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Levofloxacin-Induced Tendon Rupture: A Case Report and Review of the Literature From the Departments of Internal Medicine (LG) and Dermatology (HI), Mount Sinai Medical Center, Miami Beach, Florida, and Private Practice of Dermatology, Miami Beach, Florida Treatment with the fluoroquinolone class of antibiotics has become increasingly popular. Clinician preference for quinolones stems from their excellent gastrointestinal absorption, superior tissue penetration and broad-spectrum activity.1,2 However, this has led to widespread and indiscriminate use, affecting microbial resistance patterns and increasing drug-related morbidity.3 Although quinolone-induced tendonopathy and tendon rupture have been previously described in the literature, reports of tendon rupture in association with newer quinolones such as levofloxacin are now emerging.4,5 We describe a patient with levofloxacin-induced partial rupture of the Achilles tendon and review the literature, pathophysiology, predisposing factors, and treatment recommendations. Although quinolone-induced tendon rupture has been described in the literature,6,7 case reports of complete or partial tendon rupture specifically attributed to levofloxacin are rare thus far.4,5 Quinolone-induced tendonopathy was noted as early as 1983; Bailey et al8 reported a norfloxacin-related tendonitis in a patient with kidney failure. The first case of a tendon rupture associated with ciprofloxacin was reported in 1987.9 A pefloxacin-related tendon rupture reported in 1991 led to the published recognition of this complication in the VIDAL (French PDR) in 1992.1 In October 1996, the US Food and Drug Administration first issued a Report of Adverse Events and revised the class labeling for fluoroquinolones to include a warning of possible tendonitis/tendon rupture after more than 200 reports of quinolone-related tendonopathy over a 10-year period.10 A warning based on postmarketing surveillance reports was added to the PDR in December 2001, indicating that this risk may be increased in patients receiving concomitant corticosteroids, especially in the elderly.2 An epidemiologic study from the United Kingdom in 2002 calculated the excess risk for quinolone-induced tendonopathy at 3.2 per 1000 patient years.11 A 2001 worldwide surveillance report estimated levofloxacin-associated tendon ruptures at less than 4 per million prescriptions.5 cheapest levaquin levofloxacin review inexpensive dose Topic: cheapest levaquin levofloxacin review inexpensive dose (Read 13 times) Levofloxacin Reviews Ratings at Drugs.com A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Advanced Phonetic I don't like Levaquin at all. The doctor prescribed this to me after going in for acute sinusitus and bronchitis. He said it was a strong medication. The first night I woke up suddenly with a massive headache, and then heartburn. The next day I noticed more problems which made me feel even worse than my original ailments. I had cold sweats, felt nervous, anxious and like I was losing my mind! I couldn't sleep.I've been given this medicine twice - once for serious bronchitis/pneumonia that nearly required hospitialization. Since I am a well trained athlete, hospitalization for a lung infection was serious. Doctors tried several other drugs before the Levaquin, but Levaquin was best. Now dealing with a relatively minor bronchitis and have it again.
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