Which rare tendon injury is associated with fluoroquinolones, and which populations are at higher risk?

• A. Tendon rupture; higher risk in older adults and those on corticosteroids
• B. Tendon rupture; higher risk in young athletes
• C. Hepatotoxicity; higher risk in patients with liver disease
• D. Cardiac arrhythmias; higher risk in electrolyte imbalance

Answer: (A)

Fluoroquinolones can cause a rare injury to tendons, most commonly tendinopathy or rupture of the Achilles tendon, often occurring within days to weeks of starting the drug. The risk is particularly high in older adults and in people taking systemic corticosteroids, because aging and steroids weaken tendon structure and impair healing, making rupture more likely when the tendon is stressed. While other adverse effects like hepatotoxicity or QT prolongation can occur with these antibiotics, the tendon injury described is most strongly linked to age-related vulnerability and steroid use, rather than young athletic activity or other complications.