Hacker News Reader

Comment by Aeolun | Hacker News Reader

If they have such nasty side effects, why do we even use these at all?

The side effects aren't well known / understood. They also happen to less than 1% of people who take the drugs (at least that's the current estimate, some side effects may not be properly linked to the drugs). There's very little research on how to measure the damage done by fluoroquinolones. Once a patient says they have tingling, the drugs have already caused permanent damage, and a doctor isn't going to know what to measure to assess this damage, nor what they should have been measuring to prevent the side effect in the first place. This lack of understanding may lead to an inflated sense of safety profile.

They're used to treat antibiotic resistant infections in "hard to reach" places, since the fluorine moiety allows them to penetrate most places in the body (which is also likely related to how they cause insidious damage). This power+reach makes them a default drug for some doctors to treat infections.

We shouldn't. You probably don't want to take a quinolone antibiotic unless all other options have failed and your life is at risk. There are decades of reports of permanent, severe nerve damage after as little as a single dose. At one point the FDA even had to step in to force some unusually severe language in warning labels.

But doctors can be a stubborn bunch, and many still prescribe it way too liberally.

In developing countries they were (are?) pretty liberal with these drugs (Pakistan in my case)

The pharmacies allowed people to buy almost any medication without a doctor's prescription?

In India, yes.

Also happens with antibiotics in Spain and surprising numbers of other places

I had one in Islamabad IIRC but I am sure you can buy single blister packs

doctors aren't just stubborn.

they're well compensated by pharmaceutical companies.

Knowing doctors, this comes down more to Hanlon's razor.

Many don't know any better and have a poor grasp of the scientific method. For many being a doctor is more of a trade than a profession.

Their scope of work is too broad and they're far too busy to keep up. As a result, they're perhaps even more susceptible to marketing than average people. They don't have time to dig into pubmed and deeply understand something they see (generously) 1% of the time.

They have to rely on people who otherwise get paid to do the research. If there's no money to be made from a treatment, it won't be able to donate to universities, fund studies, or pay for advertising.

Doctors won't hear about it.

In my experience as a pharmacist, it wasn't first line, but sometimes it's second line. For UTI, respiratory tract infections, and skin and soft tissue infections. Pretty common actually.

It was the first thing prescribed to me, but I was only told "it's an antibiotic" and I had no bad issues with other antibiotics so didn't expect that I needed to be careful.

I probably took at least four more pills than I should have, even though I had a bad reaction after the first pill, I assumed it was something else that was causing it at first.

Glad I eventually made the connection, read some horror stories to confirm the likely cause, and called the doctor to switch my antibiotic before I had taken all 30 pills. Might be a lot worse off now if I had.

Because the benefits of antibiotics vastly outweigh the risks. You're better off taking antibiotics than getting a serious infection.

They should be used rationally though. Ciprofloxacin and other antibiotics in the same class are stronger medications compared to penicilins for example. The ideal situation is to figure out what the bacteria is sensitive to with a culture and antibiogram and then choose the weakest, most specific antibiotic out of that list. Of course, this requires time and resources which may not be available. In some cases, it's been proven that waiting for test results leads to worse patient outcomes so doctors will prescribe antibiotics empirically and adjust treatment later.

> Because the benefits of antibiotics vastly outweigh the risks. You're better off taking antibiotics than getting a serious infection.

But isn't antibiotics something that gets given out in many countries for more or less anything? The US comes to mind. Which to my knowledge is the reason why more and more people in those countries dies of resistent bacterias.

I'm 35 and have been given antibiotics twice in my life, and reading about people getting antibiotics for a cold baffles me.

> But isn't antibiotics something that gets given out in many countries for more or less anything? The US comes to mind.

Yes. Antibiotics have a rich history that dates all the way back to the second world war. Before the risk of bacterial resistance became well-known, use of antibiotics was much more widespread. Understanding of bacterial resistance came after they developed mechanisms to resist the drugs used to treat infections such as betalactamase.

It could be the case that cipro- and levofloxacin are widely prescribed in the USA because bacteria have already become resistant to weaker drugs. Treatment guidelines in my country have more effective options compared to CDC sources. I have no first-hand experience though.

Stronger antibiotics also happen to be very easy to use. It's generally much easier to successfully treat someone with a strong antibiotic than a weaker one. One pill once a day for three days is much easier than 3 or 4 pills at regular intervals every day for 10 days. Getting people to take pills correctly is an every day challenge in medicine, complicated treatments means people will often forget to take their pills and reduce their effectiveness.

The US is an outlier with almost anything relating to health...

About colds - perhaps it's when doctors don't first wait for the test result for a streptococcal throat infection?

https://medical-dictionary.thefreedictionary.com/streptococc...

If you tell a doctor that you had a bad reaction in the past, he or she will check a data sheet and assume you're insane or exaggerating.

There's some corruption going on in the data, perhaps? There are so many anecdotes from this class of drug, they cease to become 'just anecdotal.'

Because the side effects are considered better than dying? None of them are drugs of first resort for bacterial infection.

They're a first resort for urologists, especially for people with any kind of prostate pain, even if there's no clear sign of infection.

At least in India, they are often given as first line treatments sometimes even when there is no infection prior to surgery to prevent infections later.

I had same thing done in US for prostate surgery.

I've gotten these OTC at pharmacies in Southeast Asia, but didn't take them because I look up every medicine that I get.

OTC ffs... This is why we can’t have nice things.

They are available everywhere in SE Asia, sometimes even in supermarkets in places like Nepal.

False. They're absolutely given as a drug of first resort, all the time, in many places of the world. Happened to me.

In the US, in the early 2000s there was an anthrax terrorism scare where they tried giving thousands of people Cipro pre emptively.

Another reason is that an entire course of Cipro is like five days. It was pretty much the only antibiotic my university health center prescribed while I was there and I knew many people who took it (early 2000s, USA) because getting university students to stick with a longer regimen was very difficult.

Because antibiotics are often used to treat infections that left to their own devices could kill you.

There is often no "perfect" ligand because benefits somewhere cause harm somewhere else since evolution reused so many substrates, or the means of regulation similarly ups or down regulates anti-target activities.

Furthermore, compounds that will work are often constrained by many factors.

You're told to by someone you trust.

Benefit/Risk ratio.

Reply on news.ycombinator.com