Refractoriness to anti-Helicobacter pylori treatment attributed to phenotypic resistance patterns in patients with gastroduodenopathy in Guayaquil-Ecuador.

BACKGROUND: Treatment of Helicobacter pylori gastric infection is complex and associated with increased rates of therapeutic failure. This research aimed to characterize the H. pylori infection status, strain resistance to antimicrobial agents, and the predominant lesion pattern in the gastroduodenal mucosa of patients with clinical suspicion of refractoriness to first- and second-line treatment who were diagnosed and treated in a health center in Guayaquil, Ecuador. METHODS: A total of 374 patients with upper gastrointestinal symptoms and H. pylori infection were preselected and prescribed one of three triple therapy regimens for primary infection, as judged by the treating physician. Subsequently, 121 patients who returned to the follow-up visit with persistent symptoms after treatment were studied. RESULTS: All patients had H. pylori infection. Histopathological examination diagnosed chronic active gastritis in 91.7% of cases; premalignant lesions were observed in 15.8%. The three triple therapy schemes applied showed suboptimal efficacy (between 47.6% and 77.2%), with the best performance corresponding to the scheme consisting of a proton pump inhibitor + amoxicillin + levofloxacin. Bacterial strains showed very high phenotypic resistance to all five antimicrobials tested: clarithromycin, 82.9%; metronidazole, 69.7%; amoxicillin and levofloxacin, almost 50%; tetracycline, 38.2%. Concurrent resistance to clarithromycin-amoxicillin was 43.4%, to tetracycline-metronidazole 30.3%, to amoxicillin-levofloxacin 27.6%, and to clarithromycin-metronidazole 59.2%. CONCLUSIONS: In vitro testing revealed resistance to all five antibiotics, indicating that H. pylori exhibited resistance phenotypes to these antibiotics. Consequently, the effectiveness of triple treatments may be compromised, and further studies are needed to assess refractoriness in quadruple and concomitant therapies.

Third-line and rescue therapy for refractory Helicobacter pylori infection: A systematic review.

BACKGROUND: Due to increasing resistance rates of Helicobacter pylori (H. pylori) to different antibiotics, failures in eradication therapies are becoming more frequent. Even though eradication criteria and treatment algorithms for first-line and second-line therapy against H. pylori infection are well-established, there is no clear recommendation for third-line and rescue therapy in refractory H. pylori infection. AIM: To perform a systematic review evaluating the efficacy and safety of rescue therapies against refractory H. pylori infection. METHODS: A systematic search of available rescue treatments for refractory H. pylori infection was conducted on the National Library of Medicine's PubMed search platform based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized or non-randomized clinical trials and observational studies evaluating the effectiveness of H. pylori infection rescue therapies were included. RESULTS: Twenty-eight studies were included in the analysis of mean eradication rates as rescue therapy, and 21 of these were selected for analysis of mean eradication rate as third-line treatment. For rifabutin-, sitafloxacin-, levofloxacin-, or metronidazole-based triple-therapy as third-line treatment, mean eradication rates of 81.6% and 84.4%, 79.4% and 81.5%, 55.7% and 60.6%, and 62.0% and 63.0% were found in intention-to-treat (ITT) and per-protocol (PP) analysis, respectively. For third-line quadruple therapy, mean eradication rates of 69.2% and 72.1% were found for bismuth quadruple therapy (BQT), 88.9% and 90.9% for bismuth quadruple therapy, three-in-one, Pylera® (BQT-Pylera), and 61.3% and 64.2% for non-BQT) in ITT and PP analysis, respectively. For rifabutin-, sitafloxacin-, levofloxacin-, or metronidazole-based triple therapy as rescue therapy, mean eradication rates of 75.4% and 78.8%, 79.4 and 81.5%, 55.7% and 60.6%, and 62.0% and 63.0% were found in ITT and PP analysis, respectively. For quadruple therapy as rescue treatment, mean eradication rates of 76.7% and 79.2% for BQT, 84.9% and 87.8% for BQT-Pylera, and 61.3% and 64.2% for non-BQT were found in ITT and PP analysis, respectively. For susceptibility-guided therapy, mean eradication rates as third-line and rescue treatment were 75.0% in ITT and 79.2% in PP analysis. CONCLUSION: We recommend sitafloxacin-based triple therapy containing vonoprazan in regions with low macrolide resistance profile. In regions with known resistance to macrolides or unavailability of bismuth, rifabutin-based triple therapy is recommended.

Antibiotic resistance in periodontitis patients: A systematic scoping review of randomized clinical trials.

OBJECTIVES: The objective of the study was to evaluate the prevalence and proportions of antibiotic-resistant species in periodontitis patients. METHODS: A systematic scoping review of randomized clinical trials (RCTs) was conducted using the PRISMA extension for scoping reviews involving different databases. MeSH terms and keywords were provided to examine only RCTs with antibiotic-resistant results that included at least 3 months of follow-up of systematically healthy patients diagnosed with periodontitis and treated with systemic or local antibiotics adjunctive to subgingival debridement. RCTs that managed participants surgically, duplicate publications, and investigations implemented on animals were discarded. RESULTS: Six RCTs were chosen. These studies included 465 patients. Most investigations observed that while Aggregatibacter actinomycetemcomitans, Tannerella forsythia, and Porphyromonas gingivalis had low resistance to amoxicillin, microorganisms in many sites showed resistance to tetracycline, metronidazole, and azithromycin pretreatment. A. actinomycetemcomitans showed high resistance to tetracycline pre- and post-therapy. The proportion of antibiotic-resistant samples augmented rapidly after the prescription of antibiotics in all test groups. The percentage of antibiotic-resistant microorganisms decreased over time; at the end of the follow-up period, resistance levels were close to baseline levels. CONCLUSIONS: Adjunctive local and systemic antibiotic treatment temporarily increased the antibiotic resistance of subgingival microorganisms; nonetheless, many bacteria remained susceptible to antibiotics during their administration.

Antimicrobial Susceptibility Testing for Enterococci.

Enterococci are major, recalcitrant nosocomial pathogens with a wide repertoire of intrinsic and acquired resistance determinants and the potential of developing resistance to all clinically available antimicrobials. As such, multidrug-resistant enterococci are considered a serious public health threat. Due to limited treatment options and rapid emergence of resistance to all novel agents, the clinical microbiology laboratory plays a critical role in deploying accurate, reproducible, and feasible antimicrobial susceptibility testing methods to guide appropriate treatment of patients with deep-seated enterococcal infections. In this review, we provide an overview of the advantages and disadvantages of existing manual and automated methods that test susceptibility of Enterococcus faecium and Enterococcus faecalis to ß-lactams, aminoglycosides, vancomycin, lipoglycopeptides, oxazolidinones, novel tetracycline-derivatives, and daptomycin. We also identify unique problems and gaps with the performance and clinical utility of antimicrobial susceptibility testing for enterococci, provide recommendations for clinical laboratories to circumvent select problems, and address potential future innovations that can bridge major gaps in susceptibility testing.

Hipomelanosis macular progresiva: comunicación de un caso y revisión de la literatura científica / Progressive macular Hypomelanosis: case report andr review of scientic literature

La hipomelanosis macular progresiva es un trastorno adquirido de la pigmentación que aparece con más frecuencia en mujeres, adolescentes y adultas jóvenes. Se caracteriza por máculas hipopigmentadas asintomáticas, mal delimitadas, no descamativas, simétricas y de predominio en región lumbar. El estudio histopatológico evidencia disminución del contenido de melanina en la epidermis afectada, con número y distribución de los melanocitos conservados. En su etiopatogenia interviene el Cutibacterium acnes tipo III, bacteria responsable de la característica fluorescencia rojiza de distribución folicular que se observa con la lámpara de Wood. Por este motivo, los tratamientos propuestos incluyen el uso de tetraciclinas por vía oral y tratamientos tópicos como el peróxido de benzoílo, asociados a fototerapia UVA o UVB de banda angosta. Se presenta una paciente con hipomelanosis macular progresiva del tronco que respondió satisfactoriamente al tratamiento con doxiciclina vía oral

Progressive macular hypomelanosis is an acquired pigmentation disorder that occurs mostly in adolescent and young women. It is characterized by asymptomatic, poorly defined, non-scaly, symmetrical hypopigmented macules localized predominantly in the lumbar area. Histopathology shows a decrease in melanin content with preserved number and distribution of melanocytes in the affected epidermis. Cutibacterium acnes type III appears to be the responsible for the dermatosis and for the characteristic reddish fluorescence of follicular distribution observed with Wood´s lamp. Treatment include oral tetracyclines and topical benzoyl peroxide associated with UVA or narrow band UVB phototherapy. We present a patient with progressive macular hypomelanosis of the trunk with excellent response to treatment with oral doxycycline

Efectividad de antimicrobianos en la periodontitis crónica, leve o moderadaen el adulto / Effectiveness of antimicrobials in chronic, slight or moderate periodontitis, in adults

Introducción: En Cuba, no existen estudios que engloben a la tetraciclina y la azitromicina como antimicrobianos subgingivales en la periodontitis crónica.Objetivo: Evaluar la efectividad de la aplicación subgingival de antimicrobianos en la periodontitis crónica, leve o moderada en el adulto. Métodos: Estudio cuasiexperimental, en la Clínica Estomatológica Provincial Docente de Santiago de Cuba, entre noviembre de 2018 y diciembre de 2019, en 99 pacientes mayores de 35 años, mediante el método probabilístico, en tres grupos con 33 casos cada uno. Al grupo 1, se le aplicó la técnica del raspado y alisado radicular, en los grupos 2 y 3, se empleó una pasta subgingival de tetraciclina y azitromicina. Las variables fueron la profundidad de sondaje, el nivel de inserción clínica, comparadas mediante el Análisis de Varianza ANOVA y efectividad del tratamiento por chi-cuadrado, con un 95 por ciento. Resultados: Las medias de las variables cambiaron en el tiempo, se obtuvo una reducción de profundidad de sondaje en tratados con tetraciclina (-0.8 mm), azitromicina (-0.7 mm) y elgrupo control (-0.5 mm), mayor ganancia de inserción periodontal, se usó tetraciclina (+2.0 mm) y azitromicina (+1.0 mm), en comparación con el control (+0.7 mm). Se logró unamayor efectividad de curación con la tetraciclina 97 %, todas las terapias fueron efectivas. Conclusiones: La administración subgingival de tetraciclina y azitromicina, son efectivas para la disminución de la profundidad al sondaje y la ganancia de inserción clínica, constituyen las alternativas en la práctica clínica periodontal(AU)

Introduction: In Cuba, there are no studies which include tetracycline and azithromycin as sub-gingival antimicrobials en la in chronic periodontitis.Objective: To evaluate the effectiveness of sub-gingival application of antimicrobials in chronic, slightor moderate periodontitis, in adults. Methods: A quasi-experimental study was carried out at Santiago de Cuba Provincial Teaching Dental Clinic, from November, 2018 to December, 2019, in 99 patients older than 35 years old, bythe probabilistic method in tree groups with 33 cases each. In Group 1 the curettage or scrapping and polishing technique was applied, in groups 2 and 3, a sub gingival paste oftetracycline and azithromycin was used. The variables were the sounding depth, the level of clinical insertion, compared by Analysis of Varianza ANOVA and treatment effectiveness bychi-squared with a 95 per cent. Results: The means of the variables changed in time, a reduction pf sounding depth was obtained in patients treated by tetracycline (-0.8 mm), azithromycin (-0.7 mm) and the control group (-0.5 mm), higher gain of periodontal insertion, tetracycline was used (+2.0 mm) andazithromycin (+1.0 mm), in comparison with the control (+0.7 mm). A higher effectiveness of healing was obtained with tetracycline 97 per cent, all the therapies were effective. Conclusions:The administration of sub-gingival tetracycline and azithromycin are effective for decreasing the sounding depth and the gain of clinical insertion, they constitute alternatives in the clinical periodontal practice(AU)

Lupus miliaris disseminatus faciei: when a rare skin disease involves the eyelid / Lupus miliaris disseminatus faciei: quando uma rara dermatose acomete a pálpebra

ABSTRACT The authors present a case of lupus miliaris disseminatus faciei , a rare skin disease of unknown etiology, which may cause unaesthetic scarring due to its difficult treatment. The histopathological examination of epithelioid granulomas with caseating necrosis, together with the clinical features, are important for diagnosis and early treatment with better results. Despite difficult and unsatisfactory treatment, there are ongoing studies on therapy to improve aesthetic and social impairment. This case report describes an initial misdiagnosis delaying appropriate treatment, and highlights the value of physical examination and clinical judgment for another pathological examination, whenever necessary, aiming at better treatment outcomes in daily practice.

RESUMO Os autores apresentam um caso de lupus miliaris disseminatus faciei , uma dermatose rara, de etiologia desconhecida, que pode deixar cicatrizes não estéticas, pela dificuldade de tratamento. O exame histopatológico de granulomas compostos por células epitelioides, com necrose caseosa, e as características clínicas, são importantes para o diagnóstico e tratamento precoce, com melhores resultados. Apesar do tratamento difícil e insatisfatório, há estudos em andamento sobre terapias para melhorar o comprometimento estético e social. Este relato de caso descreve um diagnóstico inicial errôneo, que atrasou o tratamento adequado, e destaca o valor do exame físico e raciocínio clínico para solicitar outro exame anatomopatológico, quando necessário, de forma a obter melhores desfechos com o tratamento, na prática diária.

Characterization of Pathogens Isolated from Cutaneous Abscesses in Patients Evaluated by the Dermatology Service at an Emergency Department.

OBJECTIVE: Emergency department (ED) visits for the treatment of skin abscesses have increased with the emergence of community-associated methicillin-resistant Staphylococcus aureus (CAMRSA). There is limited information about the bacteriology of cutaneous abscesses evaluated in ED in Puerto Rico. The purpose of our study was to characterize the pathogens cultured from abscesses of patients in the ED consulted to the Dermatology Service of University of Puerto Rico School of Medicine. METHODS: Patients with skin abscesses consulted to the Dermatology Service by the ED of P.R. Medical Center from 2012 to 2017 were included. Data retrieved included demographic information, past medical history, prior antibiotic use, distribution of lesions, and treatment provided. Bacteriology results and antimicrobial susceptibility patterns from cultured skin lesions were recorded. RESULTS: Ninety patients diagnosed with skin abscess were evaluated. All patients underwent incision and drainage; this was the sole treatment in two patients. The most frequently administered systemic therapy was oral clindamycin in 32 patients (36%). A total of 66 patients (73%) had S. aureus isolates, most of them (85%) MRSA. Among the isolates with MRSA, 14.3% were resistant to clindamycin. All MRSA strains were susceptible to tetracycline and vancomycin. CONCLUSION: There is a high prevalence of MRSA causing abscesses in the Hispanic population evaluated in an ED in Puerto Rico. Systemic antibiotic use for the treatment of skin abscesses after incision and drainage remains high despite published guidelines arguing against their widespread use. Clindamycin resistance in our patient population appears to be more frequent than previously reported.

Efectividad de antimicrobianos en el tratamiento del raspado y alisado radicular en el adulto mayor / Effectiveness of antimicrobials in the treatment of scaling and root planing in the elderly

RESUMEN Introducción: La terapia antimicrobiana después del raspado y alisado radicular en el anciano no ha sido evaluada en la Clínica Estomatológica Provincial Docente "Mártires del Moncada", de Santiago de Cuba. Objetivo: Evaluar la efectividad de la tetraciclina y azitromicina en el tratamiento del raspado y alisado radicular en el adulto mayor. Método: Estudio cuasiexperimental de intervención terapéutica, realizado entre 2018-2019, en 30 pacientes con 60 y más años y con diagnóstico de periodontitis crónica. Se crearon tres grupos con 10 casos mediante el método aleatorio simple. El Grupo 1 tratado con la técnica convencional y los Grupos 2 y 3, después de la técnica, se aplicó una concentración subgingival de tetraciclina y azitromicina respectivamente y la colocación de cemento quirúrgico por siete días. Se emplearon variables como edad, sexo, cuadro clínico, evolución de signos y síntomas al séptimo día, 1 y 3 meses, y efectividad de curación. La validación estadística fue a través de la prueba Chi-cuadrado, con un 95 % de confiabilidad y la efectividad antimicrobiana, mediante el Análisis de Varianza ANOVA. Resultados: Predominio del grupo 65-69 años y sexo femenino, persistencia de inflamación gingival en el 30,0 % del Grupo 1 al tercer mes, disminuyó la profundidad al sondaje y hubo ganancia de inserción clínica, mejorando sus medias en el tiempo. Se logró un 100,0 % de efectividad de curación en los Grupos 2 y 3. Conclusiones: Elevada efectividad de la aplicación tópica subgingival de tetraciclina y azitromicina con cemento quirúrgico, sobre aquellos tratados con raspado y alisado radicular convencional.

ABSTRACT Introduction: Antimicrobial therapy after scaling and root planing treatment in the elderly has not been evaluated at the "Mártires del Moncada" Provincial Teaching Stomatology Clinic in Santiago de Cuba. Objective: To evaluate the effectiveness of tetracycline and azithromycin in the treatment of scaling and root planing in the elderly. Method: Quasi-experimental study of therapeutic intervention, carried out between 2018 and 2019, on 30 patients with the age of 60 and over and diagnosed with chronic periodontitis. Three groups with 10 cases were created using the simple randomized method. Group 1 treated with the conventional technique and groups 2 and 3, after using the same technique, a subgingival concentration of tetracycline and azithromycin was applied respectively and surgical cement placement for 7 days. Variables such as age, sex, clinical picture, evolution of signs and symptoms at the seventh day, 1 and 3 months, and healing effectiveness were used. The statistical validation was through the Chi-square test, with a 95% reliability and the antimicrobial effectiveness, through the Analysis of Variance ANOVA. Results: Predominance of the group age between 65 and 69 years and female sex, persistent gingival inflammation in 30,0 % of group 1 at the third month, decreased the depth of the catheterization and there was a clinical insertion gain, improving their averages in time. A 100.0% healing effectiveness was achieved in groups 2 and 3. Conclusions: High effectiveness of subgingival topical application of tetracycline and azithromycin with surgical cement, over patients treated with conventional scaling and root planing.

Nuevos retos en el tratamiento de la infección por helicobacter pylori / New challenges in the treatment of the infection for helicobacter pylori

RESUMEN La infección por helicobacter pylori afecta aproximadamente al 50% de la población mundial, es causante de gastritis crónica, úlcera péptica, cáncer gástrico y linfoma del tejido linfoide asociado a la mucosa. Desde su descubrimiento, la erradicación ha sido uno de los más importantes retos en Gastroenterología. En muchos países se desconoce la prevalencia de resistencia primaria del microorganismo a los diferentes antibióticos que empíricamente se utilizan, y por no realizar pruebas de rutina que verifican su erradicación en la práctica diaria, se ignora la efectividad de los esquemas prescritos. El incremento progresivo de la resistencia a la claritromicina y metronidazol, unido a una ausencia de antibioticoterapia alternativa, desafía la capacidad para eliminar de manera efectiva a ésta bacteria. El subcitrato de bismuto ha resurgido y su adición en la terapia ha permitido aumentar las tasas de curación por encima del 90%. Actualmente se invoca que para mejorar la eficacia en el tratamiento se debe combinar una supresión potente del ácido gástrico en tratamientos combinados cuádruples con una duración de 14 días, para la mayoría de los casos. La adherencia al tratamiento es crucial para obtener buenos resultados terapéuticos (AU).

ABSTRACT The infection for helicobacter pylori affects approximately to the world population's 50%, it is causing of chronic gastritis, peptic ulcer, gastric cancer and linfoma associated to the mucous one. From their discovery, the eradication has been one of the most important challenges in Gastroenterología. In many countries the prevalencia of primary resistance is ignored from the microorganism to the different antibiotics that empirically they are used, and for not carrying out routine tests that verify its eradication in the daily practice, the effectiveness of the prescribed outlines it is ignored. The progressive increment of the resistance to the claritromicina and metronidazol, together to an absence of alternative antibioticotherapy, challenges the capacity to eliminate from an effective way to this bacteria. The bismuth subcitrato has resurged and its addition in the therapy has allowed to increase the cure rates above 90%. At the moment it is invoked that to improve the effectiveness in the treatment, that is should combine a potent suppression of the gastric acid in combined quadruple treatments with a duration of 14 days, for most of the cases. The adherence to the treatment is crucial to obtain therapeutic good results (AU).

Nuevos retos en el tratamiento de la infección por helicobacter pylori / New challenges in the treatment of the infection for helicobacter pylori

RESUMEN La infección por helicobacter pylori afecta aproximadamente al 50% de la población mundial, es causante de gastritis crónica, úlcera péptica, cáncer gástrico y linfoma del tejido linfoide asociado a la mucosa. Desde su descubrimiento, la erradicación ha sido uno de los más importantes retos en Gastroenterología. En muchos países se desconoce la prevalencia de resistencia primaria del microorganismo a los diferentes antibióticos que empíricamente se utilizan, y por no realizar pruebas de rutina que verifican su erradicación en la práctica diaria, se ignora la efectividad de los esquemas prescritos. El incremento progresivo de la resistencia a la claritromicina y metronidazol, unido a una ausencia de antibioticoterapia alternativa, desafía la capacidad para eliminar de manera efectiva a ésta bacteria. El subcitrato de bismuto ha resurgido y su adición en la terapia ha permitido aumentar las tasas de curación por encima del 90%. Actualmente se invoca que para mejorar la eficacia en el tratamiento se debe combinar una supresión potente del ácido gástrico en tratamientos combinados cuádruples con una duración de 14 días, para la mayoría de los casos. La adherencia al tratamiento es crucial para obtener buenos resultados terapéuticos.

ABSTRACT The infection for helicobacter pylori affects approximately to the world population's 50%, it is causing of chronic gastritis, peptic ulcer, gastric cancer and linfoma associated to the mucous one. From their discovery, the eradication has been one of the most important challenges in Gastroenterología. In many countries the prevalencia of primary resistance is ignored from the microorganism to the different antibiotics that empirically they are used, and for not carrying out routine tests that verify its eradication in the daily practice, the effectiveness of the prescribed outlines it is ignored. The progressive increment of the resistance to the claritromicina and metronidazol, together to an absence of alternative antibioticotherapy, challenges the capacity to eliminate from an effective way to this bacteria. The bismuth subcitrato has resurged and its addition in the therapy has allowed to increase the cure rates above 90%. At the moment it is invoked that to improve the effectiveness in the treatment, that is should combine a potent suppression of the gastric acid in combined quadruple treatments with a duration of 14 days, for most of the cases. The adherence to the treatment is crucial to obtain therapeutic good results.

Tetraciclina 500 mg para o tratamento de hidradenite supurativa leve / Tetracycline 500 mg for treatment of mild suppurative hydradenitis

INTRODUÇÃO: Hidradenite supurativa/acne inversa (HS) é uma doença cutânea, inflamatória e crônica, do folículo piloso, caracterizada por nódulos e abscessos dolorosos e recorrentes que se rompem e levam a tratos sinusais e cicatrizes. HS tipicamente ocorre após a puberdade, com a idade média de início na segunda ou terceira décadas de vida e com predomínio do sexo feminino. Dados de um estudo de prevalência populacional no Brasil estimou uma prevalência geral de 0,41%, sem diferenças entre as regiões brasileiras. A idade média foi de 40,4 anos, e a HS foi mais prevalente entre adolescentes e adultos do que crianças e idosos. TECNOLOGIA: Cloridrato de tetraciclina (Cinatrex®, Tetraclin®, Tetramed® e cloridrato de tetraciclina). PERGUNTA: O uso de tetraciclina 500 mg é seguro, eficaz e custo-efetivo para o tratamento da hidradenite supurativa leve? EVIDÊNCIAS CIENTÍFICAS: Apenas um estudo controlado randomizado avaliou a eficácia da tetraciclina oral comparando-a com clindamicina tópica 0,1%. Os resultados mostraram diferença estatisticamente significativa a favor da tetraciclina oral apenas na avaliação global dos pacientes. Uma redução de aproximadamente 30% na gravidade da doença, avaliada pela avaliação geral do médico, porém sem diferença entre os fármacos. Nenhuma diferença foi encontrada também na avaliação da dor, nódulos ou abscessos. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: Considerando uma prevalência de 0,41% de acordo com dados de estudo epidemiológico realizado no Brasil, e de acordo com o percentual de uso de antibióticos orais por indivíduos com HS leve (62%), o impacto do fornecimento de tetraciclina para tratamento da HS leve seria em torno de 17 milhões em cinco anos. EXPERIÊNCIA INTERNACIONAL: Não foi encontrada nenhuma avaliação da clindamicina tópica para tratamento da HS em nenhuma das agências de Avaliação de Tecnologias em Saúde da Escócia (SMC), Canadá (CADTH) e Inglaterra (NICE). No entanto, na avaliação do adalimumabe para HS moderada a grave, realizada pelo NICE, o comitê recomendou o adalimumabe apenas se a doença não estiver respondendo a outros tratamentos convencionais (antibióticos tópicos e orais). MONITORAMENTO DO HORIZONTE TECNOLÓGICO: A análise do monitoramento do horizonte temporal apontou não haver medicamentos nessas fases de desenvolvimento clínico para o tratamento da hidradenite supurativa leve. CONSIDERAÇÕES: A evidência do uso de tetraciclina oral para tratamento da HS é relativamente fraca, apesar deste antibiótico ser tratamento padrão para HS leve.Embora exista pouca evidência, a terapia tem seu uso consagrado na prática clínica e vem sendo recomendado nas diretrizes internacionais de gestão da doença.Não foi encontrado ECRs controlados por placebo de tetraciclinas orais. A conduta terapêutica atual geralmente segue uma abordagem gradual, dependendo da gravidade da doença, começando com tratamento tópico para doença leve, cursos prolongados de antibióticos orais para doença leve a moderada e imunossupressores sistêmicos ou cirurgia para doença mais grave. A base de evidências para muitas dessas intervenções é relativamente fraca para fundamentarum tratamento eletivo para a HS. CONSULTA PÚBLICA: Foram recebidas 26 contribuições, sendo que 13 foram excluídas por abordarem um tema diferente ou por não conter informação. Por meio do formulário técnicocientífico foram recebidas 21 contribuições, destas 62% concordaram com a recomendação preliminar da CONITEC. Foram quatro contribuições alusivas às evidências clínicas, todas contrárias à recomendação inicial. Essas contribuições se basearam na associação da tetraciclina com outros medicamentos e na liberação de outros antibióticos do grupo das ciclinas como a minociclina e doxiciclina, considerados nos guidelines internacionais e não avaliados pela CONITEC até o momento devido à ausência de dados publicados na literatura. Não houve contribuições sobre avaliação econômica e a análise do impacto orçamentário. Foram recebidas cinco contribuições sobre experiência com a tecnologia ou opinião sobre a incorporação, todas discordantes da recomendação preliminar e oriundas de profissionais de saúde. Os argumentos se basearam na ineficácia do medicamento; na sugestão de incorporar os dois medicamentos tetraciclina e doxiciclina. Após apreciação das contribuições encaminhadas pela Consulta Pública, o plenário da CONITEC entendeu que não houve argumentação suficiente para alterar a recomendação inicial. RECOMENDAÇÃO FINAL: Os membros da CONITEC presentes na 77ª reunião ordinária, no dia 09 de maio de 2019, deliberaram, por unanimidade, por recomendar a incorporação no SUS da tetraciclina 500 mg para o tratamento de hidradenite supurativa leve, mediante Protocolo Clínico e Diretrizes Terapêuticas. Foi assinado o Registro de Deliberação nº 447/2019. DECISÃO: Incorporar a tetraciclina 500mg para o tratamento de hidradenite supurativa leve, mediante Protocolo Clínico e Diretrizes Terapêuticas, no âmbito do Sistema Único de Saúde ­ SUS. Dada pela Portaria nº 29 de 11 de junho de 2019, publicada no Diário Oficial da União (DOU) nº 112, seção 1, página 126, no dia 12 de junho de 2019.

Multilocus Sequence Typing of Treponema pallidum subsp. pallidum in Cuba From 2012 to 2017.

BACKGROUND: The increased prevalence of syphilis in Cuba prompted us to map the circulating Treponema pallidum subsp. pallidum allelic profiles in this geographic region. METHODS: Samples were collected from 2012 to 2017, from 83 male patients with ulcers or skin lesions, and were examined using multilocus sequence typing. Additionally, we analyzed the 23S rDNA and 16S rDNA regions for the presence of possible mutations leading to macrolide and tetracycline resistance. RESULTS: Among 94% of fully typed strains, we found 7 different allelic profiles, of which 4 had not been previously described. More than 87% of patients were infected with the T. pallidum SS14-like group and only 8.2% with T. pallidum Nichols-like group. As in other countries, the 1.3.1 allelic profile (ie, SS14-like) was the most common. In addition, 1 of the newly described allelic profiles represents T. pallidum strains that arose by recombination events between members of different T. pallidum subgroups. More than 90% of patients were infected with treponemes harboring the A2058G mutation. However, we found no potential tetracycline-resistant T. pallidum mutations. CONCLUSIONS: Our results suggest that, in Cuba, tetracycline antibiotics could be used to treat syphilis in penicillin-allergic patients instead of macrolides.

Resistência de Neisseria gonorrhoeae a antimicrobianos na prática clínica: como está o Brasil? / Antimicrobials resistance of Neisseria gonorrhoeae in clinical practice: where Brazil stands?

Estima-se que um milhão de infecções sexualmente transmissíveis (IST) sejam adquiridas por dia no mundo, segundo a Organização Mundial da Saúde. Elas podem ser causadas por diversos micro-organismos pelo contato sexual. Embora tratáveis, as infecções, como a clamidiana, sífilis, tricomoníase e gonorreia, são responsáveis por 350 milhões de novos casos de IST anualmente no mundo. A gonorreia é a segunda IST bacteriana mais prevalente no planeta e tem chamado atenção nos últimos anos em decorrência da baixa eficácia em seu tratamento. O agente etiológico é a Neisseria gonorrhoeae. Na maioria das mulheres, a infecção por esse micro-organismo é assintomática, dificultando ainda mais seu diagnóstico e tratamento e, portanto, aumentando o risco de desenvolvimento de suas complicações associadas. Mesmo quando diagnosticada, essa infecção está sujeita a um alto índice de insucesso terapêutico que se deve, principalmente, à grande plasticidade genética da N. gonorrhoeae para aquisição de genes cromossômicos ou plasmidiais de resistência. O aumento da resistência desse micro-organismo a antimicrobianos comumente utilizados no tratamento, como penicilina, tetraciclina e ciprofloxacina, tem sido relatado em diversos países. No Brasil, poucos estudos estão disponíveis, mas em alguns estados já foram relatadas linhagens resistentes à ciprofloxacina. Dessa forma, deve-se ressaltar a importância de novos estudos que visem descrever o perfil da resistência da N. gonorrhoeae a antimicrobianos. Tais achados certamente nortearão a implementação de sistemas de vigilância epidemiológica no país visto que, até o momento, as infecções por N. gonorrhoeae sequer estão incluídas na lista nacional de doenças e agravos de notificação compulsória.(AU)

According to the World Health Organization, approximately one million sexually transmitted infections (STI) are acquired daily in the world. These infections can be caused by several microorganisms via contact. The treatable STI, such as chlamydia, syphilis, trichomoniasis and gonorrhea, account for 350 million new cases of STI each year worldwide. Gonorrhoea is caused by Neisseria gonorrhoeae and is the second most common bacterial STI in the world. It has drawn more attention in the last years due to the low efficacy in its treatment. Most women with this infection are asymptomatic, which makes its diagnosis and treatment troublesome increasing the risk for its associated complications. Even when diagnosed, this infection is subject to a high rate of therapeutic failure mainly due to the great genetic plasticity of N. gonorrhoeae for the acquisition of chromosomal or resistance plasmid enes. Increased resistance of this microorganism to antimicrobials commonly used in treatment such as penicillin, tetracycline and ciprofloxacin has been reported in several countries. In Brazil, few studies are available, but in some states strains resistant to ciprofloxacin were alreadyreported. The refore, it is important to highlight the importance of new studies aimed at describing the resistance profile of N. gonorrhoeae to antimicrobials in Brazil context. These findings will certainly guide the implementation of epidemiological surveillance systems in the country, since until now N. gonorrhoeae infections do not figure into the national list of compulsorily notifiable diseases.(AU)

Tetracycline Reduces Kidney Damage Induced by Loxosceles Spider Venom.

Envenomation by Loxosceles spider can result in two clinical manifestations: cutaneous and systemic loxoscelism, the latter of which includes renal failure. Although incidence of renal failure is low, it is the main cause of death, occurring mainly in children. The sphingomyelinase D (SMase D) is the main component in Loxosceles spider venom responsible for local and systemic manifestations. This study aimed to investigate the toxicity of L. intermedia venom and SMase D on kidney cells, using both In vitro and in vivo models, and the possible involvement of endogenous metalloproteinases (MMP). Results demonstrated that venom and SMase D are able to cause death of human kidney cells by apoptosis, concomitant with activation and secretion of extracellular matrix metalloproteases, MMP-2 and MMP-9. Furthermore, cell death and MMP synthesis and secretion can be prevented by tetracycline. In a mouse model of systemic loxoscelism, Loxosceles venom-induced kidney failure was observed, which was abrogated by administration of tetracycline. These results indicate that MMPs may play an important role in Loxosceles venom-induced kidney injury and that tetracycline administration may be useful in the treatment of human systemic loxoscelism.