Ciprofloxacin is definitely not for most female UTIs: tendon rupture.

Ciprofloxacin harms tendons.

Fluroquinolines have long been known to cause tendon problems.  Ironically the FDA now thinks it's important.  Hence the           .

I admittedly use Fluroquinolines for male UTIs (rare, thankfully) but I am going to review that practice.

I have been strongly against the use of ciprofloxacin in female UTIs as it is needlessly strong and because of increasing resistance.  I've all but avoided ciprofloxacin except in one patient whom loves the stuff and a recent patient whom was allergic to Nitrofurantoin (Macrobid) and Septra.

Harder questions surround the use of Fluroquinolines in more serious illnesses such as severe pneumonia, etc.  I use alot of levofloxacin for inpatients.  I don't think I can change that other than my usual stopping antibiotics early when possible.

My male patients have more tendon ruptures than my femaie patients by far.

They have 407 document case of tendon rupture they think they can relate to fluoquinolones. That's out of how many millions of prescriptions?

Again, you over react.

Stopping abx early sound like a generally bad idea.

DallasDoc:

Stopping abx early sound like a generally bad idea.

There is emerging evidence that stopping antibiotics early is a good thing, or at least just as effective.

Google: whatevercondition short course antibiotics

Here's one about AOM

The point here is there are way better drugs for female UTIs than ciprofloxacin.  No reason to use it for female UTIs, especially for women without recurrent problems, and especially if they are physically active.

For male UTIs, I think the quinolones are more effective, thus making it a harder decision.

You can also Google : short course antibiotics :  and get lots of important new information about treating more conservatively.

Of course, there is Bactrim's association with Stevens-Johnson syndrome.  Macrobid is frowned on by the Beer's list (IIRC).  It seems like the only safe therapy was reviewed in "The Green Mile" with Tom Hanks.

Your practice patterns are interesting. Short course abx therapy based on emerging evidence. Rejecting vytorin based on an obviously inadequate study. Rejecting fluoroquinolones for female UTI's despite millions of scripts with only 400 some odd instances of tendon rupture.

Interesting logic. Not sure I get it however.

The emerging evidence he refers to seems based upon some years and a number of studies. 

Eg. This one from the BMJ refers to 21 studies done prior to 2006.

I can't say I've ever bought into the idea a patient had to finish a course of X days to prevent the development of resistance ... and wonder how those days of treatment have been determined. Perhaps longer courses maximize pharma's profits?

DallasDoc:

Your practice patterns are interesting. Short course abx therapy based on emerging evidence. Rejecting vytorin based on an obviously inadequate study. Rejecting fluoroquinolones for female UTI's despite millions of scripts with only 400 some odd instances of tendon rupture.

Interesting logic. Not sure I get it however.

I have not changed my practice, but I can see the point here.  Once the black box warning is there, it seems to me a direct invitation for lawyers to start the lawsuits.  "Doctor, why would you Rx that fluroquinolone when you know there is a black box warning about tendon ruptures?  Did you think Ms. Morgan' UTI really warranted that risk?"  The real failing here is the sudden proliferation of black boxes...Maybe the FDA forgot they already have a Precautions section in the package insert...

I don't have a problem with the concept of short course abx. If studies show benefit, I am willing to change. 

I do the principle of over reacting to incomplete data or restating of a known black box warning.

Female UTIs don't need fluroquinolones.

That's the real problem.

and

rupturing tendons and other tendon related injuries (that are not reported)is the icing on the cake.

The main problem is not the tendons it is overly broad spectrum antibiotics for UTIs is suboptimal care.

Ciprofloxacin is overused and it's use should be curtailed.

I have used ciprofloxacin almost exclusively for 5 years for male UTIs.  I am learning that I can even back off that the vast majority of the time - with a good urine culture to back it up.

What are you using as your first choice in female UTIs?  I am using Bactrim, but I would certainly wonder if the risk of Stevens-Johnson syndrome is higher than the risk of tendon rupture (even if the risk is a little lower for S-J, it is a more severe reaction).  The final analysis is difficult to make here, based on scanty info...except that both are rare.

Small studies always focus on small details, with multiple exclusions.  It is unfortunate that the milleu of practice is much to complicated to fit any one study exactly.

You know after more than a year arging with Jason I finally realize the advantage of a Socialized system. Follow the guidelines and stop analyzing the data. Use generalizations and avoid making your own clinical judgement and or experience. Stop individualizing your care.

The adage first do no harm actually may mean do no harm to your practice from malpractice. Let's listen to Nissen, the guy who claims that all ACE work the same and is a class effect and yet he crucifies Rosiglitazone and glorifies Pioglitazone - they are of the same class right?

Same thing with the ACCORD, let's worry about MI, forget about microvascular disease, let our patients go blind and in dialysis and save them from MI. That is what the "guideline" says.

Biological markers are not enough and we need imaging in the future for establishing endothelial integrity eg IVUS, CIMT, EBT, MRI etc. I wonder if these socialize country including that of ours will ever see that applied. Jason have not seen EBT scans if I recall.