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| |  ECF: Fluoroquinolones Appear Safe In Children With Cystic Fibrosis By Martin Goldman Special to DG News
VIENNA, AUSTRIA -- June 8, 2001 -- At the 24th European Cystic Fibrosis conference in Vienna, Austria, researchers report that, in the long term, fluoroquinolones are not likely to cause arthropathy in patients with cystic fibrosis, and that any changes appear to be reversible. Dr. S. Postnikov and her colleagues from the Russian State Medical University and two Russian children’s hospital, in Moscow, Russia, investigated the comparative tolerability of fluoroquinolones in patients with cystic fibrosis (CF). The researchers paid particular attention to the arthrotoxicity of fluoroquinolones in children with CF. Fluoroquinolones are always used in combination with aminoglycosides or cephalosporins for the management of respiratory infection or colonisation. They investigated 144 children with CF aged six months to 16 years. The patients were divided into three groups; they were treated with one of the following agents: ciprofloxacin (86 patients), ofloxacin 19 patients, or pefloxacin (39 patients). Ofloxacin concentration was determined in 10 children on the fourth day of therapy by high-performance liquid chromatography (HPLC). Height velocity was measured over three to five years. Post-mortem examination was performed on 10 patients aged 3.5 to 10 years who did not have any signs or symptoms of fluoroquinolone arthropathy while on the medication. Total duration of fluoroquinolone therapy in this group was between 14-326 days. There was no evidence of arthropathy on post-mortem examination. Height velocity was no different in the patients receiving fluoroquinolones compared with a control group of children not receiving fluoroquinolone therapy. Pefloxacin, more than any other fluoroquinolone, was associated with the development of arthropathy. However, this side effect resolved either spontaneously or with non-steroidal anti-inflammatory drug therapy after ceasing fluoroquinolone therapy. Ofloxacin was not associated with arthropathy, even when achieving serum concentrations above 4mg/mL. The authors concluded that fluoroquinolone-induced arthropathy has antibiotic and age dependent peculiarities, and that any arthropathy is completely reversible. There was no evidence of cartilaginous injury at postmortem examination, they said. While pefloxacin is the agent most likely to be associated with an arthropathy, the whole issue of the relative contraindication of fluoroquinolone deserves re-evaluation, as they are unlikely to harm CF patients in the long term, and any changes appear to be reversible, and do not interfere with growth.
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