💊 Antibiotic choices in pediatrics require special care. Here are some considerations to keep in mind in this patient population.⁠
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✨ Ceftriaxone and sulfamethoxazole/trimethoprim (Bactrim) can increase a patient’s risk for developing kernicterus. Kernicterus occurs when high levels of unconjugated bilirubin in a newborn’s blood cross the blood-brain barrier, depositing in brain tissues, thus causing neurotoxicity. This bilirubin buildup can lead to permanent neurological damage, which can manifest as movement disorders, hearing loss, and cognitive impairment.⁠
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✨ Doxycycline and tigecycline can cause tooth staining in children by binding to calcium ions in developing teeth, leading to yellow-gray or brown discoloration. This happens during tooth mineralization, as the drugs incorporate into dentin and enamel, potentially causing permanent staining if given during key developmental periods, typically up to age 8.⁠
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✨ Nitrofurantoin in pediatric patients under one-year-old for febrile urinary tract infections (UTIs) should be avoided as it doesn’t reach adequate concentrations in the kidneys to effectively treat upper urinary tract infections. It is difficult to distinguish cystitis from pyelonephritis in this population, thus other antibiotics are preferred to ensure appropriate treatment.⁠
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✨ Fluoroquinolones can be used safely in pediatric patients when necessary, and risks and benefits should be carefully considered. Although tendon rupture is rare and occurs at similar rates in both children and adults, it’s important to recognize that the risk of arthrotoxicity is greater in pediatrics. Nevertheless, research indicates that these medications do not negatively impact growth in children.⁠
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