Increased risk of achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids

Arch Intern Med. 2003 Aug 11-25;163(15):1801-7. doi: 10.1001/archinte.163.15.1801.


Background: In several case reports, the occurrence of Achilles tendon rupture has been attributed to the use of quinolones, but the epidemiologic evidence for this association is scanty.

Methods: We conducted a population-based case-control study in the General Practice Research Database in the United Kingdom during the period 1988 through 1998. Cases were defined as all persons who had a first-time recording of an Achilles tendon rupture, and who had at least 18 months of valid history before the index date. As a control group, we randomly sampled 50 000 patients with at least 18 months of valid history who were assigned a random date as index date.

Results: We identified 1367 cases that met the inclusion criteria. The adjusted odds ratio (OR) for Achilles tendon rupture was 4.3 (95% confidence interval [CI], 2.4-7.8) for current exposure to quinolones, 2.4 (95% CI, 1.5-3.7) for recent exposure, and 1.4 (95% CI, 0.9-2.1) for past exposure. The OR of Achilles tendon rupture was 6.4 (95% CI, 3.0-13.7) in patients aged 60 to 79 years and 20.4 (95% CI, 4.6-90.1) in patients aged 80 years or older. In persons aged 60 years and older, the OR was 28.4 (95% CI, 7.0-115.3) for current exposure to ofloxacin, while the ORs were 3.6 (95% CI, 1.4-9.1) and 14.2 (95% CI, 1.6-128.6) for ciprofloxacin and norfloxacin, respectively. Approximately 2% to 6% of all Achilles tendon ruptures in people older than 60 years can be attributed to quinolones.

Conclusions: Current exposure to quinolones increased the risk of Achilles tendon rupture. The risk is highest among elderly patients who were concomitantly treated with corticosteroids.

MeSH terms

  • 4-Quinolones
  • Achilles Tendon / drug effects*
  • Administration, Oral
  • Adrenal Cortex Hormones / adverse effects*
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Infective Agents / adverse effects*
  • Anti-Inflammatory Agents / adverse effects*
  • Case-Control Studies
  • Drug Therapy, Combination
  • Family Practice
  • Female
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Risk Assessment
  • Risk Factors
  • Rupture, Spontaneous / chemically induced
  • Steroids
  • United Kingdom


  • 4-Quinolones
  • Adrenal Cortex Hormones
  • Anti-Infective Agents
  • Anti-Inflammatory Agents
  • Steroids