Abdullah A Alghasham and Milap C Nahata

O B J E C T I V E: To review the pharmacokinetics, efficacy, and safety of fluoroquinolones in children.

D A T A S O U R C E S: A MEDLINE search (January 1966–March 1998) was conducted for relevant literature.

Excerpts:

"Quinolone-induced arthropathy and arthralgia has been rarely reported in children without cystic fibrosis. The first report was a case of destructive polyarthropathy in a 17-year-old boy after administration of Pefloxacin 800 mg/d for three months. The patient initially presented with joint

pain and swelling, which deteriorated over three months and resulted in progressive difficulty in walking. X-ray findings showed severe destructive polyarthropathy. Microscopic examination of the cartilage and synovial biopsies revealed fibrosis of the synovial tissue and articular cartilage. Total bilateral knee and right hip replacements were needed. Arthropathy occurred in a 12-year-old girl treated with oral Pefloxacin 400 mg twice daily for typhoid fever. The patient presented with joint pain, fever, and difficulty in rising from bed. The pain did not resolve with nonsteroidal anti-inflammatory agents. Pain in all joints resolved except for left knee pain that lasted for three months. There were no abnormal laboratory or X-ray findings in the joints. The third case involved arthropathy in a 15- year-old patient receiving intravenous Pefloxacin 400 mg every 12 hours. Pain, swelling, and redness were noted in six joints. Plain X-ray studies of the right elbow showed no abnormalities, and magnetic resonance imaging (MRI) revealed joint effusion and enhancement of the surrounding muscles and the synovial tissues. Technetium bone scans demonstrated increased initial dynamic perfusion, blood pool at five minutes, and delayed bony uptake at four static images in the right elbow. Pain resolved over two to eight weeks after Pefloxacin was discontinued. Ten months later, the M R I was normal; however, technetium bone scans showed persistent abnormalities.

Several studies have been conducted to detect cartilage lesions caused by quinolones using radiological and MRI evaluations. Twenty-nine children (age 4–18 y) with cystic fibrosis were evaluated for quinolone-induced arthropathy using MRI.141 Fourteen patients (group 1) were treated with Ciprofloxacin or ofloxacin at doses of 20 mg/kg/d for four to 28 days. The remaining 15 patients (group 2) were in a control group, given no quinolones. Transient arthralgia occurred in six patients in group 1 and four patients in group 2. Seven patients (50%) in group 1 developed changes in the reference joint (left knee) on MRI. In group 2, seven of 10 (70%) had these changes on MRI. "

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