Use of the quinolones in paediatrics.

For many years, quinolone-induced cartilage toxicity observed in experiments involving immature animals has represented an indisputable contraindication for the use of these promising antimicrobials in prepubertal patients. Clinical, magnetic resonance imaging and histopathological monitoring of patients receiving ciprofloxacin at the University of Berne, together with published data, suggest that the quinolones do not cause arthropathy in humans. Conditions that potentially qualify for quinolone use (especially ciprofloxacin) in children include oral antipseudomonal (or antistaphylococcal) therapy for pulmonary exacerbations in cystic fibrosis, and complicated urinary tract, skeletal, aural and shunt infections. In addition to these rarer indications, there is an urgent need for the quinolones in developing countries for children with endemic and epidemic shigellosis and invasive salmonellosis. At present, these compounds are not approved for paediatric use and therefore must be administered as part of a controlled study or on a compassionate use basis in individual patients.