AAP Maintains Fluoroquinolone Restrictions in Children

NEW YORK (Reuters Health) Sep 28 - Use of fluoroquinolones in children should continue to be limited to infections for which no safe and effective alternative exists, according to the Committee on Infectious Diseases of the American Academy of Pediatrics (AAP).

These agents may be the preferred option for children in some situations, but physicians should be aware of potential adverse reactions, according to a review by the Committee published online September 26 in Pediatrics.

The authors note that experimental evidence of joint damage associated with the first quinolones in juvenile animals "effectively sidelined" any large-scale evaluation of these antibiotic agents in children.

There is scant evidence of sustained injury to developing bones or joints in children treated with available fluoroquinolone agents, according to lead authors Dr. John S. Bradley with Rady Children's Hospital in San Diego, California and Dr. Mary Anne Jackson at Mercy Children's Hospital in Kansas City, Missouri, and colleagues.

"However," they note, "FDA analysis of ciprofloxacin safety data, as well as posttreatment and 12-month follow-up safety data for levofloxacin, suggest the possibility of increased musculoskeletal adverse effects in children who receive fluoroquinolones compared with agents of other classes."

Nonetheless, the approved indications for fluoroquinolones have expanded, and the report outlines recommendations in several scenarios.

For example, several topical fluoroquinolones have been approved by the U.S. Food and Drug Administration for treating acute conjunctivitis in children older than 12 months.

For treating otorrhea associated with tympanostomy tubes, topical fluoroquinolone preparations actually represent a safer alternative to aminoglycoside products, the report indicates.

Fluoroquinolones are effective for respiratory tract infections in children, the panel notes, but they are not recommended as first-line agents because safer antimicrobials are available,

A cephalosporin remains the standard for treating urinary tract infections in the pediatric population. However, the authors suggest, fluoroquinolones are a potential first-line agent in cases of pyelonephritis or complicated UTI if typically recommended agents are not appropriate.

In general, the report concludes, "Use of a fluoroquinolone in a child or adolescent may be justified in special circumstances in which (1) infection is caused by a multidrug-resistant pathogen for which there is no safe and effective alternative and (2) the options for treatment include either parenteral nonfluoroquinolone therapy or oral fluoroquinolone therapy, and oral therapy is preferred."

The authors also recommend that when practitioners prescribe a fluoroquinolone, they "should verbally review common, anticipated potential adverse events, and indicate why a fluoroquinolone is the most appropriate antibiotic agent for a child's infection."

SOURCE: http://bit.ly/nSyAbb

Pediatrics 2011;128:e1034-e1045.

um..
Sisca pernah denger dari dosen, kalau kebanyakan mengkonsumsi antibiotik bisa merusak sel.
hehe..