Ciprofloxacin safety in paediatrics: a systematic review

Adefurin, Abiodun; Sammons, Helen; Jacqz-Aigrain, Evelyne; Choonara, Imti

Abstract

Objective: To determine the safety of ciprofloxacin in
paediatric patients in relation to arthropathy, any other
adverse events (AEs) and drug interactions.
Methods: A systematic search of MEDLINE, EMBASE,
CINAHL, CENTRAL and bibliographies of relevant articles
was carried out for all published articles, regardless
of design, that involved the use of ciprofloxacin in any
paediatric age group ≤17 years. Only articles that
reported on safety were included.
Results: 105 articles met the inclusion criteria and
involved 16 184 paediatric patients. There were 1065
reported AEs (risk 7%, 95% CI 3.2% to 14.0%). The
most frequent AEs were musculoskeletal AEs, abnormal
liver function tests, nausea, changes in white blood cell
counts and vomiting. There were six drug interactions
(with aminophylline (4) and methotrexate (2)). The
only drug related death occurred in a neonate who had
an anaphylactic reaction. 258 musculoskeletal events
occurred in 232 paediatric patients (risk 1.6%, 95% CI
0.9% to 2.6%). Arthralgia accounted for 50% of these.
The age of occurrence of arthropathy ranged from
7 months to 17 years (median 10 years). All cases of
arthropathy resolved or improved with management.
One prospective controlled study estimated the risk of
arthropathy as 9.3 (OR 95% CI 1.2 to 195). Pooled safety
data of controlled trials in this review estimated the risk
of arthropathy as 1.57 (OR 95% CI 1.26 to 1.97).
Conclusion: Musculoskeletal AEs occur due to
ciprofloxacin use. However, these musculoskeletal events
are reversible with management. It is recommended that
further prospective controlled studies should be carried
out to evaluate the safety of ciprofloxacin, with particular
focus on the risk of arthropathy.

Citation

Adefurin, A., Sammons, H., Jacqz-Aigrain, E., & Choonara, I. (2011). Ciprofloxacin safety in paediatrics: a systematic review. Archives of Disease in Childhood, 96(9), https://doi.org/10.1136/adc.2010.208843

• Journal Article Type: Article
• Publication Date: Jan 1, 2011
• Deposit Date: Apr 23, 2014
• Publicly Available Date: Apr 23, 2014
• Journal: Archives of Disease in Childhood
• Print ISSN: 0003-9888
• Electronic ISSN: 1468-2044
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 96
• Issue: 9
• DOI: https://doi.org/10.1136/adc.2010.208843
• Public URL: https://nottingham-repository.worktribe.com/output/1010387
• Publisher URL: http://adc.bmj.com/content/96/9/874