Antibiotics After FQ’s

Please note that the following information is supplied as general information only and is based on anecdotal information.  Please discuss all medication use with your doctor.   Reading this page any further assumes that you have read and agree with the disclaimer.

The following information has been contributed by floxies (A big thanks to Bruce M. for contributing greatly to the data contained herein.)

Brief overview:

Of the most commonly prescribed antibiotics, Azithromycin, clindamycin, and keflex seem to be tolerated for about 80% of floxies and amoxicillin for 75%, while flagyl, bactrim, and augmentin are only tolerated for 50%. While doxycycline has a fairly high reported toleration rate of about 75-80%, please note the caution that people who did not tolerate doxycycline reported some exceptionally unpleasant  stories of long-term worsening of floxing symptoms, reminiscent of a subset of floxies that reported they do not tolerate glucocorticoids. Due to gastrointestinal effects from loss of good intestinal flora, one should ask advice on using probiotic foods or supplements with antibiotics.

Detailed overview:

The three most tolerated had a ratio of Proportion Tolerated vs. Proportion Not Tolerated of about 4:1 (yielding an odds ratio of 4), while the three least tolerated had a ratio of 1:1.

Even so, one must take into account that everyone reacts differently (i.e. medicine is …probabilistic), as exemplified by the following quotes. Regarding one of the most tolerated antibiotics, someone wrote “(the drug) brought it all (FQ symptoms) back again”, and regarding not just one but a combination of two of the least tolerated antibiotics someone said “I felt the best I have felt since floxing after taking (them)” .

Because voting was not collected blind to other individuals’ votes, statistical hypothesis testing cannot be done. If statistical tests could be done, the numbers would suggest that:

  • Azithromycin would be tolerated at a higher proportion than flagyl (generic name metronidazole, p=.001), bactrim (generic trimethoprim/sulfamethoxazole, p=.003), or augmentin (p=.008).
  • Clindamycin would be tolerated at a higher proportion than flagyl (p=.06, weak evidence).
  • Keflex (generic cephalex) would be tolerated at a higher proportion than flagyl (p=.06, weak evidence).
  • Doxycycline would be tolerated at a higher proportion than flagyl (p=.06, weak evidence), but those who didn’t tolerate it tell stories of substantial long term worsening of symptoms.
  • Amoxicillin would be tolerated at a higher proportion than flagyl (p=.06, weak evidence). It was the most used antibiotic, with proportion tolerated a little behind doxycycline.

There remains insufficient information to report in-depth on other antibiotics.

The digestive antibiotic rifaximin has been reported as being highly tolerated with very few side effects by a handful of floxies, so it is off to a good start.

We have received one report of a floxie successfully tolerating IV Vancomycin post FQ’s.

While being cautious about antibiotic usage is completely understandable, there is no reason for those suffering from a quinolone-induced syndrome to fear other non-quinolone antibiotics, if the need is determined.

Please discuss all concerns about antibiotic usage with your doctor.