Çocuklarda ilaç ilişkili döküntüler; tek merkez deneyimi

Özet

Amaç: Çocuklarda ilaç iliflkili döküntülerin klinik özellikleri, tipleri, en s›k neden olan ilaçlar ve tan›sal yöntemleri incelemek amaçlanm›flt›r. Gereç ve Yöntem: ‹leriye dönük çal›flmam›zda, May›s 2006 - May›s 2007’de Dr. Sami Ulus Kad›n Do¤um ve Çocuk Sa¤l›¤› ve Hastal›klar› E¤itim ve Araflt›rma Hastanesi Çocuk Alerji Klini¤i’ne ilaç iliflkili döküntü flüphesiyle baflvuran olgular de¤erlendirildi. Çal›flma hastanemiz Etik Kurulu taraf›ndan onayland›. ‹statistiksel analizler SPSS 11.5 paket program› kullan›larak yap›ld›. Bulgular: Yüz çocuk çal›flmaya al›nd›. Yafllar› 6 ay ile 14 yafl aras›nda (ortalama 5,6±3,6 y›l) 75 erkek ve 25 k›z çocuk vard›. En s›k ilaç kullan›m gerekçeleri üst solunum yolu enfeksiyonlar› (%64) idi. En yayg›n flüphelenilen ilaçlar olgular›n %44’ünde amoksisilin/ampisilin ve %27’sinde sefalosporinlerdi. ‹laç döküntülerinin tipleri %64’ünde ürtiker, %28’inde makülopapüler döküntü, %5’inde ürtiker-purpura, %1’inde eritema mültiforme, %1’inde “fiks” ilaç döküntüsü ve %1’inde ise ilaç iliflkili afl›r› duyarl›l›k sendromu idi. Hastalar›n %60’› ‘muhtemel’ ve %16’s› olas› ilaç alerjisi tan›s› al›rken, yaln›zca %18’inde ilaç alerjisi do¤ruland›. Ç›kar›mlar: Ayr›nt›l› ilaç öyküsü, ilaç döküntülerinin tiplerinin bilinmesi ve uygun testler; ilaç döküntüsü olan bir çocu¤un baflar›l› yönetimi için gerekli etkenlerdir.

Abstract

Aim: Cutaneous drug reactions are commonly reported type of adverse drug reactions. The aim of this study was to describe the clinical pattern of drug eruptions, and to determine drugs commonly associated with those patterns seen among children, and to suggest an approach to this problem. Material and Method: The patients suspected as having drug eruption, seen betweeen May 2006- May 2007 in Dr. Sami Ulus Research and Training Hospital of Women's and Children's Health and Diseases, Pediatric Allergy Clinic, were prospectively evaluated. The study was approved by the Local Ethics Committee SPSS 11.5 (SPSS Inc., Chiago, IL) programme was used for the statistical analysis. Results: One hundred children were enrolled the study. There were 75 boys and 25 girls, with an age range of 6 months to 14 years (mean 5.6±3.6 years). The most common indications for drug prescribed were upper respiratory tract infections (64%). The common discriminating drugs prescribed were amoxicillin/ampicillin in 44%, cephalosporins in 27% of patients. The type of drug eruptions was urticaria (64%), followed by maculopapular eruption (28%), urticaria-purpura (5%), erythema multiforme (1%), fixed drug eruption (1%), and drug hypersensitivity syndrome (1%). While it was deemed probable in 60%, possible in 16% of patients, drug allergy was only confirmed in 18% of patients. Conclusions: A detailed drug history, knowledge of the various drug eruption patterns, and appropiate diagnostic tests are essential factors to the successful management of a child with drug eruption.