Assessing fluorquinolones as risk factor for musculoskeletal disorders in children: a systematic review and meta-analysis

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 andmeta-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. Randomizedclinical 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. Datawere 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 useand musculoskeletal disorders. The pooled odds ratio was 1.02 (CI 0.76-1.38). Conclusion. Our meta-analysis does not supportmusculoskeletal 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.