Fluoroquinolones in Pediatrics

Abstract

The fluoroquinolones (FQ) are a group of antimicrobials with a broad spectrum of activity against gram positive and gram negative organisms, intracellular and anaerobic organisms. These antimicrobial agents have excellent oral bioavailability, high tissue penetration, low protein binding and a long elimination half life. The experience with these antibiotics in children has been limited to certain conditions mainly in the treatment of bronchopulmonary exacerbations in children with cystic fibrosis and in the ambulatory treatment of children with fever and neutropenia. Despite the limited use, it is recognize that there are other potential indications for the use of FQ in pediatrics such as for the treatment of children with bacterial meningitis, refractory and recurrent otitis media, pneumonia, multiply resistant salmonellosis and shigellosis and complicated urinary tract infections. Furthermore, the new FQ have shown excellent invitro activity against penicillin-resistant Streptococcus pneumoniae suggesting that these agents may be an attractive alternative for the treatment of conditions that involve these problematic strains. Cartilage toxicity due to FQ had been a major concern however; the previous experience with ciprofloxacin and recently the results from long term (12 months) prospective studies have found no evidence of such a problem in children. Ciprofloxacin was recently approved for the treatment of children with complicated urinary tract infections. If based on the safety and clinical results of ongoing clinical trials, other new FQ are approved for the treatment of other conditions in children, particularly respiratory tract diseases, caution is highly recommended to avoid selection of bacterial resistance.

Antibiogram of E. coli serotypes isolated from children aged under five with acute diarrhea in Bahir Dar town

“…Under circumstances where resistance to ampicillin, cotrimoxazole and tetracycline is common, appropriate antimicrobial agents for the treatment of diarrhea caused by E. coli are limited to fluoroquinolone. Recommendations on the use of fluoroquinolones in children suggest that these agents must remain a therapeutic alternative in selected pediatric conditions 36 .…”

Synergistic effects of glutamine and ciprofloxacin in reduction of Pseudomonas aeruginosa-induced septic shock severity

“…In the current study, we tested the hypothesis that Gln, as a potential HSP inducer and inflammatory response modulator, may have synergistic effects in combination with ciprofloxacin, as an antibiotic that has excellent in-vitro activity against P. aeruginosa [18], in …”