Antibiotic utilization based on primary treatment of pediatric XXXX .

@entity1 @entity39 @entity3509 @entity1456 @entity281 @entity733
BACKGROUND: Chemical fibrinolysis has been shown to be as effective as surgical debridement for the treatment of pediatric @entity3509 . However, no studies effectively evaluate antibiotic treatment. We evaluated antibiotic utilization among different treatments of pediatric @entity3509 . METHODS: This is a retrospective review of 169 @entity3509 @entity1 who underwent chemical and/or mechanical fibrinolysis at a dedicated @entity1 's hospital from 2005-2013. Data points included duration of therapy, cultures, presence of @entity39 or @entity733 , and adverse drug reactions. Immunocompromised @entity1 and those with additional foci of @entity281 were excluded. RESULTS: Twenty-seven @entity1 underwent video-assisted thoracoscopic surgery (VATS), 123 had chemical fibrinolysis via tube thoracostomy with @entity1456 (tPA), and 19 had tPA followed by VATS. The mean (  standard deviation) duration of total antibiotic therapy was 25.7      6.5  d; following a 24  h afebrile period of 19.4      6.3  d. @entity1 who had tPA had a significantly shorter duration of parenteral antibiotic therapy when compared with primary VATS (9.2      3.6  d versus 11.6      5.5  d, P = 0.04) and VATS following tPA (9.2      3.6  d versus 14.3      8.1  d, P  <  0.01). @entity1 with @entity39 or @entity733 (n  =  26) had an increased total duration of antibiotics (29.3      5.7  d versus 25.1      6.4  d, P  <  0.01). Seventy @entity1 (41%) had an adverse reaction related to antibiotic use. CONCLUSIONS: @entity1 with @entity3509 currently receive a protracted variable course of antibiotic therapy influenced by primary treatment and the presence of @entity39 or @entity733 . With a high incidence of adverse reactions, a standardized protocol with truncated treatment duration should be considered.
