You'll probably not like my reply.

I am pretty much anti long term antibiotics of any type. Specifically this is due to bacterial resistance that occurs from long term exposure, and the "super bugs" that develop because of it (such as multi antibiotic resitant strains of C. difficile, staphlococcus species, and other bacteria).

That said, you have to live your life. As you found out, using the same antibiotic long term eventually loses its luster by becoming ineffective. Even if it does not become ineffective, you may develop side effects that are either uncomfortable or dangerous. Flouroquinolones, which include Cipro and Levaquin, can lead to tendon rupture and peripheral neuropathy. So be aware of these, and be ready to stop taking them if they develop. My main point is that there is no antibiotic that is safe to use long term. You are kidding yourself if you think so.

http://www.webmd.com/brain/new...oroquinolone-warning

You are better off using antibiotics at the lowest doses and intermittently. You can pulse treatment (like every few weeks instead of constantly) or rotate different types. I am entering into the chronic/recurring pouchitis realm. My GI is fully on board with adding immune modulators like Imuran, but for now, switching up my biologic to Cimzia and adding bismuth subsalicylate (Pepto Bismol) seems to be improving my function well enough, after a month or so of Flagyl (I am lucky that I tolerate it). I have some Cipro on hand to use the next time I flare up.

Jan

I have been on chronic rotating antibiotics (cipro and flagyl, xifaxin, augmentin) for 20 plus years, no superbugs, no tendon issues, no slippage in effectiveness so long as I rotate.  My GIs, all 3 I have had during that time, have told me biologics are a last line treatment for chronic pouchitis.

My main side effects from 20 year long term antibiotics were severe yeast infections and warts when I stayed on too high a dosage for too long or combined antibiotics with a maximum dosage of Entocort.

I do worry about this regimen in the future because at age 51 and soon to turn 52, I am not a spring chicken any more.  And the superbugs might nail me as I get to age and become an old man.  But I can't live my life without antibiotics so the way I look at it is I have no choice, and am thankful I seem to tolerate antibiotics well.  Although I must confess I have had a strange pain in my right knee for about a month, not serious but feels sore.

Like CT, I'm always on antibiotics, though just for 4-5 years now. It doesn't take much of a lapse in treatment (perhaps a week or so) for unpleasant symptoms to return. I've carefully found the minimum effective dose, but I haven't found effective alternatives to rotate to. The good news (for me) is that at this point I have no obvious side effects. As Jan writes, you have to live your life. "Superbugs" is a bit over the top here, IMO. It's true that I'm more likely to get an infection resistant to both Cipro and Flagyl, but that's not really superbug territory, since there are still effective alternatives to those drugs for essentially all common infections.

Jan writes "there is no antibiotic that is safe to use long term," and I'm concerned that we all have different ideas of what "safe" means. If you are thinking "perfectly safe," then there are no medications of any kind that meet that standard. The actual risks of long term antibiotic use, particularly if you remain mindful of the occasional serious side effects, seem quite reasonable to me, at least given my alternatives. If I start to get tingling or numbness in my hands or feet I'll jump on that instantly. Tendon rupture is pretty darn rare, and I have to take my chances. If I thought biologics were likely to help I'd try them, too, with full knowledge that they occasionally have devastating side effects. Instead of calling them "safe," though, I'd call them "worth the risks."

I have taken Leviquin for sinus infections, strep throat, toncilitis.  It always worked well for me.  I liked it, didn't bother my stomach, and I could eat what I wanted and never worried about drug interaction.  However, with the new warnings, my doctor doesn't really want to prescribe it for me.  But we don't have a lot of options since I'm allergic to a lot of them.  I would suggest do not do any exercise when on it And maybe for a week or so when off of it.  I've never had a tendon proble, but I know folks who have, but they were rough and tough hockey players, kinda nuts to say the least.  And in their 60's.  

If you turn out to be on a fluoroquinolone (like Levaquin or Cipro) long term, it would almost certainly be an error to forego exercise, IMO, unless that's really what your doctor recommends. Stopping all exercise will hurt you in lots more ways over time than Levaquin is likely to. 

I'm not trivializing how miserable tendon rupture is, or even how likely it actually is, but rather suggesting a thoughtful balancing of risks and benefits.

Just to add to this, like Scott F, if I go off antibiotics it takes about one week before symptoms become intensely unpleasant.  I too have found the minimum effective dosages, although sometimes there is slippage and I need to bump them up.  Probiotics alone simply do not work for me, and I have tried them all.

Regarding cessation of exercise to avoid tendon rupture, that is like stopping air travel so you will never be in a plane crash.  You could still get killed in a car crash.  A few years ago on his 70th birthday, my father was squatting down to look at something under the kitchen sink and tore his MCL, couldn't bear weight and had surgery a week later.  He wasn't taking any antibiotics at all.  It just ruptured, from squatting down to look at something under the sink.  So if you give up exercise you may need to give up looking under your sink too........

Sorry, but I failed to add that I am NOT on biologics for pouchitis, but for enteropathic arthritis. I did not want the impression to be that I was suggesting them as a treatment for pouchitis, particularly early on. For me, the chronic pouchitis seemed to coincide with worsening arthritis symptoms, and the arthritis was the reason for the change to Cimzia. It takes a few months to achieve maximum benefit. My GI bumped up my Flagyl dose from 250 to 500 to get over the last flare. My GI said I was lucky to have gone so long without chronic pouchitis issues. 

Also, my point about no antibiotic being safe long term was not to imply you cannot safely take them long term, but that you cannot just blindly pop them like candy and not be fully aware that at any time you can develop side effects, sometimes serious ones that are irreversible. I agree that tendinopathy and rupture related to fluoroquinolone use has little or nothing to do with exercise. It just happens.

Sometimes I read here of people continuting with chronic use of Flagyl while they have obvious peripheral neuropathy symptoms, thinking there are no other alternatives. My step-mom wound up with Parkinson's type symptoms after years of Reglan use (not an antibiotic, but just mentioning an example). Of course, every drug has its potential pitfalls, so we all should be informed consumers. Just be ready to change your treatment course if necessary.

Yep, live your life and do what you need to do to be functional. You can't do "nothing" and sit at home as a bowel cripple. You got the j-pouch to avoid that.

Jan

Long before the warnings on Levequin came out, I was walking 4-5 miles an hour.  Walking, not running.  I was in the gym most days of the week.  Fortunately nothing ever happened.  I guess it's a balancing act.  If you never worked out before, don't start if your on Levequin. But a lot also depends on the dosage.  I'm usually on the highest dose, and a lot of times for 20 days rather than the usual 10.  I get horrible infections that don't quit.  I have really bad allergies and a not so great immunion system.

I guess we know where Jeff got his not-so-great immune system! The upside is that it gives more insight regarding some of your son's challenges.

Jan

Jan, I'm laughing because Jeffrey and I are so much alike in terms of some our health issues.  We have almost exactly the same allergies!  Bit the reason I'm laughing is because Jeffrey was adopted !!!.  Other than his autism and IBD problems, the kid is really healthy.  When he was younger, he never got the cold, stomach virus, or any virus, I did!  I got it all, all the strep, colds, stomach viruses and what ever was floating around.  It was a rare day that he was sick.  Even to this day, I catch all the daycare germs from my nieces, nephews, and other kids.  And no one catches it from me!  

Funny indeed!

Jan

I have become an anti-flouroquinolone (Avelox, Levaquin, Cipro) person, except as an absolute last resort. I have wondered if my nerve issues were delayed responses to being on those antibiotics. Read more about how these drugs work, and you will be averse to taking them except as a last line of defense. It's no longer just tendon rupture, but nerve damage that can occur with these meds. And for some people it just takes one round to do the damage. You will read about peripheral neuropathy, but many people suffer from other types of nerve damage.

Given a choice for my daughter between Cipro and Flagyl, now I go with Flagyl (and she loves me for it - oh the wonderful taste of Flagyl) - which is interesting because of the known neuropathy issues with it.

Steve