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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Current ciprofloxacin usage in children hospitalized in a referral hospital in Paris

Zhi-Tao Yang1, Jean-Ralph Zahar, Fréderic Méchaï

  • 1Service des Maladies Infectieuses et Tropicales & Centre d'Infectiologie Necker-Pasteur, Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France.

BMC Infectious Diseases
|May 29, 2013
PubMed

Insights

Fluoroquinolone (FQ) prescriptions in children were often inappropriate, with only 23.4% deemed mandatory. This highlights the need for antimicrobial stewardship programs to control FQ use and combat resistance in pediatric populations.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Stewardship
  • Pharmacovigilance

Background:

  • Increasing fluoroquinolone (FQ) use in children poses a significant risk of antimicrobial resistance.
  • Off-label FQ prescriptions are common for prophylaxis and treating resistant infections in immunocompromised children.

Purpose of the Study:

  • To assess the appropriateness of ciprofloxacin prescriptions in a pediatric cohort.
  • To evaluate FQ use patterns and identify areas for improved antimicrobial stewardship.

Main Methods:

  • A six-month monocenter audit of ciprofloxacin prescriptions in a university hospital.
  • Independent evaluation of prescription indications, infected sites, and bacteriological findings by infectious disease consultants and a pharmacist.

Main Results:

  • 98 ciprofloxacin prescriptions were analyzed; 53.1% were oral, 46.9% parenteral.
  • 23.4% of prescriptions were considered mandatory, 49.0% alternative, and 27.6% unjustified.
  • Appropriateness varied by indication, with Pseudomonas aeruginosa infections in cystic fibrosis patients being a common mandatory use.

Conclusions:

  • Only 23.4% of FQ prescriptions in this pediatric cohort were mandatory, indicating significant overuse.
  • Development of a control program, potentially via an antimicrobial stewardship team, is recommended to manage FQ use in children.
  • Addressing FQ overuse is crucial to mitigate the ecological risk and rising resistance in pediatric populations.
Abstract

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