Abstract
Compared to nalidixic acid, the new quinolones possess an enlarged antimicrobial spectrum, greatly enhanced bactericidal activity, and substantial pharmacokinetic advantages. Because their activity against streptococci is limited the quinolones presently available will never be included in routine regimens for children. Moreover, adequate pharmacokinetic studies are still lacking in pediatrics, and potential drug toxicity warrants further long-term monitoring. Nevertheless, various studies strongly suggest that there is no quinolone-induced cartilage toxicity in humans, and the results of published clinical trials with fluoroquinolones in pediatric patients show promising efficacy and safety. From a review of the available data it is concluded that use of the quinolones in children should be limited to specific infections which are usually caused byPseudomonas aeruginosa, Staphylococcus aureus orStaphylococcus epidermidis, and are complicated by underlying pathologic or special conditions such as cystic fibrosis or urologic abnormality. In each case, careful monitoring to determine efficacy, potential adverse effects including drug-drug interaction and toxicity, and any emergence of bacterial resistance is mandatory.
Similar content being viewed by others
References
Neu HC Clinical use of the quinolones. Lancet 1987, ii: 1319–1322.
Waldvogel FA Clinical role of the quinolones today and in the future. European Journal of Clinical Microbiology and Infectious Diseases 1989, 8: 1075–1079.
Christ W, Lehnert T, Ulbrich B Specific toxicologic aspects of the quinolones. Reviews of Infectious Diseases 1988, 10, Supplement 1: 141–146.
Schluter G: Ciprofloxacin: toxicologic evaluation of additional safety data. American Journal of Medicine 87, Supplement 5A: 37–39.
Wolfson JS, Murray BE Value of new quinolones in the treament and prophylaxis of infectious diseases: introductory remarks. European Journal of Clinical Microbiology and Infectious Diseases 1989, 8: 1071–1074.
Hooper DC, Wolfson JS Mode of action of the quinolone antimicrobial agents: review of recent information. Reviews of Infectious Diseases 1989, 11, Supplement 5: 902–911.
Bellido F, Pechère JC Laboratory survey of fluoroquinolone activity. Reviews of Infectious Diseases 1989, 11, Supplement 5: 917–924.
Weber AH, Scribner RK, Marks MI In vitro activity of ciprofloxacin against pediatric pathogens. Chemotherapy 1985, 31: 456–465.
Chu DTW, Fernandes PB Structure-activity relationships of the fluoroquinolones. Antimicrobial Agents and Chemotherapy 1989, 33: 131–135.
Wolfson JS Quinolone antimicrobial agents: adverse effects and bacterial resistance. European Journal of Clinical Microbiology and Infectious Diseases 1989, 8: 1080–1092.
Follath F, Bindschedler M, Wenk M, Frei R, Stalder H, Reber H Use of ciprofloxacin in the treatment ofPseudomonas aeruginosa infections. European Journal of Clinical Microbiology 1986, 5: 236–240.
Oppenheim BA, Hartley JW, Lee W, Burnie JP Outbreak of coagulase-negative staphylococcus highly resistant to ciprofloxacin in a leukemia unit. British Medical Journal 1989, 299: 294–297.
Hooper DC, Wolfson JS The fluoroquinolones: pharmacology, clinical uses, and toxicities in humans. Antimicrobial Agents and Chemotherapy 1985, 28: 716–721.
Lode H Pharmacokinetics and clinical results of parenterally administered new quinolones in humans. Reviews of Infectious Diseases 1989, 11, Supplement 5: 996–1004.
Davies BI, Maesen FPV Drug interactions with quinolones. Reviews of Infectious Diseases 1989, 11, Supplement 5: 1083–1090.
Cruciani M, Concia E, Navarra A, Perversi L, Bonetti F, Aricò M, Nespoli L Prophylactic co-trimoxazole versus norfloxacin in neutropenic children — perspective randomized study. Infection 1989, 17: 65–69.
Meyer H Ofloxacin in cystic fibrosis. Drugs 1987, 34, Supplement 1: 177–179.
Isaacs D, Slack MPE, Wilkinson AB, Westwood AW Successful treatment of pseudomonas ventriculitis with ciprofloxacin. Journal of Antimicrobial Chemotherapy 1986, 17: 535–538.
Scully BE, Nakatomi M, Ores C, Davidson S, Neu HC Ciprofloxacin therapy in cystic fibrosis. American Journal of Medicine 1987, 82, Supplement 4A: 196–201.
Lotti T, Mirone V, Imbimbo C, Russo A Ciprofloxacin in the treatment of urinary tract infections. Journal of International Medical Research 1987, 15: 240–244.
Houwen RHJ, Bijleveld CMA, de Vries-Hospers HG Ciprofloxacin for cholangitis after hepatic portoenterostomy. Lancet 1987, i: 1367.
Martorana G, Giberti C, Pizzorno R, Bonamini A, Oneto F, Curotto A, Soro O Treatment of urinary tract infections with ciprofloxacin. Clinical Therapeutics 1988, 10: 516–520.
Humphreys H, Lovering A, White LO, Williams EW Flavobacterium meningosepticum infection, in a 32-day-old child on acute peritoneal dialysis, treated with ciprofloxacin. Journal of Antimicrobial Chemotherapy 1989, 23: 292–294.
Bannon MJ, Stutchfield PR, Weindling AM, Damjanovic V Ciprofloxacin in neonatalEnterobacter cloacae septicaemia. Archives of Disease in Childhood 1989, 64: 1388–1391.
Dagan R, Schlaeffer F, Einhorn M Parenteral fluoroquinolones for the treatment of children with life-threatening infections not responding to other antibiotics. Reviews of Infectious Diseases 1989, 11, Supplement 5: 1117.
Schaad UB, Wedgwood-Krucko J, Guenin K, Buchlmann U, Kraemer R Antipseudomonal therapy in cystic fibrosis: aztreonam and amikacin versus ceftazidime and amikacin administered intravenously followed by oral ciprofloxacin. European Journal of Clinical Microbiology and Infectious Diseases 1989, 8: 858–865.
Grenier B Use of the new quinolones in cystic fibrosis. Reviews of Infectious Diseases 1989, 11, Supplement 5: 1245–1252.
Hodson ME, Roberts CM, Butland RJA, Smith MJ, Batten JC Oral ciprofloxacin compared with conventional intravenous treatment forPseudomonas aeruginosa infection in adult patients with cystic fibrosis. Lancet 1987, i: 235–237.
Bosso JA, Black PG, Matsen JM Ciprofloxacin versus tobramycin plus azlocillin in pulmonary exacerbations in adult patients with cystic fibrosis. American Journal of Medicine 1987, 82, Supplement 4A: 180–184.
Rubio TT Ciprofloxacin: comparative data in cystic fibrosis. American Journal of Medicine 1987, 82, Supplement 4A: 185–188.
Jensen T, Pedersen SS, Hoiby N, Koch C Efficacy of oral fluoroquinolones versus conventional intravenous antipseudomonal chemotherapy in treatment of cystic fibrosis. European Journal of Clinical Microbiology 1987, 6: 618–622.
Fontaine O Antibiotics in the management of shigellosis in children: what role for the quinolones? Reviews of Infectious Diseases 1989, 11, Supplement 5: 1145–1150.
Dworzack DL, Sanders CC, Horowitz EA, Allais JM, Sookpranee M, Sanders WE, Ferraro FM Evaluation of single-dose ciprofloxacin in the eradication ofNeisseria meningitidis from nasopharyngeal carriers. Antimicrobial Agents and Chemotherapy 1988, 32: 1740–1741.
Douidar SM, Snodgrass WR Potential role of fluoroquinolones in pediatric infections. Reviews of Infectious Diseases 1989, 11: 878–889.
Schaad UB, Wedgwood-Krucko J Nalidixic acid in children: retrospective matched controlled study for cartilage toxicity. Infection 1987, 15: 165–168.
Adam D Use of quinolones in pediatric patients. Reviews of Infectious Diseases 1989, 11, Supplement 5: 1113–1116.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Schaad, U.B. Use of quinolones in pediatrics. Eur. J. Clin. Microbiol. Infect. Dis. 10, 355–360 (1991). https://doi.org/10.1007/BF01967011
Issue Date:
DOI: https://doi.org/10.1007/BF01967011