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首页> 外文期刊>Paediatrics & Child Health >THE EFFICACY OF HIGH DOSE CEPHALEXIN IN THE OUTPATIENT MANAGEMENT OF MODERATE CELLULITIS FOR PEDIATRIC PATIENTS
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THE EFFICACY OF HIGH DOSE CEPHALEXIN IN THE OUTPATIENT MANAGEMENT OF MODERATE CELLULITIS FOR PEDIATRIC PATIENTS

机译：高剂量海马酚在小儿中型细胞门诊治疗中的作用

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BACKGROUND: Children with moderate cellulitis are often treated with IV antibiotics in the hospital setting, as per recommendations, since the safety and efficacy of oral treatment is still not well established. Previously in our hospital, a protocol using daily IV ceftriaxone with follow-up at the day treatment center (DTC) was used to avoid admission. In 2013, a new institutional protocol was implanted and suggested the use of high dose (HD) oral cephalexin with follow-up at the DTC for those patients. OBJECTIVES: To evaluate the safety and efficacy of the HD cephalexin protocol to treat moderate cellulitis in children as outpatient. DESIGN/METHOD: A?retrospective chart review was conducted. Children were included if they presented to the ED between January 2014 and 2016 and were diagnosed with a moderate cellulitis sufficiently severe to request a follow up at DTC and who were treated according to the standard of care with the HD oral cephalexin (100mg/kg/day) protocol. Descriptive statistics for clinical characteristics of patients upon presentation, as well as for treatment characteristics in the ED and DTC were analyzed. Treatment failure was defined as: need for admission at the time of DTC evaluation, change for IV treatment in DTC or return visit to the ED. Outcomes were compared to historic controls treated with IV ceftriaxone at the DTC, where admission was avoided in 80% of?cases. RESULTS: During the study period, 682 children with cellulitis were diagnosed in our ED. Of these, 117 patients were treated using the oral HD cephalexin outpatient protocol. Success rate was 89.5% (102/114); three patients had an alternative diagnosis at DTC. Treatment failure was reported in 12 cases; 10 patients (8.8%) required admission, one (0.9%) received IV antibiotics at DTC, and one (0.9%) had a return visit to the ED without admission or change to the treatment. This compares favorably with the previous study using IV ceftriaxone (success rate of 80%). No severe deep infections were reported or missed; 4 patients required drainage and one had a rash. The mean number of visits per patient required at the DTC was?1.6. CONCLUSION: Treatment of moderate cellulitis requiring a follow-up in a DTC, using an oral outpatient protocol with HD cephalexin is a secure and effective option. By reducing hospitalization rate and avoiding the need for painful IV insertion, HD cephalexin is a favourable option in the management of moderate cellulitis for pediatric patients, when no criteria of toxicity are present. Articles from Paediatrics & Child Health are provided here courtesy of Oxford University Press.
机译：背景：中度蜂窝织炎患儿通常按照建议在医院环境中使用静脉内抗生素治疗，因为口服治疗的安全性和有效性尚不明确。以前在我们医院，使用每日静脉注射头孢曲松钠并在日间治疗中心（DTC）进行随访的方案可避免入院。 2013年，植入了一项新的机构规程，并建议在DTC中对这些患者进行大剂量（HD）口服头孢氨苄的使用。目的：评估HD头孢氨苄方案治疗门诊儿童中度蜂窝织炎的安全性和有效性。设计/方法：进行回顾性图表审查。如果儿童在2014年1月至2016年之间接受急诊就诊，并且被诊断患有中度蜂窝组织炎，严重到足以要求DTC进行随访，并且按照HD口服头孢氨苄（100mg / kg /天）协议。分析了就诊时患者临床特征的描述性统计数据，以及ED和DTC中的治疗特征。治疗失败的定义为：在DTC评估时需要入院，在DTC中进行IV治疗变更或回访ED。将结果与在DTC用静脉注射头孢曲松治疗的历史对照进行比较，在80％的病例中避免了入院。结果：在研究期间，我们的急诊室确诊了682例蜂窝织炎患儿。其中，有117例患者接受了HD HD头孢氨苄的门诊治疗。成功率为89.5％（102/114）; 3例患者在DTC处有其他诊断。据报道有12例治疗失败。 10例患者（8.8％）需要入院，其中1例（0.9％）在DTC接受了IV抗生素治疗，另有1例（0.9％）在没有入院或未改变治疗的情况下回访了ED。与先前使用静脉注射头孢曲松的研究相比（成功率为80％），该结果令人满意。没有报告或遗漏任何严重的深部感染; 4名患者需要引流，其中1人患有皮疹。 DTC要求每位患者的平均就诊次数为1.6。结论：使用HD头孢氨苄的口服门诊治疗中度蜂窝织炎需要在DTC中进行随访是一种安全有效的选择。通过降低住院率并避免进行痛苦的IV插入，当没有毒性标准时，HD头孢氨苄是小儿患者中度蜂窝织炎治疗的理想选择。牛津大学出版社在此提供儿科学与儿童健康方面的文章。

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