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Fluoroquinolones in paediatrics
1Department of Paediatrics, Hĵpital Saint Vincent de Paul, Paris, France. dominique.gendrel@svp.ap-hop-paris.fr
Insights
Fluoroquinolones are effective antibiotics but have limited pediatric use due to joint toxicity concerns. However, ciprofloxacin shows similar safety in children and adults, suggesting potential for specific pediatric infections.
Area of Science:
- Pharmacology and Therapeutics
- Pediatric Infectious Diseases
- Microbiology
Background:
- Fluoroquinolones are broad-spectrum bactericidal antibiotics with excellent tissue penetration, widely used in adults.
- Concerns regarding potential joint toxicity in pediatric patients have historically limited their use in children.
- Evolving pathogen resistance patterns highlight the need to re-evaluate antibiotic options, including fluoroquinolones.
Purpose of the Study:
- To review the potential indications and safety profile of fluoroquinolones in pediatric populations.
- To assess the risk of arthrotoxicity in children compared to adults.
- To discuss the evolving role of fluoroquinolones in treating resistant infections in children.
Main Methods:
- Review of existing clinical data and experimental findings on fluoroquinolone use and toxicity in pediatric patients.
- Analysis of pathogen susceptibility trends to fluoroquinolones.
- Comparison of arthrotoxicity incidence between pediatric and adult populations treated with ciprofloxacin.
Main Results:
- Fluoroquinolones demonstrate activity against various pediatric pathogens, including resistant Salmonella, Shigella, and Enterobacteriaceae.
- Available data suggests ciprofloxacin's arthrotoxicity incidence in children is comparable to that in adults.
- Third-generation fluoroquinolones show improved Gram-positive activity, with potential applications in respiratory and ENT infections.
Conclusions:
- Fluoroquinolones represent a valuable second-line option for specific, severe pediatric infections, particularly those with resistant pathogens.
- Routine use in children remains limited due to potential joint complications and alternative treatments, but ciprofloxacin appears safe.
- Future fluoroquinolones may find indications in conditions like pneumococcal meningitis, pending further safety and efficacy data.
Abstract:
The fluoroquinolones are an important group of antibiotics, which are widely used in adult patients because of their high penetration in tissues and bactericidal activity. However, they are not licensed for paediatric use (except the limited indication of Pseudomonas infection in cystic fibrosis) because of their potential to cause joint toxicity (observed in experiments using juvenile animal models). In recent years, there has been a change in the susceptibility of pathogens to widely used antibiotics; however, many of these pathogens remain sensitive to the fluoroquinolones (agents which can often be administered orally to treat severe infections). Fluoroquinolones have a number of potential indications in children: cystic fibrosis, intestinal infections due to resistant strains of Salmonella spp. and Shigella spp., severe infections due to Enterobacteriaceae (including the neonatal period), complicated urinary tract infections, the immunocompromised host, and some mycobacterial infections. The third generation fluoroquinolones have improved activity against Gram-positive bacteria and could be useful in respiratory tract, and ear, nose and throat infections in adult patients. Their potential role in routine use for paediatric patients will remain limited because of potential joint complications and the availability of other treatment options. However, available clinical data does indicate that the incidence of arthrotoxicity in children treated with ciprofloxacin appears to be the same as that in adult patients. The use of other fluoroquinolones is too rare to obtain meaningful information on their toxicity in children. For future fluoroquinolones, pneumococcal meningitis will probably be a potential indication. Despite their important activity, fluoroquinolones remain a second-line treatment in children, for use following the failure of a well established antibiotic treatment, to avoid potential adverse effects and the emergence of resistant strains.