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| From
the Editor |
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Editorial
A. Abyad (Chief Editor) |
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Original contribution/Clinical Investigation
Diabetes Mellitus
- Knowledge, Management and Complications: Survey
report from Faisalabad-Pakistan
Ijaz Anwer, Ahmad Shahzad, Kashmira Nanji, Farah
Haider, Muhammad Masood Ahmad
Alanine aminotransferase
indicates excess weight and dyslipidemia
Mehmet Rami Helvaci, Orhan Ayyildiz* Mustafa
Cem Algin, Yusuf Aydin, Abdulrazak Abyad, Lesley
Pocock
Comparative Analysis of Antimicrobial Peptides
Gene Expression in Susceptible/Resistant Mice
Macrophages to Leishmania major Infection
Hamid Daneshvar, Iraj Sharifi, Alireza Kyhani,
Amir Tavakoli Kareshk, Arash Asadi
Does
socio-economic status of the patients have effect
on clinical outcomes after coronary artery bypass
grafting surgery?
Forough Razmjooei, Afshin Mansourian, Saeed
Kouhpyma
Comparison of the uterine
artery Doppler indices during pregnancy between
gestational diabetes and diabetes mellitus and
healthy pregnant women
Nazanin Farshchian, Farhad Naleini, Amir Masoud
Jaafarnejhad,
Parisa Bahrami Kamangar
Survey single dose
Gentamicin in treatment of UTI in children with
range of 1 month to 13 years old in Jahrom during
2015
Ehsan Rahmanian, Farideh Mogharab,
Vahid Mogharab
Evaluation of control of
bleeding by electro cauterization of bleeding
points of amplatz sheath tract after percutaneous
nephrolithotomy (PCNL) in Jahrom Peymanieh hospital
during year 2015-2016
Ali Reza Yousefi , Reza Inaloo
Comparison of the three-finger
tracheal palpation technique with triple ID
formula to determine endotracheal tube depth
in children 2-8 years in 2016-2017
Anahid Maleki, Alireza Ebrahim Soltani, Alireza
Takzare, Ebrahim Espahbodi,
Mehrdad Goodarzi , Roya Noori
Effect of Sevoflurane
and Propofol on pulmonary arterial pressure
during cardiac catheterization in children with
congenital heart diseases
Faranak Behnaz, Mahshid Ghasemi , Gholamreza
Mohseni, Azim Zaraki
Population and Community Studies
Prevalence
and risk factors of obesity in children aged
2-12 years in the Abu Dhabi Islands
Eideh Al-Shehhi, Hessa Al-Dhefairi, Kholoud
Abuasi, Noora Al Ali, Mona Al Tunaiji, Ebtihal
Darwish
Study and comparison
of psychological disorders in normal students
and students with multiple sclerosis in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad
Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani
Comparative
study of self-concept, physical self-concept,
and time perspective between the students with
multiple sclerosis and healthy students in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad
Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani
Relationship
between Coping Styles and Religious Orientation
with Mental Health in the Students of the Nursing-Midwifery
Faculty of Zabol
Nasim Dastras, Mohsen Heidari Mokarrar, Majid
Dastras, Shirzad Arianmehr
Tuberculosis in Abadan,
Iran (2012-2016): An Epidemiological Study
Ali-Asghar ValiPour, Azimeh Karimyan, Mahmood
Banarimehr, Marzieh Ghassemi, Maryam Robeyhavi,
Rahil Hojjati,
Parvin Gholizadeh
Family Stability and Conflict
of Spiritual Beliefs and Superstitions among
Yazdi People in Iran: A Qualitative Study
Zahra Pourmovahed , Seyed Saied Mazloomy Mahmoodabad
; Hassan Zareei Mahmoodabadi ; Hossein Tavangar
; Seyed Mojtaba Yassini Ardekani ; Ali Akbar
Vaezi
A comparative
study of the self-actualization in psychology
and Islam
Simin Afrasibi, Zakieh Fattahi
The effectiveness
of cognitive - behavioral therapy in reducing
the post-traumatic stress symptoms in male students
survivors of earthquake in the central district
of Varzeghan
Sakineh Salamat, Dr.Ahad Ahangar, Robab Farajzadeh
Reviews
Effects and mechanisms
of medicinal plants on stress hormone (cortisol):
A systematic review
Kamal Solati, Saeid Heidari-Soureshjani, Lesley
Pocock
Comparing Traditional
and medical treatments for constipation : A
Review Article
Mohammad Yaqub Rajput
A review of anti-measles
and anti-rubella antibodies in 15- 25 year old
women in Jahrom City in 2011
Ehsan Rahmania , Farideh Mogharab, Vahid Mogharab
Review of percutaneous
nephrolithotomy in children below 12 years old
in Jahrom hospital, during 2010-2014
Ali Reza Yousefi , Reza Inaloo
Physical and
mental health in Islam
Bahador Mehraki, Abdollah Gholami
International Health Affairs
The Challenges of Implementation
of Professional Ethics Standards in Clinical Care
from the viewpoint of Nursing Students and Nurses
Saeedeh Elhami, Kambiz Saberi, Maryam Ban, Sajedeh
Mousaviasl, Nasim Hatefi Moadab, Marzieh Ghassemi
Cognitive Determinants
of Physical Activity Intention among Iranian Nurses:
An Application of Integrative Model of Behavior
Prediction
Arsalan Ghaderi, Firoozeh Mostafavi, Behzad Mahaki,
Abdorrahim Afkhamzadeh,
Yadolah Zarezadeh , Erfan Sadeghi
Effect of resilience-based
intervention on occupational stress among nurses
Hossein Jafarizadeh, Ebrahim Zhiyani, Nader
Aghakhani, Vahid Alinejad, Yaser Moradi
Education and Training
Calculation of Salaries
and Benefits of Faculty Members in the Ministry
of Health and Medical Education of Iran
Abdolreza Gilavand
The effect of education
on self-care behaviors of gastrointestinal side
effects on patients undergoing chemotherapy
Shokoh Varaei, Ehsan Abadi Pishe, Shadan Pedram
Razie, Lila Nezam Abadi Farahani
Creating and
Validating the Faith Inventory for Students
at Islamic Azad University of Ahvaz
Solmaz Choheili, Reza Pasha, Gholam Hossein
Maktabi, Ehsan Moheb
Creating
and Validating the Adjustment Inventory for
the Students of Islamic Azad University of Ahvaz
Homa Choheili, Reza Pasha, Gholam Hossein Maktabi,
Ehsan Moheb
Evaluating
the Quality of Educational Services from the
Viewpoints of Radiology Students of Ahvaz Jundishapur
University of Medical Sciences
Abdolreza Gilavand, Jafar Fatahiasl
An Investigation
of Psychosocial aspect of Iranian Nursing Students'
Clinical Setting
Mahsa Boozaripour , Zanyar Karimi, Sima Zohari
Anbohi, Amir Almasi-Hashiani, Fariba Borhani
Clinical Research and Methods
Comparison of the
Antibacterial Effects of Chlorhexidine Mouth
washes with Jaftex Mouth wash on Some Common
Oral Microorganisms (An in Vitro Study)
Ebrahim Babadi, Zahra Bamzadeh, Fatemeh Babadi
Study of the effect
of plasma jet on Fusarium isolates with ability
to produce DON toxins
Elham Galin Abbasian, Mansour Bayat, Arash chaichi
Nosrati, Seyed Jamal Hashemi, Mahmood Ghoranneviss
The comparison of
anti-inflammatory effect in two methods of topical
dexamethasone injection and topical application
of ginger alcoholic extract after removing mandibular
wisdom teeth
Sahar Zandi, Seyyed Muhammadreza Alavi, Kamran
Mirzaie, Ramin Seyedian, Narges Aria, Saman
Jokar
The effect of curcumin
on growth and adherence of major microorganisms
causing tooth decay
Leila Helalat, Ahmad Zarejavid, Alireza Ekrami,
Mohammd Hosein Haghighizadeh, Mehdi Shiri Nasab
|
|
Chief
Editor -
Abdulrazak
Abyad
MD, MPH, MBA, AGSF, AFCHSE
.........................................................
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|
|
|
| November 2017
- Volume 15, Issue 9 |
|
|
Survey on single dose
Gentamicin in treatment of UTI in children from
1 month to 13 years in Jahrom during 2015
Ehsan Rahmanian (1)
Farideh Mogharab (2)
Vahid Mogharab (1)
(1) Department of Pediatrics, Jahrom University
of Medical Sciences, Jahrom, Iran
(2) Research Center, Department of Obstetrics
and Gynecology, Jahrom University of Medical
Sciences, Jahrom, Iran.
Corresponding author:
Vahid Mogharab,
Department of Pediatrics,
Jahrom University of medical sciences,
Jahrom, Iran
Tel: +989171912400
Email: mogharabvahid@yahoo.com
|
Abstract
Introduction: After
upper respiratory tract infection (URTI),
the second cause of infections in children
is urinary tract infections (UTI). About
3 to 5 percent of girls and 1 percent
of boys have suffered from UTI. Gentamicin
injection, three times a day is the treatment
for UTI. One of the most serious problems
of treatment with gentamicin is its multiple
use and its associated complications.
The aim of this study was evaluation of
treatment of UTI with a single dose of
gentamicin first as 3 mg / kg daily IV
and after urine culture becomes negative
on the second day of treatment 1mg / kg
daily IM in children with from 1 month
to 13 years in Jahrom during 2015.
Methods:
This was a randomized clinical trial study
performed on 64 children aged 1 month
to 13 years who were randomly divided
to case and control groups. All of the
children had suffered from UTI. Urine
culture was used for detection of pathogens.
Data such as sex, age, fever, leukocytosis
and treatment complications were gathered
and analyzed. After treatment the patient
was followed up for 6 weeks for detection
of recurrence.
Results:
Age: 78.12% of control of the case group
and 87.5% of case group were under 6 years
old. 68.75% of the control group and 75%
of the case group were female. The prevalence
of E.coli in the control group was 71.87%
and in the case group was 75% which had
the most prevalence in both groups. Response
to the treatment in the control group
was 93.75% and in the case group was 96.87%.
Recurrence of disease in the control group
was 28.14% and in the case group was 25%.
Ototoxicity (decrease 15 db- ) was not
observed in patients, but data showed
that 3.12% of control group suffered from
nephrotoxicity(increased Cr twice) , although
this percent was 0 in the case group.
In regard to response to the treatment,
recurrence of disease, and complications
of treatment, no significant differences
were observed (P>0.05).
Conclusions: Data
showed no significant differences in response
to the treatment and its complications
between the two studied groups. Because
of pain tolerance of injection and use
of low dose, cost beneficence for parents
and hospital, low use of syringe, lack
of personnel and nurses, prevention of
hospital admissions, and decreasing of
complications associated with multiple
use of gentamicin injection, it is recommended
to use of single dose a gentamicin for
treating UTI.
Key words:
Urinary tract infection, Single dose treatment,
Gentamicin, E.coli.
|
Urinary tract infection (UTI) is the second
most common cause of infection in children after
upper respiratory tract infections [1], as it
affects 3-5% of girls and 1% of boys [2]. The
most common age of UTI is under 5 in girls and
under 1 in uncircumcised boys [2]. The ratio
of afflicted boys to afflicted girls is 2.5-8.4:1
in the first year of life and 10:1 after the
age of one [2]. Its most prevalent pathogen
in girls is E. coli (75-90%), followed by klesiella
and then proteus, whereas proteus may be as
common as E. coli in boys aged over 1 [2]. The
key point in most cases of UTIs is timely diagnosis
and proper treatment. In the current situation
were resistant species of gram-negative bacteria
are expanding, aminoglycosides, including gentamicin,
are still considered among the strong and effective
drugs for the treatment of UTIs [3]. It is noteworthy
that the use of aminoglycosides can lead to
nephrotoxicity and also auto toxicity (renal
and hearing poisoning). Therefore, doctors try
to reduce the odds of these poisonings by prescribing
the right amount of medicines. Accordingly,
they either increase the intervals between drug
administrations or decrease their dosage [4].
Aminoglycosides are usually administered to
children and infants two or three times a day.
One of the major problems with taking these
drugs is the frequency of injections which may
cause problems such as pain tolerance (for children
and infants) and a waste of time and money (for
their parents) [5]. On the other hand, the reluctance
of the patient or their parents to be hospitalized
and lack of access to facilities make doctors
apply outpatient treatments. In this case, fewer
injections definitely further satisfy the patient
and their parents. Recent studies in adults
have shown that taking aminoglycosides once
a day maximizes antibacterial activity and minimizes
their toxicity [6, 7, 8]. However, a few studies
have been conducted on children and infants
in this regard and most of them have recommended
further studies to be conducted on this population
[9]. In a review of 24 studies about different
aminoglycosides, it was concluded that although
the use of aminoglycosides in a single dose
is recommended in children, more studies are
needed to prove its usefulness [10]. In another
study on three comprehensive studies, it was
recommended that although a single dose of aminoglycosides
is useful in the treatment of UTIs, more studies
should be conducted on children because patients
are genetically different, they respond to the
drug differently, and the dosage of medications
varies from 3 to 7 mg per kilogram of body weight
[11]. In other research conducted by Chong et
al. in Singapore, 210 patients were studied
in a randomized controlled trial. The patients,
whose age ranged between one month and 13 years,
were randomly divided into two groups. The first
group received 5 mg of gentamicin per kilogram
of body weight in a single dose and the second
group was treated with 6 mg of gentamicin per
kilogram of body weight in three days. Their
results showed that there is no significant
difference between the two groups in terms of
treatment duration, medicine discontinuation
at night, age, nephrotoxicity, and auto toxicity
[6]. In a cohort study in 2011, 79 patients
aged between one month and 16 years were divided
into two groups and treated with 7 mg per kg
of gentamicin in a single dose over three days.
The results indicated that the single dose administration
led to the non-prevalent and reversible nephrotoxicity
and affliction of only one patient, and more
prevalence of auto toxicity (2 patients were
afflicted) [12]. In another study conducted
in 2011 in Australia, 179 children aged between
one month and 12 years were divided into two
groups and treated with 5-7 mg per kg of gentamicin
in a single dose and in three days. At the end
of the trial, both groups responded to the treatment
and no case of nephrotoxicity or auto toxicity
was observed [5]. In another study, 49 children
aged between 6 months and 12 years were randomly
divided into two groups and treated with 4.5
mg per kg of gentamicin in a single dose and
three doses. In the single dose group, the fever
of patients was discontinued earlier and the
result of the urine culture test was negative
in patients of both groups in the first 48 hours.
In the three doses group, nephrotoxicity was
more prevalent and it was concluded that the
single-dose administration of gentamicin is
safer, more useful, and more economical [13].
Although UTI is the second most common cause
of infection in children after upper respiratory
tract infections [1], its prevalence is higher
in children aged under 5 [2]. Multiple injections
in a day may cause problems such as pain tolerance
(for children and infants) and waste of time
and money (for their parents) [5], and the single-dose
administration is more appropriate in most cases.
The effectiveness of this method should be proven
by conducting more studies [11, 12, 13]. Several
important differences were the trigger for the
conducting of this study: a) genetic differences
between patients [11], b) differences of patients
in response to gentamicin in numerous studies
[11], c) difference in the dose of gentamicin
in various studies (4-7 mg per kg of body weight)
[10, 11, 14], d) scarcity of studies on children
unlike those conducted on adults [10, 11, 14],
and e) gentamicin is usually administered to
patients of the control and test groups at a
concentration of 4-7 mg per kg of body weight
in a single or multiple doses. In the present
study, subjects of the control group intravenously
(IV) received gentamicin at 3 mg per kg of body
weight three times a day [2]. In the test group,
the subjects were firstly treated with 3 mg
gentamicin per kg of body weight in a single
dose (IV) and then received it intramuscularly
(IM) after a negative urine culture on the second
or third day of treatment at 1 mg per kg of
body weight. This indicates a significant difference
between the present study and other previous
ones in terms of dosage and injection method,
because the subjects were studied in an outpatient
manner rather than the inpatient manner after
a negative urine culture.
This study was a clinical-controlled trial
and according to previous studies, the sample
size of 64 pediatric patients with UTIs admitted
in the pediatric ward at Motahhari Hospital,
selected by pediatric specialist diagnosis,
were entered into the study. In the implementation
of the project, the consent of the parents of
the child was taken and the plan was implemented
in compliance with all the ethical regulations
required in the research. The name and identity
of the individuals remained confidential. No
costs were received for urinalysis, audiometry
and sonography examination. The criteria for
entering the study included: children aged 1
month to 13 years with UTIs and exit criteria
from the study included: age less than one month
and over 13 years, renal failure before treatment,
hearing impairment before starting treatment,
taking Aminoglycoside before the onset of treatment,
allergy to aminoglycosides, co-administration
of another nephrotoxic drug, and urinary obstruction.
Children admitted to the pediatric ward of Motahhari
Hospital, who were admitted with UTI diagnosis
of the pediatrician, were randomly divided into
two groups of test and control, after permission
from the parents of the patients. The criterion
for diagnosis of UTI is positive urine culture
which in case of using a urine bag, at least
two positive identical urine culture with an
organism of more than 105 colonies and, if using
mid-urine culture sample, at least one positive
cultures with an organism more than 105 and
if using a catheter, the existence of at least
103 colonies of an organism was considered a
UTI. At the time of sampling, all the necessary
notes were given to the patient companion for
a safe and sterile sampling (such as cleaning
the urethra before sampling, closing the door
of the sample vessels and quickly transferring
to the laboratory, etc.). Samples were cultured
in EMB and blood agar environments, and TSI,
Citrate tests were used for diagnosis of bacteria.
The results of the samples were in three forms:
A. Examples which were negative and excluded.
B. Samples which were mixed growth, and
were mixed growth after the repeat testing again,
were discarded from the study.
C. Samples that were positive after 2
times urine culture, were included in the study.
Urine culture was also repeated 48 hours after
treatment, and in the absence of negative culture
after 48 hours of treatment, were considered
as not responding to treatment and were excluded,
and the treatment continued on the basis of
standard treatment. At the end of the treatment,
urine culture was repeated as well.
Before the start of the treatment, PTA auditory
tests and kidney function tests (Bun, Cr) and
electrolytes (Na, K) and CBC and sonography
of the urinary tract were performed for all
patients. In the case of abnormal kidney function
tests and abnormal urinary tract sonography
or the presence of abnormalities in the auditory
system, the patients were excluded from the
study. During and after treatment, renal function
tests were performed which, when doubling, serum
creatinine was considered as nephrotoxicity.
At the end of the treatment, once again, the
patient was tested for auditory examination,
which was considered as an auto-toxicity in
the case of a reduction of 15 dB S.N.HL. After
the treatment, patients were followed up for
6 weeks, and again in case of having urine symptoms
or any fever or illness, the urine culture was
sent, and if the culture was positive, the same
type of bacterium was considered as a relapse
of the disease. The samples were collected and
cultivated from the beginning of the year 2015
to the end of the year (March) and the type
of bacterium causing infection was determined
by microbiological methods. The data was analyzed
by SPSS software version 11 after entering Excel.
According
to
the
results,
25
(78.12%)
of
the
control
group
and
28
(87.5%)
of
the
case
group
were
in
the
age
group
of
below
than
6
years.
In
terms
of
diagnosis
of
UTI,
E.
coli
formed
the
majority
of
responsible
organisms
in
both
groups
(71.77%
in
the
control
group
and
75%
in
the
case
group),
and
Proteus
in
the
control
group
and
Klebsiella
in
the
case
group
were
in
the
next
order
(Table
1).
The
most
common
finding
in
both
groups
was
an
increase
in
the
number
of
white
blood
cells.
Para
clinical
results
showed
that
in
the
control
group,
14
people
(43.75%)
in
the
case
group,
and
16
(50%)
in
the
control
group
had
leukocytosis
more
than
10000
(Table
2).
In
terms
of
the
bacteriological
response,
2
cases
from
the
control
group
and
1
patient
from
the
case
group
were
resistant
to
treatment.
In
all
3
cases,
the
urinary
culture
was
not
negative
after
48
hours.
Comparison
of
the
data
showed
that
the
response
to
treatment
is
more
in
the
case
group
(OR
=
0.48,
P
=
0.036)
(Table
3).
In
both
groups,
3
patients
had
creatinine
increase,
were
this
value
exceeded
basal
levels
only
in
one
person
(3.12%)
from
the
control
group,
which
was
considered
as
nephrotoxicity.
However,
the
post-treatment
retest
showed
creatinine
return
to
basal
counts
in
all
6
cases,
and
none
of
the
subjects
in
the
case
and
control
groups
had
a
hearing
loss
greater
than
15db,
therefore
auto
toxicity
was
observed
in
none
of
the
two
groups
(Table
4).
Of
the
control
group,
9
(28.12%)
and
8
subjects
(25%)
from
the
case
group
experienced
bacteriological
recurrences
in
a
6-week
follow-up
(Table
5).
Chi-square
and
Fisher
exact
tests
did
not
show
a
significant
difference
between
the
two
groups
in
terms
of
response
to
treatment
and
complications
from
treatment
and
illness
relapse
(p>
0.05).
Click
here
for
Tables
1
-
5
Several
studies
have
been
carried
out
on
the
use
of
gentamicin
in
the
treatment
of
UTIs
and
other
infections.
Gentamicin
is
one
of
the
bactericide
antibiotics
from
the
aminoglycoside
group.
This
antibiotic
is
condensed
in
the
kidney
parenchyma,
and
its
effects
remain
in
the
kidney
and
urine
long
after
it
is
cleared
from
the
serum.
More
than
25
different
studies
have
been
conducted
on
the
use
of
effective
values
of
gentamicin
and
the
modification
of
how
to
use
3
times
a
day
(15-16).
These
studies
are
both
in
adult
UTIs
and
in
UTIs
in
children,
infants,
hospitals,
and
others
(17-19).
It
is
very
difficult
to
compare
the
results
of
studies
with
each
other
regarding
single-dose
therapy
since
the
selection
of
patients
in
different
studies
has
been
carried
out
in
different
ways
(20-21).
Some
studies
have
investigated
the
effect
of
single-dose
therapy
on
the
first
UTI
and
some
on
frequent
UTIs
(22-25).
Others
have
considered
both
upper
and
lower
infections
(26),
and
in
some
other
studies,
the
first
infection
and
recurrent
infections
have
been
studied
together
(27-28).
In
one
study,
the
radiological
examination
of
the
urinary
system
was
part
of
the
protocol,
but
people
with
an
abnormal
urinary
system
were
not
excluded
(26).
The
results
of
this
study
and
other
studies
have
shown
the
good
and
successful
effect
of
daily
infusion,
along
with
less
renal
and
ear
toxic
effects.
Due
to
the
prolonged
effects
of
gentamicin
in
urine
and
kidneys,
and
its
bactericidal
effects
depending
on
concentration,
some
studies
have
shown
that
low
and
sequential
concentrations
produce
adaptive
resistance
in
germs
and
the
use
of
higher
concentrations
at
longer
intervals
produce
higher
concentrations
in
the
urine
and
kidneys,
and
have
better
effects
in
eliminating
the
organism
and
reducing
the
chances
of
resistance
(29,
16,
and
30-31).
Another
important
effect
of
this
prescription
is
the
reduction
of
patient
and
personnel
costs
(32).
The
results
of
this
study
showed
that
single-dose
gentamicin
treatment
did
not
differ
in
terms
of
response
to
treatment
and
the
complications
of
treatment
and
relapse
of
the
disease
by
repeated
dose
therapy
and
could
be
used
as
a
safe
and
cost-effective
treatment.
The
response
to
treatment,
which
was
defined
as
a
culture
being
negative
after
48
hours
of
onset
of
treatment,
was
found
in
93.55%
of
the
control
group
and
96.87%
of
the
case
group.
Chi-square
test
did
not
show
any
significant
difference
(P
=
0.5).
These
results
are
comparable
to
the
results
of
Wigano,
which
has
observed
100%
and
99%
in
the
two
groups
of
treatment
responses
(33).
The
results
of
Caraptise
also
showed
a
97%
response
in
the
case
group
and
98%
in
the
control
group
(34).
Keren’s
studies
also
showed
a
100%
improvement
in
microbiology
in
the
daily
single-dose
group
and
92%
in
the
multiple
daily
dosing
groups
(35).
Complications
due
to
treatment
including
nephrotoxicity
(duplication
of
creatinine)
and
auto
toxicity
(more
than
15
dB
of
hearing
loss)
also
did
not
show
any
difference
between
the
case
and
control
groups.
Studies
have
shown
that
there
are
many
consequences
for
treatment
complications.
One
of
the
problems
found
in
these
patients
was
a
30%
increase
in
baseline
creatinine,
which
included
3
cases
in
each
group,
but
only
in
one
case
in
the
control
group
of
these
6
cases,
the
creatinine
had
a
doubling
in
increase
compared
to
baseline
creatinine,
and
creatinine
test
repeat
in
each
of
the
six
cases
reported
returned
to
baseline
values.
Wigano
reported
creatinine
increase
in
3%
of
patients
in
both
groups,
and
reported
no
auditory
toxicity
in
patients
of
both
groups,
both
of
the
results
were
consistent
with
the
above
study
(33).
Caraptise
also
observed
this
in
less
than
2%
of
patients
(34).
Other
studies
also
had
similar
results
(27
and
37).
In
a
study
by
Chong
on
210
patients
aged
between
one
month
and
13
years,
there
was
no
difference
in
response
to
treatment
and
complications
from
treatment.
The
difference
between
the
study
by
Chong
and
the
above
study
was
that
in
this
study,
auto
toxicity
was
defined
as
a
hearing
loss
of
more
than
30db.
However,
the
results
of
this
study
did
not
differ
from
the
present
study
and
other
studies
that
considered
auto
toxicity
as
a
reduction
of
15-20
db
(37-41).
In
the
Emma
study,
the
results
such
as
response
to
treatment
and
recurrence
of
disease
and
nephrotoxicity,
were
in
agreement
with
the
present
study,
but
in
the
Emma
study,
the
auto
toxicity
rate
was
higher
in
single
dose
patients,
which
was
different
from
the
above
study
(42).
Another
variable
that
was
studied
in
the
present
study
was
the
measurement
of
recurrence
rate
in
a
6-week
follow-up,
which
was
defined
as
urine
culture
being
positive
again
in
this
6-week
period
and
observed
in
28.12%
of
the
control
group
and
in
25%
of
the
case
group.
According
to
Kallenius
studies,
the
success
rate
of
single-dose
treatment
was
100%
and
the
probability
of
returning
in
the
follow-up
of
8
weeks
was
52%,
which
was
not
significantly
different
from
the
present
study
in
terms
of
response
to
treatment,
but
in
terms
of
relapse,
the
results
of
these
two
studies
are
different
(23).
According
to
Khan
studies,
the
success
rate
of
single-dose
treatment
was
100%
and
the
likelihood
of
returning
infection
in
a
12-week
follow-up
was
67%,
which
was
consistent
with
the
response
to
the
treatment
of
above
study.
However,
it
was
different
with
the
above
study
in
terms
of
illness
return,
which,
of
course,
the
reason
for
the
difference
could
be
explained
by
the
fact
that
the
cause
of
a
large
reversal
of
the
disease
in
the
Khan
study
was
the
examination
of
patients
with
recurrent
UTIs
(24).
In
a
study
by
Wallen,
which
assessed
a
single-dose
of
aminoglycoside
called
amikacin
on
UTIs,
the
probability
of
success
of
a
single-dose
treatment
was
92.3%
and
the
infection
return
probability
was
26%,
which
is
far
closer
to
the
results
of
the
above-mentioned
study
(43).
The
meta-analysis
study
carried
out
by
Barza
et
al.
in
1996
also
confirms
the
results
of
the
above
study,
and
even
this
study
indicates
a
low
nephrotoxicity
in
the
single-dose
group,
and
therefore
recommends
single-dose
treatment
(44).
In
a
study
by
Labovitz
in
1972
with
the
aim
of
investigating
the
effect
of
a
single
dose
of
gentamicin
on
UTI,
it
was
also
stated
that
there
was
no
statistically
significant
difference
between
the
two
treatment
groups
in
terms
of
response
to
treatment.
This
study
also
confirms
the
results
of
the
above
study
in
terms
of
auto
toxicity
but
the
difference
is
that
in
this
study,
Gentamicin
auditory
complication
has
been
investigated
with
vestibular
function
through
clinical
examination,
which
does
not
seem
to
be
accurate
(45).
A
study
by
Dr.
Hossein
Fallahzadeh
et
al.
confirmed
the
above
study
in
terms
of
response
to
treatment
and
relapse
of
the
disease
and
nephrotoxicity,
because
there
was
no
difference
between
the
two
treatment
groups
in
this
study
(P
<0.36).
The
difference
between
the
two
studies
were
that
in
the
study
of
Dr.
Fallahzadeh,
the
effects
on
hearing
of
gentamicin
were
not
investigated
(25).
In
a
study
conducted
by
Dr.
Shams
Vazirian
et
al.,
there
was
no
significant
difference
between
the
two
groups
in
terms
of
response
to
treatment,
recurrence
and
Oscars
(P<0.5).
This
study
also
agreed
with
the
results
of
the
study.
The
difference
between
the
two
studies
were
that
in
the
above
study,
patients
were
not
evaluated
for
Oscar
creation,
and
Gentamicin’s
hearing
impairment
was
not
evaluated
in
Dr.
Vazirian’s
study
(46).
In
a
study
done
by
Dr.
Shakiba
et
al.
in
2000
on
82
patients,
there
was
no
difference
in
response
to
treatment
and
the
complications
of
treatment
between
the
two
treatment
groups.
The
difference
was
that
in
this
study,
the
auto-toxicity
was
investigated
only
based
on
clinical
symptoms
indicating
auditory
complications,
which
were
not
sufficient
(47).
The
results
of
the
study
done
by
Dr.
Honarpisheh
et
al.
in
2006
on
30
patients
also
agreed
with
the
results
of
the
above
studies
regarding
the
response
to
treatment
and
nephrotoxicity,
but
the
objection
in
this
study
was
that
the
response
to
treatment
was
considered
as
the
cessation
of
fever
which
did
not
seem
to
be
adequate,
and
the
other
difference
that
this
study
had
with
the
present
study
was
that
the
hearing
impairment
of
gentamicin
was
not
studied
(48).
This
study
was
in
agreement
with
the
study
by
Dr.
Emam
Ghoreishi
et
al
regarding
the
response
to
treatment,
but
it
was
opposed
for
nephrotoxicity,
because
in
the
study
of
Emam
Ghoreishi,
the
rate
of
nephrotoxicity
was
higher
in
the
single
dose
group
(49).
The
final
result
is
that
there
are
no
significant
differences
between
the
two
standard
treatment
groups
and
once
daily
gentamicin
treatment
in
terms
of
therapeutic
response,
renal
and
auditory
complications,
and
recurrence
of
the
disease,
and
this
method
can
be
used
as
a
cost-effective,
effective
and
low
complication
method.
It
is
suggested
that
interventional
factors
such
as
demographic
information,
mother’s
education,
the
economic,
social
and
family
background
and
the
underlying
illnesses
of
child
and
the
status
of
the
children
immune
system
should
be
taken
into
account
when
conducting
research
on
the
treatment
of
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in
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