This seems to be a big one. We are what we eat, and cows are what they eat too, and cows are raised on a steady diet of antibiotics. So eat hearty, that McBurger will cure what ails ya.
The BAD news is, those potential nasty side effects can include severe and irreversible neurological damage, both to peripheral and central nervous systems, potentially leaving the patient with disabling brain damage, and it can happen after just the first dose. No such thing as fair warning in cases like that!
So one shouldn’t want to take this drug even on a trial basis to see how it works.
Remember that recent post, a few days ago, about the electrician who checked to see if a socket was live by sticking his finger in it? If he survived that, he knew it was safe to continue whatever work he was doing. Numerous posts with snarky additional examples ensued.
Consenting to take a fluoroquinolone pile – even one – strikes me as being just like that.
Ofloxacin has been notorious for this, and in the early 1990s, the 2nd or 3rd to get on the market, Omniflox, was pulled almost immediately for this, AND various blood dyscrasias. Those didn’t show up in the test phases, or if they did, were not common enough to get it removed from the pipeline.
I remember Omniflox because I was in school at the time, and the free clinic where I volunteered got a bunch of it donated - and it all had to be discarded.
Several other FQs have come and gone on the market too. The first three that come to mind are Zagam, Raxar, and especially Trovan. I was working at a clinic when Trovan came out, and most of the people who were prescribed it couldn’t take it because it made them too dizzy to function, even if they took it at bedtime. Eventually, it was changed to institutional use only, then IV-only, and was finally withdrawn.
As long as we don’t have to go back to using sulfanilamide for anything other than vaginal packing after hysterectomy, I won’t be frightened.
We used to refer to those drugs as “Godzillacillins”. 
I was working at the grocery store when Zyvox came out, and one of the assistant managers stopped by and asked if we would stock it. We all said that it would probably be too expensive to stock as a routine matter of course (we were correct) and we sure hoped we would never see a prescription for it. We did use a lot of it at the hospital where I later worked, but the protocol was not to order it until the cultures came back. That was mainly because of an institution in town (saying what it was could give away my location) that was basically MRSA city.
Phages make a huge amount of sense. They are tailored to attack one kind of bacteria, so there is no need for probiotic readjustment to restore your working microbiome. The “problem” with phages is that you only need a dose or two, which makes it rather unprofitable to develop them.
Keflex is still effective and docs still suggest it to me if I need a prescription. Keflex, however, is instant thrush-creator for me, even if I take acidophilus tablets and eat plain yogurt twice a day. I don’t know if it’s because it’s a broader-spectrum, or because it was the Antibiotic of Choice for Kids Who Were Allergic To Penicillin, and so I took it…multiple times a year for a long time.
I’ve been treated with fluoroquinolones many times and had no trouble. Not even thrush. Here’s a good linkto put the concerns in perspective.
Grumpy, are you a man or a woman? If you get thrush or other yeast infections, you might want to also get Diflucan, which is a tablet, or nystatin, which is a liquid. Some people are way more prone to them than others; I got a vaginal infection a few years ago when I had a lot of dental work done and the dentist gave me clindamycin, which in addition didn’t get rid of the infection. 
Most people think of thrush as a mouth infection, but people can get yeast infections in any dark, moist area. The vagina is notorious for this, and uncircumcised men not infrequently have it under their foreskins.
Short-term FQ use is usually benign WRT side effects. Remember the anthrax attacks? Some people did have issues with long-term Cipro use, and that wasn’t unexpected.
Do these recommendations apply also for people using orally inhaled meds, e.g. Qvar or Albuterol? Those always caution one to rinse after each huff, with oral infections a possible adverse effect. (I assume that means thrush or similar.)
I remember wondering about that ever since that was in the news. Was it kept all hush-hush or something? I recall reading that Cipro was discontinued after people started having adverse results, but I never saw any mention of what those adverse results were.
Stephen Fried is an investigative journalist whose wife got her brain seriously damaged, apparently permanently, after a single dose of ofloxacin. He wrote a book about it, Bitter Pills. The books home page. Here is Chapter 1 on-line. Yet the report linked by GrumpyBunny just above seems to give ofloxacin a clean bill of health. By various accounts I’ve read including that one, levofloxacin gets an even cleaner bill of health – it’s just the distilled levo- form of the racemic ofloxacin. In all the literature I have ever seen about FQ’s, it’s rarely mentioned that any of the adverse reactions can be long-lasting; yet I’ve heard the same about the tendency to cause tendons to rupture – it can happen months or years post-therapy I think I’ve read from time to time.
I’m a woman, and I get Diflucan and use it way more than I’d like (I have some so I can start therapy when the thrush makes itself known, often before you can see the evidence). I just seem to be an outlier as far as thrush and inhalers.
Senegoid, I never rinsed after using albuterol – and I was given my first albuterol inhaler back in 1982 – and never had thrush from it. YMMV. Qvar appears to be an inhaled corticosteroid, so yeah, you can get thrush from that. Spacers, rinsing, and tongue-scrapers help reduce the likelihood of getting oral thrush. Salt-water rinses are said to be effective for some people.
You would only take Diflucan or nystatin if you actually have thrush (which is an oral yeast infection). You’ll know if you have it. Eating anything salty or spicy will be painful. You’ll have white patches on your tongue and/or the sides of your mouth. Unfortunately, there’s not really a preventative for it if you use the inhalers. However, it’s a minor inconvenience and the benefits of the inhaled corticosteroid greatly outweighs the possibility of thrush, which is easily treated.
There are rare and serious side effects from FQ’s, but from what I’ve read at unbiased sources, I’m comfortable taking them if needed. It sounds like Stephen Fried’s wife was one of the unlucky ones, which is sad.
Reaching back to my early career in infectious diseases, as you note, phages are amazingly specific - which is a two-edged sword. They target just the ‘bad’ guys but sometimes minor strain differences in bacteria require different phages. Also, since phages are viruses, host immune response to them is possible and probably decreases their efficacy. These two issues complicate things quite a bit and contribute to a success rate of only 50%.
I owned that book at one time and am familiar with the story. I agree, she was one of the unfortunate ones.
FQs are not recommended for routine use in children because of the potential for cartilage damage. The main exception is cystic fibrosis, and in fact FQs, Cipro in particular, account in large part for the dramatically increased life expectancy and quality of life for CF patients in recent years, because it reduces the severity of pseudomonas colonization.
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Exactly correct. Couple those issues with the problem of figuring out how to even test what is essentially a raw biological sample (which scares the FDA…more than a little bit) and you can see why bacteriophage therapy is not a slam dunk.
That said, phage-mediated therapies may have some utility - food safety, topical wound treatment, some ear infections (otitis externa/otitis media with tubes and/or rupture) - but they are not going to be the salvation of ID docs.
You are one of the only people I’ve seen who looked at these reports and got the take home message correct: the isolation device is a nifty feat of engineering that has experimental use rather than the “OMG! Perfect antibiotic discovered!” 
And that’s from someone who has been at several professional meetings in the last year where this research has been presented.
(For the uninitiated, there has never been a clinically useful antibiotic that hasn’t led to bacterial resistance arising within a shockingly short period of time - sometimes only a year or two. Nor is this surprising: evolution always figures out a way around a “problem” - always.)