Fluoroquinolones increase the risk of tendon rupture and aortic aneurysm/dissection, and some antibiotics increase C. difficile infection risk (archive bibliography on harms).
Original statement
No Arabic original wording available.
Translation
Fluoroquinolones increase the risk of tendon rupture and aortic aneurysm/dissection, and some antibiotics increase C. difficile infection risk (archive bibliography on harms).
Origin
- Source status
- Archive editors
- Attribution
- Archive editors (eltayebat.com)
- Origin
- https://eltayebat.com/rule/antibiotic-overuse/
- Attribution uncertainty
- Archive bibliography (A-ABX-12, A-ABX-14, A-ABX-15, A-ABX-16, A-ABX-21); not discussed in the narrative.
- Claimed mechanism
Collagen degradation; microbiome disruption.
- Claimed health effect
Tendon rupture, aortic events, C. difficile.
- Population concerned
Adults
- Geographic restriction by Elawady
none found
Scientific assessment
Mostly true – Correct at its core, but with limitations or minor inaccuracies.
Certainty of evidence: moderate – Further research may still affect the assessment.
1. What was claimed?
Specific antibiotic harms.
2. What is demonstrably correct?
Achilles tendon rupture OR 4.3 (2.4-7.8) for current quinolone use (A-ABX-14); aortic aneurysm/dissection RR 2.43 (A-ABX-15) and HR 1.66 (1.12-2.46), 82 extra cases per million episodes (A-ABX-16); C. difficile: clindamycin OR 16.80, fluoroquinolones OR 5.50 (A-ABX-12); penicillin-allergy label associated with MRSA (aHR 1.69) and C. difficile via alternative antibiotics (A-ABX-21).
3. What is wrong or exaggerated?
These are drug-specific, mostly rare harms; they argue for careful drug choice, not for avoiding all antibiotics.
4. What remains unclear?
Absolute risks for an individual depend on age and underlying disease and were not extracted from all studies.
5. Which studies support it?
A-ABX-12, A-ABX-14, A-ABX-15, A-ABX-16, A-ABX-21.
6. Which studies contradict it?
None reviewed against the existence of these harms; absolute risks are low (for example 82 extra aortic aneurysm or dissection cases per million treatment episodes; A-ABX-16).
7. What applies to Germany and Europe?
Data come partly from the UK and Sweden (see studies), so they are directly relevant to Europe.
8. What is known about Egypt?
No Egyptian data were reviewed; the drug-specific risks apply wherever these antibiotics are used.
9. What practical conclusion is appropriate?
Known side effects are weighed against benefit by prescribers.
Assessment details
- Rationale for certainty of evidence
Consistent findings across case-control and cohort studies in different countries; absolute risks are low.
- Source quality
Peer-reviewed pharmacoepidemiology.
- Regional transferability
High (UK, Sweden, Taiwan data).
- Individual exceptions
Elderly patients on corticosteroids have the highest tendon risk.
- Regional scope of the claim
- general (biological/medical)
- Last reviewed
- 25 October 2026 provisional
In plain language
Some antibiotics have rare but serious side effects, such as tendon tears and problems of the main artery with fluoroquinolones, or a gut infection called C. difficile after some antibiotics. These risks are real and well documented. They are a reason to choose antibiotics carefully.
Studies on this claim
Studies supporting the claim (5)
-
Antibiotics and C. difficile
Brown KA et al.. Antimicrob Agents Chemother 2013 · PMID 23478961 · DOI 10.1128/AAC.02176-12Meta-analysiscited by the Tayebat archiveabstract only checkedSome antibiotics (e.g. clindamycin) strongly raise C. difficile risk; tetracyclines did not.
Does the study support the specific claim? Yes · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Compare classes.
- How was the study done?
Meta-analysis.
- How many people, animals or samples were studied?
7 studies.
- What was actually found?
Varies by class.
- How large was the observed effect?
OR up to 16.8.
- What do the results mean in everyday life?
Choose antibiotics carefully.
- What are the study's limitations?
Few studies.
- What does it say about Elawady's specific claim?
Supports.
- Do the results apply to Germany and Europe?
High.
-
Quinolones and Achilles tendon rupture
van der Linden PD et al.. Arch Intern Med 2003 · PMID 12912715 · DOI 10.1001/archinte.163.15.1801Case-control studycited by the Tayebat archiveabstract only checkedCurrent quinolone use was linked to about 4 times higher odds of Achilles rupture.
Does the study support the specific claim? Yes · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Link.
- How was the study done?
Case-control.
- How many people, animals or samples were studied?
1367 cases.
- What was actually found?
Higher risk.
- How large was the observed effect?
OR 4.3.
- What do the results mean in everyday life?
Known side effect.
- What are the study's limitations?
Observational.
- What does it say about Elawady's specific claim?
Supports.
- Do the results apply to Germany and Europe?
High.
-
Fluoroquinolones and aortic aneurysm (Taiwan)
Lee CC et al.. JAMA Intern Med 2015 · PMID 26436523 · DOI 10.1001/jamainternmed.2015.5389Case-control studycited by the Tayebat archiveabstract only checkedCurrent use was linked to higher risk of rare aortic events.
Does the study support the specific claim? Yes · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Link.
- How was the study done?
Case-control.
- How many people, animals or samples were studied?
1477 cases.
- What was actually found?
Higher risk.
- How large was the observed effect?
RR 2.43.
- What do the results mean in everyday life?
Rare.
- What are the study's limitations?
Observational.
- What does it say about Elawady's specific claim?
Supports.
- Do the results apply to Germany and Europe?
Moderate.
-
Fluoroquinolones and aortic aneurysm (Sweden)
Pasternak B et al.. BMJ 2018 · PMID 29519881 · DOI 10.1136/bmj.k678Cohort studycited by the Tayebat archiveabstract only checkedAbout 82 extra cases per million treatment courses compared with amoxicillin.
Does the study support the specific claim? Yes · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Link.
- How was the study done?
Cohort.
- How many people, animals or samples were studied?
720,176 episodes.
- What was actually found?
Higher risk.
- How large was the observed effect?
HR 1.66; +82/million.
- What do the results mean in everyday life?
Rare.
- What are the study's limitations?
Observational.
- What does it say about Elawady's specific claim?
Supports.
- Do the results apply to Germany and Europe?
High.
-
Penicillin allergy label and resistant infections
Blumenthal KG et al.. BMJ 2018 · PMID 29950489 · DOI 10.1136/bmj.k2400Cohort studycited by the Tayebat archiveabstract only checkedPeople labelled penicillin-allergic had more MRSA and C. difficile, partly due to alternative antibiotics.
Does the study support the specific claim? Yes · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Link.
- How was the study done?
Cohort.
- How many people, animals or samples were studied?
301,399.
- What was actually found?
Higher risk.
- How large was the observed effect?
aHR 1.69.
- What do the results mean in everyday life?
Allergy labels should be checked.
- What are the study's limitations?
Observational.
- What does it say about Elawady's specific claim?
Supports.
- Do the results apply to Germany and Europe?
High.
No study in this group is marked as key.
Studies contradicting or limiting the claim (0)
No studies in this group.
Studies with mixed or unclear results (0)
No studies in this group.
Regional context
Germany / EU
Data come partly from the UK and Sweden (see studies), so they are directly relevant to Europe.
Egypt
No Egyptian data were reviewed; the drug-specific risks apply wherever these antibiotics are used.
What applies in my country?
General scientific assessment
Mostly true Correct: documented, drug-specific harms with low absolute risk.
This statement concerns biological or medical relationships. The scientific assessment above applies regardless of the country; country-specific food data do not change it.
References
- Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection.. Brown KA et al.. Antimicrob Agents Chemother 2013 · PMID 23478961 · DOI 10.1128/AAC.02176-12
- Increased risk of achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids.. van der Linden PD et al.. Arch Intern Med 2003 · PMID 12912715 · DOI 10.1001/archinte.163.15.1801
- Risk of Aortic Dissection and Aortic Aneurysm in Patients Taking Oral Fluoroquinolone.. Lee CC et al.. JAMA Intern Med 2015 · PMID 26436523 · DOI 10.1001/jamainternmed.2015.5389
- Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study.. Pasternak B et al.. BMJ 2018 · PMID 29519881 · DOI 10.1136/bmj.k678
- Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study.. Blumenthal KG et al.. BMJ 2018 · PMID 29950489 · DOI 10.1136/bmj.k2400