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Antibiotic-induced tendonitis?
Old 03-21-2009, 12:31 AM   #1
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Antibiotic-induced tendonitis?

Short version: DH and I were prescribed Levaquin to combat a recurring sinus infection. I hadn't heard about the drug before, so read the label. A potential side effect was tendonitis, tendon rupture, and other related tendon effects, though they were mostly confined to elderly people. OK, whatever, we take the drug.

The next day, I've got a sore knee and a sore ankle. The day after that, I've got a very sore Achilles tendon, and DH can barely walk, his knees hurt so badly. We call our practitioner, report what's going on, and she switches our antiobiotics to azithromycin, which we take. A couple days of babying and my Achilles is OK; DH, on the other hand, can still barely walk, his knees hurt so badly. He has an appointment with an orthopedist on Wednesday.

The info we've found on the web is not reassuring; basically, it says that the tendon problems can begin even months after the antibiotics are taken, and that they can persist for years. Little seems to be known about how to prevent, reverse, or cure the problem.

I recognize that correlation is not the same as causality, but we also subscribe to Occam's razor: the simplest explanation wins. We've got nothing else to attribute DH's severe knee pain to, and nothing else to attribute my Achilles problem to, as I've never had issues with my Achilles tendon before.

So here's the question: Has anyone on the boards had Levaquin or antibiotic-induced tendonitis or tendon rupture? Anyone know where we can find more (real) information about it? Anyone use magnesium to treat tendonitis, and how'd it go? And yes, we'll pursue the matter thoroughly through our docs, but we're just casting our net wide at this point.

Thanks for any tips/pointers.
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Old 03-21-2009, 08:50 AM   #2
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Urchina, the class of antibiotics called "quinolones" (levofloxacin, ciprofloxacin, and others) can do this, though I have never seen it cause "polyarthrtis" involving many joints at a time. That feature alone would lead me to at least do a basic check for alternatives such as gout, late onset inflammatory arthritis, etc.

If nothing turned up, the drug is a prime suspect for his symptoms. Be sure he stays in close contact with your doc til this thing is gone in a few weeks.
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Old 03-21-2009, 08:09 PM   #3
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This happened to me, with the same drug Levaquin - I don't think I even took it for 2 full days and the effect was extremely painful. For me, it settled into my achilles and into my knees, the ankles/heels are worse, though. It has been 6 or 7 years and it still pops up to haunt me occasionally, although it was far worse for the first couple years (daily pain). Thankfully nothing ever ruptured, but I've always eased off any exercise or walking when I have flare-ups.

Based on an internet recommendation I found around the couple year mark, I began taking magnesium daily and also flaxseed oil for the omega-3s. I figured that those 2 certainly wouldn't do any harm and might do some good. I'd like to think that they did, as it's reduced to an occasional situation now. YMMV, of course... and I'm certainly no medical professional.

I now know to NEVER take this drug again, or any other in the quinalone family.

Best wishes Urchina! I hope you and your husband's healing is fast & easy.

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Old 03-22-2009, 05:14 AM   #4
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I'm also not a Dr., but I wonder why a drug with this side effect profile would have been a first choice in your situation(s). Is this drug considered first line treatment for sinus infection?

I'd be camping on my Dr.'s door step until he figured this out and got some resolution. Best of luck to you both!
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Old 03-22-2009, 06:27 AM   #5
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Just an ordinary consumer like others...

But I would HATE to think that this is a drug that is even available... unless it is one of the last drugs tried on whatever is the problem...

I can tell you I would rather fight an infection without drugs than have a potential permanent disability just for taking a drug a couple of days...

And the FDA approves of this drug
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Old 03-22-2009, 07:58 AM   #6
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Quote:
Originally Posted by Texas Proud View Post
Just an ordinary consumer like others...

But I would HATE to think that this is a drug that is even available... unless it is one of the last drugs tried on whatever is the problem...

I can tell you I would rather fight an infection without drugs than have a potential permanent disability just for taking a drug a couple of days...

And the FDA approves of this drug
I was also prescribed it for a "creeping crud" sinus-infection-forever-lasting-cold. I don't know why I wasn't given something simpler like amoxycillin first, and I wish I'd known the havoc it would cause with me with as little as 4 doses. I think the PA must have been thinking to just knock the crud right out of me.

At the time it happened, the "statistics" said it was a 1-in-500 chance that it could affect your tendons. I wonder if perhaps that number is rising as more data is collected?

I did file an adverse drug reaction report in conjunction with my doctor's office (I think it was with the FDA). I figure that's the only way to make sure that this powerful antibiotic is used properly and for the right reasons. "Creeping crud" not being one of them...

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Old 03-22-2009, 08:40 AM   #7
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This didn't happen to me, but I was prescribed an antibiotic recently that had a big warning on the insert about tendon damage/possible Achilles rupture, etc. It said the effects were more likely if your were also on steroids (I was), and if you were over 65 or so (I'm not).

Still, I didn't like the sound of it. I decided to just take the prednisone (this was to be my 2nd round of prednisone, and 3rd round of antibiotics for a relapse of nasty bronchitis) and see if I got better with that alone. I had been improving but wasn't quite 100%. I figured if I didn't get better, I'd start the antibiotic. I know, I know, self-doctoring is not a good idea...but tendon damage with a BIG warning was NOT something I was going to risk.

Well, I DID get better with the prednisone and inhaler alone. The medication is still sitting untouched in my medicine cabinet. Very glad I went with my own advisement on this one.

Sometimes I think the nurse practitioners overmedicate with a shotgun approach. I have learned to read the inserts carefully. Not one person (MD, NP, PharmD) warned me about the side effects when they prescribed/dispensed this. I had to read it on my own.
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Old 03-22-2009, 08:41 AM   #8
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1:500 chance of tendon inflammation (quinolones)
1: 20 chance of significant rash or diarrhea (almost any antibiotic)

Sinusitis: maybe 24 hours less symptoms of nasal congestion.
Kind of a value judgment, but I'd pass every time (and advise my patients accordingly; some exceptions exist)

Same risks, but now consider a different diagnosis: acute kidney infection (pyelonephritis), serious pneumonia, bad and big skin infection, etc.-- all of which can be fatal. I'd run to take the drug and take my 0.02% chance of tendon inflammation.

The problem is not with the drug (they all have side-effects in at least a small percentage of patients), it's with the threshold of disease suffering and benefit for which it's given.

Sorry for your awful symptoms.
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Old 03-22-2009, 09:19 AM   #9
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I'm glad there's a real MD on the forum to give his views. When I read the first post, my reaction was, "Whaa....2 days on the drug, and already such a severe [yet uncommon] reaction in both people?

I wondered, what else could they have been doing, to bring on these awful problems?

It's not like food poisoning, where you each eat the same bad food and get the trots. Each person has only a .02 chance of the drug reaction, so my very rudimentary statistics tells me that the probability of 2 reactions in same couple = .02 x .02, or .0004.

What else could cause severe tendinitis?
--unusual exertion? Maybe a while ago, so the couple didn't remember?
--tendon stress over time?
--some food additive being consumed over a period of time?

Just thoughts, no judgment implied. Best wishes for complete recovery!
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Old 03-22-2009, 09:58 AM   #10
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Quote:
Originally Posted by Amethyst View Post
I wondered, what else could they have been doing, to bring on these awful problems?

What else could cause severe tendinitis?
--unusual exertion? Maybe a while ago, so the couple didn't remember?
--tendon stress over time?
--some food additive being consumed over a period of time?
FWIW, the tendon problems probably are from the drug, absent any obvious history of overuse, etc. But 1:500 are odds most people would accept if the benefit were great enough. A good reminder that sometimes the black swan catches up to you.
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Old 03-22-2009, 03:57 PM   #11
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Originally Posted by Rich_in_Tampa View Post
FWIW, the tendon problems probably are from the drug, absent any obvious history of overuse, etc. But 1:500 are odds most people would accept if the benefit were great enough. A good reminder that sometimes the black swan catches up to you.
I wonder, though, why doctors seem to hop around on these drugs. Isn't there some sort of guidelines regarding least potentially harmful first, moving to others as needed? Or is it based on trying to keep the bugs from getting too resistant to a particular antibiotic?

I'm also not sure some doctors spend enough time going over possible options with their patients vis-a-vis drugs. I know in my case, when I got diagnoses type II diabetic I got put on a drug. I started taking it, then did some research on the web (the doctor's best friend and worst enemy ). It turns out that the particular drug had some major FDA warnings about increasing the chances of heart attacks. And here I was, brother to a man who had died of a heart attack at age 42. I stopped the drug myself, then spent 6 months getting my blood sugar under control through diet and exercise. I never could get good explaination from my (ex) doctor as to why he put me on that particular med.
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Old 03-22-2009, 06:20 PM   #12
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I wonder, though, why doctors seem to hop around on these drugs. Isn't there some sort of guidelines regarding least potentially harmful first, moving to others as needed? Or is it based on trying to keep the bugs from getting too resistant to a particular antibiotic?

I'm also not sure some doctors spend enough time going over possible options with their patients vis-a-vis drugs. I know in my case, when I got diagnoses type II diabetic I got put on a drug. I started taking it, then did some research on the web (the doctor's best friend and worst enemy ). It turns out that the particular drug had some major FDA warnings about increasing the chances of heart attacks. And here I was, brother to a man who had died of a heart attack at age 42. I stopped the drug myself, then spent 6 months getting my blood sugar under control through diet and exercise. I never could get good explaination from my (ex) doctor as to why he put me on that particular med.
Good points. There usually are guidelines and they are generally adhered to, though many leave several options available.

Why do doctors prescribe too readily in some cases? In a small percentage of cases it is incompetence; others include marketing hype by big pharmaceuticals (e.g. the 'glitazones for diabetes), patient pressure (got a cold, need an antibiotic NOW). Other times they have the facts right but don't always weigh the risks and benefits. Sometimes it's fear of missing something -- just CYA. That last one backfires more often than not.

My estimate (and only that) is that 90% of the time the right thing is done. In the remaining 10%, the recommendation is correct but the patient didn't share in the decision as to how much discomfort, risk, etc. they are willing to accept. Finally, there are a few total inappropriate cases which usually turn out OK, but have the potential to be very bad.

As with so many things that you do differently as you gather experience (read get older), I have grown less likely to treat when a short observation period combined with safe symptomatic treatments will do. Most patients are accepting of this if you take a couple of minutes to explain.

It's OK to ask your doctor if we held off a few days and see how it goes. It kind of gives them permission to not treat.
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Old 03-23-2009, 12:48 PM   #13
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To digress, I've had a couple of bad effects (one potentially life-threatening,
one merely annoying) to drugs I probably didn't need to be taking.

The first was Clindamycin for a skin staph infection. I got colitis. Bad sh*t (no
pun intended); diarrhea for over two weeks, and feeling pretty crappy for the
remainder of a month. Probably could have got by without an antibiotic. But
Clindamycin is risky. The ironic, and instructive, thing is, it was MY fault to a
large extent. I had self-medicated over the weekend, since I had some lying
around as dental prophylaxis (asymptomatic mitral-valve prolapse); so I talked
the nurse practitioner into just continuing me on that. Another irony is that they
no longer recommend abx pre-medication for dental work for people like me.

The second was some prostatitis and primary doc gave me Flomax (you MAY have
noticed advertisements for this stuff Well, I got an interesting side-effect
called "retrograde ejaculation" (I know, TMI). Went to very-highly regarded
urologist (my doc said "I got HIM to do my vasectomy") and he said "oh, no problem,
there's another drug that doesn't do that [Uroxatral ?]". Funny, never heard of that
one, no mass advertising campaign. Here's the kicker: the urologist pretty much
stated that he thought the well-known study showing that saw palmetto is ineffective
was rigged by the drug companies, and is contradicted by anecdotal evidence from
his 30 years of practice. Interestingly, this is one place where my conventional
provider and TCM (traditional Chinese medicine) guy are on the SAME page: any
male over 40yo should be taking saw palmetto, symptoms or not. I'm fine now,
with no drugs (other than the saw palmetto).
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Old 03-25-2009, 06:22 PM   #14
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Hi all. Thank you for your thoughtful responses, and Rich, thanks for the data.

DH saw the orthopedist today; I went with him, to have another brain and pair of ears working on the problem. The MD diagnosed DH's problems as his kneecaps being pulled laterally (to the side) when flexing and bending, causing irritation and pain in the knees. He acknowledged that it could have been subsequent to the Levaquin, but didn't give us a for-sure (which we didn't expect, as it's not really possible). Treatment: ibuprofen, icing at night before bed, and physical therapy to strengthen inner quadriceps muscles (to pull the kneecap back into alignment). Prognosis is good: 90% chance of recovery (well, actually, 90% of people with this condition report improvement after physical therapy, but we'll take that as a 90% chance, even if that's not statistically accurate terminology).

And we'll never take the drugs again, unless it's life-threatening (as for, example, inhaled anthrax).

Amethyst, I, too, wish we could attribute this to something other than the drug, but I'm sorry to say that we've had very boring lives lately; no trekking in the Himalayas, no waterskiing, no handball tournaments. Just the odds caught up with both of us at the same time. And although you're right, that the chances of us both having the same reaction to the drug are small, our individual chances of having the reaction to the drug remain the same.

Thanks for the thoughts and ideas, again, and we'll move onward with physical therapy and lots of ibuprofen.
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Old 03-25-2009, 06:47 PM   #15
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I understand that there is a risk/benefit ratio with all drugs. What I don't understand is why doctors so rarely ask me to be a part of the decision making process. If the doc says there is a 1 in 100 chance this drug will (pick an outcome) and if you don't take it (or take this other, maybe less effective drug) there's a 1 in 10 chance of (pick an outcome). Then I can make an informed decision. I'm not stupid and I'm not even ignorant. What would be the harm in including the patient in the decision making process?

If I were ever to take legal action against a doc it wouldn't be because I simply didn't like the outcome. It would be because he denied me a role in the decision making process.
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Old 07-08-2010, 03:57 PM   #16
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Just wondering how people suffering from antibiotic induced tendonitis are recovering? I had been on Levaquin in the spring of '09 for chronic sinus infections and had to stop the med due to knee and elbow pain. It cleared but tendonitis set in in my achilles tendons. It's been there ever since. I filed a report with the FDA but am wondering if I'll ever rid myself of this discomfort. Just curious how others are making out.
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Old 07-10-2010, 02:58 AM   #17
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My dd was prescribed cipro after appendectomy - she had a really bad infection in her abdomen and they blasted her with antibiotics and she's had an allergic reaction to pencillin based ones so they gave her this one.

Upon reading the label - it was enough to give any mom a heart attack! The warning label says all over it that it is a drug of last resort and shouldn't particularly be used on kids! It's always hard in situations like these to choose to take these drugs or not. But I did ask the dr about it and she didn't feel as worried about the possible reaction to the drug (vs of course the infection recurring).

The internet is full of hyper people having a lot of reactions and most people don't report the neutral or positive ones, so I'd take that with a grain of salt.

Hope your hubby feels better soon...that must have given you both a scare!
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