Pefloxacin in steroid dependent and resistant idiopathic nephrotic syndrome.

Children with nephrotic syndrome who are either steroid dependent or resistant are difficult to manage. Ten children (age 8-14 years, mean 13.2 years) with idiopathic nephrotic syndrome (5 steroid dependent, 5 steroid resistant) formed the study group. All of them had received a course of cyclophosphamide at least six months previously and were now given pefloxacin in the dose of 200mg to 400mg twice daily (mean dose 2-4.6mg/kg/daily) for 4 to 8 weeks. They did not get steroid along with pefloxacin. After a mean follow up period of 18 weeks (12-20 weeks), 7 patients were in remission (2 complete, 5 partial), while 2 patients did not show any response; one patient discontinued pefloxacin within 2 weeks of start of therapy due to nausea and vomiting. One patient developed arthralgia and another discoloration of nails. There was a significant reduction in proteinuria after pefloxacin therapy (pre-3.6+/-2.02gm/24h; post 1.9+/-1.8gm/24h, p<0.006), and side effects were minimal and reversible. Thus for the subgroup of idiopathic nephrotic children who are steroid dependent or resistant and do not respond to a course of cyclophosphamide, pefloxacin could be helpful in inducing remission.