Very recently around the dinner table amongst friends who are physicians this discussion has come up, even an urgent call from an OBGYN colleague recently about this.

The discussion was about after they, themselves take cipro and have noticed tendon pain, particularly in the achilles tendon. In medical school all of us were taught in pharmacology class in the 2nd year that the class of antibiotics called flouroquinolones are notorious for tendon injuries / ruptures / pains. The theory is that the antibiotic interrupts the collagen crosslinks that forms and strengthens the fibers that is the building block of the tendon on the microscopic level. Unfortunately for certain bacterias this class of antibiotic is the only oral medication that will fight the bacteria, namely pseudomonas species,Vibrio etc. While common staph infections, other choices are available.

What is a patient to do. When prescribed a cipro or levaquin and you have had a history of achilles or other tendon problems ask your doctor if there is an alternative? Sometimes there are no other oral alternatives and you may have to do IV infusions vs oral antibiotics. The risk vs reward vs cost of IV infusion need to be evaluated individually.

What do to if you have taken Cipro , etc. and have some tendon side effects?

Call your prescribing doctor immediately

Refrain from high impact activities such as running, jumping

See a specialist for that area of tenderness, eg, Achilles: see your podiatrist

Call us if you have had any adverse reaction to Cipro, Levaquin, Avelox, particularly Achilles tendon pain, if caught early ruptures or tears can be prevented.

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