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Ross RK, Kinlaw AC, Herzog MM, Jonsson Funk M, Gerber JS. Fluoroquinolone Antibiotics and Tendon Injury in Adolescents. Pediatrics 2021; 147:e2020033316. [PMID: 33990459 PMCID: PMC8168605 DOI: 10.1542/peds.2020-033316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To estimate the association between fluoroquinolone use and tendon injury in adolescents. METHODS We conducted an active-comparator, new-user cohort study using population-based claims data from 2000 to 2018. We included adolescents (aged 12-18 years) with an outpatient prescription fill for an oral fluoroquinolone or comparator broad-spectrum antibiotic. The primary outcome was Achilles, quadricep, patellar, or tibial tendon rupture identified by diagnosis and procedure codes. Tendinitis was a secondary outcome. We used weighting to adjust for measured confounding and a negative control outcome to assess residual confounding. RESULTS The cohort included 4.4 million adolescents with 7.6 million fills for fluoroquinolone (275 767 fills) or comparator (7 365 684) antibiotics. In the 90 days after the index antibiotic prescription, there were 842 tendon ruptures and 16 750 tendinitis diagnoses (crude rates 0.47 and 9.34 per 1000 person-years, respectively). The weighted 90-day tendon rupture risks were 13.6 per 100 000 fluoroquinolone-treated adolescents and 11.6 per 100 000 comparator-treated adolescents (fluoroquinolone-associated excess risk: 1.9 per 100 000 adolescents; 95% confidence interval -2.6 to 6.4); the corresponding number needed to treat to harm was 52 632. For tendinitis, the weighted 90-day risks were 200.8 per 100 000 fluoroquinolone-treated adolescents and 178.1 per 100 000 comparator-treated adolescents (excess risk: 22.7 per 100 000; 95% confidence interval 4.1 to 41.3); the number needed to treat to harm was 4405. CONCLUSIONS The excess risk of tendon rupture associated with fluoroquinolone treatment was extremely small, and these events were rare. The excess risk of tendinitis associated with fluoroquinolone treatment was also small. Other more common potential adverse drug effects may be more important to consider for treatment decision-making, particularly in adolescents without other risk factors for tendon injury.
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Affiliation(s)
- Rachael K Ross
- Department of Epidemiology, Gillings School of Global Public Health,
| | - Alan C Kinlaw
- Division of Pharmaceutical Outcomes and Policy, School of Pharmacy
- The Cecil G. Sheps Center for Health Services Research, and
| | - Mackenzie M Herzog
- IQVIA, Durham, North Carolina
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Jeffrey S Gerber
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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52
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Kim Y, Park GW, Kim S, Moon HJ, Won S, Chung W, Yang HJ. Fluoroquinolone and no risk of Achilles-tendinopathy in childhood pneumonia under eight years of age-a nationwide retrospective cohort. J Thorac Dis 2021; 13:3399-3408. [PMID: 34277036 PMCID: PMC8264711 DOI: 10.21037/jtd-20-2256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
Background The emergence of macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMP) has made its treatment challenging. A few guidelines have recommended fluoroquinolones (FQs) as second-line drugs of choice for treating MRMP in children under the age of eight, but concerns about potential adverse events (i.e., Achilles tendinopathy; AT) have been raised. The aim of this study was to investigate the relationship between the use of FQs and the risk of AT in pneumonia in children under eight years of age. Methods Children hospitalized with pneumonia (total of 2,213,807 episodes) from 2002 to 2017 were enrolled utilizing the Korean National Health Insurance Sharing Service (NHISS) database. The independent risk of FQs for AT was analyzed by a generalized estimating equation with adjustment for age, sex, and underlying diseases. Results Among 2,213,807 episodes of pneumonia hospitalization, children in a total of 6,229 episodes (0.28%) were treated with FQs (levofloxacin 40.9%, ciprofloxacin 36.1%, moxifloxacin 11.6%, and others 11.4%). The FQ-exposure group showed a 0.19% (12/6,229) incidence of AT within 30 days after the first administration of FQ. The use of FQs increased the risk of AT (OR 3.00; 95% CI: 1.71–5.29), but became null after adjusting for age, sex, and underlying diseases (aOR 0.85; 95% CI: 0.48–1.51). All AT related to the use of FQs occurred after the use of ciprofloxacin or levofloxacin, and not in children under eight years of age. Conclusions AT was a rare adverse event of FQ use for childhood pneumonia, particularly under eight years of age. Clinicians could consider using FQs as a second-line option in the treatment of childhood pneumonia when there are no alternative therapeutic options.
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Affiliation(s)
- Yunsun Kim
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Gun Woo Park
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Sangyoung Kim
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hui Jeong Moon
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sungho Won
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Korea.,Interdisciplinary Program of Bioinformatics, Seoul National University, Seoul, Korea.,Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Wankyo Chung
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Hyeon-Jong Yang
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul, Korea.,Pediatric Allergy and Respiratory Center, Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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53
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Han Y, Ma Y, Yao S, Zhang J, Hu C. In vivo and in silico evaluations of survival and cardiac developmental toxicity of quinolone antibiotics in zebrafish embryos (Danio rerio). ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 277:116779. [PMID: 33640819 DOI: 10.1016/j.envpol.2021.116779] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/25/2021] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
Quinolones are ranked as the second most commonly used class of antibiotics in China, despite their adverse clinical and environmental effects. However, information on their cardiac developmental toxicity to zebrafish is limited. This study investigates the relationships between different quinolone structures and toxicity in zebrafish embryos using in vivo and in silico methods. All of the experimentally tested quinolones show cardiac developmental toxicity potential and present mortality and teratogenic effects in a dose-dependent manner. Theoretically, the acute toxicity values predicted using quantitative structure-toxicity relationship (QSTR) modeling based on previously reported LC50 values are in good agreement with the in vivo results. Further investigation demonstrates that the hormetic concentration response of some quinolones may be related to methylation on the piperazine ring at the C-7 position. The amino group at the C-5 position, the methylated or ethylated piperazine group at the C-7 position, halogens at the C-8 position and a cyclopropyl ring at N1 position may be responsible for cardiac developmental toxicity. In terms of survival (key ecological endpoint), the naridine ring is more toxic than the quinoline ring. This combined approach can predict the acute and cardiac developmental toxicity of other quinolones and impurities.
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Affiliation(s)
- Ying Han
- Division of Antibiotics, Institute for Chemical Drug Control, National Institutes for Food and Drug Control, Beijing, 102629, China
| | - Yuanyuan Ma
- Department of Pharmacology, NHC Key Laboratory of Biotechnology of Antibiotics, Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Shangchen Yao
- Division of Antibiotics, Institute for Chemical Drug Control, National Institutes for Food and Drug Control, Beijing, 102629, China
| | - Jingpu Zhang
- Department of Pharmacology, NHC Key Laboratory of Biotechnology of Antibiotics, Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China.
| | - Changqin Hu
- Division of Antibiotics, Institute for Chemical Drug Control, National Institutes for Food and Drug Control, Beijing, 102629, China.
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54
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Romandini A, Pani A, Schenardi PA, Pattarino GAC, De Giacomo C, Scaglione F. Antibiotic Resistance in Pediatric Infections: Global Emerging Threats, Predicting the Near Future. Antibiotics (Basel) 2021; 10:antibiotics10040393. [PMID: 33917430 PMCID: PMC8067449 DOI: 10.3390/antibiotics10040393] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/30/2021] [Accepted: 04/03/2021] [Indexed: 12/28/2022] Open
Abstract
Antibiotic resistance is a public health threat of the utmost importance, especially when it comes to children: according to WHO data, infections caused by multidrug resistant bacteria produce 700,000 deaths across all ages, of which around 200,000 are newborns. This surging issue has multipronged roots that are specific to the pediatric age. For instance, the problematic overuse and misuse of antibiotics (for wrong diagnoses and indications, or at wrong dosage) is also fueled by the lack of pediatric-specific data and trials. The ever-evolving nature of this age group also poses another issue: the partly age-dependent changes of a developing system of cytochromes determine a rather diverse population in terms of biochemical characteristics and pharmacokinetics profiles, hard to easily codify in an age- or weight-dependent dosage. The pediatric population is also penalized by the contraindications of tetracyclines and fluoroquinolones, and by congenital malformations which often require repeated hospitalizations and pharmacological and surgical treatments from a very young age. Emerging threats for the pediatric age are MRSA, VRSA, ESBL-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae and the alarming colistin resistance. Urgent actions need to be taken in order to step back from a now likely post-antibiotic era, where simple infections might cause infant death once again.
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Affiliation(s)
- Alessandra Romandini
- Department of Oncology and Hemato-Oncology, Postgraduate School of Clinical Pharmacology and Toxicology, Università degli Studi di Milano, 20122 Milan, Italy; (A.R.); (P.A.S.)
| | - Arianna Pani
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (F.S.)
| | - Paolo Andrea Schenardi
- Department of Oncology and Hemato-Oncology, Postgraduate School of Clinical Pharmacology and Toxicology, Università degli Studi di Milano, 20122 Milan, Italy; (A.R.); (P.A.S.)
| | | | - Costantino De Giacomo
- Maternal and Infantile Department of Pediatrics, ASST Grande Ospedale Metropolitano Niguarda, 20122 Milan, Italy;
- Correspondence: ; Tel.: +39-02-6444-2432
| | - Francesco Scaglione
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (F.S.)
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55
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Chehab H, Fischer PR, Christenson JC. Preparing Children for International Travel. Pediatr Rev 2021; 42:189-202. [PMID: 33795465 DOI: 10.1542/pir.2018-0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Hiba Chehab
- Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Philip R Fischer
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.,Pediatrics Department, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - John C Christenson
- Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, IN
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56
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Sharma A, Sitthi-amorn J, Gavigan P, Wolf J, Agulnik A, Brenner A, Li Y, Johnson LM. Outcomes and Disposition of Oncology Patients With Non-neutropenic Fever and Positive Blood Cultures. J Pediatr Hematol Oncol 2021; 43:47-51. [PMID: 32604334 PMCID: PMC7762736 DOI: 10.1097/mph.0000000000001878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/26/2020] [Indexed: 11/25/2022]
Abstract
Children with cancer and non-neutropenic fever (NNF) episodes are often treated as outpatients if they appear well. However, a small subset have bloodstream infections (BSIs) and must return for further evaluation. These patients may be directly admitted to inpatient units, whereas others are first evaluated in outpatient settings before admission. The best practice for securing care for patients discovered to have outpatient bacteremia are unclear. To determine outcomes and compare time to antibiotics between the 2 disposition, we retrospectively reviewed all NNF initially treated as outpatients and later had positive blood cultures from 2012 to 2016. Of 845 NNF cases initially treated in outpatient settings, 48 episodes (n=43 patients) had BSIs. Of those, 77.1% (n=37) were re-evaluated as outpatients and admitted; 14.6% (n=7) were direct admissions. The median time to antibiotic did not significantly differ between outpatient re-evaluations (119 min) and direct admissions (191 min), P=0.11. One patient met sepsis criteria upon return and required intensive care unit admission for vasopressor support. No patient died within 1 week of the febrile episode. Most patients with NNF and BSIs initially discharged are stable upon return. Institutions should evaluate their patient flows to ensure that patients receive timely care.
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Affiliation(s)
- Aditya Sharma
- Hospitalist Medicine Program, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jitsuda Sitthi-amorn
- Hospitalist Medicine Program, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Patrick Gavigan
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA
| | - Joshua Wolf
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN
| | - Alex Brenner
- College of Medicine, Florida State University, Tallahassee, FL
| | - Ying Li
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN
| | - Liza-Marie Johnson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
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Malik AA, Fuad J, Siddiqui S, Amanullah F, Jaswal M, Barry Z, Jabeen F, Fatima R, Yuen CM, Salahuddin N, Khan AJ, Keshavjee S, Becerra MC, Hussain H. Tuberculosis Preventive Therapy for Individuals Exposed to Drug-resistant Tuberculosis: Feasibility and Safety of a Community-based Delivery of Fluoroquinolone-containing Preventive Regimen. Clin Infect Dis 2021; 70:1958-1965. [PMID: 31190072 DOI: 10.1093/cid/ciz502] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/11/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Observational studies have demonstrated the effectiveness of a fluoroquinolone-based regimen to treat individuals presumed to be infected with drug-resistant tuberculosis (DR-TB). We sought to assess the feasibility of this approach in an urban setting in South Asia. METHODS From February 2016 until March 2017, all household contacts of DR-TB patients enrolled at the Indus Hospital were screened for TB symptoms at home. Children aged 0-17 years, symptomatic adults, and those with an immunocompromising condition (human immunodeficiency virus, diabetes, or malnutrition) were evaluated for TB disease. Contacts diagnosed with TB disease were started on treatment. Contacts without TB disease aged <5 years, contacts aged between 5 and 17 years with either a positive tuberculin skin test or an immunocompromising condition, or contacts aged ≥18 years with an immunocompromising condition were offered 6 months of treatment with a fluoroquinolone. RESULTS One hundred households with 800 contacts were enrolled: 353 (44.1%) individuals aged ≤17 years with a median age of 19 years (interquartile range, 10-32); 423 (52.9%) were males. In total, 737 (92.1%) individuals were screened, of which 8 were already on treatment for TB (1.1%); another 3 (0.4%) contacts were diagnosed with TB disease and started on treatment. Of 215 eligible for infection treatment, 172 (80.0%) contacts initiated and 121 (70.3%) completed treatment. No TB disease or significant adverse events were observed during 12 months of follow-up. CONCLUSIONS Fluoroquinolone-based treatment for contacts with presumed DR-TB infection is feasible and well tolerated in a high TB burden setting.
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Affiliation(s)
- Amyn A Malik
- Global Health Directorate, Indus Health Network, Karachi, Pakistan.,Interactive Research and Development Global, Singapore.,Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Junaid Fuad
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - Sara Siddiqui
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - Farhana Amanullah
- Global Health Directorate, Indus Health Network, Karachi, Pakistan.,Interactive Research and Development Global, Singapore
| | - Maria Jaswal
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - Zainab Barry
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - Farhat Jabeen
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | | | - Courtney M Yuen
- Department of Global Health and Social Medicine, Harvard Medical School.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Naseem Salahuddin
- Global Health Directorate, Indus Health Network, Karachi, Pakistan.,Indus Hospital, Karachi, Pakistan
| | - Aamir J Khan
- Global Health Directorate, Indus Health Network, Karachi, Pakistan.,Interactive Research and Development Global, Singapore
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.,Partners In Health, Boston, Massachusetts
| | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.,Partners In Health, Boston, Massachusetts
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58
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Dai FF, Liu FQ, Chen X, Yang J, Wang K, Guo CY. The treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children. J Clin Pharm Ther 2021; 46:705-710. [PMID: 33403672 DOI: 10.1111/jcpt.13331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE In recent years, the resistance of Mycoplasma pneumoniae to macrolide antibiotics has increased significantly. The health systems are facing significant challenges in carrying out the diagnosis and treatment of refractory Mycoplasma pneumoniae pneumonia in children. Levofloxacin is suitable for treating infectious diseases in various systems but limited in children due to arthropathy issues in weight-bearing joints. This study aimed to evaluate the efficacy and safety of levofloxacin in children with macrolide-resistant Mycoplasma pneumoniae pneumonia. METHODS We retrospectively enrolled six confirmed cases of refractory Mycoplasma pneumoniae pneumonia who were admitted in the paediatric respiratory ward of Shandong provincial hospital Affiliated to Shandong first Medical University between 1st January 2020 and 29th February 2020. Levofloxacin was given to the patients through the intravenous or oral route as per the following dosages :<5 years, 8-10 mg/kg q12 h; >5 years, 8-10 mg/kg, qd for 10 days. The clinical data were collected and analysed. RESULTS AND DISCUSSION The average age of the enrolled cases was six years and nine months (range, four years, and seven months to eleven years and seven months). All cases were found to be drug-resistant and were treated with azithromycin combined with antibacterial drugs. Levofloxacin was used in the patient's refractory to macrolide antibiotics. The temperature of five cases returned to normal 1-2 days after treatment with levofloxacin, and the imaging of the four cases showed expected improvements. The gastrointestinal symptoms, neurological manifestations, joint symptoms, blood parameters, liver and kidney functions, and exercise conditions of the children were closely monitored. The follow-up time of the patients ranged from one week to five months. No drug-related adverse reactions were observed in patients during treatment or during follow-up. WHAT IS NEW AND CONCLUSION The clinical symptoms and imaging significantly improved after treatment with levofloxacin, and no drug-related adverse reactions were observed. Levofloxacin proved to be an effective and safe drug in the treatment of children with macrolide-resistant mycoplasma pneumonia. This study will provide a reference for evaluating the efficacy and safety of levofloxacin in the paediatric population.
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Affiliation(s)
- Fang-Fang Dai
- Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, China
| | - Feng-Qin Liu
- Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, China
| | - Xing Chen
- Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, China
| | - Juan Yang
- Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, China
| | - Ke Wang
- Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, China
| | - Chun-Yan Guo
- Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, China
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59
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Ross RK, Gerber JS, Willis ZI, Hersh AL, Kinlaw AC. Outpatient Fluoroquinolone Use in Children, 2000-2018. J Pediatric Infect Dis Soc 2020; 10:576-585. [PMID: 33377490 PMCID: PMC8599880 DOI: 10.1093/jpids/piaa156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/30/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND While fluoroquinolones are commonly used in adults, the use in children has been low. Since 2000, there were 3 US Food and Drug Administration (FDA) Boxed warnings regarding fluoroquinolones (2008, 2013, and 2016). Our objective was to describe the use of fluoroquinolones in children and assess the impact of 3 recent FDA warnings on fluoroquinolone use. METHODS From 2000 to 2018, we assessed claims for all outpatient prescription fills to measure the use of systemic fluoroquinolones and other broad-spectrum antibiotics in children less than 18 years old in the MarketScan Commercial Claims and Encounters database. We describe demographics, indication for antibiotic, and clinical characteristics. To assess the impact of FDA warnings on fill rates, we conducted an interrupted time-series analysis. RESULTS The cohort included 34.6 million unique beneficiaries less than 18 years old with 441 062 fluoroquinolone fills (5.5 fills per 1000 person-years). The fluoroquinolone fill rate was highest among children > 11 years old. Urinary tract infection was the most common associated diagnosis (21.8%). Since 2008, the fluoroquinolone fill rate has declined. By the end of the study period in December 2018, in the (counterfactual) absence of the FDA warnings, fluoroquinolone fill rate would have been 7.5 (95% confidence interval [CI]: 5.2-9.7); however, the corresponding rate in observed data was 2.8 (95% CI: 1.7-3.9). CONCLUSIONS Fluoroquinolone use was low compared with other common broad-spectrum antibiotics and declining trends over time were associated with FDA warnings, even though these warnings were not pediatric specific. Future work should assess the adverse events at issue in these warnings in children.
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Affiliation(s)
- Rachael K Ross
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA,Corresponding Author: Rachael K. Ross, MPH, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr McGavran-Greenberg Hall CB 7435 Chapel Hill, NC 27599, USA. E-mail:
| | - Jeffrey S Gerber
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zachary I Willis
- Department of Pediatrics, Division of Pediatric Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Adam L Hersh
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah, USA
| | - Alan C Kinlaw
- Division of Pharmaceutical Outcomes and Policy, School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA,Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
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60
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Park JY, Kang HM, Kwak EM, Rhim JW, Ahn YH, Lee H, Jeong DC, Kang JH. Impact of Antibiotic Prescribing Patterns on Susceptibilities of Uropathogens in Children below 24 Months Old. Antibiotics (Basel) 2020; 9:antibiotics9120915. [PMID: 33339282 PMCID: PMC7767190 DOI: 10.3390/antibiotics9120915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 01/24/2023] Open
Abstract
Monitoring regional antibiotic resistance patterns of uropathogens are important for deciding suitable empirical antibiotics for urinary tract infections (UTIs) in children. This study aimed to investigate regional differences in antimicrobial susceptibility patterns of E. coli and Klebsiella spp. in children below 24 months old, diagnosed with their first episode of UTI, and to find factors associated with an increased risk for UTI caused by extended-spectrum β-lactamase (ESBL)-producing uropathogens. This was a retrospective cohort study of children diagnosed between 2011 and 2017 in four different hospitals located in four different regions of South Korea; regions A, B, C, and D. The government’s big data repository was used to acquire data on regional antibiotic prescriptions. The pooled antimicrobial susceptibilities of E. coli and Klebsiella spp. (n = 2044) were as follows: ampicillin–sulbactam (61.0%), 3rd generation cephalosporin (3C) (82.8%), and trimethoprim–sulfamethoxazole (72.0%). Multivariate analysis showed that children diagnosed at hospital A (OR, 1.8; 95% confidence interval [CI], 1.2–2.6; P = 0.002) and every year that increased in the study period (OR, 1.1; 95% CI, 1.1–1.2; P < 0.001) were factors associated with an increased risk for UTIs with ESBL-producers. Regions A and B had significantly higher amounts of oral 3Cs prescribed compared to regions C and D (P = 0.009), which correlate with hospitals in the regions that had higher proportions of UTIs with ESBL-producing uropathogens (A and B vs. C and D, P < 0.001). Therefore, children in certain regions are at a higher risk for UTIs caused by ESBL-producers compared to other regions, which correlate with regions that had higher amounts of oral 3Cs prescribed.
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Affiliation(s)
- Ji Young Park
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam-si 13620, Gyeonggi-do, Korea; (J.Y.P.); (Y.H.A.); (H.L.)
- Department of Pediatrics, Chung-Ang University Hospital, Seoul 06973, Korea
| | - Hyun Mi Kang
- Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (D.C.J.); (J.H.K.)
- Correspondence: ; Tel.: +82-2-2258-6273
| | - Eun Min Kwak
- Department of Pediatrics, Samsung Changwon Hospital, College of Medicine, Sung Kyun Kwan University, Changwon-si 51353, Gyeongsangnam-do, Korea;
| | - Jung-Woo Rhim
- Department of Pediatrics, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon 34943, Korea;
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam-si 13620, Gyeonggi-do, Korea; (J.Y.P.); (Y.H.A.); (H.L.)
| | - Hyunju Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam-si 13620, Gyeonggi-do, Korea; (J.Y.P.); (Y.H.A.); (H.L.)
| | - Dae Chul Jeong
- Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (D.C.J.); (J.H.K.)
| | - Jin Han Kang
- Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (D.C.J.); (J.H.K.)
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Leung AK, Hon KL, Chu WC. Acute bacterial sinusitis in children: an updated review. Drugs Context 2020; 9:dic-2020-9-3. [PMID: 33281908 PMCID: PMC7685231 DOI: 10.7573/dic.2020-9-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background In the pediatric age group, approximately 7.5% of upper respiratory tract infections (URIs) are complicated by acute bacterial sinusitis (ABS). Despite its prevalence, ABS is often overlooked in young children. The diagnosis and management present unique challenges in primary care. This is an updated narrative review on the evaluation, diagnosis, and management of ABS. Methods A PubMed search was performed using the key term ‘acute sinusitis’. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies, and reviews. The search was restricted to the English literature and children. Results Haemophilus influenzae (non-typeable), Streptococcus pneumoniae, and Moraxella catarrhalis are the major pathogens in uncomplicated ABS in otherwise healthy children. In complicated ABS, polymicrobial infections are common. The diagnosis of acute sinusitis is mainly clinical and based on stringent criteria, including persistent symptoms and signs of a URI beyond 10 days, without appreciable improvement; a URI with high fever and purulent nasal discharge at onset lasting for at least 3 consecutive days; and biphasic or worsening symptoms. Conclusion Data from high-quality studies on the management of ABS are limited. The present consensus is that amoxicillin-clavulanate, at a standard dose of 45 mg/kg/day orally, is the drug of choice for most cases of uncomplicated ABS in children in whom antibacterial resistance is not suspected. Alternatively, oral amoxicillin 90 mg/kg/day can be administered. For those with severe ABS or uncomplicated acute sinusitis who are at risk for severe disease or antibiotic resistance, oral high-dose amoxicillin-clavulanate (90 mg/kg/day) is the drug of choice.
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Affiliation(s)
- Alexander Kc Leung
- Department of Pediatrics, The University of Calgary, and The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong.,Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong
| | - Winnie Cw Chu
- Department of Imaging & Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Abstract
The major pathogens that cause atypical pneumonia are Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila. Community-acquired pneumonia (CAP) caused by M. pneumoniae or C. pneumoniae is common in children and presents as a relatively mild and self-limiting disease. CAP due to L. pneumophila is very rare in children and progresses rapidly, with fatal outcomes if not treated early. M. pneumoniae, C. pneumoniae, and L. pneumophila have no cell walls; therefore, they do not respond to β-lactam antibiotics. Accordingly, macrolides, tetracyclines, and fluoroquinolones are the treatments of choice for atypical pneumonia. Macrolides are the first-line antibiotics used in children because of their low minimum inhibitory concentrations and high safety. The incidence of pneumonia caused by macrolide-resistant M. pneumoniae that harbors point mutations has been increasing since 2000, particularly in Korea, Japan, and China. The marked increase in macrolide-resistant M. pneumoniae pneumonia (MRMP) is partly attributed to the excessive use of macrolides. MRMP does not always lead to clinical nonresponsiveness to macrolides. Furthermore, severe complicated MRMP responds to corticosteroids without requiring a change in antibiotic. This implies that the hyper-inflammatory status of the host can induce clinically refractory pneumonia regardless of mutation. Empirical macrolide therapy in children with mild to moderate CAP, particularly during periods without M. pneumoniae epidemics, may not provide additional benefits over β-lactam monotherapy and can increase the risk of MRMP.
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Affiliation(s)
- Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University of Medicine, Seoul, Korea
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Abstract
Acute auricular perichondritis is an infection and inflammatory disease of the external ear that can potentially cause serious complications if not diagnosed and treated promptly. Delays in treatment can lead to devastating focal cartilage necrosis and, subsequently, permanent deformities of the ear. We present the case of a two-year-old boy who was diagnosed with acute perichondritis after presenting to the emergency department (ED) with acute ear redness, swelling, and tenderness. In this article, we will discuss how the diagnosis of perichondritis is made and give a brief literature review on the management approaches and the reasoning behind them. Particularly, we address the dilemma of whether fluoroquinolones use in pediatric patients is safe and warranted in this disease entity, based on the latest evidence.
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Affiliation(s)
- Mark D Rivera-Morales
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA.,Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA
| | | | - Ariel Vera
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA.,Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA
| | - Latha Ganti
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA.,Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA.,Emergency Medicine, Envision Physician Services, Nashville, USA.,Emergency Medical Services, Polk County Fire Rescue, Bartow, USA
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64
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Wang JG, Cui HR, Hu YS, Tang HB. Assessment of the risk of musculoskeletal adverse events associated with fluoroquinolone use in children: A meta-analysis. Medicine (Baltimore) 2020; 99:e21860. [PMID: 32846837 PMCID: PMC7447478 DOI: 10.1097/md.0000000000021860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The use of fluoroquinolone antibiotics has been restricted in children because of their potential to cause adverse musculoskeletal events. This study was performed to systematically evaluate whether there is a difference between fluoroquinolone and non-fluoroquinolone antibiotics in terms of their associated risk of adverse musculoskeletal events in children. METHODS Cochrane Library, Embase, and PubMed databases were used to retrieve studies related to fluoroquinolone and non-fluoroquinolone-induced musculoskeletal adverse events in children. A meta-analysis was performed using Stata 11. RESULTS A total of 10 studies were included in the analysis. The combined results showed that there was no statistical difference between fluoroquinolone and non-fluoroquinolone groups in terms of musculoskeletal adverse events in children (risk ratio = 1.145, 95% confidence interval = 0.974 - 1.345, P = .101). Subgroup analysis was performed using a random-effects model. Here, the effects on the trovafloxacin and levofloxacin groups were significantly different from that of the control group. However, musculoskeletal adverse events due to either drug was not reported after long-term follow-up. CONCLUSIONS The results showed that fluoroquinolone and non-fluoroquinolone antibiotics were not different in terms of their ability to cause musculoskeletal adverse events in children. For this reason, fluoroquinolone antibiotics can be used in children as appropriate. PROSPERO REGISTRATION NUMBER CRD42019133900.
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Affiliation(s)
- Ji-gan Wang
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning
| | - Hai-Rong Cui
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yi-sen Hu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hua-Bo Tang
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning
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65
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Bahoush G, Nojoomi M. A Study on the Efficacy of Empirical Antibiotic Therapy for Splenectomized Children with Fever. J Med Life 2020; 13:151-155. [PMID: 32742506 PMCID: PMC7378339 DOI: 10.25122/jml-2019-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Thalassemia represents a heterogeneous group of inherited diseases characterized by the lack or reduced production of hemoglobin β-chains. Many patients with thalassemia require splenectomy. What should be considered in the evaluation and management of candidates for splenectomy is to cover vaccination against infections such as pneumococci and the implementation of antibiotic prophylaxis. This study aimed to investigate the effect of the antibiotic type on the outcome of acute post-splenectomy infection in patients with thalassemia. This investigation is a retrospective cohort study. One hundred fifty medical records of hemoglobinopathy patients who underwent splenectomy were collected from the Ali-Asghar Hospital, Tehran, Iran. SPSS v. 20 and SAS v. 1.9 were used to analyze the data. A total of 150 patients that were vaccinated against post-splenectomy infections and were under antibiotic prophylaxis underwent splenectomy. The most commonly prescribed drugs were ceftriaxone or cefotaxime (132 cases, 88%), followed by ceftriaxone plus clindamycin (5.3%), ceftriaxone plus amikacin (3.3%), clindamycin (1.3%), vancomycin plus amikacin (0.7%), and others (1.3%). In terms of treatment outcomes, 143 cases (95.3%) were treated with the same antibiotics, and 4 (2.7%) experienced a changed antibiotic regimen with vancomycin. The results show that perceptions of treatment for fever in splenectomized children need to be changed, and most of them do not require hospitalization and initiation of broad-spectrum antibiotics such as vancomycin for initially refractory cases, and can only be treated with daily intravenous ceftriaxone.
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Affiliation(s)
- Gholamreza Bahoush
- Department of Pediatrics, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran; Ali-Asghar Children Hospital.,Ali-Asghar Children Hospital, Tehran, Iran
| | - Marzieh Nojoomi
- Department of Community Medicine, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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66
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Propionibacterium acnes Endophthalmitis Following Baerveldt Glaucoma Device Implantation. J Glaucoma 2020; 29:e71-e73. [DOI: 10.1097/ijg.0000000000001526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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67
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Meyers RS, Thackray J, Matson KL, McPherson C, Lubsch L, Hellinga RC, Hoff DS. Key Potentially Inappropriate Drugs in Pediatrics: The KIDs List. J Pediatr Pharmacol Ther 2020; 25:175-191. [PMID: 32265601 DOI: 10.5863/1551-6776-25.3.175] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The safe use of medications in pediatric patients requires practitioners to consider the unique pharmacokinetics and pharmacodynamics of drugs prescribed in this age group. In an effort to create a standard of care for the safe use of medications in this population, a list of drugs that are potentially inappropriate for use in pediatric patients has been developed and titled the "KIDs List." METHODS A panel of 7 pediatric pharmacists from the Pediatric Pharmacy Association were recruited to evaluate primary, secondary, and tertiary literature; FDA Pediatric Safety Communications; the Lexicomp electronic database; and product information for drugs that should be considered potentially inappropriate for use in pediatric patients. Information was rated using predefined criteria. A PubMed search was conducted using the following terms: adverse drug events OR adverse drug reactions. The search was limited to humans; age <18 years; case reports, observational studies, or clinical trials; and English language. No date range was used. Results were used to create an evidence-based list of candidate drugs that was then peer-reviewed and subjected to a 30-day public comment period prior to being finalized. RESULTS A PubMed search yielded 4049 unique titles, of which 210 were deemed relevant for full review. Practitioner recommendations highlighted an additional 77 drugs. FDA Pediatric Safety Communications and the Lexicomp database yielded 22 and 619 drugs, respectively. After critical analysis, peer review, and public review the final KIDs List contains 67 drugs and/or drug classes and 10 excipients. CONCLUSIONS This extensive effort led to compilation of the first list of drugs that are potentially inappropriate for prescribing in all or in a select subgroup of pediatric patients. If avoidance is not clinically possible, the drug should be used with caution and accompanied by appropriate monitoring.
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68
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Yu PH, Hu CF, Liu JW, Chung CH, Chen YC, Sun CA, Chien WC. The incidence of collagen-associated adverse events in pediatric population with the use of fluoroquinolones: a nationwide cohort study in Taiwan. BMC Pediatr 2020; 20:64. [PMID: 32046672 PMCID: PMC7011365 DOI: 10.1186/s12887-020-1962-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the safety of using fluoroquinolones in pediatric population in Taiwan. METHODS Patients aged 0~18 years old with fluoroquinolones prescriptions ≥5 consecutive days during year 2000 to 2013 were selected from the National Health Insurance Research Database, 4-time case number were selected as controls. We evaluated the patient's outcome after the use of fluoroquinolones by reviewing a newly diagnosis of the following collagen-associated adverse events by International Classification of Diseases, Ninth Revision, Clinical Modification codes, covering tendons rupture, retinal detachments, gastrointestinal tract perforation, aortic aneurysm or dissection. RESULTS Of the enrolled patients (n = 167,105), collagen-associated adverse effects developed in 85 cases (0.051%) in 6-month tracking, including 0.051% in the fluoroquinolones study cohort (17 in 33,421) and 0.051% (68 in 133,684) in the fluoroquinolones free comparison cohort. The crude hazard ratio for collagen-associated adverse events in the fluoroquinolones group was 0.997 (0.586-1.696; p = 0.990). After adjusting for age, sex, catastrophic illness, low-income household, seasons, levels of urbanization, and healthcare, the corrected hazard ratio in 6-month tracking with FQs was 1.330 (95% CI; 0.778-2.276; p = 0.255). CONCLUSIONS There is no significant difference of collagen-associated adverse effects between fluoroquinolones group and fluoroquinolones free group from our data. We propose that fluoroquinolones for pediatric population in clinical practice may be not so harmful as previous references reported.
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Affiliation(s)
- Pei-Han Yu
- Master Program of Big Data in Biomedicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,Department of Pharmacy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chih-Fen Hu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jen-Wei Liu
- Department of Pharmacy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, 11490, Taiwan
| | - Yong-Chen Chen
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan.,Big Data Research Center, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chien-An Sun
- Big Data Research Center, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, 11490, Taiwan. .,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, 11490, Taiwan. .,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, No 325, Section 2, Cheng-Kung Road, Taipei, 11490, Taiwan, Republic of China.
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69
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Fusco NM, Nichols K. Common bacterial infections and their treatment in hospitalized pediatric patients. Am J Health Syst Pharm 2020; 76:1521-1531. [PMID: 31532502 DOI: 10.1093/ajhp/zxz164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Common bacterial infections in pediatric patients that the hospital pharmacist may encounter are reviewed, and guidance on the safe and effective use of antibiotics to treat those infections is provided. SUMMARY Pharmacists play a key role in evaluating and creating antibiotic treatment plans for patients with infections. Bacterial infections are a common reason for hospital admission in pediatric patients, and pharmacists working in hospitals may be consulted to provide treatment and monitoring recommendations. It is important for pharmacists to be aware of similarities and differences in adult and pediatric populations with regard to presenting signs and symptoms of bacterial infections, common causative pathogens, and antibiotic selection, dosing, and monitoring. This article reviews current approaches to treatment of common bacterial infections in pediatric patients and also provides general suggestions for antibiotic use. CONCLUSION Pharmacists have an opportunity to positively impact the care of pediatric patients with bacterial infections. Especially at facilities where pediatric patients are not regularly treated, pharmacists can potentially improve care through provision of recommendations for optimal antibiotic selection, dosing, and monitoring.
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Affiliation(s)
- Nicholas M Fusco
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY
| | - Kristen Nichols
- Butler University College of Pharmacy and Health Sciences, Indianapolis, IN
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70
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Arad-Cohen N, Rowe JM, Shachor-Meyouhas Y. Pharmacological prophylaxis of infection in pediatric acute myeloid leukemia patients. Expert Opin Pharmacother 2020; 21:193-205. [PMID: 31914337 DOI: 10.1080/14656566.2019.1701654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction: Pediatric patients treated for acute myeloid leukemia (AML) are at high risk of developing severe infectious complications. The choice of an optimum supportive treatment should be based on local epidemiology, as well as intensity and toxicity of the anti-leukemic therapy applied.Areas covered: This review presents an overview of recently published studies focusing on the prevention of infection in pediatric AML patients. PubMed has been systematically searched for clinical trials, reviews, and meta-analyses published in the last 10 years. The focus of this article will be limited to primary prophylaxis only, while secondary prophylaxis is beyond the scope of the current review.Expert opinion: Although anti-bacterial agents may decrease the bacterial infection burden, there is no consensus regarding prophylactic use. To that end, there is a need for further randomized controlled trials to establish the precise role of anti-bacterial prophylaxis in pediatric AML patients. The prophylactic use of anti-fungal agents is strongly recommended for all AML patients. Since the contribution of hematopoietic growth factors to improved survival has not been demonstrated, they should not be routinely applied. Decisions regarding an appropriate prophylactic strategy should be taken in collaboration with the infectious disease experts and pharmacology team.
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Affiliation(s)
- Nira Arad-Cohen
- Pediatric Hematology-Oncology Department, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Jacob M Rowe
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus Haifa, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yael Shachor-Meyouhas
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Pediatric Infectious Diseases Unit, Rambam Health Care Campus, Ruth Rappaport Children's Hospital Haifa, Israel
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71
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Rheumatologic Manifestations of CF. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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72
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Holmes AP, Hartis CE, Rollins LJ. High Direct Bilirubin Associated With Levoffoxacin Use in a Neonate. J Pediatr Pharmacol Ther 2020; 25:64-67. [PMID: 31897078 DOI: 10.5863/1551-6776-25.1.64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Limited data exist regarding the use of fluoroquinolones in the neonatal population. Levofloxacin has some utility in this population because it is one of a very limited number of antibiotics with activity against Stenotrophomonas maltophilia. We describe the successful treatment of S maltophilia tracheitis in a premature neonate using levofloxacin 10 mg/kg every 24 hours and the subsequent unexpected sharp rise in the direct bilirubin. This case illustrates a previously unrecognized adverse drug effect associated with levofloxacin use in neonates.
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73
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Tran PT, Winterstein AG, Wang X, Rhew K, Antonelli PJ. Appropriateness of Otic Quinolone Use among Privately Insured US Patients. Otolaryngol Head Neck Surg 2019; 162:102-107. [DOI: 10.1177/0194599819889607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective Considering emerging safety concerns involving otic quinolones, we assessed the extent of otic quinolone use for questionable indications. Study Design Descriptive cross-sectional study of a national sample of privately insured patients. Setting Outpatient encounters in the United States. Subjects and Methods Children and adults with outpatient pharmacy-dispensing claims for new prescriptions of otic or ophthalmic quinolones in 2017 were identified within the IBM MarketScan Commercial Claims & Encounters and the Medicare Supplemental Database. Each dispensing ≥30 days apart constituted a unique episode. Only claims with supporting ear-related diagnoses on outpatient encounters ±3 days of dispensing were considered. Ophthalmic drops were excluded if eye-related diagnoses were found ±30 days. Prescribing was classified as appropriate, questionable, or undetermined. Results We found 214,897 episodes in 200,270 patients. Adults were twice as likely as children to have otic treatment with questionable indications (6.2% vs 3.0%). Sensitivity analyses with broader time windows to ascertain diagnoses showed similar proportions of questionable use. Otalgia and cerumen impaction constituted 90% of questionable indications. Family physicians (6.8%) and internists (8.0%) had higher percentages of questionable use than other specialties. Conclusion Based on the demonstrated risks of quinolone ear drops, opportunities exist to decrease otic quinolone use, especially in adults.
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Affiliation(s)
- Phuong T. Tran
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Faculty of Pharmacy, Ho Chi Minh City University of Technology, Ho Chi Minh City, Vietnam
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
| | - Xi Wang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Kiyon Rhew
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- College of Pharmacy, Dongduk Women’s University, Seoul, South Korea
| | - Patrick J. Antonelli
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
- Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, Florida, USA
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Same RG, Hsu AJ, Tamma PD. Optimizing the Management of Uncomplicated Gram-Negative Bloodstream Infections in Children: Translating Evidence From Adults Into Pediatric Practice. J Pediatric Infect Dis Soc 2019; 8:485-488. [PMID: 31436812 PMCID: PMC6831935 DOI: 10.1093/jpids/piz051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 07/08/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Rebecca G Same
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alice J Hsu
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland
| | - Pranita D Tamma
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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75
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Stephanos K, Bragg AF. Pediatric Genitourinary Infections and Other Considerations. Emerg Med Clin North Am 2019; 37:739-754. [PMID: 31563205 DOI: 10.1016/j.emc.2019.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Pediatric patients pose a unique host of challenges to the emergency provider across all complaints and ages, but this is particularly notable in the genitourinary (GU) system. The pediatric GU system is different from that of the adult in its etiology of symptoms, complications, and treatments. Based on age, there are variations in the anatomy. These differences result in symptoms and diagnoses that must be managed differently. Although in many respects management is similar to GU emergency conditions in adults, there are, occasionally subtle, differences between the care of children and adults, which can greatly impact outcomes.
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Affiliation(s)
- Kathleen Stephanos
- Department of Emergency Medicine, University of Rochester, 601 Elmwood Avenue Box 655, Rochester, NY 14642, USA.
| | - Andrew F Bragg
- Department of Pediatrics, University of Rochester, 601 Elmwood Avenue Box 655, Rochester, NY 14642, USA
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76
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Mijovic H, Wakeham S, Ng K, Al-Rawahi GN, Tilley P, Ho L, Roberts A. Running out of options: Extensively drug-resistant urinary tract infection in an infant. Paediatr Child Health 2019; 24:371-373. [PMID: 31528107 DOI: 10.1093/pch/pxz048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 03/13/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hana Mijovic
- Department of Pediatrics, Division of Infectious Diseases, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia
| | - Susan Wakeham
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Karen Ng
- Department of Pharmacy, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia
| | - Ghada N Al-Rawahi
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia
| | - Peter Tilley
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia
| | - Louisa Ho
- Department of Urology, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia
| | - Ashley Roberts
- Department of Pediatrics, Division of Infectious Diseases, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia
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77
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Principi N, Esposito S. Antibiotic-related adverse events in paediatrics: unique characteristics. Expert Opin Drug Saf 2019; 18:795-802. [PMID: 31305171 DOI: 10.1080/14740338.2019.1640678] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Antibiotics have saved and are still saving countless human lives from the burden of infectious diseases. However, as with all other drugs, they can cause adverse events. Generally, these are uncommon, mild and spontaneously resolving. However, in some cases, they can cause relevant clinical problems. Compared with adults, children, particularly in the first years of life, have a higher risk of antibiotic-related adverse events for several reasons. Areas covered: In this paper, the conditions that can contribute to the elevated risk of antibiotic-related adverse events in children are discussed. Expert opinion: Antibiotic stewardship can be a solution to limit antibiotic abuse and misuse and consequently the incidence of antibiotic-related adverse events in children. Moreover, most of the antibiotic-associated adverse events can be avoided with more extensive pre-marketing medicine investigations, improved postmarket safety surveillance system, increased transparency throughout the clinical research enterprise, increased training of clinical pharmacologists and paediatric researchers, expanded pool of paediatric patients, and providing additional funding and incentives for paediatric drug development.
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Affiliation(s)
| | - Susanna Esposito
- b Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia , Perugia , Italy
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78
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Yang HJ. Benefits and risks of therapeutic alternatives for macrolide resistant Mycoplasma pneumoniae pneumonia in children. KOREAN JOURNAL OF PEDIATRICS 2019; 62:199-205. [PMID: 30999732 PMCID: PMC6584239 DOI: 10.3345/kjp.2018.07367] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/04/2019] [Accepted: 03/13/2019] [Indexed: 01/30/2023]
Abstract
Although Mycoplasma pneumoniae pneumonia (MPP) has been generally susceptible to macrolides, the emergence of macrolide-resistant MPP (MRMP) has made its treatment challenging. MRMP rapidly spread after the 2000s, especially in East Asia. MRMP is more common in children and adolescents than in adults, which is likely related to the frequent use of macrolides for treating M. pneumoniae infections in children. MRMP is unlikely to be related to clinical, laboratory, or radiological severity, although it likely prolongs the persistence of symptoms and the length of hospital stay. Thereby, it causes an increased burden of the disease and poor quality of life for the patient as well as a societal socioeconomic burden. To date, the only alternative treatments for MRMP are secondary antimicrobials such as tetracyclines (TCs) or fluoroquinolones (FQs) or systemic corticosteroids; however, the former are contraindicated in children because of concerns about potential adverse events (i.e., tooth discoloration or tendinopathy). A few guidelines recommended TCs or FQs as the second-line drug of choice for treating MRMP. However, there have been no evidence-based guidelines. Furthermore, safety issues have not yet been resolved. Therefore, this article aimed to review the benefits and risks of therapeutic alternatives for treating MRMP in children and review the recommendations of international or regional guidelines and specific considerations for their practical application.
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Affiliation(s)
- Hyeon-Jong Yang
- Pediatric Allergy and Respiratory Center, Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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79
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Ben-Zvi L, Sebag D, Izhaki G, Katz E, Bernfeld B. Diagnosis and Management of Infectious Arthritis in Children. Curr Infect Dis Rep 2019; 21:23. [PMID: 31144135 DOI: 10.1007/s11908-019-0678-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Septic arthritis is limb and life-threatening condition which necessitates rapid diagnosis and treatment. It is important for a medical practitioner to be familiar with this condition. This review summarizes the epidemiology, risk factors, diagnosis and differential diagnosis, complications, as well as treatment and the following-up of this condition. RECENT FINDINGS Different causative organisms require unique diagnostic and treatment approaches. Establishing the diagnosis often requires multiple diagnostic modalities, some of which are new and innovative. Differential diagnosis requires excluding non-infectious inflammatory causes, such as reactive arthritis, juvenile rheumatoid arthritis, transient synovitis, and pericapsular pyomyositis. There is no consensus regarding the nature or duration of pharmacological or surgical treatment. Treatment includes administration of appropriate antimicrobial therapy and including the use of steroids and drainage. The most common complications are osteonecrosis of the femoral head and chronic osteomyelitis. Complications of septic arthritis are mostly due to a missed diagnosis. Further studies are required to better evaluate the diagnostic and therapeutic choice.
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Affiliation(s)
- Lior Ben-Zvi
- Department of Orthopedic Surgery, Lady Davis Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel.
| | - Diklah Sebag
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Guy Izhaki
- Department of Orthopedic Surgery, Lady Davis Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel
| | - Eldad Katz
- Department of Orthopedic Surgery, Lady Davis Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel
| | - Benjamin Bernfeld
- Department of Orthopedic Surgery, Lady Davis Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel
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Stass H, Lettieri J, Vanevski KM, Willmann S, James LP, Sullivan JE, Arrieta AC, Bradley JS. Pharmacokinetics, Safety, and Tolerability of Single-Dose Intravenous Moxifloxacin in Pediatric Patients: Dose Optimization in a Phase 1 Study. J Clin Pharmacol 2019; 59:654-667. [PMID: 30681729 PMCID: PMC9252262 DOI: 10.1002/jcph.1358] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/25/2018] [Indexed: 09/01/2024]
Abstract
The pharmacokinetics, safety, and tolerability of a single dose of moxifloxacin were characterized in 31 pediatric patients already receiving antibiotics for a suspected or proven infection in an open-label phase 1 study. A dosing strategy for each age cohort (Cohort 1: ≥6 years to ≤14 years; Cohort 2: ≥2 years to <6 years; Cohort 3: >3 month to <2 years) was developed using physiology-based pharmacokinetic modeling combined with a stepwise dosing scheme to obtain a similar exposure to adults receiving 400 mg of moxifloxacin. Doses, adjusted to body weight and age, were gradually escalated from 5 mg/kg in Cohort 1 to 10 mg/kg in Cohort 3 based on interim analysis of the pharmacokinetic and safety data. Plasma and urine samples before and after the 60-minute infusion were collected for the analysis of moxifloxacin and its metabolites using a validated high-pressure liquid chromatography assay with tandem mass spectrometry. Moxifloxacin and metabolite concentrations in plasma were within the ranges observed in adults; however, clearance of all analytes was lower in pediatric patients compared with adults. Population pharmacokinetic analyses using the achieved exposure levels in the 3 age cohorts (with known body weight and clearance) predicted similar efficacy and safety profiles to adults. Moxifloxacin was well tolerated in all pediatric age cohorts. Adverse events related to moxifloxacin were mild or moderate in intensity and showed no correlation with increased weight-adjusted doses. Our findings guided the selection of age-appropriate clinical doses for a subsequent phase 3 clinical trial in pediatric patients with complicated intra-abdominal infections.
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Affiliation(s)
| | | | | | | | - Laura P. James
- Department of Pediatrics, University of Arkansas for Medical Science and Arkansas Children’s Research Institute, Little Rock, AR, USA
| | - Janice E. Sullivan
- University of Louisville/Kosair Charities Pediatric Clinical Research Unit/Norton Children’s Hospital Louisville, KY, USA
| | | | - John S. Bradley
- University of California, San Diego School of Medicine and Rady Children’s Hospital San Diego, San Diego, CA, USA
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Abstract
BACKGROUND Fluoroquinolone (FQ) prescription rates have increased over the last 10 years despite recent warnings of serious adverse effects such as peripheral neuropathy and tendinopathy. Currently, there are no published data on the extent or appropriateness of FQ prescribing in children. METHODS Drug prescription data from the PharMetrics Plus health claims database (United States) were analyzed to examine dispensing of ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin, or gemifloxacin to children from 2006 to 2015. Based on American Academy of Pediatrics recommendations, an algorithm was created to quantify inappropriate FQ prescriptions, which was further stratified by age and FQ type. RESULTS Among a cohort of 2,754,431 children, 372,357 prescriptions for an oral FQ were dispensed between 2006 and 2015. An increase was observed in FQ prescriptions from 2006 to 2013, with numbers coming down in 2014 and 2015. Ciprofloxacin was the most frequently prescribed FQ (334,268 prescriptions) followed by levofloxacin (19,386), moxifloxacin (18,434) and combined ofloxacin/gemifloxacin prescriptions (369). Of the FQ prescriptions in children, 48% were prescribed to those 10 years of age or younger, and 22% were deemed inappropriate. CONCLUSIONS Our study suggests an increase in the prescribing of FQs, mostly ciprofloxacin, over a 10-year period, although numbers have decreased slightly in 2014 and 2015. At least 1 in 5 prescriptions were deemed unnecessary. In light of recent FQ safety warnings and lack of long-term safety data with FQ use in children and potential risk of increasing antibiotic resistance, clinicians are advised to refrain from using FQs for uncomplicated community-acquired infections.
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Buglak AA, Shanin IA, Eremin SA, Lei HT, Li X, Zherdev AV, Dzantiev BB. Ciprofloxacin and Clinafloxacin Antibodies for an Immunoassay of Quinolones: Quantitative Structure⁻Activity Analysis of Cross-Reactivities. Int J Mol Sci 2019; 20:ijms20020265. [PMID: 30641870 PMCID: PMC6359390 DOI: 10.3390/ijms20020265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 12/11/2018] [Accepted: 01/07/2019] [Indexed: 11/16/2022] Open
Abstract
A common problem in the immunodetection of structurally close compounds is understanding the regularities of immune recognition, and elucidating the basic structural elements that provide it. Correct identification of these elements would allow for select immunogens to obtain antibodies with either wide specificity to different representatives of a given chemical class (for class-specific immunoassays), or narrow specificity to a unique compound (mono-specific immunoassays). Fluoroquinolones (FQs; antibiotic contaminants of animal-derived foods) are of particular interest for such research. We studied the structural basis of immune recognition of FQs by antibodies against ciprofloxacin (CIP) and clinafloxacin (CLI) as the immunizing hapten. CIP and CLI possess the same cyclopropyl substituents at the N1 position, while their substituents at C7 and C8 are different. Anti-CIP antibodies were specific to 22 of 24 FQs, while anti-CLI antibodies were specific to 11 of 26 FQs. The molecular size was critical for the binding between the FQs and the anti-CIP antibody. The presence of the cyclopropyl ring at the N1 position was important for the recognition between fluoroquinolones and the anti-CLI antibody. The anti-CIP quantitative structure–activity relationship (QSAR) model was well-equipped to predict the test set (pred_R2 = 0.944). The statistical parameters of the anti-CLI model were also high (R2 = 0.885, q2 = 0.864). Thus, the obtained QSAR models yielded sufficient correlation coefficients, internal stability, and predictive ability. This work broadens our knowledge of the molecular mechanisms of FQs’ interaction with antibodies, and it will contribute to the further development of antibiotic immunoassays.
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Affiliation(s)
- Andrey A Buglak
- A. N. Bach Institute of Biochemistry, Research Center of Biotechnology of the Russian Academy of Sciences, 33 Leninsky Prospect, 119071 Moscow, Russia.
- Faculty of Physics, St. Petersburg State University, 7/9 Universitetskaya nab., 199034 St. Petersburg, Russia.
| | - Ilya A Shanin
- Chemical Department, M. V. Lomonosov Moscow State University, Leninskie Gory, 119991 Moscow, Russia.
- XEMA Company Limited, Ninth Parkovaya street 48, 105264 Moscow, Russia.
| | - Sergei A Eremin
- Chemical Department, M. V. Lomonosov Moscow State University, Leninskie Gory, 119991 Moscow, Russia.
| | - Hong-Tao Lei
- Guangdong Provincial Key Laboratory of Food Quality and Safety, South China Agricultural University, Guangzhou 510642, China.
| | - Xiangmei Li
- Guangdong Provincial Key Laboratory of Food Quality and Safety, South China Agricultural University, Guangzhou 510642, China.
| | - Anatoly V Zherdev
- A. N. Bach Institute of Biochemistry, Research Center of Biotechnology of the Russian Academy of Sciences, 33 Leninsky Prospect, 119071 Moscow, Russia.
| | - Boris B Dzantiev
- A. N. Bach Institute of Biochemistry, Research Center of Biotechnology of the Russian Academy of Sciences, 33 Leninsky Prospect, 119071 Moscow, Russia.
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84
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Leung AK, Wong AH, Leung AA, Hon KL. Urinary Tract Infection in Children. RECENT PATENTS ON INFLAMMATION & ALLERGY DRUG DISCOVERY 2019; 13:2-18. [PMID: 30592257 PMCID: PMC6751349 DOI: 10.2174/1872213x13666181228154940] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/26/2018] [Accepted: 12/26/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Urinary Tract Infection (UTI) is a common infection in children. Prompt diagnosis and appropriate treatment are very important to reduce the morbidity associated with this condition. OBJECTIVE To provide an update on the evaluation, diagnosis, and treatment of urinary tract infection in children. METHODS A PubMed search was completed in clinical queries using the key terms "urinary tract infection", "pyelonephritis" OR "cystitis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature and the pediatric age group. Patents were searched using the key terms "urinary tract infection" "pyelonephritis" OR "cystitis" from www.google.com/patents, http://espacenet.com, and www.freepatentsonline.com. RESULTS Escherichia coli accounts for 80 to 90% of UTI in children. The symptoms and signs are nonspecific throughout infancy. Unexplained fever is the most common symptom of UTI during the first two years of life. After the second year of life, symptoms and signs of pyelonephritis include fever, chills, rigor, flank pain, and costovertebral angle tenderness. Lower tract symptoms and signs include suprapubic pain, dysuria, urinary frequency, urgency, cloudy urine, malodorous urine, and suprapubic tenderness. A urinalysis and urine culture should be performed when UTI is suspected. In the work-up of children with UTI, physicians must judiciously utilize imaging studies to minimize exposure of children to radiation. While waiting for the culture results, prompt antibiotic therapy is indicated for symptomatic UTI based on clinical findings and positive urinalysis to eradicate the infection and improve clinical outcome. The choice of antibiotics should take into consideration local data on antibiotic resistance patterns. Recent patents related to the management of UTI are discussed. CONCLUSION Currently, a second or third generation cephalosporin and amoxicillin-clavulanate are drugs of choice in the treatment of acute uncomplicated UTI. Parenteral antibiotic therapy is recommended for infants ≤ 2 months and any child who is toxic-looking, hemodynamically unstable, immunocompromised, unable to tolerate oral medication, or not responding to oral medication. A combination of intravenous ampicillin and intravenous/intramuscular gentamycin or a third-generation cephalosporin can be used in those situations. Routine antimicrobial prophylaxis is rarely justified, but continuous antimicrobial prophylaxis should be considered for children with frequent febrile UTI.
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Affiliation(s)
- Alexander K.C. Leung
- Address correspondence to this author at the Department of Pediatrics, the University of Calgary, Alberta Children’s Hospital, #200, 233 – 16th Avenue NW, Calgary, Alberta, Canada; Tel: (403) 230 3300; Fax: (403) 230 3322; E-mail:
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85
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D'Alonzo R, Mencaroni E, Di Genova L, Laino D, Principi N, Esposito S. Pathogenesis and Treatment of Neurologic Diseases Associated With Mycoplasma pneumoniae Infection. Front Microbiol 2018; 9:2751. [PMID: 30515139 PMCID: PMC6255859 DOI: 10.3389/fmicb.2018.02751] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 10/26/2018] [Indexed: 12/14/2022] Open
Abstract
Mycoplasma pneumoniae is mainly recognized as a respiratory pathogen, although it is associated with the development of several extra-respiratory conditions in up to 25% of the cases. Diseases affecting the nervous system, both the peripheral (PNS) and the central nervous system (CNS), are the most severe. In some cases, particularly those that involve the CNS, M. pneumoniae-related neuropathies can lead to death or to persistent neurologic problems with a significant impact on health and a non-marginal reduction in the quality of life of the patients. However, the pathogenesis of most of the M. pneumoniae-related neuropathies remains undefined. The main aim of this paper is to discuss what is presently known regarding the pathogenesis and treatment of the most common neurologic disorders associated with M. pneumoniae infection. Unfortunately, the lack of knowledge of the true pathogenesis of most of the cases of M. pneumoniae-mediated neurological diseases explains why treatment is not precisely defined. However, antibiotic treatment with drugs that are active against M. pneumoniae and able to pass the blood-brain barrier is recommended, even though the best drug, dosage, and duration of therapy have not been established. Sporadic clinical reports seem to indicate that because immunity plays a relevant role in the severity of the condition and outcome, attempts to reduce the immune response can be useful. However, further studies are needed before the problem of the best therapy for M. pneumoniae-mediated neurological diseases can be efficiently solved.
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Affiliation(s)
- Renato D'Alonzo
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Elisabetta Mencaroni
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Lorenza Di Genova
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Daniela Laino
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
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Moxifloxacin in Pediatric Patients With Complicated Intra-abdominal Infections: Results of the MOXIPEDIA Randomized Controlled Study. Pediatr Infect Dis J 2018; 37:e207-e213. [PMID: 29356761 DOI: 10.1097/inf.0000000000001910] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study was designed to evaluate primarily the safety and also the efficacy of moxifloxacin (MXF) in children with complicated intra-abdominal infections (cIAIs). METHODS In this multicenter, randomized, double-blind, controlled study, 451 pediatric patients aged 3 months to 17 years with cIAIs were treated with intravenous/oral MXF (N = 301) or comparator (COMP, intravenous ertapenem followed by oral amoxicillin/clavulanate; N = 150) for 5 to 14 days. Doses of MXF were selected based on the results of a Phase 1 study in pediatric patients (NCT01049022). The primary endpoint was safety, with particular focus on cardiac and musculoskeletal safety; clinical and bacteriologic efficacy at test of cure was also investigated. RESULTS The proportion of patients with adverse events (AEs) was comparable between the 2 treatment arms (MXF: 58.1% and COMP: 54.7%). The incidence of drug-related AEs was higher in the MXF arm than in the COMP arm (14.3% and 6.7%, respectively). No cases of QTc interval prolongation-related morbidity or mortality were observed. The proportion of patients with musculoskeletal AEs was comparable between treatment arms; no drug-related events were reported. Clinical cure rates were 84.6% and 95.5% in the MXF and COMP arms, respectively, in patients with confirmed pathogen(s) at baseline. CONCLUSIONS MXF treatment was well tolerated in children with cIAIs. However, a lower clinical cure rate was observed with MXF treatment compared with COMP. This study does not support a recommendation of MXF for children with cIAIs when alternative more efficacious antibiotics with better safety profile are available.
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Abstract
Antimicrobial resistance is a global public health threat and a danger that continues to escalate. These menacing bacteria are having an impact on all populations; however, until recently, the increasing trend in drug-resistant infections in infants and children has gone relatively unrecognized. This article highlights the current clinical and molecular data regarding infection with antibiotic-resistant bacteria in children, with an emphasis on transmissible resistance and spread via horizontal gene transfer.
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Affiliation(s)
- Rachel L Medernach
- Department of Pediatrics, Rush Medical College, Rush University Medical Center, 1710 W. Harrison Street, Suite 710 POB, Chicago, IL 60612, USA
| | - Latania K Logan
- Department of Pediatrics, Rush Medical College, Rush University Medical Center, 1710 W. Harrison Street, Suite 710 POB, Chicago, IL 60612, USA.
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Meesters K, Mauel R, Dhont E, Walle JV, De Bruyne P. Systemic fluoroquinolone prescriptions for hospitalized children in Belgium, results of a multicenter retrospective drug utilization study. BMC Infect Dis 2018; 18:89. [PMID: 29471791 PMCID: PMC5824605 DOI: 10.1186/s12879-018-2994-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/14/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Fluoroquinolones (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. METHODS Using 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. CONCLUSIONS FQ 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.
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Affiliation(s)
- Kevin Meesters
- Department of Pediatrics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
- Department of Pediatrics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Reiner Mauel
- Department of Pediatrics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
- Department of Pediatrics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Evelyn Dhont
- Pediatric Intensive Care Unit, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Johan Vande Walle
- Department of Pediatrics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Pauline De Bruyne
- Department of Pediatrics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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Yoo S, Choi SE, Chun J, Ahn YH, Cho KY, Lee YJ, Sung TJ, Lee KH. Current usage and effects of steroids in the management of childhood mycoplasma pneumonia in a secondary hospital. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.2.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Susie Yoo
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Seong Eun Choi
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Jiyoung Chun
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Yo Han Ahn
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Ky Young Cho
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Yong Ju Lee
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Tae Jung Sung
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Kon Hee Lee
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
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Lee H, Yun KW, Lee HJ, Choi EH. Antimicrobial therapy of macrolide-resistantMycoplasma pneumoniaepneumonia in children. Expert Rev Anti Infect Ther 2017; 16:23-34. [DOI: 10.1080/14787210.2018.1414599] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Hyunju Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ki Wook Yun
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, South Korea
| | - Hoan Jong Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, South Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, South Korea
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