Magnetic Resonance Imaging in Children Receiving Quinolones: No Evidence of Quinolone-lnduced Arthropathy

Abstract

Twenty-nine children with cystic fibrosis (CF) were investigated for quinolone-induced arthropathy. Magnetic resonance imaging (MRI) was performed in 14/14 children treated with ofloxacin or ciprofloxacin and in 10/15 of those never treated with quinolones. The frequency of pathologic MRI findings, concerning cartilage thickness, careful analysis of the cartilage structure, presence of edema, cartilage-bone borderline and the presence of fluid in joints did not show any difference between both groups. Thus the presence of quinolone-induced arthrotoxicity cannot be confirmed in this study.

In vitro Antibacterial Activities of New Fluoroquinolones against Clinical Isolates of <i>Haemophilus influenzae</i> with Ciprofloxacin-Resistance-Associated Alterations in GyrA and ParC

“…The pediatric usages of fluoroquinolones have been restricted because there were some concerns such as risk of arthropathy for the use of quinolones in children. However, the recent reports say the safety profile of fluoroquinolones in children is not substantially different from that of adults, and these types of drugs in the treatment of otolaryngology infections in children were effective [32][33][34]. It might be possible that any extension of the indications of off-label use of fluoroquinolones in pediatric patients would be given after large clinical trials in children, although Sazawal et al [35] concluded in their report that quinolone should be continued as the second-line drugs to treat children, only after failure of an early treatment.…”

Susceptibility of microorganisms isolated from chronic suppurative otitis media to ciprofloxacin

“…Since an arthropathic toxicity has been observed in growing animals, the quinolone antibiotics are generally not recommended for systemic use in children [22]. However, clinical, radiological and histopathological examinations of patients receiving oral ciprofloxacin have shown no evidence of arthropathy [6,8].…”

Ciprofloxacin for the Treatment of Uncomplicated Gonorrhea Infection in Adolescents: Does the Benefit Outweigh the Risk?

“…We reviewed 10 studies that, radiographically or pathologically by autopsy, evaluated pediatric and adolescent patients aged 5 days-24 years who were treated with ciprofloxacin or ofloxacin for 7 days-10 months [22][23][24][25][26][27][28][29][30][31]. These studies found no evidence of the cartilaginous pathology described in the original fluoroquinolone animal studies (table 1) [12][13][14][15][16][17][18][19].…”

“…Of the 9 radiographic studies that evaluated large joints, 5 used X-ray and 5 used MRI [22][23][24][25][26][27][28][29][30]. None reported pathologic changes detected as a direct effect of therapy.…”

“…None reported pathologic changes detected as a direct effect of therapy. One prospective study followed 29 pediatric patients with cystic fibrosis who had received 7-10 days of antibiotic treatment; 14 were treated with ciprofloxacin or ofloxacin, and 15 were treated with other standard cystic fibrosis antibiotic regimens [30]. The authors found similar proportions of abnormal knee X-ray and MRI findings in both treatment groups after completion of therapy (cases, 43% abnormal X-rays and 50% abnormal MRI; controls, 33% abnormal X-rays and 70% abnormal MRI.)…”