Fluoroquinolones in children with fever and neutropenia: a systematic review of prospective trials

Abstract

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 type of fluoroquinolone was administered as empiric therapy for FN.

Results: Of the 7281 reviewed articles, 10 were included in the meta-analysis that encompassed 740 episodes of FN. All studies consisted of low-risk FN episodes. The risk of treatment failure was 17% among those given ciprofloxacin monotherapy (n = 5 studies), 17% among those given nonciprofloxacin fluoroquinolone monotherapy (n = 2 studies), and 24% among those given fluoroquinolone combination therapy (n = 3 studies; P = 0.80). There were no cases of infectious deaths reported. Rates of sepsis and adverse events were very low.

Conclusion: Experience with fluoroquinolones demonstrates excellent outcomes and short-term safety, although reported studies have been restricted to low-risk patients. Fluoroquinolones can be comfortably adopted for low-risk FN, although experience in high-risk FN is uncertain in pediatrics.