Ciprofloxacin treatment of bacterial endocarditis involving prosthetic material after cardiac surgery

Ciprofloxacin safety in paediatrics: a systematic review

OBJECTIVE

To determine the safety of ciprofloxacin in paediatric patients in relation to arthropathy, any other adverse events (AEs) and drug interactions.

METHODS

A systematic search of MEDLINE, EMBASE, CINAHL, CENTRAL and bibliographies of relevant articles was carried out for all published articles, regardless of design, that involved the use of ciprofloxacin in any paediatric age group ≤ 17 years. Only articles that reported on safety were included.

RESULTS

105 articles met the inclusion criteria and involved 16 184 paediatric patients. There were 1065 reported AEs (risk 7%, 95% CI 3.2% to 14.0%). The most frequent AEs were musculoskeletal AEs, abnormal liver function tests, nausea, changes in white blood cell counts and vomiting. There were six drug interactions (with aminophylline (4) and methotrexate (2)). The only drug related death occurred in a neonate who had an anaphylactic reaction. 258 musculoskeletal events occurred in 232 paediatric patients (risk 1.6%, 95% CI 0.9% to 2.6%). Arthralgia accounted for 50% of these. The age of occurrence of arthropathy ranged from 7 months to 17 years (median 10 years). All cases of arthropathy resolved or improved with management. One prospective controlled study estimated the risk of arthropathy as 9.3 (OR 95% CI 1.2 to 195). Pooled safety data of controlled trials in this review estimated the risk of arthropathy as 1.57 (OR 95% CI 1.26 to 1.97).

CONCLUSION

Musculoskeletal AEs occur due to ciprofloxacin use. However, these musculoskeletal events are reversible with management. It is recommended that further prospective controlled studies should be carried out to evaluate the safety of ciprofloxacin, with particular focus on the risk of arthropathy.

Clinafloxacin for the Treatment of Bacterial Endocarditis

We report the results of a prospective, multicenter trial assessing intravenous and oral clinafloxacin treatment for infective endocarditis. Sixty-six patients constituted the final study population. Among the 53 patients with native valve infection, Staphylococcus aureus and Streptococcus viridans were the most common pathogens. Twelve patients with native valve infection required surgery, at which time all valve tissue culture results were negative. The overall success rate for native valve infection was 87%. Single valves were involved in 11 of 13 patients with prosthetic valve endocarditis (PVE), and multiple valves were involved in 2 cases. Enterococcus faecalis was the most common pathogen, causing 4 of the PVE cases. The overall success rate for treatment of PVE was 69%. Patients with PVE who did not respond to treatment presented with complications that predict poor prognosis. Clinafloxacin may be effective for both native and PVE, but further studies are indicated.

Clinical use of fluoroquinolones in children

OBJECTIVE

To review the pharmacokinetics, efficacy, and safety of fluoroquinolones in children.

DATA SOURCES

A MEDLINE search (January 1966-March 1998) was conducted for relevant literature.

STUDY SELECTION AND DATA EXTRACTION

Data from compassionate use and published studies were reviewed for the assessment of pharmacokinetics, efficacy, and safety of fluoroquinolones in children.

DATA SYNTHESIS

Fluoroquinolones have a 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. These antibiotics are effective in treating various infections and are well tolerated in adults. However, the use of fluoroquinolones in children has been restricted due to potential cartilage damage that occurred in research with immature animals. Fluoroquinolones have been used in children on a compassionate basis. Ciprofloxacin is the most frequently used fluoroquinolone in children, 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. Safety data of fluoroquinolones in children appear to be similar to those in adults. Fluoroquinolones are associated with tendinitis and reversible arthralgia in adults and children. However, direct association between fluoroquinolones and arthropathy remains uncertain.

CONCLUSIONS

Fluoroquinolones have been found to be effective in treating certain infections in children. Additional research is needed to define the optimal dosage regimens in pediatric patients. Although fluoroquinolones appear to be well tolerated, further investigations are needed to determine the risk of arthropathy in children. However, their use in children should not be withheld when the benefits outweigh the risks.