Meta-analysisindependent cross-checkabstract checked I-ABX-122 standard review
Fluoroquinolones raise tendon injury risk
Fluoroquinolones and the risk of tendon injury: a systematic review and meta-analysis.
Overview
Alves C et al.. Eur J Clin Pharmacol 2019 · PMID 31270563 · DOI 10.1007/s00228-019-02713-1
Pooled studies show about 2.5-fold odds of Achilles tendon rupture.
Does the study support the specific claim? Yes · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Pool tendon-injury data for fluoroquinolones
- How was the study done?
Meta-analysis
- How many people, animals or samples were studied?
15 studies
- What was actually found?
Higher risk of tendon injury
- How large was the observed effect?
OR 2.52 rupture
- What do the results mean in everyday life?
A real but rare side effect, higher in older people
- What are the study's limitations?
Heterogeneous observational studies
- What does it say about Elawady's specific claim?
Supports the claim
- Do the results apply to Germany and Europe?
High
- What can explicitly not be concluded from this study?
Exact absolute risk
Scientific in-depth review
1. Full reference
- Authors
- Alves C et al.
- Journal
- Eur J Clin Pharmacol
- Year
- 2019
- Identifier
- PMID 31270563 DOI 10.1007/s00228-019-02713-1
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Not stated in abstract.
2. Research question
Are fluoroquinolones associated with tendon injury?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and meta-analysis of observational studies
- Population
Patients treated with fluoroquinolones
- Country
Multinational
- Period
Not stated
- Sample size
15 studies
- Inclusion and exclusion criteria
Observational studies on Achilles rupture, tendinitis or any tendon disorder
4. Methods and endpoints
- Exposure / intervention
Fluoroquinolones
- Comparator
Non-use
- Endpoints
Achilles tendon rupture, Achilles tendinitis, any tendon disorder
- Statistical methods
Random-effects ORs
5. Actual results
- Results
Achilles tendon rupture OR 2.52 (95% CI 1.81-3.52; I2 76.7%); Achilles tendinitis OR 3.95 (3.11-5.01; I2 0%); any tendon disorder OR 1.98 (1.62-2.43; I2 84.5%); estimates significant in patients >=60 years.
- Absolute risks
not reported
- Authors' conclusion
Results confirm the risk of tendon injuries with fluoroquinolones; older age and corticosteroids are additional risk factors.
6. Strengths
- Pooled 15 studies
- Consistent direction
7. Weaknesses
- High heterogeneity for rupture
- Observational
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Heterogeneity.
9. Assessment of the statistical interpretation
CIs log-symmetric.
10. Relevance to the specific claim
Confirms the tendon part of the claim.
11. Independent contrary findings
Absolute risk low.
12. Transferability to Germany and Europe
High.
13. Overall methodological judgement
Supports the tendon element.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Absolute risks by age.