Alsuhaibani Mohammed, Felimban Ghada, Shoukri Mohamed, Alosaimi Abdullah, Almohaizeie Abdullah, AlHajjar Sami
Department of Pediatrics, College of Medicine, Qassim University, Qassim, Saudi Arabia.
Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Int J Pediatr Adolesc Med. 2019 Jun;6(2):47-50. doi: 10.1016/j.ijpam.2019.01.003. Epub 2019 Jan 19.
Disseminated BCGitis is a rare but serious complication of BCG vaccine in patients with underlying primary immunodeficiency. Fluoroquinolone antibiotics containing antimycobacterial regimen have been considered in the treatment of disseminated BCGitis, but there are limited data about the dosing, safety, and tolerability of fluoroquinolone such as moxifloxacin in children. The aim of this study was to report the experience with the dosing, safety, and tolerability of moxifloxacin in children with disseminated BCGitis.
This retrospective descriptive study included children who had been diagnosed with disseminated BCGitis and treated with an antimycobacterial regimen including moxifloxacin for more than two weeks from 2007 to 2017 at King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Ten children were included: six (60.0%) were male and four (40.0%) were female. The primary diagnosis for five patients was Mendelian susceptibility to mycobacterial diseases (MSMD), four patients were diagnosed with severe combined immune deficiency (SCID), and the remaining patient had human immunodeficiency virus (HIV) infection. The overall mean duration of moxifloxacin treatment was 10.1 months. Liver toxicity was recorded in three patients. The most common medications used with moxifloxacin were ethambutol and clarithromycin. Moxifloxacin serum concentration level was determined in 5 patients. No musculoskeletal side effects were reported while the patient was on moxifloxacin. The treated patients showed a different response to an antimycobacterial regimen including moxifloxacin, with mortality in two patients.
Our study suggests that moxifloxacin is generally tolerated in children and might be considered in disseminated BCGitis cases. Additionally, paying attention to side effects such as liver toxicity is recommended, particularly with the use of other antimycobacterial antibiotics, which could also be hepatotoxic. A moxifloxacin-containing regimen for disseminated BCGitis showed clinical improvement in some patients in this study, although the majority presented the same clinical condition.
播散性卡介苗病是原发性免疫缺陷患者接种卡介苗后罕见但严重的并发症。含氟喹诺酮类抗生素的抗分枝杆菌方案已被用于播散性卡介苗病的治疗，但关于莫西沙星等氟喹诺酮类药物在儿童中的给药剂量、安全性和耐受性的数据有限。本研究的目的是报告莫西沙星治疗播散性卡介苗病患儿的给药剂量、安全性和耐受性方面的经验。
这项回顾性描述性研究纳入了2007年至2017年在沙特阿拉伯利雅得法赫德国王专科医院和研究中心被诊断为播散性卡介苗病并接受包括莫西沙星在内的抗分枝杆菌方案治疗超过两周的儿童。
共纳入10名儿童：6名（60.0%）为男性，4名（40.0%）为女性。5例患者的主要诊断为孟德尔遗传性分枝杆菌病易感性（MSMD），4例患者被诊断为严重联合免疫缺陷（SCID），其余1例患者感染了人类免疫缺陷病毒（HIV）。莫西沙星治疗的总体平均持续时间为10.1个月。3例患者记录有肝毒性。与莫西沙星联合使用最常见的药物是乙胺丁醇和克拉霉素。5例患者测定了莫西沙星血清浓度水平。患者使用莫西沙星期间未报告有肌肉骨骼副作用。接受治疗的患者对包括莫西沙星在内的抗分枝杆菌方案表现出不同反应，2例患者死亡。
我们的研究表明，莫西沙星在儿童中一般耐受性良好，播散性卡介苗病病例可考虑使用。此外，建议关注肝毒性等副作用，特别是在使用其他也可能具有肝毒性的抗分枝杆菌抗生素时。本研究中，含莫西沙星的播散性卡介苗病治疗方案在部分患者中显示出临床改善，尽管大多数患者的临床状况相同。
