BAL HARBOUR, FLA. — Fluoroquinolones must be used judiciously in children, Sarah S. Long, M.D., said at the annual Masters of Pediatrics conference sponsored by the University of Miami.
These drugs are increasingly available, and they are being widely prescribed to children. More than 520,000 prescriptions for fluoroquinolones were written for this population in 2002—with more than 16,000 written for those under age 6 years and nearly 3,000 written for those under age 2 years, said Dr. Long, professor of pediatrics at Drexel University, Philadelphia.
And that was before ciprofloxacin received Food and Drug Administration approval for use in those under age 18 years with complicated urinary tract infections, pyelonephritis, and inhalation anthrax exposure, Dr. Long said.
The FDA granted this approval last year, but there is little guidance beyond that for the use of fluoroquinolones in the pediatric population.
The advantages of fluoroquinolones include oral administration, excellent oral bioavailability, and a gram-negative spectrum, but these drugs are associated with adverse musculoskeletal events. The potential for spontaneous Achilles tendon rupture is of particular concern, Dr. Long commented.
Tendon rupture is a rare event, but it is definitely “above the radar,” she said.
“These drugs do have some effect on cartilage—there is no question,” she added.
In addition, there is some concern about whether they are associated with long-term arthropathy, she noted.
Central nervous system, hepatic, and metabolic effects are also possible, and some patients experience photosensitivity and rashes after taking fluoroquinolones.
Therefore, the use of these drugs in children should be limited mainly to serious gram-negative rod infections for which there are no other treatment alternatives, Dr. Long said.
Conditions for which fluoroquinolones may be appropriate in children—other than the approved uses—include chronic otitis, chronic or acute Pseudomonas aeruginosa osteomyelitis, cystic fibrosis exacerbations, certain mycobacterium infections, and multidrug-resistant shigella, salmonella, or vibrio infections.
Topical treatment is acceptable for conjunctivitis and otitis externa that are refractory or resistant to other treatments, but fluoroquinolones should not be used for plain conjunctivitis or otitis media or for community-acquired bronchitis and pneumonia, Dr. Long said.