Use of the new quinolones in pediatrics

For many years quinolone-induced cartilage toxicity observed in experiments with some skeletally immature animals represented indisputable contraindication for the use of these promising antimicrobials in prepubertal patients. Our clinical, magnetic resonance imaging and histopathological monitoring of ciprofloxacin use, together with the published experiences of other groups, suggest that the quinolone antibiotics 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 exacerbation in cystic fibrosis, and for complicated urinary tract, skeletal, aural and shunt infections. In addition to these rare indications, there is an urgent need in developing countries for availability of the new quinolones for treating children with endemic and epidemic shigellosis and invasive salmonellosis. At present these compounds are not approved for pediatric patients; therefore each such treatment must be part of a controlled study or respect the compassionate use regularities.