As a pediatric pharmacist, you will see more clarity about the role of quinolones in CHILDREN due to new guidance from the American Academy of Pediatrics (AAP). We've been taught to shy away from quinolones in kids, because of concerns about cartilage and joint damage, and tendon rupture. Reversible joint or muscle PAIN can occur with quinolones. But the joint DAMAGE seen in beagle puppies isn't showing up in kids. And there are no reports of tendon rupture in children. It's mostly a risk in older adults or those on long-term corticosteroids. The bigger concern is quinolone resistance in kids and adults...
Continue to save oral or IV quinolones as a last resort for kids who can't take other options or who have a resistant infection. For example, consider levofloxacin (Tavanic) for pneumonia in a child with a severe penicillin allergy or highly resistant Strep pneumoniae, or ciprofloxacin (Ciprobay, Ciprocin) for a UTI when other antibiotics don't work, see Table [1] for doses.
| Table (1). Pediatric Dose of Quinolones | |||
|---|---|---|---|
| DURG | ORAL DOSE | IV DOSE | MONITORING PARAMETERS |
| Ciprofloxacin (Cibrobay) |
Preterm neonates (GA: 32 to 37 weeks): 10 mg/kg/dose every 12 hours. Term neonates: 15 mg/kg/dose every 12 hours. |
Severe infection (e.g., sepsis); usually multidrug resistant: 10 mg/kg/dose every 12 hours. | Evaluation of organ system functions (renal, hepatic, and hematopoietic) is recommended periodically during therapy; the possibility of crystalluria should be assessed, hydration status; WBC and signs of infection; number and type of stools/day for diarrhea; signs and symptoms of tendonitis. |
| Levofloxacin (Tavanic) |
Infants 6 months to < 5 years: Oral, 8 to 10 mg/kg/dose twice daily. Children ≥ 5 years: 10 mg/kg/dose once daily; maximum dose: 750 mg/day. |
Severe infection: 10 mg/kg/dose once daily; maximum dose: 750 mg/day. | |
| This information from Lexicomp.. | |||
And consider a quinolone for a confirmed pseudomonal infection, since medications in this class are the only oral option. Physicians should write a note on the prescription (Rx), such as "for resistant infection" so the pharmacist understands why quinolone is prescribed for child. Tell parents to report new joint or muscle pain. Evaluate other causes, and consider holding the quinolone if pain is severe. Feel comfortable using ophthalmic or otic quinolones in kids. They're minimally absorbed and are first-line options for some conditions. GET OUR NOTE, "Improve pediatric antimicrobial use" for more information about the best way to use antibiotics in children.
REFERENCES
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Jackson MA, Schutze GE; COMMITTEE ON INFECTIOUS DISEASES. The Use of Systemic and Topical Fluoroquinolones. Pediatrics. 2016 Nov;138(5):e20162706. Available at: https://publications.aap.org/pediatrics/article/138/5/e20162706/60708/The-Use-of-Systemic-and-Topical-Fluoroquinolones OR https://pubmed.ncbi.nlm.nih.gov/27940800
Patel K, Goldman JL. Safety Concerns Surrounding Quinolone Use in Children. J Clin Pharmacol. 2016 Sep;56(9):1060-75. Available at: https://accp1.onlinelibrary.wiley.com/doi/10.1002/jcph.715 OR https://pubmed.ncbi.nlm.nih.gov/26865283