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Background

Joint cartilage toxicity secondary to fluoroquinolone use has been observed in young animals. These early observations led to the contraindication of fluoroquinolones in children under 18 years. Nevertheless, quinolones may be the only option for oral treatment of infections caused by Pseudomonas aeruginosa.

Objective

To evaluate by systematic review and meta-analysis the relation between fluoroquinolonas and musculoskeletal disorders in children.

Methods

Data sources were Medline, Cochrane data base, and free-text search through Google and Yahoo. MESh terms were: quinolones and arthropathy-tendinopathy and children. Randomized clinical trials, cohorts and case-control studies with a primary outcome of arthropaty and/or tendinopathy were included. Each study was scored and classified for methodological key issues according to level of evidence. Data were extracted using a predetermined protocol.

Results

The search identified 277 studies of whom 8 were eligible for inclusion that included 23 166 patients. All except one failed to find a significant link between fluoroquinolones use and musculoskeletal disorders. The pooled odds ratio was 1.02 (CI 0.76-1.38).

Conclusion

Our meta-analysis does not support musculoskeletal disorders as a result of fluoroquinolones use in children under 18 years. Thus, in selected, appropriate, and mandatory cases fluoroquinolones should not be contraindicated in children.