question regarding quinolones

[o0rikio0o]

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so i've read that quinolones are contraindicated in the pediatric population due to animal models showing arrested cartilage growth plates, so what should be given to children rather than quinolones? lets say for example a UTI...

 

[WhatUpDoc!]

lets say for example a UTI...

Amoxicillin or a cephalosporin, empirically of course

 

[waster]

first line for uncomplicated UTI is going to be trimethoprim or nitrofurantoin.

 

[Stitch]

so i've read that quinolones are contraindicated in the pediatric population due to animal models showing arrested cartilage growth plates, so what should be given to children rather than quinolones? lets say for example a UTI...

there's pretty widespread quinolone resistance going around, and I wouldn't recommend treating a UTI in either population with a quinolone (wonder if the adult guys would agree, but that's what I've been reading lately). Amox is fine if you know it's something like e. coli, same for omnicef. Without knowing, however you have to account for other enterics. "Never treat an entero with a cephalo' is a good motto to have due to induced resistance during treatment. When I see a UA suggestive of UTI, I generally use Septra/Bactrim unless there's a known history with a specific bug and documented susceptibility. Younger kids (say under 6-8 months with assumed pyelo) get IV cefotaxime or ceftriaxone in addition to ampicillin.

 

[rotatores]

first line for uncomplicated UTI is going to be trimethoprim or nitrofurantoin.

Umm..no! Never once seen Macrobid (nitrofurantoin) used in pediatrics, unless maybe for a pregnant teenager. This is typically an OB med.

 

[CrazyPeds527]

The empiric treatment may vary from hospital to hospital based on local resistance rates. For example, we don't use a lot of amoxicillin because our local resistance is approaching 20%, instead we use cephalosporins and bactrim.

In peds, i haven't seen quinolones used in pre-pubertal kids without ID's giving their approval in the setting of very resistant bacteria or patient medical allergies.

The quinolone problem (arthropathy, joint cartilage problems, etc) has only been studied in beagle puppies (try to get that pediatric study past the IRB!) which is why ID folks will give the OK for special situations.

 

[bks524]

There have also been reports of tendon rupture in adults following quinilone use

 

[Marigold]

In accordance with local resistance patterns, we typically use a 3rd gen cephalosporin...like Suprax (cefixime) or Vantin (Cefpodoxime).

 

[generic]

I do see urologists using Nitrofurantoin(s) for chronic suppressive therapy in children with known VUR


Also, CF patients get ciprofloxacin fairly often...I wonder at what age they decide it's OK to use? Of course, that's a different population that often needs antibiotics that you wouldn't ever use in an otherwise healthy child...