Ciprofloxacin for treatment of tularemia in children

Background. Children with tularemia are, irrespective of severity of diseas e, usually subjected to parenteral treatment with aminoglycosides. Based on available susceptibility testing, quinolones might be effective oral alter natives of parenteral therapy. These drugs cause arthropathy in immature an imals, but this risk is currently regarded to be low in humans. Patients and methods. In 12 patients (median age, 4 years; range, 1 to 10) with ulceroglandular tularemia, a 10- to 14-day course of oral ciprofloxaci n, 15 to 20 mg/kg daily in 2 divided doses, was prescribed. Microbiologic i nvestigations included identification of the infectious agent by PCR and cu lture of wound specimens, as well as determination of antibiotic susceptibi lity of isolates of Francisella tularensis. Results. Defervescence occurred within 4 days of institution of oral ciprof loxacin in all patients. After a median period of 4.5 days (range, 2 to 24) , the patients were capable of outdoor activities. In 2 cases, treatment wa s withdrawn after 3 and 7 days because of rash. In both cases a second epis ode of fever occurred, All children recovered without complications. In 7 c ases F. tularensis was successfully cultured from ulcer specimens and teste d for susceptibility to ciprofloxacin. MIC values for all isolates were 0.0 3 mg/l. Conclusion. In our sample of 12 patients ciprofloxacin was satisfactory for outpatient treatment of tularemia in children.