We enter here, Nancyh the realm of sales promotion!

When the fluroquinolones came out, they were orginally intended to be
a third line drug. That is others, were to be tried first, and if it appeared that
resistance was present the Cipro was to be considered later.

Some people (like me) are allergic to penicillin and sulfa drugs. So Cipro is
a good choice for bladder/kidney infections in patients with those problems.
But the it was noticed that it was SO good, they started promoting it
aggressively, and really pushing the samples at doctors, who used it themselves and it quickly became highly popular and the tiers of use quickly bypassed.

Other drug companies became interested in making more money, so Me-Too quinolones came out. This is when the toxicities became more apparent.
It took several years for the tendon rupture side effect to be identified. It often occurs up to six months AFTER the drug is stopped, so it was hard
to connect to the drugs. The ME-too copy cats, were sort of rushed thru, and all of them except for Levaquin, show more toxicity than Cipro.
Some have been taken off the market entirely.

Cipro is still used heavily for cellulitis (infection of soft tissue), kidney infections and prostate infections. There is a low dose Cipro pack for bladder infections in women--it is very low dose. Levaquin was shown in studies to be very good for community acquired pneumonias, resistant to other drugs.
Cipro is still used for long term treatments of chronic prostatitis. It is here in the long term use, that PN is a potential side effect. Some people, may get the PN however, at first use (depending on their susceptibility to nerve damage).

The tiers for urinary tract infections for non allergic people are:
1) Amoxicillin or Cephalexin
2) Septra DS
3) nitrofurantoin
4) Cipro

For upper respiratory infections:
1) amoxicillin/Augmentin or erythromycin (or Zithromax) if penicillin allergic
2) Septra DS
3) Quinolones (often first line now for pneumonias)

Amoxicillin still works. Even though there are resistant strains of bacteria out there. My son had a flaming throat with Mono and amoxicllin took care of it quickly and easily. In children this is first line. (they don't use quinolones quickly in kids because of the tendon rupture issue). Although Cipro did get approved for kids, it is still withheld unless absolutely necessary. In children it is reserved for kidney or cellulitis infections. (usually from trauma or kidney birth defects).

How it goes however in the doctor's office is that Zithromax is given very frequently today. And there is some bacterial resistance developing to it. There is a new dosing of 500mg for 3 days now for that, and some pneumonias.
Zithromax works well for me. But I don't use it very often. I don't get ill much since doing my supplements (including zinc and EFAs). Essential fatty acids, really fix small imperfections in the mucous membranes, and improve mucous movement and help keep the upper airways clean. Oral zinc beefs up the immune system. I used to get about 4 bronchitis attacks/year--since I am exposed to sick people every day. That has gone down to about 1 every 3 or 4 years. I have had bronchopneumonia twice, in the past before my supplement days.

Levaquin remains very popular for the elderly population. We use alot of it
for the nursing homes. Lots of pneumonia there. In the nursing homes, long term urinary tract infections are common. They use nitrofurantoin mostly for that. I do not see long term fluroquinolones frequently there. Nitrofurantoin has new warnings on kidney damage and it too can cause PN, only not as frequently.

Use of antibiotics is controversial now, since mrsa (methicillin resistant staph) has appeared. These super bacteria are thought to be mutants resulting from over use of antibiotics or misuse of them.