RESUMEN
Hypersensitivity reactions to antibiotics are common with a prevalence of 6-10% of all adverse reactions. There is a lack of guidelines and standardization of skin tests for the screening of hypersensitivity to all antibiotics, in terms of the methodology, dose and time of evaluation of the tests. Literature from Europe and America suggests the use of non-irritating concentration (NIC) of antibiotics for skin testing such as intra dermal test (IDT), skin prick test (SPT). These are concentrations at which the drug is unlikely to produce irritation by virtue of its chemical nature resulting in false positive reactions. These concentrations have been validated by trials in their populations. Due to the increase of antibiotic resistance in our country, declaring a patient allergic to a specific class of antibiotics based on positive skin tests can further narrow the therapeutic armory. These individuals have an increased incidence of infections with resistant organisms as well as increased cost of hospitalization. This is due to the use of alternative broad spectrum antibiotics. Therefore, there is a need for a standardized protocol for the use of skin tests in screening of hypersensitivity, with validated NIC of all antibacterial agents. The aim of this article is to review literature of protocols for assessment of drug hypersensitivity with NIC of antibacterial drugs for SPT, IDT and also establish the need for research in this area in our country.
RESUMEN
Background: Dengue is one of the most important mosquito borne viral diseases presenting with varied symptomatology. A broad-angled evaluation with integration of clinical and laboratory parameters would direct the physicians through the stages of the disease process and the line of management. The objectives were to identify the pattern of management of dengue fever in pediatric in-patients and to assess the outcome. Methods: A prospective observational study was carried out in pediatric inpatients. Data were collected by intensive case record review. Patients of age group 1-18 years of both genders diagnosed of dengue fever were included. The prescribing pattern in children presenting at various stages of dengue fever was analyzed. The outcome was assessed in terms of course in hospital and duration of hospital stay. Results: A total of 110 patients diagnosed with dengue fever with one or more warning signs were admitted during the study period. Thirty percent cases had liver enzymes more than 3 times the normal and 68% patients had platelet count <1,00,000/cumm. Two cases of dengue encephalitis were reported. Most common intravenous fluid given was ringer lactate followed by isolyte P and others. Most common antibiotic prescribed was ceftriaxone followed by ampicillin and others. The symptomatic treatment given consisted of paracetamol, anti-acidity drugs and anti-emetic drugs. Vitamin K was prescribed to 41% and zinc and folic acid supplements were prescribed to 30% children. There was no correlation found between vitamin K and outcome of the disease. Conclusion: Antibiotics and vitamin K though not a part of standard World Health Organization guidelines was seen to be an important part of management. Supportive care with judicious fluid management during the critical and recovery period with continuous monitoring is required for all patients. Further comparative studies are needed to establish the role of antibiotics and other supportive measures like zinc and folic acid on the outcome of the disease.