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

Yıl 2023, Cilt: 4 Sayı: 4, 77 - 84, 30.12.2023

Öz

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.

Kaynakça

  • 1. Schroeder BM. Diagnosis and management of group A streptococcal pharyngitis. American family physician. 2003;67(4): p. 880.
  • 2. Stevens DL. Streptococcal toxic-shock syndrome: spectrum of disease, pathogenesis, and new concepts in treatment. Emerging infectious diseases. 1995;1(3): p. 69.
  • 3. Mani R, Mahadevan A, Pradhan S, Nagarathna S, Srikanth NS, Dias M, et al. Fatal Group A Streptococcal meningitis in an adult. Indian J Med Microbiol. 2007;25(2):169-70.
  • 4. Carapetis JR, Steer AC, Mulholland EK., Weber M. The global burden of group A streptococcal diseases. The Lancet infectious diseases. 2005;5(11): p. 685-694.
  • 5. Callister ME, Wall RA. Descending necrotizing mediastinitis caused by group A streptococcus (serotype M1T1). Scandinavian journal of infectious diseases. 2001; 33(10): p. 771-772.
  • 6. Maltezou HC, Tsagris V, Antoniadou A, Galani L, Douros C, Katsarolis I, et al. Evaluation of a rapid antigen detection test in the diagnosis of streptococcal pharyngitis in children and its impact on antibiotic prescription. Journal of antimicrobial Chemotherapy. 2008;62(6): p. 1407- 1412.
  • 7. Dhanda V,Vohra H, Kumar R. Virulence potential of Group A streptococci isolated from throat cultures of children from north India. The Indian Journal of Medical Research. 2011;133(6): p. 674.
  • 8. Gerber MA, Randolph MF, DeMeo KK, Kaplan EL. Lack of impact of early antibiotic therapy for streptococcal pharyngitis on recurrence rates. The Journal of pediatrics, 1990;117(6): p. 853-858.
  • 9. Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. et al. The diagnosis of strep throat in adults in the emergency room. Medical Decision Making. 1981;1(3): p. 239-246.
  • 10. Prevention CfDCa. National Hospital Ambulatory Medical Care Survey: Emergency Department Summary Tables 2017. https://www.cdc.gov/nchs/ data/nhamcs/web_tables/2017_ed_web_tables-508.pdf
  • 11. Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clinical infectious diseases. 2012;55(10): p. e86-e102.
  • 12. Sheridan EJ, Ludwig J, Helmen J, Thevatheril IT. Should you treat a symptomatic patient by phone when his child has confirmed strep throat? J Fam Pract. 2007;56(3):234-5.
  • 13. Cooper RJ, Hoffman JR, Bartlett JG, Besser RE, Gonzales R, Hickner JM, et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: background. Annals of internal medicine, 2001; 134(6): p. 509-517.
  • 14. Langlois DM, Andreae M. Group A streptococcal infections. Pediatr Rev, 2011. 32(10): p. 423-9; quiz 430.
  • 15. Ahmed MH, Hassan MF, Eida MM, Metwally LA. Evaluation of Appropriateness of Antibiotic Use and Validation of the Mclsaac-Modified Centor Score for Group A Beta Hemolytic Streptococcal Acute Pharyngitis in Suez Canal Area. Suez Canal University Medical Journal. 2015;18(2): p. 117-124.
  • 16. Humair JP, Revaz SA, Bovier P, Stalder H. Management of acute pharyngitis in adults: reliability of rapid streptococcal tests and clinical findings. Archives of Internal Medicine. 2006;166(6): p. 640-644.
  • 17. Neuner JM, Hamel MB, Phillips RS, Bona K, Aronson MD. Diagnosis and management of adults with pharyngitis: a cost-effectiveness analysis. Annals of internal medicine. 2003;139(2): p. 113-122.
  • 18. Linder JA, Stafford RS. Antibiotic treatment of adults with sore throat by community primary care physicians: a national survey, 1989-1999. Jama. 2001;286(10): p. 1181- 1186.
  • 19. Poh XE, Wu KH, Chen CC, Huang JB, Cheng FC,Chiu IM. Outcomes for Patients with Urinary Tract Infection After an Initial Intravenous Antibiotics Dose Before Emergency Department Discharge. Infectious Diseases and Therapy. 2021;10(3): p. 1479-1489.
  • 20. Liu VX, Fielding-Singh V, Greene JD, Baker JM, Iwashyna TJ, Bhattacharya J, Escobar GJ. The Timing of Early Antibiotics and Hospital Mortality in Sepsis. Am J Respir Crit Care Med. 2017;196(7): p. 856-863.
  • 21. van den Broek AK, Prins JM, Visser CE, van Hest RM. Systematic review: the bioavailability of orally administered antibiotics during the initial phase of a systemic infection in non-ICU patients. BMC infectious diseases. 2021;21(1): p. 1-11.
  • 22. Huang YH, Yan JH, Kuo KC, Wu WT, Su CM, Chiu IM. et al. Early antibiotics use in young infants with invasive bacterial infection visiting emergency department, a single medical center's experience. Pediatrics &amp; Neonatology. 2020;61(2): p. 155-159.

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

Yıl 2023, Cilt: 4 Sayı: 4, 77 - 84, 30.12.2023

Öz

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.

Kaynakça

  • 1. Schroeder BM. Diagnosis and management of group A streptococcal pharyngitis. American family physician. 2003;67(4): p. 880.
  • 2. Stevens DL. Streptococcal toxic-shock syndrome: spectrum of disease, pathogenesis, and new concepts in treatment. Emerging infectious diseases. 1995;1(3): p. 69.
  • 3. Mani R, Mahadevan A, Pradhan S, Nagarathna S, Srikanth NS, Dias M, et al. Fatal Group A Streptococcal meningitis in an adult. Indian J Med Microbiol. 2007;25(2):169-70.
  • 4. Carapetis JR, Steer AC, Mulholland EK., Weber M. The global burden of group A streptococcal diseases. The Lancet infectious diseases. 2005;5(11): p. 685-694.
  • 5. Callister ME, Wall RA. Descending necrotizing mediastinitis caused by group A streptococcus (serotype M1T1). Scandinavian journal of infectious diseases. 2001; 33(10): p. 771-772.
  • 6. Maltezou HC, Tsagris V, Antoniadou A, Galani L, Douros C, Katsarolis I, et al. Evaluation of a rapid antigen detection test in the diagnosis of streptococcal pharyngitis in children and its impact on antibiotic prescription. Journal of antimicrobial Chemotherapy. 2008;62(6): p. 1407- 1412.
  • 7. Dhanda V,Vohra H, Kumar R. Virulence potential of Group A streptococci isolated from throat cultures of children from north India. The Indian Journal of Medical Research. 2011;133(6): p. 674.
  • 8. Gerber MA, Randolph MF, DeMeo KK, Kaplan EL. Lack of impact of early antibiotic therapy for streptococcal pharyngitis on recurrence rates. The Journal of pediatrics, 1990;117(6): p. 853-858.
  • 9. Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. et al. The diagnosis of strep throat in adults in the emergency room. Medical Decision Making. 1981;1(3): p. 239-246.
  • 10. Prevention CfDCa. National Hospital Ambulatory Medical Care Survey: Emergency Department Summary Tables 2017. https://www.cdc.gov/nchs/ data/nhamcs/web_tables/2017_ed_web_tables-508.pdf
  • 11. Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clinical infectious diseases. 2012;55(10): p. e86-e102.
  • 12. Sheridan EJ, Ludwig J, Helmen J, Thevatheril IT. Should you treat a symptomatic patient by phone when his child has confirmed strep throat? J Fam Pract. 2007;56(3):234-5.
  • 13. Cooper RJ, Hoffman JR, Bartlett JG, Besser RE, Gonzales R, Hickner JM, et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: background. Annals of internal medicine, 2001; 134(6): p. 509-517.
  • 14. Langlois DM, Andreae M. Group A streptococcal infections. Pediatr Rev, 2011. 32(10): p. 423-9; quiz 430.
  • 15. Ahmed MH, Hassan MF, Eida MM, Metwally LA. Evaluation of Appropriateness of Antibiotic Use and Validation of the Mclsaac-Modified Centor Score for Group A Beta Hemolytic Streptococcal Acute Pharyngitis in Suez Canal Area. Suez Canal University Medical Journal. 2015;18(2): p. 117-124.
  • 16. Humair JP, Revaz SA, Bovier P, Stalder H. Management of acute pharyngitis in adults: reliability of rapid streptococcal tests and clinical findings. Archives of Internal Medicine. 2006;166(6): p. 640-644.
  • 17. Neuner JM, Hamel MB, Phillips RS, Bona K, Aronson MD. Diagnosis and management of adults with pharyngitis: a cost-effectiveness analysis. Annals of internal medicine. 2003;139(2): p. 113-122.
  • 18. Linder JA, Stafford RS. Antibiotic treatment of adults with sore throat by community primary care physicians: a national survey, 1989-1999. Jama. 2001;286(10): p. 1181- 1186.
  • 19. Poh XE, Wu KH, Chen CC, Huang JB, Cheng FC,Chiu IM. Outcomes for Patients with Urinary Tract Infection After an Initial Intravenous Antibiotics Dose Before Emergency Department Discharge. Infectious Diseases and Therapy. 2021;10(3): p. 1479-1489.
  • 20. Liu VX, Fielding-Singh V, Greene JD, Baker JM, Iwashyna TJ, Bhattacharya J, Escobar GJ. The Timing of Early Antibiotics and Hospital Mortality in Sepsis. Am J Respir Crit Care Med. 2017;196(7): p. 856-863.
  • 21. van den Broek AK, Prins JM, Visser CE, van Hest RM. Systematic review: the bioavailability of orally administered antibiotics during the initial phase of a systemic infection in non-ICU patients. BMC infectious diseases. 2021;21(1): p. 1-11.
  • 22. Huang YH, Yan JH, Kuo KC, Wu WT, Su CM, Chiu IM. et al. Early antibiotics use in young infants with invasive bacterial infection visiting emergency department, a single medical center's experience. Pediatrics &amp; Neonatology. 2020;61(2): p. 155-159.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makaleleri
Yazarlar

Serdar Yaşar 0000-0003-4597-5541

Ece Yiğit 0000-0002-8293-3554

Yayımlanma Tarihi 30 Aralık 2023
Gönderilme Tarihi 17 Şubat 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 4 Sayı: 4

Kaynak Göster

AMA Yaşar S, Yiğit E. The Effect of First Dose Intravenous Antibiotherapy Administered in the Emergency Department on Prognosis in Acute Tonsillopharyngitis Cases. JMS. Aralık 2023;4(4):77-84.