Could You Be Genetically Predisposed to the Dangers of Quinolone Antibiotics?

By Chris Centeno, MD /

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Let’s say this season you got the flu. If you needed antibiotics, It’s highly likely that your doctor may have recommended a drug class called the quinolones. Now research is showing that if you’re unlucky enough to have the wrong genes, taking these pills may have caused severe tendon injuries. Let me explain.

What Are Quinolones?

Quinolones are a class of antibiotics. There are many families of antibiotics, and quinolones fall under their own family based on their specific chemical structure. When we talk about “quinolones” today, this is short for fluoroquinolones. Quinolone antibiotics include levofloxacin (Levaquin), ciprofloxacin (Cipro), ofloxaxin (Floxin) norfloxacin (Noroxin), and many others (most commonly the “-oxin” and “-floxaxin” drugs).

Quinolones are prescribed for everything from simple colds to bronchitis, eye infections, dental infections, urinary tract infections, and many other issues. Unfortunately, however, the quinolone family of antibiotics has been linked to tendonitis and many other well-known side effects.

The Dangers of Quinolone Antibiotics Are Not News

I’ve shared many issues with these quinolone antibiotics before, including their effects on one of my own patients who experienced horrible side effects from this drug before making her way to me. In this case, the antibiotic was Levaquin for a dental infection. This quinolone set off a domino effect of medical tragedies, from antibiotic tendonitis to a back fusion to more side effects and, ultimately, to chronic disabling pain. Learn more about her tumultuous journey through her own testimony in her video below:

This patient was able to find an effective solution to her pain and get her active life back, but not before a great deal of irreversible damage was already done. And it all started with a Levaquin (quinolone antibiotic) prescription.

Research is consistently performed on these drugs, and one new study suggests genetics may play a role in whether or not we are at risk for the toxic effects and dangers of quinolone antibiotics. Let’s review.

New Genetic Marker Discovered That May Explain Some Quinolone Side Effects?

At a conference last year, study data was shared regarding the potential genetic link to the toxic effects of quinolones. More specifically, the purpose of the research was to determine genetic associations in those experiencing cognitive side effects due to the drug. The study consisted of 24 participants who had neuropsychiatric toxicity due to fluoroquinolones, and saliva samples were obtained from each participant.

The results? Nearly 57% shared a genetic marker that related to the metabolism of drugs. In addition, of the 24 total participants, 16 had severe gastrointestinal issues, 9 had persistent headaches, and 18 had cognitive issues. This research has been expanded into a trial of 100 participants and is currently in process. I will continue to keep an eye on this one until a final conclusion and the specific genetic marker is published as this could potentially identify those more at risk when taking these drugs.

As far back as 2010, I was sharing studies on quinolones, such as Cipro and Levaquin, that found them to be associated with Achilles tendon ruptures. How do quinolones attack our tendons? Our tendons and ligaments have their own stem cells, and quinolones have been shown to injure these stem cells. When our repairmen (our stem cells) are injured, the tendon can’t self-repair, and when they can’t repair, the tendons weaken, leading to tendonitis or tendon tears or ruptures.

Why doesn’t everyone who takes quinolones end up with antibiotic tendonitis? Perhaps there’s a connection between this new study today and the presence of a potential genetic marker that may disrupt the metabolism of quinolones in some people. I will continue to keep my eye on this one.

The upshot? If your doctor wants to prescribe a quinolone, given the potentially severe and well-documented side effects and dangers of quinolone antibiotics, push for another drug class that will cover your infection! Obviously, if you can’t avoid these drugs then it is what it is, but it never hurts to advocate for yourself!

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15 thoughts on “Could You Be Genetically Predisposed to the Dangers of Quinolone Antibiotics?

  1. NANCY PRIOLO

    Does Regenexx do jar needling or should stem cells be used for damage caused by Quinolone? My best friend has tendon damage in her arm caused by this antibiotic, and lives in constant pain. Nerve blocks in her neck have not helped. She lives in Dallas, TX.

    1. Regenexx Team

      Nancy,
      Antibiotic tendonitis would generally be treated with platelet procedures but it would depend the degree of damage. Here is the Dallas Regenexx Provider: https://regenorthosport.com Please see: https://regenexx.com/blog/antibiotic-tendonitis-can-ruin-a-life/

  2. Brian Sanderson

    Interesting post Dr Centeno. I seem to recall that quinolones were discovered as byproducts in the synthesis of quinine. Quinine also causes severe reactions for some people and so its use is now more restricted than it once was. I wonder if sensitivity to one is related to sensitivity to the other?

    1. Regenexx Team

      Brian,
      You’re correct, quinolones were discovered as one of the byproducts of the synthesis of quinine. It might be…

  3. Stacy

    Any suggestions if the ligament damage is in your neck?? I’m a Cipro victim who was impacted immensely on all fronts. Mri is also showing narrowing of transverse sinus after Cipro. Can anything be fine to help that. Really trying to avoid stents, shunts and spinal fusions! Thanks!

    1. Regenexx Team

      Stacy,

      Ligament damage causes instability and left untreated can cause a whole host of new problems. We treat cervical ligaments and cervical facet joints regularly. https://regenexx.com/blog/want-see-advanced-image-guided-injection-step-procedure-suite-dr-pitts/ and https://regenexx.com/blog/dramatic-improvement-severely-degenerated-cervical-joint-without-surgery/ and https://regenexx.com/the-regenexx-procedures/back-surgery-alternative/ If you’d like to see if your particular case would be a Candidate, we’d need more info. To do that, please submit the Candidate form to the right of the blog.

  4. Barbara Arnold

    Very interesting, you may well be right. Some may be genecticaly more suceptical. However I took cipro at least 3 or 4 times before the bomb went off in my body, which indicates it’s cummulative. Thing is, my belief is because fluroquinolone pass the bood brain barrier, all our symptoms stem from the brain sending the wrong signals. My symptoms change constantly, which tells me and I have it confirmed by a nerve conduction test that my nerves are okay and not damaged, that all my symptoms are from rewireing or wrong rewireing in my brain caused by cipro

  5. Lynn Cole

    Between taking several cortisone shots in both elbows and taking dental antibiotics over the course of about 5yrs, the tendons in my upper arms and shoulders have decided to fail me now. I am in the process of going through insurance protocols (x-rays and ultra sounds before MRI can be granted). Doctors just don’t have a clue. What does Regenexx require before being looked at (and to keep costs down there). I live just south of Detroit. Thanks.

    1. Regenexx Team

      Lynn,
      A Candidacy evaluation generally requires a recent MRI, medical history and finally the exam.

  6. Jason

    Very informative article. Are there any known musculoskeletal side effects caused by the antibiotic Doxycycline?

    Also, I am impressed with the amount of research Regenexx has done on its procedures, but have not seen any research done comparing your ortho-biologic treatment outcomes vs control groups. Are there plans to do those kind of double-blind studies?

    1. Regenexx Team

      Jason,
      Any medication can cause a problem in any patient. Among the differences between Quinolones and Doxycycline is Quinolones increase MMP expression, and Doxycycline decreases MMP expression. MMPs break things down. For double blind RCT please see: https://regenexx.com/blog/new-ccj-instability-trial-begins/

  7. Nicholas Miller

    About three years ago while on a cruise, I had a tooth infection for which I was given Cipro for a week. Shortly after returning from that trip, I had arthroscopic surgery on my left shoulder to repair a tendon tear. As part of the recover for that surgery, I was prescribed Cipro. Several months after while swinging a golf club, I tore the right distal bicep tendon completely off my forearm. After surgery, there were some complications with the incision, for which I was prescribed two weeks of Cipro. Within two months of that surgery, I began to have issues with tightness and tenderness of my right achilles tendon for which I saw another physician with no result. On my own, I began a regime of bicycle riding of 3-5 miles per day and I thought succeeded in stretching out my right achilles. Two months after that, while moderately throwing a frisbee at the beach with my grandson, I completely tore my left achilles. It was only then after researching the cause of tendon tears did I become aware of the effect of Cipro. Not one of the medical professionals that I had ever seen with my various tendon tears ever mentioned the well established reputation of Cipro associated with tendon tears. I have been advised by several legal professionals that I have no recourse.

    Sooo, I have limited use of my right arm and walk with a significant limp thanks to my experience with Cipro.

    1. Regenexx Team

      Nicholas,
      So sorry to hear of your experience; unfortunately, we see this time and time again. Hopefully your comment will help to prevent other people from taking Cipro when other antibiotics will work. We might be able to help some of your issues. Please see: https://regenexx.com/blog/antibiotic-tendonitis-can-ruin-a-life/

  8. Issouf Bantenga

    Hello. I’ve been having a neck pain for almost 2 years, after a course of antibiotics including cipro. I had anal fissure from a constipation, and I went to see a family doctor. He put me on antibiotics for 2 months ,while I didn’t have any infection. Then I got bad reactions like dizziness, palpitations and neck pain. The CT neck and the MRI don’t show big deal. I guess those drugs have damaged my ligaments, tendons or muscles in my neck. I’ve tried different treatments like chiro,acupuncture, massage, PT,prolotherapy, homeopathy, cold laser therapy ,supplements…,but nothing seems to work. Can Dr Centeno help me? I am in Chicago, thanks.

    1. Regenexx Team

      Issouf,

      While a radiologist didn’t see anything significant on the MRI, radiologists read MRI’s to rule surgery in or out. We’d be looking for different things. We can take a look the MRI images through the Candidacy process, and will ultimately need to examine you to determine what’s going on.. Please see: https://regenexx.com/blog/antibiotic-tendonitis-can-ruin-a-life/

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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