RE: Tendon issues with Fluoroquinolones

[Guest guest]

Mark,Quinolone induced tendon ruptures have been described in the literature dating back to the early and mid 80's.  A medline search will reveal many cited references.  These cases are rare, although I have treated one patient with an achilles tendon rupture and had a co-worker rupture both achilles tendons while on quinolones.  I have not heard this mentioned occuring in the canine population, however, much of the phase I and II studies were performed on dogs.  Ria Acciani MPT Acciani PTAdvanced Canine Rehabilitation6 Kenquit Road   Happy New Year! I just have to stick my 2 cents in on this topic.  I don't think that we can extrapolate from human medicine and condemn fluoroquinolones in dogs.  Additionally, both of the drugs cited are not the commonly used fluoroquinolones in veterinary medicine.  I think that until there is hard evidence that supports discontinuing using them in dogs, we should not make make suggestions to avoid their usage.    Experience wise, since Baytril hit the market (15 - 20 years ago?) I have not seen any tendon injury associated with their usage, nor have I seen any tendon injury after their usage.  Does anyone on this list know of any citation or reference addressing this human problem?  By the way, I do not work for Bayer nor am I getting paid to say this (I wish I was though). Mark B. Parchman, DVM, DACVS, CVA <clip_image002.gif> 1245 SE 3rd St., Suite C3          Tel   Bend, Oregon  97702                 Fax  tomlinson wrote: Hi LaurieIt is something we always talked about when I used to treat horses, not sure in the small animal world but I avoid them in canine athletes  Tomlinson BVSc MS PhD DACVS CCRPCertified Canine Rehabilitation Practitioner Twin Cities Animal Rehabilitation Clinic12010 Riverwood Dr, Burnsville MN 55337www.tcrehab.com<mime-attachment.jpeg>   From: VetRehab [mailto:VetRehab ] On Behalf Of Dr. Laurie McCauley Sent: Friday, January 04, 2008 3:15 PM To: VetRehab Subject: Tendon issues with Ab'sl?   I saw this come across another list that I belong to and was wondering if anyone had heard anything about it? Group Sues FDA for Stronger WarningsJan 3, 7:16 PM (ET) WASHINGTON (AP) - A consumer group sued the Food and Drug Administration Thursday, charging the agency is ignoring calls for stronger warnings that Cipro and similar antibiotics may cause serious tendon injuries. Labels of the fluoroquinolone family of antibiotics - drugs that include the popular Cipro and Levaquin - already warn about rupture of tendons and other tendon injuries, but at the bottom of a list of other side effects. The consumer group Public Citizen wants those warnings upgraded to the FDA's most severe type, a so-called black-box warning - and for patients to get pamphlets with every bottle that describe the risk. It argues that too few patients know they're supposed to quit using the drugs if they experience symptoms such as pain or inflammation, before the tendon actually ruptures. Public Citizen filed a petition seeking the stronger warning in August 2006.The state of Illinois had filed a similar petition the previous year. The FDA is violating its own statutes and putting patients at risk in taking so long to settle the issue, Public Citizen said in the suit filed in U.S.District Court for the District of Columbia. When Public Citizen first filed the petition, FDA's database showed 262 reports of tendon ruptures between November 1997 and December 2005, along with hundreds of other tendon problems in users of these antibiotics. Since then, the FDA has received an additional 74 reports of tendon ruptures, said Public Citizen's Dr. Sidney Wolfe. Only a fraction of drug side effects typically are reported to the agency, he noted. An FDA spokesman said the agency was evaluating the lawsuit and declined comment.  Warren, NJ 07059

[Guest guest]

Hi All,

If we come up with a survey, Clean run may

be willing to put it up on their website. Clean run is “the”

magazine company for agility people. This way we could reach a large

percentage of canine athlete owners.

I am not a researcher so I would need some

help. What I was thinking was to ask people:

Has your athlete torn his or her cruciate?

Was your athlete on any medication just

prior to or when this happened?

If yes, was an antibiotic or NSAID? (this way people will not

freak out thinking ab’s are going to cause cruciate damage?????)

If your dog has torn their cruciate and was on or recently on an

antibiotic, which antibiotic (list 10 or more)

Maybe a similar question with NSAIDs

Again, any thoughts/help or letting me know this would mot be a

good thing to do would be appreciated J

Laurie McCauley, DVM

TOPS Veterinary Rehabilitation

Grayslake,

IL

drmc@...

www.tops-vet-rehab.com

From: VetRehab [mailto:VetRehab ] On Behalf Of dogpt

Sent: Saturday, January 05, 2008

8:14 PM

To: VetRehab

Subject: Re: Tendon

issues with Fluoroquinolones

Mark,

Quinolone induced tendon ruptures have been described in the literature

dating back to the early and mid 80's. A medline search will reveal many cited

references. These cases are rare, although I have treated one patient with an

achilles tendon rupture and had a co-worker rupture both achilles tendons while

on quinolones. I have not heard this mentioned occuring in the canine

population, however, much of the phase I and II studies were performed on dogs.

Ria Acciani MPT

Acciani PT

Advanced Canine Rehabilitation

6 Kenquit Road

Happy New Year!

I just have to stick my 2 cents in on this topic. I don't think that we can

extrapolate from human medicine and condemn fluoroquinolones in dogs.

Additionally, both of the drugs cited are not the commonly used

fluoroquinolones in veterinary medicine. I think that until there is hard

evidence that supports discontinuing using them in dogs, we should not make

make suggestions to avoid their usage. Experience wise, since Baytril hit the

market (15 - 20 years ago?) I have not seen any tendon injury associated with

their usage, nor have I seen any tendon injury after their usage. Does anyone

on this list know of any citation or reference addressing this human problem?

By the way, I do not work for Bayer nor am I getting paid to say this (I wish I

was though).

Mark B. Parchman, DVM, DACVS, CVA

<clip_image002.gif>

1245 SE 3rd St., Suite C3 Tel

Bend,

Oregon 97702

Fax

tomlinson wrote:

Hi Laurie

It is something we always talked about when I used to treat

horses, not sure in the small animal world but I avoid them in canine athletes

Tomlinson BVSc MS PhD DACVS CCRP

Certified Canine Rehabilitation Practitioner

Twin Cities Animal Rehabilitation Clinic

12010

Riverwood Dr, Burnsville

MN 55337

www.tcrehab.com

<mime-attachment.jpeg>

From: VetRehab

[mailto:VetRehab ]

On Behalf Of Dr. Laurie McCauley

Sent: Friday, January 04, 2008

3:15 PM

To: VetRehab

Subject: Tendon issues

with Ab'sl?

I saw this come across

another list that I belong to and was wondering if anyone had heard anything

about it?

Group

Sues FDA for Stronger Warnings

Jan

3, 7:16 PM (ET)

WASHINGTON (AP) - A consumer group sued the Food and Drug

Administration Thursday, charging the agency is ignoring calls for stronger

warnings that Cipro and similar antibiotics may cause serious tendon injuries.

Labels of the fluoroquinolone family of antibiotics - drugs that

include the popular Cipro and Levaquin - already warn about rupture of tendons

and other tendon injuries, but at the bottom of a list of other side effects.

The consumer group Public Citizen wants those warnings upgraded to the

FDA's most severe type, a so-called black-box warning - and for patients to get

pamphlets with every bottle that describe the risk. It argues that too few

patients know they're supposed to quit using the drugs if they experience

symptoms such as pain or inflammation, before the tendon actually ruptures.

Public Citizen filed a petition seeking the stronger warning in August

2006.

The

state of Illinois

had filed a similar petition the previous year.

The FDA is violating its own statutes and putting patients at risk in

taking so long to settle the issue, Public Citizen said in the suit filed in U.S.

District

Court for the District of Columbia.

When Public Citizen first filed the petition, FDA's database showed 262

reports of tendon ruptures between November 1997 and December 2005, along with

hundreds of other tendon problems in users of these antibiotics. Since then,

the FDA has received an additional 74 reports of tendon ruptures, said Public

Citizen's Dr. Sidney Wolfe. Only a fraction of drug side effects typically are

reported to the agency, he noted.

An FDA spokesman said the agency was evaluating the lawsuit and

declined comment.

Warren, NJ 07059

[Guest guest]

Laurie,

I am not a researcher either but my

husband is a PhD student finishing his dissertation and he’s all about

the research at the moment so I asked for his input.

I think the survey is an excellent

idea. It will be asking all the right questions that will make it

worthwhile or not. You may find that the incidence of cruciate rupture 2’

to abx use in the canine athlete population in general is not statistically

significant but that it is significant in male dogs over 5 yrs of age, or

whatever. So, making sure you get all the info on each dog is

crucial. This may be dose dependent so the survey will probably need a

secondary step to try to obtain veterinary records. Etc, etc. You

get the idea.

I am sure there are many more people out

there who know much more than me and I will let them go further with it.

This could be the beginning of a lot of

potential research. This group of clients tend to be very willing to give

information for the betterment of canine health and medicine.

Orenbuch

evelynvet@...

www.evelynvet.com

From: VetRehab [mailto:VetRehab ] On Behalf Of Dr. Laurie McCauley

Sent: Sunday, January 06, 2008

10:21 AM

To: VetRehab

Subject: RE: Tendon

issues with Fluoroquinolones

Hi All,

If we come up with a survey, Clean run may be willing to put it up

on their website. Clean run is “the” magazine company for agility

people. This way we could reach a large percentage of canine athlete

owners.

I am not a researcher so I would need some help. What I was

thinking was to ask people:

Has your athlete torn his or her cruciate?

Was your athlete on any medication just prior to or when this

happened?

If yes, was an antibiotic or NSAID? (this way people will not

freak out thinking ab’s are going to cause cruciate damage?????)

If your dog has torn their cruciate and was on or recently on an

antibiotic, which antibiotic (list 10 or more)

Maybe a similar question with NSAIDs

Again, any thoughts/help or letting me know this would mot be a

good thing to do would be appreciated J

Laurie McCauley, DVM

TOPS Veterinary Rehabilitation

Grayslake,

IL

drmctops-vet-rehab

www.tops-vet-rehab.com

From: VetRehab

[mailto:VetRehab ]

On Behalf Of dogpt

Sent: Saturday, January 05, 2008

8:14 PM

To: VetRehab

Subject: Re: Tendon

issues with Fluoroquinolones

Mark,

Quinolone induced

tendon ruptures have been described in the literature dating back to the early

and mid 80's. A medline search will reveal many cited references. These cases

are rare, although I have treated one patient with an achilles tendon rupture

and had a co-worker rupture both achilles tendons while on quinolones. I have

not heard this mentioned occuring in the canine population, however, much of

the phase I and II studies were performed on dogs.

Ria

Acciani MPT

Acciani PT

Advanced Canine

Rehabilitation

6 Kenquit Road

On Jan 5, 2008, at

6:36 PM, Mark B. Parchman wrote:

Happy New Year!

I just have to stick my 2 cents in on this topic. I don't think that we can

extrapolate from human medicine and condemn fluoroquinolones in dogs.

Additionally, both of the drugs cited are not the commonly used

fluoroquinolones in veterinary medicine. I think that until there is hard

evidence that supports discontinuing using them in dogs, we should not make

make suggestions to avoid their usage. Experience wise, since Baytril hit the market

(15 - 20 years ago?) I have not seen any tendon injury associated with their

usage, nor have I seen any tendon injury after their usage. Does anyone on this

list know of any citation or reference addressing this human problem? By the

way, I do not work for Bayer nor am I getting paid to say this (I wish I was

though).

Mark B. Parchman, DVM, DACVS, CVA

<clip_image002.gif>

1245 SE 3rd St., Suite

C3 Tel

Bend,

Oregon 97702 Fax

tomlinson wrote:

Hi Laurie

It is something we always talked about when I used to treat

horses, not sure in the small animal world but I avoid them in canine athletes

Tomlinson BVSc MS PhD DACVS CCRP

Certified Canine Rehabilitation Practitioner

Twin Cities Animal Rehabilitation Clinic

12010

Riverwood Dr, Burnsville

MN 55337

www.tcrehab.com

<mime-attachment.jpeg>

From: VetRehab

[mailto:VetRehab ]

On Behalf Of Dr. Laurie McCauley

Sent: Friday, January 04, 2008

3:15 PM

To: VetRehab

Subject: Tendon issues

with Ab'sl?

I saw this come

across another list that I belong to and was wondering if anyone had heard

anything about it?

Group

Sues FDA for Stronger Warnings

Jan

3, 7:16 PM (ET)

WASHINGTON (AP) - A consumer group sued the Food and Drug

Administration Thursday, charging the agency is ignoring calls for stronger

warnings that Cipro and similar antibiotics may cause serious tendon injuries.

Labels of the fluoroquinolone family of antibiotics - drugs that

include the popular Cipro and Levaquin - already warn about rupture of tendons

and other tendon injuries, but at the bottom of a list of other side effects.

The consumer group Public Citizen wants those warnings upgraded to the

FDA's most severe type, a so-called black-box warning - and for patients to get

pamphlets with every bottle that describe the risk. It argues that too few

patients know they're supposed to quit using the drugs if they experience

symptoms such as pain or inflammation, before the tendon actually ruptures.

Public Citizen filed a petition seeking the stronger warning in August

2006.

The

state of Illinois

had filed a similar petition the previous year.

The FDA is violating its own statutes and putting patients at risk in

taking so long to settle the issue, Public Citizen said in the suit filed in U.S.

District

Court for the District of

Columbia.

When Public Citizen first filed the petition, FDA's database showed 262

reports of tendon ruptures between November 1997 and December 2005, along with

hundreds of other tendon problems in users of these antibiotics. Since then,

the FDA has received an additional 74 reports of tendon ruptures, said Public

Citizen's Dr. Sidney Wolfe. Only a fraction of drug side effects typically are

reported to the agency, he noted.

An FDA spokesman said the agency was evaluating the lawsuit and

declined comment.

Warren, NJ

07059

[Guest guest]

Dear Laurie,

I am not sure how to approach this but when I studied the pathophysiology of cruciate repairs, my looking up the pathology evidence indicated that usually they were secondary tears - not primary as in people. Also there was inflammation and degenerative changes present usually prior to tearing. Can any others add to this?

This being the case I have paid attention to cruciate injury in dogs and have often found there other sites of pain/inflammation in the body concurrently- most commonly the GIT. If some other condition did exist in the body that was recognized and was prescribed either NSAIDs or abios- this may be important. However would it indicate the medication is the issue or the preexisting inflammation? This angle may need to be considered in the questions asked.

Dr Toni Lynch BVSc Hons GDAnimal Chiro

RE: Tendon issues with Fluoroquinolones

Hi All,

If we come up with a survey, Clean run may be willing to put it up on their website. Clean run is “the” magazine company for agility people. This way we could reach a large percentage of canine athlete owners.

I am not a researcher so I would need some help. What I was thinking was to ask people:

Has your athlete torn his or her cruciate?

Was your athlete on any medication just prior to or when this happened?

If yes, was an antibiotic or NSAID? (this way people will not freak out thinking ab’s are going to cause cruciate damage?????)

If your dog has torn their cruciate and was on or recently on an antibiotic, which antibiotic (list 10 or more)

Maybe a similar question with NSAIDs

Again, any thoughts/help or letting me know this would mot be a good thing to do would be appreciated J

Laurie McCauley, DVM

TOPS Veterinary Rehabilitation

Grayslake, IL

drmctops-vet-rehab

www.tops-vet-rehab.com

From: VetRehab [mailto:VetRehab ] On Behalf Of dogptSent: Saturday, January 05, 2008 8:14 PMTo: VetRehab Subject: Re: Tendon issues with Fluoroquinolones

Mark,

Quinolone induced tendon ruptures have been described in the literature dating back to the early and mid 80's. A medline search will reveal many cited references. These cases are rare, although I have treated one patient with an achilles tendon rupture and had a co-worker rupture both achilles tendons while on quinolones. I have not heard this mentioned occuring in the canine population, however, much of the phase I and II studies were performed on dogs.

Ria Acciani MPT

Acciani PT

Advanced Canine Rehabilitation

6 Kenquit Road

Happy New Year!I just have to stick my 2 cents in on this topic. I don't think that we can extrapolate from human medicine and condemn fluoroquinolones in dogs. Additionally, both of the drugs cited are not the commonly used fluoroquinolones in veterinary medicine. I think that until there is hard evidence that supports discontinuing using them in dogs, we should not make make suggestions to avoid their usage. Experience wise, since Baytril hit the market (15 - 20 years ago?) I have not seen any tendon injury associated with their usage, nor have I seen any tendon injury after their usage. Does anyone on this list know of any citation or reference addressing this human problem? By the way, I do not work for Bayer nor am I getting paid to say this (I wish I was though). Mark B. Parchman, DVM, DACVS, CVA

<clip_image002.gif>

1245 SE 3rd St., Suite C3 Tel Bend, Oregon 97702 Fax tomlinson wrote:

Hi Laurie

It is something we always talked about when I used to treat horses, not sure in the small animal world but I avoid them in canine athletes

Tomlinson BVSc MS PhD DACVS CCRP

Certified Canine Rehabilitation Practitioner

Twin Cities Animal Rehabilitation Clinic

12010 Riverwood Dr, Burnsville MN 55337

www.tcrehab.com

<mime-attachment.jpeg>

From: VetRehab [mailto:VetRehab ] On Behalf Of Dr. Laurie McCauleySent: Friday, January 04, 2008 3:15 PMTo: VetRehab Subject: Tendon issues with Ab'sl?

I saw this come across another list that I belong to and was wondering if anyone had heard anything about it?

Group Sues FDA for Stronger Warnings

Jan 3, 7:16 PM (ET)

WASHINGTON (AP) - A consumer group sued the Food and Drug Administration Thursday, charging the agency is ignoring calls for stronger warnings that Cipro and similar antibiotics may cause serious tendon injuries.

Labels of the fluoroquinolone family of antibiotics - drugs that include the popular Cipro and Levaquin - already warn about rupture of tendons and other tendon injuries, but at the bottom of a list of other side effects.

The consumer group Public Citizen wants those warnings upgraded to the FDA's most severe type, a so-called black-box warning - and for patients to get pamphlets with every bottle that describe the risk. It argues that too few patients know they're supposed to quit using the drugs if they experience symptoms such as pain or inflammation, before the tendon actually ruptures.

Public Citizen filed a petition seeking the stronger warning in August 2006.

The state of Illinois had filed a similar petition the previous year.

The FDA is violating its own statutes and putting patients at risk in taking so long to settle the issue, Public Citizen said in the suit filed in U.S.

District Court for the District of Columbia.

When Public Citizen first filed the petition, FDA's database showed 262 reports of tendon ruptures between November 1997 and December 2005, along with hundreds of other tendon problems in users of these antibiotics. Since then, the FDA has received an additional 74 reports of tendon ruptures, said Public Citizen's Dr. Sidney Wolfe. Only a fraction of drug side effects typically are reported to the agency, he noted.

An FDA spokesman said the agency was evaluating the lawsuit and declined comment.

Warren, NJ 07059

[Guest guest]

Toni

I'm not sure where you got your info' but it isn't correct-cruciate dz isn't a result of inflamm-we don't see as many acute tears in humans because of dog's comformation and activity, as well as an associated collagen degenration and loads. The inflammation is not pre-existing-it's been there as part of the inflamm repsonse to the ligamentous pathology, not the opposite. Also, meniscal injury contributes to this as well.

Freedman VMD CCRT

RE: Tendon issues with Fluoroquinolones

Hi All,

If we come up with a survey, Clean run may be willing to put it up on their website. Clean run is “the” magazine company for agility people. This way we could reach a large percentage of canine athlete owners.

I am not a researcher so I would need some help. What I was thinking was to ask people:

Has your athlete torn his or her cruciate?

Was your athlete on any medication just prior to or when this happened?

If yes, was an antibiotic or NSAID? (this way people will not freak out thinking ab’s are going to cause cruciate damage?????)

If your dog has torn their cruciate and was on or recently on an antibiotic, which antibiotic (list 10 or more)

Maybe a similar question with NSAIDs

Again, any thoughts/help or letting me know this would mot be a good thing to do would be appreciated J

Laurie McCauley, DVM

TOPS Veterinary Rehabilitation

Grayslake, IL

drmctops-vet-rehab

www.tops-vet-rehab.com

From: VetRehab [mailto:VetRehab ] On Behalf Of dogptSent: Saturday, January 05, 2008 8:14 PMTo: VetRehab Subject: Re: Tendon issues with Fluoroquinolones

Mark,

Quinolone induced tendon ruptures have been described in the literature dating back to the early and mid 80's. A medline search will reveal many cited references. These cases are rare, although I have treated one patient with an achilles tendon rupture and had a co-worker rupture both achilles tendons while on quinolones. I have not heard this mentioned occuring in the canine population, however, much of the phase I and II studies were performed on dogs.

Ria Acciani MPT

Acciani PT

Advanced Canine Rehabilitation

6 Kenquit Road

Happy New Year!I just have to stick my 2 cents in on this topic. I don't think that we can extrapolate from human medicine and condemn fluoroquinolones in dogs. Additionally, both of the drugs cited are not the commonly used fluoroquinolones in veterinary medicine. I think that until there is hard evidence that supports discontinuing using them in dogs, we should not make make suggestions to avoid their usage. Experience wise, since Baytril hit the market (15 - 20 years ago?) I have not seen any tendon injury associated with their usage, nor have I seen any tendon injury after their usage. Does anyone on this list know of any citation or reference addressing this human problem? By the way, I do not work for Bayer nor am I getting paid to say this (I wish I was though). Mark B. Parchman, DVM, DACVS, CVA

<clip_image002.gif>

1245 SE 3rd St., Suite C3 Tel Bend, Oregon 97702 Fax tomlinson wrote:

Hi Laurie

It is something we always talked about when I used to treat horses, not sure in the small animal world but I avoid them in canine athletes

Tomlinson BVSc MS PhD DACVS CCRP

Certified Canine Rehabilitation Practitioner

Twin Cities Animal Rehabilitation Clinic

12010 Riverwood Dr, Burnsville MN 55337

www.tcrehab.com

<mime-attachment.jpeg>

From: VetRehab [mailto:VetRehab ] On Behalf Of Dr. Laurie McCauleySent: Friday, January 04, 2008 3:15 PMTo: VetRehab Subject: Tendon issues with Ab'sl?

I saw this come across another list that I belong to and was wondering if anyone had heard anything about it?

Group Sues FDA for Stronger Warnings

Jan 3, 7:16 PM (ET)

WASHINGTON (AP) - A consumer group sued the Food and Drug Administration Thursday, charging the agency is ignoring calls for stronger warnings that Cipro and similar antibiotics may cause serious tendon injuries.

Labels of the fluoroquinolone family of antibiotics - drugs that include the popular Cipro and Levaquin - already warn about rupture of tendons and other tendon injuries, but at the bottom of a list of other side effects.

The consumer group Public Citizen wants those warnings upgraded to the FDA's most severe type, a so-called black-box warning - and for patients to get pamphlets with every bottle that describe the risk. It argues that too few patients know they're supposed to quit using the drugs if they experience symptoms such as pain or inflammation, before the tendon actually ruptures.

Public Citizen filed a petition seeking the stronger warning in August 2006.

The state of Illinois had filed a similar petition the previous year.

The FDA is violating its own statutes and putting patients at risk in taking so long to settle the issue, Public Citizen said in the suit filed in U.S.

District Court for the District of Columbia.

When Public Citizen first filed the petition, FDA's database showed 262 reports of tendon ruptures between November 1997 and December 2005, along with hundreds of other tendon problems in users of these antibiotics. Since then, the FDA has received an additional 74 reports of tendon ruptures, said Public Citizen's Dr. Sidney Wolfe. Only a fraction of drug side effects typically are reported to the agency, he noted.

An FDA spokesman said the agency was evaluating the lawsuit and declined comment.

Warren, NJ 07059