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Antibiotics and injuries: Which class of antibiotics may bring your lifting career to a screeching halt?

It's almost that time of the year. Football season is just beginning, my lawnmower is getting less and less use, and the temperature is fluctuating more than the stock market. And the season wouldn't be complete without an endless stream of antibiotics coming from the doctors' offices. But before you go begging your doctor for an antibiotic for that runny nose, there's one class of antibiotics that you better be particularly concerned about, especially if you lift heavy weights.

And that class is.... Fluoroquinolones (i.e. Cipro, Levaquin,etc)

Introduced in the 1980s, this class antibiotics is becoming increasingly popular with each passing year primarily due to the increase in antibiotic-resistant infections. Used most commonly to treat pneumonia and bronchitis, nowadays doctors are using them to treat just about everything. In fact at my pharmacy, they're quickly creeping up the list of most popular antibiotics dispensed, right behind amoxicillin, azithromycin, and bactrim ds.

And why should you care... Tendon ruptures (those things that connect your bones to your muscles)
99 out of 100 doctors aren't going to ask you if you lift weights. In fact, 99 out of 100 doctors are probably going to tell you squatting 300 pounds is extremely dangerous:-) So it's your responsibility to be aware of potential tendon problems associated with fluoroquinolone use.

Even though they're rare (most experts agree the odds are probably 1 in 100,000), the results can be extremely devastating, especially to an athlete or weekend warrior. In fact, in 2008 the FDA required that all fluoroquinolones carry a black box warning indicating potential tendon problems associated with their use (the equivalent of wearing the scarlet letter). And what is even more concerning to you and I, we're already at a higher risk because a potential risk factor for tendon rupture is participation in sports, which includes weightlifting. In addition, you're even further at risk if you're taking corticosteroids like prednisone. Even inhaled corticosteroids for allergies (Nasonex, Flonase, Nasacort) put you at a higher risk.

Another important fact: Just because you finished your 10 day course of Cipro without any pain, don't think you're out of the woods just yet. There's been documented cases of tendon ruptures 6 months AFTER using a flouroquinolone.

How will you know? Snap, crackle, pop.
The most commonly affected tendon is the Achilles tendon. However, they can affected virtually any tendon in your body. Symptoms range from stiffness and redness surrounding the tendon to complete inability to move the affected joint. Usually the pain is quick and intense.

I saw firsthand what Levaquin can do. My mother began a 5 day course of Levaquin, and had to stop after 3 days because of the tendon pain. It was so bad she couldn't even walk up and down the stairs. And the worst part: it took 3 weeks for the pain to subside. And this is a lady who has passed 2 kidney stones without any pain medication stronger than Tylenol.

So what's your options? Ask
Ask for a different antibiotic. Tell the doctor you lift weights, and you don't want to risk injury. If you have pneumonia and are relatively healthy, ask for a z-pack. It's considered first line anyways (plus it's also a lot cheaper). With antibiotics, there is usually always alternatives. With so many of them out today, there's almost always overlapping coverage for different types of bacterial infections, unless of course you have something truly funky going on.


-Doc