Rheumatologic aspects of pediatric cystic fibrosis patients treated with fluoroquinolones

Background. The recommended and approved use of fluoroquinolones, including ciprofloxacin, is limited to adult patients because of concerns about the association of joint toxicity in young animals with quinolone administration and rare reports of joint complaints or findings in humans. Despite these warnings some quinolones have been used in children for many years, with seemingly minimal joint sequelae. Objective. This brief review will clarify the association of quinolones with arthropathy, particularly ciprofloxacin because of its widespread use, and subsequently discuss the problem of defining that association in a population of children with cystic fibrosis. Results. Examination of available clinical data to date provides no absolute evidence that ciprofloxacin induces significant arthropathy in children, in contrast to data reported in some animal species. Specifically short term ciprofloxacin-induced joint toxicity appears to be low in cystic fibrosis patients who have a significant background prevalence of arthralgias and arthritis. However, the level of detection ofjoint toxicity in these small trials may be insufficient to define rare or late adverse effects. Conclusion. Ciprofloxacin-associated arthropathy appears to occur infrequently, particularly in children with cystic fibrosis.