and has gained widespread formulary acceptance and guideline inclusion. Studies assessing levofloxacin for CAP therapy show significant advantages over standard therapy, such as trends toward reduced IV therapy and length of hospitalization, reduced mortality, and significant associated cost reduction. In addition, levofloxacin has proved highly effective in acute exacerbations of

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“…Pharmacovigilance data revealed that tendinitis occurred in 1/500,000 levofloxacin prescriptions, with tendon ruptures only in 1/1,6 million prescriptions [3], but there are probably a considerable number of unidentified cases. Tendinopathy has been most frequently reported with perfloxacin, but also occurs with levofloxacin [4]. We describe for the first time a patient with levofloxacin-associated tendinitis presenting with reoccurring symptoms induced by phenoxymethylpenicillin therapy 6 months after stopping levofloxacin treatment.…”

mentioning

confidence: 92%

“…Ball et al [1] reported that adverse events associated with fluoroquinolones range from 0.5% to almost 7%. New second-generation fluoroquinolones such as levofloxacin have an extended spectrum of antimicrobial activity compared with older substances but a similar safety profile.The potential of fluoroquinolones to induce tendinitis and even tendon rupture, usually of the Achilles tendon, is low but well documented [2][3][4][5][6][7]. Although different pathophysiological hypotheses are discussed, the mechanisms of this effect are poorly understood.…”

mentioning

confidence: 99%