Akademik Veri Yönetim Sistemi
Cocuk Sagligi ve Hastaliklari Dergisi, cilt.43, sa.4, ss.325-334, 2000 (Scopus)
Although "switch therapy", defined as initiation of antibiotherapy with intravenous antibiotics and completion of it with oral forms in patients who have been hospitalized due to serious infections, has been applied to adults successfully, but there are only a few controlled trials in children. The aims of this prospective randomized controlled study were to compare switch therapy (case) with standard therapy (control) in the treatment of children aged over two months, admitted to our clinic due to sepsis/suspected sepsis and seeming to have improved at the 48th hour assessment, and to evaluate the progressions, complications and costs of the two treatment regimens. The patients who seemed not to have improved at the 48th hour and/or whose treatment regimen was changed were excluded. Patients were classified into two categories, namely "pneumosepsis" (n=33) and "other sepsis" (n=26) according to the suspected source of sepsis (a total of 59 children including 28 girls and 31 boys). In addition to the physical examination, samples were obtained from all patients to evaluate leukocytes, peripheral blood smear, erythrocyte sedimentation rate (ESR), blood urea, creatinine, AST, ALT, and a urine analysis and proper cultures, were done. They were repeated at the 48th hour of the treatment and also on the 7th-10th days after the initiation of the treatment. Blood and urine cultures were positive in seven patients (12%). Cefuroxime ± amikacin/ clindamycin (for patients with pneumosepsis) or cefotaxime + amikacin (for patients with other sepsis) were given as initial antibiotic therapy according to our clinical antibiotherapy protocols. The patients who improved at the 48th hour of the initial treatments were randomized as to have either switch therapy and discharge or to complete the standard therapy regimen at the hospital. The treatments were given for 7-10 days. The number of patients in the switch (case) and standard (control) therapy groups was 33 and 26, respectively. There were no significant differences between case and control groups in clinical and laboratory evaluations at the 48th hour and on the 7th-10th day, except in heart and breath rates per minute (both were in normal ranges). The mean hospital stay in case and control groups was 3.5±0.5 days and 8±1.2 days, respectively, and the average cost for case and control groups was 301±38 USD and 506±56 USD, respectively (1 USD=∼460,000 TL in October 1999). No significant adverse effects were noted in either group. Switch therapy, in addition to providing psychosocial and other medical benefits, resulted in a savings of approximately 205 USD per patient. In conclusion, with the criteria chosen properly, it is believed that switch therapy can be applied to children beneficially.