antibiotic safety

Repeated Use Doesn’t Make Fluoroquinolones Safe

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“I’ve prescribed fluoroquinolone antibiotics to hundreds of patients and I’ve never seen problems like yours. It’s a good drug with an excellent safety record.” 

Some version of that statement is said to many patients who approach doctors with the many symptoms of fluoroquinolone toxicity syndrome. Fluoroquinolones (Cipro/ciprofloxacin, Levaquin/levofloxacin, Avelox/moxifloxacin and Floxin/ofloxacin) have been shown to damage connective tissue (tendons, ligaments, cartilage, fascia, etc.) throughout the body, damage the nervous systems (central, peripheral and autonomic), and lead to multi-symptom, often chronic, illness. Most of the symptoms of fluoroquinolone toxicity are listed on the 43 page warning label for cipro/ciprofloxacin.  However, disregard of patients with fluoroquinolone toxicity syndrome is, unfortunately, common. Statements like the one above are wrong-headed and foolish – here’s why:

  1. The statement of, “I’ve prescribed fluoroquinolone antibiotics to hundreds of patients and I’ve never seen problems like yours” and implying that therefore fluoroquinolones are safe, is an illogical argument based in ego, not fact.  Prescribing a drug hundreds of times does not make it a good, or safe, drug. The fact that something has been done millions times before does not mean that it’s the right way to do things. As an example, millions of people were given Vioxx before it was taken off the market because it causes heart attacks and strokes. If a physician never saw a heart attack result from Vioxx use, that doesn’t mean that they didn’t happen. They did. Thousands of people had heart attacks and died because of Vioxx. A history of doing something wrong does not make it right.  Implied in the statement that a physician has never seen fluoroquinolone damage is the assumption that what a physician sees is factual and without bias.  If a doctor regularly prescribes a drug, he or she is going to believe in its safety and efficacy based on a desire to see him or herself as one who helps patients, regardless of its actual safety and efficacy. Doctors have bias and ego just like the rest of us.  Anecdotal evidence, even anecdotal evidence from a doctor, is not able to trump experimental evidence.  Drugs need to hold up in scientific experiments and controlled trials – not in the opinion court of doctors.  In multiple experiments, fluoroquinolones have been shown to damage cells (by depleting mitochondrial DNA, magnesium, lipids, enzymes, etc.).  Science wins every time, and the scientific evidence comes down on the side of fluoroquinolones being dangerous drugs.
  2. It shows an unwillingness/inability to connect pharmaceutical drugs to multi-symptom diseases. Fluoroquinolones deplete mitochondrial DNA and lead to mitochondrial dysfunction. When mitochondria aren’t functioning properly, cells aren’t functioning properly. Mitochondria are the energy centers of eukaryotic cells – the engines. If cellular engines are malfunctioning, many systems shut down. This shut-down can lead to a cascade of damage – much of it self-perpetuating and difficult to repair. The details of the biochemistry behind this are incredibly complex and difficult, but the basic concept of drugs that cause mitochondrial damage lead to multi-symptom, chronic illness, isn’t so difficult that someone who went through med school shouldn’t be able to grasp it. But many doctors are loathe to admit that the drugs that they prescribe cause mitochondrial damage.  Many studies have shown that fluoroquinolones damage mitochondria (HERE and HERE). Even the FDA acknowledges that the mechanism through which fluoroquinolones do damage is through mitochondrial toxicity. Mitochondrial toxicity = multi-symptom, often chronic, illness. It’s not that hard. But if doctors admitted that fluoroquinolones cause multi-symptom, chronic illness, they may have to look at the relationship between all mitochondria damaging drugs (statins, SSRIs and even acetaminophen are on the list along with fluoroquinolones) and the rise in mysterious multi-symptom illnesses. If they did that, they may have to admit that the drugs they prescribed, ‘hundreds of times’ are hurting people – and who wants to do that?  It’s much easier to repeat the lie of, “these drugs have an excellent record of safety and efficacy,” than it is to admit to inflicting harm (even inadvertently) on patients.
  3. They’re not looking at delayed reactions or tolerance thresholds. Despite the fact that both delayed adverse reactions and tolerance thresholds for fluoroquinolones are documented (it all goes back to how mitochondria respond to damage – more HERE), reactions that occur after administration of the drug have stopped are not connected to the drug by many physicians. “It should be out of your system by now,” is repeated often.  That may be the case, but the drug set off an intracellular bomb and now the damage is self-perpetuating. Delayed reactions and tolerance thresholds may make recognition of adverse drug reactions difficult, but it doesn’t make them go away. Unfortunately, cells don’t always act as they “should” – they act as they do – with messy things like non-linear reactions, negative feedback loops, etc.
  4. The specialist model keeps many doctors from seeing the damage that fluoroquinolones cause. For example, ER doctors often prescribe fluoroquinolones because they’re powerful broad-spectrum antibiotics. But when people have an adverse reaction a week later that looks and feels a lot like an autoimmune disease, they’re not going to the ER for treatment because autoimmune-disease-like symptoms are for a rheumatologist or general practitioner to treat, not an ER doctor. This disconnect keeps many doctors from seeing the harm done by fluoroquinolones.
  5. Statements like, “I’ve prescribed fluoroquinolone antibiotics to hundreds of patients and I’ve never seen problems like yours. It’s a good drug with an excellent safety record.” communicate to patients that a physician’s anecdotal evidence is more important than a patient’s pain. It communicates that it’s okay for side-effects of a drug to be devastating as long as the doctor perceives the adverse reactions as rare. It’s not okay for a doctor to disobey his or her Hippocratic Oath and hurt patients – even inadvertently. And I would argue that adverse reactions to fluoroquinolones are far less rare than anyone would like to believe (arguments HERE and HERE).
  6. It shows that doctors don’t believe the warning labels on drugs. The warning label for Cipro/ ciprofloxacin is 43 PAGES long and lists many musculoskeletal and nervous system adverse effects of cipro and other fluoroquinolones. Do doctors think that the FDA is just kidding when they put all those adverse effects on the warning label?
  7. The mantra of, “fluoroquinolones have an excellent safety record” has been repeated so many times that it is assumed to be true. It is not true. There are hundreds of studies showing that fluoroquinolones profoundly damage cells and there are zero studies that show that people are immune to the damage caused by fluoroquinolones. The perception of safety is based on an unwillingness to recognize tolerance thresholds for fluoroquinolones, delayed adverse reactions to fluoroquinolones and the connection between fluoroquinolones and multi-symptom diseases.
  8. It shows that they’re afraid. Some of the fear is legitimate.  Antibiotic resistance is on the rise.  If fluoroquinolones are restricted to only being used appropriately – i.e. in life-or-death situations after all other antibiotics have failed – doctors will have fewer tools at their disposal and they may not be able to fight a nasty infection without inflicting cellular damage that results in chronic illness. No one wants to have to choose between an infection and multi-symptom, chronic illness.  It would be better to have neither. But if there aren’t any options of antibiotics that don’t cause the cellular damage that leads to oxidative stress and multi-symptom illness… well, that’s a possibility that is too frightening and daunting to think about.
  9. Too many doctors are attached to lazy medicine – throwing strong, broad-spectrum antibiotics at everyone who comes in the door with an infection (or just a high white blood cell count). If the adverse effects of fluoroquinolones were acknowledged, the pros and cons would have to be careful weighed before administering them.  A long discussion with patients about tendon ruptures, peripheral neuropathy, increased chance of diabetes, central nervous system damage, etc., would have to be had along with every prescription for Cipro, Levaquin or Avelox in order for an obligation of informed consent to be met. If broad-spectrum fluoroquinolones couldn’t be thrown at every infection, bacterial cultures would need to be done to figure out exactly what antibiotics would work best.  That takes time and money and it’s easier to do things as they have been done – even if it involves denying the damage that fluoroquinolones do.  Those pesky tests to make sure that the Hippocratic Oath is upheld may get in the way of business.

Adverse drug reactions don’t stop happening just because they’re inconvenient; or because they’re unrecognized or misdiagnosed. They don’t become rare or insignificant just because they are complicated and difficult to recognize.

Fluoroquinolones are dangerous drugs that damage cells on multiple levels. This has been shown in laboratories many times. The cellular damage caused by fluoroquinolones (along with the destruction of the microbiome) leads to multi-symptom, often chronic, illness. This has been shown by multiple patient reports.

Many doctors haven’t read the memo about how dangerous fluoroquinolones are though. Shouldn’t they know the dangers of the drugs that they prescribe?  Shouldn’t they have learned about adverse drug reactions in school?  It doesn’t seem like too much to ask for.  There are hundreds of studies showing that fluoroquinolones damage eukaryotic cells. Shouldn’t they have read them, or at least been told about them by the FDA?

You’d think so.  But the mantra of, “Fluoroquinolones have an excellent record of safety and efficacy” has been repeated so many times that it’s thought to be true just because it’s been heard over and over again.  Let’s change the mantra. How about, “fluoroquinolones are dangerous drugs that should only be used in life-or-death situations?” That mantra sounds much better.  It’s more appropriate, and it’s closer to the truth. If we keep on repeating it, maybe doctors will start to listen.

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This post was first published on October 1, 2014.

Information about Fluoroquinolone Toxicity

Information about the author, and adverse reactions to fluoroquinolone antibiotics (Cipro/ciprofloxacin, Levaquin/levofloxacin, Avelox/moxifloxacin and Floxin/ofloxacin) can be found on Lisa Bloomquist’s site, www.floxiehope.com.

Photo by karatara: https://www.pexels.com/photo/male-statue-decor-931317/

Victory at the FDA for Fluoroquinolone Victims

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In the four years since I was hurt by ciprofloxacin, a fluoroquinolone antibiotic, I have often fantasized about what I would say to the FDA if I had chance. Would I tell them about the pain and suffering I experienced after taking ciprofloxacin? Would I tell them stories about my friends who have had their lives wrecked by fluoroquinolone toxicity? Would I share with them the knowledge that I have gained from obsessively researching fluoroquinolone toxicity? Would I berate them and yell, “Do your ^%^& job?” Would I beg them to, at the very least, keep these dangerous drugs away from children?

On November 5, 2015, I had the opportunity to testify before the FDA’s Antimicrobial Drugs Advisory Committee in a meeting specifically to address the risks of fluoroquinolone antibiotics (Cipro, Levaquin, Avelox, Floxin, and their generic equivalents). I, along with thirty-five other people, testified, and I chose to note the damage that ciprofloxacin did to me and to point out some of the mechanisms through which fluoroquinolones hurt people. Others gave poignant and heart-breaking testimonies about the loss of their health, or the loss of their loved ones, and a few doctors and consumer advocates testified as well. You can read some of the presentations that were provided to the FDA committee in THIS POST.

I am happy to report that the meeting resulted in an overwhelming victory for victims of fluoroquinolone antibiotics. The committee ruled that the current warning labels do NOT appropriately address the risks associated with fluoroquinolones for treatment of sinusitis, bronchitis in those with COPD, or uncomplicated urinary tract infections.

This is a HUGE step in the right direction, and it is my sincere hope that it will result in the FDA dramatically cutting the number of unnecessary fluoroquinolone prescriptions, and better treatment for those who are suffering from adverse reactions to fluoroquinolones.

Acknowledgement of Disability Caused by Fluoroquinolones

Additionally, in the meeting brief, the FDA identified a syndrome associated with fluoroquinolone toxicity—one that “floxies” have been pushing for recognition of for years. It is called Fluoroquinolone Associated Disability (FQAD). According to the FDA:

While most of the individual AEs (adverse events) that exist within FQAD (fluoroquinolone associated disability) are currently described in fluoroquinolone labeling, the particular constellation of symptoms across organ systems is not. Individuals with FQAD were defined as U.S. patients who were reported to be previously healthy and prescribed an oral fluoroquinolone antibacterial drug for the treatment of uncomplicated sinusitis, bronchitis, or urinary tract infection (UTI). To qualify, individuals had to have AEs reported in two or more of the following body systems: peripheral nervous system, neuropsychiatric, musculoskeletal, senses, cardiovascular and skin. These body systems were chosen as they had been observed to be frequently involved with the fluoroquinolone reports describing disability. In addition, the AEs had to have been reported to last 30 days or longer after stopping the fluoroquinolone, and had to have a reported outcome of disability.”

That acknowledgement from a FDA committee, that fluoroquinolones cause a disabling constellation of symptoms in previously healthy individuals, is a HUGE victory for victims of fluoroquinolones.

Next Steps in the Fluoroquinolone Toxicity Battle

Next, the committee will make recommendations to the FDA. Presumably they will recommend that the FDA update the warning labels to note that the constellation of symptoms associated with FQAD, so as to educate physicians and patients of the risks of this class of antibiotics.

The FDA may enact other means of more properly addressing the risks associated with fluoroquinolone use, such as enrolling fluoroquinolones in the Risk Evaluation and Mitigation Strategies (REMS) program.

Several FDA committee members mentioned the need for further studies of fluoroquinolones, and hopefully some long-term and intergenerational studies will be conducted.

I hope that the FDA does all of these things, and that fluoroquinolone use is curtailed significantly. More than 23 million prescriptions for fluoroquinolones were dispensed in the U.S. in 2011 alone, and as many as 90% of those prescriptions were inappropriate given the true risk profile of fluoroquinolones.

We shall see if the FDA does anything with the information that was presented to the committee, and what they do with the committee’s recommendations.

Thoughts on Advocacy Efforts Directed at the FDA

Other groups of patient advocates who are interested in replicating the success of “floxies” in getting a favorable ruling from a FDA committee may be wondering what caused the FDA to look at fluoroquinolones. I believe that the FDA’s decision to hold the committee meeting was a culmination of several factors.

First, people have been reporting disabling reactions to fluoroquinolones to the FDA using their adverse event reporting system (FAERS). I encourage everyone who has experienced an adverse reaction to a drug or medical device to file a report with FAERS.

Second, more than 150 news stories about the dangers of fluoroquinolones have aired in the last two years. You can view them through THIS LINK. The news stories were prompted by the persistence of victims of fluoroquinolones reaching out to their local news stations.

Third, two citizens’ petitions have been filed with the FDA. One notes that serious psychiatric adverse effects can be the result of fluoroquinolone use. Another petition notes that mitochondrial toxicity should be added to the warning labels for fluoroquinolones.

Fourth, concerned citizens met with the FDA to discuss the dangers of this class of drugs.

Basically, people have been screaming at the FDA through multiple venues demanding that they hear us. At the committee meeting, they heard us.

I encourage everyone who has been hurt by a drug or medical device to report their story to the FDA, to tell their story loudly and persistently through the media, and to organize social media groups so that your message is spread far and wide, and heard loud and clear.

“Floxies” have come a long way in getting the dangers of fluoroquinolones recognized by the FDA, but we still have a long way to go. As nice as acknowledgement and being heard are, action is needed to get what we really want—change in how fluoroquinolones are viewed and prescribed. We are moving in the right direction. One step at a time, and we will reach our goals of prudent and appropriate use of fluoroquinolones, as well as healing for those adversely affected by these drugs.

Information about Fluoroquinolone Toxicity

Information about the author, and adverse reactions to fluoroquinolone antibiotics (Cipro/ciprofloxacin, Levaquin/levofloxacin, Avelox/moxifloxacin and Floxin/ofloxacin) can be found on Lisa Bloomquist’s site,www.floxiehope.com.

Antibiotics during Pregnancy: Finally Pharmacokinetic Research

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A common refrain of mine is the lack of drug testing in women, especially pregnant women and relative to the enormous hormone changes women experience across a cycle, across pregnancy or postpartum and frankly across the lifespan. Hormonally, a 16 year old is not the same as a 45 year old. A woman’s biochemistry is not the same early in her cycle as it is late in her cycle. Nor is it the same when she is on oral contraceptives or hormone replacement therapies compared to when she is not and most especially, the pregnant woman’s biochemistry is hugely different than that of a non-pregnant woman. And yet, despite the lack of testing, lack of data, and limited understanding about how medications work relative to a woman’s hormonal state, women, pregnant and non-pregnant alike, are routinely prescribed medications for which we have a very poor understanding of the basic pharmacokinetics (how a drug travels through the body) or pharmacodynamics (what it does and how it works).

Ever so slowly, this may be changing. A group of researchers from the University Chicago, recently published a study on the Influence of Body Weight, Ethnicity, Oral Contraceptives and Pregnancy on the Pharmacokinetics of Azithromycin in Women of Childbearing Age. Though the study was small with only 53 pregnant women and 25 non-pregnant women, it represents one of the few published pharmacokinetic studies done on a drug routinely prescribed to pregnant women that evaluates hormone state.

Azithromycin: the Most Common Antibiotic Prescribed During Pregnancy

Azithromycin, more commonly known as Zithromax, Azithrocin, Z-Pack or ZMax, is the most frequently prescribed antibiotic for a range of bacterial infections of the ears, skin, throat.  It is believed to be safe during pregnancy, despite having a pregnancy category rating B (a designation given a medication that has not been tested in human pregnancy but appears to be safe in animal studies). Some research shows that Azithromycin appears to have no more adverse reactions than other antibiotics, but whether it is truly safe, whether pregnant pharmacokinetics are different than non-pregnant or how they are different had never been determined. The University of Chicago study demonstrated what many have always suspected:

  • pregnant women metabolize medications differently (more slowly) than non-pregnant women
  • oral contraceptives slow drug metabolism
  • and interestingly enough, African American women show different pharmacokinetic patterns than Caucasian, Hispanic, Pacific Islander or Asian women

Pharmacokinetics: The Basics of Drug Disposition

The disposition of a drug (how it travels through the body), is affected by a number of physiological variables including plasma volume (greater when pregnant, lower when dehydrated), protein binding (fat soluble drugs travel through the system bound and protected from metabolism-preparation for excretion- by carrier proteins), liver and kidney function (our waste removal systems). Any alteration to these variables affects how long a drug stays in the body, how much of the drug is available to exert its effects on the tissues or organs, and how effectively it is cleared from the system. Determining the disposition of the drug- the pharmacokinetics- is very important for drug dosing and ultimately, safety.  Every one of those drug disposition variables is affected by the hormone changes of pregnancy, postpartum (menstruation, menopause, oral contraceptives, HRT, etc.).

In the case of Azithromycin, pregnancy significantly slowed metabolism and clearance of the drug in pregnant Caucasian, Hispanic, Pacific Islander and Asian women, but not apparently in African American women or women not taking oral contraceptives. Translated, this means that pregnant Caucasian, Hispanic, Pacific Islander and Asian women were exposed to more drug, for a longer period of time, than were African American women. Ditto for women taking oral contraceptives versus those who were not taking oral contraceptives.

The researchers did not investigate whether hormonally-related changes in immune function interacted with the pharmacodynamics of the drug–rendered it more or less clinically effective. Nor did they evaluate whether or how other medications may have influenced drug disposition. As an aside, women in the pregnant group were taking more medications, in addition to the antibiotic in question, than the non-pregnant group.

What this research does show, however, is that hormones, or at least ‘hormone state’ affects drug disposition significantly. Additional studies are needed to determine how and if more customized dosing is required in pregnant and non-pregnant women alike.

This article was posted previously in September 2012.

What Do Fluoroquinolone Antibiotics Have in Common With Gardasil?

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Horrific side effects that are generally unrecognized by medical practitioners, that’s what these medications have in common. Gardasil Week just ended on Hormones Matter. It made me realize how many bad drugs are on the market. I had an adverse reaction to a fluoroquinolone antibiotic, Cipro, and my life changed forever. Reading the Gardasil stories, I noticed similarities amongst the adverse reactions of the fluoroquinolone antibiotics, Cipro, Levaquin and Avelox and the adverse reactions to Gardasil; both are massive, system-wide and go generally unnoticed by modern medicine.

I have to admit, I’m a bit scared about writing this post. I don’t want to be labeled as “anti-vaccine” and demonized as such. I’m not anti-vaccine. Vaccines have saved thousands of lives throughout human history. Even though an antibiotic hurt me, I’m not anti-antibiotic either. Like vaccines, antibiotics have saved thousands, possibly millions of lives.  Vaccines and antibiotics together account for so much good in modern medicine that it has become almost sacrilegious to question or criticize them – as if in questioning them one negates the lives that have been saved by them.

Rogue Players

Unfortunately, some rogue players have entered both the vaccine and the antibiotic fields; Gardasil in the vaccine market and the fluoroquinolone antibiotics, Cipro, Levaquin and Avelox, in the antibiotic market. Whether the benefits outweigh the risks of these drugs and/or whether these drugs are being used properly is a question that should be asked. Unfortunately, questioning a vaccine or antibiotic leads many to a knee-jerk reaction. Often the injured individual is accused of being anti-vax or anti-antibiotic. It is as if even asking whether or not these drugs are being properly applied and the risk are being properly assessed, is offensive;  as if, in acknowledging that there are side-effects that may not outweigh the benefits for these particular drugs, you are trying to annihilate the whole class of treatments.

I’m not, in any way shape or form, proposing that we get rid of either vaccines or antibiotics. But it would be more than nice, it would be the right, just, empathetic, loving thing to do, to listen to the stories of those who have been hurt by Gardasil or fluoroquinolones, and to explore whether or not they are the right tools to use for accomplishing what we want to accomplish – the limiting of disease and infection. Sticking one’s head in the sand and insisting that all things that come out of the pharmaceutical industry are good and pro-science is a faith-based position that is, frankly, incorrect.

People are being hurt by both Gardasil and fluoroquinolne antibiotics. Disabling, ruinous effects are coming from both of these drugs. Their lives go from normal, with nothing wrong with them in the case of those being treated by Gardasil, or having possibly only a minor infection, in the case of those prescribed fluoroquinolones, to a life of suffering with chronic health problems. This isn’t right. It’s not okay. There is nothing that is okay about turning a non-existent condition into a chronic miserable condition, or an acute condition that can be cured with mild antibiotics, and turning it into a chronic syndrome that causes pain and suffering for years to come.

Too Severe to be Real?

Reactions to both Gardasil and fluoroquinolones are often delayed, weeks to months, and so severe that they are, ironically, disregarded as absurd or impossible. If hundreds or even thousands people didn’t have similar reactions, this might be a valid argument, but when a lot of people have the same reaction of body-wide breakdown, the connection between the drug and the reaction should be seen as valid and researched as such.

Hiking before Cipro, hiking after Cipro
Greg Spooner had a toxic reaction to Cipro in 2010. Details about his story are listed below.

Maybe the incredulous attitude people display when faced with a severe adverse reaction to a pharmaceutical stems from our preconceptions about what medicines should do or how they should act.  Although, we are all aware of the risk for side-effects, we believe they “should” be mild and treatable. When, in fact, some patients develop severe reactions that are systemic, complex and difficult or impossible to treat. Rather than connecting the system-wide breakdown that the patient experiences to the drug, it is easier to believe that the cause of the person’s problems were something else, or dismiss the patient with a misdiagnosis. Rarely are the illnesses linked to the medications that caused them. When the adverse reactions are so comprehensive, they’re seen as absurd and unlikely. Worse yet, they are considered impossible to treat and often dismissed. Even if a physician recognizes the connection between the medication or vaccine and the system-wide breakdown that develops, there is very little, if anything, he or she can do to treat the syndromes that arise.

But They Save Lives

“But they save lives!” is always the argument that people make in favor of these drugs.  For fluoroquinolones, OF COURSE they save lives!  No one is arguing that they don’t.  But given the severity of the adverse effects caused by fluoroquinolones, their use should be reserved for life or death situations. Unfortunately, fluoroquinolones are used as a first line of defense against urinary tract infections, sinus infections, suspected prostate infections, travelers’ diarrhea, etc., when other, safer drugs are available and are equally effective. Giving people a drug with the potential for severe negative consequences when there are effective alternatives that don’t have the same risks is a violation of the Hippocratic Oath.

Of course, if everyone reacted as badly as I did to Cipro, or as badly as Alexis, Ashley or Nicole did to Gardasil, these drugs would be taken off the market.  Everyone would know that they are dangerous and no one would take them (except, in the case of fluoroquinolones like Cipro, in a truly life-or-death situation where there were no other alternatives). But the fact that not everyone has a horrific adverse reaction to these drugs does not negate the fact that some people do.  (And more people have bad reactions to these drugs than realize it.  Because of the delay in adverse reactions, the fact that they are under-recognized by doctors and thus an incorrect diagnosis is often made, and the absurdity of the reactions being caused by an antibiotic or vaccine, people often fail to make the connection between the cause, fluoroquinolones or Gardasil, and the reaction, a chronic syndrome of pain and destruction.)

Regardless of whether or not policy change comes as a result of the harm caused by Gardasil or fluoroquinolones, the victims of both deserve sympathy and compassion.  They deserve to be able to tell their stories. They deserve to be listened to. I can only hope that the stories are heard.

Postscript. Read more about Greg Spooner’s toxic reaction to Cipro, here.

Information about Fluoroquinolone Toxicity

Information about the author, and adverse reactions to fluoroquinolone antibiotics (Cipro/ciprofloxacin, Levaquin/levofloxacin, Avelox/moxifloxacin and Floxin/ofloxacin) can be found on Lisa Bloomquist’s site, www.floxiehope.com.

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