{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T12:00:59Z","timestamp":1776340859384,"version":"3.51.2"},"reference-count":53,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SJU"],"abstract":"<jats:p>Purpose: To assess the risk of Achilles tendon rupture (ATR) following single-dose ciprofloxacin prophylaxis for transrectal prostate biopsy.\nMethods: Using the Prostate Cancer data Base Sweden (PCBaSe 5.0), we analysed 44,959 prostate biopsy exposures versus 662,520 non-exposures to assess the risk of ATR. Prostate biopsy served as a proxy for quinolone use, with single-dose ciprofloxacin being the recommended and most extensively documented prophylaxis in Sweden for this procedure. The outcome was ATR in men who underwent a biopsy compared to those who did not.\nResults: The incidence rate of ATR was 60.46 per 100,000 person-years in the no-biopsy group, compared to 62,77 per 100,000 person-years in the biopsy group. The multivariable analysis yielded a hazard ratio of 0.98 (95% confidence interval [CI]: 0.83\u20131.15). \nConclusions: Transrectal prostate biopsy was not associated with an elevated risk of Achilles tendon rupture. This provides some evidence against single-dose ciprofloxacin being a relevant risk factor for this outcome, but there is remaining uncertainty related to study limitations.<\/jats:p>","DOI":"10.2340\/sju.v61.45649","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T11:15:12Z","timestamp":1776338112000},"page":"121-126","source":"Crossref","is-referenced-by-count":0,"title":["Risk of Achilles tendon rupture following single-dose ciprofloxacin use in transrectal prostate biopsies"],"prefix":"10.2340","volume":"61","author":[{"given":"Michaela","family":"Runnaes","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik","family":"Lampa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johan","family":"Styrke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl-Johan","family":"Lundstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1183","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"149818","doi-asserted-by":"crossref","unstructured":"Alidjanov JF, Cai T, Bartoletti R, et al. The negative aftermath of prostate biopsy: prophylaxis, complications and antimicrobial stewardship: results of the global prevalence study of infections in urology 2010\u20132019. World J Urol. 2021;39:3423\u20133432.","DOI":"10.1007\/s00345-021-03614-8"},{"key":"149819","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1007\/s00345-021-03614-8","DOI":"10.1007\/s00345-021-03614-8"},{"key":"149820","doi-asserted-by":"crossref","unstructured":"Styrke J, Resare S, Lundstrom KJ, et al. Current routines for antibiotic prophylaxis prior to transrectal prostate biopsy: a national survey to all urology clinics in Sweden. F1000Res. 2020;9:58.","DOI":"10.12688\/f1000research.19260.1"},{"key":"149821","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.12688\/f1000research.19260.1","DOI":"10.12688\/f1000research.19260.1"},{"key":"149822","unstructured":"European Medicines Agency (2019). Quinolone- and fluoroquinolone-containing medicinal products. EMA\/175398\/2019. Available at: https:\/\/www.ema.europa.eu\/en\/medicines\/human\/referrals\/quinolone-fluoroquinolone-containing-medicinal-products"},{"key":"149823","unstructured":"European Medicines Agency (2018, October 5). Fluoroquinolone and quinolone antibiotics: PRAC recommends restrictions on use. EMA\/668915\/2018. Available at: https:\/\/www.ema.europa.eu\/en\/documents\/press-release\/fluoroquinolone-and-quinolone-antibiotics-prac-recommends-restrictions-use_en.pdf"},{"key":"149824","doi-asserted-by":"crossref","unstructured":"Bonkat G, Pilatz A, Wagenlehner F. Time to adapt our practice? The European Commission has restricted the use of fluoroquinolones since March 2019. Eur Urol. 2019;76:273\u2013275.","DOI":"10.1016\/j.eururo.2019.06.011"},{"key":"149825","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1016\/j.eururo.2019.06.011","DOI":"10.1016\/j.eururo.2019.06.011"},{"key":"149826","doi-asserted-by":"crossref","unstructured":"Lee CC, Lee MT, Chen YS, et al. Risk of aortic dissection and aortic aneurysm in patients taking oral fluoroquinolone. JAMA Intern Med. 2015;175:1839\u20131847.","DOI":"10.1001\/jamainternmed.2015.5389"},{"key":"149827","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1001\/jamainternmed.2015.5389","DOI":"10.1001\/jamainternmed.2015.5389"},{"key":"149828","doi-asserted-by":"crossref","unstructured":"Yu X, Jiang DS, Wang J, et al. Fluoroquinolone use and the risk of collagen-associated adverse events: a systematic review and meta-analysis. Drug Saf. 2019;42:1025\u20131033.","DOI":"10.1007\/s40264-019-00828-z"},{"key":"149829","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1007\/s40264-019-00828-z","DOI":"10.1007\/s40264-019-00828-z"},{"key":"149830","doi-asserted-by":"crossref","unstructured":"Pasternak B, Inghammar M, Svanstrom H. Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study. BMJ. 2018;360:k678.","DOI":"10.1136\/bmj.k678"},{"key":"149831","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1136\/bmj.k678","DOI":"10.1136\/bmj.k678"},{"key":"149832","doi-asserted-by":"crossref","unstructured":"Wise BL, Peloquin C, Choi H, et al. Impact of age, sex, obesity, and steroid use on quinolone-associated tendon disorders. Am J Med. 2012;125:1228.","DOI":"10.1016\/j.amjmed.2012.05.027"},{"key":"149833","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1016\/j.amjmed.2012.05.027","DOI":"10.1016\/j.amjmed.2012.05.027"},{"key":"149834","doi-asserted-by":"crossref","unstructured":"Chang HN, Pang JH, Chen CP, et al. The effect of aging on migration, proliferation, and collagen expression of tenocytes in response to ciprofloxacin. J Orthop Res. 2012;30:764\u2013768.","DOI":"10.1002\/jor.21576"},{"key":"149835","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1002\/jor.21576","DOI":"10.1002\/jor.21576"},{"key":"149836","doi-asserted-by":"crossref","unstructured":"Corps AN, Harrall RL, Curry VA, et al. Ciprofloxacin enhances the stimulation of matrix metalloproteinase 3 expression by interleukin-1beta in human tendon-derived cells. A potential mechanism of fluoroquinolone-induced tendinopathy. Arthritis Rheum. 2002;46:3034\u20133040.","DOI":"10.1002\/art.10617"},{"key":"149837","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1002\/art.10617","DOI":"10.1002\/art.10617"},{"key":"149838","doi-asserted-by":"crossref","unstructured":"Lundstrom KJ, Garmo H, Gedeborg R, et al. Short-term ciprofloxacin prophylaxis for prostate biopsy and risk of aortic aneurysm. Nationwide, population-based cohort study. Scand J Urol. 2021;55:221\u2013226.","DOI":"10.1080\/21681805.2021.1916072"},{"key":"149839","doi-asserted-by":"crossref","unstructured":"Alves C, Mendes D, Marques FB. Fluoroquinolones and the risk of tendon injury: a systematic review and meta-analysis. Eur J Clin Pharmacol. 2019;75:1431\u20131443.","DOI":"10.1007\/s00228-019-02713-1"},{"key":"149840","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1007\/s00228-019-02713-1","DOI":"10.1007\/s00228-019-02713-1"},{"key":"149841","doi-asserted-by":"crossref","unstructured":"Claessen FM, de Vos RJ, Reijman M, et al. Predictors of primary Achilles tendon ruptures. Sports Med. 2014;44:1241\u20131259.","DOI":"10.1007\/s40279-014-0200-z"},{"key":"149842","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1007\/s40279-014-0200-z","DOI":"10.1007\/s40279-014-0200-z"},{"key":"149843","doi-asserted-by":"crossref","unstructured":"Adolfsson J, Garmo H, Varenhorst E, et al. Clinical characteristics and primary treatment of prostate cancer in Sweden between 1996 and 2005. Scand J Urol Nephrol. 2007;41:456\u2013477.","DOI":"10.1080\/00365590701673625"},{"key":"149844","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1080\/00365590701673625","DOI":"10.1080\/00365590701673625"},{"key":"149845","doi-asserted-by":"crossref","unstructured":"Ludvigsson JF, Andersson E, Ekbom A, et al. External review and validation of the Swedish National Inpatient Register. BMC Public Health. 2011;11:450.","DOI":"10.1186\/1471-2458-11-450"},{"key":"149846","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1186\/1471-2458-11-450","DOI":"10.1186\/1471-2458-11-450"},{"key":"149847","doi-asserted-by":"crossref","unstructured":"Van Hemelrijck M, Wigertz A, Sandin F, et al. Cohort profile: the National Prostate Cancer Register of Sweden and Prostate Cancer data Base Sweden 2.0. Int J Epidemiol. 2013;42:956\u2013967.","DOI":"10.1093\/ije\/dys068"},{"key":"149848","doi-asserted-by":"crossref","unstructured":"Everhov AH, Frisell T, Osooli M, et al. Diagnostic accuracy in the Swedish national patient register: a review including diagnoses in the outpatient register. Eur J Epidemiol. 2025;40:359\u2013369.","DOI":"10.1007\/s10654-025-01221-0"},{"key":"149849","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1007\/s10654-025-01221-0","DOI":"10.1007\/s10654-025-01221-0"},{"key":"149850","doi-asserted-by":"crossref","unstructured":"Mohler JL, Armstrong AJ, Bahnson RR, et al. Prostate Cancer, Version 1.2016. J Natl Compr Canc Netw. 2016;14:19\u201330.","DOI":"10.6004\/jnccn.2016.0186"},{"key":"149851","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.6004\/jnccn.2016.0004","DOI":"10.6004\/jnccn.2016.0004"},{"key":"149852","doi-asserted-by":"crossref","unstructured":"Patricia M, Grambsch TMT. Proportional hazards tests and diagnostics based on weighted residuals. Biometrika. 1994;81:515\u2013526.","DOI":"10.1093\/biomet\/81.3.515"},{"key":"149853","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1093\/biomet\/81.3.515","DOI":"10.1093\/biomet\/81.3.515"},{"key":"149854","doi-asserted-by":"crossref","unstructured":"Suchak AA, Bostick G, Reid D, et al. The incidence of Achilles tendon ruptures in Edmonton, Canada. Foot Ankle Int. 2005;26:932\u2013936.","DOI":"10.1177\/107110070502601106"},{"key":"149855","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1177\/107110070502601106","DOI":"10.1177\/107110070502601106"},{"key":"149856","doi-asserted-by":"crossref","unstructured":"Leppilahti J, Puranen J, Orava S. Incidence of Achilles tendon rupture. Acta Orthop Scand. 1996;67:277\u2013279.","DOI":"10.3109\/17453679608994688"},{"key":"149857","doi-asserted-by":"crossref","unstructured":"Sheth U, Wasserstein D, Jenkinson R, et al. The epidemiology and trends in management of acute Achilles tendon ruptures in Ontario, Canada: a population-based study of 27 607 patients. Bone Joint J. 2017;99-B:78\u201386.","DOI":"10.1302\/0301-620X.99B1.BJJ-2016-0434.R1"},{"key":"149858","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1302\/0301-620X.99B1.BJJ-2016-0434.R1","DOI":"10.1302\/0301-620X.99B1.BJJ-2016-0434.R1"},{"key":"149859","doi-asserted-by":"crossref","unstructured":"Lantto I, Heikkinen J, Flinkkila T, et al. Epidemiology of Achilles tendon ruptures: increasing incidence over a 33-year period. Scand J Med Sci Sports. 2015;25:133\u2013138.","DOI":"10.1111\/sms.12253"},{"key":"149860","doi-asserted-by":"crossref","unstructured":"Huttunen TT, Kannus P, Rolf C, et al. Acute achilles tendon ruptures: incidence of injury and surgery in Sweden between 2001 and 2012. Am J Sports Med. 2014;42:2419\u20132423.","DOI":"10.1177\/0363546514540599"},{"key":"149861","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1177\/0363546514540599","DOI":"10.1177\/0363546514540599"},{"key":"149862","doi-asserted-by":"crossref","unstructured":"Daneman N, Lu H, Redelmeier DA. Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study. BMJ Open. 2015;5:e010077.","DOI":"10.1136\/bmjopen-2015-010077"},{"key":"149863","doi-asserted-by":"crossref","unstructured":"Khaliq Y, Zhanel GG. Fluoroquinolone-associated tendinopathy: a critical review of the literature. Clin Infect Dis. 2003;36:1404\u20131410.","DOI":"10.1086\/375078"},{"key":"149864","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1086\/375078","DOI":"10.1086\/375078"},{"key":"149865","doi-asserted-by":"crossref","unstructured":"Persson R, Jick S. Clinical implications of the association between fluoroquinolones and tendon rupture: the magnitude of the effect with and without corticosteroids. Br J Clin Pharmacol. 2019;85:949\u2013959.","DOI":"10.1111\/bcp.13879"},{"key":"149866","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1111\/bcp.13879","DOI":"10.1111\/bcp.13879"},{"key":"149867","doi-asserted-by":"crossref","unstructured":"van der Linden PD, Sturkenboom MC, Herings RM, et al. Increased risk of achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids. Arch Intern Med. 2003;163:1801\u20131807.","DOI":"10.1001\/archinte.163.15.1801"},{"key":"149868","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1001\/archinte.163.15.1801","DOI":"10.1001\/archinte.163.15.1801"},{"key":"149869","doi-asserted-by":"crossref","unstructured":"Baik S, Lau J, Huser V, et al. Association between tendon ruptures and use of fluoroquinolone, and other oral antibiotics: a 10-year retrospective study of 1 million US senior Medicare beneficiaries. BMJ Open. 2020;10:e034844.","DOI":"10.1136\/bmjopen-2019-034844"},{"key":"149870","doi-asserted-by":"crossref","unstructured":"https:\/\/doi.org\/10.1136\/bmjopen-2019-034844","DOI":"10.1136\/bmjopen-2019-034844"}],"container-title":["Scandinavian Journal of Urology"],"original-title":[],"link":[{"URL":"https:\/\/medicaljournalssweden.se\/SJU\/article\/download\/45649\/53515","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/medicaljournalssweden.se\/SJU\/article\/download\/45649\/53515","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T11:15:47Z","timestamp":1776338147000},"score":1,"resource":{"primary":{"URL":"https:\/\/medicaljournalssweden.se\/SJU\/article\/view\/45649"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,16]]},"references-count":53,"URL":"https:\/\/doi.org\/10.2340\/sju.v61.45649","relation":{},"ISSN":["2168-1813"],"issn-type":[{"value":"2168-1813","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,16]]}}}