THU0488\u2005ACHILLES TENDON RUPTURE ASSOCIATED WITH THE USE OF FLUOROQUINOLONES IN PATIENTS OLDER THAN 60 YEARS

Abstract

Background Fluoroquinolones (FQ) are a class of broad-spectrum antibiotics whose use has spread as they are considered safe and well tolerated drugs. Among its musculoskeletal side effects, Achilles tendon rupture (ATR) is a well-known complication that can be disabling, arising recent interest from the pharmacovigilance system after evaluating the reported side effects. Objectives To describe the epidemiological and clinical features of patients diagnosed with FQ-associated ATR in a Spanish tertiary hospital. Methods A retrospective observational study was performed, which included all patients older than 60 years who were diagnosed of ATR in our center during the period 2000-2017, identifying patients who had been previously treated with FQ. The demographic, clinical and outcome data were obtained from their medical records. Results During the study period, 44 patients with ATR were identified, 8 (14.6%) of them previously treated with FQ. In this group of patients, the mean age at diagnosis of ATR was 77.37 ± 9.54 years, being male 6 (75%). Four of them (50%) received concomitant treatment with corticosteroids (CS) and one patient had undergone kidney transplantation due to nephroangiosclerosis. Seven patients (87.5%) were treated with Levofloxacin and one case received Ciprofloxacin, all of them orally. The indication for FQ treatment in half of the cases was acute bronchitis and in the other half exacerbations of underlying respiratory pathology (chronic obstructive pulmonary disease and diffuse interstitial lung disease). The mean duration of treatment with FQ was 6.16 ± 2.4 days, while the mean time from the start of treatment to the diagnosis of ATR was 19.25 ± 14.83 days. In seven patients (87.5%) the rupture was spontaneous, while one patient presented traumatic rupture (low impact traumatism). 87.5% of the ruptures were total ruptures and all cases required surgical treatment, without recurrence reported. The comparison of the characteristics of patients with ATR who had or not received treatment with FQ is shown in the table, identifying significant differences in favor of a higher percentage of patients who were smokers, received concomitant treatment with CS and had spontaneous rupture in the group of patients who had received FQ. Fluoroquinolones Non-Fluoroquinolones p-value Age (years) 77,37 ± 9,54 70,13 ± 8,3 0,48 Sex Male 6 (75%) 25 (69,4%) 0,75 Female 2 (25%) 11 (30,6%) Smoking 5 (62,5%) 1 (2,8%) 0,00 Treatment with CS 4 (50%) 2 (5,6%) 0,01 Treatment with statins 0 (0%) 5 (13,9%) 0,26 Type of rupture Spontaneous 7 (87,5%) 8 (25,8%) 0,01 Traumatic 1 (12,5%) 23 (74,2%) Conclusion The Achilles tendon is the most frequent location of tendinopathy associated with FQ, being affected in 95% of cases. The risk factors associated to an increased risk to develop FQ-associated ATR includes age over 60 years, male gender, chronic treatment with CS and organ transplantation, all these being present in our cases. Despite being a relatively frequent adverse event, it is underdiagnosed and the risk of ATR is not usually assessed when indicating FQ treatment. It is important to perform a risk/benefit assessment, specially in patients with associated risk factors, because most ruptures are complete and require surgical treatment, and may be a potential cause of disability. References [1] Bidell M, Lodise T. Fluoroquinolone-Associated Tendinopathy: Does Levofloxacin Pose the Greatest Risk?. Pharmacotherapy. 2016;36(6):679-93. [2] Godoy-Santos A, Bruschini H, Cury J, Srougi M, De Cesar N, Fonseca L, Maffulli N. Fluoroquinolones and the Risk of Achilles Tendon Disorders: Update on a Neglected Complication. Urology. 2018;113:20-25. Disclosure of Interests None declared