Evaluation of Drug Treatment of

Bronchopneumonia at the
Pediatric Clinic in Sarajevo

(Med Arch Journal, 2016 : Svjetlana

Loga Zec, Kenen Selmanovic, Natasa
Loga Andrijic, and Lejla Zunic)
 Abstract
This study is to determine the most commonly
used antibiotics at the Pediatric Clinic in
Sarajevo and concomitant therapy in the
treatment of Bronchopneumonia
Emperical treatment and it 1st & 3rd Generation of
conformed to the guidelines Cephalosporins and Penicillins
and recommendation of the most widely used
British Thoracic Society Concomitant therapy :
antipyretics, corticosteroids,
Determine the most leukotriene antagonist,
commonly used Ab to agonist of Beta-2 adrenergic
establish system use and controlled sodium intake
of Ab agent
 1.introduction
• Bronchopneumonia(BP)the most common
clinical manifestation of Pneumonia in
pediatric population.
• Etiological causative agents: Bacteria, viruses,
parasistes & fungis.
This papper concern since bronchopneumonia is
an infectious disease, antimicrobics agents must
be used in the treatment + add
supportive&symptomatic treatment.
 Bronchopenumonia
Infectious Disease
Antimicrobic agents for treatment &
supportive/Symptomatic treatment

Frequent use of antibiotics Limitations time diagnosis

& difficulties ethiological
classification
Leads to Bacterial Resistants
Leads to severe clinical features &
inadequate respons to theraphy

Increase number of treatments dayincrease

consumption of antimicrobials
 The aim of the study to
determine the most proscribed
Ab & Supportive Concomitant
therapyaccordance with the
British Thoracic Society
Guidelines
 2. Method
• Subjects & Equipments
- Patients under 18 Diagnosis of BP
- Included 104 patients who met criteria for
enrolment
- Detailed history of the disease & detailed
information on diagnostic & treatment (Hspitalized
1st july to 31st dec 2014)
 3. Analysis
- Analysis result displayed in tables&graph as per
number of cases, percentage, & arithmetic mean
(X) with standard deviation (SD), standard eror
(SE), & range of values (min-max)
- Test age differenceuse Wilcoxon signed rank
test & one-way analysis of variance (ANOVA)
- The analysis performed using statistical software
IBM St v 21.0
• Analysed for stastitical significance to 95% of
confident limit (p<0,05%)using Wilcoxon
signed rank test & ANOVA
Null Hypotesis :
Sample population get the most
commony AB accordance with the
British Thoracic Society guidelines

Result p< dari 0,01

 4. Result
1 104 patient who met criteria for enrolment
Higher number of male subjects
(60/57,7%)female (44/42,3%)

Preschool age (39 patients/37,5%)

Infants group (22 patients/21,2%)
Newborns&adolescents each 2
patients/ 1,9%
Average age in sample was 55.3
Months-43.3 Months
 Result
1 Dominant Clinical Features

Cough 88 patients/ 84,6% Duration of Hospitalized

average 5.2 days -/+ 2.6 days
Average Body Temp: 38,7 C-/+ 0,9 The shortest 1 day
37-40.2 C The longest 15 ddays

Chest Pain66 patients/63.5% Average Oxygenation level

90.3 -/+ 0.6%
Ranged 74.4 %- 97.2%
Vomiting64 patients/ 64.5%

67 patients (64.2%) had three dominant symptoms in clinical features:

Cough, Increase of Body Temperature and Vomiting
Only 10 patients (9.61%) had the 4 symptoms (cough, increase BT,
Vomiting and chest pain)
2 Used Antibiotic Therapy
Penicillin

-Penicillin antibiotics were

administered intravenously
-Duration of Therapy 3.56-
/+1.42 days

26 patients
(25%) used
ampicillin
(17.68%)
2 1st Generation Cephalosporin
- Intravenously
adm
- Duration 4.3-
/+1.6 days

42 patients used 1st Gen

Cephalosporine40,4%
3 3rd Generation of Cephalosporin

- Intravenously
adm
- Duration 5.76-
/+ 2.62 days

33 Patients used 3rd Gen

Cephalosporins31.7%
 Recommended
Therapy for treatment
continuation

- Penicilins group28 patients (26,9%)

- Cephalosporins Group61 Patients (73.1%)
- The most recommended cefixime
- Concomitant Supportive therapy :antipyretic, methylprednisolone and
montelukast

- According to the result
1st Gen Cephalosporins
(40.4%) usedduration of
treatment (4.3 -/+ 1.6 days)
4. Discussion
3rd Gen Cephalosporins Ampicillin (17.68%)
(31.7%) usedduration of usedduration of treatment
treatment (5.76-/+2.62 days) (3.56-/+1.42 days)

Often used in group of Often used in group of

children prescholage children schoolage
The shortest duration of
Study shows that 1st gen cephalosporins & 3rd Gen treatmentpenicillin
Cephalosporin were used in infants but not in Antibiotics is more
adolcents effective than other
Antibiotics
According to the British Thoracic
Society guidelines
• Every Child with clear diagnosis of pneumonia should
receive antibiotics therapy since its not possible to
make immediate reliable diff bacterial & Viral
pathogens.
• IV adm of AB recommended for children suffering from
pneumonia in cases low intake oral (due to vomiting)
• Hospitalized children with more clinical features
• Recomm AB Intravenous: Amoxycillin, Co-Amoxyclav,
Cefuroxime, Cefotaxime/ ceftriaxone)
• Advisable consider Oral AB after parenteral AB if
possible (Switch Therapy).
 Other studies
• American Thoracic Society from 2013
indicates that patients with respiratory
disease should have specific diet rich
minerals&vitamins (adequate rehydration)
• Study conducted in US (2009-2013)
introduction of conjugate vaccination against
streptococcus would make the biggest
advanced in prevention of pneumonia
• According to the study at pediatric clinic in
Sarajevo 38 patients (37%) did not received
immunization regullary.
 Conclusion and relevance to the
guidelines of the British Thoracic Society
The Study Shows that:
Bronchopneumonia Treatment at the Pediatric
Clinic at Sarajevo are consistents with the
guidelines of the British Thoracic Society.

1st & 3rd Generation Cephalosporins

(Cephazolin&Ceftriaxone, respectively)
and penicillin antibiotics (Ampicillin)
were most common used Antimicrobial
agents
 Concomitant Therapy
Antipyretic (diclofenac & Paracetamol)
Beta2 adrenergic Rceptor agonist
(salbutamol)
Leukotrine receptor antagonist (Montellukast)
Corticosteroid (Methylprednisolone)
Availability & performance of diagnostic
tests, as well as pharmacological measures
conform to the guidelines of the British
Thoracic Society
 In Practise
Bronchopneumonia Infection clearly
diagnosisclinical symptoms+Chest X-ray+Blood
Samplewith or without Speciment culture to
make diff Bacterial inf or viral pathogens

Treat with Antibiotics (Penicillin, 1st gen

cephalosporin/3rd gen cephalosporin)oral adm if
good intake oral, IV with patients which have
difficulties intake oral

Respectively dose and duration of treatment in

add to adequate response of the therapy
 Suggestion

To reduce the incidence of

disease introduction of the
pneumococcal vaccination must
be consideredpneumococcal
infection leading cause of
Bronchopneumonia
THANK YOU......