What tendon pathology is seen on imaging in people who have taken fluoroquinolones? A systematic review.

Fluoroquinolones (FQs) are highly effective broad spectrum antibiotics. Clinical data reveal an increased incidence of tendon pain and rupture in those taking FQs, yet little is known about tendon structural changes. This review synthesises published data on tendon structural changes in people who have taken FQs. Eight databases were searched for potentially relevant articles (Medline, CINAHL, Biological Abstracts, AMED, Web of Knowledge, SCOPUS, SportDiscus and EMBASE) using MeSH and free-text searches. Inclusion and exclusion criteria determined which articles were used for this review. Twenty-six papers met the eligibility criteria. The Achilles tendon was most commonly affected, while ciprofloxacin and levofloxacin were the most commonly implicated FQs. Mean time to onset of symptoms was 16 days following first FQ dose. Imaging modalities used included MRI, B-mode ultrasound, and CT. Tendon measurements were rarely reported and intra-tendinous imaging findings were not reported in a consistent manner. Few studies imaged tendons bilaterally and only two studies were longitudinal in design.

Future studies should report imaging measures such as thickness and cross-sectional area, and use consistent descriptions of intra-tendinous changes during and post FQ treatment.