Tolerance and safety of ciprofloxacin in paediatric patients

Abstract

The Cystic Fibrosis Clinic at the Royal Belfast Hospital for Sick Children has treated 31 children with ciprofloxacin, for serious pseudomonas infection in cystic fibrosis, and carefully monitored the safety and acceptability of the drug. Initially, eight very ill children were treated on a named-patient basis, with an encouraging clinical response and few adverse effects. Children aged 10-18 years were included in a study of four consecutive exacerbations of respiratory disease, comparing (i) oral ciprofloxacin in each episode with (ii) ciprofloxacin alternating with intravenous azlocillin and tobramycin. Other children with cystic fibrosis were subsequently treated with ciprofloxacin, as the need arose. In all the groups very few adverse reactions were found; in particular only one child developed arthralgia. A total of 202 children in the UK have been treated with ciprofloxacin on a named-patient basis, and their clinicians have reported 46 adverse events that may have been drug-related. Overall ciprofloxacin appears to be safe and effective in children but concern about the possible occurrence of arthropathy remains and long term follow-up of these children may be necessary.

Antibiotics for the empirical treatment of acute infectious diarrhea in children

“…Joint disorders observed in young experimental animals during experimental toxicity trials made pharmaceutical companies decide not to seek to extend fluoroquinolone indications to Pediatrics. Such side effects have also been noted in children participating on clinical trials [81][82][83] and, indeed, among all possible adverse effects of the use of fluoroquinolones, only musculoskeletal events are more common in children than in adults [84][85][86][87]. Based on the potential risks and benefits of prescribing fluoroquinolones to children, the American Academy of Pediatrics, as well as several experts, have suggested that fluoroquinolones only be prescribed for specific infections or as a second-line antibiotic, in the case of severe bacterial infections with proven resistance to safer drugs [88][89][90][91][92].…”

Disinfection of Immature Teeth with a Triple Antibiotic Paste

“…Most anaerobic bacteria are resistant to ciprofloxacin, therefore, it is often combined with metronidazole in the treatment of mixed infections. Side effects of ciprofloxacin have been reported, however, Black et al (22) found the drug to be clinically safe when applied in low doses. When applied as an intra-canal medicament in low doses, adverse systemic side effects should be minimized.…”

Successful Treatment of Late-Onset Infection due to Resistant Klebsiella pneumoniae in an Extremely Low Birth Weight Infant Using Ciprofloxacin

“…11 The published experience with ciprofloxacin in pediatric patients suggests that the drug is effective and that significant toxicity is uncommon. 9 An acute ar- thropathy, which resolves without sequelae, has been reported in children treated with ciprofloxacin, 12 but the irreversible arthropathy described in experimental animals appears to occur rarely if at all. 13 Growth in children treated with ciprofloxacin has been found to be normal, 14 and ciprofloxacin-treated pediatric patients monitored by magnetic resonance imaging have not developed the characteristic cartilaginous abnormalities seen in experimental animals.…”

“…9 Nevertheless, ciprofloxacin has been used on a compassionate basis in children in certain clinical situations in which it has specific advantages, such as the oral treatment of pseudomonas infections in cystic fibrosis, 3 the treatment of shigellosis, 10 and the treatment of multidrug-resistant typhoid fever. 11 The published experience with ciprofloxacin in pediatric patients suggests that the drug is effective and that significant toxicity is uncommon.…”