Case report
Management of bilateral Achilles tendon rupture associated with ciprofloxacin: A review and case presentation

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Summary

Fluoroquinolone antibiotics are increasingly being recognized as a cause of Achilles tendinitis and rupture. We report the case of a 62-year old man who developed bilateral Achilles tendon rupture six days following commencement of ciprofloxacin. Tendon exploration and repair was accomplished with the use of a prosthetic substitute (Leeds-Keio ligament) but healing was complicated by left wound breakdown that was successfully repaired with a perforator-based fasciocutaneous flap. A review of the current literature on fluoroquinolone associated achilles ruptures and the various methods of tendon and soft tissue management of the primary or complicated injuries are discussed.

Section snippets

Case report

A 62-year old man with known asthma and mild chronic obstructive airway disease (COAD) of ten years duration was prescribed a one-week course of Ciprofloxacin, 250 mg twice daily by his General Practitioner (GP) for lower respiratory tract infection. His regular medication consisted of Salbutamol and Beclomethasone inhalers and oral Prednisolone 10 mg daily. While undertaking some maintenance work at home on the sixth day, he felt a sudden pain and snap in his calf and developed a limp with

Discussion

Since the first report of the association of Fluoroquinolone and tendon disorders in 1983 a causal relationship has emerged between these antibiotics and tendon ruptures from comparative studies5, 6 and a temporal relationship often exists between the intake of FQ and the occurrence of tendon disorders in reported cases. The ratio of tendinitis to rupture is 3:17 while another study reported revealed a rate of 2.4 and 1.2 respectively per 10 000 patients.5 Although over 95% cases of tendinitis

Acknowledgments

We would like to acknowledge the contribution of Mr TL Thomas, Consultant Orthopaedic Surgeon, Colchester General Hospital, Colchester, Essex, UK who played an integral part in the management of the patient.

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