Quinolonas en Pediatría

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Abstract

Resumen: Las quinolonas constituyen una familia de antibióticos bactericidas contra microorganismos grampositivos y gramnegativos, de amplio espectro. Sus características farmacodinámicas y farmacocinéticas han permitido tratar por vía oral infecciones que hasta la fecha solo se podían tratar con antibióticos parenterales. Son los antimicrombianos más ampliamente prescritos en la comunidad y este uso excesivo ha provocado un incremento de las resistencias bacterianas. En niños, el uso de las quinolonas está mucho más restringido debido a la asociación con la artropatía vista en animales jóvenes. Este documento pretende ofrecer una visión general de las quinolonas, dar a conocer sus propiedades farmacodinámicas y farmacocinéticas, el espectro bacteriano que presentan, los posibles usos en Pediatría, tanto aquellos autorizados y recogidos en la ficha técnica como los posibles usos off-label recomendados en guías clínicas y consensos, así como los posibles efectos adversos en los niños. Además, pretende alertar sobre el abuso de estos antibióticos y recomendar un uso racional de los mismos, tanto en población adulta como infantil, reservándolos para pacientes con patología moderada-grave, en los que no existe otra alternativa válida.

Translated abstract

Abstract: Quinolones form part of a family of bactericidal wide spectrum antibiotics against Gram-positive and Gram-negative microorganisms. Its pharmacodynamic and pharmacokinetic characteristics made possible to treat oral infections, in which only be alternative of treatment with parenteral antibiotics. They are the most widely prescribed antimicrobials in the community and this excessive use has led to an increase in bacterial resistance. In children, the use of quinolones is much more restricted because of the fear of its association with arthropathy, seen in trials with young animals. Our purpose is to provide an overview of quinolones, show its pharmacodynamic and pharmacokinetic properties, the bacterial spectrum that presents, the possible uses in Pediatrics (authorized and collected in the technical data sheet, and the possible off-label uses recommended in clinical guidelines and consensuses), and the side effects in children. In addition, we pretend to alert of the abuse of these antibiotics and recommend their rational use, both in adult and children, for patients with moderate-severe pathology, in which there is no other valid alternative.

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Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america.

Alison Freifeld, Eric Bow, Kent A. Sepkowitz … (2011)

This document updates and expands the initial Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guideline that was published in 1997 and first updated in 2002. It is intended as a guide for the use of antimicrobial agents in managing patients with cancer who experience chemotherapy-induced fever and neutropenia. Recent advances in antimicrobial drug development and technology, clinical trial results, and extensive clinical experience have informed the approaches and recommendations herein. Because the previous iteration of this guideline in 2002, we have a developed a clearer definition of which populations of patients with cancer may benefit most from antibiotic, antifungal, and antiviral prophylaxis. Furthermore, categorizing neutropenic patients as being at high risk or low risk for infection according to presenting signs and symptoms, underlying cancer, type of therapy, and medical comorbidities has become essential to the treatment algorithm. Risk stratification is a recommended starting point for managing patients with fever and neutropenia. In addition, earlier detection of invasive fungal infections has led to debate regarding optimal use of empirical or preemptive antifungal therapy, although algorithms are still evolving. What has not changed is the indication for immediate empirical antibiotic therapy. It remains true that all patients who present with fever and neutropenia should be treated swiftly and broadly with antibiotics to treat both gram-positive and gram-negative pathogens. Finally, we note that all Panel members are from institutions in the United States or Canada; thus, these guidelines were developed in the context of North American practices. Some recommendations may not be as applicable outside of North America, in areas where differences in available antibiotics, in the predominant pathogens, and/or in health care-associated economic conditions exist. Regardless of venue, clinical vigilance and immediate treatment are the universal keys to managing neutropenic patients with fever and/or infection.

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The Use of Systemic and Topical Fluoroquinolones

Mary Anne Jackson, Gordon Schutze (2016)

Appropriate prescribing practices for fluoroquinolones, as well as all antimicrobial agents, are essential as evolving resistance patterns are considered, additional treatment indications are identified, and the toxicity profile of fluoroquinolones in children has become better defined. Earlier recommendations for systemic therapy remain; expanded uses of fluoroquinolones for the treatment of certain infections are outlined in this report. Prescribing clinicians should be aware of specific adverse reactions associated with fluoroquinolones, and their use in children should continue to be limited to the treatment of infections for which no safe and effective alternative exists or in situations in which oral fluoroquinolone treatment represents a reasonable alternative to parenteral antimicrobial therapy.

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Ciprofloxacin safety in paediatrics: a systematic review

Abiodun Adefurin, Helen Sammons, Evelyne Jacqz-Aigrain … (2011)

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.