Fluoroquinolones Are Safe for Use in Pediatric Patients
Date First Published:
March 9, 2009
Last Updated:
May 20, 2009
Report by:
Amy Bishop, Emergency Medicine Resident (Grand Rapids Medical Education and Research)
Search checked by:
Jeffrey Jones, MD, Grand Rapids Medical Education and Research
Three-Part Question:
In [pediatric patients] do [fluoroquinolones] have an [increased risk of causing arthropathy]?
Clinical Scenario:
A pediatric patient presents to the Emergency Department with pyelonephritis. You would like to use a fluoroquinolone antibiotic, but are concerned about its safety in this patient population.
Search Strategy:
Medline 1950-5/09 using the OVID interface, Cochrane Library (2009), PubMed clinical queries
Search Details:
[(exp fluoroquinolones or fluoroquinolones.mp) AND (arthropathy.mp.)]. LIMIT to human AND English
Outcome:
52 papers were found of which 3 were relevant to the three part question
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Randomised comparison of ciprofloxacin suspension and pivmecillinam for childhood shigellosis Salam MA. Dhar U. Khan WA. Bennish ML Aug. 1998 Bangladesh | 120 patients (age 2-15) with shigella diarrhea, randomized to treatment with ciprofloxacin or pivmecillinam for 5 days. | Randomized, double-blinded | joint pain | No difference between the two groups. | Small sample size. Many patients lost to follow up at day 7, 30 and 6 months |
| arthropathy | No evidence of arthropathy/arthritis in either group at follow-up visits at | ||||
| Ciprofloxacin as antipseudomonal treatment in patients with cystic fibrosis. Schaad UB. Wedgwood J. Ruedeberg A. Kraemer R. Hampel B. 1997 Switzerland | 44 pediatric patients with cystic fibrosis randomized to ciprofloxacin or ciprofloxacin plus amikacin | randomized prospective study | joint pain | 1 patient in each group, that resolved without treatment | Small sample size. No placebo control, both groups received fluoroquinolones. Not blinded. Lack of detailed explanation of joint evaluation. |
| Sequential ciprofloxacin therapy in pediatric cystic fibrosis: comparative study vs. ceftazidime/tobramycin in the treatment of acute pulmonary exacerbations Church DA. Kanga JF. Kuhn RJ. Rubio TT. Spohn WA. Stevens JC. Painter BG. Thurberg BE. Haverstock DC. Perroncel RY. Echols RM. 1997 United States | 84 pediatric cystic fibrosis patients (age 5-17) with acute pulmonary exacerbation were randomized to ciprofloxacin or ceftazidime plus tobramycin for 10 days. | RCT | Overall adverse events | similar; 78% for ciprofloxacin, 69% for ceftazidime/tobra. p=.288 | Small sample size. Special patient population (cystic fibrosis) |
| Musculoskeletal event | identical; 22% for ciprofloxacin, 21% for ceftazidime/tobra. p=.845 |
Author Commentary:
Fluoroquinolones have been observed to cause arthropathy in juveniles of most animal species. Because of this, they have been used sparingly in children. Most of the human data has come from the use of fluoroquinolones in pediatric cystic fibrosis patients
Bottom Line:
The use of fluorquinolones appears to be safe for use in pediatric patients and does not create an increase risk for the development of arthropathy. The studies are limited, however, due to the small sample size.
References:
- Salam MA. Dhar U. Khan WA. Bennish ML. Randomised comparison of ciprofloxacin suspension and pivmecillinam for childhood shigellosis
- Schaad UB. Wedgwood J. Ruedeberg A. Kraemer R. Hampel B.. Ciprofloxacin as antipseudomonal treatment in patients with cystic fibrosis.
- Church DA. Kanga JF. Kuhn RJ. Rubio TT. Spohn WA. Stevens JC. Painter BG. Thurberg BE. Haverstock DC. Perroncel RY. Echols RM.. Sequential ciprofloxacin therapy in pediatric cystic fibrosis: comparative study vs. ceftazidime/tobramycin in the treatment of acute pulmonary exacerbations