Fluoroquinolones in pediatrics and their nephrotoxicity in adults: minireview

Long-term toxicity of fluoroquinolones: a comprehensive review

Fluoroquinolones (FQs) are highly potent bactericidal antibiotics with broad-spectrum activity against Gram-negative/positive bacteria. The Food and Drug Administration (FDA) anticipated the presence of a long-lasting incapacity of Fluoroquinolone Associated Toxicity (FQAT), which is not officially documented yet. This review aimed to précis the existing information on FQA long-term toxicity, such as cardiotoxicity, aortic aneurysm, tendon rupture, nephrotoxicity, hepatotoxicity, peripheral neuropathy, vagus nervous dysfunction, reactive oxygen species (ROS), phototoxicity, glucose hemostasis, and central nervous system (CNS) toxicity. We are focused on the CNS toxicity of FQs, either due to the direct action of the FQs on CNS receptors or by other drug co-administration, including nonsteroidal anti-inflammatory disease (NSAIDs) and theophylline. Due to the nature of the R7 side chain, FQs containing unsubstituted 7-piperazine and 7-pyrrolidine have the most significant effect. The gamma-aminobutyric acid-A (GABAA) receptor and CNS effects are inhibited through at least three possible mechanisms. Firstly, by the pharmacological action of the quinolone directly. Secondly, FQ-NSAIDs interact pharmacodynamically in which the interaction between the FQ and a receptor is significantly altered by the presence of another drug that interacts with the same receptor. An example may be the interaction between NSAIDs and some FQs. Thirdly, a pharmacokinetic drug-drug interaction leads to a higher concentration of quinolone or the other drug. An example may be the interaction between theophylline and benzodiazepines with some FQs.

Pediatric urinary tract infections: the role of fluoroquinolones

Infections of the urinary tract (UTI) occur commonly in the pediatric population. Because of the high association of pediatric UTI with congenital structural anomalies of the urinary tract and with dysfunctional elimination syndromes, it is far more common for children to be categorized as having complicated UTI than their adult counterparts. And for children more intensive therapy is often required. Early and effective treatment of UTIs in the pediatric patient is considered essential to prevent long term morbidity and potential mortality from end stage renal disease. An oral antimicrobial is more convenient than parenteral therapy and is preferable as long as clinical efficacy and safety can be assured. Oral fluoroquinolones are an attractive alternative for the treatment of complicated UTI in children, and safety must always be a factor in considering their use in this population. Although the role of fluoroquinolones in pediatric UTI is still under investigation, the limited data available demonstrate a likelihood of efficacy and safety.

Safety of fluoroquinolones in paediatrics

In the last few years, there has been increasing pressure to use fluoroquinolones in paediatric patients, since these antibiotics offer the advantage of an oral treatment regimen on an out-patient basis. However, even although this class of antibiotics generally remains well-tolerated, the restriction of fluoroquinolone use in children on a compassionate basis, which derives from their potential to cause cartilage toxicity, limits the safety data in this population and suggests a cautious use. This review reports the data of the literature on the safety of fluoroquinolones in different districts, focusing on the side effects in children and drug interactions. Moreover, data available in the literature with regards to side effects in children are reported, with particular attention to their potential in arthropathy.

Urinary tract infection: new perspectives on a common disease

Urinary tract infection is an important cause of morbidity in children, and affects up to 10% of the childhood population. Recent information suggests that the long-term outcome for children with urinary tract infection is much better than previously believed, with causal links to end-stage renal disease and hypertension not demonstrated despite 20-year cohort studies. Improvements in the use of dipstick and clinical features as diagnostic tools have occurred, but culture is still needed if the diagnosis of urinary tract infection is to be definitively established. Interventions to prevent recurrent urinary tract infection, particularly low-dose, long-term antimicrobial agents may not be effective and placebo-controlled trials are now required.