Enteral Ciprofloxacin or Levofloxacin for Ventilator-Associated
Tracheobronchitis in Children
Introduction Pseudomonas aeruginosa is the most commonly isolated
organism in children with ventilator-associated tracheobronchitis (VAT).
Enteral treatment with ciprofloxacin or levofloxacin is sometimes
employed, but supportive data are limited. The purpose of this study was
to evaluate the effectiveness and safety of enteral ciprofloxacin and
levofloxacin administration for VAT in children. Methods This was a
retrospective review of electronic medical records for children less
than 18 years of age who received enteral ciprofloxacin or levofloxacin
for the treatment of VAT from January 2013 through January 2020 at an
academic children’s hospital. Results Seventy-six children (median age
9.5, IQR 3.6-13.1 years), received ciprofloxacin or levofloxacin for VAT
treatment during the study period. Median treatment duration was 8
(range 7-10) days. Most tracheostomy cultures (n=70/82, 85%) were
polymicrobial, with P. aeruginosa most commonly isolated (n=67/224
organisms, 30%). Sixty-five children (86%) were successfully treated
with an enteral fluoroquinolone. Antibiotics were changed or extended
for two (3%) children. Ten (13%) children were prescribed antibiotics
and eight (11%) required hospitalization for a lower respiratory tract
infection within 30 days of completion of their fluoroquinolone course.
Six (8%) patients received a seizure rescue medication, seven (9%)
experienced emesis, and one (1%) had elevated transaminases.
Tendonitis, tendon rupture and QTc prolongation were not observed.
Conclusions The results of this study suggest enteral fluoroquinolones
may be effective for the treatment of VAT in children. Further study is
warranted to clarify the role of these agents in pediatric VAT.