Article Figures & Data
Figures
- Figure 1.
Schematic diagram of the observation period for a hypothetical patient according to the self-controlled case series design.
Note: The observation period for each Achilles tendon rupture case (outcome 0, no event; outcome 1, Achilles tendon rupture) was divided into baseline and exposure periods for each antibiotic (exposure 0, baseline period; exposure 1, first- and second-generation fluoroquinolones risk period; exposure 2, third-generation fluoroquinolones risk period; exposure 3, nonfluoroquinolones risk period). The risk period was set at 30 days from antibiotic prescription according to a previous study. If the risk periods for different antibiotics overlapped, the stacked risks for Achilles tendon rupture in the overlapping risk periods were combined.
Tables
First Generation Second Generation Third Generation Norfloxacin Levofloxacin Garenoxacin Nalidixic acid Tosufloxacin Sitafloxacin Pipemidic acid Ciprofloxacin Prulifloxacin Ofloxacin Moxifloxacin Lomefloxacin Pazufloxacin Characteristic Value Age, median (IQR), y 64 (48-74) Age-group, No. (%) <20 years 28 (6) 20-60 years 170 (34) >60 years 306 (61) Sex, No. (%) Male 299 (59) Female 205 (41) IQR = interquartile range.
Notes: Characteristics were as recorded at the start of the observation period.
Antibiotic Type Incidence Rate Ratio (95% CI) First- and second-generation fluoroquinolones 2.94 (1.90-4.54) Third-generation fluoroquinolones 1.05 (0.33-3.37) Nonfluoroquinolones 1.08 (0.80-1.47) Note: For each patient, comparator was the period with no antibiotic exposure.
Subgroup Incidence Rate Ratio (95% CI) First- and Second-Generation Fluoroquinolones Third-Generation Fluoroquinolones Nonfluoroquinolones Sex Male 2.94 (1.67-5.18) 0.63 (0.09-4.60) 1.06 (0.71-1.59) Female 2.86 (1.45-5.66) 1.67 (0.39-7.06) 1.14 (0.71-1.83) Recent corticosteroid usea Yes 8.34 (2.27-30.67) 6.30 (0.61-64.81) 0.92 (0.27-3.12) No 2.52 (1.32-4.81) 0.00 (0.0 to ∞) 1.07 (0.70-1.64) ↵a Use in the 30 days preceding Achilles tendon rupture.
The Article in Brief
Association Between Third-Generation Fluoroquinolones and Achilles Tendon Rupture: A Self-Controlled Case Series Analysis
Takashi Chinen , and colleagues
Background It’s widely understood that people taking a common class of antibiotics like ciprofloxacin and levofloxacin run the risk of tendonitis and tendon ruptures. However, a new analysis sheds light on newer, third-generation fluoroquinolones and suggests they may have a lower risk of Achilles tendon rupture.
What This Study Found Researchers from Jichi Medical University in Tochigi, Japan, used health care administrative data to identify 504 patient cases of Achilles tendon ruptures with co-occurrence of antibiotics. They found that third-generation fluoroquinolones were not associated with an increase in Achilles tendon rupture. First and second generation fluoroquinolones like ciprofloxacin and ofloxacin were at elevated risk of tendon rupture, which was consistent with previous evidence.
Implications
- Third-generation fluoroquinolone use was not associated with an increased risk of Achilles tendon rupture. These antibiotics may be a safer option for patients in whom this risk is elevated, such as athletes.
- Further studies are required to determine the risks of third-generation fluoroquinolones for other rare adverse events, such as aortic damage.
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