Fluoroquinolones are still only exceptionally indicated in neonatal nosocomial infections

Nosocomial infections, most notably those due to multidrug-resistant (MDR) organisms, are common in neonatal intensive care units. When they fail to r espond to conventional antimicrobials, as is often the case, fluoroquinolon e therapy should be considered. Ten cases of neonatal MDR infections (inclu ding nine due to nosocomial organisms) treated with fluoroquinolones were s een between January 1995 and June 1997. Fluoroquinolone therapy was given i n a dose of 15-20 mg/kg for a mean duration of 17 days. The outcome was fav orable in every case. Adverse effects included cytolysis and thrombocytopen ia in two patients, cytolysis and anemia in two patients, anemia without cy tolysis in one patient, and anemia with a skin rash in one patient. Follow- ups now range from six months to two years. No evidence of articular side e ffects has been recorded to date. The broad spectrum of activity and excell ent intracellular penetration of fluoroquinolones make these drugs a good t herapeutic alternative for neonatal MDR infections. As a result, fluoroquin olones are being increasingly used in neonatology, although they are not ap proved for pediatric use.