Les fluoroquinolones en pédiatrie

The safety profile of fluoroquinolones

While they are very useful agents, fluoroquinolones (FQs) are associated with a number of serious adverse effects (AEs). The objective of this paper is to describe the characteristics of frequent serious AEs related to FQs along with their risk factors, their safety in specific populations, and the main drug-drug interactions that may occur. Serious AEs commonly associated with FQs include tendon disorders (particularly tendinopathy and tendon rupture), CNS toxicity (seizure and encephalopathy), peripheral neuropathy (including small fiber neuropathy), cardiovascular toxicity (QT interval prolongation, dissection, and aneurysm rupture), disrupted glucose metabolism, phototoxicity, C. difficile infections, acute renal failure, and hepatic toxicity. Most of these AEs are common to all FQs, but some, such as acute kidney failure on crystallization with ciprofloxacin or norfloxacin, are more specific. Unlike the AEs associated with most other antibiotics, some of these AEs (e.g. tendinopathy or neuropathy) may occur after FQ discontinuation, and others may subsequently progress (e.g. FQ-associated disability). The risk of serious AE is heightened by factors having to do with patient age and comorbidities, the characteristics of the FQ treatment (dose and/or duration) and associated drug intake. To conclude, FQs appear to be associated with a higher risk of serious AEs than most of the other antibiotics available for the same indications, however some AEs can be avoided by bearing in mind the predisposing risk factors.

Population pharmacokinetics of ciprofloxacin in pediatric and adolescent patients with acute infections

The aim of the present study was to characterize the population pharmacokinetics of ciprofloxacin in patients with and without cystic fibrosis ranging in age from 1 day to 24 years and to propose a limited sampling strategy to estimate individual pharmacokinetic parameters. Patients were divided into four groups according to the treatment schedule. They received ciprofloxacin by intravenous infusion (30 min) or by the oral route. The number of samples collected from each patient ranged from 1 to 12. The population parameters were computed for an initial group of 37 patients. The data were analyzed by nonlinear mixed-effect modeling by use of a two-compartment structural model. The interindividual variability in clearance (CL) was partially explained by a dependence on age and the patient's clinical status. In addition, a significant relationship was found between weight and the initial volume of distribution. Eighteen additional patients were used for model validation and evaluation of limited sampling strategies. When ciprofloxacin was administered intravenously, sampling at a single point (12 h after the start of infusion) allowed the precise and accurate estimation of CL and the elimination half-life, as well as the ciprofloxacin concentration at the end of the infusion. It should be noted that to take into account the presence of a lag time after oral administration, a schedule based on two sampling times of 1 and 12 h is needed. The results of this study combine relationships between ciprofloxacin pharmacokinetic parameters and patient covariates that may be useful for dose adjustment and a convenient sampling procedure that can be used for further studies.

[Acute osteomyelitis in the child with sickle cell disease in a tropical zone: value of oral fluoroquinolones]

AIM

This study was designed to assess the efficacy and the safety of fluoroquinolones in their compassionate use for acute osteomyelitis in children with sickle cell disease in a tropical country.

PATIENTS AND METHODS

This study was non comparative, including twelve children (eight SS, three SC and one SEzerothalassemia) treated for acute osteomyelitis with oral ciprofloxacin or ofloxacin because of the following reasons: financial inability to afford conventional parenteral beta-lactams therapy (nine patients), refusal of hospitalization (two patients), and failure of conventional treatment (one patient).

RESULTS

The mean age of patients was 9.5 +/- 2.6 years. The long bones were the predominantly site. Salmonella species were present in 75% of cases, followed by other enterobacteriaceae (16.7%), and Staphylococcus aureus (8.3%). Successful outcome occurred in all cases after three to four-weeks of treatment and 45 days of plaster immobilization. Transient bilateral Achilles tendon tendinitis was noted in a five-year-old patient.

CONCLUSION

In economically developing countries, oral fluoroquinolones may be a therapeutic alternative for acute osteomyelitis in patients with sickle cell disease particularly in cases of financial hardship or failure with conventional therapy.