Fluoroquinolone Antibiotics and Tendon Injury in Adolescents

Abstract

In this study, we analyzed 7.6 million antibiotic prescriptions to estimate the association between oral fluoroquinolone antibiotic treatment and tendon injury in adolescents. OBJECTIVES: To estimate the association between fluoroquinolone use and tendon injury in adolescents. METHODS: We conducted an active-comparator, new-user cohort study using population-based claims data from 2000 to 2018. We included adolescents (aged 12–18 years) with an outpatient prescription fill for an oral fluoroquinolone or comparator broad-spectrum antibiotic. The primary outcome was Achilles, quadricep, patellar, or tibial tendon rupture identified by diagnosis and procedure codes. Tendinitis was a secondary outcome. We used weighting to adjust for measured confounding and a negative control outcome to assess residual confounding. RESULTS: The cohort included 4.4 million adolescents with 7.6 million fills for fluoroquinolone (275\u2009767 fills) or comparator (7\u2009365\u2009684) antibiotics. In the 90 days after the index antibiotic prescription, there were 842 tendon ruptures and 16\u2009750 tendinitis diagnoses (crude rates 0.47 and 9.34 per 1000 person-years, respectively). The weighted 90-day tendon rupture risks were 13.6 per 100\u2009000 fluoroquinolone-treated adolescents and 11.6 per 100\u2009000 comparator-treated adolescents (fluoroquinolone-associated excess risk: 1.9 per 100\u2009000 adolescents; 95% confidence interval −2.6 to 6.4); the corresponding number needed to treat to harm was 52\u2009632. For tendinitis, the weighted 90-day risks were 200.8 per 100\u2009000 fluoroquinolone-treated adolescents and 178.1 per 100\u2009000 comparator-treated adolescents (excess risk: 22.7 per 100\u2009000; 95% confidence interval 4.1 to 41.3); the number needed to treat to harm was 4405. CONCLUSIONS: The excess risk of tendon rupture associated with fluoroquinolone treatment was extremely small, and these events were rare. The excess risk of tendinitis associated with fluoroquinolone treatment was also small. Other more common potential adverse drug effects may be more important to consider for treatment decision-making, particularly in adolescents without other risk factors for tendon injury.