Arthralgias, myalgias are transient
A large multicenter, prospective, non-blinded cohort study evaluated adverse effects in children receiving fluoroquinolones versus other antibiotics.3 Duration of fluoroquinolone use was 1 to 23 days. Arthralgias or myalgias, which were only evaluated clinically, occurred more often in children receiving fluoroquinolones—10 of 276 children (3.6%) vs 1 of 249 (0.3%), respectively (odds ratio [OR]=9.3; 95% CI, 1.2-195; P=.02). All events occurred within the first 2 weeks of fluoroquinolone treatment and resolved within 20 days. No tendonopathies were reported.
Tendon rupture is rare, especially in children
A 1996 study reported the incidence of tendon disorders related to fluoroquinolones using drug surveillance data from the general population. The average age of the patients was 55 years.4
The author estimated the risk of tendon rupture associated with norfloxacin or ofloxacin to be 1 case per 23,130 days of treatment and only 1 case per 779,600 days of ciprofloxacin treatment. The estimated risk would likely be even lower in children, the author noted, because the risk of tendon rupture increases with age.
Recommendations
Ciprofloxacin is the only fluoroquinolone approved by the US Food and Drug Administration for pediatric indications. The FDA recently ordered the addition of a Boxed Warning to fluoroquinolones regarding the increased risk of tendonitis and tendon rupture. The FDA made no comments specifically about children or adolescents, and stated that the risks are increased in people older than 60.
The American Academy of Pediatrics recommends limiting fluoroquinolone use to children with infections caused by multidrug-resistant pathogens or children for whom parenteral therapy is not feasible and no other effective oral medication is available.5
The Agency for Healthcare Research and Quality (AHRQ) recommends fluoroquinolones as first-line treatment for children with uncomplicated gonorrhea who weigh more than 45 kg,6 and second-line therapy for children with bacterial meningitis,7 nongonococcal urethritis, chlamydia,6 or pelvic inflammatory disease.8
Acknowledgments
The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the US Government.