Biological and chemical changes in fluoroquinolone-associated tendinopathies: a systematic review

Domenico Rocco Bisaccia, Rocco Aicale, Domiziano Tarantino, Giuseppe M. Peretti, Nicola Maffulli

Research output: Contribution to journalArticlepeer-review


INTRODUCTION: The present systematic review investigates the biological and chemical mechanisms that affect the health and structure of tendons following the use of fluoroquinolones (FQs). SOURCES OF DATA: A total of 12 articles were included, organized, and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. AREAS OF AGREEMENT: Five mechanisms were identified: arrest of proliferation through a decreased activity of cyclin B, CDK-1, CHK-1, and increased PK-1; decrease tenocytes migration through decreased phosphorylation of FAK; decrease type I collagen metabolism through increased MMP-2; chelate effect on ions that influence epigenetics and several enzymes; fluoroquinolones-induced ROS (radical oxygen species) production in mitochondria. AREAS OF CONTROVERSY: There is no definite structure-damage relationship. The dose-effect relationship is unclear. GROWING POINTS: Knowing and defining the damage exerted by FQs plays a role in clinical practice, replacing FQs with other antibacterial drugs or using antioxidants to attenuate their pathological effects. AREAS TIMELY FOR DEVELOPING RESEARCH: Clinical and basic sciences studies for each FQs are necessary.

Original languageEnglish
Pages (from-to)39-49
Number of pages11
JournalBritish Medical Bulletin
Issue number1
Publication statusPublished - Jun 19 2019


  • achilles
  • fluoroquinolone
  • tendinopathy
  • tendon
  • tendon rupture

ASJC Scopus subject areas

  • Medicine(all)


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