Risk of Achilles tendon rupture following single-dose ciprofloxacin use in transrectal prostate biopsies

PURPOSE: To assess the risk of Achilles tendon rupture (ATR) following single-dose ciprofloxacin prophylaxis for transrectal prostate biopsy. METHODS: 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. RESULTS: 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]: 0.83-1.15). CONCLUSIONS: 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.