Ciprofloxacin for treatment of tularemia in children.
BACKGROUND
Children with tularemia are, irrespective of severity of disease, usually subjected to parenteral treatment with aminoglycosides. Based on available susceptibility testing, quinolones might be effective oral alternatives of parenteral therapy. These drugs cause arthropathy in immature animals, but this risk is currently regarded to be low in humans.


METHODS
In 12 patients (median age, 4 years; range, 1 to 10) with ulceroglandular tularemia, a 10- to 14-day course of oral ciprofloxacin, 15 to 20 mg/kg daily in 2 divided doses, was prescribed. Microbiologic investigations included identification of the infectious agent by PCR and culture of wound specimens, as well as determination of antibiotic susceptibility of isolates of Francisella tularensis.


RESULTS
Defervescence occurred within 4 days of institution of oral ciprofloxacin in all patients. After a median period of 4.5 days (range, 2 to 24), the patients were capable of outdoor activities. In 2 cases, treatment was withdrawn after 3 and 7 days because of rash. In both cases a second episode of fever occurred. All children recovered without complications. In 7 cases F. tularensis was successfully cultured from ulcer specimens and tested for susceptibility to ciprofloxacin. MIC values for all isolates were 0.03 mg/l.


CONCLUSIONS
In our sample of 12 patients ciprofloxacin was satisfactory for outpatient treatment of tularemia in children.
Johansson
A
A
Department of Clinical Microbiology, Infectious Diseases, Umeå University, Sweden.
Berglund
L
L
Gothefors
L
L
Sjöstedt
A
A
Tärnvik
A
A
D000284:Administration, Oral; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005604:Francisella tularensis / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction; D016896:Treatment Outcome; D014406:Tularemia / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology
D000890:Anti-Infective Agents; D002939:Ciprofloxacin