FOURTEEN years ago, I had written a letter, “‘Drug of choice’ for children: caution” (Feb 25, 2012), raising concern over the promotion and use of ciprofloxacin suspension in children as a ‘drug of choice’. Fourteen years later, the matter deserves to be raised again. The issue is not whether ciprofloxacin can be prescribed to children. Current prescribing information recognises limited paediatric indications. For instance, the Food and Drug Administration (FDA) specifically states that ciprofloxacin is not a drug of first choice in the paediatric population. The concern in Pakistan is whether these restrictions are actually being observed in everyday practice.

Ciprofloxacin appears to be used for a much wider range of childhood complaints, including suspected typhoid, diarrhoeal illness and unexplained fever. If such prescribing practices are common without appropriate diagnosis, microbiological evidence or consideration of alternatives, they deserve urgent regulatory scrutiny.

There is another reason for urgency. Pakistan has experienced extensive fluoroquinolone resistance in Salmonella Typhi. For instance, a large laboratory analysis of Pakistani data from 2017-19 found 66.4 per cent of such isolates resistant to ciprofloxacin. More recent paediatric data from 2024-25 also reported ciprofloxacin resistance in all extensively drug-resistant (XDR) typhoid cases.

Dr Abdul Qadeer Memon

Naushahro Feroze

Published in Dawn, November 9th, 2026