Fluoroquinolones in Children With Fever and Neutropenia: A Systematic Review of Prospective Trials

  title={Fluoroquinolones in Children With Fever and Neutropenia: A Systematic Review of Prospective Trials},
  author={Lillian Sung and Arif Manji and Joseph Beyene and Lee L. Dupuis and Sarah Alexander and Robert Phillips and Thomas Lehrnbecher},
  journal={The Pediatric Infectious Disease Journal},
Background: There has been reluctance to use fluoroquinolones in children because of arthropathy in animal models; experience in pediatric fever and neutropenia (FN) has been limited. Our primary objective was to describe the effectiveness and safety of fluoroquinolones as empiric therapy for children with FN. Methods: We conducted electronic searches of Ovid Medline, EMBASE, the Cochrane Central Register of Controlled Trials, and limited studies to prospective pediatric trials in which any… 

Rationalizing the approach to children with fever in neutropenia

First-day outpatient management, with oral or intravenous antibiotics, is now known to be efficacious and cost-effective for pediatric low-risk fever in neutropenia.

Systemic use of fluoroquinolone in children

An updated review on the safety and current recommendations for using fluoroquinolones in children and how they may be particularly helpful in treating multidrug-resistant infections that have not responded to standard antibiotic therapy in immunocompromised patients is provided.

Appropriate use of fluoroquinolones in children.

Clinical and Microbiologic Outcomes of Quinolone Prophylaxis in Children With Acute Myeloid Leukemia

The use of ciprofloxacin prophylaxis (CPx) in children with pediatric acute myeloid leukemia did not alter the incidence of overall bacteremia nor change the pattern of fever or use of supportive care, and this experience supports further investigation into the use of extended-spectrum quinolone proPHylaxis during therapy for pediatric AML.

in Hospitalized Children: Approved or Off‑label?

The majority of children were receiving ciprofloxacin off-label and in an inappropriate manner, and this issue emphasizes that antimicrobial stewardship program in pediatric hospitals should be implemented.

Strategies for Empiric Management of Pediatric Fever and Neutropenia in Patients With Cancer and Hematopoietic Stem-Cell Transplantation Recipients: A Systematic Review of Randomized Trials.

Monotherapy for high-risk FN and outpatient and oral management for low- risk FN are effective strategies and will provide the basis for guideline recommendations in pediatric FN.

Management of children with fever and neutropenia: results of a survey in 51 pediatric cancer centers in Germany, Austria, and Switzerland

An Internet-based survey was conducted in 2016 concerning the management of febrile neutropenia in pediatric oncology centers (POC) to document current practice before its implementation in clinical practice.

The Use of Systemic and Topical Fluoroquinolones

Their use in children should continue to be limited to the treatment of infections for which no safe and effective alternative exists or in situations in which oral fluoroquinolone treatment represents a reasonable alternative to parenteral antimicrobial therapy.

Current ciprofloxacin usage in children hospitalized in a referral hospital in Paris

Looking to the ecological risk of fluoroquinolones and the increase consumption in children population, it is thought that a control program should be developed to control FQ use in children.


Topical Ciprofloxacin is a better drug for the treatment of CSOM as compared to topical Neomycin, and is more effective in earlier control of congestion and discharge of ear in CSOM.



A systematic review and meta-analysis of anti-pseudomonal penicillins and carbapenems in pediatric febrile neutropenia

A meta-analysis suggests that APP–aminoglycoside, APP monotherapy, and carbapenem monotherapy are all efficacious therapeutic options for the empiric management of pediatric FN.

Safety profile of quinolone antibiotics in the pediatric population.

  • R. Grady
  • Medicine, Biology
    The Pediatric infectious disease journal
  • 2003
A review of retrospective and prospective safety data of ciprofloxacin-treated children showed that the rates of arthralgia and quinolone-induced cartilage toxicity were low and the role of fluoroquinolones in the treatment of certain serious infections in children does not appear to be compromised by safety concerns when used appropriately.

Comparative Safety Profile of Levofloxacin in 2523 Children With a Focus on Four Specific Musculoskeletal Disorders

The incidence of 1 or more of the 4 predefined musculoskeletal disorders identified in nonblinded, prospective evaluations, was statistically greater in levofloxacin-treated compared with comparator-treated children.

Comparative Study of Levofloxacin in the Treatment of Children With Community-Acquired Pneumonia

Levofloxacin was as well tolerated and effective as standard-of-care antibiotics for the treatment of CAP in infants and children.

Systemic quinolone antibiotics in children: a review of the use and safety

  • R. Grady
  • Medicine, Biology
    Expert opinion on drug safety
  • 2005
Historically, healthcare providers have reluctantly used systemic quinolone antibiotics to treat infections in children when they have been used at all. Concerns regarding the oral or parenteral use

Randomized Control Trial Comparing Oral Amoxicillin-clavulanate and Ofloxacin With Intravenous Ceftriaxone and Amikacin as Outpatient Therapy in Pediatric Low-risk Febrile Neutropenia

Outpatient therapy is efficacious and safe in pediatric LRFN and ofloxacin may be the oral regimen of choice, and diarrhea in IV arm and Vincristine, actinomycin-D, and cyclophosphamide chemotherapy in the oral arm predicted failure in subgroup analysis.

Oral ciprofloxacin vs. intravenous ceftriaxone administered in an outpatient setting for fever and neutropenia in low-risk pediatric oncology patients: randomized prospective trial.

Outpatient therapy with either oral ciprofloxacin or intravenous ceftriaxone for fever and neutropenia is effective and safe in pediatric patients with solid tumors and stage I/II non-Hodgkin lymphoma (low-risk patients).

Emperical Oral Antibiotic Therapy for Children with Low Risk Febrile Neutropenia during Cancer Chemotherapy

In hospitalized low risk patients who have fever and neutropenia, empirical therapy with oral ofloxacin and amoxy-clav may be a safe alternative to IV antibiotics.

Oral vs. intravenous empirical antimicrobial therapy in febrile neutropenic patients receiving childhood cancer chemotherapy.

There is need of larger randomized trials before oral empirical therapy administered to this population should be considered the new standard of treatment for febrile neutropenic patients, as there was no difference in the outcome in oral vs. intravenous therapy.

Oral gatifloxacin in the outpatient treatment of children with cancer fever and neutropenia

Oral GA is evaluated in oncology pediatric patients with FN and low risk of infectious complications and Gatifloxacin is an alternative, which has not been thoroughly studied in Pediatrics yet.