Ciprofloxacin as a therapeutic modality in pediatric burn wound infections: efficacious or contraindicated?
BACKGROUND
Food and Drug Administration regulations state that ciprofloxacin hydrochloride may cause arthropathies. For this reason, such therapy is contraindicated in the pediatric population. However, several studies in children with cystic fibrosis have found the drug to be efficacious. Our hypothesis was that ciprofloxacin treatment is justified in the case of multiresistant organisms in burn populations.


METHODS
During a 4-year period (January 1, 1993, to December 31, 1997) we treated 56 of our pediatric burn patients with ciprofloxacin when cultures proved resistant to other antibiotics. The burn area was 65% of the total body surface area. The average patient age was 8.4 years. Of the 56 patients who received ciprofloxacin, 50 received the recommended dose. Biopsy specimens were assessed for quantitative bacteriology and antibiotic sensitivity. Radiologic review was conducted to examine for arthropathy.


RESULTS
All patients showed unequivocal reduction in quantitative bacterial counts, and susceptibility to ciprofloxacin remained stable without the development of resistance. Of the 56 patients treated, 42 had a major reduction in their quantitative wound biopsies from 10(6) to less than 100 colonies per gram of tissue, while the remaining 14 were observed to have a 2- to 3-log decrease. No arthropathy was detected in any of the 56 patients receiving ciprofloxacin. Review of the patients' charts showed no documented adverse events associated with the use of ciprofloxacin. All patients survived their thermal injury and the complications associated with it without any untoward problems or complications of arthropathy.


CONCLUSIONS
On the basis of these data, ciprofloxacin therapy in the treatment of immunosuppressed pediatric burn patients is efficacious and does not cause arthropathy.
Heggers
J P
JP
Department of Surgery, University of Texas Medical Branch, and Shriners Hospital for Children, Galveston, USA. jphegger@utmb.edu
Villarreal
C
C
Edgar
P
P
Wolf
S
S
Klein
G L
GL
John
S D
SD
Desai
M
M
Herndon
D N
DN
D000293:Adolescent; D000367:Age Factors; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001706:Biopsy; D002056:Burns / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000209:etiology*; D016903:Drug Monitoring; D018432:Drug Resistance, Multiple; D005260:Female; D006801:Humans; D007223:Infant; D007592:Joint Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D014946:Wound Infection / Q000188:drug therapy* / Q000209:etiology*
D000890:Anti-Infective Agents; D002939:Ciprofloxacin