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Child/Adolescent Health

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Some children are already experiencing drug resistance to a class of broad-spectrum antibiotics used in adults

Bacteria have become increasingly resistant to antibiotics in the past six decades. Though children are not generally prescribed the broad-spectrum antibiotics called fluoroquinolones because they cause joint toxicity, two common bacteria are already showing fluoroquinolone resistance in 217 blood cultures taken from children, according to a new study.

Researchers from the University of Pennsylvania Center for Education and Research on Therapeutics investigated how fluoroquinolones fared against Escherichia coli and Klebsiella in 271 blood cultures containing E. coli or Klebsiella that were performed from May 1, 1999, to September 30, 2003, at the Children's Hospital of Philadelphia. Of these cultures, eight (2.9 percent) were resistant to two common fluoroquinolones, ciproflaxin and levofloxacin. These drugs are commonly prescribed to adults in both the hospital and in the community to treat bacterial infections.

Ciproflaxin was recently approved for children to treat inhalation anthrax and problematic urinary tract infections. Thirty-five (12.9 percent) of the cultures produced an enzyme, extended spectrum B-lactamase, which is also linked to drug resistance. Finally, of the eight cultures that were resistant, five also produced an extended spectrum B-lactamase enzyme (four for E. coli and one for Klebsiella pneumoniae). Mutations in the bacteria were the likely culprits for the drug resistance. However, researchers were unable to determine specific risk factors for infection with the resistant bacteria in children. This study was funded in part by the Agency for Healthcare Research and Quality (HS10399).

See "Fluroquinolone resistance in pediatric bloodstream infections because of Escherichia coli and Klebsiella species," by Jason Y. Kim, M.D., Ebbing Lautenbach, M.D., M.P.H., M.S.C.E, Jaclyn Chu, M.H.S, and others in the February 2008 American Journal of Infection Control 36(1), pp. 70-73.

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