The Use of Systemic Fluoroquinolones

Abstract

The only indications for which a fluoroquinolone (ie, ciprofloxacin) is licensed by the US Food and Drug Administration for use in patients younger than 18 years are complicated urinary tract infections, pyelonephritis, and postexposure treatment for inhalation anthrax. Nonetheless, approximately 520 000 prescriptions for fluoroquinolones were written in the United States for patients younger than 18 years in 2002; 13 800 were written for infants and children 2 to 6 years of age, and 2750 were written for infants younger than 2 years. Clinical trials of fluoroquinolones in pediatric patients with various diagnoses have been published and are reviewed. Fluoroquinolones cause arthrotoxicity in juvenile animals and have been associated with reversible musculoskeletal events in both children and adults. Other adverse events associated with fluoroquinolones include central nervous system disorders, photosensitivity, disorders of glucose homeostasis, prolongation of QT interval with rare cases of torsade de pointes (often lethal ventricular arrhythmia in patients with long QT syndrome), hepatic dysfunction, and rashes. The increased use of fluoroquinolones in adults has resulted in increased bacterial resistance to this class of antibacterial agents. This report provides specific guidelines for the systemic use of fluoroquinolones in children. Fluoroquinolone use should be restricted to situations in which there is no safe and effective alternative to treat an infection caused by multidrug-resistant bacteria or to provide oral therapy when parenteral therapy is not feasible and no other effective oral agent is available.

Population-Based Cohort Study of Anti-Infective Medication Use before and after the Onset of Type 1 Diabetes in Children and Adolescents

“…Children and adolescents with type 1 diabetes had prescriptions for more second-line anti-infectives compared with the reference cohort, including antibiotics which should be carefully prescribed in children and adolescents, such as quinolones (16,17). This observation accords with earlier studies that mentioned a higher severity of infections in patients with diabetes (18).…”

“…However, in the current study, we did not have information on autoantibodies and genetic-related risk factors for type 1 diabetes. Moreover, it is important to note that based on the recommendation of the American Academy of Pediatrics, the use of fluoroquinolones in a child or adolescent may be justified in special circumstances after careful assessment of the risks and benefits for the individual patient (16,17).…”

Characteristics of Open-Globe Injuries in Northwestern Portugal

“…However, neither formulation was available in our department. Also, in the pediatric age groups fluoroquinoloes are not an option because they affect the growth of skeletal tissues [22]. Due to the low incidence of endophthalmitis, only a large multicenter randomized study may determine the best prophylactic option for posttraumatic endophthalmitis.…”

Septic arthritis by Sphingobacterium multivorum in immunocompromised pediatric patient

“…Studies have shown that ciprofloxacin may be used in pediatric patients according to the analysis of risks and benefits in each situation 2123 One of the indications by the American Academy of Pediatrics and the World Health Organization would be its use in bacterial infection by gram negative microorganisms in immunosuppressed children 2124 …”