N. Bocquet

Apport du bromure d’ipratropium dans la prise en charge des crises d’asthme aux urgences

Background. – To determine if the addition of ipratropium bromide in the emergency department (ED) for the treatment of childhood asthma reduces rates of hospitalization and relapses for moderate and severe exacerbations. Methods. – Patients were given an oral corticosteroid treatment (2 mg/kg) and received every 20 minutes either three nebulizations with albuterol (0.15 mg/kg) and ipratropium bromide (250 μg) or six nebulizations with albuterol alone (control group). The primary end point was the need for hospitalization, additional nebulizations or a relapse during the following week. Secondary end point included the effect of age. Results. – One hundred and fourty three children, two to 15 years old, were randomized to ipratropium or control groups and 121 were evaluated on day seven. As a whole, the control group was less often hospitalized or in relapse than those treated with three nebulizations of albuterol and ipratropium (17.5% vs 37.9%, p <0.02). The ipratropium group reached the same result after three additional albuterol nebulizations. The benefit of anticholinergic therapy was observed for children less than six years of age who had a similar rate of success (73.5 vs 75.7%). Conclusion. – The association of ipratropium bromide to the first three doses of the albuterol protocol for acute asthma did not act as well as six nebulizations of albuterol alone. The effect was age dependent and two to six years old children needed more attention. Nevertheless the hospitalization rate did not support the use of ipratropium compared with repeated albuterol nebulizations.

CL184 - Traitement oral versus parentéral puis oral des pyélonéphrites chez l’enfant

Nous avons compare l’efficacite lors d’une premiere pyelonephrite chez l’enfant d’un traitement oral (PO) (cefixime) et d’un traitement sequentiel intraveineux (ceftriaxone) puis oral (cefixime) (IV/PO) sur le risque de cicatrice renale. Cent soixante et onze enfants de 1 mois a 3 ans ont ete inclus. Apres une scintigraphie au DMSA pathologique a la phase aigue, l’efficacite du traitement etait evaluee sur la presence d’une cicatrice renale sur une scintigraphie a 6 mois. Resultats : En intention de traiter, le risque de cicatrice renale n’etait pas significativement different entre les 2 groupes : 25/61(41 %) enfants traites PO versus 26/58 (44,8 %) enfants traites IV/PO. Dans l’analyse per protocole, le risque de cicatrice n’etait pas non plus significativement different: 16/52 (30,8 %) enfants traites PO et 12/44 enfants (27,3 %) traites IV/PO. Le delai d’apyrexie, l’incidence de reflux ne differaient pas dans les 2 groupes. Conclusion : Un traitement oral donne des resultats comparables a un traitement sequentiel sur le risque de cicatrice renale a distance apres une premiere pyelonephrite chez l’enfant de 1 mois a 3 ans. Ces resultats sont similaires a ceux rapportes precedemment [1-3] .