The only indications for which a
fluoroquinolone (ie,
ciprofloxacin) is licensed by the US Food and Drug Administration for use in patients younger than 18 years are complicated
urinary tract infections,
pyelonephritis, and postexposure treatment for
inhalation anthrax. Nonetheless, approximately 520,000 prescriptions for
fluoroquinolones were written in the United States for patients younger than 18 years in 2002; 13,800 were written for infants and children 2 to 6 years of age, and 2750 were written for infants younger than 2 years. Clinical trials of
fluoroquinolones in pediatric patients with various diagnoses have been published and are reviewed.
Fluoroquinolones cause arthrotoxicity in juvenile animals and have been associated with reversible musculoskeletal events in both children and adults. Other adverse events associated with
fluoroquinolones include
central nervous system disorders,
photosensitivity, disorders of
glucose homeostasis, prolongation of QT interval with rare cases of
torsade de pointes (often lethal ventricular
arrhythmia in patients with
long QT syndrome), hepatic dysfunction, and rashes. The increased use of
fluoroquinolones in adults has resulted in increased bacterial resistance to this class of
antibacterial agents. This report provides specific guidelines for the systemic use of
fluoroquinolones in children.
Fluoroquinolone use should be restricted to situations in which there is no safe and effective alternative to treat an
infection caused by multidrug-resistant bacteria or to provide oral
therapy when parenteral
therapy is not feasible and no other effective oral agent is available.