• PDF / 173,668 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 18 Downloads / 191 Views

DOWNLOAD

REPORT

---

1 S

Lack of efficacy: case report A 2.5-year-old boy exhibited lack of efficacy while being treated with montelukast and salbutamol for bronchitis [dosages and routes not stated]. The boy presented for an allergist’s consultation with his parents as the sputum cough had lasted for more than two months. He coughed at night and during the day. During examination, only crepes had heard above the lower fields of the left lung, and there was a pure vesicular wheezing in the right lung. Due to the suspicion of bronchitis, he was treated with montelukast and the use of an unsealed mole as an inhalation aerosol was suggested if signs of obstructive bronchitis occur. Anamnesis revealed that 6 months prior to the presentation, he had a wash gel capsule poisoning. After poisoning, he had cough, croak, necrosis and was hospitalised. About four hours after eating the capsule, the fever increased, he developed wheezing and auscultation gave fine rumbles over both lungs. Due to suspicion of aspiration pneumonia, he started receiving off-label antibacterial therapy with oral amoxicillin. His condition deteriorated with respiratory failure. Various laboratory findings were consistent with aspiration pneumonia. Nineteen hours after the poisoning, he was shifted to the paediatric ICU, where he was treated for 24 hours due to worsening respiratory failure, and had not required artificial lung ventilation. After poisoning, he had had painful swallowing, so infusion treatment with glucose/sodium chloride [glucose saline] was administered. For aspiration pneumonia, off-label IV ampicillin and unblocked mole inhalations were administered for 4 days due to airway obstruction syndrome. On the fifth day after poisoning, his general condition was undisturbed and treatment with amoxicillin was continued on an outpatient basis. One month following the first visit to the allergist and initiation of montelukast treatment for bronchitis, his sputum cough persisted. Based on the history of aspiration pneumonia, he was administered off-label therapy with oral amoxicillin/clavulanic acid due to suspected prolonged bacterial bronchitis. A coughing sputum persisted. Thereafter, his treatment with montelukast was discontinued, and he was treated with offlabel fluticasone propionate inhalation. Additionally, he was receiving treatment with salbutamol for bronchitis. Despite treatment with montelukast and salbutamol, cough and left lung hearing (symptoms of bronchitis) persisted (lack of efficacy). Therefore, it was decided to perform bronchoscopy. Based on the findings of inflammation and prior chemical lung damage, off-label treatment with oral prednisolone and amoxicillin/clavulanic acid, for which the inoculated microbe was sensitive was prescribed for two weeks. The treatment with inhaled fluticasone propionate was continued. Following two weeks of treatment, the cough subsided. However, the coughing cough reappeared after a few months. Also, off-label treatment with salmeterol/fluticasone propionate was attempted. He was then subjected to physiothe