Service des Maladies Infectieuses et Tropicales & Centre d'Infectiologie Necker-Pasteur, Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France.
BMC Infect Dis. 2013 May 27;13:245. doi: 10.1186/1471-2334-13-245.
Fluoroquinolones are used with increasing frequency in children with a major risk of increasing the emergence of FQ resistance. FQ use has expanded off-label for primary antibacterial prophylaxis or treatment of infections in immune-compromised children and life-threatening multi-resistant bacteria infections. Here we assessed the prescriptions of ciprofloxacin in a pediatric cohort and their appropriateness.
A monocenter audit of ciprofloxacin prescription was conducted for six months in a University hospital in Paris. Infected site, bacteriological findings and indication, were evaluated in children receiving ciprofloxacin in hospital independently by 3 infectious diseases consultants and 1 hospital pharmacist.
Ninety-eight ciprofloxacin prescriptions in children, among which 52 (53.1%) were oral and 46 (46.9%) parenteral, were collected. 45 children had an underlying condition, cystic fibrosis (CF) (21) or an innate or acquired immune deficiency (24). Among CF patients, the most frequent indication was a broncho-pulmonary Pseudomonas aeruginosa infection (20). In non-CF patient, the major indications were broncho-pulmonary (25), urinary (8), intra-abdominal (7), operative site infection (5) and bloodstream/catheter (2/4) infection. 62.2% were microbiologically documented. Twenty-three (23.4%) were considered "mandatory", 48 (49.0%) "alternative" and 27 (27.6%) "unjustified".
In our university hospital, only 23.4% of fluoroquinolones prescriptions were mandatory in children, especially in Pseudomonas aeruginosa healthcare associated infection. Looking to the ecological risk of fluoroquinolones and the increase consumption in children population we think that a control program should be developed to control FQ use in children. It could be done with the help of an antimicrobial stewardship team.
氟喹诺酮类药物在儿童中使用的频率越来越高，这极大地增加了氟喹诺酮类药物耐药性出现的风险。氟喹诺酮类药物的使用范围已经扩大，超出了标签规定的范围，用于儿童的主要抗菌预防用药或免疫功能低下儿童感染的治疗，以及危及生命的多耐药菌感染的治疗。在此，我们评估了氟喹诺酮类药物在儿科患者中的使用情况，并评估了其使用的适宜性。
在巴黎的一家大学附属医院，我们进行了一项为期六个月的氟喹诺酮类药物处方单审核。由 3 位传染病顾问和 1 位医院药剂师独立评估在该院住院的使用氟喹诺酮类药物的儿童的感染部位、细菌学发现和适应证。
共收集了 98 例儿童氟喹诺酮类药物处方，其中 52 例（53.1%）为口服，46 例（46.9%）为注射。45 例儿童存在基础疾病，包括囊性纤维化（CF）（21 例）或先天性或获得性免疫缺陷（24 例）。在 CF 患者中，最常见的适应证是支气管肺部铜绿假单胞菌感染（20 例）。在非 CF 患者中，主要适应证是支气管肺部（25 例）、泌尿道（8 例）、腹腔内（7 例）、手术部位感染（5 例）和血流/导管（2/4 例）感染。62.2%的适应证有微生物学依据。23 例（23.4%）被认为是“强制性”的，48 例（49.0%）是“替代”的，27 例（27.6%）是“不合理”的。
在我们的大学附属医院，儿童氟喹诺酮类药物处方中只有 23.4%是强制性的，特别是在铜绿假单胞菌引起的与医疗保健相关的感染中。考虑到氟喹诺酮类药物的生态风险和儿童人群中消耗量的增加，我们认为应该制定一个控制氟喹诺酮类药物使用的方案。这可以在抗菌药物管理团队的帮助下完成。
