Association Between Third-Generation Fluoroquinolones and Achilles Tendon Rupture: A Self-Controlled Case Series Analysis - PubMed (original) (raw)

Association Between Third-Generation Fluoroquinolones and Achilles Tendon Rupture: A Self-Controlled Case Series Analysis

Takashi Chinen et al. Ann Fam Med. 2021 May-Jun.

Abstract

Purpose: We investigated whether use of third-generation fluoroquinolones is associated with occurrence of Achilles tendon rupture using a case series analysis in which patients served as their own control.

Methods: We used administrative claims data to identify residents in a single Japanese prefecture who were enrolled in National Health Insurance and Elderly Health Insurance from April 2012 to March 2017 and experienced Achilles tendon rupture after receiving an antibiotic prescription. Antibiotics were categorized into 3 groups: first- and second-generation fluoroquinolones, third-generation fluoroquinolones, and nonfluoroquinolones. We used a conditional Poisson regression model to estimate the incidence rate ratio (IRR) of Achilles tendon rupture during the antibiotic exposure period relative to the nonexposure period for each patient. An exposure period was defined as 30 days from start of the prescription.

Results: Analyses were based on 504 patients with Achilles tendon rupture who had received antibiotic prescriptions. Risk of rupture was not significantly elevated during exposure to third-generation fluoroquinolones (IRR = 1.05; 95% CI, 0.33-3.37) and nonfluoroquinolones (IRR = 1.08; 95% CI, 0.80-1.47). In contrast, risk was significantly elevated during exposure to first- and second-generation fluoroquinolones (IRR = 2.94; 95% CI, 1.90-4.54). Findings were similar across subgroups stratified by sex and by recent corticosteroid use.

Conclusions: Our analysis showed that 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.

Keywords: Achilles tendon rupture; adverse effects; antibiotics; fluoroquinolone; precision medicine; self-controlled case series; tendon injuries.

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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.

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References

1. Stephenson AL, Wu W, Cortes D, Rochon PA.. Tendon injury and fluoroquinolone use: a systematic review. Drug Saf. 2013; 36(9): 709–721. - PubMed
1. Sode J, Obel N, Hallas J, Lassen A.. Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study. Eur J Clin Pharmacol. 2007; 63(5): 499–503. - PubMed
1. Wise BL, Peloquin C, Choi H, Lane NE, Zhang Y.. Impact of age, sex, obesity, and steroid use on quinolone-associated tendon disorders. Am J Med. 2012; 125(12): 1228.e23–1228.e28. - PMC - PubMed
1. van der Linden PD, Sturkenboom MC, Herings RM, Leufkens HM, Rowlands S, Stricker BH.. Increased risk of Achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids. Arch Intern Med. 2003; 163(15): 1801–1807. - PubMed
1. Tsutsui A, Yahara K, Shibayama K.. Trends and patterns of national antimicrobial consumption in Japan from 2004 to 2016. J Infect Chemother. 2018; 24(6): 414–421. - PubMed

Association Between Third-Generation Fluoroquinolones and Achilles Tendon Rupture: A Self-Controlled Case Series Analysis - PubMed (original) (raw)