Budesonide × Ciprofloxacin

Fluoroquinolone plus systemic glucocorticoid — tendinitis and tendon rupture risk (mainly Achilles tendon). The effect is amplified at age over 60, chronic kidney disease, and organ transplantation. Inhaled budesonide does not clinically affect risk.

Pain in the Achilles or other tendons, swelling, impaired function. Symptoms appear in the first weeks after starting ciprofloxacin and may persist for months after stopping.

On systemic budesonide, choose a non-fluoroquinolone antibiotic: cephalosporin, amoxicillin-clavulanate, doxycycline. If a fluoroquinolone is unavoidable, advise the patient to limit physical activity during and for a month after the course. If tendon pain appears, stop ciprofloxacin. Inhaled budesonide with ciprofloxacin is safe.