Abstract
BackgroundFluoroquinolones are used with increasing frequency in children with a major risk of increasing the emergence of FQ resistance. FQ use has expanded off-label for primary antibacterial prophylaxis or treatment of infections in immune-compromised children and life-threatening multi-resistant bacteria infections. Here we assessed the prescriptions of ciprofloxacin in a pediatric cohort and their appropriateness.MethodsA monocenter audit of ciprofloxacin prescription was conducted for six months in a University hospital in Paris. Infected site, bacteriological findings and indication, were evaluated in children receiving ciprofloxacin in hospital independently by 3 infectious diseases consultants and 1 hospital pharmacist.ResultsNinety-eight ciprofloxacin prescriptions in children, among which 52 (53.1%) were oral and 46 (46.9%) parenteral, were collected. 45 children had an underlying condition, cystic fibrosis (CF) (21) or an innate or acquired immune deficiency (24). Among CF patients, the most frequent indication was a broncho-pulmonary Pseudomonas aeruginosa infection (20). In non-CF patient, the major indications were broncho-pulmonary (25), urinary (8), intra-abdominal (7), operative site infection (5) and bloodstream/catheter (2/4) infection. 62.2% were microbiologically documented. Twenty-three (23.4%) were considered “mandatory”, 48 (49.0%) “alternative” and 27 (27.6%) “unjustified”.ConclusionIn our university hospital, only 23.4% of fluoroquinolones prescriptions were mandatory in children, especially in Pseudomonas aeruginosa healthcare associated infection. Looking to the ecological risk of fluoroquinolones and the increase consumption in children population we think that a control program should be developed to control FQ use in children. It could be done with the help of an antimicrobial stewardship team.
Highlights
Fluoroquinolones are used with increasing frequency in children with a major risk of increasing the emergence of FQ resistance
FQ use in pediatric patients has been contraindicated by regulatory authorities in the United States and the European Union, given the cartilage damage that they may induce in juvenile animal models
A total of 11,268 children were admitted between 1st December 2007 and 31st May 2008 at the NeckerEnfants malades hospital in Paris. 98 new ciprofloxacin prescriptions were collected
Summary
Fluoroquinolones are used with increasing frequency in children with a major risk of increasing the emergence of FQ resistance. FQ use has expanded off-label for primary antibacterial prophylaxis or treatment of infections in immune-compromised children and life-threatening multi-resistant bacteria infections. FQ use in pediatric patients has increased as shown in the United States, where approximately. In pediatric cystic fibrosis patients with acute pulmonary exacerbation caused by P. aeruginosa [6], ciprofloxacin is initially administered intravenously at a dose of 30 mg/kg/day divided every 8 h, followed by an oral administration at 40 mg/kg/day divided every 12 h [7]. FQ use has expanded off-label for primary antibacterial prophylaxis or treatment of infections in immune-compromised patients, infections due to lifethreatening multi-resistant bacteria, or salmonellosis or shigellosis and cholangitis [1,6,8,9]. In 2004, ciprofloxacin became the first fluoroquinolone agent approved by United States Food and Drug Administration for use in children 1 through 17 years of age [10]. As suggested by several studies [11,12,13] the increased use of fluoroquinolones will subsequently contribute to the spread of resistance
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