A 72-year-old man on oral levofloxacin for exacerbation of COPD, also taking chronic prednisolone, presents three days later with severe heel pain after walking and cannot plantarflex the foot. Ultrasound shows a ruptured Achilles tendon. Which feature most strongly predisposed him to this complication?
- A Concurrent corticosteroid therapy together with age over sixty years ✓
- B Underlying obstructive airway disease itself
- C Levofloxacin-induced peripheral neuropathy altering gait mechanics
- D Inhibition of intestinal vitamin K synthesis by the antibiotic
Correct answer: A. Concurrent corticosteroid therapy together with age over sixty years
Explanation
Fluoroquinolone-associated tendinopathy and tendon rupture occur predominantly in patients over sixty years who are receiving systemic corticosteroids; the two risks act synergistically, likely through impaired tenocyte matrix maintenance and collagen degradation. The rupture classically involves the Achilles tendon within days of starting therapy. COPD is merely the indication for treatment, neuropathy is a separate fluoroquinolone adverse effect, and vitamin K effects belong to unrelated drugs.
Reference: Katzung Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.