The Fluoroquinolone Drugs are the most toxic and dangerous antibiotic in clinical practice today.

Here is the source you requested regarding cipro causing stones:

BILATERAL HYDRONEPHROSIS FROM CIPROFLOXACIN INDUCED CRYSTALLURIA AND
STONE FORMATION
NAGESH CHOPRA*; PAUL L. FINE; BARBARA PRICE; IAN ATLAS
THE JOURNAL OF UROLOGY 2000;164:438
“Ciprofloxacin is a widely used fluoroquinolone for the treatment of
complicated and uncomplicated infections. Experimental studies in
humans and animals have indicated that crystalluria may be associated
with the administration of fluoroquinolones but, to our knowledge, no
case of obstructive uropathy has been reported. We describe a case of
bilateral urinary tract obstruction and acute renal failure due to
urinary tract stones predominantly composed of ciprofloxacin.” (which
by the way is EXACTLY what happened to me, other than the renal
failure part)

Also citing to:
Nakano M, Ishihara S, Deguchi T, Kuriyama M, Kawada Y.Fluoroquinolone
associated bladder stone.
J Urol. 1997 Mar;157(3):946. No abstract available.
PMID: 9072608 [PubMed - indexed for MEDLINE]

As well as:
Hammann C, Guelpa G.[Drug-induced calculi]
Schweiz Rundsch Med Prax. 1993 Oct 12;82(41):1129-32. French.
PMID: 8210886 [PubMed - indexed for MEDLINE]

Also I am certain that you treat hematuria as well, but never
considered cipro to be the cause:

Infection. 1985 Jul-Aug;13(4):177-8. Related Articles, Links
Ciprofloxacin-induced hematuria.
Garlando F, Tauber MG, Joos B, Oelz O, Luthy R.
We used ciprofloxacin, a quinolone-derivative, to treat a lung
infection due to Pseudomonas aeruginosa in an adult cystic fibrosis
patient. On three different occasions the use of ciprofloxacin was
associated with the development of an asymptomatic hematuria with red
blood cell casts. The mechanism responsible for this hematuria is
presently unknown, but clinicians should be aware of this potential
adverse effect of ciprofloxacin.
PMID: 2931381 [PubMed - indexed for MEDLINE]

Also citing to:
Deka PM, Rajeev TP.Unusual cause of hematuria.
Urol Int. 2001;66(1):41-2.
PMID: 11150952 [PubMed - indexed for MEDLINE]

And no doubt you use these drugs to treat prostatitis as well. And I
am sure that you have read Campbell's Urology where it is stated that
less than 5% of all cases of prostatitis is caused by a bacterial
infection. If you are prescribing this to everybody who has a case of
prostatitis then in 95% of these case there is NO logical reason to do
so. But never the less over five years ago they found it did not do a
damn thing:

Source:
Urology. 2003 Oct;62(4):614-7. Related Articles, Links

Levofloxacin for chronic prostatitis/chronic pelvic pain syndrome in
men: a randomized placebo-controlled multicenter trial.
Nickel JC, Downey J, Clark J, Casey RW, Pommerville PJ, Barkin J,
Steinhoff G, Brock G, Patrick AB, Flax S, Goldfarb B, Palmer BW, Zadra
J.
Department of Urology, Queen's University, Kingston General Hospital,
Kingston, Ontario, Canada.

“This pilot placebo-controlled study showed that 6 weeks of
levofloxacin therapy in men diagnosed with CP/CPPS resulted in symptom
improvement that was not significantly different from that with
placebo at end of treatment or follow-up.”

**********

And here is another you may have overlooked:
Subject: quinolone induced Fournier gangrene
http://www.medscape.com/viewarticle/458852_3
(use caution here, very graphic photos of this injury)

************

Source:
Past Issue Vol. 11, No. 3 March 2005
Antimicrobial Drug Prescribing for Pneumonia in Ambulatory Care
Conan MacDougall,* B. Joseph Guglielmo,* Judy Maselli,† and Ralph
Gonzales†
*University of California School of Pharmacy, San Francisco,
California, USA; and †University of California Department of Medicine,
San Francisco, California

“Of note, fluoroquinolone use in the 18- to 44-year age group more
than doubled from 2000 to 2002 (14% to 30%).Among fluoroquinolones
prescribed over all years of the study, 74% were for levofloxacin; 51%
of levofloxacin prescriptions were considered inappropriate-These
findings suggest that those prescribing antimicrobial drugs may be
increasingly using fluoroquinolones as a "one-size-fits-all" regimen
without accounting for differences due to age and other risk factors…”
(50% of the time there was no need to prescribe this drug)

**************

Source:
ODS POSTMARKETING SAFETY REVIEW
Consult: One-Year Post Pediatric Exclusivity Postmarketing
Adverse Events Review
Drug: Ciprofloxacin
NDA: 19-537, 19-847, 19-857, 20-780, 21-473, 21-554

“Pediatric Exclusivity Approval Date: December 22, 2003
The AERS database was searched for reports of adverse events (serious
and non-serious)
occurring with the use of Cipro (ciprofloxacin hydrochloride) in
pediatric patients. Up to
the "data lock" date of January 31, 2005, AERS contained 10,354 cases
for ciprofloxacin
(raw counts, all ages, foreign and domestic, as well as those with no
information on age
and country of origin).
DDRE was asked to focus on the 1-year period following the approval of
pediatric
exclusivity, December 22, 2003, to December 22, 2004. We used an AERS
data lock
date of January 31, 2005, to allow time for reports received up to
December 22, 2004, to
be entered into AERS. During the first 13 months after pediatric
exclusivity was granted,
AERS received a total of 686 cases (raw counts, all ages, foreign and
domestic, as well as
those with no information on age and country of origin).
The cases described hematological events , joint/tendon events ,
allergic hypersensitivity
reactions , CNS/convulsions , and pseudomembranous colitis, and
worsening of underlying disease.
During the first 13 months of pediatric exclusivity there was one
death, two reports of
disability and four of hospitalization.”

***********************

Source: DTB Vol 42 No 8 August 2004
“August 2004, Moxifloxacin (Avelox) when prescribed for Community
Acquired Pneumonia, Chronic Bronchitis, Acute Bacterial Sinusitis
offers no compelling advantages over established treatment. Claims
that oral moxifloxacin provides "rapid relief from chest infections"
are unsubstantiated.”

***************

Source:
Fluoroquinolone Utilization in the Emergency Departments of Academic
Medical Centers
Prevalence of, and Risk Factors for, Inappropriate Use
Ebbing Lautenbach, MD, MPH; Lori A. Larosa, PharmD; Nishaminy
Kasbekar, PharmD; Helen P. Peng, PharmD; Richard J. Maniglia, MD;
Neil O. Fishman, MD
Arch Intern Med.2003;163:601-605

“Of 100 total patients, 81 received an FQ for an inappropriate
indication. Of the 19 patients who received an FQ for an appropriate
indication, only 1 received both the correct dose and duration of
therapy. ( 1% received the appropriate drug at the appropriate dose,
hence 99% of the prescriptions were in error)”

*************

Antibiotic treatment does not help sore throats. British Medical
Journal N0 7104 Volume 315, August 9, 1997

Antibiotics do not improve sinusitis symptoms, study shows. Lancet
March 8, 1997 / World Health Report, 1996 World Health Organization
Geneva Switzerland May 1996

**********

Antibiotic use in treating bronchitis is unnecessary and risky The
Journal of Family Practice 1997;44(3):261-265

Source:
Letter
Canadian Family Physician
K. Bassett B. Mintzes V. Musini T.L. Perry Jr M. Wong J.M. Wright

“Gatifloxacin and moxifloxacin have no proven clinical advantages over
other fluoroquinolones, macrolides, or amoxicillin”

************

Not trying to bust your balls in the least here. Just trying to
provide you with the true safety profile of these drugs. If you
choose to ignore this that’s find by me. These are your patients we
are talking about here, not mine.

As I said what you now do with this information does not concern me in
the least. But you cannot now continue to claim ignorance as you have
done so far in this discussion.

Additionally, for the record, I am recognized by the courts as a
Expert Witness concerning these adverse reactions.

I rather doubt that the courts would allow this if my expertise is
based upon the ramblings of a twelve year old and his girlfriend.

Insult me all you care to.

All I am trying to do here is to prevent us from ever meeting face to
face in a civil courtroom. I find it to be a rather unpleasant affair
for all concerned. Even me.
And I am quite sure you would as well. Additionally I do not
prostitute myself either like so many of your peers. I offer my
testimony in exchange for actual out of pocket expense, not my time,
which I give freely just as I have done here and I derive NO profit
whatsoever from testifying.

But perhaps you will take the following to heart:

As stated within the 62nd meeting of the Anti-Infective Drugs Advisory
Committee (1995) where it was so eloquently stated:

"…when we talk about the issue of arthropathy that potentially
includes a number of things, ranging from simple effusion, for
instance, of a knee joint, which might rapidly resolve after the
conclusion of therapy, to a more permanent disability. .." (sic)

"…in September of 1997 there is now a ciprofloxacin suspension which
is available, and although it continues to have the same warning
statements about arthropathy in juvenile animals and the potential
concern in pediatric populations, obviously, the issue of off label
use will extend over to pediatric populations in this
formulation…."(sic)

"…An important safety question is, what adverse events should be
monitored, and Doctor Goldberger alluded to this earlier. This is some
of the examples I present. One is permanent lameness, reversible
lameness, joint effusion, joint pain, and even latent articular
disease or damage that may occur months or years following drug
exposure, and there may be others…."(sic)

"…And, data submitted to the Agency, as well as data from the
scientific literature, indicate that these lesions don't appear to be
reversible…"(sic)

"…Doctor Stahlmann in Berlin is working on an idea that it may be an
effect between the endocrines, the magnesium and the matrix and the
quinolone. And that data is just coming out now. But as to the exact
mechanism, I think you're right. I don't think we have a handle, as
far as I know, on the exact mechanism. If there's anybody else that
does, I'd sure like to hear it…"(sic)

"… Relating your personal experience, I was wondering about the
potential for a delayed effect that in fact one might have a patient
who had some histologic changes that would not be manifest clinically
for many years. Is that a potential?" (sic)

"… I think it is a potential…"(sic)

"… In trying to assess toxicity with a very sensitive assay, obviously
you've got tissue that you can look at in your animal models. There is
some human data that were collected by Doctor Urs Schaad using MRI
scanning in children and I'm wondering if you can correlate some of
your histopathologic findings with MR in the animal model to give us
an idea of how sensitive it would be sort of as a follow-up to Doctor
Klein's question is the MR something that will be able to predict long-
term outcomes, even if there are no clinical symptoms during
therapy…."(sic)

"… That I don't know. I'll just be perfectly frank. I don't know. But
on the slides I've seen from the animals from the chronic study, the
repaired articular cartilage that is there is principally
fibrocartilage yet it will provide the same joint margin and it has a
calcified base and when we stain it with safrain O screen there's no
proteoglycans there so it's going to make it an extremely
chondromalaistic area and beyond the one year I can't tell you what
the results will be…"(sic)

"…Anyway, it was by a group in Vienna where they looked at the
articular cartilage of postmortem specimens of articular cartilage
from kids with cystic fibrosis that had been on quinolones for a
period of time and they found that there was damage in the
chondrocytes…."(sic)

"…There were no deaths reported in U.S. pediatric zero to 18 year old
cases where a flouroquinolone was reported as the suspect drug.
However, there are eight deaths in the whole cohort of suspect and
concomitant flouroquinolone drug reports in the system. Five of these
deaths reported ciprofloxacin as a concomitant drug and not the
suspect drug. These five were U.S. cases with ages ranging from seven
months to six years. The remaining three deaths were all foreign, all
18 year old patients with either ofloxacin or norfloxacin reported as
the suspect drug…."(sic)

"…There are 14 reports of arthropathy or arthralgia in the pediatric
zero to 18 year old flouroquinolone reports. One report of a 14 year
old girl had both ofloxacin and lomefloxacin as the suspect drug so
there is an extra count because of the two flouroquinolones on this
one report. This particular report indicates that a pediatric
orthopedic surgeon diagnosed femoral anteversion as the cause for the
girl's arthralgia, therefore you see it listed twice, and not the
flouroquinolones. Most of the reports indicated that either an
involved knee or elbow with or without other joints was
involved…."(sic)

"…One interesting case which is not included on this slide for
arthralgias was a 15 year old boy who received ofloxacin IV for an
emergency appendectomy and had not grown more than his 70 inches in
height over the last year. The 15th percentile for height for a 15
year old boy however is 66.5 inches and the expected growth rate is
about two inches per year…"(sic)

"…Three patients had their seizure after the first dose of
flouroquinolone, one on ciprofloxacin and the other two on ofloxacin,
one of which had received ofloxacin several months earlier…"(sic)

"…The 15 psychiatric reports are a loose grouping of reports which
include events ranging from euphoria to psychosis. The ages range from
five to 18 years with the median at 15 years. There were two suicide
attempts, one on ofloxacin and the other on norfloxacin, three reports
of hallucination, one each on ciprofloxacin, ofloxacin and
norfloxacin, and one report of aggressive behavior with confusion in a
patient who had a psychiatric history and was on norfloxacin. The
seven cases of photosensitivity were reported with lomefloxacin with
one case on ciprofloxacin and two cases on ofloxacin. …"(sic)

"…I will mention that there were 152 U.S. cases aged zero to 18 years
in the U.S. AERS system suspect flouroquinolones in the WHO line
listing. The country with the most pediatric reports in the WHO
foreign reports is the United Kingdom with 177 reports followed by
Germany with 72 and France with 71. The rest of the countries had 20
or fewer reports…."(sic)

"…And with regards to muscular-skeletal events, 21 percent of the
patients had an event in ciprofloxacin…"(sic)

"…We have focused our analysis on joint disorders and pefloxacin. 79
cases were reported and consist mainly of arthralgia. I don't know the
pronunciation of hydrarthrosis -- 49 persons. It involved the knee in
52 cases, the wrist in 20 cases, the elbow in 20 cases, the shoulder
in 6 cases, the ankle in 5 cases, and the hip once. It is associated
with a functional discomfort in all cases, and when the duration of
this discomfort is known, it can persist more than one month in 61
percent of these cases. But the outcome was favorable in 58 cases
without discontinuation in two cases. …"(sic)

"…There have been sequelae in three cases with knee effusions
persisting one year later in one case with discomfort following 8
months later in the second case. The third case is articular. It is a
17-year-old patient who experienced arthropathy and the drug was not
suspected and the treatment was continued two following months. It
leads to destructive arthropathy of the knees and the hip and
prothesis was performed three years later. He was treated for a
cerebral abscess. The outcome was unknown in 18 cases. In 9 cases,
there was no follow-up. In the 9 last cases, we had a follow-up three
months later and patients were not -- were still with disabilities and
after we have no evolution…." (sic)

"… It is my understanding that one of the children had a joint
replacement, is that correct?"

" Pardon me?"

" One of the children with the complications had an artificial joint
replacement?"

"Yes."

"…If an irreversible cartilaginous lesion can occur, it is very likely
that is going to cause problems down the line and we can't even
anticipate what they are like…" (sic)
*******************

And this my friend was almost twelve years ago.

As far your questions regarding the legal aspect of malpractice?

Tequin drugmaker named in class-action lawsuit
Updated Tue. May. 9 2006 6:30 AM ET
CTV.ca News Staff
A $200,000 lawsuit has been launched against Bristol-Myers Squibb,
alleging the drugmaker failed in its duty to warn patients of the
risks associated with commonly prescribed antibiotic.
The lawsuit argues that the drugmaker failed to properly apprise one
of the plaintiffs, Alban Conlon, as well as physicians in Canada of
risks associated with Tequin.
(Plaintiff prevailed in this case and Health Canada also issued
warnings about possible adverse effects for diabetics taking Tequin
and had planned to further update safety information, including the
possibility of a "black box" warning used when a drug is potentially
lethal.)

********************

Wife of deceased inmate sues county jail, Newton Hospital The wife of
a former county jail inmate who died from uncontrolled bleeding
{allegedly as a result of taking Cipro and Coumadin} has filed a civil
action against the Sussex County jail and Newton Memorial Hospital.
Cipro is known to cause uncontrolled bleeding when given in
conjunction with Coumadin,
This appears to be something that occurs in many patients. See
http://www.njherald.com/news/newspro/viewnews.cgi?
newsid1078495795,56161,

*******************

GARFINKEL v. BAYER CORP., 8 A.D.3d 162 [1st Dept 2004]
779 N.Y.S.2d 71
GLORIA GARFINKEL, Plaintiff-Respondent, v. BAYER CORPORATION, ETC.,
Defendant-Appellant, CPW DRUGS INC., ETC., Defendant.
3961, 3961A.
Appellate Division of the Supreme Court of the State of New York,
First Department.
Decided June 22, 2004.
There are triable issues of fact as to whether the warning label for
defendant Bayer's pharmaceutical product, known as CIPRO, was
adequate at the time that CIPRO was prescribed for plaintiff. The
evidence showed that Bayer was aware of the potential association
between CIPRO use and ruptures of the achilles tendon for at least a
year prior to October 1994, when the drug was prescribed for
plaintiff, but did not during that time warn of the potential
association. In light of this evidence, a factual issue was raised as
to whether Bayer breached its duty to warn of all potential dangers in
its prescription drugs of which it knew, or, in the exercise of
reasonable care, should have known (see Martin v. Hacker, 83 N.Y.2d 1,
8).
Contrary to Bayer's contention, factual issues are also raised as to
whether its failure to warn was causally related to plaintiff's
injury. The record does not permit the conclusion that, had a warning
respecting an association between CIPRO use and achilles tendon
rupture been given, plaintiff's physician would nonetheless have
prescribed the medication or that plaintiff, who evidently owned and
consulted her own copy of the Physician's Desk Reference, would have
agreed to take it.

Massachusetts Superior Court

--------------------------------------------------------------------------------

BRIENZE v. CASSERLY, No. 01-1655-C (December 19, 2003)
DANIEL BRIENZE and PHILIP D. BRIENZE, as Executor of the Estate of
PAULA
BRIENZE v. BRIAN CASSERLY, M.D., ANDREW LEE, RPh. and CVS PHARMACY,
INC.
No. 01-1655-C.
COMMONWEALTH OF MASSACHUSETTS SUPERIOR COURT.
MIDDLESEX, SS.
December 19, 2003.

MEMORANDUM AND ORDER ON MOTION OF THE DEFENDANTS, STONEHAM CVS,
INC., improperly pled as "CVS PHARMACY, INC." and ANDREW LEE,
RPh., FOR SUMMARY JUDGMENT PURSUANT TO M.R.C.P. 56

LAURIAT, J.

Daniel Brienze ("Daniel"), brought this action to recover for
personal injuries he sustained from the adverse interaction of
two prescription medications, Ciproflaxin ("Cipro") and
Theophylline.

“The Plaintiffs' claims against Lee and CVS are based upon their
theory that Lee and CVS breached their duty to warn Daniel of the
potentially adverse interaction of Cipro and Theophylline when
they filled his prescription. Lee and CVS, hereinafter referred
to collectively as "the Defendants," now move for summary
judgment pursuant to Mass. R. Civ. P. 56, contending that
Massachusetts law imposes no such duty to warn upon pharmacists
or pharmacies.

For the reasons set forth below, this court concludes that
Massachusetts law DOES impose such a duty. Therefore, the
Defendants' motion for summary judgment is denied.”

***************************

Law suits involving sulfonamides shows that malpractice occurs when
the clinicians fails to warn the patient of adverse reactions such as
hemolytic reactions and Stevens-Johnson syndrome. Thus, if you intend
to prescribe a sulfonamide to a patient, you must inform them of these
risks (blood reaction if they have a hidden blood problem, or a severe
allergic reaction which can result in death). In most instances after
being informed of such risks, patients will prefer alternative
antibiotics which have similar coverage and less side effects.
http://www.hawaii.edu/medicine/pedia...xt/s06c05.html
Sanzari v. Rosenfeld, 34 N.J. 128, 140 (1961),
“is that the product insert, standing alone without expert testimony,
is evidence of negligence by the physician who fails to adhere to its
rules.” Id. at 121.

**********************

ANNETTE GILMARTIN, Executrix of the Estate of BRIAN GILMARTIN, and
ANNETTE GILMARTIN, Individually, Plaintiff-Appellant/ Cross-
Respondent, v. HERMAN J. WEINREB, M.D., Defendant-Respondent/Cross-
Appellant, and JEFFREY S. WEINSTEIN, D.O., S. ALAN WEINSTEIN, D.O.,
and OLD BRIDGE MEDICAL ASSOCIATES, Defendants.
DOCKET NO. A-5207-97T3
SUPERIOR COURT OF NEW JERSEY, APPELLATE DIVISION
324 N.J. Super. 367; 735 A.2d 620; 1999 N.J. Super. LEXIS 299

“A physician owes his or her patient a duty to disclose the dangers
inherent in the treatment proposed so that the patient will be in a
position to make an intelligent decision whether or not to submit to
the course of treatment that the physician proposes to take….Merely to
advise a patient of the general risk of negligence by a physician,
nurse, or technician is inadequate to the purposes of the informed
consent rule which is to provide the patient with the ability to
evaluate knowledgeably the available options and attendant
risks….Pharmaceutical package inserts and the Physician's Desk
Reference (PDR) are admissible to establish a physician's standard of
care when supported by expert testimony.”

***************

Within the package insert for Cipro it is stated that:
“Appropriate culture and susceptibility test should be performed
before treatment in order to isolate and identify organisms causing
infection and to determine their susceptibility to ciprofloxacin. “
As such I would believe that a patient who did NOT have a proven
bacterial infection and then suffered a severe reaction would have a
very good case of medical malpractice based upon being prescribe a
drug that there was no proven need for.

It's been a pleasure discussing this with you. I would hope that by
now you would have retracted your statements concerning the safety
profile of these drugs. If not then so be it. I learned years ago
that when you argue with a fool you soon find you are arguing with
yourself.

I have provided some of the documentation you requested and it would
be redundant to flood this board with the other 3,700 citations. If
these did not convince you then there is absolutely nothing more I
could possibly say anyhow.

But nevertheless I do believe that an apology would be appropriate at
this time. If not then I will simply consider the source and leave it
at that. I had expressed my own bias, provide a portion of my
documentantion and I believe that I acted respectfully toward you.
The ball is in your court now. Do with it as you please. I’ve stated
my case and I will now leave you in peace.

"Jim Hoover, regional manager for state government affairs for the
Bayer Corporation for the five northwest states, discussed second and
third generation quinolones. Bayer makes Ciprofloxacin, which has
multiple generic equivalents coming out in June that will have very
attractive prices. Normally the quinolone class of drugs is used in
patients who have failed at least one prior therapy. The patients tend
to be fairly ill and require relatively acute care that often may be
the last step before they are admitted into the hospital. ...By the time
the physicians get to this classification, they tend to have a good
idea of what bacteria is involved, what antibiotic is the most potent
for the bacteria and which penetrates that particular body side the
best. ...These drugs are often the last step before admission into the
hospital..." Alaska Pharmacy and Therapeutics Committee March 19,
2004

According to the manufacturer these drugs are often the last step
before being put in intensive care. And if I understand you correctly
you have given these to your kids? Even that is contra indicated
within the package inserts and only approved in the pediatric
population for Anthrax and serious non responding UTIs.

"davidtfull" wrote in message
...
"Jim Hoover, regional manager for state government affairs for the
Bayer Corporation for the five northwest states, discussed second and
third generation quinolones. Bayer makes Ciprofloxacin, which has
multiple generic equivalents coming out in June that will have very
attractive prices. Normally the quinolone class of drugs is used in
patients who have failed at least one prior therapy. The patients tend
to be fairly ill and require relatively acute care that often may be
the last step before they are admitted into the hospital. ...By the time
the physicians get to this classification, they tend to have a good
idea of what bacteria is involved, what antibiotic is the most potent
for the bacteria and which penetrates that particular body side the
best. ...These drugs are often the last step before admission into the
hospital..." Alaska Pharmacy and Therapeutics Committee March 19,
2004

According to the manufacturer these drugs are often the last step
before being put in intensive care. And if I understand you correctly
you have given these to your kids?

I said nothing about children.

Even that is contra indicated
within the package inserts and only approved in the pediatric
population for Anthrax and serious non responding UTIs.

Example - there 2 medications that reach excellent levels in prostatic
secretions. One is cipro. The other is a medication that far more people
have problems tolerating (Bactrim) due to the sulfa component/allergy to it,
upset stomach, etc. So yes, a quinolone is a first line agent. It has been
recommended by various expert committees as a first line agent for UTI's as
well due to the sensitivity profile of common UTI causing pathogens.

THanks for the link about the stones. Haven't read the article yet, but I
will.

to treat a mild case of epidemitis that could
have just as easily been treated with any number of much safer
antibiotics.

Such as? *Cipro is a great drug to treat epididymitis (I'm assuming that is
what you meant). *If left untreated or inadequately treated, you can end up
hospitalized with IV antibiotics.


Such as the following:

Epididymitis

Treatment: Drugs of choice in preferred order a

1. Ceftriaxone

2. Vibramycin twice a day for 10 days in addition to the shot of
Ceftriaxone

3. Floxin is listed as an alternative treatment, not a first line
agent

4. Cipro in men older than 35 years or those who participate in anal
intercourse

5. Bactrim DS

Then provide some evidence.
did that already for you

They are NOT and CANNOT be considered a first line agent for any
disease state.

Correction - they are. *That's a medical fact my friend.
No sir, this is not a medical fact. Please read the following and
tell me which disease states that you consider the quinolones to be a
first line agent for:

The usual treatment for both simple and complicated urinary tract
infections is antibiotics. The current standard of therapy for the
empiric treatment of acute uncomplicated cystitis is TMP-SMX (beta-
lactams and trimethoprim-sulfamethoxazole) for 3 days. NOT the
fluoroquinolone class. The indiscriminate misuse of the
fluoroquinolones for the treatment of UTIs and other infectious
processes has resulted in an increasing prevalence of fluoroquinolone-
resistant uropathogens worldwide.

The following is a list of drugs of choice in preferred order as
stated by the National Kidney and Urologic Diseases Information
Clearinghouse

1. Trimethoprim (Trimpex)
2. Trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim)
3. Amoxicillin (Amoxil, Trimox, Wymox)
4. Nitrofurantoin (Macrodantin, Furadantin)
5. Ampicillin (Omnipen, Polycillin, Principen, Totacillin).
6. With infections caused by Mycoplasma or Chlamydia, are usually
treated with tetracycline, trimethoprim/sulfamethoxazole (TMP/SMZ), or
doxycycline
7. Last on this list are the quinolones such as ofloxacin (Floxin),
norfloxacin (Noroxin), ciprofloxacin (Cipro)

Regarding their use in UTIs:

Asymptomatic bacteriuria

First line agents

Nitrofurantoin
cephalosporins
Trimethoprim
Trimethoprim/sulfamethoxazole

Second line agents

Ampicillin or amoxicillin
Ampicillin/sulbactam
Amoxicillin/clavulanate


Acute bacterial cystitis

First line agents:

Nitrofurantion
cephalosporins
Trimethoprim
Trimethoprim/sulfamethoxazole

Second line agents:
Ampicillin or amoxicillin
Ampicillin/sulbactam
Amoxicillin/clavulanate

Third line agents:

Fluoroquinolones
Quinolones

Acute uncomplicated pyelonephritis

First line agents:

Trimethoprim/sulfamethoxazole
1°or 2°cephalosporins
Aminoglycosides

Second line agents:

Ampicillin or amoxicillin
Ampicillin/sulbactam
Amoxicillin/clavulanate


Acute complicated pyelonephritis/
emphysematous pyelonephritis/
renal and perinephric abscess

First line agents:

1°or 2°cephalosporins or
Ampicillin or amoxicillin±Aminoglycosides
Trimethoprim/sulfamethoxazole
Imipenem or meropenem

Second line agents:

3°or 4°cephalosporins
Ticarcillin/clavulanate
Piperacillin/tazobactam

Third line agents:

Aztreonam
Fluoroquinolones

CDC guidelines with regard to the role of fluoroquinolones

Sexually transmitted diseasess:

The CDC recommends against the use of fluoroquinolones to treat drug-
resistant gonorrhea.
The CDC does NOT recommends the use of fluoroquinolones for the
treatment of gonococcal infections and associated conditions such as
pelvic inflammatory disease (PID). Consequently, only one class of
drugs, the cephalosporins, is still recommended and available for the
treatment of gonorrhea. The fluoroquinolones are NOT to be used as a
first line agent.

CAP
Fluoroquinolones are not to be used as a first line agent:
The CDC guidelines recommend that outpatient therapy of CAP utilize a
macrolide, doxycycline, or a beta-lactam (cefuroxime, amoxicillin, or
amoxicillin/clavulanate); the CDC guidelines specify that
fluoroquinolones should be reserved ONLY for patients who are
treatment failures, who have allergies to other antimicrobials, or who
have documented pneumococcal infection susceptible to fluoroquinolones
but resistant to the first-line agents. The CDC recommends that the
fluoroquinolones NOT be used as primary therapy for CAP.
Hospitalized patients: First line therapy is generally with the
combined use of a macrolide and a beta-lactam agent active against
penicillin-resistant Streptococcus pneumoniae (e.g., cefotaxime or
ceftriaxone).

Other upper and lower respiratory tract infections:

Fluoroquinolones are a second or third line agents based on the likely
or proven susceptibility of known or probable infectious agents. NOT
first line agents for upper and lower respiratory tract infections.


And if that is your basis your "facts" I now see why you're so off. *You've fallen into a self-fulfilling prophecy.
No, this is not my basis. My basis is forty years worth of clinical
studies and published (in the leading medical journals) peer reviewed
articles. The Internet only provides a ready source to find such
data.

Things you read on the internet are not "fact". *Many are comments from 12 years olds who's girlfriend hasn't logged on yet.

But the articles I purchase from Wileys and the like are indeed fact.
As well as the information obtained under the freedom of information
act via the FDA archives.


Can't sue for following the standard of care. *And as I mentioned
previously, the quinolones is one of antibiotics I have the absolute fewest
complaints over. *And believe me, we hear about it from patients when a
medication is causing some adverse reaction. *But really, you have 12 year
olds to trust...

Most certainly can sue for breach of standard of care which also
includes providing a risk/benefit discussion with the patient prior to
instituting therapy. Failure to disclose the known and listed adrs to
a drug constitutes medical malpractice and failure to obtain informed
consent. This does not mean you have to list each and every adr, but
it does mean those that are life threatening or could result in a
permanent disability MUST be disclosed prior to insituting therapy.
Case law clearly supports this legal analysis.

For using this class for anything less than a life
threatening situation has been found by the courts to be exactly that.

Um, no, it has not.
Wrong again. Under certain situations this is exactly what the courts
have held. True, this is not always the case, when a good faith
effort can be proven, but predominantly when there was no bacterial
infection to begin with and the quinolone drugs prescribed without a
valid reason to do this WAS indeed the case.

How many citations should I forward to you regarding this? Do you
prefer Supreme Court Rulings, Federal Court Rulings, Court of Appeals
or State Court Rulings? I have hundreds of each so take your pick.

Guess this last post answers all of your questions. If you have
others feel free to post them and I will do my best to answer them.

"davidtfull" wrote in message
...

to treat a mild case of epidemitis that could
have just as easily been treated with any number of much safer
antibiotics.

Such as? Cipro is a great drug to treat epididymitis (I'm assuming that is
what you meant). If left untreated or inadequately treated, you can end up
hospitalized with IV antibiotics.


Such as the following:

Epididymitis

Treatment: Drugs of choice in preferred order a

1. Ceftriaxone

2. Vibramycin twice a day for 10 days in addition to the shot of
Ceftriaxone

3. Floxin is listed as an alternative treatment, not a first line
agent

4. Cipro in men older than 35 years or those who participate in anal
intercourse

5. Bactrim DS


*** REPLY ***
I suppose I should have clarified. Most epididymitis occurs in older men.
In younger men, we think of entirely different organisms and while cipro can
still be used, there are usually others to try first. For the majority,
however, cipro is the first line agent. Your comment above about anal
intercourse is laughable.


Then provide some evidence.
did that already for you

No, you really didn't. You correctly pointed out that for younger patients
(the minority) cipro is not first line. But for most older patients, it is.
Bactrim is a great alternative especially if they
dont' have a sufla allergy.





They are NOT and CANNOT be considered a first line agent for any
disease state.

**REPLY:
But they are. It's a fact.