Fluoroquinolones carry an FDA black box warning for tendinitis and tendon rupture, most commonly involving the Achilles tendon but also rotator cuff, biceps, hand, and other tendons. Risk factors: age over 60, concurrent systemic corticosteroids, kidney/heart/lung transplantation, prior tendon disorders, strenuous activity. Onset can occur within hours to weeks and even months after the drug. Presentation: sudden tendon pain, swelling, "snap" or "pop" sensation, inability to bear weight or use the affected limb. Standard nursing response: (1) stop the fluoroquinolone immediately, (2) notify the prescriber for evaluation, (3) protect the limb with rest, immobilization, ice, elevation, and avoidance of weight-bearing or strenuous use, (4) anticipate orthopedic consult and ultrasound or MRI for diagnosis, surgical or non-surgical management depending on severity and patient factors, (5) change to a non-fluoroquinolone antibiotic guided by culture and susceptibility, (6) avoid future fluoroquinolone exposure when possible, document the adverse event, (7) educate the client about persistent risk for months after discontinuation. Reassuring and continuing, applying heat with ambulation, and adding more fluoroquinolone are unsafe.
In-depth explanation
Suspect tendon rupture in an elderly steroid user on a fluoroquinolone with a sudden snap. Stop the drug, immobilize, refer to ortho. Class warning persists for months.
For study reference only. Always follow current clinical guidelines and your institution’s protocols.