Peculiarities of Intensive Therapy of Severe Community-Acquired Infections in Children
Introduction. Despite the success of clinical microbiology, causal treatment of severe infections, including pneumonia, is empirical at the initial stage, and its adequacy is crucial for saving the patient’s life.
Objective of the study — to improve the treatment of severe pneumonia requiring intensive care in childhood.
Materials and Methods. We observed 63 patients aged 9 months to 14 years who were treated in the department of ane-sthesiology and intensive care for severe community-acquired pneumonia. The first group consisted of 30 children, who received piperacillin/tazobactam (Aurotaz-P) as initial therapy; in the second group (n = 33), the initial treatment was carried out using third-generation cephalosporins or their combination with aminoglycosides.
Results. The choice of Aurotaz-P as initial drug has been associated with a wide range of its impact on both Gram-positive and Gram-negative flora. According to the results of microbiological monitoring, the sensitivity to piperacillin/tazobactam was 95.5 %.
The average period of stay in the intensive care unit in the first group was 8.5 ± 2.3 days. In this group, there were no cases of empirical antibiotic therapy failure. In the control group, the average period of stay in the department was 14.0 ± 3.9 days — significantly longer than in patients of the first group. The need for more prolonged treatment was due to the need to change the antibiotic in 81.9 % of cases because of the lack of clinical efficacy.
Conclusions. A wide range of action, as well as the ease of dosing in childhood, allows us to consider Aurotaz-P as the drug of choice for intensive care of severe pneumonia in children, as evidenced by the results of microbiological monitoring and high clinical efficacy according to the results of this study.
Briko N.I. (2009) Prevalence and opportunities of pneumococcus infections prophylactic on the World and in Russia. Butteten’ “Vaktsinatsiia”, (2). Available at: http://www.privivka.ru/ru/expert/bulletin/archive/? іd = 1&tid = 4.
Nudga A.N., Kovaleva E.A., Galinskaia V.A., Sidorenko O.A., Ponomarenko A.I. Hard pneumonias with fatal outcome (analysis of course, peculiarities). Meditsina neotlozhnykh sostoianii, 2006, (5(6)). Available at: http://www.mif-ua.com/archive/article_print/945.
Shabalov N.P. Pneumonias in young age children. Lechashchii vrach, 2003, (2). Available at: http://www.lvrach.ru/2003/02/4530038.
Janowski A. B. Piperacillin-Tazobactam Usage at a Tertiary Pediatric Hospital: An Antimicrobial Stewardship Review. J. Pediatric Infect. Dis. Soc., 2015. Access mode: http://www.ncbi.nlm.nih.gov/pubmed/26407269#.
Zhang Y., Chen Y., Chen Z., Zhou Y., Sheng Y., Xu D., Wang Y. (2014). Effects of bronchoalveolar lavage on refractory Mycoplasma pneumoniae pneumonia. Respir. Care, 59(9), 1433-1439. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24962224.
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