Abstract

THERAPEUTIC ASPECTS OF FLUOROQUINOLONES CLINICAL ROLE IN PEDIATRICS

*Bangari Anil Kumar, T.Bhanu Chand, CH.Venkat Rao, K.Blessy Lavanya, V.P.Mahesh Kuma

Abstract

This study was aimed with an objective to review the pharmacokinetics and clinical indications of Fluoroquinolones in children.A MEDLINE search (January 1966–March 2013) was conducted for relevant literature.Data from published studies were reviewed for the assessment of pharmacokinetics, efficacy, and clinical indications of Fluoroquinolones in children.Fluoroquinolones were successfully used in immunocompromised children and also in those suffering from multidrug-resistant Gram-negative infections (including neonatal infections and multidrug-resistant enteric infections caused by Salmonella and Shigella spp).Fluoroquinolones have broad spectrum coverage of gram-positive and gram-negative bacteria, including Pseudomonas aeruginosa and intracellular organisms. Fluoroquinolones are well absorbed from the gastrointestinal tract, have excellent tissue penetration, low protein binding, and long elimination half-lives. Ciprofloxacin is the most frequently used. Fluoroquinolones in children used most often in the treatment of pulmonary infection in cystic fibrosis as well as salmonellosis and shigellosis. Other uses include chronic suppurative otitis media, meningitis, septicemia, and urinary tract infection. Fluoroquinolones are associated with tendinitis and reversible arthralgia in adults and children. The use of Fluoroquinolones in children has been restricted due to potential cartilage damage that occurred in research with immature animals. Fluoroquinolones although with limited safety data in pediatric population are used as mainstay for pulmonary infections in cystic fibrosis, Gram-negative neonatal meningitis, shigellosis and salmonellosis. Currently they are considered pediatrics as secondline antibiotics, and as alternative for other drug therapies when they do not show adequatetherapeutic effect. Many pneumococcal, staphylococcal strains are known to develop rapid resistance to them rendering them ineffective. The studies have been done to identify high rate of articular adverse effects in children treated with Fluoroquinolones, although this couldn’t be established with firm evidence. Dosing recommendations for children need to be studied more extensively along with assessment of safety data.

Keywords: Fluoroquinolones, pediatrics, cystic fibrosis, pharmacokinetics