Assess the Potential of Ciprofloxacin to Induce Arthropathy in Children: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

XIE Xiaoping , ZHU Yu ,  WANG Chaomin

Department of Pediatrics West China Second University Hospital，Sichuan University，Chengdu 610041，China;

Corresponding author：

WANG Chaomin, Email: wcm0220@sina.com

Keywords：

Ciprofloxacin; Children; Arthropathy; Systematic review

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Objective 　To assess the potential of ciprofloxacin to induce arthropathy in children and provide evidence for clinical practice.
Methods 　We searched MEDLINE(1985- March 2006), The Cochrane Library (Issue 1,2006), EMBASE(1985 to March 2006) and CBMdisk(1990 to March 2006) for randomized controlled trials (RCTs) involving the safety of ciprofloxacin in pediatrics. We assessed the methodological quality of the studies identified. RevMan 4.2 was used for meta-analysis.
Results　 Seven RCTs met the inclusion criteria. Compared with the control group, the combined rate of arthralgia did not increase compared to ciprofloxacin. The relative risk was 0.98, 95% confidence interval 0.65 to 1.48. No studies reported joint pathology and cartilage lesions on radiographic imaging, ultrasound or magnetic resonance imaging in the pediatric population.
Conclusion 　Based on the results of the review and the meta-analysis, there is no evidence that using ciprofloxacin in the pediatric population is associated with clinical arthropathy. Further well-designed clinical studies should be performed to assess the long-term consequences of the use of ciprofloxacin in children.

Citation： XIE Xiaoping,ZHU Yu,WANG Chaomin. Assess the Potential of Ciprofloxacin to Induce Arthropathy in Children: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2006, 06(8): 605-608. doi: Copy

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7.	Phillips BM, David TJ. Pathogenesis and management of arthropathy in cystic fibrosis. J R Soc Med., 1986; 79( Suppl 12):44-50.
8.	Dixey J, Redington AN, Butler RC. The arthropathy of cystic fibrosis. Ann Rheum Dis., 1988; 47(3):218-223.
9.	Phillips BM, David TJ. Pathogenesis and management of arthropathy in cystic fibrosis. J R Soc Med., 1986; 79 (Suppl 12):44-50.
10.	Richard G. Safety profile of quinolone antibiotics in the pediatric population. Pediatr Infect Dis J. , 2003; 22(12):1128-1132.
11.	Salam MA, Dhar U, Khan WA, et al. Randomised comparison of ciprofloxacin suspension and pivmecillinam for childhood shigellosis. Lancet., 1998; 352(9127):522-527.
12.	Leibovitz E, Janco J, Piglansky L, et al. Oral ciprofloxacin vs. intramuscular ceftriaxone as empiric treatment of acute invasive diarrhea in children. Pediatr Infect Dis J ., 2000; 19(11):1060-1067.
13.	Church DA, Kanga JF, Kuhn RJ, et al. Sequential ciprofloxa-cin therapy in pediatric cystic fibrosis: comparative study vs. ceftazidime/tobramycin in the treatment of acute pulmonary exacerbations. Pediatr Infect Dis J. , 1997; 16(1):97-105.
14.	Richard DA, Nousia-Arvanitakis S, Sollich V, et al. Oral ciprofloxacin vs. intravenous ceftazidime plus tobramycin in pediatric cystic fibrosis patients: comparison of antipseudomonas efficacy and assessment of safety with ultrasonography and magnetic resonance. Pediatr Infect Dis J., 1997; 16(6):572-578.
15.	Schaad UB, Wedgwood J, Ruedeberg A, et al. Ciprofloxacin as antipseudomonal treatment in patients with cystic fibrosis. Pediatr Infect Dis J. , 1997; 16(1):106-11; discussion 123-126.
16.	Zimbabwe, Bangladesh, South Africa (Zimbasa) Dysentery Study Group. Multicenter, randomized, double blind clinical trial of short course versus standard course oral ciprofloxacin for Shigella dysenteriae type 1 dysentery in children. Pediatr Infect Dis J. , 2002; 21(12):1136-1141.
17.	Zimbabwe, Bangladesh, South Africa (Zimbasa) Dysentery Study Group. Multicenter, randomized, double blind clinical trial of short course versus standard course oral ciprofloxacin for Shigella dysenteriae type 1 dysentery in children. Pediatr Infect Dis J. , 2002; 21(12):1136-1141.

1. Schaad UB. Use of the quinolones in pediatrics. In: Andriole VT, ed. The Quinolones. 3rd ed. San Diego, CA: Academic Press; 2000.455–475.
2. Tatsumi H, Senda H, Yatera S, et al. Toxicological studies on pipemidic acid: V. Effect on diarthrodial joints of experimental animals. J Toxicol Sci, 1978;3(4):357-367.
3. Echols RM. Introduction: historical perspectiveOuse of cip-rofloxacin in children. Pediatr Infect Dis J., 1997;16(1):89-90.
4. Schluter G. Ciprofloxacin: review of potential toxicologic effects. Am J Med, 1987; 82 (Suppl 4A):91–393.
5. Jick S. Ciprofloxacin safety in a pediatric population. Pediatr Infect Dis J, 1997; 160-162.
6. Takizawa T, Hashimoto K, Minami T, et al. The comparative arthropathy of fluoroquinolones in dogs. Hum Exp Toxicol., 1999; 18(6):392-399.
7. Phillips BM, David TJ. Pathogenesis and management of arthropathy in cystic fibrosis. J R Soc Med., 1986; 79( Suppl 12):44-50.
8. Dixey J, Redington AN, Butler RC. The arthropathy of cystic fibrosis. Ann Rheum Dis., 1988; 47(3):218-223.
9. Phillips BM, David TJ. Pathogenesis and management of arthropathy in cystic fibrosis. J R Soc Med., 1986; 79 (Suppl 12):44-50.
10. Richard G. Safety profile of quinolone antibiotics in the pediatric population. Pediatr Infect Dis J. , 2003; 22(12):1128-1132.
11. Salam MA, Dhar U, Khan WA, et al. Randomised comparison of ciprofloxacin suspension and pivmecillinam for childhood shigellosis. Lancet., 1998; 352(9127):522-527.
12. Leibovitz E, Janco J, Piglansky L, et al. Oral ciprofloxacin vs. intramuscular ceftriaxone as empiric treatment of acute invasive diarrhea in children. Pediatr Infect Dis J ., 2000; 19(11):1060-1067.
13. Church DA, Kanga JF, Kuhn RJ, et al. Sequential ciprofloxa-cin therapy in pediatric cystic fibrosis: comparative study vs. ceftazidime/tobramycin in the treatment of acute pulmonary exacerbations. Pediatr Infect Dis J. , 1997; 16(1):97-105.
14. Richard DA, Nousia-Arvanitakis S, Sollich V, et al. Oral ciprofloxacin vs. intravenous ceftazidime plus tobramycin in pediatric cystic fibrosis patients: comparison of antipseudomonas efficacy and assessment of safety with ultrasonography and magnetic resonance. Pediatr Infect Dis J., 1997; 16(6):572-578.
15. Schaad UB, Wedgwood J, Ruedeberg A, et al. Ciprofloxacin as antipseudomonal treatment in patients with cystic fibrosis. Pediatr Infect Dis J. , 1997; 16(1):106-11; discussion 123-126.
16. Zimbabwe, Bangladesh, South Africa (Zimbasa) Dysentery Study Group. Multicenter, randomized, double blind clinical trial of short course versus standard course oral ciprofloxacin for Shigella dysenteriae type 1 dysentery in children. Pediatr Infect Dis J. , 2002; 21(12):1136-1141.
17. Zimbabwe, Bangladesh, South Africa (Zimbasa) Dysentery Study Group. Multicenter, randomized, double blind clinical trial of short course versus standard course oral ciprofloxacin for Shigella dysenteriae type 1 dysentery in children. Pediatr Infect Dis J. , 2002; 21(12):1136-1141.

Chinese Journal of Evidence-Based Medicine

Assess the Potential of Ciprofloxacin to Induce Arthropathy in Children: A Systematic Review

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