Author/Editor		Kitanovski, Lidija; Jazbec, Janez
Title		Uporaba izkustvenega antibiotičnega zdravljenja pri otrocih s febrilno nevtropenijo v obdobju od septembra 1999 do oktobra 2000
Translated title		The use of empiric antibiotic treatment in children with febrile neutropenia from September 1999 to October 2000
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 42, št. Suppl 1
Publication year		2003
Volume		str. 93-102
Language		slo
Abstract		A retrospective analysis was undertaken for evaluation of the effectiveness of empirical antibiotic therapy of patients with neutropenia. The results were compared with our results from the 1990-95 period, as well as with the results of similar studies published in literature. During the study period (September 1999 to October 2000), 68 febrile neutropenic episodes were established in 32 patients. Monotherapy was used as primary treatment in 57 (84%) episodes and was modified in half of them. A combination of two antibiotics was used in ten patients and a triple antibiotic regimen in one patient from the start of the treatment. Antibiotic therapy was modified in 40 of 68 episodes (59%). The overall response to antibiotic therapy was quite low compared to the published results, as well as compared to our results from the 1990-95 period. The modifications of antibiotic regimens, which were done quite soon in our study (in 64% of episodes before 72 hours and in 41% before 48 hours of antibiotic treatment), are the possible reason. In most prospective studies with a clearly defined antibiotic strategy, antibiotic modification was not done before 72 hours of antibiotic therapy (except in a few cases of clinical deterioration), often even later. Different times to clinical response (depending on the use of different antibiotic strategies) as well as response rates increasing with the duration of antibiotic treatment are reported. Due to specific local epidemiologic situations and different experiences, individual centers should accept their own strategies for the management of children with febrile neutropenia. This will be possible only if the causative microorganisms, their resistance profile and the patients' clinical responses to antibiotic therapy are monitored. Therefore, every center should have its own guidelines, and these should be unified as much as possible.
Summary		V retrospektivni raziskavi smo želeli ugotoviti uspešnost antibiotičnega zdravljenja vročinskega stanja pri nevtropeničnih bolnikih in rezultate primerjati z našimi rezultati v obdobju 1990-95. Pregledali smo medicinsko dokumentacijo vseh bolnikov, ki so bili obravnavani pri nas zaradi febrilne nevtropenije (FN) v obdobju med septembrom 1999 in oktobrom 2000. Pri 32 bolnikih smo beležili 68 epizod FN. Za zdravljenje z enim antibiotikom smo se odločili v 57 primerih (84 % epizod) in smo ga kasneje spremenili pri polovici bolnikov. Desetkrat smo se odločili za kombinacijo dveh antibiotikov (od tega kar osemkrat za glikopeptidni antibiotik),1 bolnik je prejemal trotirno antibiotično zdravljenje že od začetka. Za spremembo prvotnega antibiotičnega režima smo se odločili pri 40/68 bolnikov (59 %). Za spremembo začetnega empiričnega antibiotičnega pristopa smo se odločali precej pogosteje, kot navaja literatura, pa tudi pogosteje kot pri nas v letih 1990-95. Možni vzrok so zgodnje odločitve za spremembe prvotnega antibiotičnega režima, saj je bilo pri kar 64 % bolnikov antibiotično zdravljenje spremenjeno prej kot v 72 urah in pri kar 41 % bolnikov prej kot v 48 urah od začetka zdravljeaja. V prospektivnih raziskavah, ki ugotavljajo uspešnost antibiotičnega zdravljenja in z jasno začrtanim terapevtskim režimom, se za spremembo prvotnega režima, razen izjemoma, odločajo ne prej kot po 72 urah antibiotičnega zdravljenja, pogosto pa še pozneje. Ugotavljajo različno hiter odgovor bolnika na različne oblike antibiotičnega zdravljenja in naraščanje kliničnega odgovora s časom. (Izvleček skrajšan na 2000 znakov)
Descriptors		NEUTROPENIA FEVER ANTIBIOTICS CHILD