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PROLOTHERAPY IS A GREAT ALTERNATIVE
TREATMENT FOR TENDON DAMAGE FROM FLUOROQUINOLONES ANTIBIOTICS
Ross Hauser, M.D.
As if there isn’t enough pain out there, now scientists have learned
that fluoroquinolone antibiotics damage
tendons. Yes, you can get
wake up one day and all of a sudden you have pain in or around a joint
just because you took an antibiotic.
Dick came to Caring Medical because of a severe left
shoulder
pain.
There was no precipitating event except that he needed several rounds of
Levoquin for a urinary infection because of a urethral stricture. On
physical examination he had evidence of a
supraspinatous tendinopathy
(Rotator Cuff)
which now was causing a
Frozen
Shoulder (adhesive
capsulitis). Fortunately for Dick he came in early and only necessitated
two
prolotherapy treatments one month apart. He also received aggressive
Physical therapy for the limitation of
shoulder range of motion. Within
six weeks of therapy he was back to swimming. He made a full recovery.
To show you the extent of damage that can occur with fluoroquinolones, a
client named Amy came to Caring Medical convinced she had tendon and
muscle injury from the antibiotics she took. She explained, “I had a
respiratory infection so I was given Levoquin. After the infection was
over I had pain all over my body and it hasn’t stopped!” After
questioning Amy and examining here we did some blood work. She did not
have Candida, but did have a high CPK level which can indicate muscle
damage. I am now convinced that Amy was correct, she did get muscle and
tendon damage all over her body from the fluoroquinolone antibiotic she
received. She will soon be in for her second visit.
Fluoroquinolones are a class of synthetic antibiotics which have a broad
spectrum of antibiotic activity that includes both Gram negative and
Gram positive bacteria. Some of the more common ones are Levoquin (levofloxacin),
Ciproxin (ciprofloxacin) other common drug names are Baloxin and Tequin,
and common chemical names are enoxacin, lomefloxacin and norfloxacin. In
the literature many side effects have been documented including
tendinitis and subsequent tendon rupture. The incidence is felt to be
between 0.14%-0.4% but if someone has other health conditions, the
incidence can go up to 15.6%. Advanced age seems to be the most
significant risk factor. Long periods of hemodialysis, diabetes
mellitus, hyperparathyroidism, rheumatic diseases, gout, and
corticosteroids are other predisposing factors.1,2
To investigate the cause of tendon injury, researchers at the University
of Berlin, Germany incubated human tendon cells with differing
concentrations of ciprofloxacin and levoquin. They then looked at the
cells under an electron microscope. At concentrations which are
achievable during quinolone therapy, tendon synthesis of collagen was
significantly decreased. The inhibition was dose-dependent. Effects were
intensified at higher concentrations and longer incubation periods. If
this isn’t bad enough, the researchers found that both fluoroquinolones
induced apoptosis in the cells. Apoptosis means programmed cell death.
This was confirmed by electron microscopy. In other words,
fluroquinolones can cause the tendon cells to die prematurely! Their
conclusion reads as follows: ‘Our results provide evidence that besides
changes in receptor and signaling proteins apoptosis has to be
considered as a final event in the pathogenesis of fluoroquinolone-induced
tendinopathies’.3
Summary
What’s it all about, Alfie? Sometimes strong medications are needed. The
doctor and patient must evaluate the risks and benefits before starting
any theray. Fluoroquinolones are strong antibiotics. When they are
prescribed, the doctor and user must be aware that tendon injury is a
possibility. For those suffering from chronic tendon injuries, a
treatment to consider is Prolotherapy. Prolotherapy stimulates the body
to repair painful areas, such as tendon and ligament injuries.
Prolotherapy to the injured tendon will induce a mild inflammatory
reaction which is the body’s mechanism to repair injured areas.
Prolotherapy causes a proliferation (thus the word prolo-) of the
fibroblasts which make the collagen which makes up the ligament or
tendon. Typically three to six sessions at four to six week intervals is
the usual course. If you or someone you know and love has
fluoroquinolone-induced tendon injury, tell them about Prolotherapy.
Prolotherapy offers hope for people with this condition.
References:
1. Muzi F, Gravante G, Tati E, Tati G. Fluoroquinolones-induces
tendinitis and tendon rupture in kidney transplant recipients: 2 cases
and a review of literature. Transplantation Proceedings . 2007;
39:1673-1675.
2. Kempka G, Ahr HJ, Ruther W, Schluter G. Effects of fluoroquinolones
and glucocorticoids on cultivated tendon cells in vitro. Toxicology in
Vitro. 1996;10:743-754.
3. Sendzik J, Shakibaei M, Schafer-Korting M, Stahlmann R.
Fluoroquinolones cause changes in extracellular matrix, signaling
proteins, metalloproteinases and caspase-3 in cultured human tendon
cells. Toxicology. 2005;212:24-36.
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