Don't blow out your knee because you got a cold – antibiotics and your joints

Originally published in the North Lake Tahoe Bonanza (link), January 26, 2010. I hope you are all enjoying the wonderful start we've had to our 2010/2011 ski season. If you want to enjoy each turn until the last patches of snow melt, you're going to have to stay healthy and injury-free.

During the winter we spend more time traveling and inside with others, breathing air that is stuffier and less healthy than during the summer. All of these factors predispose us to getting sick, and we do — we are far more likely to become ill during the winter than during the summer.

Obviously, illness will cut into your days skiing, but did you know that some antibiotics weaken your joints and leave you injury-prone for weeks or even months after you finish taking them? The antibiotics at fault are a class of drugs called fluoroquinolones. The most commonly prescribed fluoroquinolones are ciprofloxacin (Cipro), levofloxacin (Levaquin) and moxifloxacin (Avelox).

If you participate in sports that place your tendons at risk you should avoid fluoroquinolone antibiotics if possible. They are great disease fighters and because they work well for many common bacterial infections, they are widely used. Unfortunately, their effects on joint strength make them far from ideal for those of us who enjoy winter sports.

Most of the injuries seen in patients taking fluoroquinolones are to the tendons -- ranging from mild tendon injuries all the way to full tendon ruptures. Studies show a roughly two- to four-fold increase in the risk of tendon injuries after a course of fluoroquinolones, but the risk is quite a bit higher for those over 60 years of age. Fluoroquinolones also cause cartilage to soften, increasing your risk of other injuries, including meniscus tears.

Remember, these statistics are for the general population. Most people aren't skiing bumps, dodging trees or throwing rodeos in the terrain park. If you ski or snowboard, you already have a higher than average chance of getting banged up, so anything that weakens your joints will represent a disproportionate risk for you compared to someone with a more sedentary lifestyle.

Here in Tahoe most physicians are aware of this problem, but if you live part of the year elsewhere or are just vacationing in Tahoe your doctor may not consider the importance of your joint health when their main focus is your immediate illness. The risk of traumatic injury may be remote in their minds if they don't tend to a patient base prone to banging bumps or arcing turns at high speeds. If you make them aware of this issue, they will be able to consider if there is another type of antibiotic which will be effective for you without placing your joints at risk.

One more thing. The best strategy of all is not to get sick in the first place, so be sure to rest, drink plenty of water and make sure that you and the kids all wash your hands!

— Dr. Rebecca Gelber is an Incline Village resident and graduate of The Johns Hopkins School of Medicine. She is an adjunct professor with the UNR School of Medicine and practices locally at Tahoe Aesthetic and Integrative Medicine, 775-298-1750,