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Nalidixic acid induced pseudotumour cerebri in children
A Riyaz1, C M Aboobacker, P R Sreelatha
1Department of Paediatrics, Medical College, Calicut.
Insights
Nalidixic acid overdose in children can cause pseudotumor cerebri. Many cases involved unnecessary prescriptions for diarrhea, highlighting a need for better drug concentration control and doctor awareness.
Area of Science:
- Pediatrics
- Pharmacology
- Neurology
Background:
- Nalidixic acid, a quinolone antibiotic, is commonly prescribed for acute dysentery.
- Emerging evidence suggests a link between nalidixic acid use and pseudotumor cerebri in pediatric patients.
- Pseudotumor cerebri (idiopathic intracranial hypertension) presents with increased intracranial pressure without a clear cause.
Purpose of the Study:
- To investigate the association between nalidixic acid administration and the development of pseudotumor cerebri in infants and young children.
- To identify factors contributing to the increased incidence of this adverse drug reaction.
Main Methods:
- A retrospective case series analysis of 20 pediatric patients diagnosed with pseudotumor cerebri.
- Review of patient medical records, focusing on medication history, dosage, and indication for nalidixic acid use.
Main Results:
- All 20 patients received higher than recommended doses of nalidixic acid.
- 85% of patients were prescribed nalidixic acid for acute watery diarrhea, an inappropriate indication.
- High drug concentration in commercial preparations and lack of physician awareness were identified as contributing factors.
Conclusions:
- Over-prescription and incorrect dosage of nalidixic acid are significant risk factors for pseudotumor cerebri in children.
- Reducing nalidixic acid concentration in preparations and promoting judicious prescribing practices are crucial.
- Emphasizing oral rehydration solution for acute watery diarrhea can prevent unnecessary nalidixic acid exposure.
Abstract:
Nalidixic acid, the quinolone frequently used in the treatment of acute dysentery, is now emerging as an important cause of pseudotumour cerebri in infants and young children. A study of 20 such cases showed that all the patients had received a higher than recommended dose of nalidixic acid and that 85% of them were given the drug unnecessarily (i.e., for acute watery diarrhoea). A high concentration of the drug in the commercial preparations as well as the lack of awareness about this among doctors, especially the general practitioners, is the possible contributory factor leading to this situation. A simple measure of bringing down the concentration of nalidixic acid in the available preparations and sticking to oral rehydration solution alone in the treatment of acute watery diarrhoea, can bring down the incidence of this condition.