Arthropathy fluoroquinolones

The answer is a. (Katzung, p 800.) Fluoroquinolones are not recommended in patients less than 18 years old. They have a tendency to damage growing cartilage and cause arthropathy The arthropathy is generally reversible. Tendinitis may occur, and in rare instances in adults, this finding may lead to tendon ruptures. 

Fluoroquinolones may damage growing cartilage and cause an arthropathy. Thus, these drugs are not routinely recommended for patients under 18 years of age. However, the arthropathy is reversible, and there is a growing consensus that fluoroquinolones may be used in children in some cases (eg, for treatment of pseudomonal infections in patients with cystic fibrosis). Tendinitis, a rare complication that has been reported in adults, is potentially more serious because of the risk of tendon rupture. Risk factors for tendonitis include advanced age, renal insufficiency, and concurrent... 

Contraindications Fluoroquinolones should be avoided in pregnancy, in nursing mothers and in children under 18 years of age, since articular cartilage erosion (arthropathy) occurs in immature experimental animals. 

Topical administration of the fluoroquinolones to immature animals does not cause arthropathy, and the ophthalmic dosage form does not appear to affect the weight-bearing joints in humans. All the topical ophthalmic fluoroquinolones, except levofloxacin, are approved for use in patients 1 year of age and older. 

Arthropathy has been reported with various fluoroquinolones, particularly in children. In a Russian study in children with cystic fibrosis five were withdrawn (four taking ciprofloxacin and one taking pefloxacin) (94). Two had an arthropathy that was drug- and age-dependent. Quinolone-induced arthropathy was more common with pefloxacin and occurred only in children over 10 years old with a history of joint problems. The arthropathy fully recovered within 7 days to 3 months and there was no cartilage damage. 

The quinolones and fluoroquinolones may produce arthropathy, and hence should not be used in prepubertal children or pregnant women. Nalidixic acid and cinoxacin are useful only for treating urinary tract infections. Ciprofloxacin is useful for both urinary tract infections and prostatitis (see also Figure 85). 

The quinolones and fluoroquinolones may produce arthropathy, and hence should not be used in prepubertal children or pregnant women. 

Susceptibility factors Children The evidence for quinolone-induced arthropathy in children has been reviewed [33 ]. Data from animal studies and case reports, including tendon-related adverse reactions seen in adults, support a policy of restricting the use of fluoroquinolones in children and adolescents. The emergence of fluoroquinolone-resistant pneumococci is another reason for restricting their use. The authors cited statements from the American Academy of Pediatrics on cases in which... 

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