BACKGROUND: There has been reluctance to use fluoroquinolones in children because of arthropathy in animal models; experience in pediatric fever and neutropenia (FN) has been limited. Our primary objective was to describe the effectiveness and safety of fluoroquinolones as empiric therapy for children with FN. METHODS: We conducted electronic searches of Ovid Medline, EMBASE, the Cochrane Central Register of Controlled Trials, and limited studies to prospective pediatric trials in which any type of fluoroquinolone was administered as empiric therapy for FN. RESULTS: Of the 7281 reviewed articles, 10 were included in the meta-analysis that encompassed 740 episodes of FN. All studies consisted of low-risk FN episodes. The risk of treatment failure was 17% among those given ciprofloxacin monotherapy (n = 5 studies), 17% among those given nonciprofloxacin fluoroquinolone monotherapy (n = 2 studies), and 24% among those given fluoroquinolone combination therapy (n = 3 studies; P = 0.80). There were no cases of infectious deaths reported. Rates of sepsis and adverse events were very low. CONCLUSION: Experience with fluoroquinolones demonstrates excellent outcomes and short-term safety, although reported studies have been restricted to low-risk patients. Fluoroquinolones can be comfortably adopted for low-risk FN, although experience in high-risk FN is uncertain in pediatrics.
BACKGROUND: There has been reluctance to use fluoroquinolones in children because of arthropathy in animal models; experience in pediatric fever and neutropenia (FN) has been limited. Our primary objective was to describe the effectiveness and safety of fluoroquinolones as empiric therapy for children with FN. METHODS: We conducted electronic searches of Ovid Medline, EMBASE, the Cochrane Central Register of Controlled Trials, and limited studies to prospective pediatric trials in which any type of fluoroquinolone was administered as empiric therapy for FN. RESULTS: Of the 7281 reviewed articles, 10 were included in the meta-analysis that encompassed 740 episodes of FN. All studies consisted of low-risk FN episodes. The risk of treatment failure was 17% among those given ciprofloxacin monotherapy (n = 5 studies), 17% among those given nonciprofloxacin fluoroquinolone monotherapy (n = 2 studies), and 24% among those given fluoroquinolone combination therapy (n = 3 studies; P = 0.80). There were no cases of infectious deaths reported. Rates of sepsis and adverse events were very low. CONCLUSION: Experience with fluoroquinolones demonstrates excellent outcomes and short-term safety, although reported studies have been restricted to low-risk patients. Fluoroquinolones can be comfortably adopted for low-risk FN, although experience in high-risk FN is uncertain in pediatrics.
Authors: Adam J Esbenshade; M Cecilia Di Pentima; Zhiguo Zhao; Ayumi Shintani; Jennifer C Esbenshade; Monique E Simpson; Kathleen C Montgomery; Robert B Lindell; Haerin Lee; Ato Wallace; Kelly L Garcia; Karel G M Moons; Debra L Friedman Journal: Pediatr Blood Cancer Date: 2014-10-18 Impact factor: 3.167
Authors: Ar Nateghian; Jl Robinson; P Vosough; M Navidinia; M Malekan; A Mehrvar; B Sobouti; P Bahadoran; Z Gholinejad Journal: Mediterr J Hematol Infect Dis Date: 2014-07-01 Impact factor: 2.576
Authors: Arne Simon; Rhoikos Furtwängler; Norbert Graf; Hans Jürgen Laws; Sebastian Voigt; Brar Piening; Christine Geffers; Philipp Agyeman; Roland A Ammann Journal: GMS Hyg Infect Control Date: 2016-05-12
Authors: Max Scheler; Thomas Lehrnbecher; Andreas H Groll; Ruth Volland; Hans-Jürgen Laws; Roland A Ammann; Philipp Agyeman; Andishe Attarbaschi; Margaux Lux; Arne Simon Journal: Infection Date: 2020-06-10 Impact factor: 3.553