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Çocuklarda toplum kaynaklı pnömoninin insidansı ve mortalitesi yıllar içinde azalmakla birlikte, halen tüm dünyada önde gelen mortalite ve morbidite nedenidir. Bu çalışmada, toplum kaynaklı pnömoni nedeni ile hastaneye yatırılan çocuk olgularda, ülkemizde sık olarak kullanılan ampirik antibiyotik tedavi seçeneklerinden ampisilin-sulbaktam ve seftriaksonun klinik yanıt açısından karşılaştırılması amaçlanmıştır. Ampisilin-sulbaktam veya seftriakson tedavilerinden yalnızca birini almış 1 ay-18 yaş aralığında 205 hasta çalışmaya dahil edilmiştir. Bu hastaların 132'si (%64,4) ampisilin-sulbaktam, 73'ü (%35,6) seftriakson almıştır. Ampisilin-sulbaktam veya seftriakson başlandıktan sonra 72 saat içinde klinik iyileşme görülmemesi veya herhangi bir zamanda kötüleşme nedeni ile tedavi değişikliği yapılması (daha geniş spektrumlu antibiyotik tedavi gerekliliği) tedavi başarısızlığı olarak kabul edilmiştir. Ampisilin-sulbaktam alan hastalardan %95,5'inin (126 olgu), seftriakson alan hastalardan %87,7'sinin (64 olgu) tedavisi başarı ile sonlanmıştır. İki antibiyotik tedavisi arasındaki bu farklar istatistiksel olarak anlamlı bulunmuştur (p=0,04). Ampirik antibiyotik tedavisi başarısız olan tüm hasta grubu için komorbid hastalık varlığı [OR (%95 CI): 5,55 (1,49-20,65), p=0,011], lober/multilober infiltrasyon [OR (%95 CI): 5,03 (1,33-18,94), p=0,017] ve plevral efüzyon varlığı [OR (%95 CI): 4,96 (1,09-22,54), p=0,038] tedavi başarısızlığı üzerinde etkisi olabilecek faktörler olarak bulunmuştur. Ampisilin-sulbaktam alan hastalarda yatış öncesi antibiyotik kullanımı [OR (%95 CI): 14,34 (1,08-188,94), p=0,043], seftriakson alan hastalarda komorbid hastalık varlığı [OR (%95 CI): 5,22 (1,03-26,45), p=0,046] tedavi başarısızlığı üzerine etkisi olabilecek olası faktörler olarak bulunmuştur. Tüm yatış süresince ampirik antibiyotik toplam maliyetleri karşılaştırıldığında seftriakson alanlar için ortanca değerin 128,5 TL, ampisilin-sulbaktam alanlar için 71,5 TL olduğu görülmüş, bu fark istatistiksel olarak anlamlı bulunmuştur. Çalışmamız komplike olmayan TKP'nin hastanede tedavisinde ampisilin-sulbaktam ile seftriaksonun karşılaştırıldığı ilk çalışma olup, ampisilin-sulbaktamın başarılı olduğu gösterilmiştir. Ayrıca ampisilin-sulbaktamın ilaç maliyeti seftriaksona göre daha düşüktür. Ampisilin-sulbaktam, komplike olmayan TKP'nin hastanede ampirik tedavisinde etkili, güvenilir ve düşük maliyetli bir antibiyotik seçeneği olabilir. Childhood community acquired pneumonia is a leading cause of mortality and morbidity worldwide, despite the fact that its incidence and mortality rates have been declined in recent years. In this study, we aimed to compare the clinical responses to ampicillin/sulbactam and ceftriaxone which are empiric antibiotic options commonly used in our country for inpatient treatment of pediatric community acquired pneumonia. A total of 205 children between 1 month and 18 years of age treated with only one of the ampicillin/sulbactam or ceftriaxone were included in the study. 132 (64,4%) of these patients treated with ampicillin/sulbactam and 73 (35,6%) with ceftriaxone. Treatment was defined as failure if the initial ampicillin/sulbactam or ceftriaxone therapy was changed because of no clinical improvement within 72 hours or more after their use or clinical worsening at any time. 95,5% of patients receiving ampicillin/sulbactam whereas 87,7% of patients receiving ceftriaxone have successfully completed treatment. These differences between the two antibiotic treatments were statistically significant. For the entire patients in whom empiric antibiotic therapy failed, existence of comorbidity [OR (%95 CI): 5,55 (1,49-20,65), p=0,011], lober/multilober infiltration [OR (%95 CI): 5,03 (1,33-18,94), p=0,017] and pleural effusion [OR (%95 CI): 4,96 (1,09-22,54), p=0,038] were found to be factors that could have an impact on treatment failure. Antibiotic use before admission in patients receiving ampicillin/sulbactam [OR (%95 CI): 14,34 (1,08-188,94), p=0,043] and existence of comorbidity in patients receiving ceftriaxone [OR (%95 CI): 5,22 (1,03-26,45), p=0,046] were found to be factors that could have an impact on treatment failure. When the total drug cost of empiric antibiotics over the entire duration of admission was compared, median cost for ceftriaxone group was 128,5 TL, and for ampicillin/sulbactam group was 71,5 TL. These differences between the two antibiotic treatments were statistically significant. Our study was the first one comparing ampicillin/sulbactam and ceftriaxone in the inpatient treatment of pediatric uncomplicated community acquired pneumonia. It was shown that ampicillin/sulbactam can be effective in this area. Also, the drug cost of ampicillin/sulbactam is lower than that of ceftriaxone. Ampicillin/sulbactam may be an option that can be preferred to being effective, reliable and cheap in empiric treatment of hospitalized children with community acquired pneumonia.

© 2016 by Pediatric Infectious Diseases Society.Objective: Deep neck infections can cause significant morbidity and mortality in children. The aim of this study was to evaluate clinical and microbiological findings and treatment outcomes of radiologically confirmed deep neck infections in children. Material and Methods: This is a retrospective record review of pediatric patients with radiologically confirmed deep neck infections admitted to our clinic between January 2009 and December 2014. Results: During the study period, a total of 36 patients (23 boys/13 girls; mean age: 9.5±5.3 years, range 1-17 years) diagnosed with deep neck infections were followed. The number of cases increased towards the last years of the study. Twenty patients (55.5%) had peritonsillar, 8 (22%) had retropharyngeal, 4 (11%) had parapharyngeal, and 4 (11%) had mixed type infection. Most peritonsillar and parapharyngeal infections occurred in adolescents, whereas retropharyngeal infections occurred generally in preschool children. The most common presenting signs and symptoms were fever (86%), dysphagia (86%), sore throat (72%), and tonsillopharyngitis (72%). Group A beta-hemolytic streptococcus (GABHS) was the most frequently isolated pathogen. Fifteen patients (42%) recovered with only antibiotic treatment, and most of the patients (86%) were given intravenous ampicillinsulbactam+ clindamycin. Complications occurred in two patients (5.5%) with retropharyngeal infection, including airway obstruction, internal jugular vein thrombosis, and septic shock. Mortality was seen in only one patient (2.7%) with invasive GABHS infection. Conclusion: An increase in the incidence of pediatric deep neck infections has been observed in recent years, and this increase was congruent with the increase in group A streptococcal abscesses.

Acute osteomyelitis (AOM) is a devastating disease with potential sequela and mortality in case of delay in diagnosis and treatment. Navicula can be involved rarely and Salmonella species can cause AOM in otherwise healthy children. In this report, a 4-year-old boy without immunodeficiency, sickle-cell disease, and any history of gastrointestinal symptoms or suspicious food consumption, but with an ankle sprain history, presented with acute navicular Salmonella osteomyelitis. He recovered without surgical intervention and complication. Trauma can facilitate salmonella osteomyelitis in otherwise healthy children. Prompt diagnosis and treatment can prevent complications and the requirement of surgical interventions in AOM.