Murat ÇİFTEL, Ayşe SÜLEYMAN, Halil ERTUĞ

Akut Romatizmal Ateşli Çocuklarda Penisilin Tedavisi: Yan Etkileri, Malpraktis ve Anaflaktik Reaksiyon

Akut romatizmal ateş ARA gelişmekte olan ülkelerde daha sıktır. ARA sistemik bir hastalık olup çocuklarda grup A streptokok GAS farenjitinden sonra gelişir. Romatizmal kapak hastalığı otoimmün cevap sonucu oluşur. Penisilin GAS ile oluşan tonsillofarenjitin tedavisinde, ARA’nın primer ve sekonder proflaksisinde kullanılmaktadır. Primer proflakside tek doz intramüsküler İM benzatin penisilin veya oral penisilin V fenoksimetilpenisilin 10 gün süre ile verilir. Romatizmal kapak hastalığı mevcut ise en az 40 yaşına kadar veya yaşam boyu benzatin penisilin ile sekonder proflaksi uygulamak gerekir. Penisilin İM enjeksiyonu çocuklarda korkuya ve ağrıya neden olabilir. İM enjeksiyon sırasında ağrıyı azaltmak için lidokain veya lidokain-prilokain EMLA krem kullanılabilir. Penisilinin en ciddi yan etkisi anaflaktik reaksiyondur. Anaflaktik reaksiyon penisilinin majör veya minör determinantı ile oluşabilir. Penisiline bağlı anaflaksiyi önlemek için penisilin alerjisini iyi sorgulamak ve deri testini uygun olarak yapmak ve yorumlamak gerekir. Penisilin alerji şüphesi varsa deri testi yapmadan hastaların pediatrik alerji tarafından majör ve minör determinant kullanılarak yapılan testler ile değerlendirilmesi ve penisilin alerjisinin aydınlatılması gerekir. Penisilin allerjisi olanlarda alternatif ilaç yokluğunda desensitizasyon yapılabilir. Penisilin uygulanırken deri testinin uygun şekilde yapılması ve yorumlanması, olası anaflaksi reaksiyona müdahale için gerekli malzemenin ve ilaçların hazırda bulundurulması ve anaflaksiye uygun müdahalenin yapılması tıbbi ve yasal açıdan önemlidir. Penisilin pediatri ve pediatrik kardiyolojide sık kullanılan bir ilaçtır

Anahtar Kelimeler:

Akut romatizmal ateş, penisilin, anafilaksi

Penicillin Therapy in Children with Acute Rheumatic Fever: Side Effects, Malpractice and Anaphylactic Reactions

Acute rheumatic fever ARF is more common in developing countries. ARF is a systemic disorder, which develops in children following group A streptococcal GAS pharyngitis. Rheumatic valvular disease is caused by autoimmune responses. Penicillin is used in the treatment of GAS tonsillopharyngitis and in primary and secondary prophylaxis against ARF. A single intramuscular IM injection of benzathine penicillin or oral penicillin V phenoxymethylpenicillin is administered as primary prophylaxis for 10 days. In the presence of rheumatic valvular disease, secondary prophylaxis with the injection of benzathine penicillin is required for life, or at least until the age of 40. IM injection of penicillin may cause fear and pain in children. Lidocaine or lidocaine-prilocaine EMLA creams can be used to decrease pain associated with IM injections. The most serious side effect of penicillin is, however, the anaphylactic reaction. This reaction can be caused by minor or major determinants of penicillin. Patients should be questioned about the past history of the penicillin allergy, and penicillin skin testing should be performed and interpreted appropriately in order to prevent anaphylactic reaction related to penicillin administration. In the presence of the suspicion of a penicillin allergy, skin testing should be avoided, and the patient should be tested by a pediatric allergy specialist using major and minor determinants to confirm a penicillin allergy. Patients who are allergic to penicillin can undergo desensitization in the absence of an alternative drug. It is a medical and legal obligation to perform and interpret the skin test appropriately, to keep the necessary equipment and drugs available for possible anaphylactic reactions, and to treat the patient appropriately in the case of an anaphylactic reaction. Penicillin is commonly used in pediatrics and pediatric cardiology

Keywords:

Acute rheumatic fever, penicillin, anaphylaxis,

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