Palappallil Dhanya Sasidharan
Assistant Professor, Department of Pharmacology, Government TD Medical College , Alappuzha, Kerala, India .
J Clin Diagn Res. 2015 Aug;9(8):OC05-9. doi: 10.7860/JCDR/2015/14753.6322. Epub 2015 Aug 1.
There are several conflicting recommendations on the use of antibiotics in snakebite victims. This study aimed to identify the pattern of antibiotics used following snake envenomation in a tertiary care hospital of Kerala.
Retrospective review of case records from January to August 2011 was done and all the cases filed as snakebite were reviewed and details entered in a structured performa. Data was analysed using SPSS 16 and results were expressed mainly using descriptive statistics.
Three hundred and thirteen cases were evaluated with mean age 37.58± 14.54 year and 51.1% were males. Out of total, 94.6% received antibiotics of which 88.85% were oral, 8.1% parenteral and 3.04% both. There were total 454 prescriptions of antibiotics. In all seven different types of antibiotics were prescribed alone or in combination of which Ampicillin (205) was the commonest followed by Cloxacillin (194). The mean antibiotic usage was 1.46±0.716 per patient and the mean duration of antibiotic use was 3.16±1.446 days. In patients with no envenomation the mainly prescribed antibiotic was Cloxacillin (126). Intravenous antibiotics like Piperacillin plus Tazobactam were given only in patients with either local or systemic envenomation.
The main pattern of use of antibiotics following snakebite envenomation is Ampicillin alone or in combination empirically, Cloxacillin prophylatically and Piperacillin with Tazobactam for severe established infections. The choice of antibiotics is based on the clinician's discretion. Since the study setting is in a developing country the prophylactic use of antibiotics may be justified weighing the concerns of secondary infections.
关于蛇咬伤患者使用抗生素的建议存在几种相互矛盾的情况。本研究旨在确定喀拉拉邦一家三级护理医院中蛇咬伤后抗生素的使用模式。
对2011年1月至8月的病例记录进行回顾性分析，审查所有登记为蛇咬伤的病例，并将详细信息录入结构化表格。使用SPSS 16进行数据分析，结果主要用描述性统计表示。
共评估了313例病例，平均年龄为37.58±14.54岁，男性占51.1%。总计94.6%的患者接受了抗生素治疗，其中88.85%为口服给药，8.1%为胃肠外给药，3.04%为两种给药方式均采用。抗生素处方总计454份。总共单独或联合使用了七种不同类型的抗生素，其中氨苄西林（205份）最为常用，其次是氯唑西林（194份）。每位患者的平均抗生素使用量为1.46±0.716，抗生素的平均使用时长为3.16±1.446天。在未出现中毒症状的患者中，主要开具的抗生素是氯唑西林（126份）。仅在出现局部或全身中毒症状的患者中使用静脉注射抗生素，如哌拉西林加他唑巴坦。
蛇咬伤中毒后抗生素的主要使用模式是经验性单独或联合使用氨苄西林，预防性使用氯唑西林，对于严重的已确诊感染使用哌拉西林加他唑巴坦。抗生素的选择基于临床医生的判断。由于本研究的背景是在一个发展中国家，考虑到继发感染的问题，预防性使用抗生素可能是合理的。
