Snapping an achilles is something I would hate, the crack of the tendon, the total disability, the long recovery, no thank you.

But imagine walking along and suddenly rupturing both achilles tendons.

Now that would be truly awful.

But that would not happen without massive trauma or a prescription for a fluoroquinolone antibiotic like ciprofloxacin.

These are powerful antibiotics, used for UTI’s, prostatitis and hard to shift infections, are making headlines for all the wrong reasons.

They have long been associated with increased risk of tendon rupture as well as risk of tendinitis, but also neuropathy that leaves people in terrible pain. 

The question is how does it affect collagen and nerves?

The nerve questions is unclear, likely something to do with mitochondria function but that remains unclear. 

For collagen, it seems to be stopping the cells that make collagen, FIBROBLASTS, from working AND also increases an enzyme (metalloproteinase-2) that breaks connective tissue down. 

“Incubation of Achilles tendon, Achilles paratenon, and shoulder capsule fibroblasts with ciprofloxacin resulted in a statistically significant 66% to 68% decrease in cell proliferation compared with control cells at day 3 in culture. Ciprofloxacin caused a statistically significant 36% to 48% decrease in collagen synthesis compared with controls in all fibroblast cultures”

“This study demonstrates that ciprofloxacin stimulates matrix-degrading protease activity from fibroblasts and that it exerts an inhibitory effect on fibroblast metabolism.”

So we are constantly breaking down old collagen and replacing it with new fresh stuff. 

If the breakdown is increased and the building is reduced, then we have a short fall of collagen and snap. 

There go your achillies tendons, your rotator cuff, and on. 

And it’s not just full rupture, it can be more subtle. This review looked at all tendon disorders. 

“A literature search was conducted to identify observational studies which reported results on the risk of Achilles tendon rupture (ATR), risk of Achilles tendinitis (AT), or risk of any tendon disorders (ATD). A meta-analysis was performed by pooling odds ratios (ORs) with their 95% confidence intervals (CIs).”

And yes there was an association.

“The results of this meta-analysis confirm the risk of tendon injuries associated with fluoroquinolones. Older age and concomitant use of corticosteroids seem to be additional risk factors for tendinopathy.”

But it get worse, remember your arteries are made of type 1 & 3 collagen.

You know where this is going……

Overall, 284 cases (mean age 43.2   10.4 years; 58.5% men) and 568 controls qualified for the analysis. Thirty (10.6%) patients in the spontaeous cervical arterial dissection group and 16 (2.8%) in the non-CeAD IS group were fluoroquinolone users (P ≤ 0.001). The use of these antibiotics was associated with a more than twofold increased risk of spontaeous cervical arterial dissection [odds ratio (OR) 2.31; 95% confidence interval (CI) 1.00–5.30] after adjusting for confounders

Think about that for a moment……they are out there ready to pop in to get a neck adjustment after that nasty chest infection/UTI etc, and you line them up and they stroke out.

This is serious stuff.

I have seen a carotid artery dissection in clinic, and thankfully I referred him out, but I could have so easily adjusted his neck.

Could taking collagen and glycine (the latter is a rate limiter for collagen production) help overcome the issues?

We have no data on that at all.

However, we do know the two ways collagen may help.

And frankly we don’t have anything else to offer, so I would 100% be taking it if I was on ciprofloxacin.