Related Experiment Videos
Use of quinolones in pediatric patients
1Department of Antimicrobial Therapy and Infection Immunology, Dr. v. Haunersches Children's Hospital of the University, Munich, FRG.
Insights
Quinolone antibiotics may harm young animal cartilage, but human studies show no adverse effects in children treated with nalidixic acid. Human cartilage appears less sensitive to quinolone-induced arthropathy.
Area of Science:
- Pharmacology
- Pediatric Medicine
- Toxicology
Background:
- Animal studies indicate quinolones can cause irreversible cartilage damage in juvenile joints.
- This has led to contraindications for new quinolones in children and pregnant women.
- Nalidixic acid, an early quinolone used in pediatrics, also shows arthropathic potential in animal models.
Purpose of the Study:
- To investigate the actual incidence of quinolone-associated arthropathy in children treated with nalidixic acid.
- To evaluate the safety of nalidixic acid in pediatric patients despite animal study findings.
- To explore potential interspecies differences in cartilage sensitivity to quinolones.
Main Methods:
- Retrospective analysis of three studies involving children treated with nalidixic acid.
- Utilized careful X-ray examinations for arthropathy detection.
- Included comparisons with control patient groups.
Main Results:
- No cases of quinolone-associated arthropathy were detected in any of the three retrospective studies.
- X-ray examinations and control group comparisons did not reveal adverse joint effects.
- Findings suggest human cartilage may be insensitive or only slightly sensitive to quinolone arthropathy.
Conclusions:
- Despite animal data, nalidixic acid appears safe regarding arthropathy in pediatric patients.
- Interspecies differences likely explain the discrepancy between animal and human study outcomes.
- Prospective studies on new quinolones in children are warranted to confirm efficacy and safety.
Abstract:
Animal experiments have shown that quinolones can cause irreversible damage to cartilage in strained joints of young animals. Since a similar effect in humans cannot be excluded, the new quinolones are contraindicated in children and pregnant women. Nalidixic acid was the first quinolone developed and was often used in pediatric patients for the treatment of urinary tract infections. This compound is also known to cause damage to juvenile cartilage in animal studies but is still licensed for pediatric use. In three different retrospective studies of children treated with nalidixic acid, no case of quinolone-associated arthropathy could be detected by careful X-ray examinations or comparisons with control patients. This disparity most probably can be explained by interspecies differences: human cartilage may be insensitive or only slightly sensitive to the arthropathic effects of quinolones. Careful prospective evaluations of the efficacy and safety of new quinolones in childhood infections are both medically indicated and ethically justified.