SWITCH
THERAPY IN HOSPITALIZED CHILDREN WITH SEPSIS
Ildirim I,
Bayram Y, Celebi S, Ozakin C, Ercan I, HacimustafaoGluM
Uludag
University Medical Faculty, Bursa, Turkey
Objective: 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 2 month. Admitted to our clinic due to sepsis/suspected sepsis and
seemed to be improved at the 48th hour assessment, and to evaluate the
progressions, complications and costs of the two treatment regimens.
Methods: 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; 28 girls and 31
boys). In addition to physical examination, laboratory parameters were
repeated at the 48th hour and on the 7-10th days after the initiation of
the treatment. The patients who have been improved at 48th hour of the
initial treatments were randomized as to have either switch therapy or
discharge or to complete standard therapy regimen at the hospital. The
treatments have been given for 7-10 days. The patients in the switch and
standard therapy groups were 33 and 26 respectively.
Results: 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
antibiotics. There were no significant differences between case and control
groups in clinical and laboratory evaluations at 48th hours and on the
7-10th days, except in heart and breath rates per minute (both of them were
in normal ranges). The mean hospital stays in case and control groups were
3.5±0.5 days and 8±1.2 days respectively, and the average costs for case
and control groups were 301±38 USD and 506±56 USD respectively. No
significant adverse effect was noted in both groups. By means of switch
therapy, beside psychosocial and other medical benefits, approximately 205
USD savings per patient were detected in this study.
Conclusion: In conclusion, having
the criteria chosen properly it was thought that switch therapy could be
applied to children safely.