Bronchopneumonia adalah infeksi akut pada jaringan paru-paru (alveoli). Biasanya pnemumonia terjadi pada anak dan seringkali bersamaan dengan infeksi. Bronchopneumoniapada anak saat ini menjadi penyakit yang paling sering terjadi pada anak. Masalah keperawatan utama yang terjadi pada anak dengan . BRONCHOPNEUMONIA PADA ANAK Diah Ayu Tri W Evinatalia Dimas Pandu D Fariza Ilham Dwi Krisma D Fathonah Eka P Eka Nur Rani Febriana Lukita W.
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Bronchopneumonia is the most common clinical manifestation of pneumonia in pediatric population and leading infectious cause of mortality in children under 5 years. Evaluation of treatment involves diagnostic procedures, assessment of disease severity and treatment for disease with an emphasis on vulnerability of the population. To determine the most commonly used antibiotics at the Pediatric Clinic in Sarajevo and concomitant therapy in the treatment of bronchopneumonia. The study was retrospective and included a total of patients, hospitalized in pulmonary department of the Pediatric Clinic in the period from July to December The treatment of bronchopneumonia at the Pediatric Clinic was empirical and it conformed to the guidelines and recommendations of British Thoracic Society.
Evaluation of Drug Treatment of Bronchopneumonia at the Pediatric Clinic in Sarajevo
First and third generation of cephalosporins and penicillin antibiotics were the most widely used antimicrobials, with parenteral route of brobchopneumonia and average duration of treatment of 4.
In addition to pharmacotherapy, hospitalized patients were subjected to a diet with controlled intake of sodium, which included probiotic-rich foods and adequate hydration. Recommendations for further antimicrobial treatment include oral administration of first-generation cephalosporins and penicillin antibiotics.
Results of the drug treatment of bronchopneumonia at the Pediatric Clinic of the University Qnak Center of Sarajevo are comparable to the guidelines of the British Thoracic Society. It is necessary to establish a system for rational use of antimicrobial agents in order to reduce bacterial resistance.
Bronchopneumonia is the most common clinical manifestation vronchopneumonia pneumonia in pediatric population. It is a leading infective cause of mortality in children under 5 years of age.
Inbronchopneumonia caused death inof children under 5 years. Etiological causative agents of bronchopneumonia are bacteria, viruses, parasites and fungi. Since pediatric population is vulnerable and specific, clinical features are often non-specific and conditioned by numerous factors.
These factors include certain age group, presence of comorbidity, exposure to risk factors, carried out immunization etc. The most reliable way to diagnose bronchopneumonia is through chest X-ray, but that is not enough to determine the ethiological agent, so the treatment of bronchopneumonia is clinical rather than ethiological in most cases.
Since bronchopneumonia is an infectious disease, antimicrobic agents must be used in the treatment, along with additional supportive and symptomatic treatment. However, frequent use of antibiotics leads to a rise in bacterial resistance 1. Bacterial resistance, along with limitations in establishment of timely diagnosis and difficult ethiological classification, often leads to severe clinical features and inadequate response to therapy, which results in increased number of treatment days, as well as increased consumption of antimicrobials.
The aim of this study was to determine the most often proscribed antibiotics and supporting concomitant therapy in treatment for bronchopneumonia at the Pediatric Clinic in Sarajevo, and to determine whether the treatment is in accordance with the British Thoracic Society guidelines.
The study included patients under 18 with diagnosis of bronchopneumonia, patients with detailed history of the disease and detailed information on diagnostics and treatment carried out at the Pediatric Clinic, and patients who were hospitalized in the pulmonary department in the period from 1 st July to 31 st December Analysis results are displayed in tables and graphs as per number of cases, percentage, and arithmetic mean X with standard deviation SDstandard error SE and a range of values min-max.
The study included patients who met criteria for enrollment. In the total sample, there was a higher number of male subjects 60 or According to the formed age groups, the highest number of patients was in the preschool and school age groups 39 patients each or Age groups of newborns and adolescents included 2 patients each or 1.
Average age in sample was The youngest patient was 1 month old and the oldest was months old 16 years. Cough was present in 88 or Chest pain was experienced by 66 or Duration of hospital stay number of days of hospitalization averaged 5. Out of total number of subjects, 66 or In the period of the study July-Decemberreadmission to hospital due to bronchopneumonia was recorded in 12 subjects or Average oxygenation level was The largest number of patients—67 of them In newborn and infant age group, the following symptoms prevailed: In preschool children age group, cough was present in In school children age group, cough as a symptom was present in In adolescent age group, cough, chest pain and increased body temperature were present in all subjects, while vomiting was not observed at all.
Within this group, the most widely used medicine was ampicillin First-generation cephalosporins were administered to 42 patients The only medicine in this group that was administered was cefazolin with average dose of 1, Third-generation cephalosporins were administered to 33 or Total duration of the antibiotic therapy averaged 4. Medicines from the group of penicillins were recommended for continuation of treatment of 28 patients The most commonly recommended medication in the aforementioned group was ampicillin in two forms suspension and tablets.
The average dose of ampicillin was Drugs in cephalosporins group were recommended in total of 61 subjects The most recommended medication in this group was cefixime, with an average recommended daily dose of 8.
Among other drugs recommended for treatment continuation at home, antipyretics were recommended in 54 or We present the results of patients who were hospitalized at pulmology department of the Pediatric Clinic with diagnosis of bronchopneumonia. According brohchopneumonia the results of our study we recommend oral administration of first-generation cephalosporins and penicillin antibiotics as effective treatment for bronchopneumonia in the pediatric population.
In the last 30 years, a lot of research has been done with the purpose of achieving a more effective treatment of bronchopneumonia in the pediatric population and a bronchhopneumonia in bronchopneumonia-caused mortality. The turning point was year when the World Health Organization undertook activities to establish a unified strategy to combat pneumonia worldwide 1.
The Pediatric Clinic of the University Clinical Center of Sarajevo has also based its principles of treating bronchopneumonia on observing guidelines and protocols, as well as principles of good clinical practice. Hence the usual empirical treatment is based on proven connection of certain causative agents with specific populations, while etiological treatment is very rare.
A study done on hospitalized children in Africa in found that there is a very low risk of failure when using drugs mentioned in the guidelines and protocols relative to the targeted etiological treatment 0. According to the research done by the World Health Organization, for quality management of bronchopneumonia, certain criteria must be met in order to refer a child to hospital treatment: Treatment of bronchopneumonia involves administration of medicines and use of high calorie dietary regimes with adequate hydration.
Pharmacological measures imply administration of antimicrobial and concomitant therapy. Antimicrobials used in the treatment of bronchopneumonia are first and third generation of cephalosporins, as well as penicillin based antibiotics. In our study, antibiotic therapy lasted 4. Cefazolin in the group of first-generation cephalosporins was administered in 42 patients, or in In all patients, cefazolin was administered intravenously at a dose of 1, Third-generation cephalosporins have been administered intravenously to 33 patients, or The most commonly used medicine in the group of third-generation cephalosporins was ceftazidime.
A total of 17 subjects in the treatment received ceftazidime, the lowest dose was given in infants mg and the highest dose was given to school-aged children 2, mg. The average duration of treatment with ceftazidime was 5. Ampicillin as the most often used drug from the penicillin group was administered in 18 patients with an average dose of 1, Shortest duration of therapy has been recorded in the penicillin group of antibiotics.
Studies in India fromconducted on a total of 1, children at the pediatric departments in 20 hospitals, showed that the treatment with penicillin antibiotics is more effective in comparison to treatment with other antibiotics 4. Study showed that the second and third generation of cephalosporins were used in infants, but not in adolescents.
In the treatment of children of preschool age, first-generation cephalosporins were most often used, while third-generation cephalosporins were most often used in school-aged children. According to the dose of administered antibiotic, it has been shown that dose increases linearly with age, with the lowest dose administered in infants.
Evaluation of Drug Treatment of Bronchopneumonia at the Pediatric Clinic in Sarajevo
Duration of treatment with third-generation cephalosporins was longest in infants 7 days and shortest in children of preschool age 4. According to the guidelines of the British Thoracic Society, certain guidelines should be adhered to during treatment of bronchopneumonia.
Every child with a clear diagnosis of pneumonia should receive antibiotic therapy since it is not possible to make immediate reliable differentiation of bacterial and viral pathogens 5.
Intravenous administration of antibiotics is recommended for children suffering from pneumonia in cases when a child cannot tolerate oral intake of drugs or their absorption i. Recommended intravenous antibiotics for treatment of severe bronchopneumonia are: Use of these antibiotics can be rationalized if microbiological diagnostics is performed 7.
It is advisable to consider oral administration of medicines in patients to whom antibiotics were administered intravenously and who subsequently experienced noticeable improvement in clinical features 8.
The main problem is the lack of clear definition of the moment or conditions when the patient should make the switch to oral administration 9.
Studies conducted in Italy inshowed that intravenous administration of antimicrobials has several far-reaching effects on pediatric patients and treatment itself In the opinion of child psychologists, parenteral bronchoopneumonia of administration is considered to be traumatic for the child, with more rapid appearance of adverse effects Studies of the American Thoracic Society from indicated that patients with respiratory disease should have a specific diet rich in minerals and vitamins with a moderate amount of easily digestible proteins, poor in carbohydrates and rich in fat Important aspects in the treatment of child bronchopneumonia are rest and adequate hydration.
It is necessary to work on prevention in order to reduce the incidence of morbidity. Studies conducted in UK in showed that introduction of vaccination revolutionized prevention of infectious diseases.
It has been shown that introduction of vaccines against measles reduced incidence of mortality by 2. Studies conducted in the United States in the period have shown that introduction of the conjugate vaccine against Streptococcus pneumoniae bronchoopneumonia make the biggest advance in prevention of pneumonia, since it is the most common etiologic agent of this type of pneumonia.
Controlled study with use of WHO standardization of radiographic definition of pneumonia included 37, children. Vaccination effectiveness of Italian single-blind study from showed that bronchopnwumonia was a statistically significant difference in occurrence of bronchopneumonia in children who are not immunized compared to those who are Increase in use of third-generation cephalosporins, and aminopenicillins is a cause for concern.
Since such increase is also observed in vulnerable pediatric population, current situation must be analyzed and restrictive-educational measures ought to be recommended based on results of such analysis. Hence the use of antibiotics would be rationalized Study results showed that Pediatric clinic has access to modern diagnostic tests, the treatment is carried out in accordance with the protocols and guidelines, which largely correspond to the guidelines of the British Thoracic Society.
The latest antimicrobials and concomitant therapy for treatment are bronchopnejmonia.