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 FDA Guidelines for Quinolones due to Disabling Side Effects 
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Post FDA Guidelines for Quinolones due to Disabling Side Effects
The FDA issued new guidelines for fluoroquinolone antibiotics in March of 2016, revised/updated in July of 2016. ... 511530.htm

These guidelines now advise against use of floroquinolone meds for simple or "uncomplicated" urinary tract infections due to increasing concerns of: "disabling and potentially permanent side effects of the tendons, muscles, joints, nerves, and central nervous system that can occur together in the same patient." (note: the central nervous system is your BRAIN)

Bacterial Prostatitis is NOT an uncomplicated UTI, & this is a prostatitis forum, but I thought we might want to address insuring one gets a proper diagnostic of bacterial prostatits before starting on these meds. Urologist's still can (and do) legally prescribe quinolone meds for what they "suspect" is bacterial prostatitis without a confirmed diagnosis, culture or sensitivity. However...

A positive urine culture can certainly indicate infection in the prostate, but may also occur with a bladder infection (uncomplicated), epididymitis (uncomplicated), or kidney infection (complicated), without involvement of the prostate.

A positive semen culture should be a bit more specific, and indicate infection in the prostate, but possibly also uncomplicated epididymitis. Epididymitis usually involves swelling and pain in the scrotum, so a positive semen culture without scrotal symptoms would most likely be bacterial prostatitis.

A culture of "Expressed Prostatic Secretions" obtained through digital massage is the only way to test prostatic fluid specifically, without contamination from infection in the bladder, kidney, or epididymis, though these infections still can cross-contaminate the prostatic fluid as it passes through the urethra.

A painful and enlarged prostate on digital/rectal examination can also "indicate" bacterial prostatits, but without a proper culture and sensitivity, ANY antibiotic therapy would be a shot in the dark regarding the pathogen and its sensitivity. Benign Hypertrophy (age related enlargement) of the prostate can also result in a painful and enlarged prostate where no bacterial infection exists!

I'm not a doctor, but I personally would not want to start on extended duration quinolone meds based solely on a hunch, or even a positive urine culture (which may be a simple bladder infection); and even then, quinolones would not be my first choice to treat. When I developed relapsing bacterial epididymitis (most likely coming from the prostate), my board certified urologist said resistance to quinolone meds had become so common, he had stopped using them as his initial therapy (without a positive culture and sensitivity), and was now using Bactrim.

Bactrim has it's own reputation for allergic reactions (sometimes serious), but rarely results in "persistent and/or disabling side effects" now being associated with quinolone meds. After researching alternatives to both quinolones and Bactrim, I about begged my uro to at least "TRY" fosfomycin, & he reluctantly agreed. I've now been symptom free for over 2 months (after completing the fosfo) and for the first time since June of last year, this ordeal is now fading into my past.

If I ever did relapse, and additional (more aggressive) fosfomycin therapy failed to provide lasting results, I personally would want to try Bactrim, and save the quinolones as a "treatment of last resort". With the latest revisions to the (multiple) black box warnings for quinolones, it would appear the FDA (and my uro) agree.

We all would like to believe our doctors (particularly board certified specialist's) are staying up to date and modifying their practice as needed, but this isn't always the case. Some simply stick with what has worked for them in the past, and if serious side effects occur or resistant pathogens fail to respond, they say this happens sometimes and couldn't have been avoided.

Bottom Line... We all need to do our homework and carefully consider the options for treatment before we blithely grab a scrip from our doc's and head off for the pharmacy. Has a bacterial infection of the prostate been confirmed? Has the pathogen involved been confirmed through culture/sensitivity to be susceptible to what is being prescribed? Are there ANY safer options to be tried before initiating treatment with medications of last resort?

In my case, although a sensitivity study for my beta-lactam resistant haemophilus (semen culture) could not be performed due to the small size of the growth, there was a safer option to TRY before I resorted to the Big Guns sulfa/quinolones, & it appears to have worked! Fosfomycin has been shown effective against many resistant organisms (even MRSA). ... MC2764175/

How long will it take before urologist's begin utilizing this as a safer and possibly more effective "first try" option? The number of pro-active patients may provide the answer!

Once you eliminate the impossible, whatever remains, no matter how improbable, must be the truth
Sherlock Holmes

Tue Jan 17, 2017 8:09 pm
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