From the Guidelines
Ciprofloxacin should be used with caution in children due to potential side effects, including musculoskeletal adverse events, central nervous system disorders, and other adverse events. The most concerning side effects include arthrotoxicity, which can cause joint pain, joint swelling, and cartilage abnormalities that can affect growth 1. Children may also experience gastrointestinal effects, such as nausea, vomiting, diarrhea, and abdominal pain, as well as neurological side effects like headaches, dizziness, sleep disturbances, and rarely seizures. Some children may develop allergic reactions ranging from rash to severe reactions like Stevens-Johnson syndrome. Ciprofloxacin can also cause photosensitivity, making skin more susceptible to sunburn.
According to a study published in Pediatrics in 2006, the rates of musculoskeletal adverse events occurring within 6 weeks of treatment were 9.3% in patients receiving ciprofloxacin compared with 6.0% in control patients 1. The study also found that most reported musculoskeletal events associated with fluoroquinolone use were of moderate intensity and were transient.
Key side effects to consider when prescribing ciprofloxacin to children include:
- Musculoskeletal adverse events, such as arthrotoxicity and tendinopathy
- Central nervous system disorders, such as headaches, dizziness, and sleep disturbances
- Gastrointestinal effects, such as nausea, vomiting, diarrhea, and abdominal pain
- Allergic reactions, ranging from rash to severe reactions like Stevens-Johnson syndrome
- Photosensitivity, making skin more susceptible to sunburn
Due to these risks, ciprofloxacin is generally reserved for serious infections where benefits outweigh risks, and alternative antibiotics are unavailable or ineffective 1. The FDA has issued guidelines for the systemic use of fluoroquinolones in children, recommending that fluoroquinolone use be restricted to situations in which there is no safe and effective alternative to treat an infection caused by multidrug-resistant bacteria or to provide oral therapy when parenteral therapy is not feasible and no other effective oral agent is available.
From the FDA Drug Label
Ciprofloxacin, like other quinolones, causes arthropathy and histological changes in weight-bearing joints of juvenile animals resulting in lameness. Although effective in clinical trials, ciprofloxacin is not a drug of first choice in the pediatric population due to an increased incidence of adverse events compared to the controls, including events related to joints and/or surrounding tissues. The rates of these events in pediatric patients with complicated urinary tract infection and pyelonephritis within six weeks of follow-up were 9.3% (31/335) versus 6% (21/349) for control agents. Musculoskeletal adverse events in patients with cystic fibrosis were reported in 22% of the patients in the ciprofloxacin group and 21% in the comparison group. Decreased range of motion was reported in 12% of the subjects in the ciprofloxacin group and 16% in the comparison group Arthralgia was reported in 10% of the patients in the ciprofloxacin group and 11% in the comparison group.
Los efectos secundarios de la ciprofloxacina en niños incluyen:
- Artralgia: dolor en las articulaciones
- Artritis: inflamación de las articulaciones
- Decreased range of motion: disminución de la movilidad en las articulaciones
- Musculoskeletal adverse events: eventos adversos musculoesqueléticos, como dolor o inflamación en los músculos y huesos
- Lameness: cojera o dificultad para caminar debido a la artritis o artralgia Estos efectos secundarios pueden ocurrir en hasta el 22% de los pacientes pediátricos que reciben ciprofloxacina, y pueden ser más frecuentes en pacientes con cystic fibrosis 2. Es importante tener en cuenta que la ciprofloxacina no es el medicamento de primera elección en la población pediátrica debido a la mayor incidencia de eventos adversos en comparación con los controles 2.
From the Research
Side Effects of Ciprofloxacin in Children
The use of ciprofloxacin in children has been associated with several side effects, including:
- Gastrointestinal reactions, such as diarrhea and vomiting, which were reported in 50% of patients in one study 3
- Central nervous system (CNS) reactions, such as seizures and headaches, which were reported in 23% of patients in one study 3
- Skin and allergic reactions, such as rash and itching, which were reported in 19.1% of patients in one study 3
- Musculoskeletal reactions, such as arthralgia and arthritis, which were reported in 8.6% of patients in one study 3
- Hematological reactions, such as anemia and thrombocytopenia, which were reported in 3.8% of patients in one study 3
- Cardiovascular reactions, such as bradycardia and hypotension, which were reported in 2.9% of patients in one study 3
- Nephrological reactions, such as renal failure and hematuria, which were reported in 0.9% of patients in one study 3
Severity of Side Effects
The severity of side effects associated with ciprofloxacin use in children can vary, with some studies reporting:
- Mild side effects in 47.2% of patients 3
- Moderate side effects in 47.8% of patients 3
- Severe side effects in 5% of patients 3
- Reversible arthralgia in 36 out of 1,113 patients with cystic fibrosis, with no cartilage damage demonstrated by radiographic procedures 4
Risk-Benefit Assessment
The use of ciprofloxacin in children should be based on a risk-benefit assessment, taking into account the potential benefits of treatment and the potential risks of side effects 5, 6. In general, ciprofloxacin should only be used in children when the benefits outweigh the risks, such as in life-threatening cases or when other treatment options are not available 6.