[Tendinopathy associated with fluoroquinolones: individuals at risk, incriminated physiopathologic mechanisms, therapeutic management].

The use of fluoroquinolones in urology has grown considerably over recent years. Unfortunately, although these molecules are not associated with severe life-threatening complications, they have nevertheless been associated with tendon lesions responsible for functional disability. The frequency of these complications is probably underestimated. There is a variable lag-time (3 to 5 days) between introduction of the antibacterial and onset of pain. The symptom most frequently reported is pain over the tendon affected and the tendons most frequently affected are those submitted to high constraints. Bilateral lesions are present in 66% of cases. Although Pefloxacin is associated with the highest frequency of tendon complications (2.7% versus 0.2-0.3% for other fluoroquinolones), the duration of treatment appears to be important in every case, with a peak frequency after a fortnight of treatment. Although these complications were considered for a long time to be associated with patients presenting certain risk factors (age, steroid therapy, renal failure), they can also occur suddenly, in young adult sportsmen or non-sportsmen, with no known tendon disease. Several hypotheses have been proposed to explain the development of these cases of tendinopathy: immuno-allergic mechanisms, direct toxicity of the molecule on collagen fibres, cell-mediated oxidative aggression, or tendon necrosis due to vascular mechanisms. The outcome remains favourable in 75% of cases of tendinitis and in 49% of cases for tendon rupture. Contraindications must therefore be identified and the duration of treatment must be adapted, as the functional handicap can be long and particularly severe.