A 68-year-old woman started on levofloxacin for community-acquired pneumonia returns after one week complaining of pain and swelling in her Achilles tendon while walking. Which feature of her history most strongly predisposes her to this adverse effect?
- A Long-term prior corticosteroid use ✓
- B Concurrent use of a proton pump inhibitor
- C History of hypertension controlled with amlodipine
- D Vegetarian diet with low vitamin B12 intake
Correct answer: A. Long-term prior corticosteroid use
Explanation
Fluoroquinolone-associated tendinopathy and tendon rupture, most often involving the Achilles tendon, are strongly associated with concomitant corticosteroid therapy, age above 60 years, and organ transplantation. Corticosteroids potentiate collagen degeneration induced by fluoroquinolones. The drug should be stopped immediately if tendon pain appears. Options B, C, and D have no established association with fluoroquinolone tendinopathy.
Reference: Katzung Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.