Two days on ciprofloxacin — why did his Achilles tendon snap?
Quinolone antibiotics can damage tendons. Age over 60 and a steroid make it far more likely.
Select any card for the reasoning, what to watch for and an exam tip.
The puzzle
A 76-year-old man takes prednisolone for polymyalgia rheumatica. He is given ciprofloxacin for acute prostatitis. Two days later his heel aches, and while climbing the stairs he feels a sudden kick at the back of his ankle and can’t push off on that foot.
The answer, step by step
Who is most at risk
- People over 60.
- Anyone taking a corticosteroid.
- Kidney impairment, or a solid-organ transplant.
- A past tendon problem on a quinolone: contra-indicated.
What to do
Key takeaway
Ciprofloxacin and other quinolones can rupture tendons, sometimes within 48 hours. Avoid them with corticosteroids, take care over 60, use them only when other antibiotics are unsuitable, and tell patients to stop at the first tendon pain.