`Not too sure what planet you live on Doc, but finding support for not using the fqs as a first line agent here in the States will prove to be an exercise in futility.  Just about all of the guidelines here recommend them as first line agents.  You will find pretty much the same in all those reviews you are so fond of.  Got into a knock down drag out fight about this a few years ago with one of your peers.  He loves the damned things and produced evidence that indeed they are recommended as first line agents for just about anything you can think of.  Things might of changed since then but I highly doubt it.    And from my own experience dealing with these survivors RARELY if ever did they suffer from a serious infection.  I would venture to say about 75% or more of those on my forum did not even have ANY kind of bacterial infection to begin with.  Maybe that is why they got hit so hard.  Just like my case, 24 and 48 hour cultures showed no bacterial growth.  Given a 1000 mg a day of levaquin (for two weeks) to treat a ``suspected`` bladder infection when in fact I had a kidney stone and was pissing blood from it.  When the cultures came back negative he then insisted I had chronic bacterial prostatitis.  Even though about nine months earlier my prostate was just fine.  (As well as when I changed urologists down the road)    The stone was on the xray but the radiologist missed it. I was on these drugs for almost two months.  Started out with floxin, switched to cipro and finally levaquin.  Complained the WHOLE time about most of these adrs we are discussing and the urologist told me flat out they had NOTHING to do with the fluoroquinolones.  Safe and effective, well tolerated, etc., etc., just like you have stated within your article.  Might be the reason he blew off my concerns and crippled me for life instead of stopping the drugs.  May have believed they may not help, but certainly could not hurt, based upon such information as you are presenting.  I have met only ONE doctor who has treated me in the past twenty years that had any idea regarding these reactions.  And that was because she suffered them herself.  Not bitching here, just explaining the current situation here in the States is all.   Oh and the FDA AERS system?  What a joke.  They excluded ANY REPORTS prior to 1997.  So you are handicapped right from the get go.  Thirty five years worth of data is missing.  Anything prior to 1997 resides on another database and the two are not linked and the second database is no longer available.  Takes specialized software to even access it.  Play around with it a bit and you will see what I mean.  Here is the link: http://www.fdable.com/aers/advanced     `