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Ciprofloxacin safety in paediatrics: a systematic review

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


Abiodun Adefurin

Helen Sammons

Evelyne Jacqz-Aigrain

Imti Choonara


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.


Adefurin, A., Sammons, H., Jacqz-Aigrain, E., & Choonara, I. (2011). Ciprofloxacin safety in paediatrics: a systematic review. Archives of Disease in Childhood, 96(9), doi: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
Public URL
Publisher URL
Copyright Statement Copyright information regarding this work can be found at the following address:


Ciprofloxacin_safety_in_paediatrics_paper.pdf (207 Kb)

Copyright Statement
Copyright information regarding this work can be found at the following address:

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