Impact of age, sex, obesity, and steroid use on quinolone-associated tendon disorders

Am J Med. 2012 Dec;125(12):1228.e23-1228.e28. doi: 10.1016/j.amjmed.2012.05.027. Epub 2012 Sep 28.


Background: Quinolone antibiotics are associated with increased risk of tendinopathy. Identifying at-risk individuals has important clinical implications. We examined whether age, sex, glucocorticoid use, obesity, diabetes, and renal failure/dialysis predispose individuals to the adverse effects of quinolones.

Methods: Among 6.4 million patients in The Health Improvement Network (THIN) database, 28,907 cases of Achilles tendonitis and 7685 cases of tendon rupture were identified in a case-crossover study. For each participant, we ascertained whether there was a prescription of a quinolone and comparison antibiotic within 30 days before the diagnosis of tendon disorder (case period) and a prescription of the same medications within 30 days 1 year before disease diagnosis (control period).

Results: Use of quinolones was strongly associated with an increased risk of Achilles tendonitis (odds ratio [OR], 4.3; 95% confidence interval [CI], 3.2-5.7) and tendon rupture (OR, 2.0; 95% CI, 1.2-3.3). No association was found between the use of other antibiotics and either outcome. The association with Achilles tendonitis was stronger among participants who were aged more than 60 years (OR, 8.3 vs 1.6), who were nonobese (OR, 7.7 vs 2.4), and who used oral glucocorticoids (OR, 9.1 vs 3.2). The association was nonsignificantly stronger in women (OR, 5.0 vs 3.6), diabetic persons (OR, 7.0 vs 4.1), and those in renal failure or receiving dialysis (OR, 20.0 vs 3.9). The effect for tendon rupture was stronger in women, with borderline significance in glucocorticoid users and nonobese persons.

Conclusion: Quinolone-associated tendinopathy is more pronounced among elderly persons, nonobese persons, and individuals with concurrent use of glucocorticoids.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Achilles Tendon
  • Age Factors
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects*
  • Databases, Factual
  • Diabetes Mellitus / epidemiology
  • Drug Prescriptions / statistics & numerical data
  • Female
  • Fluoroquinolones / administration & dosage
  • Fluoroquinolones / adverse effects*
  • Glucocorticoids / therapeutic use
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Obesity / epidemiology
  • Renal Dialysis
  • Rupture / epidemiology
  • Sex Factors
  • Tendinopathy / epidemiology*
  • Tendon Injuries / epidemiology*


  • Anti-Bacterial Agents
  • Fluoroquinolones
  • Glucocorticoids