The use of fluoroquinolones in children

Purpose of review: The fluoroquinolones are an important group of antibiotics widely used in the treatment of various infectious diseases in adults, as a result of an excellent spectrum of activity, good tissue penetration and convenient ways of administration. Their use in children is limited as a result of possible fluoroquinolone-induced joint/cartilage toxicity observed mainly in juvenile animal studies. Recent findings: 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.). The fluoroquinolones were shown to be efficacious and well tolerated in the treatment of complicated cases of acute otitis media. The emergence of Streptococcus pneumoniae with reduced susceptibility to fluoroquinolones has been described worldwide. No arthropathy associated with fluoroquinolone use in children was evident. Summary: With the exception of cystic fibrosis and life-endangering infections, the use of fluoroquinolones in pediatrics should be limited to Gram-negative neonatal meningitis, Salmonella and Shigella spp. infections, chronic suppurative otitis media and some cases of complicated acute otitis media. Unskilled use of fluoroquinolones in children, particularly in community-acquired lower respiratory infections, could accelerate the emergence of pneumococcal resistance.