The concerns about fluoroquinolone-associated adverse events (AEs), including tendon injury, have likely resulted in its limited use in pediatrics. However, reports of fluoroquinolone-induced tendon injury are almost exclusively in adults. In this issue of Pediatrics, Ross et al report an active comparator cohort study using US claims data to evaluate outcomes of adolescents prescribed oral fluoroquinolones and other broad-spectrum antibiotics in the outpatient setting from 2000 to 2018. The primary outcome was tendon rupture and the secondary outcome was tendinitis as identified by International Classification of Diseases and Current Procedural Terminology codes. The authors did observe a small increase in tendon rupture in adolescents prescribed fluoroquinolone. However, >52 000 adolescents would need to be treated with a fluoroquinolone for one additional tendon rupture to occur. Tendinitis was also observed more frequently in the fluoroquinolone-prescribed teenagers, with a number needed to treat-to-harm >4400.

The strengths of the study...

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