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The Annals of Pharmacotherapy: Vol. 37, No. 7, pp. 1014-1017. DOI 10.1345/aph.1C505
© 2003 Harvey Whitney Books Company.
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Levofloxacin-Associated Achilles Tendon Rupture

A Scott Mathis, PharmD

Assistant Clinical Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ; Clinical Specialist, Pharmacy Department, Saint Barnabas Medical Center, Livingston, NJ

Vicky Chan, BS

PharmD Student, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey

Margaret Gryszkiewicz, BS

PharmD Student, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey

Robert T Adamson, PharmD

Corporate Director of Clinical Pharmacy Services, Saint Barnabas Health Care System, West Orange, NJ

Gary S Friedman, MD

Physicians in Kidney Disease and Cell Therapy, West Orange, NJ

Reprints: A Scott Mathis PharmD, Pharmacy Department, Saint Barnabas Medical Center, 94 Old Short Hills Rd., Livingston, NJ 07039-5672, FAX 973/322-5185, E-mail smathis{at}sbhcs.com

OBJECTIVE: To describe a case of levofloxacin-induced partial Achilles tendon rupture; this occurred in the presence of known risk factors and acute renal failure.

CASE SUMMARY: A 79-year-old white man received levofloxacin for presumed pneumonia, developed acute renal failure in the setting of dehydration, and began having ankle pain on the 12th day of admission. Levofloxacin was discontinued, and magnetic resonance imaging revealed a 6-cm partial tear and degenerative changes.

DISCUSSION: The Naranjo probability scale indicates a possible association between levofloxacin and tendon rupture because the event occurred in the setting of known risk factors such as steroid use, renal failure, older age, and male gender.

CONCLUSIONS: Levofloxacin, like other fluoroquinolones, may cause Achilles tendon rupture, and this may be particularly likely with known risk factors.

Key Words: acute renal failure, fluoroquinolone, levofloxacin, tendon rupture

Published Online, May 21, 2003. www.theannals.com, DOI 10.1345/aph.1C505




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