[Viral etiology of severe acute respiratory infections in a pediatric intensive care unit]. / Etiología viral de las infecciones respiratorias agudas graves en una unidad de cuidados intensivos pediátricos.

OBJECTIVES.: To identify the main viral etiological agents in patients with severe acute respiratory infection (SARI) hospitalized in a Pediatric Intensive Care Unit (PICU) and to analyze their clinical characteristics. MATERIALS AND METHODS.: Prospective longitudinal study in children under five years of age hospitalized due to SARI at the PICU of t Instituto Nacional de Salud del Niño (National Children´s Hospital) in Lima, Peru. Real-time direct immunofluorescence and RT-PCR tests were performed for the diagnosis of respiratory viruses on tracheal aspirate or nasopharyngeal swab samples. RESULTS.: We included 117 patients. Median age was four months, 66% had comorbidity and 91% required mechanical ventilation. Respiratory virus monoinfection was identified in 47% and viral co-infection in 2.6%, with the respiratory syncytial virus subtype A (RSV-A) being the most frequent. The median length of hospitalization was 21 days and 20 (17%) patients died. An association was found between a history of chronic lung disease and RSV-A infection (p=0.045), and between Down syndrome and influenza A virus infection (p=0.01). After controlling for potential confounders, congenital heart disease (RR 3.1; 95% CI: 1.3-5.8, p=0.002) and nosocomial infection (RR 2.6; 95% CI: 1.0-5.3, p=0.01) were found to increase the risk of death in patients with SARI. CONCLUSIONS.: RSV-A was the most common viral etiology in children under five hospitalized by SARI at the PICU. No association was found between viral infection and patient survival.

OBJETIVOS.: Identificar los principales agentes etiológicos virales en pacientes con infección respiratoria aguda grave (IRAG) hospitalizados en una Unidad de Cuidados Intensivos Pediátricos (UCIP) y analizar sus características clínicas. MATERIALES Y MÉTODOS.: Estudio longitudinal prospectivo en menores de cinco años hospitalizados por IRAG en la UCIP del Instituto Nacional de Salud del Niño en Lima, Perú. Se realizaron pruebas de inmunofluorescencia directa y RT-PCR en tiempo real para el diagnóstico de virus respiratorios en muestras de aspirado traqueal o hisopado nasofaríngeo. RESULTADOS.: Se incluyeron 117 pacientes. La mediana de edad fue cuatro meses, el 66% presentaron comorbilidad y el 91% requirieron ventilación mecánica. Se identificó monoinfección por virus respiratorios en el 47% y coinfección viral en el 2,6%, siendo el virus sincicial respiratorio subtipo A (VSR-A) el más frecuente. La mediana del tiempo de hospitalización fue de 21 días y 20 (17%) pacientes fallecieron. Se encontró asociación entre el antecedente de enfermedad pulmonar crónica y la infección por el VSR-A (p=0,045) y entre el síndrome de Down y la infección por virus influenza A (p=0,01). Después de controlar por potenciales factores de confusión, se halló que la cardiopatía congénita (RR: 3,1; IC 95%: 1,3-5,8; p=0,002) y la infección nosocomial (RR: 2,6; IC 95%: 1,0-5,3; p=0,01) incrementaron el riesgo de muerte en pacientes con IRAG. CONCLUSIONES.: El VSR-A fue la etiología viral más frecuente en menores de cinco años hospitalizados por IRAG en la UCIP. No se encontró asociación entre la infección viral y la sobrevida del paciente.

Unusual pattern of Plasmodium falciparum drug resistance in the northwestern Peruvian Amazon region.

High levels of Plasmodium falciparum resistance to both chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) have been documented throughout the Amazon Basin of South America. Because of reports about the persistent efficacy of both of these drugs in the northwestern Peruvian Amazon region, we carried out an evaluation of the therapeutic efficacy of chloroquine (25 mg/kg) and SP (25 mg/kg of the sulfadoxine component) for the treatment of uncomplicated P. falciparum infections at two sites: Ullpayacu and Pampa Hermoza/Alianza. A total of 111 patients were enrolled. Only 5 (14.3%) of the 35 patients who received CQ had an adequate clinical and parasitologic response (ACPR). Six subjects (17%) had early treatment failure, 1 (2.9%) had late clinical failure, and 23 (65.7%) had late parasitologic failure (LPF). Of the subjects treated with SP, 92.3% had ACPR and 7.7% had LPF. Based on these findings, it is clear that there are at least limited areas within the Peruvian Amazon region where P. falciparum strains continue to be sensitive to SP.

[Dengue in Peru: a quarter century after its reemergence]. / Dengue en el Perú: a un cuarto de siglo de su reemergencia.

A health problem each time more frequent and dispersed in tropical and subtropical areas of the world, including Peru where it entered in 1990, is dengue. It is produced by the dengue virus with four serotypes and transmitted by Aedes aegypti, a vector that coexists with humans and whose presence is favored by deficient sanitary, social and economic conditions. Manifestations of severe forms of the disease such as shock and bleeding, are related to the frequent co-circulation of the four serotypes and the emergence of new genotypes such as American/Asian serotype 2. The new classification of the disease by WHO as dengue with or without warning signs and severe dengue, is contributing to more timely diagnosis and treatment, enabling reductions in mortality. Of note is the need to highlight the surveillance of acute febrile illness and Aedes indices that contribute to a timely diagnosis and guide vector control measures through sanitary education and environmental management with community and intersectoral participation, in a creative manner according to ecological niches. An alternative for complementary prevention would be vaccination using tetravalent vaccines whose safety and efficacy must be guaranteed before its use in the population under the framework of comprehensive strategies.

Etiología viral de las infecciones respiratorias agudas graves en una unidad de cuidados intensivos pediátricos / Viral etiology of severe acute respiratory infections in a pediatric intensive care unit

RESUMEN Objetivos. Identificar los principales agentes etiológicos virales en pacientes con infección respiratoria aguda grave (IRAG) hospitalizados en una Unidad de Cuidados Intensivos Pediátricos (UCIP) y analizar sus características clínicas. Materiales y métodos. Estudio longitudinal prospectivo en menores de cinco años hospitalizados por IRAG en la UCIP del Instituto Nacional de Salud del Niño en Lima, Perú. Se realizaron pruebas de inmunofluorescencia directa y RT-PCR en tiempo real para el diagnóstico de virus respiratorios en muestras de aspirado traqueal o hisopado nasofaríngeo. Resultados. Se incluyeron 117 pacientes. La mediana de edad fue cuatro meses, el 66% presentaron comorbilidad y el 91% requirieron ventilación mecánica. Se identificó monoinfección por virus respiratorios en el 47% y coinfección viral en el 2,6%, siendo el virus sincicial respiratorio subtipo A (VSR-A) el más frecuente. La mediana del tiempo de hospitalización fue de 21 días y 20 (17%) pacientes fallecieron. Se encontró asociación entre el antecedente de enfermedad pulmonar crónica y la infección por el VSR-A (p=0,045) y entre el síndrome de Down y la infección por virus influenza A (p=0,01). Después de controlar por potenciales factores de confusión, se halló que la cardiopatía congénita (RR: 3,1; IC 95%: 1,3-5,8; p=0,002) y la infección nosocomial (RR: 2,6; IC 95%: 1,0-5,3; p=0,01) incrementaron el riesgo de muerte en pacientes con IRAG. Conclusiones. El VSR-A fue la etiología viral más frecuente en menores de cinco años hospitalizados por IRAG en la UCIP. No se encontró asociación entre la infección viral y la sobrevida del paciente.

ABSTRACT Objectives. To identify the main viral etiological agents in patients with severe acute respiratory infection (SARI) hospitalized in a Pediatric Intensive Care Unit (PICU) and to analyze their clinical characteristics. Materials and Methods. Prospective longitudinal study in children under five years of age hospitalized due to SARI at the PICU of t Instituto Nacional de Salud del Niño (National Children´s Hospital) in Lima, Peru. Real-time direct immunofluorescence and RT-PCR tests were performed for the diagnosis of respiratory viruses on tracheal aspirate or nasopharyngeal swab samples. Results. We included 117 patients. Median age was four months, 66% had comorbidity and 91% required mechanical ventilation. Respiratory virus monoinfection was identified in 47% and viral co-infection in 2.6%, with the respiratory syncytial virus subtype A (RSV-A) being the most frequent. The median length of hospitalization was 21 days and 20 (17%) patients died. An association was found between a history of chronic lung disease and RSV-A infection (p=0.045), and between Down syndrome and influenza A virus infection (p=0.01). After controlling for potential confounders, congenital heart disease (RR 3.1; 95% CI: 1.3-5.8, p=0.002) and nosocomial infection (RR 2.6; 95% CI: 1.0-5.3, p=0.01) were found to increase the risk of death in patients with SARI. Conclusions. RSV-A was the most common viral etiology in children under five hospitalized by SARI at the PICU. No association was found between viral infection and patient survival.

Cost-effectiveness analysis of pneumococcal conjugate vaccines in preventing pneumonia in Peruvian children.

INTRODUCTION: Pneumococcal pneumonia (PP) has a high burden of morbimortality in children. Use of pneumococcal conjugate vaccines (PCVs) is an effective preventive measure. After PCV 7-valent (PCV7) withdrawal, PCV 10-valent (PCV10) and PCV 13-valent (PCV13) are the alternatives in Peru. This study aimed to evaluate cost effectiveness of these vaccines in preventing PP in Peruvian children <5 years-old. METHODOLOGY: A cost-effectiveness analysis was developed in three phases: a systematic evidence search for calculating effectiveness; a cost analysis for vaccine strategies and outcome management; and an economic model based on decision tree analysis, including deterministic and probabilistic sensitivity analysis using acceptability curves, tornado diagram, and Monte Carlo simulation. A hypothetic 100 vaccinated children/vaccine cohort was built. An incremental cost-effectiveness ratio (ICER) was calculated. RESULTS: The isolation probability for all serotypes in each vaccine was estimated: 38% for PCV7, 41% PCV10, and 17% PCV13. Avoided hospitalization was found to be the best effectiveness model measure. Estimated costs for PCV7, PCV10, and PCV13 cohorts were USD13,761, 11,895, and 12,499, respectively. Costs per avoided hospitalization were USD718 for PCV7, USD333 for PCV10, and USD 162 for PCV13. At ICER, PCV7 was dominated by the other PCVs. Eliminating PCV7, PCV13 was more cost effective than PCV10 (confirmed in sensitivity analysis). CONCLUSIONS: PCV10 and PCV13 are more cost effective than PCV7 in prevention of pneumonia in children <5 years-old in Peru. PCV13 prevents more hospitalizations and is more cost-effective than PCV10. These results should be considered when making decisions about the Peruvian National Inmunizations Schedule.

Correlation of serotype-specific dengue virus infection with clinical manifestations.

BACKGROUND: Disease caused by the dengue virus (DENV) is a significant cause of morbidity throughout the world. Although prior research has focused on the association of specific DENV serotypes (DENV-1, DENV-2, DENV-3, and DENV-4) with the development of severe outcomes such as dengue hemorrhagic fever and dengue shock syndrome, relatively little work has correlated other clinical manifestations with a particular DENV serotype. The goal of this study was to estimate and compare the prevalence of non-hemorrhagic clinical manifestations of DENV infection by serotype. METHODOLOGY AND PRINCIPAL FINDINGS: Between the years 2005-2010, individuals with febrile disease from Peru, Bolivia, Ecuador, and Paraguay were enrolled in an outpatient passive surveillance study. Detailed information regarding clinical signs and symptoms, as well as demographic information, was collected. DENV infection was confirmed in patient sera with polyclonal antibodies in a culture-based immunofluorescence assay, and the infecting serotype was determined by serotype-specific monoclonal antibodies. Differences in the prevalence of individual and organ-system manifestations were compared across DENV serotypes. One thousand seven hundred and sixteen individuals were identified as being infected with DENV-1 (39.8%), DENV-2 (4.3%), DENV-3 (41.5%), or DENV-4 (14.4%). When all four DENV serotypes were compared with each other, individuals infected with DENV-3 had a higher prevalence of musculoskeletal and gastrointestinal manifestations, and individuals infected with DENV-4 had a higher prevalence of respiratory and cutaneous manifestations. CONCLUSIONS/SIGNIFICANCE: Specific clinical manifestations, as well as groups of clinical manifestations, are often overrepresented by an individual DENV serotype.

Spatial and temporal characteristics of the 2009 A/H1N1 influenza pandemic in Peru.

BACKGROUND: Highly refined surveillance data on the 2009 A/H1N1 influenza pandemic are crucial to quantify the spatial and temporal characteristics of the pandemic. There is little information about the spatial-temporal dynamics of pandemic influenza in South America. Here we provide a quantitative description of the age-specific morbidity pandemic patterns across administrative areas of Peru. METHODS: We used daily cases of influenza-like-illness, tests for A/H1N1 influenza virus infections, and laboratory-confirmed A/H1N1 influenza cases reported to the epidemiological surveillance system of Peru's Ministry of Health from May 1 to December 31, 2009. We analyzed the geographic spread of the pandemic waves and their association with the winter school vacation period, demographic factors, and absolute humidity. We also estimated the reproduction number and quantified the association between the winter school vacation period and the age distribution of cases. RESULTS: The national pandemic curve revealed a bimodal winter pandemic wave, with the first peak limited to school age children in the Lima metropolitan area, and the second peak more geographically widespread. The reproduction number was estimated at 1.6-2.2 for the Lima metropolitan area and 1.3-1.5 in the rest of Peru. We found a significant association between the timing of the school vacation period and changes in the age distribution of cases, while earlier pandemic onset was correlated with large population size. By contrast there was no association between pandemic dynamics and absolute humidity. CONCLUSIONS: Our results indicate substantial spatial variation in pandemic patterns across Peru, with two pandemic waves of varying timing and impact by age and region. Moreover, the Peru data suggest a hierarchical transmission pattern of pandemic influenza A/H1N1 driven by large population centers. The higher reproduction number of the first pandemic wave could be explained by high contact rates among school-age children, the age group most affected during this early wave.

Dengue en el Perú: a un cuarto de siglo de su reemergencia / Dengue in Peru: a quarter century after its reemergence

Un problema sanitario cada vez más frecuente y disperso en áreas tropicales y subtropicales del mundo, incluido el Perú donde ingresó en 1990, es el dengue. Es producido por el virus del dengue con cuatro serotipos y transmitido por el Aedes aegypti, vector que convive con los humanos y cuya presencia es favorecida por deficientes condiciones sanitarias, sociales y económicas. Manifestaciones de formas severas de la enfermedad como el choque y sangrado, están relacionadas con la frecuente cocirculación de los cuatro serotipos y la aparición de nuevos genotipos como el americano/asiático del serotipo 2. La nueva clasificación de la enfermedad por la OMS como dengue con o sin signos de alarma y dengue grave, está contribuyendo a un diagnóstico y tratamiento más oportunos, permitiendo reducir la letalidad. Debe destacarse la necesidad de la vigilancia del síndrome febril y los índices aédicos que contribuyan a un diagnóstico oportuno y orienten las medidas de control vectorial mediante educación sanitaria y manejo ambiental con participación comunitaria e intersectorial, de manera creativa según los nichos ecológicos. Una alternativa de prevención complementaria sería la vacunación utilizando vacunas tetravalentes cuya seguridad y eficacia deben estar garantizadas antes de su uso poblacional en el marco de estrategias integrales.

A health problem each time more frequent and dispersed in tropical and subtropical areas of the world, including Peru where it entered in 1990, is dengue. It is produced by the dengue virus with four serotypes and transmitted by Aedes aegypti, a vector that coexists with humans and whose presence is favored by deficient sanitary, social and economic conditions. Manifestations of severe forms of the disease such as shock and bleeding, are related to the frequent co-circulation of the four serotypes and the emergence of new genotypes such as American / Asian serotype 2. The new classification of the disease by WHO as dengue with or without warning signs and severe dengue, is contributing to more timely diagnosis and treatment, enabling reductions in mortality. Of note is the need to highlight the surveillance of acute febrile illness and Aedes indices that contribute to a timely diagnosis and guide vector control measures through sanitary education and environmental management with community and intersectoral participation, in a creative manner according to ecological niches. An alternative for complementary prevention would be vaccination using tetravalent vaccines whose safety and efficacy must be guaranteed before its use in the population under the framework of comprehensive strategies.

[Comunicable diseases, mental health and exposure to environmental pollutants in population living near Las Bambas mining project before exploitation phase, Peru 2006]. / Enfermedades transmisibles, salud mental y exposición a contaminantes ambientales en población aledaña al proyecto minero Las Bambas antes de la fase de explotación, Perú 2006.

OBJECTIVE: To determine the prevalence of communicable diseases, mental health and environmental pollutants exposure in population living near Las Bambas mining project before exploitation phase. MATERIAL AND METHODS: Cross sectional study performed in 453 subjects (children and adults) living in three Apurimac region districts: Haquira, Chalhuahuacho and Progreso. Psychomotor development, intelligence quotient, anxiety and depression levels and the presence of communicable diseases (viral hepatitis B, C and delta, syphilis and HIV) were evaluated, as well as heavy metals (lead in blood, and cadmium, arsenic and mercury in urine samples) and serum cholinesterase levels. RESULTS: Mean age was 29 ± 17.25 years, 59.2% were female and a range of 6 to 15 years of living in the area was found. No cases of HIV, hepatitis C and delta were found, 1.4% were positive for syphilis and in relation to hepatitis B, we found 1,7% of subjects positive to total anti HBc and 0.5% positive for HBsAg. Heavy metal testing identified people with exceeding limits of mercury in 1.8% arsenic in 4.6%, lead in 24.3% and cadmium in 43.9%. Besides, 29.1% of the population had cholinesterase levels below normal range. Among children, 12.5% were at psychomotor development levels of risk; 2.1% and 3.1% suffered from mild and borderline intellectual disability (mental retardation), respectively. 34.3% of subjects older than 12 had anxiety and 17.5% depression. CONCLUSIONS: Evidence of heavy metal environmental pollution and presence of communicable diseases in this population were already found. Future careless mining activity could worsen the current health situation.

Enfermedades transmisibles, salud mental y exposición a contaminantes ambientales en población aledaña al proyecto minero Las Bambas antes de la fase de explotación, Perú 2006 / Comunicable diseases, mental health and exposure to environmental pollutants in population living near Las Bambas mining project before exploitation phase, peru 2006

Objetivo. Determinar la prevalencia de enfermedades transmisibles, salud mental y exposición a contaminantes ambientales en la población aledaña al proyecto minero Las Bambas antes de la fase de explotación. Materiales y métodos. Estudio descriptivo transversal realizado en 453 personas (niños y adultos) residentes en tres distritos de la región Apurímac: Haquira, Chalhuahuacho y Progreso. Se evaluó el desarrollo psicomotor, coeficiente intelectual y niveles de ansiedad y depresión, así como la presencia de enfermedades transmisibles (sífilis, VIH, hepatitis viral B, C y Delta,) metales pesados (nivel de plomo en sangre, nivel de cadmio, arsénico y mercurio, en orina) y colinesterasa sérica. Resultados. La edad promedio fue de 29,0 ± 17,3 años, 59,2 por ciento fueron mujeres y el tiempo de residencia fue de 6 a 15 años. No se encontraron casos de VIH, hepatitis C y Delta, 1,4 por ciento fueron positivos a sífilis y en relación con hepatitis B se encontró 1,7 por ciento positivos a anti HBc total y 0,5 por ciento positivos a HBs Ag. Se encontraron valores por encima de lo permitido de mercurio en 1,8 por ciento de la población, arsénico en 4,6 por ciento, plomo en 24,3 por ciento y cadmio en 43,9 por ciento. Además, el 29,1 por ciento de la población tuvo valores de colinesterasa inferiores al rango referencial. En la población infantil, 12,5 por ciento presentaba riesgo en su desarrollo psicomotor; 2,1 por ciento y 3,1 por ciento presentaba retardo mental leve y fronterizo, respectivamente; 34,3 por ciento de los mayores de 12 años sufrían de ansiedad y 17,5 por ciento de depresión. Conclusiones. Existen evidencias de contaminación ambiental por metales pesados y presencia de enfermedades transmisibles en esta población. Una futura explotación minera irresponsable podría agravar dicha situación epidemiológica.

Objective. To determine the prevalence of communicable diseases, mental health and environmental pollutants exposure in population living near Las Bambas mining project before exploitation phase. Material and methods. Cross sectional study performed in 453 subjects (children and adults) living in three Apurimac region districts: Haquira, Chalhuahuacho and Progreso. Psychomotor development, intelligence quotient, anxiety and depression levels and the presence of communicable diseases (viral hepatitis B, C and delta, syphilis and HIV) were evaluated, as well as heavy metals (lead in blood, and cadmium, arsenic and mercury in urine samples) and serum cholinesterase levels. Results. Mean age was 29 ± 17.25 years, 59.2 percent were female and a range of 6 to 15 years of living in the area was found. No cases of HIV, hepatitis C and delta were found, 1.4 percent were positive for syphilis and in relation to hepatitis B, we found 1,7 percent of subjects positive to total anti HBc and 0.5 percent positive for HBsAg. Heavy metal testing identified people with exceeding limits of mercury in 1.8 percent arsenic in 4.6 percent, lead in 24.3 percent and cadmium in 43.9 percent. Besides, 29.1 percent of the population had cholinesterase levels below normal range. Among children, 12.5 percent were at psychomotor development levels of risk; 2.1 percent and 3.1 percent suffered from mild and borderline intellectual disability (mental retardation), respectively. 34.3 percent of subjects older than 12 had anxiety and 17.5 percent depression. Conclusions. Evidence of heavy metal environmental pollution and presence of communicable diseases in this population were already found. Future careless mining activity could worsen the current health situation.

Estudio de bioequivalencia del ibuprofeno 400 mg tabletas / Bioquivalence study of ibuprofen 400 mg tablets

Objetivo. Determinar la biodisponibilidad de dos formulaciones de ibuprofeno 400mg tabletas, para establecer si el medicamento multifuente (genérico) es bioequivalente al de referencia (Motrin® 400mg). Materiales y métodos. Se diseñó un estudio abierto, randomizado, cruzado, dos periodos, con siete días de lavado, con 12 voluntarios sanos de ambos sexos, entre 21 y 48 años, quienes ingirieron una tableta del medicamento genérico o de referencia, según randomización, con 200mL de agua. Luego de ingerir el medicamento se colectó 4mL de sangre por voluntario para la cuantificación plasmática de ibuprofeno. Las muestras de plasma se analizaron por cromatografía líquida acoplada al espectrofotómetro de masas (LC-MS/MS) con ionización electrospray ión negativo, aplicando monitoreo de reacción selectiva. La bioequivalencia se determinó con los parámetros farmacocinéticos de área bajo la curva AUC(0-t), UC(0-∞) y concentración máxima (Cmax). Resultados. Según análisis estadístico, se encontraron: AUC multifuente(0-t) = 86,85 (μg*h)/mL, AUCRef.(0-t)= 81,20 (μg*h)/mL, AUCmultifuente(0-∞)= 88,67 (μg*h)/mL, AUCRef.(0-∞)= 82,83(μg*h)/mL, Cmáxmultifuente = 17,70 ug/mL, CmáxRef. =18,09 μg/mL, con rango de 0,93-1,24 para AUC(0-t), 0,93-1,24 para AUC(0-∞) y 0,81-1,19 para Cmax. Conclusión. Los valores encontrados de ibuprofeno están dentro de los requisitos de la OMS y la FDA, para establecer bioequivalencia (0,80û1,25), demostrándose que el ibuprofeno genérico es bioequivalente al de referencia en velocidad y cantidad de ibuprofeno absorbido en el organismo.

Objective. To determine the bioavailability of two dosage forms of ibuprofen 400mg tablets, for establishing if the multisource (generic) drug is bioequivalent to the reference (Motrin® 400mg tablets). Materials and methods. It was designed an opened study, randomized, two periods, cross over, and seven days washout period, with 12 healthy volunteers (male and female), between 21 and 48 years old, who have taken one tablet of the multisource or reference tablets; according to randomization; with 200 mL of water. After drug intake 4 mL of blood was collected from each volunteer, for quantification of ibuprofen. The plasma samples with ibuprofen and sodium diclofenac (internal standard) were analyzed by liquid chromatography tandem mass spectrometry (LC-MS/MS) with negative ion electrospray ionization using selected reaction monitoring. The bioequivalence was established with pharmacokinetics parameters: area under the curve AUC(0-t), AUC(0-∞) and maximum concentration (Cmax). Results. According to statistical analysis were founded: AUCmultisource(0-t) = 86.85 (ug*h)/mL, AUCRef.(0-t) = 81.20 (ug*h)/mL, AUCmultisource(0-∞) = 88.67 (ug*h)/mL, AUCRef.(0-∞) = 82.83 (ug*h)/mL, Cmáxmultisource = 17.70 ug/mL, CmáxRef.=18.09 ug/mL, with intervals of 0.93-1.24 for AUC(0-t), 0.93-1.24 for AUC(0-∞) and 0.81-1.19 for Cmax. Conclusions. The values founded for AUC(0-t), AUC(0-∞) and Cmax are within the established limits by WHO and FDA (0,80 -1,25), so ibuprofen 400mg tables; multisource drug, is bioequivalent to Motrin 400mg tablets, with regard to both the rate and extent of absorption.