Akut Tonsillofarenjit Vakalarında Acil Serviste Uygulanan İlk Doz İntravenöz Antibiyotiğin Hastalık Seyrine Etkisi

Year 2023, Volume: 4 Issue: 4, 77 - 84, 30.12.2023

Serdar Yaşar Ece Yiğit

Abstract

Amaç: Streptococcus pyogenes (S.pyogenes) erişkinlerde akut tonsillofarenjitin en sık bakteriyel etkenidir. Uygun ve hızlı başlanan antibiyotik tedavisi ile hastalık süresi kısalmakta, komplikasyonlar engellenmekte ve diğer insanlara bulaş azalmaktadır. Çalışmamızda S. pyogenes’e bağlı akut tonsillofarenjit tanısı koyduğumuz hastalarda acil servisimizde uygulanan ilk doz intravenöz amoksisilin+klavulonik asit tedavisinin hastalık seyrini nasıl etkilediğini tespit etmeyi hedefledik.

Materyal Metot:
Çalışmamıza acil servisimize ve iç hastalıkları polikliniğimize üst solunum yolu enfeksiyonu semptomları ile başvuran, hızlı antijen testi ile streptokok antijenini pozitif tespit ettiğimiz ve Centor Kriterlerine göre 2 puan ve üzerinde puan alan hastalar dahil edilmiştir. Başvuru anında ve 72 saat sonunda tam kan sayımı ve C-reaktif protein (CRP) düzeyleri ölçülmüştür. Hastalar başvuru anında ilk doz antibiyotiği 1000 mg amoksisilin ve 200 mg klavulonik asit olarak intravenöz (İV) olarak alıp sonrasında aynı antibiyotiğin oral formunu 2x1 pozolojide kullananlar ve başvuru anında İV antibiyotik uygulanmamış, aynı antibiyotik aynı pozolojide direkt olarak oral formda başlanmış olanlar olarak ikiye ayrılmıştır. İki grup arasında 72 saat sonunda bakılan lökosit, nötrofil ve CRP düzeyleri arasında anlamlı farklılık olup olmadığı araştırılmıştır.

Bulgular:
Yaş, cinsiyet ve Centor skorları açısından gruplar arasında istatistiksel anlamlı farklılık tespit edilmemiştir. Başlangıç anı ve 72 saat sonrası karşılaştırıldığında her iki grupta lökosit, nötrofil ve CRP değerlerindeki değişim istatistiksel olarak anlamlıdır (p <0,001). Gruplar birbiri ile karşılaştırıldığında başlangıç anı ve 72 saat sonrasındaki değişim her üç parametre için de istatistiksel anlamlı olarak farklıdır (p<0,001).

Sonuç:
Benzer klinik durumda olan hastalardan ilk doz antibiyotik tedavisini acil servisimizde İV olarak alan hastaların yalnızca oral antibiyotik kullanan hastalara göre 72 saatin sonunda enfeksiyona bağlı yükselen laboratuvar parametrelerinde anlamlı olarak daha fazla düşüş olduğunu tespit edilmiştir.

Keywords

Farenjit, Antibakteriyel Ajanlar, Acil Tedavi

The Effect of First Dose Intravenous Antibiotherapy Administered in the Emergency Department on Prognosis in Acute Tonsillopharyngitis Cases

Abstract

Aim: Streptococcus pyogenes (S.pyogenes) is the most common bacterial cause of acute tonsillopharyngitis in adults. With appropriate and rapid antibiotic treatment, the duration of the disease is shortened, complications are prevented and transmission is reduced. We aimed to determine how the first dose of intravenous amoxicillin+clavulanic acid treatment administered in our emergency department affects the course of the disease in patients diagnosed with acute tonsillopharyngitis due to S. pyogenes.

Material Method: Patients who applied to our emergency department and internal medicine outpatient clinic with symptoms of upper respiratory tract infection, were positive for streptococcal antigen in the rapid antigen test and scored 2 points or more according to the Centor Criteria were included in our study. Complete blood count (CBC) and C-reactive protein (CRP) levels were measured at the time of admission and at the end of 72 hours. The patients were divided into two groups: the group who received the first dose of antibiotics as 1000 mg amoxicillin and 200 mg clavulonic acid intravenously at the time of admission and then used the oral form of the same antibiotic in a 2x1 posology and the group which intravenous antibiotics were not administered at the time of admission and the same antibiotic was started directly in oral form in the same posology. It was investigated whether there was a significant difference between the leukocyte, neutrophil and CRP levels measured at the end of 72 hours between the two groups.

Results: Age, gender and Centor scores did not show statistically significant differences between the groups. The change in leukocyte, neutrophil and CRP values was statistically significant in both groups when the onset and 72 hours were compared (p <0.001). The change between the groups at the beginning and at the end of 72 hours was statistically significantly different for all three parameters (p<0.001).

Conclusion: It was determined that patients who received the first dose of antibiotic treatment in our emergency department had a significantly higher decrease in laboratory parameters that had increased due to infection at the end of 72 hours compared to patients who used only oral antibiotics.

Keywords

Pharyngitis, Anti-Bacterial Agents, Emergency Treatment

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