Prescription and indications for the use of fluoroquinolones in a group of outpatients in Colombia / [Prescripción e indicaciones de uso de fluoroquinolonas en un grupo de pacientes ambulatorios de Colombia].

Introduction: There is evidence of the indiscriminate use of antibiotics for different pathologies. Objective: To determine the prescription patterns and indications for the use of fluoroquinolones in a group of outpatients in Colombia. Materials and methods: We conducted a descriptive pharmaco-epidemiological study on prescription-indication using a population database where patients with outpatient fluoroquinolone prescriptions were included from May to October, 2018. We obtained the information on sociodemographic, pharmacological, and clinical variables, as well as on the diagnosis according to the International Classification of Diseases, version 10, and we established if the use was approved by the regulatory agencies or if it was off-label. Results: A total of 23,373 patients were identified who were using fluoroquinolones; their mean age was 47.9 ± 18.1 years and women predominated (n=15,767, 67.5%). Ciprofloxacin was the medication most commonly prescribed (n=19,328, 82.7%), followed by norfloxacin (n=3076, 13.2%), levofloxacin (n=573, 2.5%), and moxifloxacin (n=394; 1.7%). The main indications were urinary tract infection in unspecified site (n=10,777, 46.1%), diarrhea and gastroenteritis of presumed infectious origin (n=3077, 13.2%), and acute cystitis (n=956; 4.2%). The prescriptions followed approved indications in 76% (n=17,759) of cases while the rest were used off-label or without indication for nasopharyngitis or soft-tissue infections, for example. Being male (OR=1.26, 95%CI:1.18-1.34) and under 35 years of age (OR=1.92, 95%CI:1.48-1.50) were associated with a greater probability of using fluoroquinolones in unapproved indications. Conclusions: Fluoroquinolones, particularly ciprofloxacin, are being prescribed especially to women with urinary tract infections, but up to a quarter of the patients received them for unapproved indications by regulatory agencies.

Introducción. Existen evidencias sobre el uso indiscriminado de antibióticos en el tratamiento de diversas enfermedades. Objetivo. Determinar los patrones de prescripción y de indicaciones de uso de las fluoroquinolonas en un grupo de pacientes ambulatorios en Colombia. Materiales y métodos. Se llevó a cabo un estudio descriptivo farmacoepidemiológico del tipo de prescripción e indicaciones de uso a partir de una base de datos poblacionales que incluía pacientes con prescripciones ambulatorias de fluoroquinolonas entre mayo y octubre de 2018. Se recabó la información sobre las variables sociodemográficas, farmacológicas y clínicas (diagnóstico según la Clasificación Internacional de Enfermedades, versión 10) y se estableció la proporción del uso de fluoroquinolonas en indicaciones aprobadas y no aprobadas por las agencias reguladoras. Resultados. Se identificaron 23.373 pacientes que habían recibido fluoroquinolonas; su edad media era de 47,9 ± 18,1 años y 15.767 eran mujeres (67,5 %). La ciprofloxacina fue el medicamento más prescrito (n=19.328; 82,7 %), seguida de la norfloxacina (n=3.076; 13,2 %), la levofloxacina (n=573; 2,5 %) y la moxifloxacina (n=394; 1,7 %). Las principales indicaciones fueron la infección de las vías urinarias en sitio no especificado (n=10.777; 46,1 %), la diarrea y la gastroenteritis de presunto origen infeccioso (n=3.077, 13,2 %) y la cistitis aguda (n=956; 4,2 %). El 76 % (n=17.759) de las prescripciones correspondía a indicaciones aprobadas y el resto a usos no aprobados, como la rinofaringits o las infecciones de tejidos blandos. El ser hombre (odds ratio, OR=1,26; IC95%: 1,18-1,34) y tener menos de 35 años (OR=1,92; IC95%:1,48-1,50) se asociaron con una mayor probabilidad de uso de fluoroquinolonas en indicaciones no aprobadas. Conclusión. Las fluoroquinolonas, en particular la ciprofloxacina, se están prescribiendo especialmente a mujeres con infecciones de las vías urinarias, pero hasta la cuarta parte de los pacientes las recibieron para usos no aprobados por las agencias reguladoras.

Isoquinolone alkaloids mitigate microscopic digestive tract lesions induced by sub-acute ruminal acidosis (SARA) in feedlot cattle / Alcaloides isoquinolínicos atenuam lesões microscópicas digestivas induzidas por acidose ruminal subaguda em bovinos confinados

Feedlot cattle is submitted to a diet rich in energy and reduced in fibres that induces the sub-acute ruminal acidosis (SARA) with its lesions and clinical signs. Recent studies have demonstrated some amelioration of this condition by the use of isoquinolone alkaloids found in Macleaya cordata (Papaveraceae) such as Sanguinarine and Chelerythrine. These compounds have demonstrated antimicrobial, antiinflammatory and immune-modulatory effects in both humans and animals The aim on this study, using histopathology and a score system, was to evaluate the differences between a non-treated and a treated group feed with these alkaloids, present in trade preparation Sangrovit-RS® as a source of sanguinarine (SG), chelerythrine (CH) and protropine (PA) standardized to 0.15% w/w SG, using feedlot cattle under a high-grain diet as an inflammatory model for gastrointestinal system. The samples of forestomachs were evaluated and graded using scores ranging from zero (0) to three (3) obtained at light-microscopic fields of 400X. Parameters such as inflammation, hydropic degeneration, hyperkeratosis, and vesicle formation were accessed in the different layers of the tissues, considering the severity and dispersion of the microscopic lesions. The soft tissues such as the abomasum, small intestine, cecum and colon had their total amount of inflammatory cells counted at light-microscopic fields of 200X. The rumen of the SG-CH-PRO-treated group showed a significant reduction in the epithelial hydropic degeneration scores (p ≤ 0.001) and lamina propria inflammation (p ≤ 0.001).The reticulum had a similar reduction in scores of epithelial (p ≤ 0.002) and stratum corneum hydropic degeneration (p ≤ 0.001), hyperkeratosis (p ≤ 0.002) and inflammation in lamina propria (p ≤ 0.001) and epithelium (p ≤ 0.002). The omasum had no significant differences. All non-keratinized tissues, except for ileum, had a significant decrease (p ≤ 0.001) in the total counting of inflammatory cells. In this trial, the feedlot cattle feed with high grain diet and treated with isoquinolone alkaloids expressed lesions that indicate ameliorations and worsening's. Ameliorating effects of the alkaloids were better demonstrated in tissues with reduced or no corneal layer in the mucosa and in the absence of a lipopolysaccharides rich acidic environment reinforcing the notion of the topic action, the dependence of the media pH and the time of exposure modulating the pharmacological mechanisms of these alkaloids. The observed cytolytic (oncolysis) effect in epithelial forestomachs cells under low pH values, worsening the osmotic status, should be considered before clinical applications.(AU)

As dietas para bovinos confinados possuem alta quantidade de alimentos energéticos com menor quantidade de alimentos volumosos (fibras), favorecendo a indução de acidose ruminal subaguda com formação de lesões gastrointestinais e sintomas clínicos deletérios. Recentes trabalhos têm demonstrado alguma amenização desta condição pelo uso de alcaloides isoquinolínicos encontrados na Macleaya cordata (Papaveraceae) tais como a sanguinarina e a cheleretrina, os quais tem demonstrado efeitos anti-inflamatórios, antimicrobianos e imuno modulatórios em humanos e animais. O objetivo deste estudo foi, através da histopatologia e de um sistema de escores, avaliar as diferenças entre um grupo não tratado e um grupo tratado com alcaloides isoquinolínicos, presentes na formulação Sangrovit RS® como fonte de sanguinarina (SG), chelerethrina (CH) and protropina (PA) padronizadas em 0,15 % w/w SG, usando bovinos em confinamento recebendo uma dieta rica em grãos como modelo inflamatório para o sistema gastrointestinal. Amostras dos pré-estômagos foram avaliadas por escores variando de zero a três, obtidos por microscopia de luz em diferentes campos em aumentos de 400X. Inflamação, degeneração hidrópica, hiperqueratose e formação de vesículas foram avaliadas nas diferentes camadas dos pré-estômagos tendo em vista a intensidade e a extensão das lesões. Tecidos não queratinizados como abomaso e intestino delgado, ceco e cólon tiveram seu total de células inflamatórias contadas por microscopia de luz em diferentes campos com aumentos de 200X. No rumem do grupo tratado houve uma redução significante no número de campos contendo degeneração hidrópica epitelial (p ≤ 0,001) e inflamação de lâmina própria (p ≤ 0,001). O retículo teve uma redução similar nos escores scores de degeneração hidrópica epitelial (p ≤ 0.002), degeneração hidrópica no estrato córneo (p ≤ 0.001), hiperqueratose (p ≤ 0.002) e inflamação na lamina própria (p ≤ 0.001) e inflamação epitelial (p ≤ 0.002). Não foram encontradas diferenças significantes no omaso. Todos os tecidos não queratinizados, exceto pelo íleo, tiveram uma redução significativa (p ≤ 0.001) no total de células inflamatórias. Neste experimento, bovinos em confinamento recebendo dieta rica em grãos e tratados com alcaloides isoquinolínicos tiveram lesões que tiveram melhoras e pioras. Os efeitos de melhora foram melhor demonstrados em tecidos sem camada córnea e na ausência de um meio ácido rico em lipopolisacarídeos, reforçando a noção da ação tópica, da dependência do pH do meio e do tempo de exposição modulando os mecanismos farmacológicos destes alcalóides. O efeito citolítico (oncólise) sobre células epiteliais de pré-estômagos em baixos valores de pH, piorando o estado osmótico das células, deveria ser considerado antes das aplicações clínicas.(AU)

La administración de ondansetrón no mejora la evolución de los niños con gastroenteritis aguda sin deshidratación / Administration of ondansetron does not improve the course of children with acute gastroenteritis without dehydration

Sobre la base de una viñeta clínica de un niño con gastroenteritis aguda sin deshidratación, el autor de este artículo realiza una búsqueda bibliográfica para revisar la evidencia que avala el uso de ondansetrón para tratar sus vómitos, práctica bastante común en instituciones con acceso a este fármaco en sus centrales de emergencia. Luego de dicha búsqueda, el autor concluye que en niños con gastroenteritis aguda sin deshidratación, la administración de ondansetrón no reduce la necesidad de hidratación intravenosa ni la frecuencia ni la severidad de los vómitos. (AU)

Based on a clinical vignette of a child with acute gastroenteritis without dehydration, the author of this article performs a literature search to review the evidence supporting the use of ondansetron to treat his vomiting, a fairly common practice in institutions with access to this drug in their emergency rooms. After this search, the author concludes that in children with acute gastroenteritis without dehydration, the administration of ondansetron does not reduce the need for intravenous hydration or the frequency or severity of vomiting. (AU)

Ursolic acid: A novel antiviral compound inhibiting rotavirus infection in vitro.

Rotavirus is one of the leading causes of severe acute gastroenteritis in children under 5 years of age, mainly affecting developing countries. Once the disease is acquired, no specific treatment is available; as such, the development of new drugs for effective antirotaviral treatment is critical. Ursolic acid is a pentacyclic triterpenoid with antiviral activity, which has been studied extensively in vitro and in vivo. To study the potential antirotaviral activity of ursolic acid, its toxic potential for viral particles (virucidal effect) and cultured cells (cytotoxicity) was analysed. No effect on virion infectivity was observed with treatments of up to 40 µM ursolic acid, while incipient cytotoxicity started to be evident with 20 µM ursolic acid. The antiviral potential of ursolic acid was evaluated in in-vitro rotavirus infections, demonstrating that 10 µM ursolic acid inhibits rotavirus replication (observed by a decrease in viral titre and the level of the main viral proteins) and affects viral particle maturation (a process associated with the endoplasmic reticulum) 15 h post infection. Interestingly, ursolic acid was also found to hamper the early stages of the viral replication cycle, as a significant reduction in the number and size of viroplasms, consistent with a decrease in VP6 and NSP2 viral proteins, was observed 4 h post infection. As such, these observations demonstrate that ursolic acid exhibits antiviral activity, suggesting that this chemical could be used as a new treatment for rotavirus.

Use of chicken immunoglobulin Y in general virology.

Immunoglobulin Y (IgY), an antibody present in birds, reptiles, and amphibians, is actively transported from the serum to egg yolks, where it is stored in large quantities. The use of chicken polyclonal IgY instead of mammalian IgG antibodies for biomedical applications has ethical and economic advantages, such as the lack of a need for animal bleeding because the antibodies are extracted from eggs after hen immunization and the low cost of the production and purification methods. This article reviews the latest IgY applications in diagnostic virology and the therapeutic use of IgY in viral gastroenteritis.

Campylobacter Species Isolated from Pigs in Grenada Exhibited Novel Clones: Genotypes and Antimicrobial Resistance Profiles of Sequence Types.

Infections caused by Campylobacter species pose a severe threat to public health worldwide. However, in Grenada, the occurrence and characteristics of Campylobacter in food animals, including pigs, remain mostly unknown. In this study, we identified the sequence types (STs) of Campylobacter from young healthy pigs in Grenada and compared the results with previous studies in Grenada and other countries. Antimicrobial resistance patterns and diversity of the Campylobacter clones were evaluated. Ninety-nine Campylobacter isolates (97 Campylobacter coli and 2 Campylobacter jejuni) were analyzed by multilocus sequence typing. Eighteen previously reported STs and 13 novel STs were identified. Of the 18 previously reported STs, eight STs (ST-854, -887, -1068, -1096, -1445, -1446, 1556, and -1579) have been associated with human gastroenteritis in different geographical regions. Among these 18 previously reported STs, ST-1428, -1096, -1450, and -1058 predominated and accounted for 18.2%, 14.1%, 11.1%, and 8.1% of all isolates, respectively. Of the 13 novel STs, ST-7675 predominated and accounted for 20% (4 of 20 isolates), followed by ST-7678, -7682, and -7691, each accounting for 10% (2 of 20 isolates). Antimicrobial resistance testing using Epsilometer test revealed a low resistance rate (1-3%) of all C. coli/jejuni STs to all antimicrobials except for tetracycline (1-10.1%). Some of the C. coli STs (13 STs, 24/99 isolates, 24.2%) were resistant to multiple antimicrobials. This is the first report on antimicrobial resistance and multidrug resistance patterns associated with Campylobacter STs recovered from swine in Grenada. This study showed that pigs in Grenada are not major reservoirs for STs of C. coli and C. jejuni that are associated with human gastroenteritis worldwide.

Fatal Cardiac Arrest in 2 Children: Possible Role of Ondansetron.

INTRODUCTION: Ondansetron is commonly used to treat vomiting in gastroenteritis, but has a United States Food and Drug Administration black box warning for risk of Q wave to T wave time interval (QT) prolongation. We report 2 pediatric cases of fatal refractory cardiac arrest after administration of ondansetron. CASES: A 10-year-old previously healthy boy presented to the emergency room with gastroenteritis symptoms. After intravenous fluids, morphine, antibiotics, and 2 doses of ondansetron, the patient became unresponsive with agonal respirations and a wide complex tachycardia consistent with ventricular tachycardia. In a second case, an 86-day-old infant with previously unidentified congenital cardiomyopathy presented to our emergency department with gastroenteritis symptoms. The patient received ondansetron and subsequently experienced repeated bouts of supraventricular tachycardia which progressed to ventricular fibrillation. Resuscitation efforts failed in each case, and both patients expired. DISCUSSION: Ondansetron can cause dose-dependent QT prolongation effects, which are more clinically relevant when other proarrhythmic elements are present. There is very limited published experience on use of ondansetron in children younger than 2 years. Our 2 cases join 2 previous case reports of death after ondansetron administration for gastroenteritis. The pharmacology of ondansetron's cardiac effects and drug-induced QT prolongation is discussed. CONCLUSIONS: Patients may have hidden risk factors that, together with ondansetron, could result in a proarrhythmic state that could lead to adverse effects, such as arrhythmias. Administration of ondansetron should be individualized and used cautiously in patients with risk factors for arrhythmia.

Is racecadotril effective for acute diarrhea in children? -First update. / ¿Es efectivo el racecadotrilo como tratamiento para la diarrea aguda en niños? -Primera actualización.

This article updates the December 2015 Living FRISBEE (Living FRISBEE: Living FRIendly Summary of the Body of Evidence using Epistemonikos), based on the detection of two systematic reviews not identified in the previous version. Gastroenteritis or acute watery diarrhea is usually a self-limited disease, but it is still associated to substantial healthcare costs and remains a frequent demand for medical care. Racecadotril, an intestinal enkephalinase inhibitor, has been used as treatment because it would decrease the duration of acute diarrhea and fluid loss. However there is still no evidence supporting its routine use. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified five systematic reviews including nine randomized trials relevant for our question. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded racecadotril probably reduces the duration of acute diarrhea in pediatric patients, without increasing adverse effects.

Este resumen Epistemonikos (Living FRISBEE: Living FRIendly Summary of the Body of Evidence using Epistemonikos) es una actualización del resumen publicado en Diciembre de 2015, basado en la detección de dos nuevas revisiones sistemáticas que no habían sido identificadas en la versión anterior. La gastroenteritis o diarrea aguda es una enfermedad habitualmente autolimitada, pero que consume recursos sanitarios y constituye un motivo de consulta frecuente en pediatría. El racecadotrilo, un inhibidor de la encefalinasa intestinal, se ha usado como tratamiento porque disminuiría la duración de la diarrea y la pérdida de líquidos, pero no hay evidencia que justifique su uso rutinario. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos cinco revisiones sistemáticas que en conjunto incluyen nueve estudios aleatorizados relevantes para nuestra pregunta. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el uso de racecadotrilo probablemente disminuye la duración del cuadro de diarrea aguda en población pediátrica y que no se asociaría a mayor tasa de eventos adversos.

Development, characterization and evaluation of the dissolution profile of sulfasalazine suspensions / Desenvolvimento, caracterização e avaliação do perfil de dissolução de suspensões sulfasalazina

This paper reports the development, characterization and in vitrodissolution behavior of sulfasalazine suspensions for treatment of chronic intestinal inflammatory diseases. Three formulations were developed, from powdered sulfasalazine obtained from different suppliers. The sulfasalazine was characterized regarding concentration, Fourier Transform Infrared Spectroscopy (FTIR), Differential Scanning Calorimetry (DSC), X-Ray Diffraction (XRD), particle size distribution, polydispersion and solubility. The suspensions were developed and characterized regarding pH, viscosity, density, particle size, sedimentation volume, concentration and dissolution. The pH values were slightly acidic. The method of preparing the suspensions reduced the particle sizes and made the size distribution more homogeneous. The dissolution studies showed that the sulfasalazine suspensions had low solubility in acidic media, but dissolve quickly, reaching levels of 85%, in neutral media or media containing 0.5% of surfactants such as polysorbate 80. Besides this, the sulfasalazine suspensions were classified as having immediate dissolution because they reached dissolution levels near 100% in 20 minutes...

O trabalho reporta o desenvolvimento, caracterização e estudo in vitro de dissolução de suspensões de sulfassalazina para uso em doenças inflamatórias crônicas intestinais. Desenvolveram-se três formulações baseadas em fornecedores diferentes de pó de sulfassalazina. A sulfassalazina foi caracterizada quanto a Teor, Infravermelho por Transformada de Fourier (FTIR), Calorimetria Diferencial de Varredura (DSC), Difração de Raios-X (XRD), distribuição de tamanho das partículas, índice de polidispersão e solubilidade. A suspensão foi desenvolvida e caracterizada quanto a pH, viscosidade, densidade, tamanho de partícula, volume de sedimentação, teor e estudo de dissolução. Os valores de pH determinados foram levemente ácidos. O método de preparo das suspensões reduziu o tamanho das partículas e tornou a distribuição de tamanho mais homogênea. Os estudos de dissolução mostraram que a suspensão de sulfassalazina tem problemas de solubilidade em meios de caráter ácido, entretanto, sofre dissolução rápida acima de 85% em meios neutros ou contendo 0,5% de tensoativos como Polissobato 80. Além disso, as suspensões de sulfassalazina foram classificadas como formulações de dissolução imediata porque a partir de 20 minutos sofrem dissolução em torno de 100%...

Ibuprofen-associated acute kidney injury in dehydrated children with acute gastroenteritis.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) induce acute kidney injury (AKI) in volume-depleted patients; however the prevalence of this complication is likely underestimated. We assessed the impact of ibuprofen exposure on renal function among dehydrated children with acute gastroenteritis (AGE) to further characterize NSAID-associated AKI. METHODS: Over a 1-year period dehydrated children with AGE (n = 105) were prospectively enrolled and grouped as cases, presenting with AKI (n = 46) or controls, not presenting with AKI (n = 59). AKI was defined by pediatric RIFLE (pRIFLE) criteria. RESULTS: Among the children enrolled in the study, AKI prevalence was 44 %, and 34 (54 %) of the 63 patients who received ibuprofen developed renal impairment. Relative to the controls, children presenting with AKI were younger (median age 0.66 vs. 1.74 years; p < 0.001) and received ibuprofen more frequently (74 vs. 49 %, p = 0.01). After adjusting for the degree of dehydration, ibuprofen exposure remained an independent risk factor for AKI (p < 0.001, odds ratio 2.47, 95 % confidence interval 1.78-3.42). According to the pRIFLE criteria, 17 patients were at the 'risk' stage of AKI severity, 24 were at the 'injury' stage, and five were at the 'failure' stage; none required dialysis. Distribution of patients within categories was similar regardless of ibuprofen exposure. All cases fulled recovered from AKI. CONCLUSIONS: Ibuprofen-associated AKI was 54 % in our cohort of dehydrated children with AGE. Drug exposure increased the risk for developing AKI by more than twofold, independent of the magnitude of the dehydration.

N-Acetylcysteine treatment of rotavirus-associated diarrhea in children.

Rotaviruses are the leading cause of severe, acute, and dehydrating diarrhea affecting children under 5 years of age worldwide. Despite an important reduction in rotavirus-caused deaths as a consequence of the rotavirus vaccine, alternative or complementary strategies for preventing or treating rotavirus-associated diarrhea are needed mainly in the poorest countries. We describe the cases of four rotavirus-unvaccinated 12-13-month-old girls and a 5-year-old boy who developed rotavirus-associated diarrhea confirmed by enzyme-linked immunosorbent assay, Western blotting, and immunochemistry analyses. After the first day of diarrheal episodes, three of the five patients were immediately administered oral N-acetylcysteine (NAC) 60 mg/kg daily, divided into three equal doses every 8 hours. The other two patients did not receive NAC and served as controls. Administration of NAC resulted in a decreased number of diarrheal episodes, excretion of fecal rotavirus antigen, and resolution of symptoms after 2 days of treatment. Our results suggest that NAC treatment after the first diarrheal episode could be an efficient strategy for treating rotavirus-affected children and preventing the associated severe life-threatening accompanying dehydration.

Gastrenterite eosinofílica / Eosinophilic gastroenteritis

A gastrenterite eosinofílica é uma doença rara com apresentação heterogênea caracterizada pela presença de intenso infiltrado de eosinófilos em um ou em múltiplos segmentos do trato gastrin- testinal. Foi realizada revisão da literatura com ênfase em diag- nóstico, diagnóstico diferencial e tratamento, com o objetivo de divulgá-la entre a comunidade médica e viabilizar diagnóstico e tratamento precoces dessa entidade clínica, a fim de evitar complicações.(AU)

Eosinophilic gastroenteritis is a rare disease with heterogeneous presentation characterized by intense eosinophilic infiltration in one or multiple segments of the gastrointestinal tract. This review of the literature emphasized diagnosis, differential diagnosis and treatment in order to disseminate this clinical entity among the medical community and facilitate early diagnosis and treatment in order to avoid complications.(AU)

Emprego de probióticos em infecções gastrointestinais e em terapias com antibióticos / Use of probiotics in gastrointestinal infections and antibiotic therapy

São considerados probióticos alguns micro-organismos, principalmente bactérias, que atuam na regulação da microflora intestinal e conferindo ao hospedeiro alguns benefícios, como a melhoria do sistema imunológico, proteção contra colonização de patógenos e controle da flora intestinal em tratamentos com antibióticos. Esta revisão objetiva discorrer sobre algumas funções destes micro-organismos bem como relatar alguns resultados encontrados em experimentos realizados visando à compreensão a ação dos probióticos em infecções gastrointestinais. Os trabalhos realizados nesta área indicam que os probióticos podem ser considerados como uma possibilidade na prevenção e no tratamento de infecções gastrointestinais, bem como coadjuvante em terapias com antibióticos.

Emprego de probióticos em infecções gastrointestinais e em terapias com antibióticos / Use of probiotics in gastrointestinal infections and antibiotic therapy

São considerados probióticos alguns micro-organismos, principalmente bactérias, que atuam na regulação da microflora intestinal e conferindo ao hospedeiro alguns benefícios, como a melhoria do sistema imunológico, proteção contra colonização de patógenos e controle da flora intestinal em tratamentos com antibióticos. Esta revisão objetiva discorrer sobre algumas funções destes micro-organismos bem como relatar alguns resultados encontrados em experimentos realizados visando à compreensão a ação dos probióticos em infecções gastrointestinais. Os trabalhos realizados nesta área indicam que os probióticos podem ser considerados como uma possibilidade na prevenção e no tratamento de infecções gastrointestinais, bem como coadjuvante em terapias com antibióticos.(AU)

Probiotics are some microorganisms,mainly bacteria, that act inthe regulation of intestinal microfloraand giving the host some benefitssuch as improved immune system,protection against colonization of pathogensand control of intestinal florain antibiotic treatments. This reviewaims to report some features of thesemicroorganisms as well to repot someresults found in experiments aimed atunderstanding the actin of probioticsin gastrointestinal infections. Theworks done in this area indicate thatprobiotics can be considered as apossibility in preventing and treatinggastrointestinal infections, as well asadjuvant therapies with antibiotics. (AU)

Nitazoxanide for the empiric treatment of pediatric infectious diarrhea.

We conducted a double-blind, placebo-controlled clinical trial to demonstrate the efficacy of nitazoxanide suspension for the treatment of presumed infectious diarrhea in children. Eligible patients must have had diarrheal illness lasting 3-29 days. Patients were randomized to receive either nitazoxanide or placebo twice daily for three days. The primary endpoint was time from first dose to resolution of symptoms. One hundred children mean age 3.3 years were enrolled. The median time to resolution of symptoms for nitazoxanide treated patients was 23 hours (IQR 4-48 hours) vs 103.5 hours (IQR 63->168 hours) for placebo (p<0.001). An analysis by disease subset indicated nitazoxanide treated patients had statistically shorter durations of diarrheal illness associated with Giardia lamblia (n=32, p<0.001) and those with no identified enteropathogen (n=38, p=0.008), when compared to placebo. The study medication was well tolerated. Overall, nitazoxanide was effective at reducing the duration of diarrheal illness associated with multiple etiologies, including patients with no identified enteropathogen. These results suggest nitazoxanide may be a viable therapeutic option for the empiric treatment of diarrheal illness in children where the etiology is unknown or presumed to be of infectious origin. Clinical trial registry number NCT01326338.

[Acute gastroenteritis caused by a Vibrio cholerae non-O1, non-O139 strain harboring a genetic region homologous to the VpaI-7 pathogenicity island]. / Gastroenteritis aguda causada por Vibrio cholerae no-O1, no-O139 que porta una región homologa a la isla de patogenicidad VpaI-7.

Pathogenic Vibrio cholerae isolates, the etiologic agents of cholera, generally express one of two O antigens (O1 or O139). Most environmental isolates are nonpathogenic and are referred to as "non-O1, non-O139". However some V. cholerae non-O1, non-O139 strains are clearly pathogenic and have caused outbreaks or sporadic cases of gastroenteritis and extraintestinal infections in humans. We report a case of acute gastroenteritis by a V. cholerae non-O1, non-O139 harboring a genetic region homologous to a segment of the VpaI-7 V. parahaemolyticus pathogenicity island.

Gastroenteritis aguda causada por Vibrio cholerae no-O1, no-O139 que porta una región homologa a la isla de patogenicidad VpaI-7 / Acute gastroenteritis caused by a Vibrio cholerae non-O1, non-O139 strain harboring a genetic region homologous to the VpaI-7 pathogenicity island

Pathogenic Vibrio cholerae isolates, the etiologic agents of cholera, generally express one of two O antigens (O1 or O139). Most environmental isolates are nonpathogenic and are referred to as "non-O1, non-O139". However some V. cholerae non-O1, non-O139 strains are clearly pathogenic and have caused outbreaks or sporadic cases of gastroenteritis and extraintestinal infections in humans. We report a case of acute gastroenteritis by a V. cholerae non-O1, non-O139 harboring a genetic region homologous to a segment of the VpaI-7 V. parahaemolyticus pathogenicity island.

Cepas patogénicas de Vibrio cholerae, el agente causal del cólera, expresan generalmente uno de dos antígenos O (denominados O1 u O139). La mayoría de las cepas ambientales son no patogénicas y corresponden al tipo denominado "no-O1, no-O139". Sin embargo, algunas cepas de este tipo son claramente patogénas y han causado brotes de gastroenteritis e infecciones extra-intestinales en humanos. Se reporta un caso clínico de gastroenteritis aguda causado por una cepa de V. cholerae no-O1, no-O139 que contiene en su genoma una región homóloga a un segmento de la isla de patogenicidad VpaI-7 descrita previamente en V. parahaemolyticus.

Oral zinc for the treatment of acute gastroenteritis in Polish children: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To evaluate the efficacy and safety of zinc in the treatment of acute gastroenteritis (AGE) in children in Poland. STUDY DESIGN: Children aged 3 to 48 months with AGE were enrolled in a randomized, double-blind, placebo-controlled trial in which they received zinc sulfate (10 or 20 mg/day depending on age) or placebo for 10 days. A total of 141 of 160 children recruited were available for intention-to-treat analysis. The primary outcome was the duration of diarrhea. RESULTS: In the experimental group (n = 69) compared with the control group (n = 72), there was no significant difference in the duration of diarrhea (P > .05). Similarly, there was no significant difference in the groups in secondary outcome measures such as stool frequency on days 1, 2, and 3, vomiting frequency, intravenous fluid intake, and the number of children with diarrhea lasting >7 days. CONCLUSION: Children living in a country where zinc deficiency is rare do not appear to benefit from the use of zinc in the treatment of AGE.