[Cartilage-damaging effect of quinolones]

The cartilage damaging effect of quinolones on juvenile experimental animals represents an unusual effect which is unknown, in this form, for other classes of substances. Since the damage is manifested at quite low doses the manufacturers and regulatory agencies have taken the consequence of declaring these preparations counter-indicated for children and adolescents up to the end of the growing period. Motor disturbances were observed only rarely, and only in individual cases, seen after therapeutic use of these drugs for the treatment of bacterial infections. In spite of long-term and sometimes high dose treatment with nalidixic acid during the 1960s and 1970s (the arthropathogenic effect on dogs was first described in 1977) no joint alterations could be demonstrated clinically or by x-ray. From this conclusion can be drawn that the effects seen in animal experiments under therapeutic conditions do not occur with the same intensity in humans. But, since many questions concerning this unusual toxic potential are still unanswered, quinolones continue to be counter-indicated for patients who are in the growing phase. Further experimental data and clinical observations are necessary to exclude with certainty the possible danger of joint damage to young patients. Even today it is still unclear whether the generally favourable clinical observations made with nalidixic acid also hold true for the other quinolones and whether differences in the possible risks exist. It will only become possible to define, with the necessary amount of certainty, indications for the use of quinolones in pediatrics when further information is available.