84 research outputs found
Evaluation of micafungin use in children
No full textMicafungin is recommended especially in patients with liver and kidney failure and in the presence of other side effects due to antifungals apart from its known priority indications such as invasive candidiasis. The aim of this study was to evaluate the children who have received micafungin treatment. In the study, 125 children who were hospitalized in the pediatric wards and intensive care units of our hospital and had used micafungin between November 2016 and January 2019 were analyzed retrospectively. Clinical data, micafungin indication, blood values on the first and fourth days of the treatment, side effects of the drug and efficacy were evaluated. Sixty percent (75/125) of the patients were male and the mean age of all the patients were 58 +/- 67 (0-215, 30) months. Approximately half of the cases (48%) had malignancy and 13% of them were premature. Sixty-two percent (n= 37) of the malignencies were hematological (27 acute lymphocytic leukemia, nine acute myeloid leukemia, one myelodysplastic syndrome) and 38% (n= 23) were oncological (six neuroblastoma, four Hodgkin lymphoma, two Non-Hodgkin's lymphoma, five sarcomas, one hepatoblastoma, five others) malignencies. The major cause of hospitalization was sepsis (53%). The patients had several risk factors like immunosuppressive therapy (n= 68, 54%), neutropenia (n= 61, 49%), central venous catheter (n= 102, 82%), nasogastric tube (n= 63, 50%), endotracheal intubation tube (n= 49, 39%), urinary catheter (n= 14, 11%) and total parenteral nutrition (n= 81, 65%). Thirteen percent (n= 16) of the cases were post-operative patients. Candida species were cultivated in 97 clinical specimens (blood, endotracheal aspirate, sputum, urine, etc.) among 23 (18%) of the patients. Thirteen (10%) of the patients had candidemia and 62% of them were non-albicans strains. In all candidemias, strains were echinocandin susceptible, and blood cultures were negative within four days. When all the patients (n= 125) were evaluated, a significant decrease in C-reactive protein, an increase in sodium, and a decrease in alanine aminotransferase were observed on the fourth day of micafungin treatment (p< 0.05). A total of 39 (31%) patients underwent various antifungal treatments for median seven (1-60) days prior to micafungin treatment. Fourteen (36%) of these 39 patients, had elevated liver function tests (LFT), 10 (26%) of them had hypokalemia, and five (13%) of them had elevated renal function tests. Ten (26%) patients had antifungal-induced hypokalemia previously; and potassium levels were normalized after micafungin treatment (p= 0.0001). The patients for which micafungin treatment was chosen due to elevated liver function tests (n= 47, 38%), whether the antifungalinduced or not; alanine aminotransferase and aspartate aminotransferase levels were decreased after micafungin treatment (p= 0.0001 and p= 0.0001, respectively). Nineteen (15%) of the patients have died within the first 30 days of micafungin treatment and one of them had candidemia. No micafungin treatment related significant side effects were observed in any of the patients. Our study showed that micafungin could be a safe and effective option in pediatric cases including newborns with high liver and kidney function tests
Meningitis caused by Neisseria Meningitidis, Hemophilus Influenzae Type B and Streptococcus Pneumoniae during 2005-2012 in Turkey A multicenter prospective surveillance study
No full textSuccessful vaccination policies for protection from bacterial meningitis are dependent on determination of the etiology of bacterial meningitis. Cerebrospinal fluid (CSF) samples were obtained prospectively from children from 1 month to <= 18 years of age hospitalized with suspected meningitis, in order to determine the etiology of meningitis in Turkey. DNA evidence of Neisseria meningitidis (N. meningitidis), Streptococcus pneumoniae (S. pneumoniae), and Hemophilus influenzae type b (Hib) was detected using multiplex polymerase chain reaction (PCR). In total, 1452 CSF samples were evaluated and bacterial etiology was determined in 645 (44.4%) cases between 2005 and 2012; N. meningitidis was detected in 333 (51.6%), S. pneumoniae in 195 (30.2%), and Hib in 117 (18.1%) of the PCR positive samples. Of the 333 N. meningitidis positive samples 127 (38.1%) were identified as serogroup W-135, 87 (26.1%) serogroup B, 28 (8.4%) serogroup A and 3 (0.9%) serogroup Y; 88 (26.4%) were non-groupable. As vaccines against the most frequent bacterial isolates in this study are available and licensed, these results highlight the need for broad based protection against meningococcal disease in Turkey.Novartis Vaccines and Diagnostics; GlaxoSmithKlineGlaxoSmithKlineThe study was supported by Novartis Vaccines and Diagnostics (for 5 years) and by GlaxoSmithKline (for 2 years). The authors declare that they have no other conflicts of interest
Cost effectiveness of both (monovalent and pentavalent) rotavirus vaccines
No full textObjective: Rotavirus (RV) infections constitute a substantial burden in Turkey, particularly in children under 5 years of age. RV vaccines are administered to infants by payment only,and no reimbursement is available. The first aim of this study is to evaluate the cost effectiveness of implementing a national basis monovalent or pentavalent RV vaccination program in target populations.Material and Methods: A decision tree model was employed using demographic and epidemiological input obtained from study sources conducted before in our region and international literature. Monovalent or pentavalent vaccination was assumed to protect in 83.7% or 90% of severe RV acute gastroenteritis (RVAGE) in children respectively. Costs inputs were obtained from a provincial study conducted in 2007. Univariate sensitivity analyses and Monte-Carlo simulations were performed.Results: The vaccination program was cost effective and cost saving compared to no vaccination with 85% coverage. Monovalent and pentavalent RV vaccination led to a mean of 2,316 (95% CI: 2.240-2.392) and 2.972 (95% CI: 2.677-3.267) life-years gained (LYG) with 83.7% and 90% efficacy level respectively. Monovalent and pentavalent RV vaccinations avoided 551.820 (95% CI: 539.032; 564.609) and 683,529 (95% CI: 638.906-728.158) individuals with clinical acute gastroenteritis (AGE) cases requiring hospital visits respectively. In the simulation for monovalent and pentavalent vaccines, the cost of RVAGE was 116.1 million TL ((sic)59.2 million) in the non-vaccinated cohort and 35 and 22.5 million TL ((sic)17.8 and 11.5 million) in the vaccinated cohort respectively. The cost of the vaccination program was estimated to be approximately 65.6 and 83.4 million TL ((sic)33.5 and 42.5 million) and the incremental cost was approximately-15.4 million TL (-(sic)7.9 million) and -15.3 million TL(-(isc) 9.6 million) respectively.Conclusion: This analysis suggests that both monovalent and pentavalent RV vaccinations of children are very cost effective and also cost saving. Therefore, RV vaccination is associated with a positive return on investment from a public payers' perspective and supports the continued recommendation of RV vaccines as well as their full funding in Turkey
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