The Center for Podiatric Care and Sports Medicine

Journalist Taking Prophylactic Antibiotics Ruptures Achilles Tendon

Posted by on Tuesday, February 5th, 2013


Foreign affairs journalists travel for work. It’s just part of the job. After all, you can’t very well report on famine in Africa or labor disputes in Central America without seeing the situation first-hand. But this kind of travel—often to third-world and developing nations—caries a certain amount of risk. There’s the risk of violence, especially if you’re reporting on political or social unrest. There’s the risk of cultural misunderstanding: reporters aren’t always welcome in foreign lands. And, there’s the risk of illness.



It’s not pretty, but diarrhea is one of the most common and troubling symptoms travelers suffer. It can actually be quite dangerous: dehydration can lead to death in severe cases. Much of the time, travelers’ diarrhea is caused by bacteria in the water supply or in the food. E. coli is the most common cause (it accounts for 20-50% of TD cases) and E. coli, as we’ve learned from many years of medical experimentation, is very controllable with antibiotics. So, as a prophylactic measure, many traveling journalists are taking antibiotics before they get sick, girding their intestines for a likely exposure. The problem: the antibiotics most commonly prescribed as prophylactics have a very troubling side effect. They may cause tendon rupture.



The Achilles tendon is most commonly at risk. Spontaneous ruptures are rare (one in 100,000 people) but in the presence of these antibiotics, rupture risk is three times higher. The risk is even greater for people over 60 who tend to have less elastic tendons. I would also venture a guess that chronic high-heel wearers (who tend to have thicker, less elastic Achilles tendons) may also be at greater risk. The antibiotics in question, the fluoroquinolones (including Levaquin and Cipro) are some of the most frequently prescribed. Annual sales of Levaquin exceeded $2.3 billion last year.



Rupturing the Achilles tendon isn’t only excruciating, it’s difficult to fix. Some ruptures can be treated with immobilization and rest (often for a few months). It typically involves wearing a cast or walking boot with wedges to elevate your heel (which will allow the torn tendon to heal safely). Surgery is typically indicated for severe ruptures (even for minor ruptures, surgery can reduce the risk of a re-rupture down the line). Surgery involves stitching the tendon together and, in some cases, reinforcing it with other tendons.



For a foreign journalist, an Achilles tendon rupture may mean a lost job. This is a debilitating injury and, while TD can be debilitating too, it doesn’t typically take six months of recovery time and surgery to correct. If you have serious TD, take antibiotics. Otherwise, it may be safer to drink bottled water and watch what you eat.


If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.