A 68-year-old athlete receives a course of levofloxacin for acute bacterial sinusitis. Ten days into therapy he presents with pain and swelling over the Achilles tendon. The most appropriate management is:

• A Continue the full course and add a compression bandage
• B Stop the fluoroquinolone immediately and switch to an alternative class ✓
• C Add a nonsteroidal anti-inflammatory drug and complete the course unchanged
• D Reduce the levofloxacin dose by half and continue for the planned duration

Explanation

Fluoroquinolone-associated tendinitis and tendon rupture, most commonly involving the Achilles tendon, is a recognized adverse effect with peak incidence in older patients and those on corticosteroids. Any tendon pain during therapy mandates immediate discontinuation of the fluoroquinolone and rest of the affected limb, since continued exposure risks complete rupture. Dose reduction or analgesic addition does not remove the causative agent.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.