Related Experiment Videos
[Fluoroquinolones in children]
1Hôpital Saint Vincent de Paul, 82 Av Denfert-Rochereau, 75014 Paris, France. dominique.gendrel@svp.ap-hop-paris.fr
Insights
Fluoroquinolones are recommended for pediatric cystic fibrosis patients but carry risks like arthrotoxicity. Their use should be limited to severe infections with no alternatives, balancing benefits against risks to combat bacterial resistance.
Area of Science:
- Pediatric infectious diseases
- Pharmacology
- Antimicrobial stewardship
Background:
- Fluoroquinolones are rarely recommended for children, primarily for pyocyanic infections in cystic fibrosis.
- Arthrotoxicity is a key contraindication, though use is considered for serious infections lacking alternatives.
Purpose of the Study:
- To review current and potential pediatric indications for fluoroquinolones.
- To discuss safety concerns, particularly arthrotoxicity, in pediatric populations.
- To emphasize restricted use and antimicrobial stewardship.
Main Methods:
- Literature review of fluoroquinolone use in pediatric populations.
- Analysis of contraindications and potential indications.
- Discussion of safety data and reporting challenges.
Main Results:
- Current pediatric use is limited to specific indications like cystic fibrosis.
- Potential uses include multidrug-resistant infections and complicated UTIs.
- Arthrotoxicity risk is similar or slightly higher than in adults; underreporting of adverse events is an issue.
Conclusions:
- Fluoroquinolones should remain second or third-line agents for severe pediatric infections when no other options exist.
- Restricting use is crucial to minimize risks and slow the emergence of resistant bacteria.
- Newer quinolones may offer alternatives for specific conditions like resistant pneumococcal meningitis.
Abstract:
The only currently recommended pediatric use of fluoroquinolones involves ciprofloxacine for treatment of pyocyanic infection in children with cystic fibrosis. The main contraindication for use of fluoroquinolones in children is arthrotoxicity. Notwithstanding they are occasionally used for serious infections when there is no other therapeutic alternative. In addition to cystic fibrosis, potential pediatric indications include multidrug-resistant salmonella and shigellosis, certain enterobacterial infections in newborns, complicated urinary tract infections, and severe multidrug-resistant bacterial infection especially in immunocompromised subjects. The availability of new quinolones against pneumococcus should have little impact on current therapeutic strategies for upper or lower respiratory tract infections since potential indications in children are limited. However when the new generation reaches the market, fluoroquinolones should offer new alternatives for treatment of penicillin-resistant pneumococcal meningitis. Studies comparing children and adults have shown that arthrotoxicity is approximately the same or only slightly higher. The main problem for assessment of adverse effects is that pediatricians often fail to report the limited number of cases in which fluoroquinoles have been prescribed. Regardless fluoroquinolones must remain a second or third line agent for treatment of severe infection in cases in which no other alternative especially by the oral route is available. Use must be restricted to situations in which the risks are outweighed by potential benefits. Limiting pediatric use will slow down the emergence of resistant bacteria.