How common is this? I'm 64 so well in the at-risk age bracket. I was given ciprofloxacin yesterday for a testicular infection but got scared when I read about tendon injuries it can cause, sometimes within 48bhoyrs of starting the course. So I asked the GP for something else and she gave me doxycyclin, which has the added risk of eroding your aesophagus. Then I read that Doxy also can cause tendon ruptures so now I'm in an agony of anxiety.
Has anybody any experience of these?
Secondary to this I've been taking Finasteride for a month or two to shrink my prostate. Sex has come to an end and now I've discovered a lump on a testicle that is basically stagnant infected semen, hence the antibiotics. Anybody got any words of experience on tendon injuries or lumps in the epididymis?
It's sensible to read those leaflets, so well done there. That said - they're listing risks, not making promises. That said, the licensing authorities have recently made extra rules for ciprofloxacin and related abx that mean your leaflet may have been "extra-scary" (and not only about tendons)
You do have to be fairly unlucky to experience either of the things you've listed, even as an older patient. The reported overall opulation risk is below 1 in 10,000 for tendon rupture with cipro, for example, though over 60 is a risk factor as you clearly know (taking oral steroids for any reason? They'd further increase yr risk. Do you have rheumatoid arthritis? that might too)
It's about the same for severe oesophaegeal events with doxy - and if you swallow it with a decent glug of water and aren't lying in bed/doing a handstand at the time, then it'll blat straight down yr oesophagus and hit the stomach "immediately" which will reduce that risk quite a way further
Doxy and tendons - not heard of that (for humans); would love to see what you've found (it does interfere with a paeticular enzyme system that is involved in connective tissue maintenance but I'm sure one purported "magic" effect of doxy is enhancing tendon repair due to that) <<though just had a quick look and there are, as always, conflicting studies - all in little animals>>
Having said all that, guess what? I think I ruptured a tendon very shortly after taking cipro for exactly your indication. Was "only" my plantaris (crappy little muscle/tendon in the calf) and wasn't imaged or diagnosed by anyone other than me, but it fit perfectly with the typical description of that injury. I did it jumping over a puddle from a near-standing start
(perhaps avoid "explosive" exercise like, err, puddle jumping for a few weeks ?)
<FWIW: pharmacist; special interest in infection. those ^ views are mine and are intended as conversational rather than comprehensive. You did a far more sensible thing in talking to a GP who knows you (and your knackers) better than I do>
Thanks for a well-informed reply, isn't this forum amazing!
I often think pharmacists know much more than GPs who tend to be creatures of habit in their prescribing. I've only met my new Scottish GP once but I've had about 6 phone conversations with her and I get the impression she quite enjoys talking to a patient who takes an interest in his meds rather than just blindly accepting what she dishes out.
Btw during one of my all-night sleepless vigils I read something interesting on the internet about Drs finding that hitting difficult bacteria with alternating antibiotics was delivering some surprising results. Did you see that?
creatures of habit in their prescribing
Magic ! I spend quite a lot of my time writing and disseminating guidelines and, while blind obedience is bad there's actually good evidence that patients whose docs follow guidelines really do tend to do better (mostly studied in hospital situations but I bet it's at least equally true in primary care)
These days GPs tend to use something like either the NICE CKS service or a localised version of it. Google that and you'll be up all night again !
On rotating antibiotics, not quite sure what you've read: Caution - lecture approaching !
some like it as a broad strategy (say, within a hospital or region) to stop extensive development of resistance to drug X; you use X for a period in all suitable cases but then rotate on to Y, Z and then back around. Trouble is that you often need to stop using drug X for quite a long time to see significant fall in resistance rates.
The other approach can be just to allow any one of several (effective) drugs to be used, essentially at random to stop any 1 resitance ever getting too high.
If you mean for a single patient, then we'd often try to switch about a bit when managing recurrent infections because there's a worry that they may be harbouring bugs that are resistant too previous courses, principally in their gut first-off but they can then turn up in urine etc pretty easily. (Even if we prevously treated a hospital pneumonia with a fancy drug, the resistance will "breed" in their gut so the next resistant infection might be a different bug in a different body site)
During a single infection in a single patient, we don't give drugs in a specified sequence apart from very particular circumstances ("yet", perhaps! I've seen a little bit of lab stuff looking at rapid rotation and effects on resistance in cultures). Several antibiotics work far better against actively dividing bacteria and so it's tempting to imagine a way of "forcing" all infecting organisms into a growth phase all at once but I don't think we've a way to achieve that in general use.
Of course, if our 1st treatment appears to be failing we may be forced to change - hopefully by then we've been able to culture & test the pathogen too.
Might combine two or more at once, often because we're not totally sure what's actually causing the infection but also sometimes because we know or suspect that a pt may have something (or things) hard to treat with just one drug (even the abx that work in the lab may be borderline) or else it's in a region(s) of the body that makes it hard to reach. There are also some drugs used in combination because they're synergistic together and then there are a few drugs where you must use them with at least one other or we might expect treatment failure due to resistance appearing at the site of infection even during the course of treatment.
... or almost all of that together, so pts with, say, cystic fibrosis may have highly resistant bugs in their lungs and those lungs may well be bunged up with mucus, making drug delivery hard to achieve in the required amounts even when we get them to inhale it.
If you mean rotating drugs used for long-term prevention of recurrent infection - you REALLY don't want me crapping on about my views on that
You need to research now likely that this will happen. It might only occur in people who are not fit.hence the majority of the population.usually with side effects they have the number of people affected. Ie one in ten could get this.one in hundred could get this.maybe look at the WebMD site.
I'm GP and here is what I warn patients about with these:
Cipro - small risk tendon rupture, rare, has happened to one of my patients
Doxy - 1. acid reflux symptoms common. Advice as per scaredypants above. Especially if patients have history of reflux/indigestion or are taking meds for that, or are taking NSAIDs (eg Ibuprofen) 2. sun sensitivity uncommon but can be severe / spoil a holiday
Finasteride - Sexual dysfunction common. Resolves on stopping it but I'm not aware of good alternatives (prostate shrinkers) which don't have the same SE
I generally prefer not to take medication for anything (eg I haven't taken paracetamol/ibuprofen for years) but have had to take both cipro and doxy in the last few years and didn't worry too much either time. I couldn't quantify the cipro risk but I would imagine a course carries a similar annual risk to your health as a car journey. I prescribe cipro for men of your age with epididymitis (which is common) as per guidelines mentioned above.
I looked into this a while back when I had to take something which had same listed side effect. I was training a lot at that point so stopped running and generally did more swimming and low impact plus reduced workload and was careful. Nothing snapped 👍
I spent 6 weeks on Cipro for Prostatitis and survived ok, was also worried about spontaneous tendon rupture - pretty serious side affect to potentially have.
It would be a disaster. I'm already in the full throes of a breakdown and we hope to move into our new house in December, when we will be taking up lots of physical activities like carrying and lifting stuff that we haven't done for months.
I was so ill at the time I couldn't even cycle to work, spent 6 months doing nothing.
Well after 5 doses of doxycyclin I've got a pain and swelling behind my left knee, especially noticeable when I kneel down and sit back.
Honestly if I didn't have family and friends who love me I'd be looking for the exit now, I've had enough of this ill-fated caper.
Well after 5 doses of doxycyclin I’ve got a pain and swelling behind my left knee
Don't panic GT
OK, granted it's slightly tempting in terms of chronology (if quite a bit too fast) but I'd be amazed if it's related to the antibiotics
Remember I am not even a doctor, let alone yours, so I'd suggest you have another chat with her
How much bike riding have you been doing lately? Grunted up any ded steep/technical climbs or done any sprints? Changed saddle position/shoes/cleats? Running? Walking like John Wayne? (standing-start puddle jumping? 😉 )
(can I have a fiver on Baker's cyst ? BUT I can't win unless your doc tells you what it is)
Oh, and top tip from me if yer knackers are still sore - wearing 2 pairs of proper brief-type undies changed my life (briefly !)
I had Baker's cysts about 20 years ago and yes that's what this feels like. The pain started as I walked the short distance to the building site. I haven't cycled for months because of depression. Mrs GTi and I are stuck in a filthy mouse-infested holiday bungalow costing thousands a month in Scotland in deteriorating weather waiting for the builder to finish our new house, which is too big and too ostentatious and has gobbled all of our life savings. If I receive a life-changing tendon injury in the next months we are definitely in the shit as I doubt we would get an operation. I am well and truly in the incident pit now, and too far in to get out.
Truly we are the victims of our own stupidity in having left Lancashire in panic when partying neighbours moved in next door. We sold our lovely comfortable house and moved into temporary. Now we have to restart our lives from scratch buying everything new. When we move into the new house I will be lifting heavy boxes and climbing the stairs dozens of times a day. One serious injury will be a disaster and I doubt hospitals are doing orthopedic operations now.
If I didn't have a family and friends I'd be looking for the exit at this point.
You need to take the anti-biotics to potentially clear the infection in your nut.
Have you had the snip ? If so, epididymis pain is a common issue and potentially permanent. I've had it since my snip 8 years ago. No infection. A year after the snip had the epididymis cut out on my worse nut (not a nice operation - nearly chucked up when I realised what they did afterwards...) - I still have pain in both. Try the antibiotics first.
Your current mental health won't help with how you are seeing things and your anxiety will rocket. Try and compartmentalise things like others have said.
Your current mental health won’t help with how you are seeing things and your anxiety will rocket.
Yes, been there. When you're not in a good place mentally you read the side effect list on the packet then as you take the pills you pretty much convince yourself you are experiencing all the worst symptons of the side effects...
Odds are you won't have any and it will be plain sailing, your brain just can't see that right now.
