Impact of Short course prophylactic antibiotics in poisoning: A Randomized Double Blind placebo controlled trial

John, Jose (2007) Impact of Short course prophylactic antibiotics in poisoning: A Randomized Double Blind placebo controlled trial. Masters thesis, Christian Medical College, Vellore.

[img]
Preview
Text
200101107john_jose.pdf

Download (1MB) | Preview

Abstract

OBJECTIVE : The primary objective of the study was to evaluate the impact of a short course prophylactic antibiotics for the prevention of pneumonia in patients aged fourteen years and above who receive gastric lavage for poisoning. Design : Single centre, prospective, randomized double blind placebo controlled trial Setting : A 2200 bedded tertiary care teaching hospital in South India. PARTICIPANTS AND METHODS : A randomized double blind placebo controlled trial was performed aiming at the reduction of the incidence of pneumonia in poisoned subjects. Between October 31st 2005 and August 1st 2006, one hundred and four patients who were hospitalized following poison ingestion and received gastric lavage were included in the study. Of the 104 subjects, 53 were randomized into the prophylactic antibiotic group (a combination of three doses of crystalline penicillin 20 lakh units given four hours apart and single dose of Levofloxacin 500 mg administered intravenously) and 51 into the placebo group. Primary outcome was the occurrence of pneumonia as defined by the objective criteria. Secondary outcome measures were mortality, duration of intensive care and hospital stay and of mechanical ventilation. RESULTS : Overall 12 patients fulfilled the objective criteria for pneumonia. Nine were in the placebo group and three in the prophylactic antibiotic group. (p= 0.056). The risk ratio for patients receiving prophylactic antibiotics compared to patients receiving placebo was 0.32 [95% confidence interval, CI=0.09 -1.12]. Although the risk reduction in terms of aspiration pneumonia with antibiotics was 68%; this did not reach statistical significance. All pneumonia occurred in the mechanical ventilated population. Out of 32 ventilated patients, 12 developed pneumonia, 3 in the antibiotic group and 9 in the placebo group.(p value= 0.014).The risk ratio for patients receiving patients receiving prophylactic antibiotics compared to patients receiving placebo in the was 0.29 [95% confidence interval, CI = 0.10 - 0.89]. Number needed to treat to avoid an episode of pneumonia was 2.3 in the mechanical ventilated population. No differences in the other outcome parameters were found. CONCLUSIONS : Use of short course antibiotic prophylaxis of a combination regimen of three doses of intravenously administered crystalline penicillin and a single dose of levofloxacin showed a trend towards a reduction in the incidence of pneumonia in poisoned patients randomized to the prophylactic antibiotic group. A subgroup analysis of mechanical ventilated patients revealed that prophylaxis is probably an effective strategy for the prevention of pneumonia in mechanically ventilated poisoned subjects. These observations justify the conduct of a larger prospective study to evaluate the role of prophylactic antibiotics in poisoned patients.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Impact of Short course ; prophylactic antibiotics ; poisoning.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 15 Feb 2018 17:34
Last Modified: 15 Feb 2018 17:34
URI: http://repository-tnmgrmu.ac.in/id/eprint/5725

Actions (login required)

View Item View Item