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Chapter 22 : Quinolones in Pediatrics
Category: Clinical Microbiology
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Quinolones are bactericidal and active against a wide range of gram-positive and gram-negative bacterial pathogens relevant to pediatric infections. These include Pseudomonas aeruginosa, nosocomially acquired Enterobacteriaceae, methicillin-sensitive and methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis. Widespread use of fluoroquinolones has resulted in emergence of resistance; therefore, it is important to give careful thought to the site of infection and pathogens in each patient. Use of fluoroquinolones in children should be strictly limited to the specific infections complicated by special conditions for which the benefit of these drugs is clear and for which no alternative safe and effective antibiotic therapy is available. Quinolones penetrate well into tissues, especially into infected tissues, and are accumulated within macrophages and the polymorphonuclear leukocytes. Photosensitivity occurs most often with agents containing a halogen substituent at the 8 position, such as lomefloxacin, clinafloxacin, and sparfloxacin. Experience with the use of quinolones in children has increased, particularly in children with cystic fibrosis who are given ciprofloxacin. Antibiotic therapy has been shown to be a major factor in improving survival in patients with cystic fibrosis. Gastrointestinal infections are a major health problem in infants and children worldwide, causing severe morbidity and mortality. Ciprofloxacin has been shown to be an effective agent in the treatment of osteomyelitis, especially when the pathogen is a gram-negative organism. In neonates, besides gram-negative organisms, pathogens such as Listeria monocytogenes, group B streptococci, and Mycoplasma hominis are also susceptible to gatifloxacin, moxifloxacin, and clinafloxacin.