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Ciprofloxacin Treatment in Preterm Neonates in Bangladesh: Lack of Effects on Growth and Development

Ahmed, ASM Nawshad Uddin MBBS, FCPS*†; Khan, Naila Z. MBBS, FCPS, PhD; Saha, Samir K. PhD§; Chowdhury, MAK Azad MBBS, FRCP*; Muslima, Humaira MBBS, DCM; Law, Paul MD, MPH; Islam, Maksuda BA§; Bhattacharya, Mallika MSc; Darmstadt, Gary L. MD, MS∥¶

The Pediatric Infectious Disease Journal: December 2006 - Volume 25 - Issue 12 - p 1137-1141
doi: 10.1097/01.inf.0000245105.99934.5f
Original Studies

Background: Quinolone-induced arthropathic toxicity in weight-bearing joints observed in juvenile animals during preclinical testing has largely restricted the routine use of ciprofloxacin in the pediatric age group. As histopathologic, radiologic and magnetic resonance imaging monitoring evidence has gathered supporting the safety of fluoroquinolones in children, many pediatricians have started to prescribe quinolones to some patients on a compassionate basis.

Objective: The objective of this study was to ascertain the safety of ciprofloxacin in preterm neonates <33 weeks gestational age treated at Dhaka Shishu (Children) Hospital in Bangladesh.

Methods: Long-term follow up was done to monitor the growth and development of preterm infants who were administered intravenous ciprofloxacin in the neonatal period. Ciprofloxacin was used only as a life-saving therapy in cases of sepsis produced by bacterial agents resistant to other antibiotics. Another group of preterm neonates with septicemia who were not exposed to ciprofloxacin, but effectively treated with other antibiotics and followed up, were matched with cases for gender, gestational age and birth weight and included as a comparison group. Forty-eight patients in the ciprofloxacin group and 66 patients in the comparison group were followed up for a mean of 24.7 ± 18.5 months and 21.6 ± 18.8 months, respectively.

Results: No osteoarticular problems or joint deformities were observed in the ciprofloxacin group during treatment or follow up. No differences in growth and development between the groups were found.

Conclusions: Ciprofloxacin is a safe therapeutic option for newborns with sepsis produced by multiply resistant organisms.

Supplemental Digital Content is Available in the Text.

From the *Department of Neonatology, the ‡Child Development Centre, Child Development and Neurology Unit, and the §Department of Microbiology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh; the †Department of Pediatrics, Kumudini Women's Medical College, Mirzapur, Tangail, Bangladesh; the ∥Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD; and the ¶Saving Newborn Lives Initiative, Save the Children–US, Washington, DC.

Accepted for publication September 1, 2006.

Address correspondence to: Gary L. Darmstadt, MD, MS, Department of International Health, E8153, Bloomberg School of Public Health, The Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205. E-mail

© 2006 Lippincott Williams & Wilkins, Inc.