Abstract
BackgroundFluoroquinolones (FQ) are increasingly prescribed for children, despite being labeled for only a limited number of labeled pediatric indications. In this multicenter retrospective drug utilization study, we analyzed indications for systemic FQ prescriptions in hospitalized children and the appropriateness of the prescribed dose.MethodsUsing data obtained from electronic medical files, the study included all children who received a systemic FQ prescription in two Belgian university children’s hospitals between 2010 and 2013. Two authors reviewed prescribed daily doses. Univariate and multivariate logistic regression models were used to analyze risk factors for inadequately dosing.Results262 FQ prescriptions for individual patients were included for analysis. 16.8% of these prescriptions were for labeled indications, and 35.1% were guided by bacteriological findings. Prescribed daily dose was considered to be inappropriate in 79 prescriptions (30.2%). Other FQ than ciprofloxacin accounted for 9 prescriptions (3.4%), of which 8 were correctly dosed. Underdosing represented 45 (56.9%) dosing errors. Infants and preschool children were at particular risk for dosing errors, with associated adjusted OR of 0.263 (0.097–0.701) and 0.254 (0.106–0.588) respectively.ConclusionsFQ were often prescribed off-label and not guided by bacteriological findings in our study population. Dosing errors were common, particularly in infants and preschool children. FQ prescriptions for children should be improved by specific pediatric antimicrobial stewardship teams. Furthermore, pharmacokinetic studies should optimise dosing recommendations for children.
Highlights
Fluoroquinolones (FQ) are increasingly prescribed for children, despite being labeled for only a limited number of labeled pediatric indications
These findings likely influence both the labeling guidelines and prescribers behavior, there is no evidence of significant irreversible musculoskeletal side effects resulting from FQ use in children [13, 14]. Another concern in liberally prescribing FQ for children is the rapidly growing resistance rates of different germs for FQ [15, 16]. In this retrospective multicenter drug utilization study, we aimed to investigate indications for FQ prescription in a population of children hospitalized in two Belgian university children’s hospitals
The percentage of underdosing was similar in our population of overweight and obese children compared to normal weight children (17.9% vs. 17.4%, p = 0.956)
Summary
Fluoroquinolones (FQ) are increasingly prescribed for children, despite being labeled for only a limited number of labeled pediatric indications. The safety of FQ for growing children has been debated, as experiments in different juvenile animals showed irreversible cartilage tissue damage after exposure to systemic FQ [10,11,12] These findings likely influence both the labeling guidelines and prescribers behavior, there is no evidence of significant irreversible musculoskeletal side effects resulting from FQ use in children [13, 14]. Another concern in liberally prescribing FQ for children is the rapidly growing resistance rates of different germs for FQ [15, 16] In this retrospective multicenter drug utilization study, we aimed to investigate indications for FQ prescription in a population of children hospitalized in two Belgian university children’s hospitals. Another goal was to assess the adequacy of prescribed doses, and risk factors for incorrectly dosed FQ prescriptions within this population
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