Observational studyBMJ open2020
Association between tendon ruptures and use of fluoroquinolone, and other oral antibiotics: a 10-year retrospective study of 1 million US senior Medicare beneficiaries.
Observational study in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 44 citations in OpenAlex.
- Risk of antimicrobial-associated organ injury among the older adults: a systematic review and meta-analysis.BMC geriatrics · 2021Pooled it
- Fluoroquinolone Use and Risk of Pneumothorax in Adults Hospitalized With Community Acquired Pneumonia: A Retrospective Cohort Study.The clinical respiratory journal · 2026Article
- Performance of the Self-Controlled Case Series for Drug Safety Signal Detection: A Multi-Database Study.Pharmacoepidemiology and drug safety · 2026Article
- Activity of Natural Substances and n-Undecyl-α/β-l-Fucopyranoside Against the Formation of Pathogenic Biofilms byAntibiotics (Basel, Switzerland) · 2026Article
- Use of oral fluoroquinolones in France between 2014 and 2023: a nationwide drug utilization study.JAC-antimicrobial resistance · 2025Article
- A Prospective Randomized Pilot Study on the Efficacy of a Dietary Supplementation Regimen of Vitamin E and Selenium for the Prevention of Fluoroquinolone-Induced Tendinopathy.Pharmaceuticals (Basel, Switzerland) · 2025Article
- Article
- Analyses of Adverse Drug Reactions to Fluoroquinolones in Spontaneous Reports Before and After the Referral and in Clinical Routine Cases.Drugs in R&D · 2025Article
- Pouchitis unveiled: exploring clinical features, diagnosis, and cutting-edge treatments.Therapeutic advances in gastroenterology · 2025Review
- Recent developments in Achilles tendon risk-analyzing rupture factors for enhanced injury prevention and clinical guidance: Current implications of regenerative medicine.Journal of orthopaedic translation · 2024Review
- Achilles tendon complications of fluoroquinolone treatment: a molecule-stratified systematic review and meta-analysis.EFORT open reviews · 2024Article
- Drugs Associated with Adverse Effects in Vulnerable Groups of Patients.Clinics and practice · 2024Review
- Acute Patellar Tendon Ruptures: An Update on Management.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2024Article
- Article
- Overview of Side-Effects of Antibacterial Fluoroquinolones: New Drugs versus Old Drugs, a Step Forward in the Safety Profile?Pharmaceutics · 2023Review
- Treatment of proximal patellar tendon rupture with custom-made anchor-like plate and suture: cases report and literature review.Frontiers in surgery · 2023Article
- Extensor mechanism ruptures.EFORT open reviews · 2022Review
- Optimizing repair of tendon ruptures and chronic tendinopathies: Integrating the use of biomarkers with biological interventions to improve patient outcomes and clinical trial design.Frontiers in sports and active living · 2022Review
- Fluoroquinolone-associated suspected tendonitis and tendon rupture: A pharmacovigilance analysis from 2016 to 2021 based on the FAERS database.Frontiers in pharmacology · 2022Article
- Fluoroquinolone-Transition Metal Complexes: A Strategy to Overcome Bacterial Resistance.Microorganisms · 2021Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo assess the association of fluoroquinolone use with tendon ruptures compared with no fluoroquinolone and that of the four most commonly prescribed non-fluoroquinolone antibiotics in the USA.
designRetrospective observational study.
settingUS seniors enrolled in the federal old-age, survivor's insurance programme.
participants1 009 925 Medicare fee-for-service beneficiaries and their inpatient, outpatient, prescription drug records were used.
interventionsSeven oral antibiotics, fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) and amoxicillin, amoxicillin-clavulanate, azithromycin and cephalexin. PRIMARY AND SECONDARY OUTCOME MEASURES: All tendon ruptures combined, and three types of tendon ruptures by anatomic site, Achilles tendon rupture, rupture of rotator cuff and other tendon ruptures occurred in 2007-2016.
resultsOf three fluoroquinolones, only levofloxacin exhibited a significant increased risk of tendon ruptures-16% (HR=1.16; 95% CI 1.06 to 1.28), and 120% (HR=2.20; 95% CI 1.50 to 3.24) for rotator cuff and Achilles tendon rupture, respectively, in the ≤30 days window. Ciprofloxacin (HR=0.96; 95% CI 0.89 to 1.03) and moxifloxacin (HR=0.59; 95% CI 0.37 to 0.93) exhibited no increased risk of tendon ruptures combined.Among the non-fluoroquinolone antibiotics, cephalexin exhibited
conclusionsIn our study, fluoroquinolones as a class were not associated with the increased risk of tendon ruptures. Neither ciprofloxacin nor moxifloxacin exhibited any risk for tendon ruptures. Levofloxacin did exhibit significant increased risk. Cephalexin with no reported effect on metalloprotease activity had an equal or greater risk than levofloxacin; so we question whether metalloprotease activity has any relevance to observed associations with tendon rupture. Confounding by indication bias may be more relevant and should be given more consideration as explanation for significant associations in observational studies of tendon rupture.
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Registered trials
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