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Acute Kidney Injury after Administration of Tosufloxacin Tosilate in Children with Mycoplasma pneumoniae Pneumonia
1)Department of Pediatrics, Hakujikai Memorial Hospital, 2)Department of Pediatrics, Teikyo University School of Medicine, 3)Koyama Pediatrics and Otolaryngology Clinic
Takeshi TAJIMA1)2), Hideaki MIYASHITA1), Kotaro MIENO1)2), Yasuhiro SATO2), Yoshiaki SHIBUYA2), Satoshi KOYAMA3) & Taketoshi IITSUKA1)
(Received December 21, 2018)
(Accepted May 15, 2019)
Key words: acute kidney injury, antimicrobials, tosufloxacin tosilate, Mycoplasm pneumoniae pneumonia, child

It is not uncommon for children with severe infectious diseases to show acute kidney injury, but it is rare for these patients to have Mycoplasma pneumoniae pneumonia.

After experiencing a child who had acute kidney injury with M. pneumoniae pneumonia, this study focused on renal dysfunction in patients with this infection and investigated retrospectively from medical records, the relationship of this condition with antimicrobial drug treatment. The diagnosis of M. pneumoniae pneumonia was made from clinical symptoms, chest X-ray photographs and serologic antibody rise in paired sera.

Based on the diagnostic criteria described above, 230 patients with M. pneumoniae pneumonia, who had visited the Department of Pediatrics, Hakujikai Memorial Hospital, Adachi-ku, Tokyo from April 2015 to March 2016, were investigated for their serum creatinine levels. The patients ranged in age from 8 months to 15 years, and the male-female ratio was 1: 1.05 (112 boys and 118 girls). Eighty eight children were not receiving antimicrobial agents when they visited this hospital. However, 63 patients received β-lactams, 43 macrolides, 33 new quinolones, and 3 tetracyclines.

Only 4 of the 230 patients received tosufloxacin tosylate, and they were found to have more than twice the reference value of the serum creatinine level based on the criteria of the Acute Kidney Injury (AKI) Practice Guidelines 2016. Uemura et al showed the reference serum creatine levels of Japanese children. None of the cases exceeding 1.5 times the reference serum creatinine levels were suspected of abnormal variability in the groups of children without antibiotic administration, β-lactams, macrolides, or tetracyclines. Among the new quinolone drugs, tosufloxacin tosilate was administrated to 32 patients. In 2009, tosufloxacin tosilate fine granules was approved in Japan for pediatric patients, and in 2017, the indication was expanded to children with M. pneumoniae pneumonia. However, new quinolone drugs are rarely prescribed for children worldwide, and experience of their use is small. Therefore, it is thought by this study that attention to renal function is necessary for the use of new quinolone drugs.

[ Kansenshogaku Zasshi 93: 643-648, 2019 ]

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