Fluoroquinolones should be considered in specific situations when there is no safe, effective alternative.

In a clinical report published online Oct. 31 in Pediatrics, guidelines are presented for the use of systemic and topical fluoroquinolones in children.

Mary Anne Jackson, M.D., and colleagues from the American Academy of Pediatrics Committee on Infectious Diseases discuss the use of systemic and topical fluoroquinolones in children.

The researchers note that fluoroquinolones are broad-spectrum agents which should be considered for use in specific situations. These include infection caused by a multidrug-resistant pathogen for which there is no alternative that is safe and effective, and for situations in which oral fluoroquinolone therapy is an acceptable alternative to parenteral non-fluoroquinolone therapy. Fluoroquinolones may also represent a preferred option or an acceptable alternative to standard therapy due to concerns of antimicrobial resistance, toxicity, or tissue penetration characteristics.

“In the case of fluoroquinolones, as is appropriate with all antimicrobial agents, prescribing clinicians should verbally review common, anticipated, potential adverse events, such as rash, diarrhea, and potential musculoskeletal or neurologic events and indicate why a fluoroquinolone is the most appropriate antibiotic agent for a child’s infection,” the authors write.


Most Common Infections for Which Fluoroquinolones Are Effective Therapy

Infection Primary Pathogen(s)a Fluoroquinolone
Systemic antibiotic requirementb
 UTI Escherichia coli, Pseudomonas aeruginosa, Enterobacter species, Citrobacter species, Serratia species Ciprofloxacinc
 Acute otitis media, sinusitis Streptococcus pneumoniae, Haemophilus influenzae Levofloxacind
 Pneumonia S pneumoniae, Mycoplasma pneumoniae (macrolides preferred for Mycoplasma infections) Levofloxacind
 Gastrointestinal infections Salmonella species, Shigella species Ciprofloxacinc
Topical antibiotic requiremente
 Conjunctivitis S pneumoniae, H influenza Besifloxacin, levofloxacin, gatifloxacin, ciprofloxacin, moxifloxacin, ofloxacin
 Acute otitis externa, tympanostomy tube–associated otorrhea P aeruginosa, Staphylococcus aureus, mixed Gram-positive/Gram-negative organisms Ciprofloxacin,f ofloxacin
  • a Assuming that the pathogen is either documented to be susceptible or presumed to be susceptible to fluoroquinolones.

  • b If oral therapy is appropriate, use other classes of oral antibiotics if organisms are susceptible.

  • c Dose of ciprofloxacin. Oral administration: 20–40 mg/kg per day, divided every 12 hours (maximum dose: 750 mg/dose); IV administration: 20–30 mg/kg per day, divided every 8–12 hours (maximum dose: 400 mg/dose).

  • d Dose of levofloxacin. Oral or IV administration: for children 6 months to 5 years of age, 16–20 mg/kg per day divided every 12 hours; for children 5 years and older, 10 mg/kg per day once daily (maximum dose: 750 mg/dose).

  • e Systemic toxicity of fluoroquinolones is not a concern with topical therapy: the use of topical agents should be determined by suspected pathogens, efficacy for mucosal infection, tolerability, and cost. Other systemic therapy may be required for more severe infection.

  • f Available with and without corticosteroid.

Source: CDC