The battle against emerging antibiotic resistance: should fluoroquinolones be used to treat children?
Inappropriate use of antibiotic drugs in humans and animals has led to widespread resistance among microbial pathogens. Resistance is the phenotypic expression corresponding to genetic changes caused by either mutation or acquisition of new genetic information. In some cases, multidrug resistance occurs. Streptococcus pneumoniae is one of the most important respiratory pathogens, playing a major role in both upper and lower respiratory tract infections. Pneumococcal resistance to antimicrobials may be acquired by means of horizontal transfer followed by homologous recombination of genetic material from the normal flora of the human oral cavity or by means of mutation. Resistance to penicillins and macrolides has been increasing for some time, but, recently, fluoroquinolone resistance has become an issue as well. We are concerned that, if fluoroquinolones are approved for use in children, their widespread use will result in rapid emergence of pneumococcal resistance, because children are more often colonized in the nasopharynx with high-density populations of pneumococci than are adults.
Division of Infectious Diseases, McMaster University School of Medicine, Hamilton, Ontario, Canada.
Lionel A
LA
Mandell
Lance R
LR
Peterson
Richard
R
Wise
David
D
Hooper
Donald E
DE
Low
Urs B
UB
Schaad
Keith P
KP
Klugman
Patrice
P
Courvalin
D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015195:Drug Design; D004351:Drug Resistance / Q000502:physiology*; D018432:Drug Resistance, Multiple; D024841:Fluoroquinolones; D005544:Forecasting; D006801:Humans; D008826:Microbial Sensitivity Tests; D013290:Streptococcal Infections / Q000188:drug therapy*; D013296:Streptococcus pneumoniae / Q000187:drug effects*
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D024841:Fluoroquinolones