Originally Posted by lhowemt
While risks are evaluated from a population wide basis, individual use should be person specific. I hear of no other problems associated with other antibiotics, and this wouldn't be the first wonder drug "later" found to cause problems. Sure, this is anecdotal, but that is no reason to discount avoiding one drug if other options exist. You might consider widening your pool of people to avoid it with, such as family with hisotry and other existing tendon/joint issues (such as RA). Honestly I get so tired of the pro-cipro mantra, sometimes it seems like there is a huge conspiracy to protect it and utterly disregard people's concerns. It reminds me of Vioxx. I think this does more harm than good for the use of the drug. When drugs get pulled from the market those people that have no other options lose that drug as an option.
90 days isn't enough to look at either, with my mother it was after a couple of doses over perhaps a year? I don't recall the exact time frame (and now she is gone). She was also over 65, and I think the warning specifically recommends avoiding Cipro of senior people due to potential tendon issues. Drugs are so complicated, we each respond differently. We need to be our own advocate.
While I will agree that a lot of factors should and need to be considered when prescribing any medication to anyone, one thing that is often overlooked is what we are actually trying to accomplish by giving out said antibiotic to the person in question. Each hospital and region should have their own antibiogram to help guide and tailor treatment for suspected pathogens, which when combined with the patient's medical history will help us prescribe the right agent.
For example, we have a large percentage of females over the age of 65 that are growing extended beta lactamase resistant E. coli, pseudomonas, and, Enterobacter in their urine. When I'm prescribing an antibiotic for one of them to go home on for their UTI, I may be doing so with a fluoroquinolone in hopes of covering them against some of the more exotic bugs out there, which our micro lab has shown our bugs to be susceptible to. Nothing is more frustrating than sending a 70 year who is perfectly stable home with a UTI, only to have her come back in 48 hours fulminately septic, altered, and sent to the ICU b/c we prescribed something with less coverage.
Everything has their pluses and minuses. Fluoroquinolones are not on the list of drugs to avoid in the elderly (unless they have other problems, medications, etc that make them a higher risk). Macrobid is contraindicated. Amox, augmentin, etc have limited use and come with very common side effects. Bactrim has one of the worst side effect profiles of any antibiotic. What's left?