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Comment by avgDev | Hacker News Reader

Just a word of advice, if you suffer from tendon pain and took flouroquinolone antibiotics within last 12 months. Never, take those again.

I have been dealing with widespread tendon issues for the past 7 years due to that medication. The black box warning reflects the issues somewhat. These should be last resort antibiotics but are given out in the US for suspected UTIs.

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In UK there was just recently published Guidelines for [1] Safe prescribing of fluoroquinolones.

'Do not use fluoroquinolones in patients with known aortic aneurysm, aortic dissection or history of serious side effects related to quinolone treatment (including tendon disease/disorder) unless there are no other treatment options available'

'Patients should be counselled to discontinue fluoroquinolone treatment and seek urgent medical attention at the first sign of:

- Tendon pain or inflammation (particularly in shoulder or ankle)

- Symptoms of neuropathy such as pain, burning, pins & needles, tingling, numbness or weakness

- Sudden-onset of severe and constant abdominal, chest or back pain

1. https://www.ncl-mon.nhs.uk/wp-content/uploads/Guidelines/5_F...

So basically it fucks with your connective tissue?

> The histopathologic findings [of the tendons] include degenerative lesions, fissures, interstitial edema without cellular infiltration, necrosis and neovascularization [1]

Basically it dissolves, and the achilles tendon is the most common rupture, at least with cipro.

1. https://www.ncbi.nlm.nih.gov/pubmed/22035890

As far as I am aware, the association with aortic aneurysm is weak ( I think a relative risk of 2) from an associate only study (ie no causation proven). So take these with a pinch of salt, especially for those with a penicillin allergy as covering some bugs without penicillins or flouroquinolones can be tricky.

You seem really knowledge about this. I'm 20 years deep into a tendon problem that has flowered into way too many parts of my body than it should be. Was just accepted into Mayo and going in early 2020. Could I chat with you about that experience?

How permanent is the levaquin (etc) damage supposed to be?

Honestly, nobody knows. The issue is severely under-diagnosed. I have been doing PT but it is very difficult when several tendons are involved. Specialists are baffled. I have talked to people who have been suffering for 20+ years, and those who mostly recovered in 1, 2, 3 or even 10 years to where they would rate their recovery at 90%.

However, it is believed that the muscles/tendons will never perform at the same capacity again. Recovery is mostly about getting to relatively pain free life and ability to work and do things.

I have been to mayo clinic, seen 30+ physicians, numerous specialists and ruled out every disease known to cause such symptoms. Only one physician said that my symptoms align with toxicity of that medication and none of the physicians reported it to the FDA. This is very saddening considering the amount of research and information from the organizations like FDA and EMA.

Well I ask because I was prescribed Levaquin for sinus infection about 10 years ago, and read the warnings about fluoroquinalones with tendon degradation, so quit after one pill, and saline rinsed extensiely, which eventually worked.

I've rolled my ankle and had multple achiles strains since, which I'd never known before. Of course, one pill is not much dose.

Thanks for discussing.

Single dose is enough to cause problems. I had only two doses through the IV when I had kidney stones. I have read of people having mild tendon problems after a single dose of levaquin/cipro that lasted years and would flare up.

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