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Use of the quinolones in paediatrics
1Department of Pediatrics, University of Berne, Switzerland.
Insights
Quinolones, including ciprofloxacin, do not appear to cause joint problems in children, contrary to earlier animal studies. This suggests potential new uses for these antibiotics in pediatric patients with specific infections.
Area of Science:
- Pharmacology
- Pediatrics
- Infectious Diseases
Background:
- Historically, quinolone antimicrobials were contraindicated in children due to observed cartilage toxicity in juvenile animal models.
- This toxicity concern has limited the use of valuable antibiotics in pediatric populations for many years.
Purpose of the Study:
- To evaluate the safety and efficacy of quinolone use, specifically ciprofloxacin, in pediatric patients.
- To reassess the contraindication of quinolones in prepubertal children based on human clinical data.
Main Methods:
- Clinical monitoring of pediatric patients receiving ciprofloxacin.
- Magnetic resonance imaging (MRI) assessments.
- Histopathological examination of affected tissues.
- Review of published literature on quinolone use in children.
Main Results:
- Clinical, MRI, and histopathological data suggest quinolones do not induce arthropathy in humans.
- Identified potential indications for quinolone use in children include cystic fibrosis exacerbations, complicated urinary tract infections, skeletal infections, and shunt infections.
- Highlighted the critical need for quinolones in developing countries for treating shigellosis and invasive salmonellosis in children.
Conclusions:
- The long-standing contraindication of quinolones in prepubertal patients based on animal studies may not apply to humans.
- Ciprofloxacin and other quinolones show promise for treating various pediatric infections, including those caused by resistant bacteria.
- Current lack of approval necessitates administration within controlled studies or compassionate use programs for pediatric patients.
Abstract:
For many years, quinolone-induced cartilage toxicity observed in experiments involving immature animals has represented an indisputable contraindication for the use of these promising antimicrobials in prepubertal patients. Clinical, magnetic resonance imaging and histopathological monitoring of patients receiving ciprofloxacin at the University of Berne, together with published data, suggest that the quinolones do not cause arthropathy in humans. Conditions that potentially qualify for quinolone use (especially ciprofloxacin) in children include oral antipseudomonal (or antistaphylococcal) therapy for pulmonary exacerbations in cystic fibrosis, and complicated urinary tract, skeletal, aural and shunt infections. In addition to these rarer indications, there is an urgent need for the quinolones in developing countries for children with endemic and epidemic shigellosis and invasive salmonellosis. At present, these compounds are not approved for paediatric use and therefore must be administered as part of a controlled study or on a compassionate use basis in individual patients.