{
  "abstract": "This study evaluated the association between individual fluoroquinolones and tendon disorders in Japan using two spontaneous reporting systems: the Food and Drug Administration Adverse Event Reporting System (FAERS) and the Japanese Adverse Drug Event Report (JADER). Five agents—ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin, and ofloxacin—were analyzed for “Muscle, tendon and ligament injuries” and “Tendon disorders.” All fluoroquinolones showed positive signals in the FAERS, whereas only levofloxacin demonstrated consistent and robust associations in the Japanese subset of the FAERS and the JADER. In the JADER, levofloxacin exhibited strong signals for muscle, tendon, and ligament injuries (reporting odds ratio [ROR] 30.6, information component [IC] 4.5) and tendon disorders (ROR 134.2, IC 5.8). Stratified analysis revealed markedly stronger signals in males, particularly those aged ≥70 years (relative ROR 12.21 and 25.67; IC delta 3.18 and 2.85, respectively). Oral levofloxacin was associated with higher reporting odds than intravenous administration. Time-to-onset analysis indicated that most tendon-related adverse events occurred within 14 days after drug initiation. Levofloxacin exhibited the most consistent and robust association with tendon disorders, especially in males aged ≥70 years in Japan. Therefore, clinicians in Japan should exercise caution when prescribing levofloxacin to older male patients.",
  "abstract_shown": true,
  "affiliations": [
    "Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan",
    "Department of Pharmacy, National Cancer Center Hospital, Tokyo, Japan",
    "Office of Infection Control and Prevention, National Cancer Center Hospital, Tokyo, Japan",
    "Endowed Course of Social Community Pharmacy, Gifu Pharmaceutical University, Gifu, Japan"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Toshihisa Nakashima"
    },
    {
      "affs": [
        1
      ],
      "name": "Yoshihiro Noguchi"
    },
    {
      "affs": [
        2
      ],
      "name": "Rikuto Masuda"
    },
    {
      "affs": [
        3
      ],
      "name": "Tomoaki Yoshimura"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6vvzsd932txb5.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0358427",
  "fulltext_url": null,
  "id": "6vvzsd932txb5",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0358427",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "3005|Pharmacovigilance and Adverse Drug Reactions"
    ],
    [
      "plos",
      "/Biology and life sciences/Anatomy/Biological tissue/Connective tissue/Ligaments"
    ],
    [
      "plos",
      "/Biology and life sciences/Anatomy/Biological tissue/Connective tissue/Tendons"
    ],
    [
      "plos",
      "/Biology and life sciences/Anatomy/Renal system"
    ],
    [
      "plos",
      "/Medicine and health sciences/Anatomy/Biological tissue/Connective tissue/Ligaments"
    ],
    [
      "plos",
      "/Medicine and health sciences/Anatomy/Biological tissue/Connective tissue/Tendons"
    ],
    [
      "plos",
      "/Medicine and health sciences/Anatomy/Renal system"
    ],
    [
      "plos",
      "/Medicine and health sciences/Critical care and emergency medicine/Trauma medicine/Traumatic injury/Musculoskeletal injury"
    ],
    [
      "plos",
      "/Medicine and health sciences/Epidemiology/Medical risk factors"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmacology/Drug research and development/Drug safety"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmacology/Routes of administration"
    ],
    [
      "plos",
      "/Research and analysis methods/Research design/Clinical research design/Adverse events"
    ]
  ],
  "openalex": "W7212311897",
  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0358427&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-11",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/6vvzsd932txb5.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:56Z",
      "native_id": "10.1371/journal.pone.0358427",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0358427"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "plos:anatomy",
      "subfield": "physiology"
    }
  ],
  "title": "Levofloxacin-associated tendon disorders: Sex-, age-, and route-specific disproportionality analysis using FAERS and JADER",
  "title_text": "Levofloxacin-associated tendon disorders: Sex-, age-, and route-specific disproportionality analysis using FAERS and JADER",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:56Z",
  "url": "https://research.draconitic.com/paper/6vvzsd932txb5",
  "venue": "PLOS One",
  "versions": []
}