Safety Profile of Nebulized Ciprofloxacin-Dexamethasone After Pediatric Airway Surgery

To evaluate the safety profile and patterns of use of nebulized ciprofloxacin-dexamethasone (CPD) in pediatric patients undergoing airway surgery.

A retrospective chart review was performed of patients who underwent airway surgery at a tertiary pediatric center between 2019 and 2023 and received nebulized CPD 0.3%-0.1% postoperatively. Demographic, clinical, and procedural data were extracted. Exposure was defined as any postoperative nebulized administration. Adverse events were considered potentially CPD-related if they occurred during administration or within 30 days of discontinuation without a better explanation. Outcomes included endocrine, metabolic, infectious, pulmonary, and inflammatory complications.

A total of 399 patients received nebulized CPD. Mean age was 46.2 months (range: newborn-20.7 years). Indications included subglottic stenosis (92.5%), post-laryngotracheal reconstruction (5.3%), airway foreign body (2.0%), and supraglottoplasty (0.3%). Comorbidities were frequent, including neurologic conditions (47.6%), cardiac anomalies (41.6%), and bronchopulmonary dysplasia (25.1%). Most patients (93.4%) received CPD in the inpatient setting, for a mean duration of 11.7 days. No cases of adrenal suppression, glucose abnormalities, or bronchial hyperreactivity were identified. One patient had suspected airway fungal infection while receiving chemotherapy, though pathology was negative. Among the 85.7% of patients who underwent postoperative endoscopic evaluation, no significant inflammatory findings were observed.

Nebulized CPD Was Uniformly Incorporated Into Postoperative Airway Management in This Large Pediatric Cohort and Well Tolerated, With no Significant Adverse Events Observed. These Findings Support the Safety of CPD in Medically Complex Children and Highlight the Need for Multicenter Prospective Studies to Evaluate Efficacy and Optimize Dosing Protocols.