CIPROFLOXACIN USE IN NEONATAL SEPSIS: EMPHASIS ON CARTILAGE

Abstract

fection in neonates is frequently complicated by systemic sepsis and therefore may become rapidly life-threatening. As multidrug-resistant organisms become more of a problem in neonatal intensive care units, there is a need to evaluate the use of other available antibiotics to treat serious neonatal infections. Ciprofloxacin is a safe therapeutic option for newborns with sepsis produced by multiply resistant organisms. The use of ciprofloxacin is an important therapeutic advance because of its broad antibacterial spectrum, bactericidal effect at therapeutic doses and good penetration of the cerebrospinal fluid. Restrictions in its use result from concerns about the potential of joint toxicity, observed in juvenile animals, and the risk of emergence of drug-resistant pathogens. Activities of MMPs are regulated by their inhibitors, the tissue inhibitor of metalloproteinases (TIMPs) especially TIMP-1 that regulates MMPs activities. proteolytic degradation of the articular cartilage still occurs, suggesting an imbalance between MMP and TIMP activity in favor of the MMPs, and Restoring the imbalance between MMP and TIMP activity or changing it into a balance in favor of TIMP activity may, therefore, protect the articular cartilage and bone from MMP-mediated degradation.

The aim of this work was to evaluate the adverse effects of ciprofloxacin treatment of neonatal sepsis (if any): hepatic, renal, hematological, and especially its arthropathogenic effect. The study included 45 neonates were divided into 3 groups: 20 neonates with septicemia who recieved ciprofloxacin in a dose of 20 mg/kg in two divided doses as a slow intravenous infusion over a period of 30 minutes, for a period of 14 days. 15 cases of neonates with septicemia received antibiotic treatment rather than ciprofloxacin and 10 healthy stable neonates with no clinical signs or laboratory evidence for sepsis serving as a control group All neonate groups were subjected to laboratory investigations as Hb, TLC, CRP, blood culture, Plt, PT, PTT, AST, ALT, ALP, S.K, S.Mg, S.Ca, S.Na, S.Creat., BUN, S.Bilirubin, S.TIMP1 and radiological investigation as ultrasonography evaluation of the right knee joint anteroposterior, cranicaudal and transverse diameter and longitudinal and transverse area of the lower end of femur and upper end of tibia, "two layer" appearance of the cartilage, fluid in the suprapatellar bursa, and contour of the epiphyses at the beginning and 14 days later. As regard demographic characteristics, clinical characteristics, laboratory characteristics (baseline) and