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A Cc, a)u?I1{figtuf,uu Original Article
n r :1 oiYu s nI fr f, a u v t o s {rl a uI: n 6 o r fi o1 a Yar o'r fi
ruasn a r ruffufru dffun r:rirq rut osffu
Antibiotics in Dengue Infection Patient
and Effect to Liver Function Test
aadvaflflfit ?rdag?oluRo u.u.
rnu3u frorurqa ?.Tt.u.
I:sils rur asa ::rirj :vtrYndvvdo.t?t?9t1{ft:fl?::n
dt v dtr?::FIIJ:VUIINU[?Tfl 1:ari-dallvr 6 ourJlr 2 T{qunlail-fl{firflil 2552
Sasitorn Vibulwatanakii M.D.
Kasuin Pattanakul D.N.M.
Sawanpracharak Hospital
Nakhon Sawan
Sawanpracharak Medical ]ournal
VoL o No. z May-August 2009
ullJYtfiouo
Tn0ilrvasFfqnfi afi nurdn:rnr:l{urilfi firur rmcnr:'lfra.ri.nl0*aanrdanrirtu{rJrer
I: n fi n rd'atr ia r nr.,: fi ri a u tfir iu n r :in uT'lul:.: ?\ tl 1 u 1 a lLn s,{ a ? o',:'n 1 :'Iff ur rJfr fi euvri a nr:Yirr uta.: nu
I:tu srur n ar:: d'rl:cmfndAa
nlTFInUltt\:1IT?fUU1
firhuarEl e {u fi'r rs fl d;rlflrlt{vlUluladr::d'tl:rtrinr$ ri.:rroi{q
rfiaun-uurau zs41 fi.,:rdau8.,:tt1Au zs42,iru:u 138 nu rrnrlfiiunr:u r a 3 c u - aA - u eu e,, - 6
T fr o o u [n u rt:t o E u tt u nt : h 0t u?ia Lr :6 ta { R fi d n 1 u u? o u ? ?1 tl1 A1 d rt : fl 1 :unn rimmr:Ior ai6 r u sn LLacPC R'jr r{lul:n1{ror.o fi 1o r; lf, rd o n o o n (D H F)
a u9 a dn-aL{rdonaanZon(DSS)u (e, ! vn a I Yvu ,ad U
ftrnruruzuilnn:a.:ilnuaililrun.ltaUanr:Lrt:utl1u0u?us tlav 6t1:u1n1{ruru{gaorvssofd,a
ilaan rnaari1nauLfi TUn1::nu1 [uL:\:vttnurnLtns[Qletn0nu:etilun1:o v a - J d d 6
Yt1,:1U?tfl { DlU LU?Um rJ A tn:n taan n1
Hanrn:?arf,an6uflunr:fiotdahiamr.:fi tge nu,irrrunr{lu DF, DHF
uay DSS 'iruru 42, 58 ttag 33 nu finrilutaflar 34.0, 42.0 LLaz 2g.g
mtrdrd'u vrufi nrt'lfi HtJfrflruriauay 70.3 (97/1 38) Inufr dn:r nr:'lfi
I4<fr6r"t1{ilflnu'l
:rJuuunr:?ffs$
lo,rlnailn?ou-l'iI
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HAfl1tflRU"l
enrJfifirur'lu{ilra oHF iaaas 7s.s (44tsl) {tJeu oss toaaz 69.7
nr:ldirorrJ6itrrtor{rlrtrl:n6nr{01:imalflunsRl!d!rildn'lnr:rirlrutordlAntibiotics in Dengue Infection Patient and Effect to Liver Function Test flfr e oriufr 2\.a.-d.a.2ss2
(23ls3) ras{d?n Dr 5aflar 63.8 (30/42) zfinza',:tnrJfifirurd1firru
Amoxicillin Saaas 45.4 (44197) Ampicillin SaEJas 5.2 (5t97) LtasBactrim
touac 2.0 (2197) a-n:rnr:ldiuar:u*rnu ioaav 21.7 (got138) rda
6 n ur fi .: zu a fi r': r 6 a',: t a.: n r :'[fr a r il fi fi r u v ri a n 1 :d1 { 1 u I o',: riu'lu {rh EJ
I: n 6 or r{ah ia r or.,: fi n u'j {si fr n ?1 il urr n eifi a1 n n d il dlillfifu ur r-J fr fi r u rA d "'t ' u oe ':acr cturidrul:nfiorr{ahiarn.:fi nuriauf,r,:dt iaunrlOf:AlttaUAlil:Oot:1fl1:LZ?J1Ug{?U . lTaLn.ln Y\UFl'elu?'hl-"i
ZO.g InUltUl Amoxicillin llrnfi fl Fr umtrjr ru zuafi'r.,:6 u.ma.tnr:ltrnrJfi firu;I o u Y C OU
rianr:rir.:rUtOitFtUUAcnl:UfiU1 UnA1nfll1.,:n1TLty{?1Erl1rJ1:O L{LtU'lyl'.l.:
9f 6' v I a u I O 9a
nr:iiiqi:'Ell:nta{a.lnn1:ou1il u Lnn uarnototlunlfi nunafl1{ Lnatoaef,?El
lfrriulqlurnfi fi oda rncnrtintn nfi oanr}yn1 rn:nfiouolnnr:lfr atlfr firw
LLasn?1 il {6U rfl amrttrnugfi qln Eilrjdr riluooualmfla,o : nr:'lfisrilfifirur, {rJral:n6orr{ahiaror.,:fi, Amoxicillin, fl1:1i1',]1u?lo',lriu
Abstract
Objective
Setting
Design
Subiects
Method
To study rate of antibiotics sued and rate of intravenous fluid
prescribed in in-patients infected with Dengue virus and an effect on
liver function test.
Sawanpracharak hospital
Descriptive study.
138 patients, age 8 days to 15 years who had been diagnosed
as DF, DHF and DSS, admitted in Sawanpracharak hospital during
Sep 1998-Aug 1999. All patients were confirmed having dengue
infection by ELISA and PCR.
lnformation on the use of antibiotics and intravenous fluid administration
were retreived before admission. On the day of thrombocytopenia
liver function profile was ordered and subsequently review to see the
association between groups that use antibiotics and do not use.
138 patients confirmed for dengue infection were classified into
3 groups : DF 47 (34.0ol"), DHF 58 (42.00/") and DSS 33 (23.9o/o)
respectively. The dengue infection groups with prior antibiotics used
was 97 patients out of 138 patients (70.3%). The rate of antibiotics
used in DHF was 75.90/" (44158), DSS was found 69.7% (23133) and
Results
(, v (
6?:TnilTctffn$tfZaf: nfirr ir;odinrufira rnuiu rYnrurqa 86
Conclusion
Key words
uYll{"1
nriul:prfi nr{alriauntfi tdud l:nld,rofi lO"ngue fever: OD ltaclrnlttdaotaon
(dengue hemorrhagic fever: DHF uav
dengue shock syndrome: DSS) IoatanrrI:nltu6oooo nfl ulfrlja u Lmsfi nmileir drudao
lun{ruI:n 6 or tda artnopodborn rirrr ru-naa ng-t c/ Jo -' dUEl.: [UUil ilfi 111611 nGUil1{61'l E'l:6XAl??A{ tn n
'lurl:,rn rrin EJ d *ru ur fi :r H.,:ru rirh ul:nr4y a d, a
t o v
L?monoanunv 40,000 n.0 80,000 nu d1fi:u
o',:ra{orun:ar::d' tufl 2ss1 fi frr-hul:Fr{\9 A o a C, vL?taanaan a1u?u 2,619 nu nntillJon:1
drEiryirn-u z4g.g oiauauil:czrn: d.on'ir
rirfoagru s tl (zsao-25s0) d.:il'dn:thu127 .6 riauauil:rtrn:(1) frdesf46nr u{ohfa
du (v t
,, d.tFhlfl il nil1v{uttfl 11u0?ua1n1:[?fl.] LLas[uuoU
DF was 63.8% (30147). The three most common antibiotics used
were Amoxicillin 45.4o/o (44197), Ampicillin 5.2"/, (5197) and Bactrim
2.0o/" (2J97) respectMely. Rate of received intravenous fluid administration
was 21 .7% (301138). No effect on liver function test in group that
used antibiotic compare to group that did not use antibiotic
I The rate of antibiotics used in dengue patient was at 70.30/",
and an Amoxicillin was being used the most. There was no evidence
of abnormal liver function test or drug allergy in patients who receive
antibiotics treatment. However, clinicians should well aware of WHO
diagnosis criteria before giving any antibiotics in suspected dengue
infection. Therefore, closely monitor would help clinicians to diagnose
more accurately for a proper treatment. This would not only decreased
the side effect from antibiotics but also prevented an unnecessary
expense.
I Antibiotics used, Dengue lnfection, Amoxicillin, liver function test
eA 09vf?1 A1 U?1]A{Qv6{1 il1:n Lil n1:?UAAs L?Ft
1du6 a or a a nlfi rirtrir,{ u'ir dr u'[m nllfiiu nr:fn ur uio.: fi ulor fltfiiu a r rJ fi fi a u rri a u urr- i oo AL:.:v{ Er1u1a ty{ o L}1 Ft:ou nail n1:n n [1a
aa Aruu nfi 6afit amq n a1 ilhJlfi' Ior u u',:hl fi n dngru
^anllFla ruaa1fl a1 n1:uasa1 n1:Lt6ln{ a1 nn1:
rir:ro n runlr'r?a\: dnluuinr:arorrrudt'[uqq6le f a ! d
n1: t?1 nlTU:U1An1 ilil',rn:n1u[:nnn rUAt{:fl Uvooctd.Sl
ndu:vuurra"[o'Lu16narq o-s fl tuflu.F1.2s4g rru'irsidral:nn{oiasas 23.6{lfiiu nT :inur fir s urilfi firurln atrjdr rfl u(')
InEilriqirrf,lutu{ilral:nur"ortufl u.a. 2s44c,v
[ar 2551 frnrllu5aetav BO.4 un; oo.9(2) $ntvd se X t d
ti.,:fi uurhirud.,fnrniurdennlurmrim?ay{qfin:ril
nr:ldYlorr.lfriru:tor(il'loI:nfinrdolriata{6rrncnrt!d!riuf,ri:-rnl:rirllutow'lfld o aulud 2\.A.-d.A.2ss2Antibiotics in Dengue Infection Patient and Effect to Livs Fmction lesl
nr:'lfr uT rJfi firu"'luqutu rirtfr rfi or ru 4 fl :riluil a1 u firu ri a anruuinl:d1 f,''l:6udfl ttae
rr:au nir cirh a I: rrl{rf, o n a a n o1a?ir'[fr ufi or
ytovtJfl 1 2 e Ltil i fl t O U Fl fl n 1 :Yl 1',: 1 U t A.: Fl U A U 1.: ?1 U.1
n r :'[fr utJ fr fi r u slor Efl il sir rfl u
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A auHnu11q H ut{1\::6uu1 nqil n? o u'hl
6a{rha arqrYturri g i'u oufi{ ts tl 'iruru1 38 Fru dirlflrlroil u1u1nd?r:d-ilT,zrfndU 'a u . a an.,:rto'rrdau nuu'lElll rl.d. 2541 n{tnau
fi.,:urrrru u.d. zs42 uras ldfinT :ifiodtrrflu
I:rrlf,ror.:fi (oD nial:rrlfr6anaan (DHF unc
DSS) rnilvinr:ifiodal:n DF 6a {rhadfi41n1ild6.,1 nlTTlFtdou tourniquet "[fi ruaurn
^A 3 tv rtt ,
Lravil tJu?u Ln tLn Lil fi a1 n1:LtdFl',: nr:irta.:
9{ARtrflRUl
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fl ufl il{a ila fir u rn:frurntn[frij n n:4.:o{
i q,, r- c "i r --frounanjrEl [nfl Ltvma Lkm{Entnnmrururn: aufl.l
q{r Av u a Et v a A -y 4Ln:.:nr:r0u n{uuTln LuttuuuuYlnmffTl{?lu
6o hepatic faiture dturno.nrvrfiorqrnridra il:snaufirfl LIIFI altl fiaqi 'frurufudrhuddYUaailnmvtanulu Lta?fl .lolotnnql nfl Mlat811{ Yd Y ?' --.- "- - ttlfiLndnnru Ltaen?E!fi nt{an',lna1?tl?aua
rir nr : 6 n ur rd a t ffi Br a fi i'n qr.hra',: d' rd a fi n r*T
dnm nT :'[fi arrJfr firuv rnen'lrlfr dr:rirnr',:
ilaao 60 n rir tufrrlr ad fi rr r#ahiaron: fi ri ou rfir{uvolI
rurir nr:inr*rluL:.:vlurula uaur.la tlillfl"dau
oi o nr :rir,,:r ufl 4t n-utu {rh u fl lfi iu El'nJfi fi r u r95"%utrAd
n''rre{erR1 uniil:se h nr::uu:s?11u u1u0t?uv
YhlULy{Od,o&eo
LilUtAilA tUA{FlU LUnl:n1 ttu?l]1{A 0lq
d1il1:nn:ruda aT rJfr firurdtfiq1 n n1:'[fr
tgvvolr%riau rdriu n1i5nul-Lu [T.Jv't u1u1a UTs? n n1:
iuil:vmruar ri auetrl:.:tr{u1u1a In a ufiunr:
lfiiu urrJfrfirur rl:s{fi nr:lfiiu d1:1i1
nr.,:mno n tda n n"r 6ln1ur'l Ellurad rn a r{riunr:inur ttae zunn:?an1:yi1.]1u?a'oniu (liver
function test) tui'udzuatnEnt6ann*r
vt, o OY A s. q de.idr Erilrz: Ft Er1 il1 hl a fl ta LilTFI?\1ldau n1 il{ q
d aa i-
a1fl 6fl 1U?\U1UlA fi:AnAUnnnnpratd
Inrariruunn{rarrJfrfiruv tflu + n{u 6o
1) ndru Penicillin ifirrri u1 Amoxicillin,
Cloxacillin Ltar Ampicillin 2) n{ru Bactrim
3) n4il Macrolide lfiud Erythromycin,
Roxithromycin tLns Azithromycin 4) n{ru
Cephalosporin lfirrri Cephalexin, Cefuroxime
ttffr Cefprozill
irn:rvfflaunlnalfiLlrun:tJ sPSSo'd,Jy
for windows u'lLduatilun?1iln L[at :oflar
u i Au n- aa vr.rilr afi LFI:u n1:?uaqfl Fl13J a1 n1:
(clinical diagnosis) a1nflil1:ttvrnd'jrrilu
I:nfi oud'ahiarn.:fi 1 B0 Fru rfialfi zuaor:?ofl1.:
ruliu u tfi uu il a n1Td1 fl utr a.: riu'lu n { ru {rJr u
y{a1dil1 rnru,rinr:ifioderl:n oHr 6o{rleu dtfiiuarrlfrfiruv riun{udtr,lfiiuerT rJfrfrrurJa r {Yafrfrarnr:nlil clinical criteria ?la{[:nLttaoFl
uavrnrueinT :ifiodflI:n DSS dafrrlaal:rrlf,a Aa c Y\ d a
rdanoanfi :r01n1T{on ryil?u4n:luEjuuunl:6 or r#atriarrrt fi In u d.,: n:to serology n:?a Ltu n
lg M uav lg G firetiE rusn uacd'ln:ro
pcn fi nr:nriu ariu'lr tilunr:6 q td'alria
t Og aa[nu Lt6nFl
^^iYr1{6flnYl
d
chi-square test
P value < 0.05
ovovn1fiunuud1n6u
f, ?rrd'lhs"drindtrta'r: afir: iqatiSolufioa tnu?u rlruurqo 88
serotogy fi u a-u nr:ifi o du 6 o rd'otria ror.: fio vL a 3u e at'X
Trualu?u r.rilr uFrn ru'a LrrdtFhlfl Yl{du 1 38 nu
uirurun,ftu or ,fiuru 47 Au fintfluiatlav
34.0 DHF siruru 58 ail finr{lutaunc 42.o
rac DSS druru 33 Ftu fiorrfluiasav 23.9
rir.,:ara 7-10 tl nt-liaflns 68.1 a-nmdtu
ry\Flt1u : rv{F[il4.: rirriu 1.4 : 1 {rJauiaaars+.s ar rYuo g'lurzrr ufi a.:
A ,y,, A 4y e vTsurL?41n{ ttFl ry!? U LTiltJ Llt AUt?1:U
nr:fnur'Lul:{vlu1u1n nldrfrrha DF il'la u A ay -
n a
Sunr:Snurrr.railLturu 4 ?u raflav 31.9
(1st47) uar{rJru DHF/DSS rurirnr:fnurA an v v
riloilLz u.ru 4 iu 5aanv 27.4 (25191) :rttrA Y tv \ drv a - 4
r?n1raa un{ uFtr.lil? u3J Lflaufl{?umil1uou
I:.,rv^rurrrn?4.o{d?E oF rrirniu 3.0 1.2 {uruav {rJru DHF / DSS rvirri'l 3.9 1.7 ?-u
j(m1r'hrYl 1)
l ru fr1rJr ulfiiu znr.Jfr firurd1u?u e7 nu
fiB,rflutaan, zo.3 (g7t1sa) dn:rnr:tfiilurrJfifirur'[u{rJ':u DHF Soaas 75.s (aar158)
{rlru oss Souac os.7 \zslss) rrar{rJru{,DF Saaas ffi.a (30/47) (n1fl.1fi 2)
4i , ,ad. iffi atler:rurtfi orto.:n{ruaT rJfl firurfr
lfiir "lu{r]ral:nfr n ud'altfarn.:fr riourflT ilnr:fnur'[ul:.,:fl u'lur n vru'irlfiiu u1 nd ilpeniciilin ioanr 52.0 (s1lsr) tiln:rutiirr5aflns 4s.4 (44197) uav Bactrim 5oflnc 2.0
Joa(2197) rilaalrufltuFtuln6iil penicittin #[fi
l tu'ir{drulfiitLsr Amo4ycillin 6nr{luiasac",
45.4 (44197) (Ft1:1.:fi 3 ras 4)A a a \vv V
rilo Flnul n{ n1T LFI:u d'lTu1Yl1.:maaFl4 oo yr, f a &l u- d, v u
t6an n.Llurlilru [:nn ntto L?5dLn.] nnouL'll1:u{o
nt:inr*r'[ula{y{ El1u1a yru'ir r'Ir]aflI:nr fi n rfi a
r u dev Y aL??drn{ n Ln:u d1:u111'l{Haa n tn a n a1 nauil'l
I:.,:narura finuflutafla v 21 .7 (30/138) Iprtl
{rhu DSS, DHF uav DF lfiiuar:fifiprrflutauac i 1.6, 8.7 uav 1.4 Frlurilrr-t-l
druaarul r Enul afi ,id': slfiiuar:ti', tirru.I:.:uenurn 6a lro*aru1n{.ru?-Ft 6orrflu
iauas 12.3 (17l1gg) (n1T'].:id 5)
'[u nr:fi nur nlTyi'l.]'tu? a.: riu fi frrla cr
t il vv o -
t.
7 nu LiJ La:u n''lrar?anr:rirtruta.: d'u lrilu
{rhalun{rudtfiirarr.Jfrflrur o nu Lrae
iiltfiiuurilfrflrur r nu) 6.,:1fi6nu16.:,.lan1T
rimu'tra.:rYrtufir-hu t st nu [tafl\u'irfrrhnr A &u - ".J,r- ,a.t d lLTnnnLua L?Tdtn.rnil LaruEJlu0t?uvil nmY'llnu
z a.: riu fi nrl n fiIn s or:rav'l u Fil aspartate&,
aminotransferase (AST) Fl',lttoi 51-2OO VILqiruru 33 nu fiorrfluiauas 3G.3 rdorrltflu
d v yn , -lU Uy tad d r
lnuu nu rJila un8ilfr LeJ LFt u1il07?u, sJ Fl1 ASTu{q6,e
Ff.lLrFl 51-20O t/LA1U?U 17 A\ nntilU:OUAEJ d d , --Jo I a r
42.5 unsnJOnl5aUmaUrn AST YlrJnlnnillfl fYnI r , o e r, \v a !
2oo t/L fr.:1ilnu1u{rhellfrr6anoanfirlnfit vn Aqv- rad d r
ilu'jr{rhufildfu arr.Jfr flrucfi Fir AST rlrnn'i'tru
2oo t/L Sounv z+.r {rJrun4rudtillfiiuurr.Jfrfirur firir esr il1nn'i't 2oo ttlL Saaar
t \eu ,ad tl rd1 2.5 viu?1 fl1:LF|TU UlUo?l?UsLillJ zuA nOn'l
AST adT.:fiu-adrrirgmt.:4fifi 1mr:r.,:d o) rdo
fi nurfi .,:rir Alanine aminotransferase (ALT)Y o u,. , Jto- ,aa
Ft',rrLFl 51 -200 ua Luryil?UnailnLnfl-lu1u0z?Us,d d v 9n , 4 'tC/- rAC
ril5uu rn au nu llil? fl nqilYt Lil LFt?u El1U0f,2us
aorr{luioflav ss.a unv 60.0 rirhsnriildtfigq
arrlfifiruvfirir RLT rurnn'ir 2oo tttL6 or rfluiatrnv 30.8 u.ltuu rfi fl u riu frrla s nriru
dtrilfiiuu',r.lfifirurfiri1 ALr rur#':r zoo
pvu fi arflu3aeta" zo.o nr:t,friuurrJfifituu
nr:1diru*lfrirurtol{i601:nfinrdol:iatalfittasn':ud,riuf,fir-rnr:ril'rr,to'r6'r-rfld o qu"ud 2fl.A.-d.a.2ss2Antibiotics in Dengue Infetion Patient ild Effet to Liver Function Test
lilfi runoia ri1 ALT adr.:fi riaeiT n"rynr.:afi 6i 8aY' 4u- ri4
(n1:1.0fr 7) uanal nilN ryil?ull LFEUUIU0t?ug
runclsilfiiuarrlfr firuvfi :criu ALT il1nn'i1
1,ooo ti/L qiruru 1 Ltns 2 Au drurufu
ad?in:Rl
aavn1:?uaQU
rflurn:rsdrulmqi{rha DHFuas oss fiiutfftul:.:r,rururaosdtfiiltrfir s-a {u :?ttioflnv
d.:fiotlfiiuaLlfrfirur lorulunr:fin*.dult1 m d.:ri:hiarrur:nlfiodal:nldrdaoraanlfirniuau
rY.:ruoifirhetfltfloufi.:{udd{n:?afi1 AST rnc fltflriaurdriunr:inur'[ul:.:narulad?r:d'q
ALT fl a{ {rla et ndrudtrilfiiu atJfi firuvtafi agq
, olr v.s.t {u drundrufilfi5uatJfrfirurrafia +.0 i'u
q
lfirduuvrd'uhjm:rudrlmq 6o nl:Ann1ilvh , o ea zri OErlv ee - -4--Yfthsadrr Lndfr orrfr alrilfrnT :if,qa'nfr Qnfr attsr{{d..:orrhhJ {n1rn n n1:'[fr arrJfr firuvlfi
:rarrrurd{dru or rnr DHF/DSS
. v c A ,-uil:vtrfnd tqdu 3.6 1.7 uas 3.9 1.7 1uJ d. , ) -, u t c{'r rilutr.: tralyl rJil? uolat?1 d:vEls{o n unfl
qJ ql
rirr or n nr:fi nurtat anrfu dznrl l 16 n uvi.:q
ado d, --^- ia, d-t1fr ilfi1:1?fl "tutl'tr.fl . 2542 neln1tflnfl 4.0
, a1nflr:finurnu,irfian:rnr:'[fisr Ltav 4.7 {u ntruriroiuo vYtdarqrflo']o1n
r.Jfrfiruv'[u{drnl:n6nr{ahiarn.ofi 5auav firJratdrfitiunr:inurrdatfiuidh.t:nu1u1a
,Ja doriruflr.,:q.: urifiairur.nei.:lilfi:ru.:ru quzrrsrlr.:?\u1u'ra'Lu{'ruforlnfirdut uas
n1:Anu1 tta.:drur nrin n&t'luil:rtn fl uasYr,"'Jd
rir.:il:stm rtn.: un n. rt. z 532-2551 ("' {',141 Q il
fi a1 ud1 tfi 4dvi.'[ti*u nr:lfr urr,Jfr fixusq.:'[u
{tr uI:rr 6 n rd'oleiara.r fi In entu'jrdr',::cu'l Fl
?a{fldilAflr*rag1udr.:rdau fiurnru fi quT uu- A r dr' 4^
[asnuutElu {'.:ril.:qrnilnou I tvl:1etila?\uvt, j o A rtrit e o6lv €
{ilr sfr rur or? fl L5o.-t Lt Lu q 4:au Qs?l1 []1 Ltll{Yl u
oto u r t ^ I t -.-.4-)Tii00rJ ufl n [Tn Lnu n n n{ [:n n n tuoau 6J
urnn'j{:n tfirdarraan(o) 6.:a1qtflumtfi 4md.:
dvirtfrfi nmlfia'lJfr firurudru{u1u{rt? Er uo nI a 3a, v v
or nfi nr:fi nurii ttlunr:dau n1 il{o ry
n {dr ue\ eu u r-4 -.4-l -
frauma.: mufi a.,llot:un1T?u4ilfl ?1FlFl tto L?:fla A d d 4---.t -unrfi fi.:r6ntf;nara:su'j't.: o-za tdauffru't
fir er rda.:lfl rdsul^r #u"[rln:tuar tm 4 (acute
febrile illness without localizing sign) fiarru4
e1n occult bacteremia nuldtogae 5(5' 6)
q n d.,: rYr or r ru reu u d i 0i a 6.: dr ril u fi a.: iu {rJ r u
rdrin r*r'[ul:.r n EJ1 u1 a d? :: ri'r] :smin d Io er
Avu,a 6 tfr Er.r Lilila1n.lr?o{n1?vzofl ?ileil1 LT{l {tnulaY u
redrlfrfrilaulfiiuar:f1LLAYn?U[ilFln.:nA1?O' {aou&e44.
n1.]fi AOn LaA n nlQ1 fl n1::nu1 tUo{Flu ?f, n1l
n Lra frd? uI:nrlf, 16a n aa n'[u rtat nr:'lfrar:rlrqq
nr :fi q r : rur vte.: tfi n ua sil3 ru r ru ar tti"t fitttYutOYa
adr.,:tmrursallJ 1 l5ailnun1:atLaoul{ Lna{Flt % v trv - Y e-9-.-Y-'
dlrnrnz?uil4.,:nunr:1fiaT :drrurnufi uluffJr u
dn :r n r :1fi iu ar rJ fr fi aur'[u {rl r u
DHF, DSS uas DF anr{lUiaAac 75.9, 69.76 | en Jcu-
ttnc 63.8 Fllilnlnu AttfiU?',lLlll?tlYlLFl?u
NI:TUAAU DHF UAg DSS ilAM:1N1:LFI:U.AdtYvuOf
urilfl trur6{ risuL?l1Tufl 1::nM LU [:ilr{u1u1a
DSSdv \Yvilarl:1n1:LFr:u
dl,rrnr:6nrdaftiaror.lfifrarqrr'.,:ruri r flduhl 6.:r{luarru4rir'[frfinr:'lfrutJfifieusrurriouA d. Ja ov rad- 6l <-^-' X o u6.:riluarumqnilnl:Lfiurilfifiruv'lurfinn{tfi dtniuarn{ru Macrolide uav Cephalosporin
, J ,'- u o t e tt I r Qcz r 5l ' th ' a
nouileyL?11:un1:Tnu1"[ul:,,:yluruta or'r{u lilvlunmLturiornag LunqililLtllEluzunta',l
aidirirAcgfiqorlunr:quainur{rJru16nfir{lu utlfifirurtfi miorfioralntunrurriunr:"[fi
dlr:61:strindr':tarr afir: iqatiiouufioa rnuiu frouurqa 90
mndil Macrolide uar Cephalosporin #thjq
, J .ad &tv- r et
ruv{in a1 u fi.: enr.Jfr firucfllfiiu 6{rulu qj rilu, \e r i A v
flail Penicillin Lnun Amoxltillin ulnfldn ffiu{,: ,;{, a d -:^Lil:?ilflailm lilTr:1utu Ft o{ a1a il il:ri 1Eu
q
' Js- r oea ail1nn?1u [nu01afl 0 Lmrnnn?1ilq6u LduYrl{
LFlrugfi a uaerfi n nr:d'a ar riahllfituI:.:l r arur a f, ?::d'il:suT indo'n:T nr:da fl r
&?a.:tfia Streptococcus pneumoniae rian{n
penicilin i) zsqg, 2550 rar 2551 finrilu
Saaar 61, 76 $nr 56 nrrurirpiu(8) l^ru'j'tq - )a , J-,. ,vu A &rlqe'ufi fi zu n ri o n'r:fi {rJr ulfiiu rfi a d a ar'[ur a A s- dq - j o aL:,,nrt Etlura tn n?tu IFr El uilaa uil d1 n q 2
il:snr: 6o flq{udruunnn lfruri nr:tfiiuurilfrfiaur dnrJqq-Emdo 6. n.ru*dr{aornvn At,- v, J A qllu?Ernuilu{LUfl{eJu?unuou I 1'{Uaau'y t d I - 6:u , d Jn{ da{ a fl 1{ il n?1 eJ fl }.ll/\luDnuo EJ'l{fi a n tn 9.1
r il v g a| .J o v o ,a % a[3JLn UOnfllnU d{mdln6uIUL?{UOUn nA
avu uy r rl r a X 3rrl^rm u arrnulq&: Laafl 1{ LT?1 n1T[nn tzan0 u1o
t ,u' a v v I a
Ludnlunl:ruuu 1 rnaalnilqaud\ltd:iln1:'Ifi utJfr firuv n1rfi n n1ilo-n:1 nt:1fi ,,{, da
HrIn udr uu n n1 sJil:etRn r{e f,a ar ore fi deu
dr s'lfi uv'r yr riiu 56.: n m u dl vflu 6z o { n1 :'[fr,Ad -n- ^ N N
urr.lfrflrur rYu a m:r n1:t n nrrf,a 6 a Br'[u
I:.,tflururalfi(') Center for Disease Control
and Preventions lfirrusrirrurnrfllTn?unNg & i 6ettoFrafll LnE tfi Unaln:n1\:61fr1:6ild?l
vaqtroto"rr:smtin fi .:fl rumr uavrflrtouluur fl dr il'r
.v .J & ailTUrunuuilqrlnrril(n) uon81nf, nr:fr
51 9 .ad O U3J1Fr:fl 1:Fr?U nil n1: tufl 1u0tXUs Lfi tmtJlc6ltJ6,qvrAA
tilutJ1 n:n1:a n!aa g d?uu a aa f,.]:?3J fl { n1:- N 3 s ,a%
v{ zuU'l fl 1:T1 EhllU ttrA n A U1A1 fl il A.:U0U n n1:
nmfi1fi uFrLlulfl1{nr:lfi uT rJfrfirur (antibiotic
guideline) nlTn'lu qil n1:'[fi u'rrJfr firur
n1: feedback n'r:'[nfl rilfr firur'tfr ur^rn ri{rd ar
{4.:m:rutilu:sfls(10)X r ou ,ad
ua n81 nuv{u?1 n1T [ur.r'ru0t?uva1ad y d t o u oogt
3J ilA'm.t Lri U{FtOfl 1T?l1.:',tU?t4.,:nUm1 lfi n1 AST
tunr ALT rfi ru{u(") 6.:fro.::srior:sf.,:nr:1fi.Ad 6 et, i a X u u d A
u1ufl z?u3 Lu,,ru? u [:Ftnarta L?:drn{n {{ilnfiocl{unrrrufioriln6ta{ AST uas ALT
: ! u , a ,.^.rrfi rufluurridrurur nhirfi u zoo ulLtlz) Inflv{uer
rir Rsr rfierrurnn'j'r ALT il:rarru 2-g Lyi'ro d X r o v tad rl rd'Lu nr :F nurilvi u'ir nr:'[fr ar rJfr frruslai fr
zunriorir AST un; ALT msrdarilSaurfiauia@
'JAN1:M:?Q AST UAV ALT fliJ:iFIUTJIflN?1
)u , o q,. s xq a A200 L/L fi.:hinr-rLu riilr ul:nl{rfi a noa nfi il n A{
- I t ett r a 3u v dalnnlTFlfl Uluv{U?1 r.Ju? U L:nnn tta L?:dtFh]flJr-- ,Ad d t
flLnruerluf,U?usrJrJa AST uac ALT il1nn?1Ad,gt
200 ull nnrlju?auav 24.1 rras 30.8 il1nfl?1J t-- ,ad A a- e
ryil?811 Lil IATUU1U0{?Ug CI{ilOFlrl:Auns 1 2.5
rLn&20.0 nrilrir riu udlil fi n?1 eJ rn nFh{o rhddv o u oof, , A a ailu Er d1 FtfllYt1.0 rtn Fr f,.] d?ufi u{ tn na1 nu1il1 fu
ur rJfi flruvfilffki rur nvr a unchjtfi 6 n n1 il Fi1
AST uac ALT naanrrar'tuzirr:rarinqm'[u
rirhgl or mia oHr arvlursoiudlnr:yil.rluqd u €u o - j
fl O{ tAUf, El tl nU 6l',ldFl [U?U11 I ?A',: n1:il? U tLAc
aaa.lauilnamEflu 2 dilnl?i('', d.:nT :6ntnda , E v du J o - A A
talstaa n n:24n1 taufl EJil Flu Lqa u Lu?u7l 4 di'.,:
ud,Jouutra,ath: t!u:sEjs?]n1fl]'t{1uta.lnu g.l LlJ r.l Fril nnd.0qFr
a o o I I o 6 v duA 1 A A s eJ r.l A il1 Lm n 1 fl 1 T?1 1',11 U? A',1 tA U{ fl eJ n U
lri fr nm ru un n oir.,:dt'or rq ulu n { ru {rh udtfiiurAd v I yi G!\ l49v racl
u1110t?usnu n q il ryil? Er11 LIr LFr:u Er1il0t?ucI d v a
Nlriuafrt6(14)v{u'hfr1-l'1ut?fiJIAENNUfN:FINMff q {DHF Lras DSS 18 Ftu fifiarnr: hepatic
encephalopathy kj fi nm u #run-u ii':cfi 'jt tJ^ o v s
acetaminophen ntnunlfi uFlfl uo'ln1:mu?1El
nr:'ldfr0rrJq'ixlrttol{rJro1:n6nrdohiatnlfittavn:llfirr{r{firnr:{r'rruto':6:rfld o qfud 2\.A.-d.a. zs52
Antibiotics in Dengue Infection Patimt and Effect to Liver Function TesI
ruoiodr.,:l:fin1iln1:'[frs,rlorayr-rhlfiprrrx fifiru{ dt;rJrruunr:'[fiarilfifiturfit'{uu-.1
sir rtlu fi armd n rd ar nr:'lfi a.rfi dun:r a ri a n'u n{ til fi au LA ru rrarda rya nr:'lfi urilfr fi aur'lu
tu6,l.,uiruird'ut*,o,or.:fi uanorndarnr: {rlraI:nr6or{ahiator.:firflurlrrxaodri.:hifi
rfl:n{aurron.rA^d'rtriarnrfiiirir'lfrrfin '[n:lnflfirnr:i{n {i'i'arfiu'jrfloryadrflu
liver faiture fiarrmnornrJo{uari.rt'lorarir,,:rnd.: r]:slatriaejrtEi',:oiaqnaln:n1{n1:utlnsilu
fitailnrflarjr.,: Xfirrri Dengue antigen, n1id51,0n?riln:cfi1infi',:nr:'[frfl11Jfrfirur'lu
protong shock unrqerfrrafia drug intoxication {rlranqruddrhisilr{lufia.:'[fiunsfirir6'rpu a et v.r- e ) - -- 4^- :ute rjrocfiil:ylgmilufirura:usrndnimfi.t:ruq?tn".:rIutu nr:4 ua ryilr a m nm 3J1 Fl? u Llo.: ac
febrile illness dtrjn:ruaT tu4 nr:finr:tfl't
:vr-.,:fi nntru{rJraadr',:tnfi?n rrfiarirlr-J{nr: d?il
eOrindqnfitt firaraunr:he*d'alrfaro'ifido {,1, nI:nfi e'rd'atrfarn.:fitfifu
r{lun{rudtrifio.:nr:srilfifirur nr:'lfiuurmrt arilfrfiruriaflas 70.3 rrar{rJrg oHr t{lu
nr:ifiodul:nto.:a.,:d'nr:aurfialantrs'ror fqg n{rufitfiiuatJfrfiruvrurndqn uridtfirurnid
rqflrsfiriludrnt:noAaU tourniquet'[fr q^ ri ou rfiriu nr:fnur'[ul:':fl fl rula 6 a
,{au?n d.:rflunr:n:aoirrnrai4riruifiqd'a Amoxicillin untrjvruzuatun:n{aurianr:rir.:ru
tfirirrmv finmrula (sensitive) q.: irrrriufr
tfi ntdanmaoir (leukopenia) ovriralfrriula
lunr:inuT rasifiodu ufiatornflaryudn
rotriumionr:ufrar ornnr:'[frat Jfifreur
'[urirhuiilirnr:6nur
rIfi nr*rliri aunu'irfi am ruh uavnrr ildr tylrctuA
aglu:rd'u6(") tfi anottkymrnr:fiatl1 Lrars Ov. t^d A
nr:uu{uror n nrrtdHrilfl Truv:rru d{ nlrqrU
rfiHilr.: ta:r*gfialor uhi'ir rflu nr:fi nr:il:vtfi u nr:'[fi arrlfr flr ur'[u {rJa ul:n fi n r{a
hia rn.: fi drutiu nr:fnur"[ul:.:n sruraa drt3 i o ya e u 6le
arir raru a tfr 41fi il nr::ril n:v?{ n1: Lu ?l'13J1 n
Agu{flu
adr.rt:fr nrl n.,:fi nurdrjrf,aryafl
2s41 6t zs+z rurfinr*rrda.:oln nl:6nul
14 0.,: o'n :r nr :'[fi a tJ fr fi r u v'[u {rJ e aI: n 6 or rda
hfa rnt fi rilu{a rynd nr n'jr riaudr.: n#tri fi
nr:nldauuila.ournfn tda',:fl n rnrmrinfl.:
R:rn:n[ aia6r: tdtnsrirnT :i6'HLdatdLda
fisr6n:turJ:sntfl
satau n ilrv{ntim {',: fi:rn:ni afafi r:
aatiuqtnrl,t 6n ulistrfiuuT :r?fi idnpuflfi
rir uuvrirtunT :fi nurdrraslfitir arirnr:6nura&Lu?6ueuu
fl zsss dlto*u'lr'tnufi1r{1rFt1rurrricftkild
dt::d'il:s1tfntjttzdt: afit: iUatiinrufita rnsiu finurqo 92
9Atondl:otilo{1. {'tuFt'lunilI:nfinrio. :1tl{1u:eurninm frrJral:nlf,tfraooan 'rl ZSSI. un:ar::d':
dr fn.:T u ar or :ru az 6'.: tt {or u n: ar :: r{; zss r .
z. ritinl:rr6orrirli*,J n:runru4ruI:nBnria n:srl:r.,rd1fi1:6u6t?r. nr:rir:eoqruRlv{n1:
'lrin,r:utuT arurrngrul:rrfirrrf,orduuvrfiu:numrulq1ur6n1ur{a1ur{u1u1a tl zs+g-255t.
uunu$' n:vm:?.:d1fl1T6ud?l; 2551.
3. Antibiotic used in dengeu infection [online].2552 [cited 2009 Apr 27]; Available
f rom : U R L: http://www. ncbi. n I m. n ih. gov/sites/entrez
4. Pancharoen C, Kulwichit W, Tantawichien T, Thisyakorn U, Thisyakorn C. Dengue
infection: a global concern. J Med assoc Thai 2002;85 suppl: S25-S33.
s. qu,t fidmnl. Common infectious diseases in preschool cfrildren. tu: q^:rini drrrirpfilrti,
u::il14n1:. trtmanfnToun;?. fl:{Lrlile: frr.:frudru,iT rier nrnfiruvi; 2546. mrir
60-9.
6. au1 fiaarn:. Acute febrile illness without localizing signs.'[u' r:riz qtnia{dd,
4nButri ?-t:fiufi', lnl:ori ltfiivruor:1n:, E',1 {r:e::ru, u::rul-onrr. Pediatric".
primary care: case illustration. n?.ltYly'l 9: Text and Journal Publication: 2546.
ufir tzt-g.7. Kalayanarooj S, Nimmannitya S, Suntayakorn DW, Vaughn A, Nisalak S, Green V,
et al. Can doctors make an accurale diagnosis of dengue infections at an early
stage? Dengue Bulletin 1999; 23: 1-9.
B. Annual Report of Antimicrobialsusceptibility Report 2W6,2W7,2008 in Sawanpracharak
Hospital. u Fr:dxrrd': I:',:t'i urur a ar:: d'rl:c{rinr$; 2552.
9. aUm anm:nuind. il1rtrflmn'ruqunr:6nrr{af,aflr1ul:.:r,{u1u1a.lu:o'',:4: tfiott,'irfit,u^r,daudtot-"'i.:firur }iram, TTstrEt ?pltu?TLrtt, ni ltfifinaduuri, u::curBnr:. Update on pediatric
d a ': 2550. vtilt zzt-ea.infectious disease 2OO7. nT.:Lflv'I9: :{FIaUnl:v,{ilTl
10. Apisarnthanarak A, Danchaivichitr S, Khawchareonporn T. Effective of education
and antibiotic control program in a tertiary care center in Thailand. Clinical lnfectious
Disease 2006; 42: 768-75.'11. Lacy CF, Armstrong LL, Goldman MP, Lance LL. Drug information handbook.
14th ed. ohio: Lexi-comp; 2006. p. 105.l|||66vvaaoav(4
t z. ffirrftU nau16u?a. antrusarnr:mrrnaun Lu: fl?fiFt1 aua, QuYlv{{t* ?sd, u::ru1f,fl1:.--ro-o " -
: q
ldufi o oraan tn{ fi . n?.,i trtY't e : fi tla{lrtiru; 2549. urir t 1 8-33.
13. Qiu E X, Gubler DJ, Liu JC, Chen QQ. Dengue in China: a clinical review. Bulletin
93nr:lCirorrJfiirultor{rJrul:n6ardoLiatnrfiuacn:r!frrriufriunr:rirrrutolfrt
Antibicics in Dengue ldcction hti€nt and m€d to Live( Fimction Test fld o qdud 2 il.n.-6.a. 2ss2
of the Pan American Health Organization 1993; 71:349.
14.Suvatte V, Vajadarul C, Laohapand T. Liver failure and hepatic encephalopathy
in dengue hemorrhagic fever/dengue shock syndrome: a correlation study with
acetaminophen usage. Southeast Asian Journal of Tropical Medicine and Public
Health 1990; 21: 694.6 d u d aa u u f rlvA A
1 S. FFrfl 6U naenorqo, qonfl ilrururuilng. uu?Tn{n1T?Uoauuasf,nurlt:n lflmanaafl m.0n.
fl:{ryrile: I:rfirtv{oranruiEr; zsao. nrir s+.
16. WHO. Dengue hemonhagic fever: diagnosis, treatnent, control. Geneva: WHO; 1986.
lT.Teeraratkul A, Limpakarnjanarat K, Nisalak A, Nimmannitya S, Predictive value of
clinical and laboratory findings for early diagnosis of dengue and dengue hemonhagic
fever. Southeast Asian Joumal of Tropical Medicine and Public Healh 1990; 21: 696.
J A 'i 4v e u a o IFl't:1.1fr 1 :3UcL? A1 n.,: LMi t5tJ il ['[AU ttn:U n1:TnU1 [U [:{v{ U1U1 A
?rEtrL?41
({u)
.iruau{rleu nu(iasac)
DF DHF/DSS
1
2
3
4
5
6
7
II10
8(17.0)
3(6.3)
8(17.21
15(31.e)
7(14.e)
s(10.6)
0
0
1(2.1)
0
11(12.0)
3(3.3)
21(2s.O)
25(27.41
20(21.e)
5(5.4)
4(4.3)
1(1.1)
0
1(1.1)
:'1il 47(100) e1(100)
ar::d'rl:vtrfndrrtar: duaanfit: irladinrufioo rnrBu r{omqa 94
J o vt a yyvrr1:'r.ofi 2'r"T uru nrlr u rnudn:1 n1:lfifuarrJfl firur
Serology diagnosiso ytt
01u?ur.tu?u
(nu)
o-n:r nr :lfiiu ur rJ fi fl r u;nu (iaH6s)
DF
DHF
DSS
47
58
33
30(63.8)
44(75.e)
23(6e.7)
T?3J 138 e7(70.3)
) ,a.r As" teq0l'l:1{n 3 {Un?4.:?l1U0{?UsTlrJll?gLA:U
o v,, .h--,iruru{rjrsfrtdiuurrJfriiruc au 15acrar1Serology
diagnosisu1nnil
Penicillin
fl1nnilBactrim
fl1nnacrol
,J
ide
U']nnil r r" [uY]:11JzUFtCephalosporine
:?IJ
DF
DHF
DSS
18(18.6)
20(20.6)
13(13.4)
0
1(1.0)
1(1.0)
12(12.4)
23(23.7)
e(e.3)
30(30.e)
44(45.4)
23(23.7)
0
0
0
0
0
0
:?tl 51(52.6) 2(2.o) 44(45.4) e7(100)
J ^ A As"n1:1.ifi 4 tfinza.:srndt Penicillin uuasarnrirudu.l fi{deulfiiu
a ,ad
duoulufl{?uc,iTuru{drg nu (;ouac)
Amoxicillin
Ampicillin
Penicillin
Cloxacillin.A
narJau I
13(13.4)
4(4.1)
1(1.0)
0
12(',t2.4)
31(32.0)
1(1.0)
0
1(1.0)
34(35.0)
44(45.4\
5(5.2)
1(1.0)
1(1.0)
46(47.4)
30(30.e) 67(6e.0) e7(100)
nr:ldituriiirurtor{lhuI:nfinrCol:iararfiunrn:rldrriuf,tirnr:tiroutold:-r95 iot,",i* in Dengue lnfection
n1 fl .,:fi 5 d nl uy{ Et 1 u1 ad {d ? flhliu nr:inr*r uaslfiiu al :rIT mr.: n a a a td a n rir
riaurflriu nr:inu'rlul:{l lEl1u1adr::drhvtrind
'iruru {rJr adtfif, artti., e nu (;a Erns)
dn'ruv{Et1u1aDF DHF DSS I?lJ
I:rfluru1a'[uq-.]m{n'[nf,r6u.: o 8(5.8) 9(6.5) 17(12-3)
nf,finvrurura 2(1.4) 1(0.7) 2(1.4) 5(3.6)
I:.,:r,is'rurnqrutuoo4(2.9)4(2.9)da1fiauril-Ej 0 2(1.4) 0 2(1.4)
nfif,nunnd o 1(0.7) 1(o'7) 2{1.4)
2(1.4) 12(8.7) 16(1 1 .6) 30(21.7):'tiJ
nr:r.:fi o ri.r nsr'lundufirlaodtulfiirulJfifiru; uartfriuutJfifiruv
rir Rsr
(u/L)
lejlfiiutnilfifiaur tfiiucnr.JfifirurP value
nu(5ouar; nu(5aaar)
0-50
51 -200
il1nn'i1 2oo
18(45.0)
17(42.5)
5(12.5)
36(3e.6)
33(36.3)
22(24.1) 0.313
40(100) e1 (100)
AST - aspartate aminotransferase
nr:r.gfi 7 Fi1 ALT'lundrufrrlrudtulfiiru1Jfiflrur ga, 16ius1Jfifirur
ri,r Rrr kjlfriusrilfifiau, tfiiuatlfifirur
(u/L) nu(iauac) nu(fagav)P value
rurnn'jr zoo 8(20.0)
14(15.4)
4e(53.8)
28(30.8) 0.424
0-50
51-200
8(20.0)
24(60.0)
:'llJ 40(1 0o)
ALT - alanine aminotransferase
e1(100)
