Importance of therapeutic windows in paediatric antibiotic therapy failures

摘要

Our objective was to investigate the clinical and therapeutic context after failures of antibiotic therapy with therapeutic windows in order to help optimize the management of bacterial infections by a descriptive analysis of medical records of hospitalized patients in the department of medical pediatrics in the teaching hospital of Yopougon-Abidjan(Cote d'lvoire)from January 2000 to December 2004.Analyses of cases.-Out of a total of 8584 hospitalization cases,there were 3136 cases of bacterial infections among whom we met 27 cases of treatment failures with stopping antibiotic therapy and therapeutic window.The infectious diseases encountered in these 27 cases were pleuropulmonairy infections(37%),meningitis(37%)followed by sepsis(22.22%)and finally gastroenteritis(3.7%).The antibiotic therapy was probabilistic in 55.6% of cases.Persistent fever and non improvement in the clinical condition of the patient were the main reasons for stopping antibiotics.In 13 cases,it was decided a continuation of antibiotic treatment either with the same molecules as before(3.7%),or by changing for another drug(44.4%).The association of two antibiotics remains the most common prescriptions after therapeutic window.In monotherapy,pefloxacin was the most often prescribed antibiotic followed by cefapirine.Alone or in combination,beta-lactam antibiotics were most often prescribed,followed by quinolones and aminoglycosides.A stationary evolution was the most common(53.84%)after 72 h of therapeutic window,followed by complications(30.76%)or clinical improvement(15.40%).Results and conclusion.-Among the 27 cases,10 were released including two patients with a persistent fever;the others have had a clinical improvement.Two patients died and there was one case of escape.The use of therapeutic window is a difficult choice as attested by the limited number of cases recorded over five years.This practice nonetheless requires to be completely effective,the effective realization of paraclinical examinations allowing identification of the organism and the availability of antibiotics needed to combat it.