A forum user writes: I’ve suffered from urinary tract infections (UTIs) before, and I woke up this morning with one. I am taking ciprofloxacin and have just Googled whether or not I should run through it or rest, only to find some horror stories about tendon rupture while using this antibiotic. What should I do?
Antibiotics are wonderful medications that have saved countless lives and reduced the misery of many infections, such as those in the urinary tract. However, they do have a dark side that deserves close attention.
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In addition to antibiotic resistance from overuse, there are hidden side effects that can plague users. Those side effects can include tendinitis and tendon rupture, peripheral neuropathy (pain from nerve damage, often in the hands and feet), as well as central nervous system effects like hallucinations, and even watery or bloody diarrhea.
Ciproflaxin is part of a class of antibiotics called fluoroquinolones, which includes levoflaxin and moxifloxacin. The class is critical for the treatment of some difficult infections like anthrax and plague. However, they are widely used around the world for lesser infections and are even available over the counter in some countries, leading to antibiotic resistance.
Of course, it’s the tendon rupture associated with fluoroquinolones which is of great concern to runners. Clearly I know little about you and there are likely good reasons your physician chose to put you on ciproflaxin. The FDA Black Box Warning on the fluoroquinolones specifically details tendon rupture as a potential side effect of the medication and suggests using alternate antibiotics whenever possible.
A part of shared medical decision-making, however, allows you to ask for alternates in your care process. Medication allergies, antibiotic resistance, and other factors contribute to the final treatment plan and you should have some input into the medication choices that affect you as a runner.
I would suggest that, at the least, you stop running while on the medication and only gradually resume after you have been off a few days and are sure there is no tendon pain or swelling, both before you return to the roads and early in your return. The six months or more you would have to take off for a ruptured Achilles tendon to fully heal is worth the few days of prevention.
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Get answers to questions on health, injuries and sports medicine from runner-friendly physician William Roberts, M.D. If you have a question for the Sports Doc, please ask it on our Health & Injuries forum.