From the Guidelines
Ceftriaxone is not typically associated with Achilles tendon rupture, and it is considered a safer alternative to fluoroquinolones in terms of tendon-related adverse effects. Unlike fluoroquinolone antibiotics, which carry a well-documented risk of tendinopathy and tendon rupture, ceftriaxone works through a different mechanism by inhibiting bacterial cell wall synthesis. The provided evidence, including guidelines from the Centers for Disease Control and Prevention 1, does not mention ceftriaxone as a cause of Achilles tendon rupture.
Key Points to Consider
- Ceftriaxone's mechanism of action is distinct from fluoroquinolones, which are known to cause tendon damage by affecting collagen synthesis and increasing the activity of matrix metalloproteinases that break down tendon tissue.
- The guidelines provided focus on the recommended regimens for treating sexually transmitted diseases with ceftriaxone, without mentioning tendon rupture as a potential side effect.
- High-risk patients, such as the elderly, those on corticosteroids, or with kidney disease, may still need to be cautious with any medication, including ceftriaxone, and report any unusual tendon pain to their healthcare provider.
Clinical Implications
- When choosing an antibiotic, particularly for high-risk patients, ceftriaxone may be preferred over fluoroquinolones due to its safer profile regarding tendon-related adverse effects.
- Any unusual tendon pain experienced while taking ceftriaxone or any other medication should be promptly reported to a healthcare provider, as it is essential to monitor for potential side effects, even if they are rare or not well-documented.
From the Research
Ceftriaxone and Achilles Tendon Rupture
- There is no direct evidence in the provided studies that ceftriaxone causes Achilles tendon rupture 2, 3, 4, 5, 6.
- The studies primarily discuss the association between fluoroquinolone antibiotics and Achilles tendon rupture, with some mentioning other types of antibiotics 2, 3, 4, 5.
- Ceftriaxone is a cephalosporin antibiotic, and its properties and uses are described in one of the studies, but it does not mention any association with tendon rupture 6.
- The available evidence suggests that fluoroquinolones, not ceftriaxone, may be associated with an increased risk of tendon ruptures, including Achilles tendon rupture 2, 3, 4, 5.
Fluoroquinolones and Achilles Tendon Rupture
- Fluoroquinolone antibiotics have been implicated in the etiology of Achilles tendinitis and subsequent tendon rupture 2.
- A retrospective study found that levofloxacin, a type of fluoroquinolone, exhibited a significant increased risk of tendon ruptures, including Achilles tendon rupture 3.
- Case reports and series have described patients who experienced bilateral Achilles tendon ruptures following fluoroquinolone use, including levofloxacin 4, 5.
Management of Fluoroquinolone-Related Achilles Tendon Ruptures
- A case series found that functional rehabilitation can be an effective management strategy for patients with Achilles ruptures following fluoroquinolone use 5.