Ciprofloxacin in preterm neonates: case report and review of the literature

Abstract

We report the use of ciprofloxacin in a preterm boy suffering from an invasive multiple resistant Enterobacter cloacae infection. The treatment was effective, after other antibiotics failed, and no adverse effects were observed during 3 years of follow up. The literature on compassionate ciprofloxacin use in 28 preterm or low birth weight infants is reviewed. Ciprofloxacin has been used to treat neonatal pneumonia, meningitis and septicaemia and was effective in all cases. Side-effects were limited to dental dyschromia and one observation on the emergence of resistance. Pharmacokinetics of ciprofloxacin were studied in seven preterm infants; iv doses ranging from 4 to 40 mg/kg per day revealed adequate serum peak concentrations (0.98-5.7 mg/l) but trough-peak ratios were high (median ratio: 32%), suggesting slower elimination in preterm infants as compared to older children. CSF concentrations were 0.10-1.45 mg/l.

Conclusion: Ciprofloxacin treatment of preterm or low birth weight infants may be effective and without severe side effects in infections with bacteria resistant to other antibiotics